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van der Weegen S, Verwey R, Spreeuwenberg M, Tange H, van der Weijden T, de Witte L. The development of a mobile monitoring and feedback tool to stimulate physical activity of people with a chronic disease in primary care: a user-centered design. JMIR Mhealth Uhealth 2013; 1:e8. [PMID: 25099556 PMCID: PMC4114510 DOI: 10.2196/mhealth.2526] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 05/28/2013] [Indexed: 01/23/2023] Open
Abstract
Background Physical activity is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes. A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients. As a prerequisite for useful technology, it is important to involve the end-users in the design process from an early stage. Objective The aim of this study was to investigate the user requirements for a tool to stimulate physical activity, embedded in primary care practice. The leading principle of this tool is to change behavior by self-monitoring, goal-setting, and feedback. Methods The research team collected qualitative data among 15 patients, 16 care professionals, and several experts. A prototype was developed in three stages. In stage 1, the literature was searched to identify end-users and context. In stage 2, the literature, experts and patient representatives were consulted to set up a use case with the general idea of the innovation. In stage 3, individual interviews and focus groups were held to identify the end-user requirements. Based on these requirements a prototype was built by the engineering team. Results The development process has led to a tool that generally meets the requirements of the end-users. A tri-axial activity sensor, worn on the hip, is connected by Bluetooth to a smartphone. In an app, quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization, and an image shows a sun when the goal is reached. Overviews about activity per half an hour, per day, week, and month are provided. In the menu of the app and on a secured website, patients can enter information in individual sessions or read feedback messages generated by the system. The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient. Conclusions This study demonstrates that a user-centered approach brings in valuable details (such as the requirements for feedback in activity minutes per day) to improve the fit between the user, technology, and the organization of care, which is important for the usability and acceptability of the tool. The tool embedded in primary care will be evaluated in a randomized controlled trial.
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Affiliation(s)
- Sanne van der Weegen
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, Netherlands.
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Dean E, Gormsen Hansen R. Prescribing optimal nutrition and physical activity as "first-line" interventions for best practice management of chronic low-grade inflammation associated with osteoarthritis: evidence synthesis. ARTHRITIS 2012; 2012:560634. [PMID: 23346399 PMCID: PMC3546455 DOI: 10.1155/2012/560634] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/23/2012] [Accepted: 11/24/2012] [Indexed: 02/07/2023]
Abstract
Low-grade inflammation and oxidative stress underlie chronic osteoarthritis. Although best-practice guidelines for osteoarthritis emphasize self-management including weight control and exercise, the role of lifestyle behavior change to address chronic low-grade inflammation has not been a focus of first-line management. This paper synthesizes the literature that supports the idea in which the Western diet and inactivity are proinflammatory, whereas a plant-based diet and activity are anti-inflammatory, and that low-grade inflammation and oxidative stress underlying osteoarthritis often coexist with lifestyle-related risk factors and conditions. We provide evidence-informed recommendations on how lifestyle behavior change can be integrated into "first-line" osteoarthritis management through teamwork and targeted evidence-based interventions. Healthy living can be exploited to reduce inflammation, oxidative stress, and related pain and disability and improve patients' overall health. This approach aligns with evidence-based best practice and holds the promise of eliminating or reducing chronic low-grade inflammation, attenuating disease progression, reducing weight, maximizing health by minimizing a patient's risk or manifestations of other lifestyle-related conditions hallmarked by chronic low-grade inflammation, and reducing the need for medications and surgery. This approach provides an informed cost effective basis for prevention, potential reversal, and management of signs and symptoms of chronic osteoarthritis and has implications for research paradigms in osteoarthritis.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 1Z3
| | - Rasmus Gormsen Hansen
- Department of Physical Therapy, Ringsted and Slagelse Hospitals, Region Zealand, Denmark
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103
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Sassen B, Kok G, Mesters I, Crutzen R, Cremers A, Vanhees L. A web-based intervention for health professionals and patients to decrease cardiovascular risk attributable to physical inactivity: development process. JMIR Res Protoc 2012; 1:e21. [PMID: 23612470 PMCID: PMC3626153 DOI: 10.2196/resprot.1804] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/18/2011] [Accepted: 08/30/2012] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patients with cardiovascular risk factors can reduce their risk of cardiovascular disease by increasing their physical activity and their physical fitness. According to the guidelines for cardiovascular risk management, health professionals should encourage their patients to engage in physical activity. OBJECTIVE In this paper, we provide insight regarding the systematic development of a Web-based intervention for both health professionals and patients with cardiovascular risk factors using the development method Intervention Mapping. The different steps of Intervention Mapping are described to open up the "black box" of Web-based intervention development and to support future Web-based intervention development. METHODS The development of the Professional and Patient Intention and Behavior Intervention (PIB2 intervention) was initiated with a needs assessment for both health professionals (ie, physiotherapy and nursing) and their patients. We formulated performance and change objectives and, subsequently, theory- and evidence-based intervention methods and strategies were selected that were thought to affect the intention and behavior of health professionals and patients. The rationale of the intervention was based on different behavioral change methods that allowed us to describe the scope and sequence of the intervention and produced the Web-based intervention components. The Web-based intervention consisted of 5 modules, including individualized messages and self-completion forms, and charts and tables. RESULTS The systematic and planned development of the PIB2 intervention resulted in an Internet-delivered behavior change intervention. The intervention was not developed as a substitute for face-to-face contact between professionals and patients, but as an application to complement and optimize health services. The focus of the Web-based intervention was to extend professional behavior of health care professionals, as well as to improve the risk-reduction behavior of patients with cardiovascular risk factors. CONCLUSIONS The Intervention Mapping protocol provided a systematic method for developing the intervention and each intervention design choice was carefully thought-out and justified. Although it was not a rapid or an easy method for developing an intervention, the protocol guided and directed the development process. The application of evidence-based behavior change methods used in our intervention offers insight regarding how an intervention may change intention and health behavior. The Web-based intervention appeared feasible and was implemented. Further research will test the effectiveness of the PIB2 intervention. TRIAL REGISTRATION Dutch Trial Register, Trial ID: ECP-92.
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Affiliation(s)
- Barbara Sassen
- Innovation in Health Care, University of Applied Sciences, Utrecht, Netherlands.
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104
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Jansink R, Braspenning J, Keizer E, van der Weijden T, Elwyn G, Grol R. Misperception of patients with type 2 diabetes about diet and physical activity, and its effects on readiness to change. J Diabetes 2012; 4:417-23. [PMID: 22613223 DOI: 10.1111/j.1753-0407.2012.00207.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of the present study was to assess misperceptions about lifestyle among patients with type 2 diabetes and their effects on readiness to change. METHODS Nine hundred and forty patients, with an HbA1c >7% and a body mass index >25 kg/m(2), from 57 general practices participated in a cross-sectional survey. Misperceptions of lifestyle (fruit, vegetable, and fat consumption, as well as physical activity) and readiness to change were determined with validated questionnaires. Logistic regression analysis calculated the association of misperception with readiness to change. RESULTS The response rate was 55.4%. Misperception existed for all lifestyle behaviors (physical activity, 41.5%; consumption of fruit, 40.1%; consumption of vegetables, 69.2%; consumption of fat, 21.6%). Misperception significantly affected readiness to change the relevant lifestyle (odds ratios [95% confidence intervals] ranging from 2.67 [1.68-4.23] to 1.80 [1.16-2.79]), except in the case of fruit consumption. The degree of misperception varied greatly between the different lifestyle behaviors and was somewhat larger (1-10%) than that in the general Dutch population. CONCLUSIONS Patients with type 2 diabetes misperceive their lifestyle behaviors, which hinders lifestyle changes. The variations in misperception and readiness to change show that diversity should be considered in lifestyle counseling for patients with type 2 diabetes.
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Affiliation(s)
- Renate Jansink
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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105
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ten Hoor GA, Peters GJY, Kalagi J, de Groot L, Grootjans K, Huschens A, Köhninger C, Kölgen L, Pelssers I, Schütt T, Thomas S, Ruiter RAC, Kok G. Reactions to threatening health messages. BMC Public Health 2012; 12:1011. [PMID: 23171445 PMCID: PMC3575362 DOI: 10.1186/1471-2458-12-1011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 11/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Threatening health messages that focus on severity are popular, but frequently have no effect or even a counterproductive effect on behavior change. This paradox (i.e. wide application despite low effectiveness) may be partly explained by the intuitive appeal of threatening communication: it may be hard to predict the defensive reactions occurring in response to fear appeals. We examine this hypothesis by using two studies by Brown and colleagues, which provide evidence that threatening health messages in the form of distressing imagery in anti-smoking and anti-alcohol campaigns cause defensive reactions. METHODS We simulated both Brown et al. experiments, asking participants to estimate the reactions of the original study subjects to the threatening health information (n = 93). Afterwards, we presented the actual original study outcomes. One week later, we assessed whether this knowledge of the actual study outcomes helped participants to more successfully estimate the effectiveness of the threatening health information (n = 72). RESULTS Results showed that participants were initially convinced of the effectiveness of threatening health messages and were unable to anticipate the defensive reactions that in fact occurred. Furthermore, these estimates did not improve after participants had been explained the dynamics of threatening communication as well as what the effects of the threatening communication had been in reality. CONCLUSIONS These findings are consistent with the hypothesis that the effectiveness of threatening health messages is intuitively appealing. What is more, providing empirical evidence against the use of threatening health messages has very little effect on this intuitive appeal.
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Affiliation(s)
- Gill A ten Hoor
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Gjalt-Jorn Y Peters
- Dept. of Research Methods & Statistics, Faculty of Psychology, Open University, P.O. Box 2960, 6401, DL, Heerlen, The Netherlands
| | - Janice Kalagi
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Lianne de Groot
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Karlijne Grootjans
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Alexander Huschens
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Constanze Köhninger
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Lizan Kölgen
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Isabelle Pelssers
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Toby Schütt
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Sophia Thomas
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Robert AC Ruiter
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Gerjo Kok
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Noordman J, van Lee I, Nielen M, Vlek H, van Weijden T, van Dulmen S. Do trained practice nurses apply motivational interviewing techniques in primary care consultations? J Clin Med Res 2012; 4:393-401. [PMID: 23226172 PMCID: PMC3513421 DOI: 10.4021/jocmr1120w] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2012] [Indexed: 01/13/2023] Open
Abstract
Background Reducing the prevalence of unhealthy lifestyle behaviour could positively influence health. Motivational interviewing (MI) is used to promote change in unhealthy lifestyle behaviour as part of primary or secondary prevention. Whether MI is actually applied as taught is unknown. Practice nurses’ application of motivational interviewing in real-life primary care consultations was examined. Furthermore, we explored if (and to what extent) practice nurses adjust their motivational interviewing skills to primary versus secondary prevention. Methods Thirteen Dutch practice nurses, from four general practices, trained in motivational interviewing participated, 117 adult patients visiting the practice nurse participated, 117 practice nurse-patient consultations between June and December 2010 were videotaped. Motivational interview skills were rated by two observers using the Behaviour Change Counselling Index (BECCI). Data were analyzed using multilevel regression. Results Practice nurses use motivational interviewing techniques to some extent. Substantial variation was found between motivational interviewing items. No significant differences in the use of motivational interviewing between primary and secondary prevention was found. Conclusions Motivational interviewing skills are not easily applicable in routine practice. Health care providers who want to acquire motivational interview skills should follow booster sessions after the first training. The training could be strengthened by video-feedback and feedback based on participating observation. A possible explanation for the lack of differences between the two types of prevention consultations may be the gain to help patients in primary consultations by preventing complications equals the necessity to help the disease from aggravating in secondary prevention.
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Affiliation(s)
- Janneke Noordman
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
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107
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Noordman J, van der Weijden T, van Dulmen S. Communication-related behavior change techniques used in face-to-face lifestyle interventions in primary care: a systematic review of the literature. PATIENT EDUCATION AND COUNSELING 2012; 89:227-244. [PMID: 22878028 DOI: 10.1016/j.pec.2012.07.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/23/2012] [Accepted: 07/10/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To systematically review the literature on the relative effectiveness of face-to-face communication-related behavior change techniques (BCTs) provided in primary care by either physicians or nurses to intervene on patients' lifestyle behavior. METHODS PubMed, EMBASE, PsychINFO, CINAHL and The Cochrane Library were searched for studies published before October 2010. Fifty studies were included and assessed on methodological quality. RESULTS Twenty-eight studies reported significantly favorable health outcomes following communication-related BCTs. In these studies, 'behavioral counseling' was most frequently used (15 times), followed by motivational interviewing (eight times), education and advice (both seven times). Physicians and nurses seem equally capable of providing face-to-face communication-related BCTs in primary care. CONCLUSION Behavioral counseling, motivational interviewing, education and advice all seem effective communication-related BCTs. However, BCTs were also found in less successful studies. Furthermore, based on existing literature, one primary care profession does not seem better equipped than the other to provide face-to-face communication-related BCTs. PRACTICE IMPLICATIONS There is evidence that behavioral counseling, motivational interviewing, education and advice can be used as effective communication-related BCTs by physicians and nurses. However, further research is needed to examine the underlying working mechanisms of communication-related BCTs, and whether they meet the requirements of patients and primary care providers.
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Affiliation(s)
- Janneke Noordman
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
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108
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Vonk Noordegraaf A, Huirne JAF, Pittens CA, van Mechelen W, Broerse JEW, Brölmann HAM, Anema JR. eHealth program to empower patients in returning to normal activities and work after gynecological surgery: intervention mapping as a useful method for development. J Med Internet Res 2012; 14:e124. [PMID: 23086834 PMCID: PMC3510728 DOI: 10.2196/jmir.1915] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 01/31/2012] [Accepted: 05/29/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Full recovery after gynecological surgery takes much longer than expected regardless of surgical technique or the level of invasiveness. After discharge, detailed convalescence recommendations are not provided to patients typically, and postoperative care is fragmented, poorly coordinated, and given only on demand. For patients, this contributes to irrational beliefs and avoidance of resumption of activities and can result in a prolonged sick leave. OBJECTIVE To develop an eHealth intervention that empowers gynecological patients during the perioperative period to obtain timely return to work (RTW) and prevent work disability. METHODS The intervention mapping (IM) protocol was used to develop the eHealth intervention. A literature search about behavioral and environmental conditions of prolonged sick leave and delayed RTW in patients was performed. Patients' needs, attitudes, and beliefs regarding postoperative recovery and resumption of work were identified through focus group discussions. Additionally, a literature search was performed to obtain determinants, methods, and strategies for the development of a suitable interactive eHealth intervention to empower patients to return to normal activities after gynecological surgery, including work. Finally, the eHealth intervention was evaluated by focus group participants, medical doctors, and eHealth specialists through questionnaires. RESULTS Twenty-one patients participated in the focus group discussions. Sufficient, uniform, and tailored information regarding surgical procedures, complications, and resumption of activities and work were considered most essential. Knowing who to contact in case of mental or physical complaints, and counseling and tools for work reintegration were also considered important. Finally, opportunities to exchange experiences with other patients were a major issue. Considering the determinants of the Attitude-Social influence-self-Efficacy (ASE) model, various strategies based on a combination of theory and evidence were used, resulting in an eHealth intervention with different interactive functionalities including tailored convalescence recommendations and a video to communicate the most common pitfalls during the perioperative period to patients and employers. Fifteen patients in the focus groups, 11 physicians, and 3 eHealth specialists suggested points for improvement to optimize the usability of the eHealth intervention and judged it an approachable, appropriate, and attractive eHealth intervention to empower gynecological patients. CONCLUSIONS The IM protocol was a useful method to develop an eHealth intervention based on both theory and evidence. All patients and stakeholders judged the eHealth intervention to be a promising tool to empower gynecological patients during the perioperative period and to help them to return to normal activities and work.
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Janssen V, Gucht VD, Dusseldorp E, Maes S. Lifestyle modification programmes for patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol 2012; 20:620-40. [DOI: 10.1177/2047487312462824] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | - Stan Maes
- Leiden University, Leiden, The Netherlands
- TNO, Leiden, The Netherlands
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110
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Huis A, van Achterberg T, de Bruin M, Grol R, Schoonhoven L, Hulscher M. A systematic review of hand hygiene improvement strategies: a behavioural approach. Implement Sci 2012; 7:92. [PMID: 22978722 PMCID: PMC3517511 DOI: 10.1186/1748-5908-7-92] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 08/23/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many strategies have been designed and evaluated to address the problem of low hand hygiene (HH) compliance. Which of these strategies are most effective and how they work is still unclear. Here we describe frequently used improvement strategies and related determinants of behaviour change that prompt good HH behaviour to provide a better overview of the choice and content of such strategies. METHODS Systematic searches of experimental and quasi-experimental research on HH improvement strategies were conducted in Medline, Embase, CINAHL, and Cochrane databases from January 2000 to November 2009. First, we extracted the study characteristics using the EPOC Data Collection Checklist, including study objectives, setting, study design, target population, outcome measures, description of the intervention, analysis, and results. Second, we used the Taxonomy of Behavioural Change Techniques to identify targeted determinants. RESULTS We reviewed 41 studies. The most frequently addressed determinants were knowledge, awareness, action control, and facilitation of behaviour. Fewer studies addressed social influence, attitude, self-efficacy, and intention. Thirteen studies used a controlled design to measure the effects of HH improvement strategies on HH behaviour. The effectiveness of the strategies varied substantially, but most controlled studies showed positive results. The median effect size of these strategies increased from 17.6 (relative difference) addressing one determinant to 49.5 for the studies that addressed five determinants. CONCLUSIONS By focussing on determinants of behaviour change, we found hidden and valuable components in HH improvement strategies. Addressing only determinants such as knowledge, awareness, action control, and facilitation is not enough to change HH behaviour. Addressing combinations of different determinants showed better results. This indicates that we should be more creative in the application of alternative improvement activities addressing determinants such as social influence, attitude, self-efficacy, or intention.
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Affiliation(s)
- Anita Huis
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Theo van Achterberg
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Marijn de Bruin
- Communication Science, Wageningen University, Wageningen, The Netherlands
| | - Richard Grol
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Lisette Schoonhoven
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Marlies Hulscher
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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111
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Hirvonen N, Huotari ML, Niemelä R, Korpelainen R. Information behavior in stages of exercise behavior change. ACTA ACUST UNITED AC 2012. [DOI: 10.1002/asi.22704] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | - Maija-Leena Huotari
- Information Studies/Faculty of Humanities; University of Oulu; P.O. Box 1000; 90014 University of Oulu; Finland
| | - Raimo Niemelä
- Information Studies/Faculty of Humanities; University of Oulu; P.O. Box 1000; 90014 University of Oulu; Finland
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O'Reilly SL, McCann LR. Development and validation of the Diet Quality Tool for use in cardiovascular disease prevention settings. Aust J Prim Health 2012; 18:138-47. [PMID: 22551836 DOI: 10.1071/py11005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 07/05/2011] [Indexed: 11/23/2022]
Abstract
The aim of this study was to develop and evaluate a dietary screening tool for use in a secondary cardiovascular disease (CVD) prevention setting to identify an individual's overall dietary quality. The Diet Quality Tool (DQT) was validated against a 4-day food diary for 37 individuals with established CVD attending cardiac rehabilitation. Construct validity was demonstrated for % energy from saturated fat (P=0.002, r=-0.500), dietary fibre (P<0.001, r=0.559) and omega-3 fatty acids (P=0.048, r=0.327). Criterion validity was established with a significant difference found between mean (95% CI) dietary intakes of fibre (28.2g, 4.4 to 17.3) and % total energy from saturated fat (10.6%, -4.8 to -0.8) for those with better DQT scores (>60%) versus those with poorer scores (≤60%) when compared with 4-day food diary nutrient values. The usefulness of the DQT was confirmed by both patients (n=25) and cardiac rehabilitation health professionals (n=8). The DQT was found to be a valid and useful dietary assessment tool with potential for use in a secondary CVD prevention setting. The tool has the capacity to be used in a wider variety of settings and further refinement of the tool would enable a greater amount of nutrients to be reliably screened.
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Affiliation(s)
- S L O'Reilly
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, Australia.
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113
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Aittasalo M, Rinne M, Pasanen M, Kukkonen-Harjula K, Vasankari T. Promoting walking among office employees - evaluation of a randomized controlled intervention with pedometers and e-mail messages. BMC Public Health 2012; 12:403. [PMID: 22672576 PMCID: PMC3444317 DOI: 10.1186/1471-2458-12-403] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 06/06/2012] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The purpose of the study was to evaluate a 6-month intervention to promote office-employees' walking with pedometers and e-mail messages. METHODS Participants were recruited by 10 occupational health care units (OHC) from 20 worksites with 2,230 employees. Voluntary and insufficiently physically active employees (N = 241) were randomized to a pedometer (STEP, N = 123) and a comparison group (COMP, N = 118). STEP included one group meeting, log-monitored pedometer-use and six e-mail messages from OHC. COMP participated in data collection. Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) and costs were assessed with questionnaires (0, 2, 6, 12 months), process evaluation and interviews (12 months). RESULTS The intervention reached 29% (N = 646) of employees in terms of participation willingness. Logistic regression showed that the proportion of walkers tended to increase more in STEP than in COMP at 2 months in "walking for transportation" (Odds ratio 2.12, 95%CI 0.94 to 4.81) and at 6 months in "walking for leisure" (1.86, 95%CI 0.94 to 3.69). Linear model revealed a modest increase in the mean duration of "walking stairs" at 2 and 6 months (Geometric mean ratio 1.26, 95%CI 0.98 to 1.61; 1.27, 0.98 to 1.64). Adoption and implementation succeeded as intended. At 12 months, some traces of the intervention were sustained in 15 worksites, and a slightly higher number of walkers in STEP in comparison with COMP was observed in "walking stairs" (OR 2.24, 95%CI 0.94 to 5.31) and in "walking for leisure" (2.07, 95%CI 0.99 to 4.34). The direct costs of the intervention were 43 Euros per participant. CONCLUSIONS The findings indicate only modest impact on some indicators of walking. Future studies should invest in reaching the employees, minimizing attrition rate and using objective walking assessment. TRIAL REGISTERATION: ISRCTN79432107.
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Affiliation(s)
- Minna Aittasalo
- The UKK Institute for Health Promotion Research, P.O. Box 30, FI-33501, Tampere, Finland
| | - Marjo Rinne
- The UKK Institute for Health Promotion Research, P.O. Box 30, FI-33501, Tampere, Finland
| | - Matti Pasanen
- The UKK Institute for Health Promotion Research, P.O. Box 30, FI-33501, Tampere, Finland
| | | | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, P.O. Box 30, FI-33501, Tampere, Finland
- National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
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Linke SE, Rutledge T, Myers MG. Intermittent exercise in response to cigarette cravings in the context of an Internet-based smoking cessation program. Ment Health Phys Act 2012; 5:85-92. [PMID: 23956792 PMCID: PMC3743265 DOI: 10.1016/j.mhpa.2012.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Interventions using sustained aerobic exercise programs to aid smoking cessation have resulted in modest, short-term cessation rates comparable to conventional cessation methods. No smoking cessation trial to date has prescribed intermittent bouts of exercise in response to nicotine cravings. OBJECTIVES This pilot randomized controlled trial examined the feasibility and efficacy of an Internet-based smoking cessation program alone (CON) vs. the same Internet-based program + intermittent exercise in response to cigarette cravings (EX). STUDY POPULATION Participants (N = 38; mean age = 43.6 [SD = 11.5]; 60.5% women) were generally healthy, inactive adult smokers who desired to quit. RESULTS The overall retention rate was 60.5% (n = 23), and no significant retention rate differences were found between groups (EX vs. CON). Although retained participants achieved a higher cessation rate (26.1%) than all enrolled participants (15.8%), adjusted intent-to-treat and per-protocol binary logistic regression analyses revealed no significant cessation rate differences between EX and CON groups. Linear regression results indicated that additional days of self-reported exercise on the study website during the intervention phase predicted significantly higher reduction rates among EX group participants, F(2, 16) = 31.08, p < .001. CONCLUSIONS Results were mixed with regard to the incremental benefit of exercise in the presence of the apparently valuable Internet-based smoking cessation program. The results support findings from related research and underscore the need for additional investigation into both the mechanisms underlying the effect of exercise on cigarette cravings and the challenges of poor adherence in the context of exercise-based smoking cessation interventions.
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Affiliation(s)
- Sarah E. Linke
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
- UCSD Department of Family & Preventive Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Thomas Rutledge
- San Diego VA Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161-911B, USA
- UCSD Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Mark G. Myers
- San Diego VA Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161-911B, USA
- UCSD Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093, USA
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115
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O'Donnell MP, Bensky JM. Integrating wellness into hospital systems. Am J Health Promot 2011; 26:TAHP1-TAHP14. [PMID: 22040401 DOI: 10.4278/ajhp.26.2.tahp] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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116
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Kok G, van Essen GA, Wicker S, Llupià A, Mena G, Correia R, Ruiter RAC. Planning for influenza vaccination in health care workers: an Intervention Mapping approach. Vaccine 2011; 29:8512-9. [PMID: 21939722 DOI: 10.1016/j.vaccine.2011.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 08/26/2011] [Accepted: 09/06/2011] [Indexed: 11/30/2022]
Abstract
Influenza vaccination uptake by health care workers (HCWs) decreases the transmission of influenza to vulnerable patients and prevents influenza-related absenteeism. Vaccination is effective, easy, and generally without serious side-effects. However, vaccination rates of HCWs are too low. This paper's objective is to apply Intervention Mapping (IM), a planning process for the systematic theory- and evidence-based development of health promotion interventions, to the development of voluntary educational interventions to promote influenza vaccination in HCWs. IM consists of the following six steps: needs assessment, program objectives, methods and applications, program development, planning for program implementation, and planning for program evaluation. Examples are provided to illustrate the activities associated with these steps. It is concluded that applying IM in the (influenza) vaccination field may help the development of effective behavior change interventions.
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Affiliation(s)
- Gerjo Kok
- Work & Social Psychology, Maastricht University, the Netherlands.
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Carlfjord S, Andersson A, Bendtsen P, Nilsen P, Lindberg M. Applying the RE-AIM framework to evaluate two implementation strategies used to introduce a tool for lifestyle intervention in Swedish primary health care. Health Promot Int 2011; 27:167-76. [PMID: 21398336 DOI: 10.1093/heapro/dar016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to evaluate two implementation strategies for the introduction of a lifestyle intervention tool in primary health care (PHC), applying the RE-AIM framework to assess outcome. A computer-based tool for lifestyle intervention was introduced in PHC. A theory-based, explicit, implementation strategy was used at three centers, and an implicit strategy with a minimum of implementation efforts at three others. After 9 months a questionnaire was sent to staff members (n= 159) and data from a test database and county council registers were collected. The RE-AIM framework was applied to evaluate outcome in terms of reach, effectiveness, adoption and implementation. The response rate for the questionnaire was 73%. Significant differences in outcome were found between the strategies regarding reach, effectiveness and adoption, in favor of the explicit implementation strategy. Regarding the dimension implementation, no differences were found according to the implementation strategy. A theory-based implementation strategy including a testing period before using a new tool in daily practice seemed to be more successful than a strategy in which the tool was introduced and immediately used for patients.
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Affiliation(s)
- Siw Carlfjord
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, SE-581 83 Linköping, Sweden.
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Dean E, Lomi C, Bruno S, Awad H, O'Donoghue G. Addressing the common pathway underlying hypertension and diabetes in people who are obese by maximizing health: the ultimate knowledge translation gap. Int J Hypertens 2011; 2011:835805. [PMID: 21423684 PMCID: PMC3057046 DOI: 10.4061/2011/835805] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 01/11/2011] [Indexed: 01/22/2023] Open
Abstract
In accordance with the WHO definition of health, this article examines the alarming discord between the epidemiology of hypertension, type 2 diabetes mellitus (T2DM), and obesity and the low profile of noninvasive (nondrug) compared with invasive (drug) interventions with respect to their prevention, reversal and management. Herein lies the ultimate knowledge translation gap and challenge in 21st century health care. Although lifestyle modification has long appeared in guidelines for medically managing these conditions, this evidence-based strategy is seldom implemented as rigorously as drug prescription. Biomedicine focuses largely on reducing signs and symptoms; the effects of the problem rather than the problem. This article highlights the evidence-based rationale supporting prioritizing the underlying causes and contributing factors for hypertension and T2DM, and, in turn, obesity. We argue that a primary focus on maximizing health could eliminate all three conditions, at best, or, at worst, minimize their severity, complications, and medication needs. To enable such knowledge translation and maximizing health outcome, the health care community needs to practice as an integrated team, and address barriers to effecting maximal health in all patients. Addressing the ultimate knowledge translation gap, by aligning the health care paradigm to 21st century needs, would constitute a major advance.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 1Z3
| | - Constantina Lomi
- Department of Physiotherapy, Akmi Metropolitan College, 15125 Athens, Greece
| | - Selma Bruno
- Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, 59072-970 Natal, RN, Brazil
| | - Hamzeh Awad
- Department of Prevention and Care of Diabetes, Faculty of Medicine, Dresden University of Technology and Ludwig-Maximilian University, 80336 Munich, Germany
| | - Grainne O'Donoghue
- Department of Physiotherapy, School of Public Health, Physiotherapy, and Population Science, University College Dublin, Dublin 4, Ireland
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