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Barley EA, Borschmann RD, Walters P, Tylee A. Interventions to encourage uptake of cancer screening for people with severe mental illness. Cochrane Database Syst Rev 2016; 9:CD009641. [PMID: 27668891 PMCID: PMC6457619 DOI: 10.1002/14651858.cd009641.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Adults with severe mental illness (i.e. schizophrenia or other related psychotic disorders and bipolar disorder) can be at greater risk of cancer than those without severe mental illness (SMI). Early detection of cancer through screening is effective in improving patient outcomes including death. However, people with SMI are less likely than others to take up available cancer screening. OBJECTIVES To determine the effectiveness of interventions targeted at adults with SMI, or their carers or health professionals, and aimed at increasing the uptake of cancer screening tests for which the adults with SMI are eligible. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (October 25, 2012; December 19, 2014; April 07, 2015; July 04, 2016). SELECTION CRITERIA All randomised controlled trials (RCTs) of interventions, targeted towards adults with SMI or their carers or health professionals, to encourage uptake of cancer screening tests for which the adults with SMI were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and assessed these against the inclusion criteria. MAIN RESULTS We did not find any trials that met the inclusion criteria. AUTHORS' CONCLUSIONS A comprehensive search showed that currently there is no RCT evidence for any method of encouraging cancer screening uptake in people with SMI. No specific approach can therefore be recommended. High-quality, large-scale RCTs are needed urgently to help address the disparity between people with SMI and others in cancer screening uptake.
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Affiliation(s)
- Elizabeth A Barley
- University of West LondonCollege of Nursing, Midwifery and HealthcareParagon HouseBoston Manor RoadBrentfordMiddlesexUKTW8 9GA
| | - Rohan D Borschmann
- Royal Children's HospitalCentre for Adolescent Health, Murdoch Childrens Research InstituteFlemington RoadParkvilleMelbourneVictoriaAustralia3052
| | - Paul Walters
- Dorset HealthCare University NHS Foundation Trust and Bournemouth UniversityDepartment of Mental HealthC/o Weymouth & Portland CMHTRadipole LaneWeymouthUKDT4 0QE
| | - Andre Tylee
- King's College LondonHealth Service and Population Research Department, Institute of PsychiatryDe Crespigny ParkLondonUKSE5 8AF
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Holmberg C, Sarganas G, Mittring N, Braun V, Dini L, Heintze C, Rieckmann N, Muckelbauer R, Müller-Nordhorn J. Primary prevention in general practice - views of German general practitioners: a mixed-methods study. BMC FAMILY PRACTICE 2014; 15:103. [PMID: 24885100 PMCID: PMC4046439 DOI: 10.1186/1471-2296-15-103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 05/16/2014] [Indexed: 11/29/2022]
Abstract
Background Policy efforts focus on a reorientation of health care systems towards primary prevention. To guide such efforts, we analyzed the role of primary prevention in general practice and general practitioners’ (GPs) attitudes toward primary prevention. Methods Mixed-method study including a cross-sectional survey of all community-based GPs and focus groups in a sample of GPs who collaborated with the Institute of General Practice in Berlin, Germany in 2011. Of 1168 GPs 474 returned the mail survey. Fifteen GPs participated in focus group discussions. Survey and interview guidelines were developed and tested to assess and discuss beliefs, attitudes, and practices regarding primary prevention. Results Most respondents considered primary prevention within their realm of responsibility (70%). Primary prevention, especially physical activity, healthy eating, and smoking cessation, was part of the GPs’ health care recommendations if they thought it was indicated. Still a quarter of survey respondents discussed reduction of alcohol consumption with their patients infrequently even when they thought it was indicated. Similarly 18% claimed that they discuss smoking cessation only sometimes. The focus groups revealed that GPs were concerned about the detrimental effects an uninvited health behavior suggestion could have on patients and were hesitant to take on the role of “health policing”. GPs saw primary prevention as the responsibility of multiple actors in a network of societal and municipal institutions. Conclusions The mixed-method study showed that primary prevention approaches such as lifestyle counseling is not well established in primary care. GPs used a selective approach to offer preventive advice based upon indication. GPs had a strong sense that a universal prevention approach carried the potential to destroy a good patient-physician relationship. Other approaches to public health may be warranted such as a multisectoral approach to population health. This type of restructuring of the health care sector may benefit patients who are unable to afford specific prevention programmes and who have competing demands that hinder their ability to focus on behavior change.
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Affiliation(s)
- Christine Holmberg
- Berlin School of Public Health, Charité Universitätsmedizin Berlin, Seestr, 73, 13347 Berlin, Germany.
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Barley E, Borschmann R, Walters P, Tylee A. Interventions to encourage uptake of cancer screening for people with severe mental illness. Cochrane Database Syst Rev 2013:CD009641. [PMID: 23857563 DOI: 10.1002/14651858.cd009641.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adults with severe mental illness (i.e. schizophrenia or other related psychotic disorders and bipolar disorder) can be at greater risk of cancer than those without severe mental illness (SMI). Early detection of cancer through screening is effective in improving patient outcomes including death. However, people with SMI are less likely than others to take up available cancer screening. OBJECTIVES To determine the effectiveness of interventions targeted at adults with SMI, or their carers or health professionals, and aimed at increasing the uptake of cancer screening tests for which the adults with SMI are eligible. SEARCH METHODS We searched electronically the Cochrane Schizophrenia Group's Register (25th October 2012). SELECTION CRITERIA All randomised controlled trials (RCTs) of interventions, targeted towards adults with SMI or their carers or health professionals, to encourage uptake of cancer screening tests for which the adults with SMI were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and assessed these against the inclusion criteria. MAIN RESULTS We did not find any trials that met the inclusion criteria. AUTHORS' CONCLUSIONS A comprehensive search showed that currently there is no RCT evidence for any method of encouraging cancer screening uptake in people with SMI. No specific approach can therefore be recommended. High-quality, large-scale RCTs are needed urgently to help address the disparity between people with SMI and others in cancer screening uptake.
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Affiliation(s)
- Elizabeth Barley
- Florence Nightingale School of Nursing and Midwifery, King’s College London, London, UK.
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Gelly J, Mentre F, Nougairede M, Duval X. Preventive services recommendations for adults in primary care settings: agreement between Canada, France and the USA--a systematic review. Prev Med 2013; 57:3-11. [PMID: 23571186 DOI: 10.1016/j.ypmed.2013.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/27/2013] [Accepted: 03/29/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To analyze the level of agreement between recommendations on preventive services developed by Canada, France and the USA. METHODS We gathered recommendations on primary and secondary preventive services to adults up to November 3rd, 2011 from Canadian and US Task Forces, and equivalent French agencies. We excluded recommendations on immunization, long-term diseases or pregnancy. RESULTS Among 250 recommendations, 84 (34%) issued by a single country could not be compared; 43 (26%) of the remaining 166 were in strong agreement (strictly identical grades between advising countries); 25 of 43 resulted in a proposal to be implemented in clinical practice, two others not to be implemented in clinical practice and 16 were indeterminate about implementation. Strong agreement was more frequent for recommendations concerning history-taking and physical examination than for those concerning interventions (odds ratio (OR)=11.3, 95%CI: 1.6-241.2; p=0.04), and for recommendations concerning a high-risk population than for those concerning the general population (OR=3.1, 95%CI: 1.4-7.0; p=0.006). Agreement did not differ either according to maximum time range between recommendations' publication or according to the advising country. CONCLUSION Agreement between recommendations is low particularly on those concerning non-clinical preventive services or non-high-risk individuals.
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Affiliation(s)
- Julien Gelly
- Univ Paris Diderot, Sorbonne Paris Cité, Dept. of General Practice, F-75018, Paris, France.
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Harris MF, Lloyd J, Litt J, van Driel M, Mazza D, Russell G, Smith J, Del Mar C, Denney-Wilson E, Parker S, Krastev Y, Jayasinghe UW, Taylor R, Zwar N, Wilson J, Bolger-Harris H, Waters J. Preventive evidence into practice (PEP) study: implementation of guidelines to prevent primary vascular disease in general practice protocol for a cluster randomised controlled trial. Implement Sci 2013; 8:8. [PMID: 23327664 PMCID: PMC3564812 DOI: 10.1186/1748-5908-8-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/11/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There are significant gaps in the implementation and uptake of evidence-based guideline recommendations for cardiovascular disease (CVD) and diabetes in Australian general practice. This study protocol describes the methodology for a cluster randomised trial to evaluate the effectiveness of a model that aims to improve the implementation of these guidelines in Australian general practice developed by a collaboration between researchers, non-government organisations, and the profession. METHODS We hypothesise that the intervention will alter the behaviour of clinicians and patients resulting in improvements of recording of lifestyle and physiological risk factors (by 20%) and increased adherence to guideline recommendations for: the management of CVD and diabetes risk factors (by 20%); and lifestyle and physiological risk factors of patients at risk (by 5%). Thirty-two general practices will be randomised in a 1:1 allocation to receive either the intervention or continue with usual care, after stratification by state. The intervention will be delivered through: small group education; audit of patient records to determine preventive care; and practice facilitation visits adapted to the needs of the practices. Outcome data will be extracted from electronic medical records and patient questionnaires, and qualitative evaluation from provider and patient interviews. DISCUSSION We plan to disseminate study findings widely and directly inform implementation strategies by governments, professional bodies, and non-government organisations including the partner organisations.
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Affiliation(s)
- Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW, 2052, Australia
| | - John Litt
- Discipline of General Practice, Flinders University, Adelaide, Australia
| | - Mieke van Driel
- Discipline of General Practice, University of Queensland, St Lucia, QLD, Australia
| | - Danielle Mazza
- School of Primary Health Care, Monash University, Melbourne, Australia
| | - Grant Russell
- School of Primary Health Care, Monash University, Melbourne, Australia
| | - Jane Smith
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Chris Del Mar
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | | | - Sharon Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Yordanka Krastev
- Ethics Secretariate, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Upali W Jayasinghe
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Richard Taylor
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Nick Zwar
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Jinty Wilson
- National Heart Foundation of Australia, Melbourne, Australia
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van Limpt PM, Harting J, van Assema P, Ruland E, Kester A, Gorgels T, Knottnerus JA, van Ree JW, Stoffers HE. Effects of a brief cardiovascular prevention program by a health advisor in primary care; the 'Hartslag Limburg' project, a cluster randomized trial. Prev Med 2011; 53:395-401. [PMID: 21925203 DOI: 10.1016/j.ypmed.2011.08.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine in primary care patients at high risk for a cardiovascular event, the effects on biomedical risk factors for and incidence of cardiovascular events, of a brief cardiovascular prevention program executed by a health advisor. DESIGN cluster randomized controlled trial with 1275 patients (24 general practices) in and around Maastricht, the Netherlands (1999-2004). INTERVENTION health advisors were to complete computerized cardiovascular risk profiles, provide multi-factorial tailored health education and advice, and communicate with GP's to optimize treatment. OUTCOME differences in changes in risk factors between baseline and follow up at 6, 18, and 36 months and incidence of cardiovascular events at 36 months. PROCESS Because of logistic reasons risk profiles were put on paper instead of in the computerized patient files. On average patients attended 2.3 counseling sessions. Interaction with GPs was less productive than expected. OUTCOME Effect after six months on BMI (-0.20 kg/m(2) (95% CI -0.38 to -0.01, p=0.039), Cohen's d: -0.18), and after 18 months on HDL-cholesterol (+0.05 mmol/l (95% CI +0.01 to +0.09, p=0.014), Cohen's d: 0.14). No other (subgroup) effects were found. CONCLUSION Given the lack of clinically meaningful effects, implementation of this intervention in its present form is not justified.
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Affiliation(s)
- Patrick M van Limpt
- Department of General Practice, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands.
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Abstract
AIMS The present study aimed to evaluate the frequency and the target group of alcohol screening and brief interventions in health-care settings and how well this level of activity reflects public opinion. DESIGN A general population survey. SETTING AND PARTICIPANTS A random sample of Finns aged 15-69 years with a 74% response rate (n = 2725). MEASUREMENTS Frequency counts were used to evaluate the level of activity. Logistic regression models were used to examine which groups were asked and advised about alcohol use and which groups considered it useful. FINDINGS More than 90% had positive attitudes towards being asked about their alcohol use. Of those who had been in contact with health care (n = 2062) in the 12 months before the survey, 33.3% had been asked about their alcohol use, being most often men, young, heavy drinkers and those of high socio-economic status. Thirty-seven per cent of those who had been asked were given advice, being most often heavy drinkers and those with a normal body mass index. However, 50% of heavy drinkers who had been asked about their alcohol use had not been advised about it. Of those who had been advised, 71.9% considered it useful, especially older subjects, and also including heavy episodic drinkers, although less than others. CONCLUSIONS In Finland, the frequency of health-care professionals asking and giving advice on alcohol is relatively low. However, public opinion towards these discussions is positive. Our results encourage the support and uptake of systematic screenings and brief interventions in health-care settings.
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Affiliation(s)
- Pia Mäkelä
- National Institute for Welfare and Health, Department of Alcohol, Drugs and Addiction, Helsinki, Finland.
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Sanchez A, Grandes G, Cortada JM, Pombo H, Balague L, Calderon C. Modelling innovative interventions for optimising healthy lifestyle promotion in primary health care: "prescribe Vida Saludable" phase I research protocol. BMC Health Serv Res 2009; 9:103. [PMID: 19534832 PMCID: PMC2714033 DOI: 10.1186/1472-6963-9-103] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 06/18/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The adoption of a healthy lifestyle, including physical activity, a balanced diet, a moderate alcohol consumption and abstinence from smoking, are associated with large decreases in the incidence and mortality rates for the most common chronic diseases. That is why primary health care (PHC) services are trying, so far with less success than desirable, to promote healthy lifestyles among patients. The objective of this study is to design and model, under a participative collaboration framework between clinicians and researchers, interventions that are feasible and sustainable for the promotion of healthy lifestyles in PHC. METHODS AND DESIGN Phase I formative research and a quasi-experimental evaluation of the modelling and planning process will be undertaken in eight primary care centres (PCCs) of the Basque Health Service--OSAKIDETZA, of which four centres will be assigned for convenience to the Intervention Group (the others being Controls). Twelve structured study, discussion and consensus sessions supported by reviews of the literature and relevant documents, will be undertaken throughout 12 months. The first four sessions, including a descriptive strategic needs assessment, will lead to the prioritisation of a health promotion aim in each centre. In the remaining eight sessions, collaborative design of intervention strategies, on the basis of a planning process and pilot trials, will be carried out. The impact of the formative process on the practice of healthy lifestyle promotion, attitude towards health promotion and other factors associated with the optimisation of preventive clinical practice will be assessed, through pre- and post-programme evaluations and comparisons of the indicators measured in professionals from the centres assigned to the Intervention or Control Groups. DISCUSSION There are four necessary factors for the outcome to be successful and result in important changes: (1) the commitment of professional and community partners who are involved; (2) their competence for change; (3) the active cooperation and participation of the interdisciplinary partners involved throughout the process of change; and (4) the availability of resources necessary to facilitate the change.
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Affiliation(s)
- Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Josep M Cortada
- Deusto Health Centre, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Haizea Pombo
- Primary Care Research Unit of Bizkaia, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Laura Balague
- Renteria Health Centre, Basque Health Service (Osakidetza), Renteria, Spain
| | - Carlos Calderon
- Alza Health Centre, Basque Health Service (Osakidetza), Donostia-San Sebastian, Spain
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Omer K, Mhatre S, Ansari N, Laucirica J, Andersson N. Evidence-based training of frontline health workers for door-to-door health promotion: a pilot randomized controlled cluster trial with Lady Health Workers in Sindh Province, Pakistan. PATIENT EDUCATION AND COUNSELING 2008; 72:178-85. [PMID: 18395396 DOI: 10.1016/j.pec.2008.02.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 02/05/2008] [Accepted: 02/17/2008] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Demonstrate the effective use of community-based evidence for health promotion by Lady Health Workers (LHWs) in Sindh, Pakistan. METHODS A baseline study on mothers and children provided local evidence for risk communication tools designed and tested by LHWs. The communities were randomized to intervention and control. LHWs visited women before and after childbirth to discuss safe practices in pregnancy, in the intervention group LHW using the new tools and in the control group using their standard procedures. A household survey and focus groups permitted assessment of the impact of the intervention. RESULTS Women in the intervention communities were more likely to attend prenatal checkups, to stop routine heavy work during pregnancy, to give colostrum to newborn babies, and to maintain exclusive breastfeeding for four months. Community focus groups confirmed a positive reaction to the tools. CONCLUSION Discussion by lay health workers of local evidence underlying safe motherhood messages improved uptake of protective health practices. PRACTICE IMPLICATIONS Door-to-door health promotion based on culturally appropriate interaction around relevant evidence can have a positive impact on health practices. Engaging health workers from the onset builds capacities, improves dialogue within the health system and performance of frontline health workers.
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Gorin SS, Ashford AR, Lantigua R, Desai M, Troxel A, Gemson D. Implementing academic detailing for breast cancer screening in underserved communities. Implement Sci 2007; 2:43. [PMID: 18086311 PMCID: PMC2266776 DOI: 10.1186/1748-5908-2-43] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 12/17/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND African American and Hispanic women, such as those living in the northern Manhattan and the South Bronx neighborhoods of New York City, are generally underserved with regard to breast cancer prevention and screening practices, even though they are more likely to die of breast cancer than are other women. Primary care physicians (PCPs) are critical for the recommendation of breast cancer screening to their patients. Academic detailing is a promising strategy for improving PCP performance in recommending breast cancer screening, yet little is known about the effects of academic detailing on breast cancer screening among physicians who practice in medically underserved areas. We assessed the effectiveness of an enhanced, multi-component academic detailing intervention in increasing recommendations for breast cancer screening within a sample of community-based urban physicians. METHODS Two medically underserved communities were matched and randomized to intervention and control arms. Ninety-four primary care community (i.e., not hospital based) physicians in northern Manhattan were compared to 74 physicians in the South Bronx neighborhoods of the New York City metropolitan area. Intervention participants received enhanced physician-directed academic detailing, using the American Cancer Society guidelines for the early detection of breast cancer. Control group physicians received no intervention. We conducted interviews to measure primary care physicians' self-reported recommendation of mammography and Clinical Breast Examination (CBE), and whether PCPs taught women how to perform breast self examination (BSE). RESULTS Using multivariate analyses, we found a statistically significant intervention effect on the recommendation of CBE to women patients age 40 and over; mammography and breast self examination reports increased across both arms from baseline to follow-up, according to physician self-report. At post-test, physician involvement in additional educational programs, enhanced self-efficacy in counseling for prevention, the routine use of chart reminders, computer- rather than paper-based prompting and tracking approaches, printed patient education materials, performance targets for mammography, and increased involvement of nursing and other office staff were associated with increased screening. CONCLUSION We found some evidence of improvement in breast cancer screening practices due to enhanced academic detailing among primary care physicians practicing in urban underserved communities.
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Affiliation(s)
- Sherri Sheinfeld Gorin
- Department of Health and Behavior Studies, Columbia University, 525 W 120Street, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168Street, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, 1130 St. Nicholas Avenue, New York, NY, USA
| | - Alfred R Ashford
- Herbert Irving Comprehensive Cancer Center, 1130 St. Nicholas Avenue, New York, NY, USA
- Harlem Hospital Center, MLK Pavilion, New York, NY, USA
- College of Physicians and Surgeons, Columbia University, 600 W 168Street, New York, NY, USA
| | - Rafael Lantigua
- Herbert Irving Comprehensive Cancer Center, 1130 St. Nicholas Avenue, New York, NY, USA
- College of Physicians and Surgeons, Columbia University, 600 W 168Street, New York, NY, USA
| | - Manisha Desai
- Herbert Irving Comprehensive Cancer Center, 1130 St. Nicholas Avenue, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168Street, New York, NY, USA
| | - Andrea Troxel
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 632 Blockley Hall, Philadelphia, PA, USA
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Corrrigan M, Cupples ME, Smith SM, Byrne M, Leathem CS, Clerkin P, Murphy AW. The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems. BMC Health Serv Res 2006; 6:90. [PMID: 16848896 PMCID: PMC1543625 DOI: 10.1186/1472-6963-6-90] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 07/18/2006] [Indexed: 11/10/2022] Open
Abstract
Background Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems. Methods In four general practices, one rural and one urban, in Northern Ireland and the Republic of Ireland, patients with CHD were purposively selected. Four focus groups with patients (N = 23) and four with staff (N = 29) informed the development of the intervention by exploring how it could be tailored and integrated with current secondary prevention activities for CHD in the two healthcare settings. Following an exploratory trial the acceptability and feasibility of the intervention were discussed in four focus groups (17 patients) and 10 interviews (staff). The data were analysed using thematic analysis. Results Integrating qualitative research into the development of the intervention provided depth of information about the varying impact, between the two healthcare systems, of different funding and administrative arrangements, on their provision of secondary prevention and identified similar barriers of time constraints, training needs and poor patient motivation. The findings also highlighted the importance to patients of stress management, the need for which had been underestimated by the researchers. The qualitative evaluation provided depth of detail not found in evaluation questionnaires. It highlighted how the intervention needed to be more practical by minimising administration, integrating role plays into behaviour change training, providing more practical information about stress management and removing self-monitoring of lifestyle change. Conclusion Qualitative research is integral to developing the design detail of a complex intervention and tailoring its components to address individuals' needs in different healthcare systems. The findings highlight how qualitative research may be a valuable component of the preparation for complex interventions and their evaluation.
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Affiliation(s)
- Mairead Corrrigan
- Division of Medical Education, Queen's University Belfast, Northern Ireland, UK
| | - Margaret E Cupples
- Division of Public Health and Primary Care, Queen's University Belfast, Northern Ireland, UK
| | - Susan M Smith
- Department of Public Health and Primary Care, Trinity College Dublin, Ireland
| | - Molly Byrne
- Department of Psychology, NUI Galway, Ireland
| | - Claire S Leathem
- Division of Public Health and Primary Care, Queen's University Belfast, Northern Ireland, UK
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Forbes C, Jepson R, Martin-Hirsch P. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev 2002:CD002834. [PMID: 12137660 DOI: 10.1002/14651858.cd002834] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cervical cancer is the third most common cancer world-wide. Increasing the uptake of screening, alongside increasing informed choice is of great importance in controlling this disease through prevention and early detection. OBJECTIVES To assess the effectiveness of interventions aimed at increasing uptake, and informed uptake of cervical cancer screening. SEARCH STRATEGY Twenty-three electronic databases (to March 2000) were searched with no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs), or quasi-RCTs of interventions to increase uptake/informed uptake of cervical cancer screening. DATA COLLECTION AND ANALYSIS Data on study characteristics and quality were extracted independently by two reviewers. Where data were available, relative risks and 95% CI were calculated and a chi-squared test for heterogeneity was performed. MAIN RESULTS Thirty-five studies were included (27 RCTs and eight quasi-RCTs). Heterogeneity between studies limited statistical pooling of data. Overall, however, invitations appear to be effective methods of increasing uptake. In addition, there is limited evidence to support the use of educational materials. The number and quality of included studies limited evidence regarding effectiveness of other interventions. Informed uptake of cervical screening was not considered by any studies. REVIEWER'S CONCLUSIONS There was some evidence to support the use of invitation letters to increase the uptake of cervical screening. There was limited evidence to support educational interventions but it was unclear what format was most effective. The majority of the studies were from developed countries and so the relevance to developing countries is unclear.
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Affiliation(s)
- C Forbes
- NHS Centre for Reviews & Dissemination, University of York, Heslington, York, North Yorkshire, UK, YO10 5DD.
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