1
|
Platzer F, Steverink N, Haan M, Vorstman J, de Greef M, Goedendorp M. Community Wise-effects and participant perceptions of a community- based -positive health intervention for older inhabitants of low SES neighbourhoods: a mixed-methods approach. BMC Public Health 2023; 23:1251. [PMID: 37370084 DOI: 10.1186/s12889-023-16148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The Community Wise (CW) intervention applies a community-based approach to improve the physical fitness, self-management ability, loneliness, social cohesion, and well-being of older adults living in neighbourhoods characterized by lower socioeconomic status (SES). METHODS Participants (N = 108) were recruited using several strategies, including door-to-door visits and community key peers. The study was based on a pre-test/post-test design. Outcomes were assessed through mixed methods using questionnaires, performance tests, semi-structured interviews, and focus-group sessions. RESULTS Results showed significant improvements on aerobic endurance and shoulder flexibility, but no significant improvements on self-management ability, social cohesion, loneliness, or well-being. Qualitative data analysis did indicate that participants experienced improvements on social connectedness with members of the group, as well as on self-management ability. CONCLUSION The results of the intervention seem to depend on programme fidelity and method of assessment. Adapting the intervention and including more older adults with poor health status could lead to better outcomes in the future. This results of this study should be interpreted in light of the complexity and methodological challenges of conducting a community-based health-promotion intervention for this target group. TRAIL REGISTRATION Retrospective registration.
Collapse
Affiliation(s)
- Feline Platzer
- Department of Health Psychology, University Medical Center Groningen, PO Box 30.001, Hanzeplein 1 9700 RB, Groningen, Netherlands.
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands.
| | - Nardi Steverink
- Department of Health Psychology, University Medical Center Groningen, PO Box 30.001, Hanzeplein 1 9700 RB, Groningen, Netherlands
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Marieke Haan
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Jiska Vorstman
- Department of Health Psychology, University Medical Center Groningen, PO Box 30.001, Hanzeplein 1 9700 RB, Groningen, Netherlands
| | - Mathieu de Greef
- Department of Health Studies, Hanze University of Applied Science, Groningen, the Netherlands
| | - Martine Goedendorp
- Department of Health Psychology, University Medical Center Groningen, PO Box 30.001, Hanzeplein 1 9700 RB, Groningen, Netherlands
| |
Collapse
|
2
|
Reeves D, Woodham AA, French D, Bower P, Holland F, Kontopantelis E, Cotterill S. The influence of demographic, health and psychosocial factors on patient uptake of the English NHS diabetes prevention programme. BMC Health Serv Res 2023; 23:352. [PMID: 37041541 PMCID: PMC10091609 DOI: 10.1186/s12913-023-09195-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/17/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND The prevention of type 2 diabetes (T2DM) is a major concern for health services around the world. The English NHS Diabetes Prevention Programme (NHS-DPP) offers a group face-to-face behaviour change intervention, based around exercise and diet, to adults with non-diabetic hyperglycaemia (NDH), referred from primary care. Previous analysis of the first 100,000 referrals revealed just over half of those referred to the NHS-DPP took up a place. This study aimed to identify the demographic, health and psychosocial factors associated with NHS-DPP uptake to help inform the development of interventions to improve uptake and address inequities between population groups. METHODS Drawing on the Behavioral Model of Health Services Utilization we developed a survey questionnaire to collect data on a wide range of demographic, health and psychosocial factors that might influence uptake of the NHS-DPP. We distributed this questionnaire to a cross-sectional random sample of 597 patients referred to the NHS-DPP across 17 general practices, chosen for variation. Multivariable regression analysis was used to identify factors associated with NHS-DPP uptake. RESULTS 325 out of 597 questionnaires were completed (54%). Only a third of responders took up the offer of a place. The best performing model for uptake (AUC = 0.78) consisted of four factors: older age; beliefs concerning personal vulnerability to T2DM; self-efficacy for reducing T2DM risk; and the efficacy of the NHS-DPP. After accounting for these, demographic and health-related factors played only a minor role. CONCLUSION Unlike fixed demographic characteristics, psychosocial perceptions may be amenable to change. NHS-DPP uptake rates may be improved by targeting the beliefs of patients about their risk of developing T2DM, their ability to carry out and sustain behaviours to reduce this risk, and the efficacy of the NHS-DPP in providing the necessary understanding and skills required. The recently introduced digital version of the NHS DPP could help address the even lower uptake amongst younger adults. Such changes could facilitate proportional access from across different demographic strata.
Collapse
Affiliation(s)
- David Reeves
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Adrine Ablitt Woodham
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - David French
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Peter Bower
- Centre for Primary Care and Health Services Research, School of Health Sciences, NIHR ARC Greater Manchester, The University of Manchester, Manchester, UK
| | - Fiona Holland
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| |
Collapse
|
3
|
van Het Bolscher-Niehuis MJT, Uitdehaag MJ, Bergsma A, Francke AL. Self-managing physical and mental health: A qualitative study on older adults' views and support needs in the Netherlands. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1894-1902. [PMID: 34528745 DOI: 10.1111/hsc.13568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
To help older adults stay healthy and independent, different stakeholders have developed self-management programmes that aim to support older adults in maintaining or improving physical and mental health. These programmes do not always match older adults' needs and preferences. The aim of this study was to gain insight into independently living older adults' views and support needs in self-managing physical and mental health. A qualitative study was performed to collect data. Sixteen independently living older adults from the eastern part of the Netherlands were recruited through purposive sampling. The interviews were audiotaped, transcribed verbatim and subjected to thematic analysis. The results demonstrate that older adults who live independently believe that maintaining physical and mental health is an important pre-condition for remaining independent and living a meaningful life. They are positive about their health, tend to keep on going with an optimistic attitude and choose activities that suit them regarding type and intensity. The older adults believe deterioration is a normal part of getting older. They focus on preservation and adapt to their natural decline. However, some older adults struggle with their deterioration but prefer self-management rather than seeking professional support. To reach the target group, it has been suggested that nurses and other healthcare professionals tailor their support to the way older adults view and manage the maintenance of both physical and mental health.
Collapse
Affiliation(s)
| | - Madeleen J Uitdehaag
- Research Group Nursing, Saxion University of Applied Sciences, Deventer/Enschede, The Netherlands
| | - Ad Bergsma
- Research Group Nursing, Saxion University of Applied Sciences, Deventer/Enschede, The Netherlands
| | - Anneke L Francke
- NIVEL, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Amsterdam Public Health research institute, VU University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Ecological Predictors of Older Adults' Participation and Retention in a Physical Activity Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063190. [PMID: 35328876 PMCID: PMC8949961 DOI: 10.3390/ijerph19063190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 11/26/2022]
Abstract
Research is still lacking regarding the question as to how programs to promote healthy ageing should be organized in order to increase acceptance and thus effectiveness. For older adults, ecological factors, such as the physical distance to program sites, might predict participation and retention. Thus, the key aim of this analysis was to examine these factors in a physical activity intervention trial. Adults (N = 8299) aged 65 to 75 years were invited to participate and n = 589 participants were randomly assigned to one of two intervention groups with 10 weeks of physical activity home practice and exercise classes or a wait-list control group. Response, participation, and dropout data were compared regarding ecological, individual, and study-related variables. Kaplan–Meier curves and Cox regression models were used to determine predictors of dropout. In total, 405 participants completed the study. Weekly class attendance rates were examined regarding significant weather conditions and holiday periods. The highest rates of nonresponse were observed in districts with very high neighborhood levels of socioeconomic status. In this study, ecological factors did not appear to be significant predictors of dropout, whereas certain individual and study-related variables were predictive. Future studies should consider these factors during program planning to mobilize and keep subjects in the program.
Collapse
|
5
|
Lippke S, Ratz T, Keller FM, Juljugin D, Peters M, Pischke C, Voelcker-Rehage C. Mitigating feelings of loneliness and depression by means of web-based or print-based physical activity interventions: Pooled analysis of two community-based intervention trials (Preprint). JMIR Aging 2022; 5:e36515. [PMID: 35943790 PMCID: PMC9399846 DOI: 10.2196/36515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/20/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Physical activity (PA) is associated with benefits, such as fewer depressive symptoms and loneliness. Web- and print-based PA interventions can help older individuals accordingly. Objective We aimed to test the following research questions: Do PA interventions delivered in a web- or print-based mode improve self-reported PA stage of change, social-cognitive determinants of PA, loneliness, and symptoms of depression? Is subjective age a mediator and stage of change a moderator of this effect? Methods Overall, 831 adults aged ≥60 years were recruited and either allocated to a print-based or web-based intervention group or assigned to a wait-list control group (WLCG) in 2 community-based PA intervention trials over 10 weeks. Missing value imputation using an expectation-maximization algorithm was applied. Frequency analyses, multivariate analyses of variance, and moderated mediation analyses were conducted. Results The web-based intervention outperformed (47/59, 80% of initially inactive individuals being adopters, and 396/411, 96.4% of initially active individuals being maintainers of the recommended PA behavior) the print-based intervention (20/25, 80% of adopters, and 63/69, 91% of maintainers) and the WLCG (5/7, 71% of adopters; 141/150, 94% of maintainers). The pattern regarding adopters was statistically significant (web vs print Z=–1.94; P=.02; WLCG vs web Z=3.8367; P=.01). The pattern was replicated with stages (χ24=79.1; P<.001; contingency coefficient 0.314; P<.001); in the WLCG, 40.1% (63/157) of the study participants moved to or remained in action stage. This number was higher in the groups receiving web-based (357/470, 76%) or print-based interventions (64/94, 68.1%). A significant difference was observed favoring the 2 intervention groups over and above the WLCG (F19, 701=4.778; P<.001; η2=0.098) and a significant interaction of time and group (F19, 701=2.778; P<.001; η2=0.070) for predictors of behavior. The effects of the interventions on subjective age, loneliness, and depression revealed that both between-group effects (F3, 717=8.668; P<.001; η2=0.018) and the interaction between group and time were significant (F3, 717=6.101; P<.001; η2=0.025). In a moderated mediation model, both interventions had a significant direct effect on depression in comparison with the WLCG (web-based: c′ path −0.86, 95% CI −1.58 to −0.13, SE 0.38; print-based: c′ path −1.96, 95% CI −2.99 to −0.92, SE 0.53). Furthermore, subjective age was positively related to depression (b path 0.14, 95% CI 0.05-0.23; SE 0.05). An indirect effect of the intervention on depression via subjective age was only present for participants who were in actor stage and received the web-based intervention (ab path −0.14, 95% CI −0.34 to −0.01; SE 0.09). Conclusions Web-based interventions appear to be as effective as print-based interventions. Both modes might help older individuals remain or become active and experience fewer depression symptoms, especially if they feel younger. Trial Registration German Registry of Clinical Trials DRKS00010052 (PROMOTE 1); https://tinyurl.com/nnzarpsu and DRKS00016073 (PROMOTE 2); https://tinyurl.com/4fhcvkwy International Registered Report Identifier (IRRID) RR2-10.2196/15168
Collapse
Affiliation(s)
- Sonia Lippke
- Psychology & Methods, Jacobs University Bremen, Bremen, Germany
| | - Tiara Ratz
- Department of Reproductive Endocrinology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | | | | | - Manuela Peters
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Claudia Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Claudia Voelcker-Rehage
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Muenster, Muenster, Germany
| |
Collapse
|
6
|
Vilpunaho T, Sund R, Koivumaa-Honkanen H, Honkanen R, Kröger H, Rikkonen T. Urban RCT participants were healthier than non-participants or rural women. J Clin Epidemiol 2021; 140:44-55. [PMID: 34487834 DOI: 10.1016/j.jclinepi.2021.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate sociodemographic characteristics and physical and mental health indicators between participants and nonparticipants of a large-scale 2-year exercise RCT including noninvited women living in nearby rural area in Finland. STUDY DESIGN AND SETTING From a previous OSTPRE study cohort, 914 women (aged 72-84) participated in Kuopio Fall Prevention Study in 2016-2019. The participants were compared to non-participants (n = 4,536) and noninvited OSTPRE women (n = 7,119) living outside the urban recruitment area. RESULTS Participants were younger (P< 0.001) with higher education (P< 0.001) and had more often regular hobbies (P< 0.001) and physical exercising (P< 0.001) than nonparticipants or noninvited. They reported better functional capability (P< 0.001), mental (P< 0.001) and subjective health (P< 0.001), lower number of medications (P< 0.001), less fear of falls (P< 0.001), but more frequent falls (P= 0.002) and more often musculoskeletal diseases (P= 0.006). Participants also showed better functional capacity in the clinical measurements. In register analysis, urban-rural differences in the prevalence of diseases were detected. CONCLUSION In population-based exercise interventions, participants are more likely to be better off in respect to physical and mental wellbeing, functional capability and sociodemographic status. Recruiting participants only from cities increases unavoidable selection bias due to urban-rural differences which should be noticed when interpreting and generalizing RCT results. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT02665169.
Collapse
Affiliation(s)
- Tommi Vilpunaho
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland.
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland; Institute of Clinical Medicine, Psychiatry, University of Eastern Finland (UEF), Kuopio, Finland; Mental Health and Wellbeing Center, Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland; Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| |
Collapse
|
7
|
Girard M, Kaczorowski J, Lussier MT, Martin V. Attendance, activation and health profiles of participants, a prospective study on a regional cardiometabolic disease self-management program in Laval, Canada. BMC Public Health 2021; 21:497. [PMID: 33711973 PMCID: PMC7953555 DOI: 10.1186/s12889-021-10558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 03/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background Chronic diseases are responsible for over 70% of all deaths globally. While some self-management programs have been shown to be efficacious in preventing or altering trajectories for some chronic conditions, scaling-up and sustaining such programs beyond tightly-controlled study conditions remain a major challenge. CISSS-Laval partnered with the Cardiovascular Health Awareness Program team to co-develop Cible-santé/prévention and evaluate the first cohort of participants enrolled in the program, in order to better understand the program’s implementation and scope. The objective of the current study was to describe the profile of attendees and the level of engagement of participants in a new, region-wide cardiometabolic disease self-management program offered in Laval, Canada. Methods This was a prospective study with no comparison group. Potential participants were identified and referred to the program from April to December 2015 by their primary care health professional practicing in one of the city’s interdisciplinary primary care clinics. They had their blood pressure, waist circumference and body mass index measured by trained volunteers, and completed a questionnaire on health habits, level of activation and the risk of developing prediabetes and type 2 diabetes over the next 10 years. Results A descriptive analysis of the first cohort of 141 Cible-Santé/prévention participants showed very low attendance. Furthermore, only 1 in 10 of enrolled participants completed the full program. The program typically attracted adults with some risk factors associated with their conditions (high waist circumference, obesity), but with an already high level of knowledge, skills and confidence to participate in self-management activities. Conclusion This study provides a portrait of new participants to a self-management cardiometabolic disease program, which highlights the potential of supporting patients ready to make changes but also exposes the difficulty of attracting a larger number and diversity of participants and in encouraging completion of the program. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10558-6.
Collapse
Affiliation(s)
- Magali Girard
- University of Montreal Hospital Research Centre (CRCHUM), 850, rue St-Denis, Montreal, Canada.
| | - Janusz Kaczorowski
- University of Montreal Hospital Research Centre (CRCHUM), 850, rue St-Denis, Montreal, Canada.,Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada
| | - Marie-Thérèse Lussier
- Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada
| | | |
Collapse
|
8
|
Goodridge D, Bandara T, Marciniuk D, Hutchinson S, Crossman L, Kachur B, Higgins D, Bennett A. Promoting chronic disease management in persons with complex social needs: A qualitative descriptive study. Chron Respir Dis 2020; 16:1479973119832025. [PMID: 30836794 PMCID: PMC6402059 DOI: 10.1177/1479973119832025] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
While there are both ethical and practical imperatives to address health inequity issues related to chronic disease management for persons with social complexity, existing programs often do not appropriately address the needs of these individuals. This leads to low levels of participation in programs, suboptimal chronic disease management, and higher health-care utilization. The aims of this project were to describe the challenges related to availability, accessibility, and acceptability faced by socially complex patients with Chronic Obstructive Pulmonary Disease (COPD) who were eligible, but declined enrollment in a traditional Chronic Disease Management Program (CDMP). Using a qualitative descriptive study approach informed by a health equity lens, interviews with participants, managers, and a focus group with providers were used to gather data addressing the above aims. Qualitative data were analyzed using Braun and Clarke’s theoretical thematic analysis approach. The ability of participants to manage chronic disease was profoundly influenced by contextual and personal factors, such as poverty, disability, personal attitudes and beliefs (including shame, mistrust, and hopelessness), and barriers inherent in the organization of the health-care system. The existing chronic disease management program did not adequately address the most critical needs of socially complex patients. Challenges with accessibility and acceptability of chronic disease management and health services played important roles in the ways these socially complex participants managed their chronic illness. The individualistic approach to self-management of chronic illness inherent in conventional CDMP can be poorly aligned with the needs, capacity, and circumstances of many socially complex patients. Innovative models of care that promote incremental and guided approaches to enhancing health and improving self-efficacy need further development and evaluation.
Collapse
Affiliation(s)
- Donna Goodridge
- 1 College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Thilina Bandara
- 1 College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Darcy Marciniuk
- 1 College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shelly Hutchinson
- 2 Chronic Disease Management Program, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Lois Crossman
- 2 Chronic Disease Management Program, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Brittany Kachur
- 2 Chronic Disease Management Program, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Dana Higgins
- 2 Chronic Disease Management Program, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Andrew Bennett
- 1 College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
9
|
Barmentloo LM, Olij BF, Erasmus V, Smilde D, Schoon Y, Polinder S. Personal preferences of participation in fall prevention programmes: a descriptive study. BMC Geriatr 2020; 20:185. [PMID: 32466747 PMCID: PMC7254764 DOI: 10.1186/s12877-020-01586-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/19/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Participation in fall prevention programmes is associated with lower risk of injurious falls among older adults. However participation rates in fall prevention interventions are low. The limited participation in fall prevention might increase with a preference based approach. Therefore, the aims of this study are to a) determine the personal preferences of older adults regarding fall prevention and b) explore the association between personal preferences and participation. METHODS We assessed the personal preferences of older adults and the association between their preferences, chosen programme and participation level. Nine different programmes, with a focus on those best matching their personal preferences, were offered to participants. Twelve weeks after the start of the programme, participation was assessed by questionnaire. Logistic regression was performed to test the association between preferences and participation and an ANOVA was performed to assess differences between the number of preferences included in the chosen programme and participation level. RESULTS Of the 134 participants, 49% preferred to exercise at home versus 43% elsewhere, 46% preferred to exercise alone versus 44% in a group and 41% indicated a programme must be free of charge while 51% were willing to pay. The combination of an external location, in a group and for a fee was preferred by 27%, whereas 26% preferred at home, alone and only for free. The presence of preferences or the extent to which the programme matched earlier preferences was not associated with participation. CONCLUSION Despite the fact that preferences can vary greatly among older adults, local programmes should be available for at least the two largest subgroups. This includes a programme at home, offered individually and for free. In addition, local healthcare providers should cooperate to increase the accessibility of currently available group programmes.
Collapse
Affiliation(s)
- Lotte M Barmentloo
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Branko F Olij
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - Dini Smilde
- GENERO foundation, Rotterdam, the Netherlands
| | - Yvonne Schoon
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| |
Collapse
|
10
|
Poli A, Kelfve S, Motel-Klingebiel A. A research tool for measuring non-participation of older people in research on digital health. BMC Public Health 2019; 19:1487. [PMID: 31703655 PMCID: PMC6842243 DOI: 10.1186/s12889-019-7830-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/22/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Healthcare services are being increasingly digitalised in European countries. However, in studies evaluating digital health technology, some people are less likely to participate than others, e.g. those who are older, those with a lower level of education and those with poorer digital skills. Such non-participation in research - deriving from the processes of non-recruitment of targeted individuals and self-selection - can be a driver of old-age exclusion from new digital health technologies. We aim to introduce, discuss and test an instrument to measure non-participation in digital health studies, in particular, the process of self-selection. METHODS Based on a review of the relevant literature, we designed an instrument - the NPART survey questionnaire - for the analysis of self-selection, covering five thematic areas: socioeconomic factors, self-rated health and subjective overall quality of life, social participation, time resources, and digital skills and use of technology. The instrument was piloted on 70 older study persons in Sweden, approached during the recruitment process for a trial study. RESULTS Results indicated that participants, as compared to decliners, were on average slightly younger and more educated, and reported better memory, higher social participation, and higher familiarity with and greater use of digital technologies. Overall, the survey questionnaire was able to discriminate between participants and decliners on the key aspects investigated, along the lines of the relevant literature. CONCLUSIONS The NPART survey questionnaire can be applied to characterise non-participation in digital health research, in particular, the process of self-selection. It helps to identify underrepresented groups and their needs. Data generated from such an investigation, combined with hospital registry data on non-recruitment, allows for the implementation of improved sampling strategies, e.g. focused recruitment of underrepresented groups, and for the post hoc adjustment of results generated from biased samples, e.g. weighting procedures.
Collapse
Affiliation(s)
- Arianna Poli
- Division Ageing and Social Change (ASC), Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
| | - Susanne Kelfve
- Division Ageing and Social Change (ASC), Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
- Aging Research Center (ARC), Karolinska Institutet & Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden
| | - Andreas Motel-Klingebiel
- Division Ageing and Social Change (ASC), Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
| |
Collapse
|
11
|
Bixo L, Cunningham JL, Ekselius L, Öster C, Ramklint M. 'Sick and tired': Patients reported reasons for not participating in clinical psychiatric research. Health Expect 2019; 24 Suppl 1:20-29. [PMID: 31605443 PMCID: PMC8137497 DOI: 10.1111/hex.12977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/04/2023] Open
Abstract
Background Meaningful and generalizable research depends on patients' willingness to participate. Studies often fail to reach satisfactory representativeness. Objective This paper aims to investigate reasons for not participating in research among young adult patients with psychiatric illness. Method A quantitative cross‐sectional study was performed based on questionnaires reported on by 51 psychiatric patients (14 males, 35 females and two unspecified) who had previously declined participation in an ongoing research project. Thereafter, a qualitative interview with subsequent content analysis was conducted with ten additional patients (five males, five females). Results The questionnaires indicate being ‘too tired/too sick to participate’ as the most common barrier. Lack of time and fear of needles were other common barriers. Lack of trust or belief in the value of research was less inhibitive. In the interviews, disabling psychiatric symptoms were confirmed as the main reason for not participating. Several potential ways to increase participation were identified, such as simplification of procedures and information as well as providing rewards and feedback, and building relationships before asking. Conclusion This study is unusual as it focuses on the group of young people attending psychiatry outpatient clinics we know very little about – those who do not partake in research. Our results indicate that fatigue and sickness reduce research participation and identify factors that may facilitate enrolment of this important group.
Collapse
Affiliation(s)
- Liv Bixo
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Janet L Cunningham
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Caisa Öster
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| |
Collapse
|
12
|
Vilpunaho T, Kröger H, Honkanen R, Koivumaa-Honkanen H, Sirola J, Kuvaja-Köllner V, Sund R, Rikkonen T. Randomised controlled trial (RCT) study design for a large-scale municipal fall prevention exercise programme in community-living older women: study protocol for the Kuopio Fall Prevention Study (KFPS). BMJ Open 2019; 9:e028716. [PMID: 31230026 PMCID: PMC6596943 DOI: 10.1136/bmjopen-2018-028716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Falls are a substantial health problem in seniors, causing fractures and being the leading cause of fatal injuries. The benefits of physical activity in fall prevention have been shown in randomised controlled trials (RCTs) in small cohorts (eg, ≤200 persons), but there is a gap between the known health effects of exercise and the large-scale implementation of effective activity in communities. Mental health and subjective well-being (SWB) should also be studied since they are strongly related to healthy ageing. Thus far, the proven efficacy of communal strategies to reduce falls and improve healthy ageing is sparse. METHODS AND ANALYSIS In 2016, a 2-year RCT was launched in Kuopio, Finland to estimate the efficacy of a large, population-based, fall prevention exercise programme in community-living older women (born 1932-1945). Both the intervention and control group (n=457+457) receive health education. The intervention group is also offered free 6-month supervised training courses (weekly gym training and Taiji sessions), followed by a free 6-month unsupervised use of exercise facilities, as well as unsupervised low-cost exercise is also offered for another 12 months. During the whole 24-month follow-up, controls are free to pursue all their normal physical activities. Both study groups undergo the study measurements three times. Outcome measures include recording of falls, injuries, bone mineral density, changes in health and functional status and cognitive performance, deaths and SWB. Finally, the cost-effectiveness and cost-utility analysis will be conducted from the societal view. The main analyses comparing outcomes between study groups will be conducted using the intention to treat principle. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Research Ethics Committee of the Hospital District of North Savo. All regulations and measures of ethics and confidentiality are handled in accordance with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT02665169; Pre-results.
Collapse
Affiliation(s)
- Tommi Vilpunaho
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Finland
| | - Risto Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland - Kuopio Campus, Finland
- Department of Psychiatry, Kuopio University Hospital, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Finland
| | - Virpi Kuvaja-Köllner
- Department of Health and Social Management, University of Eastern Finland - Kuopio Campus, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
| |
Collapse
|
13
|
Bongers KTJ, Schoon Y, Olde Rikkert MGM. Self-management tasks to improve mobility and reduce fall risk are not leading to lower research participation in older adults. Arch Gerontol Geriatr 2018; 78:14-17. [PMID: 29883804 DOI: 10.1016/j.archger.2018.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 05/25/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE OF STUDY The first aim is to evaluate, in a sub-study, the recruitment process of the Senior Step Study, which was an intervention study on the self-management of mobility and fall risk; the second aim is to explore the reasons mentioned by older people, from three different settings, for (not) participating. METHODS Subjects were community-dwelling older persons, residents of homes for the elderly, and older persons regularly visiting community centres. The effectiveness of different recruitment procedures was analysed for each setting separately. We also analysed reasons for accepting and declining participation between the settings. RESULTS The total inclusion rate was 27.9%. A personal initial approach (i.e., first contact was face-to-face or in a group meeting) did not improve the inclusion rate. More subjects consented to participate after an introductory meeting (which was planned after the first face-to-face contact) compared to persons not having one (p < 0.01). At different settings, subjects gave different reasons for participation. No differences were found in the reasons for refusing participation. Especially in homes for the elderly, people refused to participate because the research was too burdensome. CONCLUSIONS The inclusion rates in this study are comparable to other self-management studies with older people. An introductory meeting during which the study design and benefits of participating are explained and formal interim evaluations of the recruitment process may benefit recruitment. Recruiting older persons for self-management tasks is possible with the appropriate recruitment process, enabling more research on this increasingly important research topic.
Collapse
Affiliation(s)
- Kim T J Bongers
- Radboud University Medical Center, Department of Geriatric Medicine, Post Office Box 9101, NL, 6500 HB, Nijmegen, The Netherlands
| | - Yvonne Schoon
- Radboud University Medical Center, Department of Geriatric Medicine, Post Office Box 9101, NL, 6500 HB, Nijmegen, The Netherlands.
| | - Marcel G M Olde Rikkert
- Radboud University Medical Center, Department of Geriatric Medicine, Post Office Box 9101, NL, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
14
|
Doyle C, Bhar S, Fearn M, Ames D, Osborne D, You E, Gorelik A, Dunt D. The impact of telephone-delivered cognitive behaviour therapy and befriending on mood disorders in people with chronic obstructive pulmonary disease: A randomized controlled trial. Br J Health Psychol 2017; 22:542-556. [PMID: 28544504 DOI: 10.1111/bjhp.12245] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 04/10/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The main objectives of this pragmatic randomized controlled trial were to investigate the impact of cognitive behaviour therapy (CBT) and an active social control (befriending) on depression and anxiety symptoms in people with chronic obstructive pulmonary disease (COPD). METHODS Eligible participants were randomly allocated to receive eight weekly telephone interventions of CBT (n = 54) or befriending (n = 56). Repeated-measures ANOVA was used to assess changes in scores and Cohen's d was used to assess effect sizes. RESULTS Significant improvement was observed in anxiety symptoms for the befriending group from baseline (T1) to post-intervention assessment (T2) and to 8-week follow-up assessment (T3), with a small to medium effect size (Cohen's d = 0.3). Significant improvement was noted in depression symptoms from T1 to T2 for both groups, but only the CBT group had a significant difference at T3, with a small to medium effect size (Cohen's d = 0.4). For secondary outcomes, there was a significant change in COPD symptoms from T1 to T2 for the befriending group; however, at T3 this change was no longer significant. Finally, there was a significant change in general self-efficacy for both groups between T1 and T2, and T1 and T3. CONCLUSION Cognitive behaviour therapy reduced depression symptoms but not anxiety. Befriending reduced depression symptoms in the short term and anxiety symptoms in both the short term and long term. Further research is needed to demonstrate non-inferiority of telephone delivery compared with other formats, and to understand the impact of befriending which has the potential to be a cost-effective support for people with COPD. Statement of contribution What is already known on this subject? Depression and anxiety are common comorbidities in people with chronic obstructive pulmonary disease. Mood disorders are not commonly routinely treated in people with chronic obstructive pulmonary disease. Telephone-administered CBT has been shown to be as effective as face-to-face CBT in reducing depression and anxiety. What does this study add? Telephone-administered CBT can reduce depression symptoms in people with COPD. Telephone-administered befriending can reduce anxiety and depression symptoms in people with COPD. People with COPD who have mood disorders would prefer to have CBT than befriending.
Collapse
Affiliation(s)
- Colleen Doyle
- National Ageing Research Institute, Melbourne, Victoria, Australia.,Australian Catholic University, Melbourne, Victoria, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Marcia Fearn
- National Ageing Research Institute, Melbourne, Victoria, Australia
| | - David Ames
- National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Debra Osborne
- National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Melbourne, Victoria, Australia
| | - Alex Gorelik
- Melbourne Epicentre, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - David Dunt
- Centre for Health Policy, The University of Melbourne, Victoria, Australia
| |
Collapse
|
15
|
Doyle C, Dunt D, Ames D, Fearn M, You E(C, Bhar S. Study protocol for a randomized controlled trial of telephone-delivered cognitive behavior therapy compared with befriending for treating depression and anxiety in older adults with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:327-34. [PMID: 26929616 PMCID: PMC4760208 DOI: 10.2147/copd.s100859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND COPD is an umbrella term to describe chronic lung diseases that cause limitations in lung airflow, including emphysema and chronic bronchitis. The prevalence of depression and anxiety in people with COPD is high, although these comorbidities are often undiagnosed, untreated, or undertreated. There is a need to identify efficacious treatments for depression and anxiety in people with COPD. Cognitive behavior therapy (CBT) for the treatment of anxiety and depression has a strong evidence base. There has been some success delivering this treatment over the telephone in limited studies. The aim of this study is to evaluate the efficacy of both telephone-administered CBT and befriending on outcomes for patients with diagnosed COPD who have at least mild levels of depression and/or anxiety. METHODS The protocol described in this paper is of a pragmatic randomized controlled trial comparing eight sessions of telephone CBT to an active social control, referred to as befriending. Primary outcome measures will include depression and anxiety symptoms, and secondary outcome measures will include quality of life, self-efficacy, and COPD symptom severity. Participants' satisfaction with the intervention and therapeutic alliance will also be assessed. Measures will be taken pre- and postdelivery of the intervention and again at 8 weeks following the intervention. CONCLUSION People with COPD often have limitations to their mobility because of their breathlessness. They are often already attending many medical appointments and could be reluctant to attend for face-to-face psychological treatment. The results of this study should identify the relative efficacy of CBT delivered over the telephone to this population, which, if successful, may be a cost-effective and more palatable alternative to face-to-face treatment of depression or anxiety for this population.
Collapse
Affiliation(s)
- Colleen Doyle
- Australian Catholic University, Melbourne, VIC, Australia
| | - David Dunt
- Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - David Ames
- National Ageing Research Institute, Melbourne, VIC, Australia
| | - Marcia Fearn
- National Ageing Research Institute, Melbourne, VIC, Australia
| | | | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
16
|
Home telehealth uptake and continued use among heart failure and chronic obstructive pulmonary disease patients: a systematic review. Ann Behav Med 2015; 48:323-36. [PMID: 24763972 PMCID: PMC4223578 DOI: 10.1007/s12160-014-9607-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved. Purpose The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth. Methods This research performs a narrative synthesis of the results from included studies. Results Thirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or withdrawal found that almost one third of patients who were offered telehealth refused and one fifth of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of, home telehealth use were identified. Conclusions Research reports need to provide more details regarding telehealth refusal and abandonment, in order to understand the reasons why patients decide not to use telehealth. Electronic supplementary material The online version of this article (doi:10.1007/s12160-014-9607-x) contains supplementary material, which is available to authorized users.
Collapse
|
17
|
Sheffet AJ, Voeks JH, Mackey A, Brooks W, Clark WM, Hill MD, Howard VJ, Hughes SE, Tom M, Longbottom ME, Brott TG. Characteristics of participants consenting versus declining follow-up for up to 10 years in a randomized clinical trial. Clin Trials 2015; 12:657-63. [PMID: 26122922 DOI: 10.1177/1740774515590807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND With patients living a decade or longer post-procedure, long-term data are needed to assess the durability of carotid artery stenting versus carotid endarterectomy. Identifying characteristics of those consenting or declining to continue in long-term follow-up may suggest strategies to improve retention in clinical trials. PURPOSE This report describes differences between patients choosing or declining to continue follow-up for up to 10 years in the Carotid Revascularization Endarterectomy versus Stenting Trial. METHODS Following completion of the primary outcome, patients who were in active Carotid Revascularization Endarterectomy versus Stenting Trial follow-up were asked to continue beyond their original 4-year commitment for a maximum of 10 years. The characteristics of those who consented were compared with those who declined. Univariate and multivariable logistic regression were used for analysis, and backwards stepwise logistic regression (the most parsimonious model) was used to determine the factors associated with continuation. RESULTS Of the 1921 active Carotid Revascularization Endarterectomy versus Stenting Trial participants for whom consent to extend follow-up was requested, 1695 (88%; mean age: 68.4) consented; 226 (12%; mean age: 69.6) declined. Of those who did not consent versus those who consented, 66% versus 48% were symptomatic at baseline (p<0.0001), at follow-up 28% versus 20% were smokers (p=0.009), 85% versus 90% were hypertensive (p=0.01), and 84% versus 94% were dyslipidemic (p<0.0001). Additional factors that differed between those who did not consent and those who consented included the mean number of years in the study at time of consent (4.8 years vs 3.7 years (p=<0.0001)) and patients from sites that enrolled <30 patients compared to sites randomizing 30 or more (70% vs 52% (p<0.0001)). Multivariable logistic regression indicated that those with lesser odds of consenting to the extended follow-up were older (odds ratio: 0.80; 95% confidence interval: 0.67, 0.96), more likely to be symptomatic (odds ratio: 0.58; 95% confidence interval: 0.42, 0.80), smokers (odds ratio: 0.48; 95% confidence interval: 0.34, 0.70), were in the study 5+ years versus <3 (odds ratio: 0.21; 95% confidence interval: 0.13, 0.34), and at a site that randomized <30 patients (odds ratio: 0.46; 95% confidence interval: 0.33, 0.63), while patients with dyslipidemia at follow-up had increased odds of consenting (odds ratio: 2.28 (1.47, 3.54)). CONCLUSION Symptomatic status, increasing age, randomized at lower volume centers, and longer time in follow-up were associated with reduced odds of consenting to long-term follow-up. Identifying factors associated with reduced willingness to extend participation long-term can suggest targeted strategies to improve retention in future clinical trials.
Collapse
Affiliation(s)
- Alice J Sheffet
- Department of Surgery, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Jenifer H Voeks
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Ariane Mackey
- Department of Neurology, CHU de Québec-Hôpital de l'Enfant Jésus, Québec City, QC, Canada
| | | | - Wayne M Clark
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Michael D Hill
- Department of Neurology, University of Calgary, Calgary, AB, Canada
| | - Virginia J Howard
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan E Hughes
- Department of Surgery, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - MeeLee Tom
- Department of Surgery, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | | | - Thomas G Brott
- Department of Surgery, Rutgers, The State University of New Jersey, Newark, NJ, USA Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | |
Collapse
|
18
|
Petter J, Reitsma-van Rooijen MM, Korevaar JC, Nielen MMJ. Willingness to participate in prevention programs for cardiometabolic diseases. BMC Public Health 2015; 15:44. [PMID: 25637105 PMCID: PMC4323020 DOI: 10.1186/s12889-015-1379-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 01/08/2015] [Indexed: 11/13/2022] Open
Abstract
Background Cardiometabolic diseases are the leading cause of death worldwide and result in decreased quality of life for patients and increased healthcare costs. Population-based prevention programs may prevent the onset and development of cardiometabolic diseases. The effectiveness of these programs depends on participation rates. This study identified factors related to willingness to participate in health checks and lifestyle intervention programs to prevent cardiometabolic diseases. Methods A questionnaire was sent to 1,500 Dutch adults, participating in the Dutch Health Care Consumer Panel of NIVEL. The questionnaire was developed by NIVEL. Predictors of willingness to participate were identified with logistic regression analyses. Predictors investigated were socio-demographic variables, risk factors for cardiometabolic diseases and motivational aspects. Results The response rate was 63%. 56% of the participants in our study were willing to participate in a health check. Higher age was associated with increased willingness to participate, as was the desire to know the actual risk for cardiometabolic diseases (OR = 4.6). Becoming unnecessarily worried was identified as a barrier (OR = 0.3). 47% were willing to participate in a lifestyle intervention program. People aged 39–65 were most willing to participate. Attention for prevention relapse behavior (OR = 3.3), informing the general practitioner about results (OR = 2.6) and conducting the program in a group (OR = 2.0) were positively associated with willingness to participate in lifestyle interventions. Conclusions Willingness to participate in a health check depended on personal beliefs, whereas social aspects contributed most to willingness to participate in a lifestyle intervention program. This information can be used to optimize and tailor the promotion of prevention programs.
Collapse
Affiliation(s)
- Jessica Petter
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
| | | | - Joke C Korevaar
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Markus M J Nielen
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
| |
Collapse
|
19
|
Michelet M, Lund A, Sveen U. Strategies to recruit and retain older adults in intervention studies: a quantitative comparative study. Arch Gerontol Geriatr 2014; 59:25-31. [PMID: 24698174 DOI: 10.1016/j.archger.2014.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/03/2014] [Accepted: 03/07/2014] [Indexed: 11/15/2022]
Abstract
Recruitment and retention of participants in randomized controlled trials (RCTs) drawn from the older population is challenging, and studies have shown that poor recruitment and retention may lead to biased samples and results. Several strategies to improve the participation of older adults in research are outlined in the literature. The objective was to identify factors associated with participation in an RCT aiming at preventing depressive symptoms and social isolation in a later phase following a stroke, in an older population living in their homes. Strategies to improve participation were applied in the RCT "Lifestyle intervention for older adults in rehabilitation after stroke: development, implementation and evaluation". Quantitative data collected on participants (n=99) and non-participants (n=56) in the trial were compared using statistical analyses. The findings are in line with earlier studies in that the participants were younger (p=0.01) and received less help in the home (p=0.01) than did non-participants. The results differ from earlier studies in that participants had a higher rate of depressive symptoms (participation rate was 57% with HAD depression scale score 0-2, 61% with score 3-4, 62% with score 5-6 and 79% with a score 7 or above). The findings also illustrate a poorer health-related quality of life among the participants in the role physical domain on Short Form-36 (p=0.01). The results indicate that the use of targeted strategies to enhance participation may lead to a less biased sample as well as the inclusion of more subjects who seem to meet the aims of the intervention.
Collapse
Affiliation(s)
- Mona Michelet
- Norwegian Centre for Ageing and Health, Vestfold Mental Health Trust, pb. 2136, 3103 Tønsberg, Norway.
| | - Anne Lund
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo, Postboks 4, St. Olavs plass, 0130 Oslo, Norway; Oslo University Hospital, Geriatric Medicine, Pb 4956, Nydalen, 0424 Oslo, Norway
| | - Unni Sveen
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo, Postboks 4, St. Olavs plass, 0130 Oslo, Norway; Oslo University Hospital, Geriatric Medicine, Pb 4956, Nydalen, 0424 Oslo, Norway
| |
Collapse
|
20
|
Dattalo M, Giovannetti ER, Scharfstein D, Boult C, Wegener S, Wolff JL, Leff B, Frick KD, Reider L, Frey K, Noronha G, Boyd C. Who participates in chronic disease self-management (CDSM) programs? Differences between participants and nonparticipants in a population of multimorbid older adults. Med Care 2012; 50:1071-5. [PMID: 22892650 PMCID: PMC3494793 DOI: 10.1097/mlr.0b013e318268abe7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Self-care management is recognized as a key component of care for multimorbid older adults; however, the characteristics of those most likely to participate in Chronic Disease Self-Management (CDSM) programs and strategies to maximize participation in such programs are unknown. OBJECTIVES To identify individual factors associated with attending CDSM programs in a sample of multimorbid older adults. RESEARCH DESIGN Participants in the intervention arm of a matched-pair cluster-randomized controlled trial of the Guided Care model were invited to attend a 6-session CDSM course. Logistic regression was used to identify factors independently associated with attendance. SUBJECTS All subjects (N = 241) were aged 65 years or older, were at high risk for health care utilization, and were not homebound. MEASURES Baseline information on demographics, health status, health activities, and quality of care was available for CDSM participants and nonparticipants. Participation was defined as attendance at 5 or more CDSM sessions. RESULTS A total of 22.8% of multimorbid older adults who were invited to CDSM courses participated in 5 or more sessions. Having better physical health (odds ratio [95% confidence interval] = 2.3 [1.1-4.8]) and rating one's physician poorly on support for patient activation (odds ratio [95% confidence interval] = 2.8 [1.3-6.0]) were independently associated with attendance. CONCLUSIONS Multimorbid older adults who are in better physical health and who are dissatisfied with their physicians' support for patient activation are more likely to participate in CDSM courses.
Collapse
Affiliation(s)
- Melissa Dattalo
- Johns Hopkins Bayview Internal Medicine Residency Program, 4940 Eastern Avenue, Baltimore, MD 21224, P: 630-921-1715, F: 410-550-0491
| | - Erin R. Giovannetti
- 5200 Eastern Ave, Mason F. Lord Building, 7 Floor, Center Tower, Baltimore, MD 21224 P: 410-274-8824, F: 410-550-8701
| | - Daniel Scharfstein
- 615 N. Wolfe Street, E3547, Baltimore, MD 21117, P: 410-955-2420, F: 410-955-0958
| | - Chad Boult
- 624 N. Broadway, Hampton House Room 693, Baltimore, MD 21205, P: 410-955-6546, F: 410-955-0470
| | - Stephen Wegener
- 600 N. Wolfe Street, Phipps 174, Baltimore, MD 21297, P: 410-502-2438, F: 410-502-2419
| | - Jennifer L. Wolff
- 624 N. Broadway, Hampton House, Room 692, Baltimore, MD 21205, P: 410-502-0458, F: 410-955-0470
| | - Bruce Leff
- 5505 Hopkins Bayview Circle, Beacham Center, Baltimore, MD 21224, P: 410-550-2652, F: 410-550-8701
| | - Kevin D. Frick
- 624 N. Broadway, Hampton House, Room 606, Baltimore, MD 21205, P: 410-614-4018, F: 410-955-0470
| | - Lisa Reider
- 624 N. Broadway, Hampton House Room 355, Baltimore, MD 21205, P: 410-502-3962, F: 410-955-0470
| | - Katherine Frey
- 624 N. Broadway, Hampton House Room 350, Baltimore, MD 21205, P: 410-502-9109, F: 410-955-0470
| | - Gary Noronha
- 3100 Wyman Park Dr, Baltimore, MD 21211, P: 410-338-3421, F: 410-338-3498
| | - Cynthia Boyd
- 5200 Eastern Ave, Mason F. Lord Building, 7 Floor, Center Tower, Baltimore, MD 21224, P: 410-550-8676, F: 410-550-8701
| |
Collapse
|
21
|
Barreto PDS. Participation bias in postal surveys among older adults: the role played by self-reported health, physical functional decline and frailty. Arch Gerontol Geriatr 2012; 55:592-8. [PMID: 22534027 DOI: 10.1016/j.archger.2012.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 03/25/2012] [Accepted: 03/29/2012] [Indexed: 11/28/2022]
Abstract
Postal survey is a simple and efficient way to collect information in large study samples. The purpose of this study was to find out differences between older adults who responded to a postal survey on health outcomes and those who did not, and to examine the importance of frailty, physical functional decline and poor self-reported health in determining non-response. We mailed out a questionnaire on general health twice at a year's interval to 1000 individuals ≥60 years, and members of the medical insurance scheme of the French national education system. At Year1, 535 persons responded to the questionnaire (65% women, 70.9 ± 8.4 years). A year later (Year2), we obtained 384 responses (63.3% women, 70.5 ± 7.8 years). Compared to respondents, non-respondents at Year2 were more frequently categorized as frail, reported more often to be in bad health, and had more physical functional declines. Frailty, physical functional decline and poor self-reported health increased the likelihood of not responding to Year2 questionnaire, with poor self-reported health weakening the association of physical functional decline and non-response. Respondents of this postal survey are fitter and healthier than non-respondents. This participation bias precludes the generalization of postal surveys results.
Collapse
|
22
|
Elskamp ABM, Hartholt KA, Patka P, van Beeck EF, van der Cammen TJM. Why older people refuse to participate in falls prevention trials: a qualitative study. Exp Gerontol 2012; 47:342-5. [PMID: 22310657 DOI: 10.1016/j.exger.2012.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/09/2012] [Accepted: 01/20/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVES Falls are a major public health problem. Older persons are frequently underrepresented in trials, including falls prevention trials. Insight into possible reasons for non-participation could help to improve trial designs and participation rates among this age-group. The aim of this study was to explore reasons why older people refuse to participate in falls prevention trials. SETTING A qualitative study. PARTICIPANTS Community-dwelling adults aged ≥65 years who attended the Emergency Department due to a fall and refused to participate in a falls prevention trial (IMPROveFALL-study). MEASUREMENTS A structured interview guide was used, and interview transcripts were subjected to an independent content analysis by two researchers. RESULTS 15 interviews were conducted. A main reason to refuse trial participation was mobility impairment. In contrast, younger and more "active" and mobile seniors considered themselves "too healthy" to participate. Persons with multiple comorbidities mentioned that they attended a hospital too often, or experienced adequate follow-up by their own physicians already. Transport problems, including distance to the hospital, parking facilities, and travel expenses were another issue. During the interviews it was emphasized by the patients, that they knew the reason for their fall. However, they were not familiar with the positive effects of falls prevention programmes. CONCLUSIONS Older persons reported multiple reasons to refuse participation in a falls prevention study, such as health-related factors, several practical problems, and personal beliefs about the causes and preventability of falls. Anticipation of those issues might contribute to an improvement in participation rates of older fallers, shorter study duration, and a better generalizability of research findings.
Collapse
Affiliation(s)
- Annemijn B M Elskamp
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | | | | |
Collapse
|
23
|
McGue M, Osler M, Christensen K. Causal Inference and Observational Research: The Utility of Twins. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2010; 5:546-56. [PMID: 21593989 PMCID: PMC3094752 DOI: 10.1177/1745691610383511] [Citation(s) in RCA: 348] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Valid causal inference is central to progress in theoretical and applied psychology. Although the randomized experiment is widely considered the gold standard for determining whether a given exposure increases the likelihood of some specified outcome, experiments are not always feasible and in some cases can result in biased estimates of causal effects. Alternatively, standard observational approaches are limited by the possibility of confounding, reverse causation, and the nonrandom distribution of exposure (i.e., selection). We describe the counterfactual model of causation and apply it to the challenges of causal inference in observational research, with a particular focus on aging. We argue that the study of twin pairs discordant on exposure, and in particular discordant monozygotic twins, provides a useful analog to the idealized counterfactual design. A review of discordant-twin studies in aging reveals that they are consistent with, but do not unambiguously establish, a causal effect of lifestyle factors on important late-life outcomes. Nonetheless, the existing studies are few in number and have clear limitations that have not always been considered in interpreting their results. It is concluded that twin researchers could make greater use of the discordant-twin design as one approach to strengthen causal inferences in observational research.
Collapse
Affiliation(s)
- Matt McGue
- Department of Psychology, University of Minnesota, Minneapolis Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Merete Osler
- Institute of Public Health, University of Southern Denmark, Odense, Denmark Research Center for Prevention and Health, Glostrup Hospital, Glostrup, Denmark
| | - Kaare Christensen
- The Danish Twin Registry and The Danish Aging Research Center Institute of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
24
|
Groeneveld IF, Proper KI, van der Beek AJ, Hildebrandt VH, van Mechelen W. Factors associated with non-participation and drop-out in a lifestyle intervention for workers with an elevated risk of cardiovascular disease. Int J Behav Nutr Phys Act 2009; 6:80. [PMID: 19951417 PMCID: PMC3224927 DOI: 10.1186/1479-5868-6-80] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 12/01/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-response and drop-out are problems that are commonly encountered in health promotion trials. Understanding the health-related characteristics of non-participants and drop-outs and the reasons for non-participation and drop-out may be beneficial for future intervention trials. METHODS Male construction workers with an elevated risk of cardiovascular disease (CVD) were invited to participate in a lifestyle intervention study. In order to investigate the associations between participation and CVD risk factors, and drop-out and CVD risk factors, crude and multiple logistic regression analyses were performed. The reasons for non-participation and drop-out were assessed qualitatively. RESULTS 20% of the workers who were invited decided to participate; 8.6% of the participants dropped out before the first follow-up measurement. The main reasons for non-participation were 'no interest', 'current (para-)medical treatment', and 'feeling healthy', and for drop-out they were 'lack of motivation', 'current (para-)medical treatment', and 'disappointment'. Participants were 4.2 years older, had a higher blood pressure, higher total cholesterol, and lower HDL cholesterol than non-participants, and were more likely to report 'tiredness and/or stress' and 'chest pain and/or shortness of breath'. After adjusting for age, most risk factors were not significantly associated with participation. Drop-outs were 4.6 years younger than those who completed the study. The prevalence of smoking was higher among non-participants and drop-outs. CONCLUSION Participants had a worse CVD risk profile than non-participants, mainly because of the difference in age. Non-participants and drop-outs were younger and more likely to be smokers. The main reasons for non-participation and drop-out were health-related. Investigators in the field of health promotion should be encouraged to share comparable information. TRIAL REGISTRATION Current Controlled Trials ISRCTN60545588.
Collapse
Affiliation(s)
- Iris F Groeneveld
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
25
|
Elzen H, Slaets JPJ, Snijders TAB, Steverink N. Evaluation of the chronic disease self-management program (CDSMP) among chronically ill older people in the Netherlands. Soc Sci Med 2007; 64:1832-41. [PMID: 17355901 DOI: 10.1016/j.socscimed.2007.02.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Indexed: 10/23/2022]
Abstract
Many chronically ill older patients in the Netherlands have a combination of more than one chronic disease. There is therefore a need for self-management programs that address general management problems, rather than the problems related to a specific disease. The Chronic Disease Self-Management Program (CDSMP) seems to be very suitable for this purpose. In evaluations of the program that have been carried out in the United States and China, positive effects were found on self-management behaviour and health status. However, the program has not yet been evaluated in the Netherlands. Therefore, the aim of this study was to evaluate the short-term and longer-term effects of the program among chronically ill older people in the Netherlands. One hundred and thirty-nine people aged 59 or older, with a lung disease, a heart disease, diabetes, or arthritis were randomly assigned to an intervention group (CDSMP) or a control group (care-as-usual). Demographic data and data on self-efficacy, self-management behaviour and health status were collected at three measurement moments (baseline, after 6 weeks, and after 6 months). The patients who participated rated the program with a mean of 8.5 points (range 0-10), and only one dropped out. However, our study did not yield any evidence for the effectiveness of the CDSMP on self-efficacy, self-management behaviour or health status of older patients in the Netherlands. Because the patients who participated were very enthusiastic, which was also indicated by very high mean attendance (5.6 out of 6 sessions) and only one dropout, it seems too early to conclude that the program is not beneficial for these patients.
Collapse
Affiliation(s)
- Henrike Elzen
- University Medical Center Groningen, Groningen, The Netherlands.
| | | | | | | |
Collapse
|