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Sørensen JB, Lee KSK, Dawson A, Dawson A, Senarathna L, Pushpakumara PHGJ, Rajapakse T, Konradsen F, Glozier N, Conigrave KM, Siriwardhana P, Hansen D, Buhl A, Priyadhasana C, Senawirathna K, Herath M, Mantillake S, Fonseka P, Pearson M. Evaluating the programme and behavior change theories of a community alcohol education intervention in rural Sri Lanka: a study protocol. Glob Health Action 2023; 16:2273625. [PMID: 37971492 PMCID: PMC10795635 DOI: 10.1080/16549716.2023.2273625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
Risky alcohol use is a major public health problem globally and in Sri Lanka. While a reduction in alcohol consumption can result in physical, mental, and social benefits, behaviour change is difficult to achieve. Effective, context-adapted interventions are required to minimise alcohol-related harm at a community level. THEATRE is a complex, community-based intervention evaluating whether a promising Sri Lankan pilot study that utilised arts-based research to moderate alcohol use can be scaled up. While the scaled-up pilot study protocol is presented elsewhere, the aim of this protocol paper is to describe the intervention programme theory and evaluation design, and modifications made to the study resulting from COVID-19 and the financial crisis. Drawing on the Behaviour Change Wheel (BCW) and Theoretical Domains Framework, behaviour change theories are presented with potential pathways to guide implementation and evaluation. Alcohol consumption patterns and context of drinking is detailed. The multifaceted intervention targets individuals and communities using arts-based interventions. Four of nine BCW functions are employed in the design of the intervention: education, persuasion, modelling and enablement, and training. Modifications made to the study due to COVID-19 and the financial crisis are described. Ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2018/21-July 2018 and Feb 2022) and the University of Sydney (2019/006). Findings will be disseminated locally to community members and key stakeholders and via international peer-reviewed publications.
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Affiliation(s)
| | - K. S. Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Royal Price Alfred Hospital, Camperdown, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Andrew Dawson
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Royal Price Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Angela Dawson
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Lalith Senarathna
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - P. H. G. Janaka Pushpakumara
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Family Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Thilini Rajapakse
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, University of Peradeniya, Peradeniya, Sri Lanka
| | - Flemming Konradsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| | - Katherine M. Conigrave
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Royal Price Alfred Hospital, Camperdown, NSW, Australia
- Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, Camperdown, NSW, Australia
| | - Prabash Siriwardhana
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Sociology, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | | | - Alexandra Buhl
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Chamill Priyadhasana
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kamal Senawirathna
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Malith Herath
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | - Melissa Pearson
- Faculty of Medicine, South Asian Clinical Toxicology Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Central Clinical School, University of Sydney, Sydney, Australia
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Xiang X, Han M, Luo X, Yu Y, Lu X, Cai S, Huang L. Development of a behavior change intervention to improve physical activity in patients with COPD using the behavior change wheel: a non-randomized trial. Sci Rep 2023; 13:22929. [PMID: 38129630 PMCID: PMC10739839 DOI: 10.1038/s41598-023-50099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of this study was to evaluate whether a theory-based behavior change intervention could promote changes in physical activity (PA) and sedentary behavior (SB) among patients with chronic obstructive pulmonary disease (COPD), as well as its effects on symptoms of dyspnea, lung function, exercise capacity, self-efficacy, and health-related quality of life (HRQoL). A quasi-experimental design and convenience sampling were adopted. A total of 92 patients with stable COPD were recruited from outpatient and inpatient centers of two hospitals in Zhejiang Province, China. Both the experimental and control groups received standard medical care provided in the hospital. The experimental group performed a PA program based on the behavior change wheel theory. Outcomes were measured at baseline (T0) and after 4 weeks (T1), 8 weeks (T2), and 12 weeks of the intervention (T3). The primary outcome was PA measured by the International Physical Activity Questionnaire (IPAQ). Secondary outcomes included SB measured by the IPAQ, dyspnea measured by the modified Medical Research Council (mMRC) questionnaire, exercise capacity assessed by 6-min walk distance (6MWD), self-efficacy measured by the Exercise Self-Regulatory Efficacy Scale (EX-SRES), and HRQoL measured by the COPD Assessment Test (CAT). In addition, we measured lung function using a spirometer at baseline and 12 weeks. Of the 89 patients included in this study, 64 were male (71.91%), with a mean age of 67.03 ± 6.15 years. At 12 weeks, the improvements in PA, SB, mMRC, 6MWD, EX-SRES and CAT were all statistically significant (P < 0.05) in the experimental group compared to the control group. Repeated measures analysis of variance showed that there were group effects and time effects on total PA, SB, mMRC, 6MWD, EX-SRES, and CAT in both groups (P < 0.001). However, there was no significant difference in pulmonary function between the two groups before and after intervention (P < 0.05). The PA program based on theory significantly increased PA levels, reduced sedentary time, enhanced exercise capacity and self-efficacy as well as HRQoL in patients with stable COPD. Due to the limited intervention time in this study, the pulmonary function of COPD patients may not be reversed in a short time, and the long-term effect of this program on the pulmonary function of patients needs to be further explored.Trial registration: Clinical Trials.gov (ChiCTR2200060590). Registered 05/06/2022.
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Affiliation(s)
- Xinyue Xiang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Maomao Han
- Department of Nursing, Haining People's Hospital, Haining, Zhejiang Province, China
| | - Xiaolin Luo
- Zhejiang Evaluation Center for Medical Service and Administration, Hangzhou, Zhejiang Province, China
| | - Yudi Yu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiaorong Lu
- Department of Nursing, Haining People's Hospital, Haining, Zhejiang Province, China
| | - Shasha Cai
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lihua Huang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
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Rosário F, Vasiljevic M, Pas L, Angus C, Ribeiro C, Fitzgerald N. Efficacy of a theory-driven program to implement alcohol screening and brief interventions in primary health-care: a cluster randomized controlled trial. Addiction 2022; 117:1609-1621. [PMID: 34935229 DOI: 10.1111/add.15782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Screening and brief interventions (SBI) in primary health-care practices (PHCP) are effective in reducing reported alcohol consumption, but have not been routinely implemented. Most programs seeking to improve implementation rates have lacked a theoretical rationale. This study aimed to test whether a theory-based intervention for PHCPs could significantly increase alcohol SBI delivery. DESIGN Two-arm, cluster-randomized controlled, parallel, 12-month follow-up, trial. SETTING PHCPs in Portugal. PARTICIPANTS Staff from 12 PHCPs (n = 222, 81.1% women): nurses (35.6%), general practitioners (28.8%), receptionists (26.1%) and family medicine residents (9.5%); patients screened for alcohol use: intervention n = 8062; controls n = 58. INTERVENTION AND COMPARATOR PHCPs were randomized to receive a training and support program (n = 6; 110 participants) tailored to the barriers and facilitators for implementing alcohol SBIs following the principles of the Behavior Change Wheel/Theoretical Domains Framework approach, or to a waiting-list control (n = 6; 112 participants). Training was delivered over the first 12 weeks of the trial. MEASUREMENTS The primary outcome was the proportion of eligible patients screened (unit of analysis: patient list). Secondary outcomes included the brief intervention (BI) rate per screen-positive patient and the population-based BI rate (unit of analysis: patient list), and changes in health providers' perceptions of barriers to implementation and alcohol-related knowledge (unit of analysis: health provider). FINDINGS The implementation program had a significant effect on the screening activity in the intervention practices compared with control practices at the 12-month follow-up (21.7% vs. 0.16%, intention-to-treat analysis, p = 0.003). Although no significant difference was found on the BI rate per screen-positive patient (intervention 85.7% vs. control 63.6%, p = 0.55, Bayes factor = 0.28), the intervention was effective in increasing the population-based BI rate (intervention 0.69% vs. control 0.02%, p = 0.006). Health providers in the intervention arm reported fewer barriers to SBI implementation and higher levels of alcohol-related knowledge at 12-month follow-up than those in control practices. CONCLUSION A theory-based implementation program, which included training and support activities, significantly increased alcohol screening and population-based brief intervention rates in primary care.
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Affiliation(s)
- Frederico Rosário
- Instituto de Medicina Preventiva e Saúde Pública, Faculty of Medicine, Lisbon University, Lisbon, Portugal.,Agrupamento de Centros de Saúde Dão Lafões, Viseu, Portugal
| | - Milica Vasiljevic
- Department of Psychology, Durham University, Durham, UK.,Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Leo Pas
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Colin Angus
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Cristina Ribeiro
- Instituto de Medicina Preventiva e Saúde Pública, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Niamh Fitzgerald
- Institute for Social Marketing & Health (ISMH), Faculty of Health Sciences & Sport, University of Stirling, Stirling, Scotland, UK
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Zhu X, Lee MK, Weiser E, Griffin JM, Limburg PJ, Finney Rutten LJ. Initial validation of a self-report questionnaire based on the Theoretical Domains Framework: determinants of clinician adoption of a novel colorectal cancer screening strategy. Implement Sci Commun 2021; 2:119. [PMID: 34666841 PMCID: PMC8527805 DOI: 10.1186/s43058-021-00221-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening for average risk adults age 45 and older continues to be underutilized in the USA. One factor consistently associated with CRC screening completion is clinician recommendation. Understanding the barriers and facilitators of clinical adoption of emerging CRC screening strategies is important in developing effective intervention strategies to improve CRC screening rates. We aimed to develop a questionnaire based on the Theoretical Domains Framework (TDF) to assess determinants of clinical adoption of novel CRC screening strategies, using the multi-target stool DNA test (mt-sDNA; Cologuard®) as an example, and test the psychometric properties of this questionnaire on a sample of US clinicians. METHODS A web survey was administered between November and December 2019 to a national panel of clinicians including primary care clinicians (PCCs) and gastroenterologists (GIs) to assess 10 TDF constructs with 55 items. Confirmatory factor analysis (CFA) was used to examine whether the a priori domain structure was supported by the data. Discriminant validity of domains was tested with Heterotrait-Monotrait ratio (HTMT). Internal consistency for each scale was assessed using Cronbach's alpha. Criterion validity was assessed with self-reported mt-sDNA use and mt-sDNA recommendation as the outcomes. RESULTS Complete surveys were received from 814 PCCs and 159 GIs (completion rate, 24.7% of 3299 PCCs and 29.6% of 538 GIs). Providers were excluded from analysis if they indicated not recommending CRC screening to average-risk patients (final N = 973). The final questionnaire consisted of 38 items covering 5 domains: (1) knowledge; (2) skills; (3) identity and social influence; (4) optimism, beliefs about consequences, and intentions; and (5) environmental context and resources. CFA results confirmed a reasonable fit (CFI = 0.948, SRMR = 0.057, RMSEA = 0.080). The domains showed sufficient discriminant validity (HTMT < 0.85), good internal consistency (McDonald's omega > 0.76), and successfully differentiated providers who reported they had ordered mt-sDNA from those who never ordered mt-sDNA and differentiated providers who reported routinely recommending mt-sDNA from those who reported not recommending mt-sDNA. CONCLUSIONS Findings provide initial evidence for the validity and internal consistency of this TDF-based questionnaire in measuring potential determinants of mt-sDNA adoption for average-risk CRC screening. Further investigation of validity and reliability is needed when adapting this questionnaire to other novel CRC screening strategy contexts.
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Affiliation(s)
- Xuan Zhu
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
| | - Minji K Lee
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | | | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Paul J Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Rosário F, Vasiljevic M, Pas L, Fitzgerald N, Ribeiro C. Implementing alcohol screening and brief interventions in primary health care: study protocol for a pilot cluster randomized controlled trial. Fam Pract 2019; 36:199-205. [PMID: 29939239 DOI: 10.1093/fampra/cmy062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol is one of the most important risk factors contributing to the global burden of disease. Screening and brief interventions in primary care settings are effective in reducing alcohol consumption. However, implementation of such interventions in routine practice has been proven difficult. Most programmes in practice and research have lacked a theoretical rationale for how they would change practitioner behaviour. OBJECTIVE To determine whether a theory-based behaviour change intervention delivered to primary care practices significantly increases delivery of alcohol screening. METHODS We will conduct a two-arm, cluster-randomized controlled, parallel, open trial. Twelve primary care practices will be randomized to one of two groups: training and support; and waiting-list control. Family physicians, nurses and receptionists will be eligible to participate. The intervention will be a training and support programme. The intervention will be tailored to the barriers and facilitators for implementing alcohol screening and brief interventions following the principles of the Behaviour Change Wheel approach. The primary outcome will be the proportion of patients screened with the Alcohol Use Disorders Identification Test. CONCLUSION This study will test whether a theory-driven implementation programme increases alcohol screening rates in primary care. Results from this trial will provide a useful addition to existing evidence by informing implementation researchers what areas of behaviour change are critical to increasing alcohol screening rates. TRIAL REGISTRATION clinicaltrials.gov NCT02968186.
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Affiliation(s)
- Frederico Rosário
- Tomaz Ribeiro Primary Health Care Center, Dão Lafões Primary Health Care Centers Grouping, Viseu, Portugal.,Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Milica Vasiljevic
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Leo Pas
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Cristina Ribeiro
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Division of Quality Management, Directorate-General of Health, Lisbon, Portugal
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