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Sheridan SL. From guidelines to decision aids and adherence supports: Insights from the process of evidence translation. PATIENT EDUCATION AND COUNSELING 2023; 113:107806. [PMID: 37229931 DOI: 10.1016/j.pec.2023.107806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To explore the evidence-translator's experience of the expert-recommended process of translating guidelines into tools for decision making, action, and adherence with the goal of improvement. METHODS A single reviewer dual reviewed the content, quality, certainty, and applicability of primary atherosclerotic cardiovascular prevention guidelines from the U.S. Preventive Services Task Force at the time of this work and used targeted searches of Medline to define the ideal structure and outcomes of tools; fill in gaps in guidelines; identify end-user needs; and choose and optimize existing tools in preparation for testing. RESULTS Guidelines addressed screening, treatments, and/or supports, but never the combination of all three. None provided all of the information needed for evidence translation. Searches in Medline filled in some evidence gaps and provided key insights into end-user needs and effective tools. However, evidence translators are left with complicated decisions about how to use and align evidence. CONCLUSION Guidelines provide some, but not all, of the evidence needed for evidence translation, requiring additional intensive work. Evidence gaps result in complicated decisions about how to use and align evidence and balance feasibility and rigor. PRACTICE IMPLICATIONS Guidelines, standards groups, and researchers should work to better support the process of evidence translation.
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Benedetti DJ, Hammack-Aviran CM, Diehl C, Beskow LM. Landscape of pediatric cancer treatment refusal and abandonment in the US: A qualitative study. Front Pediatr 2023; 10:1049661. [PMID: 36699305 PMCID: PMC9869139 DOI: 10.3389/fped.2022.1049661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To describe United States (US) pediatric oncologists' experiences with treatment refusal or abandonment, exploring types and frequency of decision-making conflicts, and their impact. Study design We conducted exploratory qualitative interviews of pediatric oncologists (n = 30) with experience caring for a pediatric patient who refused or abandoned curative treatment. Interviewees were recruited using convenience and nominated expert sampling, soliciting experiences from diverse geographic locations and institution sizes across the US. We analyzed transcripts using applied thematic analysis to identify and refine meaningful domains. Results Many oncologists reported multiple experiences with refusal and abandonment. Most anticipated case frequency would increase due to misinformation, particularly on the internet. Interviewees described cases of treatment refusal and abandonment, but also a wider variety of cases than previously described in existing publications, including cases involving: non-adherence; negotiations for different treatments; negotiations for complementary and alternative medicine; delayed treatment initiation; and refusal of a component of recommended therapy. Cases often involved multiple stages or types of conflicts. Recurring patient/family behaviors emerged: clear opposition to treatment from the outset; hesitancy about treatment despite initiating therapy; and psychosocial circumstances becoming an obstacle to treatment completion. Oncologists revealed substantial professional and personal repercussions of these cases. Conclusion Oncologist interviews highlight a broad range of conflicts, yielding a taxonomy of treatment refusal, non-adherence and abandonment (TRNA) that accounts for the heterogeneity of situations described. Cases' complexity and interrelatedness points to a functional model of TRNA that includes families' behaviors. This preliminary taxonomy and model warrant further research and examination to refine the model and generate strategies to prevent and mitigate TRNA.
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Affiliation(s)
- Daniel J. Benedetti
- Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Catherine M. Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Laura M. Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
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3
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Cumpston MS, McKenzie JE, Welch VA, Brennan SE. Strengthening systematic reviews in public health: guidance in the Cochrane Handbook for Systematic Reviews of Interventions, 2nd edition. J Public Health (Oxf) 2022; 44:e588-e592. [PMID: 35352103 PMCID: PMC9715291 DOI: 10.1093/pubmed/fdac036] [Citation(s) in RCA: 123] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Decision makers in public health practice and policy rely on access to trustworthy, relevant, synthesized evidence. The second edition of the Cochrane Handbook for Systematic Reviews of Interventions ('the Handbook') reflects a major revision in guidance for authors of systematic reviews, incorporating a decade of methodological development and a number of significant changes to previous recommendations. This paper aims to highlight new guidance that addresses a number of key methodological challenges for authors of systematic reviews in public health. RESULTS The revised Handbook includes guidance on framing public health research questions for synthesis, considering equity, intervention complexity, risk of bias assessment and synthesis methods other than meta-analysis. Reviews of public health interventions frequently encounter the types of methodological complexity addressed in this new guidance. CONCLUSION We hope that readers will find that the Cochrane Handbook includes detailed and thoughtful guidance on both conceptualizing and executing systematic reviews relevant to public health questions. Considering the available methods guidance will, we hope, provide support for authors of public health reviews to tackle the challenges they encounter, strengthen their analysis and provide useful answers to the important questions asked by stakeholders and users of public health evidence.
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Affiliation(s)
| | - Joanne E McKenzie
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Vivian A Welch
- Methods Centre, Bruyère Research Institute, University of Ottawa, Ottawa K1N 6N5, Canada,School of Epidemiology and Public Health, University of Ottawa, Ontario K1N 6N5, Canada
| | - Sue E Brennan
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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4
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Pouls BPH, Vriezekolk JE, Bekker CL, Linn AJ, van Onzenoort HAW, Vervloet M, van Dulmen S, van den Bemt BJF. Effect of Interactive eHealth Interventions on Improving Medication Adherence in Adults With Long-Term Medication: Systematic Review. J Med Internet Res 2021; 23:e18901. [PMID: 33416501 PMCID: PMC7822716 DOI: 10.2196/18901] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/06/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background Medication nonadherence leads to suboptimal treatment outcomes, making it a major priority in health care. eHealth provides an opportunity to offer medication adherence interventions with minimal effort from health care providers whose time and resources are limited. Objective The aim of this systematic review is twofold: (1) to evaluate effectiveness of recently developed and tested interactive eHealth (including mHealth) interventions on medication adherence in adult patients using long-term medication and (2) to describe strategies among effective interventions. Methods MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Web of Science were systematically searched from January 2014 to July 2019 as well as reference lists and citations of included articles. Eligible studies fulfilled the following inclusion criteria: (1) randomized controlled trial with a usual care control group; (2) a total sample size of at least 50 adult patients using long-term medication; (3) applying an interactive eHealth intervention aimed at the patient or patient’s caregiver; and (4) medication adherence as primary outcome. Methodologic quality was assessed using the Cochrane risk of bias tool. Selection and quality assessment of studies were performed by 2 researchers (BP and BvdB or JV) independently. A best evidence synthesis was performed according to the Cochrane Back Review Group. Results Of the 9047 records screened, 22 randomized clinical trials were included reporting on 29 interventions. Most (21/29, 72%) interventions specified using a (mobile) phone for calling, SMS text messaging, or mobile apps. A majority of all interactive interventions (17/29) had a statistically significant effect on medication adherence (P<.05). Of these interventions, 9 had at least a small effect size (Cohen d ≥ 0.2) and 3 showed strong odds for becoming adherent in the intervention group (odds ratio > 2.0). Our best evidence synthesis provided strong evidence for a positive effect of interventions using SMS text messages or interactive voice response, mobile app, and calls as mode of providing adherence tele-feedback. Intervention strategies “to teach medication management skills,” “to improve health care quality by coordinating medication adherence care between professionals,” and “to facilitate communication or decision making between patients and health care providers” also showed strong evidence for a positive effect. Conclusions Overall, this review supports the hypothesis that interactive eHealth interventions can be effective in improving medication adherence. Intervention strategies that improve patients’ treatment involvement and their medication management skills are most promising and should be considered for implementation in practice.
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Affiliation(s)
- Bart P H Pouls
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Johanna E Vriezekolk
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Annemiek J Linn
- Amsterdam School of Communication Research, University of Amsterdam,, Amsterdam, Netherlands
| | - Hein A W van Onzenoort
- Department of Clinical Pharmacy, Amphia Hospital, Breda, Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marcia Vervloet
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands.,Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Bart J F van den Bemt
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
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5
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A systematic review of pharmacists' interventions to support medicines optimisation in patients with visual impairment. Int J Clin Pharm 2019; 41:1400-1407. [PMID: 31531815 DOI: 10.1007/s11096-019-00907-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/07/2019] [Indexed: 01/17/2023]
Abstract
Background People with visual impairment often report poorer health and encounter many challenges when using medicines. Pharmacists can play a significant role in optimising medicines use for these patients. However, little is known about pharmacists' current practices when providing services to this population nor the impact of such services, if any, on medicines optimisation-related outcomes. Aim of the review This systematic review aims to identify the types, and assess the effectiveness of, interventions provided by pharmacists on medicines optimisation-related outcomes. Method Systematic searches of the following electronic databases were carried out from date of inception to March 2018: Cochrane Library; MEDLINE; EMBASE; International Pharmaceutical Abstracts; Scopus; and Cumulative Index to Nursing and Allied Health Literature. Several trial registries and grey literature resources were also searched. Any randomised controlled trials, non-randomised controlled trials, controlled before-and-after studies, or interrupted time series analyses reporting on interventions provided by pharmacists to adult visually impaired patients and/or their caregivers in order to improve medicines optimisation-related outcomes of medicine safety, adherence, patient satisfaction, shared decision making, or quality of life were included. Results A total of 1877 titles/abstracts were screened, and 27 full text articles were assessed for eligibility. On examination of full texts, no studies met the inclusion criteria for this review. Conclusion This review highlights the need for future research that would be vital for promoting the safe and effective use of medicines and the delivery of pharmaceutical care services to people with visual impairment.
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Ryan R, Hill S. Supporting implementation of Cochrane methods in complex communication reviews: resources developed and lessons learned for editorial practice and policy. Health Res Policy Syst 2019; 17:32. [PMID: 30922338 PMCID: PMC6437949 DOI: 10.1186/s12961-019-0435-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/10/2019] [Indexed: 12/23/2022] Open
Abstract
Every healthcare encounter involves some form of communication and there is growing recognition that effective health communication is central to the delivery of safe, high-quality healthcare. Conversely, poor communication has a range of adverse consequences for those receiving healthcare and the systems delivering care, including elevated patient safety risks. Increasing understanding and documentation of the key role that good communication plays in healthcare design and delivery has meant there is growing demand from policy-makers and other decision-makers for evidence on the effects of health communication interventions - that is, how best to communicate. While systematic reviews of such interventions are fundamental to building this evidence base, such interventions and reviews are often highly complex and pose considerable challenges for authors and editors. In this paper, we describe our experience as a Cochrane editorial group identifying common issues in reviews of communication interventions and developing resources to support authors to better meet these challenges. Our analysis found that issues typically fell into one or more of the following three stages of the review process: understanding and applying systematic review methods (e.g. selecting outcomes for analysis); reporting the review's methods (e.g. describing key decisions made in conducting the review); and interpreting the findings (e.g. incorporating quality of the evidence into findings of the review). We also found that common issues reflected both practical difficulties (such as the typically large size of reviews and disparate measures for outcomes) and conceptual challenges (for instance, the difficulties of identifying comparisons). While extensive advice for Cochrane systematic reviewers exists, this standardised advice does not cover all of the issues emerging for complex communication reviews. In response, we therefore developed a collection of resources, both general and targeted to specific methodological issues. Here, we describe the types of resources developed and the aims of these, the rationale for why we needed to fill specific gaps in existing advice, and reflect on the lessons for future editorial practice, policies and research in relation to the implementation of Cochrane review methods in the area of health communication.
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Affiliation(s)
- Rebecca Ryan
- Cochrane Consumers and Communication Group, Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Victoria, 3086 Australia
| | - Sophie Hill
- Cochrane Consumers and Communication Group, Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Victoria, 3086 Australia
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Muloliwa AM, Cliff J, Oku A, Oyo-Ita A, Glenton C, Ames H, Kaufman J, Hill S, Cartier Y, Bosch-Capblanch X, Rada G, Lewin S. Using the COMMVAC taxonomy to map vaccination communication interventions in Mozambique. Glob Health Action 2018; 10:1321313. [PMID: 28573937 PMCID: PMC5496065 DOI: 10.1080/16549716.2017.1321313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Improved communication about childhood vaccination is fundamental to increasing vaccine uptake in low-income countries. Mozambique, with 64% of children fully vaccinated, uses a range of communication interventions to promote uptake of childhood immunisation. OBJECTIVES Using a taxonomy developed by the 'Communicate to Vaccinate' (COMMVAC) project, the study aims to identify and classify the existing communication interventions for vaccination in Mozambique and to find the gaps. METHODS We used a qualitative research approach to identify the range of communication interventions used in Mozambique. In-depth semi-structured interviews were carried out with key purposively selected personnel at national level and relevant documents were collected and analysed. These data were complemented with observations of communication during routine vaccination and campaigns in Nampula province. We used the COMMVAC taxonomy, which organises vaccination communication intervention according to its intended purpose and the population targeted, to map both routine and campaign interventions. RESULTS We identified interventions used in campaign and routine vaccination, or in both, fitting five of the seven taxonomy purposes, with informing or educating community members predominating. We did not identify any interventions that aimed to provide support or facilitate decision-making. There were interventions for all main target groups, although fewer for health providers. Overlap occurred: for example, interventions often targeted both parents and community members. CONCLUSIONS We consider that the predominant focus on informing and educating community members is appropriate in the Mozambican context, where there is a high level of illiteracy and poor knowledge of the reasons for vaccination. We recommend increasing interventions for health providers, in particular training them in better communication for vaccination. The taxonomy was useful for identifying gaps, but needs to be more user-friendly if it is to be employed as a tool by health service managers.
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Affiliation(s)
| | - Julie Cliff
- b Faculdade de Medicina , Universidade Eduardo Mondlane , Maputo , Mozambique
| | - Afiong Oku
- c Community Medicine Department , University of Calabar , Calabar , Nigeria
| | - Angela Oyo-Ita
- c Community Medicine Department , University of Calabar , Calabar , Nigeria
| | - Claire Glenton
- d Global Health Unit , Norwegian Institute of Public Health , Oslo , Norway
| | - Heather Ames
- d Global Health Unit , Norwegian Institute of Public Health , Oslo , Norway
| | - Jessica Kaufman
- e Centre for Health Communication and Participation, School of Psychology and Public Health , La Trobe University , Melbourne , Australia
| | - Sophie Hill
- e Centre for Health Communication and Participation, School of Psychology and Public Health , La Trobe University , Melbourne , Australia
| | - Yuri Cartier
- f International Union for Health Promotion and Education , Saint-Maurice , France
| | - Xavier Bosch-Capblanch
- g Swiss Tropical and Public Health Institute , Basel , Switzerland.,h University of Basel , Basel , Switzerland
| | - Gabriel Rada
- i Evidence-based Healthcare Program , Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Simon Lewin
- d Global Health Unit , Norwegian Institute of Public Health , Oslo , Norway.,j Health Systems Research Unit , South African Medical Research Council , Tygerberg , South Africa
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Synnot A, Bragge P, Lowe D, Nunn JS, O'Sullivan M, Horvat L, Tong A, Kay D, Ghersi D, McDonald S, Poole N, Bourke N, Lannin N, Vadasz D, Oliver S, Carey K, Hill SJ. Research priorities in health communication and participation: international survey of consumers and other stakeholders. BMJ Open 2018; 8:e019481. [PMID: 29739780 PMCID: PMC5942413 DOI: 10.1136/bmjopen-2017-019481] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To identify research priorities of consumers and other stakeholders to inform Cochrane Reviews in 'health communication and participation' (including such concepts as patient experience, shared decision-making and health literacy). SETTING International. PARTICIPANTS We included anyone with an interest in health communication and participation. Up to 151 participants (18-80 years; 117 female) across 12 countries took part, including 48 consumers (patients, carers, consumer representatives) and 75 professionals (health professionals, policymakers, researchers) (plus 25 people who identified as both). DESIGN Survey. METHODS We invited people to submit their research ideas via an online survey open for 4 weeks. Using inductive thematic analysis, we generated priority research topics, then classified these into broader themes. RESULTS Participants submitted 200 research ideas, which we grouped into 21 priority topics. Key research priorities included: insufficient consumer involvement in research (19 responses), 'official' health information is contradictory and hard to understand (18 responses), communication/coordination breakdowns in health services (15 responses), health information provision a low priority for health professionals (15 responses), insufficient eliciting of patient preferences (14 responses), health services poorly understand/implement patient-centred care (14 responses), lack of holistic care impacting healthcare quality and safety (13 responses) and inadequate consumer involvement in service design (11 responses). These priorities encompassed acute and community health settings, with implications for policy and research. Priority populations of interest included people from diverse cultural and linguistic backgrounds, carers, and people with low educational attainment, or mental illness. Most frequently suggested interventions focused on training and cultural change activities for health services and health professionals. CONCLUSIONS Consumers and other stakeholders want research addressing structural and cultural challenges in health services (eg, lack of holistic, patient-centred, culturally safe care) and building health professionals' communication skills. Solutions should be devised in partnership with consumers, and focus on the needs of vulnerable groups.
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Affiliation(s)
- Anneliese Synnot
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jack S Nunn
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Molly O'Sullivan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lidia Horvat
- Safer Care Victoria, Melbourne, Victoria, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Debra Kay
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Davina Ghersi
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- National Health and Medical Research Council, Canberra, New South Wales, Australia
| | - Steve McDonald
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Naomi Poole
- Australian Commission on Safety and Quality in Healthcare, Sydney, New South Wales, Australia
| | - Noni Bourke
- Bass Coast Health, Wonthaggi, Victoria, Australia
| | - Natasha Lannin
- Alfred Health, Melbourne, Victoria, Australia
- School of Allied Health (Occupational Therapy), La Trobe University, Melbourne, Victoria, Australia
| | - Danny Vadasz
- Health Issues Centre, Melbourne, Victoria, Australia
| | - Sandy Oliver
- University College London, London, UK
- Universityof Johannesburg, Johannesburg, South Africa
| | - Karen Carey
- Formerly of Consumers Health Forum, Canberra, Australia
| | - Sophie J Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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Slaughter SE, Zimmermann GL, Nuspl M, Hanson HM, Albrecht L, Esmail R, Sauro K, Newton AS, Donald M, Dyson MP, Thomson D, Hartling L. Classification schemes for knowledge translation interventions: a practical resource for researchers. BMC Med Res Methodol 2017; 17:161. [PMID: 29207955 PMCID: PMC5718087 DOI: 10.1186/s12874-017-0441-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/22/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND As implementation science advances, the number of interventions to promote the translation of evidence into healthcare, health systems, or health policy is growing. Accordingly, classification schemes for these knowledge translation (KT) interventions have emerged. A recent scoping review identified 51 classification schemes of KT interventions to integrate evidence into healthcare practice; however, the review did not evaluate the quality of the classification schemes or provide detailed information to assist researchers in selecting a scheme for their context and purpose. This study aimed to further examine and assess the quality of these classification schemes of KT interventions, and provide information to aid researchers when selecting a classification scheme. METHODS We abstracted the following information from each of the original 51 classification scheme articles: authors' objectives; purpose of the scheme and field of application; socioecologic level (individual, organizational, community, system); adaptability (broad versus specific); target group (patients, providers, policy-makers), intent (policy, education, practice), and purpose (dissemination versus implementation). Two reviewers independently evaluated the methodological quality of the development of each classification scheme using an adapted version of the AGREE II tool. Based on these assessments, two independent reviewers reached consensus about whether to recommend each scheme for researcher use, or not. RESULTS Of the 51 original classification schemes, we excluded seven that were not specific classification schemes, not accessible or duplicates. Of the remaining 44 classification schemes, nine were not recommended. Of the 35 recommended classification schemes, ten focused on behaviour change and six focused on population health. Many schemes (n = 29) addressed practice considerations. Fewer schemes addressed educational or policy objectives. Twenty-five classification schemes had broad applicability, six were specific, and four had elements of both. Twenty-three schemes targeted health providers, nine targeted both patients and providers and one targeted policy-makers. Most classification schemes were intended for implementation rather than dissemination. CONCLUSIONS Thirty-five classification schemes of KT interventions were developed and reported with sufficient rigour to be recommended for use by researchers interested in KT in healthcare. Our additional categorization and quality analysis will aid in selecting suitable classification schemes for research initiatives in the field of implementation science.
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Affiliation(s)
| | - Gabrielle L. Zimmermann
- Alberta SPOR SUPPORT Unit KT Platform, Edmonton, Canada
- University of Calgary, Calgary, Canada
| | - Megan Nuspl
- Alberta SPOR SUPPORT Unit KT Platform, Edmonton, Canada
| | - Heather M. Hanson
- University of Calgary, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | | | - Rosmin Esmail
- University of Calgary, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | | | | | | | | | | | - Lisa Hartling
- University of Alberta, Edmonton, Canada
- Alberta SPOR SUPPORT Unit KT Platform, Edmonton, Canada
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Kaufman J, Ryan R, Glenton C, Lewin S, Bosch-Capblanch X, Cartier Y, Cliff J, Oyo-Ita A, Ames H, Muloliwa AM, Oku A, Rada G, Hill S. Childhood vaccination communication outcomes unpacked and organized in a taxonomy to facilitate core outcome establishment. J Clin Epidemiol 2017; 84:173-184. [PMID: 28238788 DOI: 10.1016/j.jclinepi.2017.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/11/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We present a comprehensive taxonomy of outcomes for childhood vaccination communication interventions. Adding to our earlier map of trial outcomes, we aimed to (1) identify relevant outcomes not measured in trials, (2) identify outcomes from stakeholder focus groups, and (3) organize outcomes into a taxonomy. STUDY DESIGN AND SETTING We identified additional outcomes from nonvaccination health communication literature and through parent and health care professional focus groups. We organized outcomes into the taxonomy through iterative discussion and informed by organizational principles established by leaders in core outcome research. RESULTS The taxonomy includes three overarching core areas, divided into eight domains and then into outcomes. Core area one is psychosocial impact, including the domains "knowledge or understanding," "attitudes or beliefs," and "decision-making." Core area two is health impact, covering "vaccination status and behaviors" and "health status and well-being." Core area three is community, social, or health system impact, containing "intervention design and implementation," "community participation," and "resource use." CONCLUSION To our knowledge, this taxonomy is the first attempt to conceptualize the range of potential outcomes for vaccination communication. It can be used by researchers selecting outcomes for complex communication interventions. We will also present the taxonomy to stakeholders to establish core outcome domains.
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Affiliation(s)
- Jessica Kaufman
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia.
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia
| | - Claire Glenton
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway
| | - Simon Lewin
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway; Health Systems Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg 7505, Cape Town, South Africa
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland; Universität Basel, Petersplatz 1, CH-4003, Basel, Switzerland
| | - Yuri Cartier
- International Union for Health Promotion and Education, 42 boulevard de la Libération, Saint-Denis 93203, France
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo CP 257, Mozambique
| | - Angela Oyo-Ita
- Department of Community Medicine, University of Calabar, Calabar PMB 1115, Cross River State, Nigeria
| | - Heather Ames
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway
| | - Artur Manuel Muloliwa
- Provincial Directorate of Health, Av. Samora Machel n(º) 1016 R/C, C.P. N(º) 14, Nampula, Mozambique
| | - Afiong Oku
- Department of Community Medicine, University of Calabar, Calabar PMB 1115, Cross River State, Nigeria
| | - Gabriel Rada
- Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Avda, Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia
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Colquhoun HL, Lowe D, Helis E, Belanger D, Ens B, Hill S, Mayhew A, Taylor M, Grimshaw JM. Evaluation of a training program for medicines-oriented policymakers to use a database of systematic reviews. Health Res Policy Syst 2016; 14:70. [PMID: 27654820 PMCID: PMC5031302 DOI: 10.1186/s12961-016-0140-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 08/24/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Suboptimal prescribing and medications use is a problem for health systems globally. Systematic reviews are a comprehensive resource that can help guide evidence-informed decision-making and implementation of interventions addressing such issues; however, a barrier to the use of systematic reviews is their inaccessibility (due to both dispersion across journals and inaccessibility of content). Publicly available databases, such as Rx for Change, provide quick access to summaries of appraised systematic reviews of professional and consumer-oriented interventions to improve prescribing behaviour and appropriate medication use, and may help maximise the use of evidence to inform decisions. The present study aims to evaluate a training program to improve attitudes towards, confidence in skills, intentions to use, and use of systematic review evidence contained within Rx for Change. METHODS Guided by the Knowledge to Action framework, a training program with content customised to local provider and consumer contexts was developed with knowledge user input. The training program consisted of a 6 minute information video, a 1 hour workshop with hands-on, interactive and didactic components, and two post-training reminders. Forty-nine people from five medicines-focused organisations in Canada and Australia attended one of six workshops. Participants were surveyed immediately pre and post and 3 months after training to evaluate their attitudes towards, confidence in skills, intentions to use, and use of Rx for Change, and attitudes towards and confidence in skills for using evidence for decision-making. Analyses for differences for each of the outcomes at three time points (pre, post and 3 months after training) was performed using a random effects model. RESULTS Immediately post-training, there were higher respondent attitudes towards Rx for Change (mean increase = 0.54 out of 5, 95% CI, 0.18-0.83, P < 0.005); intention to use Rx for Change (0.53, 95% CI, 0.21-0.86, P < 0.005); confidence in skills for using Rx for Change (2.08, 95% CI, 1.74-2.42, P < 0.005); and confidence in skills for using evidence in policy decision-making (0.50, 95% CI, 0.22-0.77, P < .005) compared to pre-training. Confidence in skills for using both Rx for Change and evidence were maintained 3 months after training (both P < 0.005). CONCLUSIONS Participants of this training program reported sustained improvements in their confidence in skills for using evidence in policy decision-making. This may have important implications for uptake of systematic review evidence promoting improved prescribing and medication use.
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Affiliation(s)
- Heather L Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada.
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, 3086, Australia
| | - Eftyhia Helis
- Knowledge Mobilization and Liaison Officer Program, Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, ON, Canada
| | - Denis Belanger
- Knowledge Mobilization and Liaison Officer Program, Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, ON, Canada
| | - Brendalynn Ens
- Knowledge Mobilization and Liaison Officer Program, Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, ON, Canada
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, 3086, Australia
| | - Alain Mayhew
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère Street, Annex E - 208, Ottawa, ON, K1N 5C8, Canada
| | - Michael Taylor
- Public Health, School of Allied Health, Australian Catholic University, Fitzroy, VIC, 3065, Australia
| | - Jeremy M Grimshaw
- Department of Medicine, University of Ottawa, Epidemiology & Community Medicine, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Sieben A, van Onzenoort HA, van Laarhoven KJ, Bredie SJ. A Multifaceted Nurse- and Web-Based Intervention for Improving Adherence to Treatment in Patients With Cardiovascular Disease: Rationale and Design of the MIRROR Trial. JMIR Res Protoc 2016; 5:e187. [PMID: 27624877 PMCID: PMC5039334 DOI: 10.2196/resprot.5750] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/30/2016] [Accepted: 08/25/2016] [Indexed: 01/01/2023] Open
Abstract
Background Poor adherence to medication is one of the limitations in the treatment of cardiovascular diseases, thereby increasing the risk of premature death, hospital admissions, and related costs. There is a need for simple and easy-to-implement interventions that are based on patients’ perspectives, beliefs, and perceptions of their illness and medication. Objective The objective is to test the effectivity of this intervention to improve medication adherence in patients with established cardiovascular disease, that is, in secondary prevention. Methods In this study the effect of a personalized visualization of cardiovascular risk levels through a website aiming at supporting self management in combination with a group consultation and communication intervention by a nurse on adherence to treatment in 600 patients with manifest cardiovascular diseases will be assessed. The health belief model was chosen as main theoretical model for the intervention. Results Primary outcome is adherence to treatment calculated by refill data. Secondary outcomes include the Beliefs about Medication Questionnaire and the Modified Morisky Scale. Patients are followed for one year. Results are expected by 2015. Conclusions This study assesses adherence to treatment in a high-risk cardiovascular population by applying an intervention that addresses patients’ capacity and practical barriers as well as patients’ beliefs and perceptions of their illness and medication. ClinicalTrial ClinicalTrials.gov NCT01449695; https://clinicaltrials.gov/ct2/show/NCT01449695 (Archived by WebCite at http://www.webcitation.org/6kCzkIKH3)
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Affiliation(s)
- Angelien Sieben
- Radboud University Nijmegen Medical Centre, Department of Surgery, Division of Vascular Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
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Colquhoun HL, Helis E, Lowe D, Belanger D, Hill S, Mayhew A, Taylor M, Grimshaw JM. Development of training for medicines-oriented policymakers to apply evidence. Health Res Policy Syst 2016; 14:57. [PMID: 27473051 PMCID: PMC4966170 DOI: 10.1186/s12961-016-0130-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 07/03/2016] [Indexed: 11/27/2022] Open
Abstract
Background Health systems globally promote appropriate prescribing by healthcare providers and safe and effective medicine use by consumers. Rx for Change, a publicly available database, provides access to systematic reviews regarding best practices for prescribing and using medicines. Despite the value of the database for improving prescribing and medicine use, its use remains suboptimal. This study aimed to develop a training program for five medicine-focused organisations in Canada and Australia to facilitate the use and understanding of the Rx for Change database. Methods Four steps were undertaken: 1) key informant interviews were completed across all organisations to understand the knowledge user perspective; 2) a directed content analysis was completed of the interview transcripts and proposed training was developed; 3) a second round of feedback on the proposed training by knowledge users was gathered; and 4) feedback was integrated to develop the final training. Results Sixteen key informant interviews with knowledge users were conducted. Themes for training content included the scope of, navigation and strategies for using Rx for Change (generic content) and practical examples on incorporating evidence within their workplace context (tailored content). The final training consisted of an informational video, a 60-minute face-to-face workshop and two post-training reminders. Conclusions A method of engaging knowledge users in the development of a training program to improve the use of an on-line database of systematic reviews was established and used to design training. Next steps include the delivery and evaluation of the training.
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Affiliation(s)
- H L Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada.
| | - E Helis
- Canadian Agency for Drugs and Technologies in Health (CADTH), 865 Carling Avenue, Ottawa, ON, K1S 5S8, Canada
| | - D Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - D Belanger
- Canadian Agency for Drugs and Technologies in Health (CADTH), 865 Carling Avenue, Ottawa, ON, K1S 5S8, Canada
| | - S Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - A Mayhew
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère Street, Annex E - 208, Ottawa, ON, K1N 5C8, Canada
| | - M Taylor
- Public Health, School of Allied Health, Australian Catholic University, Fitzroy, VIC, 3065, Australia
| | - J M Grimshaw
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère Street, Annex E - 208, Ottawa, ON, K1N 5C8, Canada.,Department of Medicine, University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
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14
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Models of Care for musculoskeletal health: Moving towards meaningful implementation and evaluation across conditions and care settings. Best Pract Res Clin Rheumatol 2016; 30:359-374. [DOI: 10.1016/j.berh.2016.09.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/16/2016] [Indexed: 12/31/2022]
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Walsh L, Hill S, Wluka AE, Brooks P, Buchbinder R, Cahill A, Dans LF, Lowe D, Taylor M, Tugwell P. Harnessing and supporting consumer involvement in the development and implementation of Models of Care for musculoskeletal health. Best Pract Res Clin Rheumatol 2016; 30:420-444. [DOI: 10.1016/j.berh.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/06/2016] [Accepted: 09/08/2016] [Indexed: 01/08/2023]
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Ryan R, Hill S. Making rational choices about how best to support consumers' use of medicines: a perspective review. Ther Adv Drug Saf 2016; 7:159-64. [PMID: 27493719 DOI: 10.1177/2042098616651198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inappropriate medicine use and polypharmacy create significant challenges for consumers and the health systems they live in, worldwide. In this review, we describe the evidence underpinning interventions directed primarily at healthcare consumers, including information provision, pharmacist-delivered interventions and practical supports, such as reminders to improve outcomes related to medicines. We identify a relatively small number of strategies that seem effective or promising: self-monitoring and self-management programmes, simplified dosing regimens and pharmacist-delivered interventions such as medication review. These interventions could be applied in practice to address some of the problems associated with inappropriate use of medicines, multimorbidity and polypharmacy. The evidence also indicates that success with many strategies is not consistent, suggesting that understanding the individual's context and their preferences will also be important for improving medicines' use. In addition, some strategies in current use are ineffective. Taken together, we argue that the evidence should inform deliberate, rational decisions between strategies to support consumers in using medicines safely and effectively. Future medicine-use research should likewise build rationally and constructively on what is known about promising interventions, avoiding duplication of past research, and working to help consumers negotiate the many challenges presented by polypharmacy.
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Affiliation(s)
- Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Victoria 3086, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Victoria, Australia
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Ryan RE, Weir M, Leslie B, Worswick J, Lowe DB, Hill SJ. Evidence on Optimal Prescribing and Medicines Use for Decision Makers: Scope and Application of the
Rx for Change
Database. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2011.tb00107.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Rebecca E Ryan
- Centre for Health Communication and Participation, Australian Institute for Primary Care and AgeingLa Trobe University
| | | | - Bill Leslie
- Canadian Agency for Drugs and Technologies in Health
| | | | | | - Sophie J Hill
- Centre for Health Communication and Participation, Australian Institute for Primary Care and AgeingLa Trobe University Bundoora Victoria
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Lokker C, McKibbon KA, Colquhoun H, Hempel S. A scoping review of classification schemes of interventions to promote and integrate evidence into practice in healthcare. Implement Sci 2015; 10:27. [PMID: 25885047 PMCID: PMC4352247 DOI: 10.1186/s13012-015-0220-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 02/17/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many models and frameworks are currently used to classify or describe knowledge translation interventions to promote and integrate evidence into practice in healthcare. METHODS We performed a scoping review of intervention classifications in public health, clinical medicine, nursing, policy, behaviour science, improvement science and psychology research published to May 2013 by searching MEDLINE, PsycINFO, CINAHL and the grey literature. We used five stages to map the literature: identifying the research question; identifying relevant literature; study selection; charting the data; collating, summarizing, and reporting results. RESULTS We identified 51 diverse classification schemes, including 23 taxonomies, 15 frameworks, 8 intervention lists, 3 models and 2 other formats. Most documents were public health based, 55% included a literature or document review, and 33% were theory based. CONCLUSIONS This scoping review provides an overview of schemes used to classify interventions which can be used for evaluation, comparison and validation of existing and emerging models. The collated taxonomies can guide authors in describing interventions; adequate descriptions of interventions will advance the science of knowledge translation in healthcare.
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Affiliation(s)
- Cynthia Lokker
- Department of Clinical Epidemiology and Biostatistics, Health Information Research Unit, McMaster University, CRL Building, 1280 Main Street West, Hamilton, L8S 4 K1, ON, Canada.
| | - K Ann McKibbon
- Department of Clinical Epidemiology and Biostatistics, Health Information Research Unit, McMaster University, CRL Building, 1280 Main Street West, Hamilton, L8S 4 K1, ON, Canada.
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1 V7, Canada.
| | - Susanne Hempel
- RAND Corporation, 1776 Main Street, m4339, Santa Monica, 90407, CA, USA.
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Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, Kaufman C, Cowie G, Taylor M. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev 2014; 2014:CD007768. [PMID: 24777444 PMCID: PMC6491214 DOI: 10.1002/14651858.cd007768.pub3] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Many systematic reviews exist on interventions to improve safe and effective medicines use by consumers, but research is distributed across diseases, populations and settings. The scope and focus of such reviews also vary widely, creating challenges for decision-makers seeking to inform decisions by using the evidence on consumers' medicines use.This is an update of a 2011 overview of systematic reviews, which synthesises the evidence, irrespective of disease, medicine type, population or setting, on the effectiveness of interventions to improve consumers' medicines use. OBJECTIVES To assess the effects of interventions which target healthcare consumers to promote safe and effective medicines use, by synthesising review-level evidence. SEARCH METHODS We included systematic reviews published on the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. We identified relevant reviews by handsearching databases from their start dates to March 2012. SELECTION CRITERIA We screened and ranked reviews based on relevance to consumers' medicines use, using criteria developed for this overview. DATA COLLECTION AND ANALYSIS We used standardised forms to extract data, and assessed reviews for methodological quality using the AMSTAR tool. We used standardised language to summarise results within and across reviews; and gave bottom-line statements about intervention effectiveness. Two review authors screened and selected reviews, and extracted and analysed data. We used a taxonomy of interventions to categorise reviews and guide syntheses. MAIN RESULTS We included 75 systematic reviews of varied methodological quality. Reviews assessed interventions with diverse aims including support for behaviour change, risk minimisation and skills acquisition. No reviews aimed to promote systems-level consumer participation in medicines-related activities. Medicines adherence was the most frequently-reported outcome, but others such as knowledge, clinical and service-use outcomes were also reported. Adverse events were less commonly identified, while those associated with the interventions themselves, or costs, were rarely reported.Looking across reviews, for most outcomes, medicines self-monitoring and self-management programmes appear generally effective to improve medicines use, adherence, adverse events and clinical outcomes; and to reduce mortality in people self-managing antithrombotic therapy. However, some participants were unable to complete these interventions, suggesting they may not be suitable for everyone.Other promising interventions to improve adherence and other key medicines-use outcomes, which require further investigation to be more certain of their effects, include:· simplified dosing regimens: with positive effects on adherence;· interventions involving pharmacists in medicines management, such as medicines reviews (with positive effects on adherence and use, medicines problems and clinical outcomes) and pharmaceutical care services (consultation between pharmacist and patient to resolve medicines problems, develop a care plan and provide follow-up; with positive effects on adherence and knowledge).Several other strategies showed some positive effects, particularly relating to adherence, and other outcomes, but their effects were less consistent overall and so need further study. These included:· delayed antibiotic prescriptions: effective to decrease antibiotic use but with mixed effects on clinical outcomes, adverse effects and satisfaction;· practical strategies like reminders, cues and/or organisers, reminder packaging and material incentives: with positive, although somewhat mixed effects on adherence;· education delivered with self-management skills training, counselling, support, training or enhanced follow-up; information and counselling delivered together; or education/information as part of pharmacist-delivered packages of care: with positive effects on adherence, medicines use, clinical outcomes and knowledge, but with mixed effects in some studies;· financial incentives: with positive, but mixed, effects on adherence.Several strategies also showed promise in promoting immunisation uptake, but require further study to be more certain of their effects. These included organisational interventions; reminders and recall; financial incentives; home visits; free vaccination; lay health worker interventions; and facilitators working with physicians to promote immunisation uptake. Education and/or information strategies also showed some positive but even less consistent effects on immunisation uptake, and need further assessment of effectiveness and investigation of heterogeneity.There are many different potential pathways through which consumers' use of medicines could be targeted to improve outcomes, and simple interventions may be as effective as complex strategies. However, no single intervention assessed was effective to improve all medicines-use outcomes across all diseases, medicines, populations or settings.Even where interventions showed promise, the assembled evidence often only provided part of the picture: for example, simplified dosing regimens seem effective for improving adherence, but there is not yet sufficient information to identify an optimal regimen.In some instances interventions appear ineffective: for example, the evidence suggests that directly observed therapy may be generally ineffective for improving treatment completion, adherence or clinical outcomes.In other cases, interventions may have variable effects across outcomes. As an example, strategies providing information or education as single interventions appear ineffective to improve medicines adherence or clinical outcomes, but may be effective to improve knowledge; an important outcome for promoting consumers' informed medicines choices.Despite a doubling in the number of reviews included in this updated overview, uncertainty still exists about the effectiveness of many interventions, and the evidence on what works remains sparse for several populations, including children and young people, carers, and people with multimorbidity. AUTHORS' CONCLUSIONS This overview presents evidence from 75 reviews that have synthesised trials and other studies evaluating the effects of interventions to improve consumers' medicines use.Systematically assembling the evidence across reviews allows identification of effective or promising interventions to improve consumers' medicines use, as well as those for which the evidence indicates ineffectiveness or uncertainty.Decision makers faced with implementing interventions to improve consumers' medicines use can use this overview to inform decisions about which interventions may be most promising to improve particular outcomes. The intervention taxonomy may also assist people to consider the strategies available in relation to specific purposes, for example, gaining skills or being involved in decision making. Researchers and funders can use this overview to identify where more research is needed and assess its priority. The limitations of the available literature due to the lack of evidence for important outcomes and important populations, such as people with multimorbidity, should also be considered in practice and policy decisions.
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Affiliation(s)
- Rebecca Ryan
- Centre for Health Communication and Participation, School of Public Health and Human Biosciences, La Trobe University, Bundoora, VIC, Australia, 3086
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Genova J, Nahon-Serfaty I, Dansokho SC, Gagnon MP, Renaud JS, Giguère AMC. The Communication AssessmenT Checklist in Health (CATCH): a tool for assessing the quality of printed educational materials for clinicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2014; 34:232-242. [PMID: 25530293 DOI: 10.1002/chp.21257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION There is little guidance available on strategies to improve the communication quality of printed educational materials (PEMs) for clinicians. The purposes of this study were to conceptualize PEM communication quality, develop a checklist based on this conceptualization, and validate the checklist with a selection of PEMs. METHODS From a literature review of the strategies influencing communication quality, we generated a conceptual map and developed the Communication AssessmenT Checklist in Health (CATCH) consisting of 55 items nested in 12 concepts. Two raters independently applied CATCH to 45 PEMs evaluated in the studies included in a Cochrane systematic review. From these results, we conducted an item analysis and assessed content validity of CATCH using a hierarchical cluster analysis to explore the extent to which our CATCH operationalization truly represented the communication quality concepts. RESULTS Some concepts were better covered in the studied PEMs, whereas others were not covered consistently. We observed 3 contrasting PEM clusters. A first cluster (n = 22) was characterized by longer PEMs and comprised mostly high-impact peer-reviewed scientific articles or clinical practice guidelines. A second cluster (n = 22) consisted of PEMs shorter than 4 pages that used special fonts, color, pictures, and graphics. A third cluster consisted of a single brief PEM. DISCUSSION With CATCH it is possible to categorize and understand the mechanisms that can trigger a change in behavior in health care providers. Additional research is needed to validate CATCH before it can be recommended for use.
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Willis N, Hill S, Kaufman J, Lewin S, Kis-Rigo J, De Castro Freire SB, Bosch-Capblanch X, Glenton C, Lin V, Robinson P, Wiysonge CS. "Communicate to vaccinate": the development of a taxonomy of communication interventions to improve routine childhood vaccination. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:23. [PMID: 23663327 PMCID: PMC3655915 DOI: 10.1186/1472-698x-13-23] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 05/05/2013] [Indexed: 11/25/2022]
Abstract
Background Vaccination is a cost-effective public health measure and is central to the Millennium Development Goal of reducing child mortality. However, childhood vaccination coverage remains sub-optimal in many settings. While communication is a key feature of vaccination programmes, we are not aware of any comprehensive approach to organising the broad range of communication interventions that can be delivered to parents and communities to improve vaccination coverage. Developing a classification system (taxonomy) organised into conceptually similar categories will aid in: understanding the relationships between different types of communication interventions; facilitating conceptual mapping of these interventions; clarifying the key purposes and features of interventions to aid implementation and evaluation; and identifying areas where evidence is strong and where there are gaps. This paper reports on the development of the ‘Communicate to vaccinate’ taxonomy. Methods The taxonomy was developed in two stages. Stage 1 included: 1) forming an advisory group; 2) searching for descriptions of interventions in trials (CENTRAL database) and general health literature (Medline); 3) developing a sampling strategy; 4) screening the search results; 5) developing a data extraction form; and 6) extracting intervention data. Stage 2 included: 1) grouping the interventions according to purpose; 2) holding deliberative forums in English and French with key vaccination stakeholders to gather feedback; 3) conducting a targeted search of grey literature to supplement the taxonomy; 4) finalising the taxonomy based on the input provided. Results The taxonomy includes seven main categories of communication interventions: inform or educate, remind or recall, teach skills, provide support, facilitate decision making, enable communication and enhance community ownership. These categories are broken down into 43 intervention types across three target groups: parents or soon-to-be-parents; communities, community members or volunteers; and health care providers. Conclusions Our taxonomy illuminates and organises this field and identifies the range of available communication interventions to increase routine childhood vaccination uptake. We have utilised a variety of data sources, capturing information from rigorous evaluations such as randomised trials as well as experiences and knowledge of practitioners and vaccination stakeholders. The taxonomy reflects current public health practice and can guide the future development of vaccination programmes.
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Affiliation(s)
- Natalie Willis
- Centre for Health Communication and Participation, Australian Institute for Primary Care & Ageing, La Trobe University, Bundoora, VIC 3086, Australia.
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Lewin S, Hill S, Abdullahi LH, de Castro Freire SB, Bosch-Capblanch X, Glenton C, Hussey GD, Jones CM, Kaufman J, Lin V, Mahomed H, Rhoda L, Robinson P, Waggie Z, Willis N, Wiysonge CS. 'Communicate to vaccinate' (COMMVAC). building evidence for improving communication about childhood vaccinations in low- and middle-income countries: protocol for a programme of research. Implement Sci 2011; 6:125. [PMID: 22132930 PMCID: PMC3259054 DOI: 10.1186/1748-5908-6-125] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 12/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective provider-parent communication can improve childhood vaccination uptake and strengthen immunisation services in low- and middle-income countries (LMICs). Building capacity to improve communication strategies has been neglected. Rigorous research exists but is not readily found or applicable to LMICs, making it difficult for policy makers to use it to inform vaccination policies and practice.The aim of this project is to build research knowledge and capacity to use evidence-based strategies for improving communication about childhood vaccinations with parents and communities in LMICs. METHODS AND DESIGN This project is a mixed methods study with six sub-studies. In sub-study one, we will develop a systematic map of provider-parent communication interventions for childhood vaccinations by screening and extracting data from relevant literature. This map will inform sub-study two, in which we will develop a taxonomy of interventions to improve provider-parent communication around childhood vaccination. In sub-study three, the taxonomy will be populated with trial citations to create an evidence map, which will also identify how evidence is linked to communication barriers regarding vaccination. In the project's fourth sub-study, we will present the interventions map, taxonomy, and evidence map to international stakeholders to identify high-priority topics for systematic reviews of interventions to improve parent-provider communication for childhood vaccination. We will produce systematic reviews of the effects of high-priority interventions in the fifth sub-study. In the sixth and final sub-study of the project, evidence from the systematic reviews will be translated into accessible formats and messages for dissemination to LMICs. DISCUSSION This project combines evidence mapping, conceptual and taxonomy development, priority setting, systematic reviews, and knowledge transfer. It will build and share concepts, terms, evidence, and resources to aid the development of communication strategies for effective vaccination programmes in LMICs.
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Affiliation(s)
- Simon Lewin
- Norwegian Knowledge Centre for the Health Services, Olavs plass N-0130 Oslo, Norway.
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Weir MC, Ryan R, Mayhew A, Worswick J, Santesso N, Lowe D, Leslie B, Stevens A, Hill S, Grimshaw JM. The Rx for Change database: a first-in-class tool for optimal prescribing and medicines use. Implement Sci 2010; 5:89. [PMID: 21087505 PMCID: PMC3000374 DOI: 10.1186/1748-5908-5-89] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 11/18/2010] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Globally, suboptimal prescribing practices and medication errors are common. Guidance to health professionals and consumers alone is not sufficient to optimise behaviours, therefore strategies to promote evidence-based decision making and practice, such as decision support tools or reminders, are important. The literature in this area is growing, but is of variable quality and dispersed across sources, which makes it difficult to identify, access, and assess. To overcome these problems, by synthesizing and evaluating the data from systematic reviews, we have developed Rx for Change to provide a comprehensive, online database of the evidence for strategies to improve drug prescribing and use. METHODS We use reliable and valid methods to search and screen the literature, and to appraise and analyse the evidence from relevant systematic reviews. We then present the findings in an online format which allows users to easily access pertinent information related to prescribing and medicines use. The database is a result of the collaboration between the Canadian Agency for Drugs and Technologies in Health (CADTH) and two Cochrane review groups. RESULTS To capture the body of evidence on interventions to improve prescribing and medicines use, we conduct comprehensive and regular searches in multiple databases, and hand-searches of relevant journals. We screen articles to identify relevant systematic reviews, and include them if they are of moderate or high methodological quality. Two researchers screen, assess quality, and extract data on demographic details, intervention characteristics, and outcome data. We report the results of our analysis of each systematic review using a standardised quantitative and qualitative format. Rx for Change currently contains over 200 summarised reviews, structured in a multi-level format. The reviews included in the database are diverse, covering various settings, conditions, or diseases and targeting a range of professional and consumer behaviors. CONCLUSIONS Rx for Change is a novel database that synthesizes current research evidence about the effects of interventions to improve drug prescribing practices and medicines use.
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Affiliation(s)
- Michelle C Weir
- Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, ON, K1N 6N5, Canada.
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