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Hershberger PJ, Bricker DA, Castle A, Crawford TN, Flowers SR, Goff AL, Conway K. Compassionate Curiosity: Mitigating the Effects of Bias Through Motivational Interviewing. Health Equity 2024; 8:351-354. [PMID: 39011081 PMCID: PMC11249126 DOI: 10.1089/heq.2024.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 07/17/2024] Open
Abstract
There is strong evidence that the implicit biases of health care professionals affect the treatment of patients, and that minority and other marginalized patients are disproportionately harmed. Assumptions made about patient knowledge or lack thereof function as judgments that are prone to bias, which then affect the education and advice imposed upon patients. We review how the motivational interviewing (MI) approach to patient engagement includes components of evidence-based bias-mitigating strategies, such as understanding circumstances from the patient's point of view, and therefore we propose that the MI approach can reduce the impact of bias in patient care.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Dean A Bricker
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Angie Castle
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Timothy N Crawford
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Stacy R Flowers
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Alexandria L Goff
- Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Katharine Conway
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
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Vatsolaki E, Agouropoulos A, Papagiannoulis E, Gizani S. Two years outcome of an individualized oral health preventive program for preschool children with neurodevelopmental disorders. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38831338 DOI: 10.1111/scd.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024]
Abstract
AIMS Limited data exist on the effectiveness of oral health preventive programs in children with Neurodevelopmental Disorders (NDD). The aim of this study was to evaluate the effectiveness of an individualized preventive oral health program for preschool children with NDD at a rehabilitation center, over a two years period. METHODS AND RESULTS In this study, 102 preschool children with NDD were assessed for caries (dmft), oral hygiene status (Green & Vermillion Index) and presence of developmental dental defects. An individualized preventive program was applied based on caries risk and children were followed for two years. Effectiveness of the program was assessed for caries and dental plaque change and explanatory individual factors were used in multivariate models. After two years prospective, dmft increased significantly from 1.1 (SD = 2.7) to 2.04 (SD = 3.6), while GVPI was reduced significantly from 1.8 (SD = 0.9) to 1.4 (SD = 0.9). Children in the moderate and high-risk groups missed significantly more follow-ups compared to the low caries risk group (p < .001) while older maternal age (OR = 1.38, 95%CI = 1.057-1.808) and consumption of more than three sugary snacks/day (OR = 0.005, 95%CI = 0-0.0794) were significantly correlated with dental caries. CONCLUSION The individualized preventive program for preschool children with NDD was effective in improving oral hygiene but not dental caries status.
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Affiliation(s)
- Eleni Vatsolaki
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Agouropoulos
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Papagiannoulis
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotiria Gizani
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Hershberger PJ, Pei Y, Bricker DA, Crawford TN, Shivakumar A, Castle A, Conway K, Medaramitta R, Rechtin M, Wilson JF. Motivational interviewing skills practice enhanced with artificial intelligence: ReadMI. BMC MEDICAL EDUCATION 2024; 24:237. [PMID: 38443862 PMCID: PMC10916112 DOI: 10.1186/s12909-024-05217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Finding time in the medical curriculum to focus on motivational interviewing (MI) training is a challenge in many medical schools. We developed a software-based training tool, "Real-time Assessment of Dialogue in Motivational Interviewing" (ReadMI), that aims to advance the skill acquisition of medical students as they learn the MI approach. This human-artificial intelligence teaming may help reduce the cognitive load on a training facilitator. METHODS During their Family Medicine clerkship, 125 third-year medical students were scheduled in pairs to participate in a 90-minute MI training session, with each student doing two role-plays as the physician. Intervention group students received both facilitator feedback and ReadMI metrics after their first role-play, while control group students received only facilitator feedback. RESULTS While students in both conditions improved their MI approach from the first to the second role-play, those in the intervention condition used significantly more open-ended questions, fewer closed-ended questions, and had a higher ratio of open to closed questions. CONCLUSION MI skills practice can be gained with a relatively small investment of student time, and artificial intelligence can be utilized both for the measurement of MI skill acquisition and as an instructional aid.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
| | - Yong Pei
- Department of Computer Science, College of Computing and Software Engineering, Kennesaw State University, Kennesaw, GA, USA
| | - Dean A Bricker
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Timothy N Crawford
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Ashutosh Shivakumar
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Angie Castle
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Katharine Conway
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Raveendra Medaramitta
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Maria Rechtin
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Josephine F Wilson
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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Den Hamer-Jordaan G, Groenendijk-Van Woudenbergh GJ, Haveman-Nies A, Van Hell-Cromwijk MC, Van Der Veen YJJ, Algra HF, Kroeze W. Factors associated with dietary behaviour change support in patients: A qualitative study among community nurses. J Adv Nurs 2024; 80:500-509. [PMID: 37518977 DOI: 10.1111/jan.15808] [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: 11/18/2022] [Revised: 06/01/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
AIM To explore which factors, influencing dietary behaviour change support among patients by Dutch community nurses (CNs; nurses), are key focal points in training programmes. BACKGROUND Nurses have an important role in counselling patients towards healthier dietary behaviour to prevent or delay long-term complications from chronic lifestyle-related diseases. Most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential. DESIGN A qualitative descriptive study. METHODS Data were collected in the Netherlands in 2018-2019 via semi-structured face-to-face interviews with 18 nurses. Interview guide themes were informed by the COM-B model, using validated descriptions in Dutch. Data were recorded, transcribed and analysed using inductive thematic analysis. RESULTS Factors that affected dietary behaviour change support were linked to (1) the nurse (role identity, dietary knowledge and competences such as methodical approach, behaviour change techniques and communication techniques), (2) nurse-patient encounter (building a relationship with a patient, supporting patient autonomy and tailoring the approach) and (3) cooperation and organizational context. CONCLUSION It is of utmost importance to pay attention to nurses' role identity regarding dietary behaviour change support, as this underlies professional behaviour. This should be accompanied by improving competences on dietary behaviour change support. Focus on competences regarding the application of behaviour change technique is crucial. Furthermore, having a relationship of trust with a patient was important for discussing sensitive topics such as diet. IMPACT The promotion of a healthy diet provides opportunities to contribute to patient autonomy and self-management. Well-fitted training offers for (senior) nurses will lead to improved professional practice of nurses, leading to healthier dietary behaviour of patients. PATIENT OR PUBLIC CONTRIBUTION A nurse provided feedback on the interview guide.
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Affiliation(s)
- Gerlinde Den Hamer-Jordaan
- Department of Nursing, Christian University of Applied Sciences (CHE), Ede, The Netherlands
- Department of Consumption and Healthy Lifestyles, Wageningen University, Wageningen, The Netherlands
| | | | - Annemien Haveman-Nies
- Department of Consumption and Healthy Lifestyles, Wageningen University, Wageningen, The Netherlands
| | | | - Ytje J J Van Der Veen
- Department of Nursing, Christian University of Applied Sciences (CHE), Ede, The Netherlands
| | - Hylkje F Algra
- Department of Nursing, Christian University of Applied Sciences (CHE), Ede, The Netherlands
| | - Willemieke Kroeze
- Department of Nursing, Christian University of Applied Sciences (CHE), Ede, The Netherlands
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Gerwing J, White AEC, Henry SG. Communicative Practices Clinicians Use to Correct Patient Misconceptions in Primary Care Visits. HEALTH COMMUNICATION 2023:1-16. [PMID: 38111218 PMCID: PMC11182885 DOI: 10.1080/10410236.2023.2283658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
To investigate how clinicians correct patient misconceptions, we analyzed 23 video recordings of primary care visits. Analysis focused on operationalizing, identifying, and characterizing clinician corrections, integrating two inductive approaches: microanalysis of clinical interaction and conversation analysis. According to our definition, patient misconception-clinician correction episodes met three essential criteria: (1) the clinician refuted something the patient had said, (2) which the patient had presented without uncertainty, and (3) which contained a proposition that was factually incorrect. We identified 59 such episodes; the patient misconceptions most commonly related to medication issues; fewer than half had foreseeable implications for patients' future actions. We identified seven clinician correction practices: Three direct practices (displaying surprise, marking disagreement, contradicting the patient) and four indirect practices (presenting the correct proposition, providing explanations, invoking an outside authority, demonstrating with evidence). We found an almost equal distribution of these direct and indirect practices.
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Affiliation(s)
- J. Gerwing
- Health Services Research Unit, Akershus University Hospital, Norway
| | - Anne E. C. White
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, USA
| | - Stephen G. Henry
- Department of Internal Medicine, University of California Davis, Sacramento, California, USA
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Yassin R, Amer H, Tantawi ME. Effectiveness of silver diamine fluoride versus sodium fluoride varnish combined with mother's motivational interviewing for arresting early childhood caries: a randomized clinical trial. BMC Oral Health 2023; 23:710. [PMID: 37789300 PMCID: PMC10548636 DOI: 10.1186/s12903-023-03456-3] [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: 05/28/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Silver Diamine Fluoride (SDF) has gained attention as one of the minimally invasive modalities to manage ECC although it causes black staining of treated carious lesions. A possible affordable alternative may be Sodium Fluoride (NaF) varnish combined with good oral hygiene promoted by parental Motivational Interviewing (MI). The study compared the effectiveness of 38% SDF solution and 5% NaF varnish supported by parental MI in arresting ECC. MATERIALS AND METHODS Children aged ≤ 4 years old with at least one active carious lesion (ICDAS score ≥ 3) were randomly assigned to treatment by a single application of 38% SDF solution or a single application of 5% NaF varnish supported by two MI sessions for mothers at baseline and after three months. Chi-Squared test was used to compare groups and multilevel logistic regression analysis was used to assess the effect of the interventions on ECC arrest adjusting for confounders. The interaction between the type of intervention and baseline lesion severity, moderate (ICDAS 3/4) or advanced (ICDAS 5/6), was also assessed. RESULTS The study included 165 children with 949 active lesions. After 6 months, there were no significant differences between SDF and NaF/MI groups in overall caries arrest (63.7% and 58.1%, p = 0.08), and in moderate lesions (72.9% and 69.6%, p = 0.52). However, in advanced lesions, the arrest rate was significantly higher in the SDF than the NaF/ MI group (60.3% and 50.0%, P = 0.01). Multilevel multiple logistic regression showed no significant differences between the interventions (AOR = 1.56, P = 0.27) with significant interaction between the intervention and baseline lesion severity (p < 0.001). Moderate lesions treated with SDF (AOR = 3.69, P = 0.008) or NaF/MI (AOR = 3.32, P < 0.001) had significantly higher odds of arrest than advanced lesions treated with NaF/ MI with no difference between advanced lesions treated with SDF or NaF/ MI (AOR = 1.85, P = 0.155) in arrest rate. CONCLUSION NaF/ MI can be an alternative to SDF in arresting advanced and moderate ECC lesions without staining with stronger effect on moderate lesions (ICDAS 3/4). TRIAL REGISTRATION The trial was retrospectively registered at clinicaltrial.gov registry (#NCT05761041) on 9/3/2023.
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Affiliation(s)
- Randa Yassin
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Hala Amer
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Singh B, Olds T, Brinsley J, Dumuid D, Virgara R, Matricciani L, Watson A, Szeto K, Eglitis E, Miatke A, Simpson CEM, Vandelanotte C, Maher C. Systematic review and meta-analysis of the effectiveness of chatbots on lifestyle behaviours. NPJ Digit Med 2023; 6:118. [PMID: 37353578 DOI: 10.1038/s41746-023-00856-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/01/2023] [Indexed: 06/25/2023] Open
Abstract
Chatbots (also known as conversational agents and virtual assistants) offer the potential to deliver healthcare in an efficient, appealing and personalised manner. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of chatbot interventions designed to improve physical activity, diet and sleep. Electronic databases were searched for randomised and non-randomised controlled trials, and pre-post trials that evaluated chatbot interventions targeting physical activity, diet and/or sleep, published before 1 September 2022. Outcomes were total physical activity, steps, moderate-to-vigorous physical activity (MVPA), fruit and vegetable consumption, sleep quality and sleep duration. Standardised mean differences (SMD) were calculated to compare intervention effects. Subgroup analyses were conducted to assess chatbot type, intervention type, duration, output and use of artificial intelligence. Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment tool. Nineteen trials were included. Sample sizes ranged between 25-958, and mean participant age ranged between 9-71 years. Most interventions (n = 15, 79%) targeted physical activity, and most trials had a low-quality rating (n = 14, 74%). Meta-analysis results showed significant effects (all p < 0.05) of chatbots for increasing total physical activity (SMD = 0.28 [95% CI = 0.16, 0.40]), daily steps (SMD = 0.28 [95% CI = 0.17, 0.39]), MVPA (SMD = 0.53 [95% CI = 0.24, 0.83]), fruit and vegetable consumption (SMD = 0.59 [95% CI = 0.25, 0.93]), sleep duration (SMD = 0.44 [95% CI = 0.32, 0.55]) and sleep quality (SMD = 0.50 [95% CI = 0.09, 0.90]). Subgroup analyses showed that text-based, and artificial intelligence chatbots were more efficacious than speech/voice chatbots for fruit and vegetable consumption, and multicomponent interventions were more efficacious than chatbot-only interventions for sleep duration and sleep quality (all p < 0.05). Findings from this systematic review and meta-analysis indicate that chatbot interventions are efficacious for increasing physical activity, fruit and vegetable consumption, sleep duration and sleep quality. Chatbot interventions were efficacious across a range of populations and age groups, with both short- and longer-term interventions, and chatbot only and multicomponent interventions being efficacious.
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Affiliation(s)
- Ben Singh
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia.
| | - Timothy Olds
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Jacinta Brinsley
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Dot Dumuid
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Rosa Virgara
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Lisa Matricciani
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Amanda Watson
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Kimberley Szeto
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Emily Eglitis
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Aaron Miatke
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Catherine E M Simpson
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Corneel Vandelanotte
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Carol Maher
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
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Veinot TC, Gillespie B, Argentina M, Bragg-Gresham J, Chatoth D, Collins Damron K, Heung M, Krein S, Wingard R, Zheng K, Saran R. Enhancing the Cardiovascular Safety of Hemodialysis Care Using Multimodal Provider Education and Patient Activation Interventions: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46187. [PMID: 37079365 PMCID: PMC10160944 DOI: 10.2196/46187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, with most patients with ESKD receiving in-center hemodialysis treatment. This life-saving treatment can result in cardiovascular and hemodynamic instability, with the most common form being low blood pressure during the dialysis treatment (intradialytic hypotension [IDH]). IDH is a complication of hemodialysis that can involve symptoms such as fatigue, nausea, cramping, and loss of consciousness. IDH increases risks of cardiovascular disease and ultimately hospitalizations and mortality. Provider-level and patient-level decisions influence the occurrence of IDH; thus, IDH may be preventable in routine hemodialysis care. OBJECTIVE This study aims to evaluate the independent and comparative effectiveness of 2 interventions-one directed at hemodialysis providers and another for patients-in reducing the rate of IDH at hemodialysis facilities. In addition, the study will assess the effects of interventions on secondary patient-centered clinical outcomes and examine factors associated with a successful implementation of the interventions. METHODS This study is a pragmatic, cluster randomized trial to be conducted in 20 hemodialysis facilities in the United States. Hemodialysis facilities will be randomized using a 2 × 2 factorial design, such that 5 sites will receive a multimodal provider education intervention, 5 sites will receive a patient activation intervention, 5 sites will receive both interventions, and 5 sites will receive none of the 2 interventions. The multimodal provider education intervention involved theory-informed team training and the use of a digital, tablet-based checklist to heighten attention to patient clinical factors associated with increased IDH risk. The patient activation intervention involves tablet-based, theory-informed patient education and peer mentoring. Patient outcomes will be monitored during a 12-week baseline period, followed by a 24-week intervention period and a 12-week postintervention follow-up period. The primary outcome of the study is the proportion of treatments with IDH, which will be aggregated at the facility level. Secondary outcomes include patient symptoms, fluid adherence, hemodialysis adherence, quality of life, hospitalizations, and mortality. RESULTS This study is funded by the Patient-Centered Outcomes Research Institute and approved by the University of Michigan Medical School's institutional review board. The study began enrolling patients in January 2023. Initial feasibility data will be available in May 2023. Data collection will conclude in November 2024. CONCLUSIONS The effects of provider and patient education on reducing the proportion of sessions with IDH and improving other patient-centered clinical outcomes will be evaluated, and the findings will be used to inform further improvements in patient care. Improving the stability of hemodialysis sessions is a critical concern for clinicians and patients with ESKD; the interventions targeted to providers and patients are predicted to lead to improvements in patient health and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46187.
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Affiliation(s)
- Tiffany Christine Veinot
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Brenda Gillespie
- Department of Biostatistics, Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI, United States
| | | | - Jennifer Bragg-Gresham
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Michael Heung
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
| | - Sarah Krein
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States
- Veterans Affairs Center for Clinical Management Research, US Department of Veterans Affairs, Ann Arbor, MI, United States
| | | | - Kai Zheng
- School of Information and Computer Sciences, University of California Irvine, Irvine, CA, United States
| | - Rajiv Saran
- Division of Nephrology, School of Medicine, Ann Arbor, MI, United States
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, United States
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Groenendijk-van Woudenbergh GJ, van Hell-Cromwijk MC, van der Veen YJJ, Algra HF, Kroeze W. Facilitators and barriers for promoting healthy eating among primary care patients: results of a qualitative study among practice nurses. Fam Pract 2022; 39:144-149. [PMID: 34482402 DOI: 10.1093/fampra/cmab092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Practice nurses have an important role in promoting healthy eating to prevent or delay long-term complications from chronic lifestyle-related diseases. OBJECTIVE To identify the facilitators and barriers encountered by practice nurses at a professional level when promoting healthy eating among patients. METHODS Face-to-face semi-structured interviews were conducted with 21 Dutch practice nurses. Data were recorded, transcribed and analysed using inductive thematic analysis. RESULTS Two main themes were determined: professional characteristics and professional-patient encounter. Professional characteristics included good communication skills and experience facilitated the successful promotion of healthy eating, while a lack of communication skills and lack of knowledge about diet were perceived as barriers. The most frequently identified facilitators for professional-patient encounter included ensuring a personal connection with patients, creating food awareness, focussing on small changes, adopting a tailored approach, motivating and arranging extra consultations. Barriers included lack of skills to raise the topic, lack of persistence, inability to find a common understanding, lack of competence in handling patients' own choices and underuse of existing educational materials. CONCLUSIONS Further research using the identified facilitators and barriers for promoting healthy eating in primary care patients with chronic diseases could assist in the development of future training programmes for practice nurses.
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Affiliation(s)
| | | | - Ytje J J van der Veen
- Department of Nursing, Christian University of Applied Sciences (CHE), Ede, The Netherlands
| | - Hylkje F Algra
- Department of Nursing, Christian University of Applied Sciences (CHE), Ede, The Netherlands
| | - Willemieke Kroeze
- Department of Nursing, Christian University of Applied Sciences (CHE), Ede, The Netherlands
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10
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Sharp A, Brown B, Shreve T, Moore K, Carlson M, Braughton D. Direct-Care Staff Perceptions of Patient Engagement and Treatment Planning in Detox. J Behav Health Serv Res 2021; 48:566-582. [PMID: 34590236 DOI: 10.1007/s11414-021-09757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
As the prevalence of substance use disorders and drug-related deaths continue to rise, addiction treatment facilities are charged with providing effective and efficient services to curb the national substance use crisis. Direct-care staff in treatment service facilities play a crucial role in whether or not evidence-based practices are incorporated. Without their understanding and utilization of patient engagement best practices, an organization risks maintaining the status quo rather than actively pursuing improved outcomes through empirically supported approaches. Through in-depth interviews (N=13) with nurses, counselors, and behavioral health technicians in an inpatient detoxification facility, this study evaluates the perspectives and experiences of direct-care staff through a lens of patient engagement in treatment planning. The findings from these interviews elucidate how participants' personal characteristics and values, perspectives of patient engagement, understanding of treatment planning, and organizational culture and operations facilitate or inhibit the integration of patient engagement for treatment planning in detox.
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Affiliation(s)
- Amanda Sharp
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Down Blvd., Tampa, FL, 33612, USA.
| | - Bonnie Brown
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Down Blvd., Tampa, FL, 33612, USA
| | - Tayler Shreve
- Department of Justice, Law, and Criminology, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA
| | - Kathleen Moore
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Down Blvd., Tampa, FL, 33612, USA
| | - Melissa Carlson
- Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Down Blvd., Tampa, FL, 33612, USA
| | - David Braughton
- Agency for Community Treatment Services, Inc., 4612 N 56th St., Tampa, FL, 33610, USA
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Hershberger PJ, Pei Y, Bricker DA, Crawford TN, Shivakumar A, Vasoya M, Medaramitta R, Rechtin M, Bositty A, Wilson JF. Advancing Motivational Interviewing Training with Artificial Intelligence: ReadMI. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:613-618. [PMID: 34113205 PMCID: PMC8186935 DOI: 10.2147/amep.s312373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Motivational interviewing (MI) is an evidence-based, brief interventional approach that has been demonstrated to be highly effective in triggering change in high-risk lifestyle behaviors. MI tends to be underutilized in clinical settings, in part because of limited and ineffective training. To implement MI more widely, there is a critical need to improve the MI training process in a manner that can provide prompt and efficient feedback. Our team has developed and tested a training tool, Real-time Assessment of Dialogue in Motivational Interviewing (ReadMI), that uses natural language processing (NLP) to provide immediate MI metrics and thereby address the need for more effective MI training. METHODS Metrics produced by the ReadMI tool from transcripts of 48 interviews conducted by medical residents with a simulated patient were examined to identify relationships between physician-speaking time and other MI metrics, including the number of open- and closed-ended questions. In addition, interrater reliability statistics were conducted to determine the accuracy of the ReadMI's analysis of physician responses. RESULTS The more time the physician spent talking, the less likely the physician was engaging in MI-consistent interview behaviors (r = -0.403, p = 0.007), including open-ended questions, reflective statements, or use of a change ruler. CONCLUSION ReadMI produces specific metrics that a trainer can share with a student, resident, or clinician for immediate feedback. Given the time constraints on targeted skill development in health professions training, ReadMI decreases the need to rely on subjective feedback and/or more time-consuming video review to illustrate important teaching points.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Yong Pei
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Dean A Bricker
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Timothy N Crawford
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Ashutosh Shivakumar
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Miteshkumar Vasoya
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Raveendra Medaramitta
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Maria Rechtin
- Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Aishwarya Bositty
- Department of Computer Science and Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Josephine F Wilson
- Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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van Heuckelum M, van den Ende CHM, van Dulmen S, van den Bemt BJF. Electronic Monitoring Feedback for Improving Medication Adherence and Clinical Outcomes in Early Rheumatoid Arthritis: A Randomized Clinical Trial. Patient Prefer Adherence 2021; 15:1107-1119. [PMID: 34079231 PMCID: PMC8164714 DOI: 10.2147/ppa.s297170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/19/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Non-adherence to medication (range 30-107%) is a major issue in patients with rheumatoid arthritis (RA). Previous research has shown that electronic monitoring feedback (EMF) might be an effective strategy to improve medication adherence in chronic conditions. Therefore, this study investigated the effectiveness of electronic monitoring feedback in patients with early RA to improve medication adherence and clinical outcomes compared to usual care. METHODS An open-label randomized clinical trial was performed to compare EMF with standard care during a 12-month follow-up period on two sites of the Sint Maartenskliniek (Nijmegen and Boxmeer) in the Netherlands. Patients were eligible if they: (1) had a (working) diagnosis of early RA, (2) were currently using methotrexate, (3) were aged ≥18 years, and (4) had a life expectancy of ≥12 months. Primary outcome was the difference in proportion of non-adherent patients measured with the Compliance Questionnaire on Rheumatology after 12 months. Secondary outcomes were beliefs about medicines, medication adherence measured with the MMAS-8®, patients' health status, prescription of biologic DMARDs, and disease activity after 12 months. RESULTS Of the 367 initially-invited patients, 93 patients with early RA agreed to participate in this study. No significant difference was found in the proportion of non-adherent patients between the intervention arm and the usual care arm after 12 months follow-up (60.0% and 61.3%, p=0.93, respectively). Patients in the intervention arm tended to discontinue methotrexate earlier than patients in the usual care arm (median time in weeks: 15.7 (9.1-33.6) and 21.9 (19-28.4), respectively, p=0.31), whereas patients in the usual care arm tended to initiate biologic DMARDs earlier than those in the intervention arm (median time in weeks: 11.9 (5.7-22) and 17 (9.9-40.9), respectively, p=0.55). CONCLUSION This study illustrates the challenge of targeting non-adherence with EMF in patients with early RA and shares important lessons learned about designing adherence intervention trials with respect to study attrition, accounting for drug survival, intervention fidelity, intervention uptake, and technical aspects.
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Affiliation(s)
- Milou van Heuckelum
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Promoting physical activity in primary care: a systematic review and meta-analysis. Br J Gen Pract 2021; 71:e399-e405. [PMID: 33824160 PMCID: PMC8049206 DOI: 10.3399/bjgp.2020.0817] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/23/2020] [Indexed: 01/17/2023] Open
Abstract
Background Promoting physical activity is an important part of patient care in primary care and has been investigated in many studies with a wide range of intervention characteristics, often including external support. It is unclear, however, if promoting physical activity is effective. Aim To investigate the effectiveness of behaviour change interventions to promote physical activity in primary care. Design and setting This is a systematic review and meta-analysis to evaluate physical activity promotion in a primary care setting. Method EMBASE, MEDLINE, PsycInfo, and the Joanna Briggs Institute Database were searched for ‘physical activity’, ‘interview’, ‘motivation’, ‘primary care’, and equivalent words to identify randomised controlled trials with physical activity as the outcome at patient level. Results The review identified 25 eligible studies. The quality appraisal showed that most studies reported insufficient details regarding randomisation, group allocation, blinding, and fidelity of intervention delivery. The included studies reported a wide range of interventions with varying numbers of follow-up visits or phone calls. The overall effect size for interventions with a 6-month follow-up interval was 0.04 (95% confidence interval [CI] = −0.06 to 0.14), and for interventions with a 12-month follow-up interval it was 0.19 (95% CI = 0.03 to 0.36). Only one intervention based on three motivational interviewing sessions achieved a moderate effect. Conclusion Counselling to promote physical activity in primary care has a limited effect on patients’ behaviour and it might not, on its own, be enough to change physical activity behaviour.
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Song X, Hallensleben C, Zhang W, Jiang Z, Shen H, Gobbens RJJ, Kleij RMJJVD, Chavannes NH, Versluis A. Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e24602. [PMID: 33788700 PMCID: PMC8047793 DOI: 10.2196/24602] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 12/22/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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Affiliation(s)
- Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Weihong Zhang
- Faculty of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zongliang Jiang
- Faculty of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Hair BY, Sripipatana A. Patient-Provider Communication and Adherence to Cholesterol Management Advice: Findings from a Cross-Sectional Survey. Popul Health Manag 2021; 24:581-588. [PMID: 33416441 DOI: 10.1089/pop.2020.0290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
High cholesterol is a preventable risk factor for heart disease. This study examines which aspects of patient-provider communication are associated with patient report of increased adherence to cholesterol management advice in a diverse, low-income patient population accessing the health care safety net, using the 2014 Health Center Patient Survey. Patient-provider communication measures included patient report of: how often a provider listened carefully, gave easy-to-understand information, knew important information about the patient's medical history, showed respect, and spent enough time with the patient. Outcome measures were patient report of following provider advice to eat fewer high fat or high cholesterol foods, manage weight, increase physical activity, or take prescribed medicine. In adjusted analyses, when patients perceived their provider always knew their medical history, patients were more likely to report taking prescribed medication (adjusted odds ratio [aOR]: 3.2; 95% confidence interval [CI]: 1.6, 6.6). Knowledge of medical history (aOR: 2.8, 95% CI: 1.4, 5.8), spending enough time (aOR: 2.3, 95% CI: 1.2, 4.4), and providing easily understandable information (aOR: 2.2, 95% CI: 1.0, 4.7) were significantly associated with report of following physical activity advice. Knowledge of medical history (aOR: 2.3, 95% CI: 1.0, 5.2) and providing easily understandable information (aOR: 3.3, 95% CI: 1.4, 7.9) were significantly associated with report of following weight management advice. This study indicates different components of patient-provider communication influence patient adherence to lifestyle modification advice and medication prescription. These results suggest a tailored approach to optimize the impact of patient-provider communication on cholesterol management advice adherence.
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Affiliation(s)
- Brionna Y Hair
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland, USA
| | - Alek Sripipatana
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland, USA
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Sharp A, Armstrong A, Moore K, Carlson M, Braughton D. Patient Perspectives on Detox: Practical and Personal Considerations through a Lens of Patient-Centered Care. Subst Use Misuse 2021; 56:1593-1606. [PMID: 34228598 DOI: 10.1080/10826084.2021.1936050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Inpatient detoxification is often required before a client can move on to additional substance abuse treatment services. Although often short-term, time spent in inpatient detoxification tends to have long-lasting effects on the recovery process. This qualitative study focuses on one treatment facility in Tampa, Florida that offers a range of recovery services, including inpatient detox and outpatient treatment. Focus groups (N = 70 participants) captured client perceptions of direct clinical care operations, access to resources, and relationships with direct care staff within the inpatient detox program. Perceptions were then assessed using a thematic analysis approach with attention to the literature on person-centered care best practices, behavior change, and patient engagement theories to better understand how facility practices affect treatment engagement and retention. Findings elucidated several practical facilitators and barriers to recovery such as facility resources, services offered, transition to aftercare, and sustainability of treatment. Findings also illuminated several personal facilitators and barriers including patient-staff interactions, personal motivation, and family and community support. The resulting recommendations for practice and research are discussed.
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Affiliation(s)
- Amanda Sharp
- University of South Florida, Tampa, Florida, USA
| | | | | | | | - David Braughton
- Agency for Community Treatment Services, Tampa, Florida, USA
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Maltinsky W, Swanson V. Behavior change in diabetes practitioners: An intervention using motivation, action planning and prompts. PATIENT EDUCATION AND COUNSELING 2020; 103:2312-2319. [PMID: 32402490 DOI: 10.1016/j.pec.2020.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES It is important for health professionals to have behavior change skills to empower people to manage long-term-conditions. Theoretically derived, competency-based training can be particularly effective where it considers reflective and automatic routes to behavior change. The aim of this study was to develop, deliver and evaluate a motivational, action and prompting behavior change skills intervention for diabetes health practitioners in Scotland, UK. METHODS This was a longitudinal intervention study. A 2-day intervention was delivered to 99 health professionals. Participants set behavioral goals to change practice, completing action and coping plans post-training. Motivation and plan quality were evaluated in relation to goal achievement at 6-week follow-up. RESULTS Post-training, practitioners could develop high quality work-related action and coping plans, which they were motivated to enact. Although under half responded at follow-up, most reported successful goal achievement. There was no difference in plan quality for goal achievers, non-achievers and non-responders. Barriers and facilitators of behavior change included institutional, service-user and individual factors. CONCLUSIONS The intervention successfully used planning to implement participants' behaviour change goals. PRACTICE IMPLICATIONS Planning interventions are helpful to support clinicians to change their practice to help people self-manage diabetes care but may not fit demands of day-to-day clinical practice.
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Affiliation(s)
- Wendy Maltinsky
- Centre for Health and Behaviour Change, Psychology Division, University of Stirling, Stirling FK9 4LA, United Kingdom.
| | - Vivien Swanson
- Centre for Health and Behaviour Change, Psychology Division, University of Stirling, Stirling FK9 4LA, United Kingdom
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18
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James S, Mcinnes S, Halcomb E, Desborough J. General practice nurses’ communication strategies for lifestyle risk reduction: A content analysis. J Adv Nurs 2020; 76:3082-3091. [DOI: 10.1111/jan.14518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/21/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Sharon James
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong Bega Australia
| | - Susan Mcinnes
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong & Illawarra Health & Medical Research Institute Wollongong Australia
| | - Elizabeth Halcomb
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong & Illawarra Health & Medical Research Institute Wollongong Australia
| | - Jane Desborough
- Department of Health Services Research and Policy Research School of Population HealthCollege of Medicine, Biology and the EnvironmentAustralian National University Acton Australia
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Hoplock LB, Lobchuk MM, Lemoine J. Perceptions of an evidence-based empathy mobile app in post-secondary education. EDUCATION AND INFORMATION TECHNOLOGIES 2020; 26:1273-1292. [PMID: 32863732 PMCID: PMC7447085 DOI: 10.1007/s10639-020-10311-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
Cognitive empathy (also known as perspective-taking) is an important, teachable, skill. As part of a knowledge translation project, we identified a) interest in an evidence-based cognitive empathy mobile app and b) which faculties believe that cognitive empathy is important for their profession. Students (n = 638) and instructors/professors (n = 38) completed a university-wide survey. Participants in Education, Social Work, and the Health Sciences were among those most interested in the app. The majority of participants said that they would prefer for the app to be free or less than $3 for students. Most participants preferred a one-time payment option. Across 17 faculties, all but one had 60% or more of its sampled members say that cognitive empathy is important for their profession. Results illuminate perceptions of cognitive empathy instruction and technology. Results also provide insight into issues to consider when developing and implementing an educational communication app.
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Affiliation(s)
- Lisa B. Hoplock
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2 Canada
| | - Michelle M. Lobchuk
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2 Canada
| | - Jocelyne Lemoine
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2 Canada
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Dixon D, Johnston M. MAP: A mnemonic for mapping BCTs to three routes to behaviour change. Br J Health Psychol 2020; 25:1086-1101. [PMID: 32715603 DOI: 10.1111/bjhp.12458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Over 90 behaviour change techniques (BCTs) have been specified but there is limited guidance to assist non-specialist practitioners in the choice of which BCTs to select for use with clients. This paper describes the development of MAP, a theory-based mnemonic designed to aid practitioners in their use of BCTs. Each BCT is MAPed to one or more of three recognized routes to behaviour change, namely Motivation development, Action control, and Prompted or cued route. DESIGN A cross-sectional online discriminant content validity (DCV) questionnaire. METHODS Fourteen judges participated, decided whether each BCT affects behaviour via each of the three routes, and provided a confidence rating for each judgement. Wilcoxon one-sample tests classified each BCT to a route or combination of routes. Intraclass correlation coefficients (ICC) assessed agreement between judges. RESULTS Fifty-eight BCTs were judged to affect behaviour via a single route; 28, 21, and nine BCTs were judged to act via the Motivation, Action, or Prompted routes, respectively. Judges did not agree on a route for 35 BCTs. Overall ICC (0.89) value was high and did not differ between routes. CONCLUSIONS There was good agreement on candidate BCTs for interventions designed to operate through Motivation, Action, or Prompted/Cued psychological processes. MAP is a mnemonic that can be used by non-specialist practitioners who implement behaviour change with their clients. MAP is not a replacement for sophisticated theory-based organization of BCTs required for theory testing. While providing practical guidance, further work is necessary to establish effectiveness of BCTs tailored to each route.
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James S, Desborough J, McInnes S, Halcomb EJ. Nonverbal communication between registered nurses and patients during chronic disease management consultations: Observations from general practice. J Clin Nurs 2020; 29:2378-2387. [DOI: 10.1111/jocn.15249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/06/2020] [Accepted: 03/13/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Sharon James
- School of Nursing University of Wollongong BEGA NSW Australia
| | - Jane Desborough
- Department of Health Services Research and Policy Research School of Population Health College of Medicine, Biology and the Environment Australian National University ACTON ACT Australia
| | - Susan McInnes
- School of Nursing University of Wollongong WOLLONGONG NSW Australia
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Romero-Rodríguez E, Pérula de Torres LÁ, Fernández García JÁ, Roldán Villalobos A, Ruiz Moral R, Parras Rejano JM. Impact of a primary care training program on the prevention and management of unhealthy alcohol use: A quasi-experimental study. PATIENT EDUCATION AND COUNSELING 2019; 102:2060-2067. [PMID: 31178165 DOI: 10.1016/j.pec.2019.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the impact of a training program targeted to Primary Care (PC) professionalson the acquisition of communication skills, attitudes, and knowledge about the prevention and management of unhealthy alcohol use. METHODS A quasi-experimental, pre- and post-intervention study was performed in PC centers of Cordoba (Spain). Family doctors, residents and nurses participated in the study. The intervention was based on a motivational interviewing training program, which consisted in a workshop on learning skills, attitudes and knowledge about the alcohol management. PC providers were videotaped with a standardized patient in order to check the clinical and communication competencies acquired. A descriptive, bivariate and multivariate analysis was carried out (p < 0.05). RESULTS PC providers' communication skills and attitudes showed significant improvements in the variables studied (p < 0.001), as well as in the clinical interview evaluation parameters. CONCLUSION The present study reveals the impact of a training program targeted to PC professionals on communication skills, attitudes, and knowledge about the prevention and management of patients with unhealthy alcohol use. PRACTICE IMPLICATIONS Training activities targeted to PC providers represent a valuable strategy to improve communication skills, attitudes and knowledge of these professionals in their clinical practice.
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Affiliation(s)
- Esperanza Romero-Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.
| | - Luis Ángel Pérula de Torres
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Teaching Unit of Family and Community Medicine, Health District of Cordoba and Guadalquivir, Cordoba, Spain; Program of Preventive Activities and Health Promotion -PAPPS- (semFYC). Barcelona, Spain
| | - José Ángel Fernández García
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Villarrubia Health Center, Andalusian Health Service, Cordoba, Spain
| | - Ana Roldán Villalobos
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Teaching Unit of Family and Community Medicine, Health District of Cordoba and Guadalquivir, Cordoba, Spain; Carlos Castilla Del Pino Health Center, Andalusian Health Service, Cordoba, Spain
| | - Roger Ruiz Moral
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Francisco de Vitoria University, Madrid, Spain
| | - Juan Manuel Parras Rejano
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Villanueva del Rey Health Center, Andalusian Health Service, Cordoba, Spain
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James S, McInnes S, Halcomb E, Desborough J. Lifestyle risk factor communication by nurses in general practice: Understanding the interactional elements. J Adv Nurs 2019; 76:234-242. [DOI: 10.1111/jan.14221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/19/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Sharon James
- School of Nursing University of Wollongong Bega NSW Australia
| | - Susan McInnes
- School of Nursing University of Wollongong Wollongong NSW Australia
| | | | - Jane Desborough
- Department of Health Services Research and Policy Research School of Population Health College of Medicine, Biology and the Environment Australian National University Canberra ACT Australia
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Keller AO, Ortiz A. Physical Activity Health Communication for Adults With Mood Disorders in the United States. West J Nurs Res 2019; 42:97-107. [PMID: 31113294 DOI: 10.1177/0193945919848772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Using national representative data, this study sought to examine receipt of physical activity communication and counseling among adults with mood disorders in comparison to the general population in the United States. The sample consisted of adult primary-care visits in the National Hospital Ambulatory Medical Care and National Ambulatory Medical Care Surveys. Multivariable logistic regression was used to examine the relationship between mental health status and receipt of physical activity communication and counseling. Overall, less than 20% of visits included physical activity communication and counseling. Controlling for covariates, visits for adults with a mood disorder diagnosis were associated with an increased odds of including physical activity communication and counseling, odds ratio = 1.25, 95% confidence interval = [1.08, 1.45]. Although adults with mood disorders were more likely to receive physical activity communication and counseling, most primary-care visits for adults in the United States did not include physical activity communication and counseling.
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Holmgren M, Sandberg M, Ahlström G. To initiate the conversation - Public health nurses' experiences of working with obesity in persons with mobility disability. J Adv Nurs 2019; 75:2156-2166. [PMID: 31115062 PMCID: PMC6851847 DOI: 10.1111/jan.14081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/26/2019] [Accepted: 03/06/2019] [Indexed: 01/05/2023]
Abstract
Aim Developing a theory explaining how public health nurses accomplish and adapt counselling in lifestyle habits to decrease obesity in people with mobility disability. Design Empirical research ‐ qualitative. Method Classic grounded theory with face‐to‐face interviews, 2017–2018, using inductive approach to understand public health nurses' intervening experiences with obesity patients. Results To initiate the conversation emerged as the main concern meaning having difficulties initiating conversations about obesity with patients. Public health nurses’ facilitators to communicate lifestyle changes emerged as the pattern generating the theory, which consists of the categories; person‐centeredness in the situation, experience and knowledge, strengthening conditions, access to other professionals and prioritization in everyday work. Conclusions Public health nurses hesitate to raise topics of obesity in patients with mobility disability. They advocate increased integration with lifestyle changes in everyday work including multi‐professional cooperation. The implication is testing the emerged theory at primary health care centres. Impact Obesity is more common in people with mobility disability than in those without. There is a need to understand how public health nurses adapt counselling in lifestyle habits. Public health nurses hesitate to talk about obesity with patients in fear of offending anyone. Public health nurses did not distinguish between patients with or without mobility disability. Several facilitators could be helpful initiating conversation with the patients. Public health nurses need more time and resources to facilitate conversation with patients with mobility disability to counsel lifestyle changes.
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Affiliation(s)
- Marianne Holmgren
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Sandberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Lim NLY, Shorey S. Effectiveness of technology-based educational interventions on the empowerment related outcomes of children and young adults with cancer: A quantitative systematic review. J Adv Nurs 2019; 75:2072-2084. [PMID: 30740758 DOI: 10.1111/jan.13974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/10/2018] [Accepted: 12/03/2018] [Indexed: 01/28/2023]
Abstract
AIM To determine the effectiveness of technological-based educational interventions on the empowerment-related outcomes of children and young adults with cancer. DESIGN Quantitative systematic review. DATA SOURCES Six electronic databases, including PubMed, Cochrane Library, EMBASE, CINAHL, Scopus, and PsycINFO, were searched to identify eligible randomized controlled trials from each database's point of inception to December 2017. Grey literature was also searched from ProQuest and MedNar. REVIEW METHODS A narrative summary of the results was undertaken owing to the small number of eligible studies and high heterogeneity across the studies. RESULTS Five studies were included in the review. Five empowerment-related outcomes under the domain "patient states" were identified at differing time points of 3-month postintervention, immediate postintervention, and during treatment: (a) self-efficacy; (b) cancer knowledge; (c) health locus of control; (d) emotional well-being; and (e) quality of life. At 3-month postintervention, health locus of control was found to be significant in two studies and self-efficacy and cancer knowledge were found to be significant in one study. No difference in quality of life was found. At immediate postintervention, a beneficial indication was observed. During treatment, no statistical significance was found regarding the effectiveness of a technological-based cognitive behavioural package. CONCLUSION Weak evidences led to inconclusive findings on the effectiveness of technological-based educational interventions on the empowerment-related outcomes of children and young adults with cancer. Future research will benefit from well-designed clinical trials that use a common outcome measurement to provide more information regarding the effectiveness of such interventions.
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Affiliation(s)
- Natalie L Y Lim
- Nursing Division, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shefaly Shorey
- Yong Loo Lin School of Medicine, Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
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Rowe CA, Sirois FM, Toussaint L, Kohls N, Nöfer E, Offenbächer M, Hirsch JK. Health beliefs, attitudes, and health-related quality of life in persons with fibromyalgia: mediating role of treatment adherence. PSYCHOL HEALTH MED 2019; 24:962-977. [PMID: 30724586 DOI: 10.1080/13548506.2019.1576913] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fibromyalgia is a chronic illness characterized by pain and fatigue. Persons with fibromyalgia experience increased the risk for poor mental and physical health-related quality of life, which may be dependent on multiple factors, including health beliefs, such as confidence in physicians and the health-care system, and health behaviors, such as treatment adherence. Respondents with fibromyalgia (n = 409) were recruited nationally, via support organizations, and completed self-report measures: Multidimensional Health Profile - Health Functioning Index (MHP-H), Short-Form-36 Health Survey (SF-36v2), and Medical Outcomes Study (MOS) Measure of Patient Adherence - General Adherence Items. In mediation models, belief in the healthcare system and health-care personnel, and health efficacy exerted an indirect effect through treatment adherence on mental and physical quality of life. Adaptive health beliefs and attitudes were related to greater treatment adherence and, in turn, to a better quality of life. Maladaptive health beliefs and mistrusting attitudes about physician-level and systemic-level healthcare provision are negatively related to both treatment adherence and consequent physical and mental health-related quality of life in persons with fibromyalgia. Future randomized controlled trials are needed to determine if therapeutic strategies to alter health values might improve adherence and self-rated health.
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Affiliation(s)
| | - Fuschia M Sirois
- b Department of Psychology , University of Sheffield , Sheffield , UK
| | - Loren Toussaint
- c Department of Psychology , Luther University , IA , Decorah , US
| | - Niko Kohls
- d Department of Integrative Health Promotion , Coburg University of Applied Sciences and Arts , Coburg , Germany
| | - Eberhard Nöfer
- d Department of Integrative Health Promotion , Coburg University of Applied Sciences and Arts , Coburg , Germany
| | | | - Jameson K Hirsch
- f Department of Psychology , East Tennessee State University , Johnson City , TN , USA
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James S, Halcomb E, Desborough J, McInnes S. Lifestyle risk communication by general practice nurses: An integrative literature review. Collegian 2019. [DOI: 10.1016/j.colegn.2018.03.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Walsh K, Grech C, Hill K. Health advice and education given to overweight patients by primary care doctors and nurses: A scoping literature review. Prev Med Rep 2019; 14:100812. [PMID: 30805277 PMCID: PMC6374522 DOI: 10.1016/j.pmedr.2019.01.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 01/08/2023] Open
Abstract
Health advice for overweight patients in primary care has been a focus of obesity guidelines. Primary care doctors and nurses are well placed to provide evidence based preventive health advice. This literature review addressed two research questions: ‘When do primary care doctors and nurses provide health advice for weight management?’ and ‘What health advice is provided to overweight patients in primary care settings?’ The study was conducted in the first half of 2018 and followed Arksey and O'Malley (2005) five stage framework to conduct a comprehensive scoping review. The following databases were searched: Emcare, Ovid, Embase, The Cochrane library, Proquest family health, Health source (nursing academic), Joanna Briggs Institute EBP database, Medline, PubMed, Rural and remote, Proquest (nursing and allied health) and TRIP using search term parameters. Two hundred and forty-eight (248) articles were located and screened by two reviewers. Twenty-three research papers met the criteria and data were analysed using a content analysis method. The results show that primary care doctors and nurses are more likely to give advice as BMI increases and often miss opportunities to discuss weight with overweight patients. Body Mass Index (BMI) is often wrongly categorised as overweight, when in fact it is in the range of obese, or not recorded and when health advice is given, it can be of poor quality. Few studies on this topic included people under 40 years, practice nurses as the focus and those with a BMI of 25–29.9 without a risk factor. A ‘toolkit’ approach to improve advice and adherence to evidence based guidelines should be explored in future research.
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Affiliation(s)
- Kristina Walsh
- School of Nursing and Midwifery, the University of South Australia, Australia
| | - Carol Grech
- School of Nursing and Midwifery, the University of South Australia, Australia
| | - Kathy Hill
- School of Nursing and Midwifery, the University of South Australia, Australia
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Bouma AJ, van Wilgen P, Lemmink KAPM, Stewart R, Dijkstra A, Diercks RL. Barrier-belief lifestyle counseling in primary care: A randomized controlled trial of efficacy. PATIENT EDUCATION AND COUNSELING 2018; 101:2134-2144. [PMID: 30072044 DOI: 10.1016/j.pec.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/14/2018] [Accepted: 07/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Intervening on barrier beliefs (BBs) may inhibit the role of barriers as mediating factors in lifestyle behavior. The aim of this study was to analyze the effects of a barrier-belief counseling intervention (BBCI) on physical activity (PA) and healthy food intake. METHODS An RCT was conducted in a primary care setting among adults (aged 18-70), with two interventions: a BBCI (n = 123) and a standardized lifestyle group intervention (SLI) (n = 122). A non-treated hanging control group (n = 36) received no intervention. Outcomes on PA (accelerometer and SQUASH) and fruit and vegetable intake (self-report) were measured with follow-ups at 6, 12 and 18 months, and analyzed using multiple regression. RESULTS The BBCI was more effective on PA compared with the SLI (p < .01): in the short term all PA outcomes improved (p < .05), in the long term moderate-to-vigorous PA outcomes improved (p < .05), all with small effect sizes. No differences between interventions were found on fruit and vegetable intake. None of the outcomes in the control group changed over time. CONCLUSIONS BBCI in primary care improves PA compared with SLI. PRACTICE IMPLICATIONS The customized BB approach seems promising for implementation in healthcare practice to stimulate PA.
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Affiliation(s)
- Adrie J Bouma
- Hanze University of Applied Sciences Groningen, Institute of Sports Studies, Zernikeplein 17, 9766 AS Groningen, The Netherlands.
| | - Paul van Wilgen
- Transcare, Transdisciplinary Pain Management Centre, Barkmolenstraat 196, 9723 DM Groningen, The Netherlands.
| | - Koen A P M Lemmink
- Center for Human Movement Sciences, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Roy Stewart
- Faculty of Medical Sciences, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Arie Dijkstra
- Faculty of Behavioral and Society Sciences, Grote Kruisstraat 2/1, 9712 TS, University of Groningen, Groningen, The Netherlands.
| | - Ron L Diercks
- Department of Sports Medicine and Orthopedic Surgery, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Frost H, Campbell P, Maxwell M, O’Carroll RE, Dombrowski SU, Williams B, Cheyne H, Coles E, Pollock A. Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLoS One 2018; 13:e0204890. [PMID: 30335780 PMCID: PMC6193639 DOI: 10.1371/journal.pone.0204890] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 09/17/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The challenge of addressing unhealthy lifestyle choice is of global concern. Motivational Interviewing has been widely implemented to help people change their behaviour, but it is unclear for whom it is most beneficial. This overview aims to appraise and synthesise the review evidence for the effectiveness of Motivational Interviewing on health behaviour of adults in health and social care settings. METHODS A systematic review of reviews. Methods were pre-specified and documented in a protocol (PROSPERO-CRD42016049278). We systematically searched 7 electronic databases: CDSR; DARE; PROSPERO; MEDLINE; CINAHL; AMED and PsycINFO from 2000 to May 2018. Two reviewers applied pre-defined selection criteria, extracted data using TIDIER guidelines and assessed methodological quality using the ROBIS tool. We used GRADE criteria to rate the strength of the evidence for reviews including meta-analyses. FINDINGS Searches identified 5222 records. One hundred and four reviews, including 39 meta-analyses met the inclusion criteria. Most meta-analysis evidence was graded as low or very low (128/155). Moderate quality evidence for mainly short term (<6 months) statistically significant small beneficial effects of Motivational Interviewing were found in 11 of 155 (7%) of meta-analysis comparisons. These outcomes include reducing binge drinking, frequency and quantity of alcohol consumption, substance abuse in people with dependency or addiction, and increasing physical activity participation. CONCLUSIONS We have created a comprehensive map of reviews relating to Motivational Interviewing to signpost stakeholders to the best available evidence. More high quality research is needed to be confident about the effectiveness of Motivational Interviewing. We identified a large volume of low quality evidence and many areas of overlapping research. To avoid research waste, it is vital for researchers to be aware of existing research, and the implications arising from that research. In the case of Motivational Interviewing issues relating to monitoring and reporting fidelity of interventions need to be addressed.
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Affiliation(s)
- Helen Frost
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Scotland, United Kingdom
| | - Pauline Campbell
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), Glasgow Caledonian University, Glasgow, United Kingdom
| | - Margaret Maxwell
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Ronan E. O’Carroll
- School of Health Sciences, Division of Psychology, University of Stirling, Stirling, Scotland, United Kingdom
| | - Stephan U. Dombrowski
- School of Health Sciences, Division of Psychology, University of Stirling, Stirling, Scotland, United Kingdom
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Scotland, United Kingdom
| | - Helen Cheyne
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Emma Coles
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Alex Pollock
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), Glasgow Caledonian University, Glasgow, United Kingdom
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Lobchuk M, Hoplock L, Halas G, West C, Dika C, Schroeder W, Ashcroft T, Clouston KC, Lemoine J. Heart health whispering: A randomized, controlled pilot study to promote nursing student perspective-taking on carers' health risk behaviors. BMC Nurs 2018; 17:21. [PMID: 29849504 PMCID: PMC5968556 DOI: 10.1186/s12912-018-0291-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lifestyle counseling is described as a "major breakthrough" in the control of chronic diseases. Counseling can be challenging to nurses due their lack of motivation to counsel, hesitancy to appear non-judgmental, lack of empathy, and lack of time. Nurses voice their need for more training in counseling communication skills. Our main objective was to engage in ongoing development and testing of a promising Heart Health Whispering perspective-taking intervention on nursing students' clinical empathy, perceptual understanding, and client readiness to alter health risk behaviors. METHODS In this randomized controlled pilot study, the full intervention (perspective-taking instructions, practice, and video-feedback) and partial intervention (video-feedback only) comprised 24 and 18 nursing students, respectively. Quantitative data were collected with a 10-item pre- and post-intervention clinical empathy tool, a one-item 'readiness to change' health risk behavior tool plus similarity ratings on students' empathic accuracy were calculated. Data were analyzed using Independent Samples t Tests and mixed model ANCOVA models. Students' and actors' evaluative responses toward the intervention phases were collected by handwritten notes, and analyzed using content analysis and constant comparison techniques. RESULTS The main finding was that students in the full intervention group reported greater clinical empathy in the post versus baseline condition. Students underestimated their clinical empathy in comparison to carers' reports in the post-condition. In both intervention groups, carers reported more readiness to change in the post-condition. Carers identified favorable and unfavorable perceptions and outcomes of approaches taken by students. Students desired immediate and direct feedback after the video-dialogue and -tagging exercise. CONCLUSIONS Heart Health Whispering is a promising intervention to help educators in basic and continuing education to bolster nurse confidence in empathic conversations on health risk behaviors. This intervention incorporates commonly used strategies to teach empathic communication along with a novel video-analysis application of a perspective-taking task. Student and carer actor comments highlighted the value in opportunities for students to engage in self-evaluation and practicing the empathic process of taking the client's perspective on health risk behaviors.
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Affiliation(s)
- Michelle Lobchuk
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Lisa Hoplock
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Gayle Halas
- Max Rady Faculty of Health Sciences, College of Medicine, University of Manitoba, P228-770, Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Christina West
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Cheryl Dika
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Wilma Schroeder
- Red River College, Nursing, 2055 Notre Dame Avenue, Winnipeg, MB R3H 0J9 Canada
| | - Terri Ashcroft
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Kathleen Chambers Clouston
- Department of Surgery, Section of General Surgery, University of Manitoba, 770 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Jocelyne Lemoine
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
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Rindlisbacher F, Davis JM, Ramseier CA. Dental students' self-perceived communication skills for patient motivation. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2017; 21:166-174. [PMID: 26960781 DOI: 10.1111/eje.12196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 06/05/2023]
Abstract
AIMS The aim of this study was to evaluate dental students' self-perceived communication skills for patient motivation over the course of their training. MATERIALS AND METHODS Pre-clinical and clinical dental students at the University of Bern School of Dental Medicine were surveyed annually from 2008 to 2011 utilising a written questionnaire. Self-reported data were pooled from all classes per time-point in the curriculum. RESULTS A total of 157 students were surveyed from five classes with an overall response rate of 94.8%. A total of 393 questionnaires were available for analysis. The self-perceived skill-sets for general patient care and patient communication were rated at the end of the first clinical year with mean Visual Analog Scale values of 75.0 ± 1.6 and 75.1 ± 1.5, respectively. During the second clinical year, the self-perceived skills increased in both patient care (82.5 ± 1.2, P = 0.0004) and patient communication (81.4 ± 1.4, P = 0.0034). The students rated their competence higher when providing oral hygiene instructions as opposed to motivating patients to quit tobacco use, modify their diet or employ stress-reduction strategies (P < 0.005). At the end of the pre-clinical year, 74.5% of the students expressed interest in receiving more extensive communication training (P < 0.004). CONCLUSIONS Though dental students in this study demonstrated a steady increase in their level of comfort motivating patients to utilise oral hygiene instructions, they also expressed the desire for more motivational training early in their curriculum. Therefore, these results may indicate the need to enhance communications training in patient motivation on all behavioural aspects early in the dental curriculum.
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Affiliation(s)
- F Rindlisbacher
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - J M Davis
- School of Allied Health, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - C A Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Samdal GB, Eide GE, Barth T, Williams G, Meland E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. Int J Behav Nutr Phys Act 2017. [PMID: 28351367 DOI: 10.1186/s12966–017–0494-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE This systematic review aims to explain the heterogeneity in results of interventions to promote physical activity and healthy eating for overweight and obese adults, by exploring the differential effects of behaviour change techniques (BCTs) and other intervention characteristics. METHODS The inclusion criteria specified RCTs with ≥ 12 weeks' duration, from January 2007 to October 2014, for adults (mean age ≥ 40 years, mean BMI ≥ 30). Primary outcomes were measures of healthy diet or physical activity. Two reviewers rated study quality, coded the BCTs, and collected outcome results at short (≤6 months) and long term (≥12 months). Meta-analyses and meta-regressions were used to estimate effect sizes (ES), heterogeneity indices (I2) and regression coefficients. RESULTS We included 48 studies containing a total of 82 outcome reports. The 32 long term reports had an overall ES = 0.24 with 95% confidence interval (CI): 0.15 to 0.33 and I2 = 59.4%. The 50 short term reports had an ES = 0.37 with 95% CI: 0.26 to 0.48, and I2 = 71.3%. The number of BCTs unique to the intervention group, and the BCTs goal setting and self-monitoring of behaviour predicted the effect at short and long term. The total number of BCTs in both intervention arms and using the BCTs goal setting of outcome, feedback on outcome of behaviour, implementing graded tasks, and adding objects to the environment, e.g. using a step counter, significantly predicted the effect at long term. Setting a goal for change; and the presence of reporting bias independently explained 58.8% of inter-study variation at short term. Autonomy supportive and person-centred methods as in Motivational Interviewing, the BCTs goal setting of behaviour, and receiving feedback on the outcome of behaviour, explained all of the between study variations in effects at long term. CONCLUSION There are similarities, but also differences in effective BCTs promoting change in healthy eating and physical activity and BCTs supporting maintenance of change. The results support the use of goal setting and self-monitoring of behaviour when counselling overweight and obese adults. Several other BCTs as well as the use of a person-centred and autonomy supportive counselling approach seem important in order to maintain behaviour over time. TRIAL REGISTRATION PROSPERO CRD42015020624.
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Affiliation(s)
- Gro Beate Samdal
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Geir Egil Eide
- Department for Research and Development, Haukeland University Hospital, Bergen, Norway.,Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tom Barth
- Member of Motivational Interviewing Network of Trainers (MINT), Allasso, Norway
| | | | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway
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Samdal GB, Eide GE, Barth T, Williams G, Meland E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. Int J Behav Nutr Phys Act 2017; 14:42. [PMID: 28351367 PMCID: PMC5370453 DOI: 10.1186/s12966-017-0494-y] [Citation(s) in RCA: 400] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/13/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose This systematic review aims to explain the heterogeneity in results of interventions to promote physical activity and healthy eating for overweight and obese adults, by exploring the differential effects of behaviour change techniques (BCTs) and other intervention characteristics. Methods The inclusion criteria specified RCTs with ≥ 12 weeks’ duration, from January 2007 to October 2014, for adults (mean age ≥ 40 years, mean BMI ≥ 30). Primary outcomes were measures of healthy diet or physical activity. Two reviewers rated study quality, coded the BCTs, and collected outcome results at short (≤6 months) and long term (≥12 months). Meta-analyses and meta-regressions were used to estimate effect sizes (ES), heterogeneity indices (I2) and regression coefficients. Results We included 48 studies containing a total of 82 outcome reports. The 32 long term reports had an overall ES = 0.24 with 95% confidence interval (CI): 0.15 to 0.33 and I2 = 59.4%. The 50 short term reports had an ES = 0.37 with 95% CI: 0.26 to 0.48, and I2 = 71.3%. The number of BCTs unique to the intervention group, and the BCTs goal setting and self-monitoring of behaviour predicted the effect at short and long term. The total number of BCTs in both intervention arms and using the BCTs goal setting of outcome, feedback on outcome of behaviour, implementing graded tasks, and adding objects to the environment, e.g. using a step counter, significantly predicted the effect at long term. Setting a goal for change; and the presence of reporting bias independently explained 58.8% of inter-study variation at short term. Autonomy supportive and person-centred methods as in Motivational Interviewing, the BCTs goal setting of behaviour, and receiving feedback on the outcome of behaviour, explained all of the between study variations in effects at long term. Conclusion There are similarities, but also differences in effective BCTs promoting change in healthy eating and physical activity and BCTs supporting maintenance of change. The results support the use of goal setting and self-monitoring of behaviour when counselling overweight and obese adults. Several other BCTs as well as the use of a person-centred and autonomy supportive counselling approach seem important in order to maintain behaviour over time. Trial Registration PROSPERO CRD42015020624 Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0494-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gro Beate Samdal
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Geir Egil Eide
- Department for Research and Development, Haukeland University Hospital, Bergen, Norway.,Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tom Barth
- Member of Motivational Interviewing Network of Trainers (MINT), Allasso, Norway
| | | | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway
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Improving Health and Reducing Comorbidity Associated with HIV: The Development of TAVIE en santé, a Web-Based Tailored Intervention to Support the Adoption of Health Promoting Behaviors among People Living with HIV. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4092304. [PMID: 28393077 PMCID: PMC5368366 DOI: 10.1155/2017/4092304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/30/2017] [Indexed: 01/14/2023]
Abstract
Background. In the domain of health behavior change, the deployment and utilization of information and communications technologies as a way to deliver interventions appear to be promising. This article describes the development of a web-based tailored intervention, TAVIE en santé, to support people living with HIV in the adoption of healthy behaviors. Methods. This intervention was developed through an Intervention Mapping (IM) framework and is based on the theory of planned behavior. Results. Crucial steps of IM are the selection of key determinants of behavior and the selection of useful theory-based intervention methods to change the targeted determinants (active ingredients). The content and the sequence of the intervention are then created based on these parameters. TAVIE en santé is composed of 7 interactive web sessions hosted by a virtual nurse. It aims to develop and strengthen skills required for behavior change. Based on an algorithm using individual cognitive data (attitude, perceived behavioral control, and intention), the number of sessions, theory-based intervention methods, and messages contents are tailored to each user. Conclusion. TAVIE en santé is currently being evaluated. The use of IM allows developing intervention with a systematic approach based on theory, empirical evidence, and clinical and experiential knowledge.
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Koide K, Okamoto R, Okada M. Comparison of Public Health Nurse’s Lifestyle Counseling Skills for Clients with Different Readiness of Behavior Changes in Primary Care Settings. Health (London) 2017. [DOI: 10.4236/health.2017.96065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dorflinger LM, Fortin AH, Foran-Tuller KA. Training primary care physicians in cognitive behavioral therapy: A review of the literature. PATIENT EDUCATION AND COUNSELING 2016; 99:1285-1292. [PMID: 26979474 DOI: 10.1016/j.pec.2016.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 02/26/2016] [Accepted: 02/28/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Patients often seek mental health treatment through primary care. Training primary care physicians (PCPs) in approaches to address common mental health concerns may be a useful method for narrowing gaps in care. Cognitive Behavioral Therapy (CBT) is especially applicable in medical settings given its brief, skill-based approach and strong evidence for a number of presenting problems. This paper reviews the current literature on training PCPs in CBT with a focus on PCP-level outcomes. METHODS We reviewed studies that described and evaluated CBT training programs for PCPs. Of 652 records identified and screened, 33 full-text articles were assessed for eligibility, resulting in 9 articles identified for inclusion. RESULTS We extracted and report information about study design, participants, intervention and dose, training content, and outcomes (PCP reaction, learning, and performance; patient outcomes). CONCLUSION There was substantial variability in sample size, methodology, training content and design, and assessment of outcomes, which translated into mixed findings across studies. In order to best assess effectiveness and allow replicability, future studies should provide adequate information about training curricula and assess multiple levels of learning outcomes. PRACTICE IMPLICATIONS Additional studies are needed to determine whether PCPs effectively implement skills within routine practice after CBT training.
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Affiliation(s)
- Lindsey M Dorflinger
- VA Connecticut Healthcare System, West Haven, USA; Yale University School of Medicine, New Haven, USA
| | | | - Kelly A Foran-Tuller
- VA Connecticut Healthcare System, West Haven, USA; Yale University School of Medicine, New Haven, USA.
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Ogunbayo OJ, Schafheutle EI, Cutts C, Noyce PR. How do community pharmacists conceptualise and operationalise self-care support of long-term conditions (LTCs)? An English cross-sectional survey. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:121-132. [PMID: 27324310 DOI: 10.1111/ijpp.12283] [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] [Received: 11/10/2015] [Accepted: 05/20/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore community pharmacists' contributions to self-care support of long-term conditions by; investigating their conceptual understanding of self-care principles; identifying self-care support activities they considered important and their engagement in them; and examining barriers and enablers. METHODS A questionnaire was developed using existing literature and qualitative interviews, piloted and distributed online to a random sample of 10 000 community pharmacists in England between August and November 2014. The questionnaire contained sections addressing the above objectives. Data were analysed using descriptive statistics; free text comments were analysed using content analysis. KEY FINDINGS A total of 609 responses were received; 334 completed all sections of the survey. Responses to statements exploring conceptual understanding showed that respondents were more likely to agree with self-care principles about patients taking responsibility and being more actively involved in their health and care; they agreed less with self-care principles promoting patient autonomy and independence. Respondents considered medicines-related self-care support activities as a lead role for community pharmacy, which they said they engaged in regularly. Whilst many agreed that other self-care support activities such as supporting self-monitoring and collaborative care planning were important, they indicated only limited engagement. Respondents identified access to patient records and availability of private consultation rooms as their main barriers and enablers, respectively; working relationship with GPs and skill-mix in community pharmacy were viewed as both barriers and enablers. CONCLUSIONS Community pharmacists in this study conceptualised and operationalised self-care support of long-term conditions (LTCs) from a narrow, medicines-focussed perspective, rather than from a multifaceted, patient-focussed perspective. A concerted and coherent strategy that builds on the strengths, and tackles the identified barriers is needed if community pharmacy is to improve contributions to self-care support of LTCs.
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Affiliation(s)
- Oladapo J Ogunbayo
- Manchester Pharmacy School, The University of Manchester, Manchester, UK.,Centre for Pharmacy Postgraduate Education (CPPE), Manchester Pharmacy School, The University of Manchester, Manchester, UK
| | | | - Christopher Cutts
- Centre for Pharmacy Postgraduate Education (CPPE), Manchester Pharmacy School, The University of Manchester, Manchester, UK
| | - Peter R Noyce
- Manchester Pharmacy School, The University of Manchester, Manchester, UK
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Greene J, Hibbard JH, Alvarez C, Overton V. Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels. Ann Fam Med 2016; 14:148-54. [PMID: 26951590 PMCID: PMC4781518 DOI: 10.1370/afm.1904] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE We aimed to identify the strategies used to support patient behavior change by clinicians whose patients had an increase in patient activation. METHODS This mixed methods study was conducted in collaboration with Fairview Health Services, a Pioneer Accountable Care Organization. We aggregated data on the change in patient activation measure (PAM) score for 7,144 patients to the primary care clinician level. We conducted in-depth interviews with 10 clinicians whose patients' score increases were among the highest and 10 whose patients' score changes were among the lowest. Transcripts of the interviews were analyzed to identify key strategies that differentiated the clinicians whose patients had top PAM change scores. RESULTS Clinicians whose patients had relatively large activation increases reported using 5 key strategies to support patient behavior change (mean = 3.9 strategies): emphasizing patient ownership; partnering with patients; identifying small steps; scheduling frequent follow-up visits to cheer successes, problem solve, or both; and showing caring and concern for patients. Clinicians whose patients had lesser change in activation were far less likely to describe using these approaches (mean = 1.3 strategies). Most clinicians, regardless of group, reported developing their own approach to support patient behavior change. Those whose patients showed high activation change reported spending more time with patients on counseling and education than did those whose patients showed less improvement in activation. CONCLUSIONS Clinicians vary in the strategies they use to promote behavior change and in the time spent with patients on such activities. The 5 key strategies used by clinicians with high patient activation change are promising approaches to supporting patient behavior change that should be tested in a larger sample of clinicians to validate their effectiveness.
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Affiliation(s)
- Jessica Greene
- School of Nursing, George Washington University, Washington, DC
| | | | - Carmen Alvarez
- School of Nursing, Department of Community-Public Health, Johns Hopkins University, Baltimore, Maryland
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Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care. Sci Rep 2015; 5:18853. [PMID: 26686267 PMCID: PMC4685421 DOI: 10.1038/srep18853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/16/2015] [Indexed: 11/30/2022] Open
Abstract
Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients’ experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients’ perspective; and (ii) to investigate how quality varies with patients’ demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of “coordination of patient information”, “continuity of care”, and “range of service provided”. Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.
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Forsyth A, Deane FP, Williams P. A lifestyle intervention for primary care patients with depression and anxiety: A randomised controlled trial. Psychiatry Res 2015; 230:537-44. [PMID: 26453120 DOI: 10.1016/j.psychres.2015.10.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 08/10/2015] [Accepted: 10/01/2015] [Indexed: 11/28/2022]
Abstract
This study aimed to evaluate the efficacy of a diet and exercise lifestyle intervention on mental health outcomes for patients currently being treated for depression and/or anxiety in primary care. Patients (n=119) referred by general practitioners to the 12-week randomised controlled trial were assigned to either an intervention of six visits to a dual qualified dietitian/exercise physiologist (DEP) where motivational interviewing and activity scheduling were used to engage patients in individually-tailored lifestyle change (focussed on diet and physical activity), or an attention control with scheduled telephone contact. Assessments conducted at baseline (n=94) and 12 weeks (n=60) were analysed with an intent-to-treat approach using linear mixed modelling. Significant improvement was found for both groups on Depression, Anxiety and Stress Scale (DASS) scores, measures of nutrient intake and total Australian modified Healthy Eating Index (Aust-HEI) scores. Significant differences between groups over time were found only for iron intake and body mass index. Patients participating in individual consultations with a dietitian were more likely to maintain or improve diet quality than those participating in an attention control. This study provides initial evidence to support the role of dietitians in the management of patients with depression and/or anxiety.
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Affiliation(s)
- Adrienne Forsyth
- School of Health Sciences, University of Wollongong, Wollongong, NSW, Australia.
| | - Frank P Deane
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Peter Williams
- School of Health Sciences, University of Wollongong, Wollongong, NSW, Australia
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Nevanperä N, Keränen AM, Ukkola O, Laitinen J. Effects of Group Counseling Transmitted Through Videoconferencing on Changes in Eating Behaviors. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:555-559.e1. [PMID: 26323164 DOI: 10.1016/j.jneb.2015.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 07/22/2015] [Accepted: 07/28/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To compare the effects of constructivism-based dietary group counseling transmitted through videoconferencing (VC) and face-to-face (FF) counseling on changes in eating behaviors. METHODS Altogether, 74 participants with high risk of type 2 diabetes were divided into FF and VC groups based on their place of residence in northern Finland. Constructivism-based dietary group counseling, a nonrandomized intervention, was performed (evaluations at 0, 6, and 21 months). The Three-Factor Eating Questionnaire-18 was used to evaluate cognitive restraint eating (CR), emotional eating (EE), and uncontrolled eating (UE). Data were analyzed using ANOVA and ANCOVA (significance level of 0.05). RESULTS Cognitive restraint eating increased and UE decreased between baseline and 6 months in both groups, but between baseline and 21 months only in the FF group (P = .005 and P = .021, respectively). Emotional eating decreased only in the VC group (P = .016). There were no differences between groups at 6 or 21 months. CONCLUSIONS AND IMPLICATIONS Constructivism-based counseling delivered through videoconferencing was effective at improving eating behaviors.
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Affiliation(s)
- Nina Nevanperä
- Finnish Institute of Occupational Health, Helsinki, Finland; Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Oulu, Finland.
| | - Anna-Maria Keränen
- Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Oulu, Finland; Clinical Research Center, Oulu University Hospital, Oulu, Finland
| | - Olavi Ukkola
- Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, Oulu, Finland; Clinical Research Center, Oulu University Hospital, Oulu, Finland
| | - Jaana Laitinen
- Finnish Institute of Occupational Health, Helsinki, Finland
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Perceptions of Participants in a Group, Community, Exercise Programme for People with Multiple Sclerosis. Rehabil Res Pract 2015; 2015:123494. [PMID: 26491567 PMCID: PMC4600491 DOI: 10.1155/2015/123494] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 08/30/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. The purpose of this study was to explore the perceptions of people with multiple sclerosis of a community based, group exercise programme. Method. A pragmatic programme evaluation approach using qualitative research design was adopted. Focus groups were used to gather data from 14 participants who had taken part in a RCT of community based exercise interventions for PwMS who used at most a stick to walk outdoors. Data were transcribed verbatim and thematic analysis was used to first identify categories and then to group them into themes. Results. Three themes emerged, psychological benefits, physical benefits, and knowledge gained. The psychological benefits included the role of the group as a social and motivational factor, empowerment, confidence, hope, sense of achievement, and pride. Physical benefits were improved energy and reduced fatigue and improved ability and participation. Knowledge gained caused a shift from thoughts that exercise might do harm, to sufficient knowledge that would give participants confidence to exercise themselves. The role of the group was a key element in the positive outcomes. Conclusions. The qualitative analysis supports the findings of the main trial confirming positive effects of community exercise interventions by reducing the impact of MS and fatigue and improving participation.
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Naidu R, Nunn J, Irwin JD. The effect of motivational interviewing on oral healthcare knowledge, attitudes and behaviour of parents and caregivers of preschool children: an exploratory cluster randomised controlled study. BMC Oral Health 2015; 15:101. [PMID: 26328785 PMCID: PMC4556322 DOI: 10.1186/s12903-015-0068-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/14/2015] [Indexed: 11/25/2022] Open
Abstract
Background Motivational Interviewing (MI) has been used across primary healthcare and been shown to be effective in reducing the prevalence of early childhood caries (ECC) in preschool children. This study aimed to compare the effect of MI, in contrast to traditional dental health education (DHE), on oral health knowledge, attitudes, beliefs and behaviours among parents and caregivers of preschool children in Trinidad. Method The design of this exploratory study included a cluster randomised controlled trial and semi-structured focus groups. Six preschools (79 parents and caregivers) in Eastern Trinidad were randomly assigned to a test or control group (3 preschools in each group). Parents and caregivers in the test-group (n = 25) received a talk on dental health using an MI approach and the control-group (n = 54) received a talk using traditional DHE. Both groups received additional, written dental health information. The MI group also received two telephone call follow-ups as part of the MI protocol. Both groups were given questionnaires before the talks and four months later. Question items included oral health knowledge, beliefs, attitudes, brushing behaviour, oral health self-efficacy, oral health fatalism and a specific instrument to asses ‘readiness for change’, the Readiness Assessment of Parents Concerning Infant Dental Decay (RAPIDD). Participants in the test-group were also invited to take part in a focus group to share their views on the dental health talk. Results At four month follow-up, knowledge items on fluoride use, tooth brushing, dietary practice and dental attendance increased in both the test (DHE + MI) and control (DHE) groups ((p < 0.05, Chi Square test). In the test-group there were increases in mean child tooth brushing frequency and reduction in oral health fatalism (p < 0.05 t-test). Findings from a thematic analysis of the focus group suggested that the MI talk and telephone follow-up were well accepted and helpful in supporting parent and caregiver efforts to improve oral health practices for their preschool children. Conclusion In this exploratory controlled study there was some evidence that using an MI approach when delivering oral health information had a positive effect on parent/ caregiver oral health knowledge, attitudes and behaviours compared to traditional DHE. There is need for further research involving the use of brief-counselling techniques in this Caribbean population.
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Affiliation(s)
- Rahul Naidu
- School of Dentistry, The University of the West Indies, St Augustine, Trinidad and Tobago.
| | - June Nunn
- School of Dental Science, Trinity College Dublin, Dublin 2, Ireland.
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Moral RR, Torres LAPD, Ortega LP, Larumbe MC, Villalobos AR, García JAF, Rejano JMP. Effectiveness of motivational interviewing to improve therapeutic adherence in patients over 65 years old with chronic diseases: A cluster randomized clinical trial in primary care. PATIENT EDUCATION AND COUNSELING 2015; 98:977-983. [PMID: 25858633 DOI: 10.1016/j.pec.2015.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 01/29/2015] [Accepted: 03/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of motivational interviewing (MI) in improving medication adherence in older patients being treated by polypharmacy. METHODS Cluster randomized clinical trial in 16 primary care centers with 27 health care providers and 154 patients. Thirty-two health care providers were assigned to an experimental (EG) or control group (CG). INTERVENTIONS MI training program and review of patient treatments. Providers in the EG carried out MI, whereas those in the CG used an "advice approach". Three follow-up visits were completed, at 15 days and at 3 and 6 months. Medication adherence in both groups was compared (p<0.05). RESULTS Patients recruited: 70/84 (EG/CG). Mean age: 76 years; female: 68.8%. The proportion of subjects changing to adherence was 7.6% higher in the EG (p<0.001). Therapeutic adherence was higher for patients in the EG (OR=2.84), women (OR=0.24) and those with high educational levels (OR=3.93). CONCLUSION A face-to-face motivational approach in primary care helps elderly patients with chronic diseases who are being treated by polypharmacy to achieve an improved level of treatment adherence than traditional strategies of providing information and advice. PRACTICE IMPLICATIONS MI is a patient-centered approach that can be used to improve medication adherence in primary care. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov (NCT01291966).
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Affiliation(s)
- Roger Ruiz Moral
- Faculty of Medicine, Francisco de Vitoria University, Madrid, Spain.
| | - Luis Angel Pérula de Torres
- Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain.
| | - Laura Pulido Ortega
- Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain.
| | - Margarita Criado Larumbe
- Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain.
| | - Ana Roldán Villalobos
- Teaching Unit of Family and Community Medicine of Córdoba (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Cordoba, Reina Sofia University Hospital, Cordoba, Spain.
| | - Jose Angel Fernández García
- Villarrubia Health Center, UGC Occidente (Córdoba-Guadalquivir Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Córdoba/Reina Sofia University Hospital, Córdoba, Spain.
| | - Juan Manuel Parras Rejano
- Villanueva del Rey Health Center, UGC-Pueblonuevo Penyarroya (Northern Córdoba Health District), Maimonides Institute for Biomedical Research Córdoba (IMIBIC)/University of Córdoba/Reina Sofia University Hospital, Córdoba, Spain.
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Chang YP, Compton P, Almeter P, Fox CH. The Effect of Motivational Interviewing on Prescription Opioid Adherence Among Older Adults With Chronic Pain. Perspect Psychiatr Care 2015; 51:211-9. [PMID: 25159493 DOI: 10.1111/ppc.12082] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/20/2014] [Accepted: 07/10/2014] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To test the effect of office-based motivational interviewing (MI) on prescription opioid adherence in older adults with chronic pain. DESIGN AND METHODS Pre- and post-design was used. Thirty chronic pain patients participated in a 4-week MI in two outpatient settings. FINDINGS Participants demonstrated a significantly reduced risk of prescription opioid misuse, decreased substance use, increased self-efficacy, increased motivation to change, and decreased depression at both the post-test and 1-month follow-up. PRACTICE IMPLICATION MI can be effectively delivered in outpatient settings for older adults who are at risk for opioid misuse. Clinicians could incorporate MI techniques to enhance prescription opioid adherence.
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Affiliation(s)
- Yu-Ping Chang
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Peggy Compton
- School of Nursing and Health Studies, Georgetown University, Washington DC, USA
| | - Pamela Almeter
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Chester H Fox
- Department of Family Medicine, University at Buffalo, The State University of New York, New York, New York, USA
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Henry SG, Jerant A, Iosif AM, Feldman MD, Cipri C, Kravitz RL. Analysis of threats to research validity introduced by audio recording clinic visits: Selection bias, Hawthorne effect, both, or neither? PATIENT EDUCATION AND COUNSELING 2015; 98:849-856. [PMID: 25837372 PMCID: PMC4430356 DOI: 10.1016/j.pec.2015.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 02/05/2015] [Accepted: 03/07/2015] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To identify factors associated with participant consent to record visits; to estimate effects of recording on patient-clinician interactions. METHODS Secondary analysis of data from a randomized trial studying communication about depression; participants were asked for optional consent to audio record study visits. Multiple logistic regression was used to model likelihood of patient and clinician consent. Multivariable regression and propensity score analyses were used to estimate effects of audio recording on 6 dependent variables: discussion of depressive symptoms, preventive health, and depression diagnosis; depression treatment recommendations; visit length; visit difficulty. RESULTS Of 867 visits involving 135 primary care clinicians, 39% were recorded. For clinicians, only working in academic settings (P=0.003) and having worked longer at their current practice (P=0.02) were associated with increased likelihood of consent. For patients, white race (P=0.002) and diabetes (P=0.03) were associated with increased likelihood of consent. Neither multivariable regression nor propensity score analyses revealed any significant effects of recording on the variables examined. CONCLUSION Few clinician or patient characteristics were significantly associated with consent. Audio recording had no significant effect on any of the 6 dependent variables examined. PRACTICE IMPLICATIONS Benefits of recording clinic visits likely outweigh the risks of bias in this setting.
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Affiliation(s)
- Stephen G Henry
- Department of Internal Medicine, University of California Davis, Sacramento, USA; Center for Healthcare Policy and Research, University of California Davis, Sacramento, USA.
| | - Anthony Jerant
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, USA; Department of Family and Community Medicine, University of California Davis, Sacramento, USA
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California Davis, Davis, USA
| | - Mitchell D Feldman
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Camille Cipri
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, USA
| | - Richard L Kravitz
- Department of Internal Medicine, University of California Davis, Sacramento, USA; Center for Healthcare Policy and Research, University of California Davis, Sacramento, USA
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Merkx A, Ausems M, Budé L, de Vries R, Nieuwenhuijze MJ. Dutch Midwives’ Behavior and Determinants in Promoting Healthy Gestational Weight Gain, Phase 2: A Quantitative Approach. INTERNATIONAL JOURNAL OF CHILDBIRTH 2015. [DOI: 10.1891/2156-5287.5.3.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: Unhealthy gestational weight gain (GWG) contributes to long-term obesity in women and their offspring. The aim of this study is to quantify midwives’ behavior in promoting healthy GWG and to identify the most important determinants related to this behavior.METHODS: A survey based on the attitude–social influence–self-efficacy (ASE) model and prior qualitative research was conducted among 112 Dutch practicing midwives.RESULTS: Midwives were moderately active in monitoring GWG and diet education and less active in physical activity education. Regression analysis showed that efforts to promote healthy GWG were associated with several determinants, including attitudes, self-efficacy, social influence, the involvement of other health workers, health promotion, and barriers.PRACTICE IMPLICATIONS: The identified behavioral determinants provide insight into ways to stimulate midwives to promote healthy GWG.
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Hunter C, Chew-Graham CA, Langer S, Drinkwater J, Stenhoff A, Guthrie EA, Salmon P. 'I wouldn't push that further because I don't want to lose her': a multiperspective qualitative study of behaviour change for long-term conditions in primary care. Health Expect 2014; 18:1995-2010. [PMID: 25376672 PMCID: PMC5810675 DOI: 10.1111/hex.12304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 01/17/2023] Open
Abstract
Background Health outcomes for long‐term conditions (LTCs) can be improved by lifestyle, dietary and condition management‐related behaviour change. Primary care is an important setting for behaviour change work. Practitioners have identified barriers to this work, but there is little evidence examining practices of behaviour change in primary care consultations and how patients and practitioners perceive these practices. Objective To examine how behaviour change is engaged with in primary care consultations for LTCs and investigate how behaviour change is perceived by patients and practitioners. Design Multiperspective, longitudinal qualitative research involving six primary health‐care practices in England. Consultations between patients with LTCs and health‐care practitioners were audio‐recorded. Semi‐structured interviews were completed with patients and practitioners, using stimulated recall. Patients were re‐interviewed 3 months later. Framework analysis was applied to all data. Participants Thirty‐two people with at least one LTC (chronic obstructive pulmonary disease, diabetes, asthma and coronary heart disease) and 10 practitioners. Results Behaviour change talk in consultations was rare and, when it occurred, was characterized by deflection and diffidence on the part of practitioners. Patient motivation tended to be unaddressed. While practitioners positioned behaviour change work as outside their remit, patients felt uncertain about, yet responsible for, this work. Practitioners raised concerns that this work could damage other aspects of care, particularly the patient–practitioner relationship. Conclusion Behaviour change work is often deflected or deferred by practitioners in consultations, who nevertheless vocalize support for its importance in interviews. This discrepancy between practitioners’ accounts and behaviours needs to be addressed within primary health‐care organizations.
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Affiliation(s)
- Cheryl Hunter
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences and National School for Primary Care Research, Keele University, Keele, Staffs, UK
| | - Susanne Langer
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | | | - Alexandra Stenhoff
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Elspeth A Guthrie
- Manchester Mental Health and Social Care Trust, Manchester, UK.,University of Manchester, Manchester, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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