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Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, Miyamatsu N, Nishio Y, Ogura M, Sata M, Sekiguchi K, Takeya Y, Tamura K, Wakatsuki A, Yoshida H, Fujioka Y, Fukazawa R, Hamada O, Higashiyama A, Kabayama M, Kanaoka K, Kawaguchi K, Kosaka S, Kunimura A, Miyazaki A, Nii M, Sawano M, Terauchi M, Yagi S, Akasaka T, Minamino T, Miura K, Node K. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J 2024; 88:763-842. [PMID: 38479862 DOI: 10.1253/circj.cj-23-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuhiko Hara
- Department of Health and Nutrition, Wayo Women's University
| | - Hisashi Kai
- Department of Cardiology, Kurume Univeristy Medical Center
| | | | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Masatsune Ogura
- Department of General Medical Science, Chiba University School of Medicine
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Yasushi Takeya
- Division of Helath Science, Osaka University Gradiate School of Medicine
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | | | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Yoshio Fujioka
- Division of Clinical Nutrition, Faculty of Nutrition, Kobe Gakuin University
| | | | - Osamu Hamada
- Department of General Internal Medicine, Takatsuki General Hospital
| | | | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kenjiro Kawaguchi
- Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
| | | | | | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
- Yale New Haven Hospital Center for Outcomes Research and Evaluation
| | | | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Meidicine
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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Holetzek T, Euler S, Jaehn P, Schliephacke LJ, Trunev A, Holmberg C. [On the Potential of Prevention Counselors in the Primary Care Setting: Evaluation Study of an Intervention in the State of Brandenburg (Germany)]. DAS GESUNDHEITSWESEN 2024. [PMID: 38653471 DOI: 10.1055/a-2266-9954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF THE STUDY The study investigates the extent to which medical assistants can support primary prevention measures in family practices as prevention advisors. METHODS Between July 2019 and December 2020, preventive measures were implemented by trained prevention counselors in general practitioners' practices in a rural region in Brandenburg. They consisted of longer-term support for individuals in lifestyle changes in the areas of "nutrition", "exercise" and "relaxation". The accompanying process and outcome evaluation included pre-post comparisons of selected medical parameters as well as the investigation of possible changes in health literacy and health-related quality of life using standardized questionnaires (HeiQ-Core, SF-12v2). Furthermore, thematic analyses of training documents, participant surveys using a questionnaire, two focus groups with prevention counselors, and five interviews with study participants were conducted. RESULTS Four primary care practices and two health care facilities were recruited and seven health care workers were trained as prevention counselors. Thirty-eight individuals were enrolled in the prevention program. Although overall counseling sessions were conducted according to training specifications, various individual as well as structural barriers ensured low uptake of the intervention. CONCLUSIONS The extent to which preventive measures adapted to the individual can be successfully established in primary care practices with the help of health care workers trained as prevention counselors depends strongly on the respective practice structures as well as the patient clientele. Temporal integration and coordination of the activities of prevention advisors in the daily practice routine seems to be likely to lead to success in interventions of the kind evaluated here.
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Affiliation(s)
- Tim Holetzek
- Medizinische Hochschule Brandenburg Theodor Fontane, Institut für Sozialmedizin und Epidemiologie, Brandenburg an der Havel, Germany
| | - Sylvia Euler
- Medizinische Hochschule Brandenburg Theodor Fontane, Institut für Sozialmedizin und Epidemiologie, Brandenburg an der Havel, Germany
| | - Philipp Jaehn
- Medizinische Hochschule Brandenburg Theodor Fontane, Institut für Sozialmedizin und Epidemiologie, Brandenburg an der Havel, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Fakultät für Gesundheitswissenschaften, Brandenburg an der Havel, Germany
| | - Laura Josephin Schliephacke
- Medizinische Hochschule Brandenburg Theodor Fontane, Institut für Sozialmedizin und Epidemiologie, Brandenburg an der Havel, Germany
| | - Andrea Trunev
- Ärztenetz Südbrandenburg e.V., Finsterwalde, Germany
| | - Christine Holmberg
- Medizinische Hochschule Brandenburg Theodor Fontane, Institut für Sozialmedizin und Epidemiologie, Brandenburg an der Havel, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Fakultät für Gesundheitswissenschaften, Brandenburg an der Havel, Germany
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Greenwood H, Davidson AR, Thomas R, Albarqouni L. Common barriers and enablers to the use of non-drug interventions for managing common chronic conditions in primary care: an overview of reviews. BMC PRIMARY CARE 2024; 25:108. [PMID: 38582829 PMCID: PMC10998330 DOI: 10.1186/s12875-024-02321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/23/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Non-drug interventions are recommended for chronic condition prevention and management yet are underused in clinical practice. Understanding barriers and enablers to using non-drug interventions may help implement non-drug interventions in primary care. We aimed to conduct an overview of reviews to identify and summarise common barriers and enablers for using non-drug interventions for common chronic conditions in primary care. METHODS We included qualitative and quantitative reviews that used systematic process or methods to examine barriers and enablers to using non-drug interventions for chronic condition prevention and management in primary care settings. We searched 5 electronic databases (PubMed, Cochrane Database of Systematic Reviews, EMBASE, PsycInfo and CINAHL) from inception to September 2022. Two authors independently screened reviews. One author extracted and deductively coded data to Consolidated Framework of Implementation Research (CFIR) (and where relevant, Theoretical Domains Framework [TDF]). A second author validated 10% of extracted data and coding. Data was synthesised thematically using CFIR and TDF. One author assessed the methodological quality of included reviews using a modified AMSTAR 2 tool, with 10% validated by a second author. We assessed overlap between primary studies in included reviews. RESULTS From 5324 records, we included 25 reviews, with data predominately from patients. Overall, 130 subthemes (71 barrier and 59 enabler) were identified across 4 CFIR domains (Innovation, Outer Setting, Inner Setting, and Individuals), and all TDF domains. Common barrier and enabler subthemes were identified for CFIR constructs of Innovation Adaptability, Innovation Cost, Innovation Relative Advantage, Local Attitudes, External Pressure, Local Conditions, Relational Connections, Available Resources, and Access to Knowledge and Information. For TDF domains, important barrier and enabler subthemes were identified for Knowledge, Skills, Environmental Context and Resources, Beliefs about Consequences, Reinforcement, and Emotion. CONCLUSIONS We synthesised reviews to provide new insight into common barriers and enablers for using non-drug interventions to prevent and manage chronic conditions in primary care. The factors identified can inform the development of generalisable implementation interventions to enhance uptake of multiple non-drug interventions simultaneously. TRIAL REGISTRATION This study was registered in PROSPERO (CRD42022357583).
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Affiliation(s)
- Hannah Greenwood
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
| | - Alexandra R Davidson
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Rae Thomas
- Tropical Australian Academic Health Centre, Townsville, Australia
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
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Klapec-Basar M, Kovač T, Apatić R, Mudri Ž, Basar T, Jurić S, Gmajnić R, Lovrić R. Prevalence of risk factors for development of cardiovascular diseases in urban and rural areas of Eastern Croatia: a cross-sectional study. Cent Eur J Public Health 2024; 32:16-24. [PMID: 38669153 DOI: 10.21101/cejph.a7709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/06/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE Cardiovascular diseases are the leading global cause of death. Due to the disparities in cardiovascular risk factors between rural and urban populations, this study aims to assess the differences in the prevalence of risk factors in urban and rural areas of eastern Croatia. METHODS The cross-sectional study included 280 participants (140 from urban and 140 from rural areas) registered at studied general practice offices. Methods included e-health records, questionnaire, physical examination methods, and blood sampling for laboratory tests. RESULTS The most common risk factors among participants were elevated total cholesterol (83.6%), elevated LDL cholesterol (81.8%), increased body mass index (75.0%), increased waist-hip ratio (82.9%), increased waist circumference (63.2%), and arterial hypertension (70.1%). The rural participants had a significantly higher prevalence of arterial hypertension (p = 0.023), increased body mass index (p = 0.004), increased waist circumference (p = 0.004), increased waist-hip ratio (p < 0.001), and increased LDL cholesterol (p = 0.029), while the urban participants had a significantly higher prevalence of insufficient physical activity (p < 0.001). CONCLUSIONS In the examined sample, the prevalence of cardiovascular risk factors is generally high. Participants from rural areas are significantly more susceptible to cardiovascular risk factors than participants from urban areas.
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Affiliation(s)
- Mirta Klapec-Basar
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Institute for Expertise, Professional Rehabilitation and Employment of Persons with Disabilities, Osijek, Croatia
| | - Tanja Kovač
- Nursing Institute "Prof. dr. sc. Radivoje Radic", Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Renata Apatić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Nursing Institute "Prof. dr. sc. Radivoje Radic", Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Željko Mudri
- Nursing Institute "Prof. dr. sc. Radivoje Radic", Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Tin Basar
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Stjepan Jurić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Neurology, University Hospital Centre Osijek, Osijek, Croatia
| | - Rudika Gmajnić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- General Practice Office, Osijek, Croatia
| | - Robert Lovrić
- Nursing Institute "Prof. dr. sc. Radivoje Radic", Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Nilsing Strid E, Wallin L, Nilsagård Y. Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals. Scand J Prim Health Care 2024; 42:201-213. [PMID: 38241166 PMCID: PMC10851800 DOI: 10.1080/02813432.2023.2301556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 12/28/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Prior to a multifaceted implementation strategy for a healthy lifestyle-promoting practice the expectations of primary health care managers, appointed internal facilitators and health care professionals on supporting change was explored. DESIGN This study had an explorative qualitative design using data gathered from individual interviews and focus groups. Qualitative content analysis with a deductive category development was applied using the Consolidated Framework for Implementation Research. SETTING AND PARTICIPANTS The study was conducted in a primary care setting in central Sweden as a part of the Act in Time research project. Prior to a multifaceted implementation strategy, we held 16 individual interviews with managers and appointed facilitators and five focus groups with 26 health care professionals. RESULTS Managers, facilitators, and professionals held similar expectations, where their expressed need for support corresponded to three constructs: Readiness for implementation, Implementation climate, and Engaging. Our findings indicate the need for strong leadership engagement to focus on how the healthy lifestyle-promoting practice can be anchored among the professionals. Managers at all levels should communicate the vision and goals, enable facilitators and professionals to improve their competencies, build inter-professional teams, and jointly plan the new practice. CONCLUSION To change to a healthy lifestyle promoting practice professionals request support from their managers, who in turn need support from the middle and top managers. The requested support includes helping to prioritise health promotion and enabling the primary care centres to build competence and take ownership of the implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT04799860.
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Affiliation(s)
- Emma Nilsing Strid
- University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ylva Nilsagård
- University Health Care Research Center, Örebro University, Örebro, Sweden
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Ares-Blanco S, López-Rodríguez JA, Fontán Vela M, Polentinos-Castro E, del Cura-González I. Sex and income inequalities in preventive services in diabetes. Eur J Gen Pract 2023; 29:2159941. [PMID: 36661248 PMCID: PMC9870013 DOI: 10.1080/13814788.2022.2159941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cancer preventive services (gynaecological cancer screening, colon cancer screening) and cardiometabolic screening are recommended by guidelines to individuals. People with diabetes were less likely to receive them than those without diabetes in some studies. OBJECTIVES To analyse differences in the coverage of preventive services in people with diabetes compared to non-diabetic individuals and in people with diabetes according to sex and household income. METHODS We analysed data collected from the European Health Interview Survey 2013-2015, including individuals aged 40-74 (n = 179,318), 15,172 with diabetes from 29 countries. The income of a household (HHI) was described in quintiles. The relationship between the coverage of preventive services (cardiometabolic, vaccination, cancer screening) and sociodemographic characteristics was analysed with multiple logistic regression. RESULTS Women comprised 53.8% of the total and 40% were 60-74 years. People with diabetes compared to those without diabetes had higher reported coverage of cardiometabolic screening (98.4% vs. 90.0% in cholesterol measurement; 97.0% vs. 93.6% in blood pressure measurement), colorectal cancer screening (27.1% vs. 24.6%) but lower coverage of gynaecological cancer screening (mammography: 29.2% vs. 33.5%, pap smear test: 28.3% vs. 37.9%). Among diabetic patients, women were less likely to receive cholesterol screening (OR = 0.81; 95% CI: 0.72-0.91) and colon cancer screening (OR = 0.79; 95% CI: 0.73-0.86) compared to men. Being affluent was positively associated with receiving cardiometabolic screening and mammography in diabetic patients. CONCLUSION People with diabetes reported higher coverage of preventive services except gynaecological cancer screening. Disparities were found in diabetes among women and less affluent individuals.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,CONTACT Sara Ares-Blanco Avenida Albufera, Madrid, 285 28038, Spain
| | - Juan A. López-Rodríguez
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,General Ricardos Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Health Services Research on Chronic Patients Network (REDISSEC), Health Outcomes-Oriented Cooperative Research Networks (RICORS-RICAPS), ISCIII, Madrid, Spain
| | - Mario Fontán Vela
- Medicina Preventiva Department, Hospital Universitario Infanta Leonor, Madrid, Spain,Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Madrid, Spain
| | - Elena Polentinos-Castro
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Health Services Research on Chronic Patients Network (REDISSEC), Health Outcomes-Oriented Cooperative Research Networks (RICORS-RICAPS), ISCIII, Madrid, Spain
| | - Isabel del Cura-González
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Health Services Research on Chronic Patients Network (REDISSEC), Health Outcomes-Oriented Cooperative Research Networks (RICORS-RICAPS), ISCIII, Madrid, Spain
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van den Houdt SCM, Widdershoven J, Kupper N. Patient and healthcare professionals' perceived barriers and facilitators to the implementation of psychosocial screening in cardiac practice: A Delphi study. Gen Hosp Psychiatry 2023; 85:104-113. [PMID: 37862959 DOI: 10.1016/j.genhosppsych.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Psychosocial risk factors contribute to the incidence and progression of coronary heart disease (CHD). Psychosocial screening may identify individuals who are at risk and aid them with getting appropriate care. To successfully implement psychosocial screening in the cardiology practice, the current study aims to identify key barriers and facilitators to its implementation and evaluate their perceived importance among health care professionals (HCPs) and patients. METHODS We took a modified 3-round Delphi study approach to gain insight into key determinants that could either impede or ease implementation. Round 1 gathered data from HCPs (n = 9; cardiologists, medical psychologists, cardiac nurses) and CHD patients (n = 21), which we transcribed verbatim, coded, and processed into unique determinants. In rounds 2 and 3, participants were asked to select the most relevant determinants and rank them based on importance. Subsequently, determinants were classified by implementation level. RESULTS Patients were generally more positive towards screening. HCP barriers included time-constraints, disruption of primary activities, and limited knowledge on psychosocial risk and screening, while patient barriers were commonly related to accessibility and patient characteristics (e.g., health literacy, motivation). Facilitators of both groups mainly pertained to the use of the screener and follow-up care, such as increasing the accessibility and the benefits of the screener. CONCLUSION Barriers may be targeted by enhancing the effects of the facilitators. Increasing the accessibility to the screener and interventions, improving information provision, and appointing a contact person to oversee the screening process may ease the screening and care process for both patients and HCPs.
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Affiliation(s)
- Sophie C M van den Houdt
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands
| | - Jos Widdershoven
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands; Department of Cardiology, Elisabeth-TweeSteden hospital, the Netherlands
| | - Nina Kupper
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, the Netherlands.
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Lienhart G, Elsa M, Farge P, Schott AM, Thivichon-Prince B, Chanelière M. Factors perceived by health professionals to be barriers or facilitators to caries prevention in children: a systematic review. BMC Oral Health 2023; 23:767. [PMID: 37853400 PMCID: PMC10585780 DOI: 10.1186/s12903-023-03458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Considered the most prevalent noncommunicable disease in childhood, dental caries is both an individual and a collective burden. While international guidelines highlight prevention as a major strategy for caries management in children, health professionals still struggle to implement prevention into their clinical practice. Further research is needed to understand the gap between the theoretical significance of dental prevention and its lack of implementation in the clinical setting. This systematic review aims to identify and classify factors perceived by health professionals to be barriers or facilitators to caries prevention in children. METHOD A systematic literature search was conducted in three electronic databases (Medline, Web of Science and Cairn). Two researchers independently screened titles, abstracts and texts. To be selected, studies had to focus on barriers or facilitators to caries prevention in children and include health professionals as study participants. Qualitative and quantitative studies were selected. The factors influencing caries prevention in children were sorted into 3 main categories (clinician-related factors, patient-related factors, and organizational-related factors) and then classified according to the 14 domains of the theoretical domains framework (TDF). RESULTS A total of 1771 references were found by combining manual and database searches. Among them, 26 studies met the inclusion criteria, of which half were qualitative and half were quantitative studies. Dentists (n = 12), pediatricians (n = 11), nurses (n = 9), and physicians (n = 5) were the most frequently interviewed health professionals in our analysis. Barriers and facilitators to caries prevention in children were categorized into 12 TDF domains. The most frequently reported domains were Environmental Context and Resources, Knowledge and Professional Role and Identity. CONCLUSION This systematic review found that a wide range of factors influence caries prevention in children. Our analysis showed that barriers to pediatric oral health promotion affect all stages of the health care system. By highlighting the incompatibility between the health care system's organization and the implementation of caries prevention, this study aims to help researchers and policy-makers design new interventions to improve children's access to caries prevention. TRIAL REGISTRATION PROSPERO CRD42022304545.
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Affiliation(s)
- Guillemette Lienhart
- Service d'Odontologie, Hospices Civils de Lyon, 6/8 Place Deperet, 69007, Lyon, France.
| | - Masson Elsa
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Pierre Farge
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon 8, France
| | - Anne-Marie Schott
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon 8, France
| | | | - Marc Chanelière
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon 8, France
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Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, Christodorescu RM, Crawford C, Di Angelantonio E, Eliasson B, Espinola-Klein C, Fauchier L, Halle M, Herrington WG, Kautzky-Willer A, Lambrinou E, Lesiak M, Lettino M, McGuire DK, Mullens W, Rocca B, Sattar N. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023; 44:4043-4140. [PMID: 37622663 DOI: 10.1093/eurheartj/ehad192] [Citation(s) in RCA: 148] [Impact Index Per Article: 148.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Christoffersen NB, Nilou FE, Thilsing T, Larsen LB, Østergaard JN, Broholm-Jørgensen M. Exploring targeted preventive health check interventions - a realist synthesis. BMC Public Health 2023; 23:1928. [PMID: 37798691 PMCID: PMC10557298 DOI: 10.1186/s12889-023-16861-8] [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: 12/27/2022] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Preventive health checks are assumed to reduce the risk of the development of cardio-metabolic disease in the long term. Although no solid evidence of effect is shown on health checks targeting the general population, studies suggest positive effects if health checks target people or groups identified at risk of disease. The aim of this study is to explore why and how targeted preventive health checks work, for whom they work, and under which circumstances they can be expected to work. METHODS The study is designed as a realist synthesis that consists of four phases, each including collection and analysis of empirical data: 1) Literature search of systematic reviews and meta-analysis, 2) Interviews with key-stakeholders, 3) Literature search of qualitative studies and grey literature, and 4) Workshops with key stakeholders and end-users. Through the iterative analysis we identified the interrelationship between contexts, mechanisms, and outcomes to develop a program theory encompassing hypotheses about targeted preventive health checks. RESULTS Based on an iterative analysis of the data material, we developed a final program theory consisting of seven themes; Target group; Recruitment and participation; The encounter between professional and participants; Follow-up activities; Implementation and operation; Shared understanding of the intervention; and Unintended side effects. Overall, the data material showed that targeted preventive health checks need to be accessible, recognizable, and relevant for the participants' everyday lives as well as meaningful to the professionals involved. The results showed that identifying a target group, that both benefit from attending and have the resources to participate pose a challenge for targeted preventive health check interventions. This challenge illustrates the importance of designing the recruitment and intervention activities according to the target groups particular life situation. CONCLUSION The results indicate that a one-size-fits-all model of targeted preventive health checks should be abandoned, and that intervention activities and implementation depend on for whom and under which circumstances the intervention is initiated. Based on the results we suggest that future initiatives conduct thorough needs assessment as the basis for decisions about where and how the preventive health checks are implemented.
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Affiliation(s)
- Nanna Bjørnbak Christoffersen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Freja Ekstrøm Nilou
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Trine Thilsing
- Research Unit of General Practice, University of Southern, Odense, Denmark
| | - Lars Bruun Larsen
- Research Unit of General Practice, University of Southern, Odense, Denmark
- Steno Diabetes Center Zealand, Holbæk, Denmark
| | | | - Marie Broholm-Jørgensen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Strid EN, Wallin L, Nilsagård Y. Expectations on implementation of a health promotion practice using individually targeted lifestyle interventions in primary health care: a qualitative study. BMC PRIMARY CARE 2023; 24:122. [PMID: 37328813 PMCID: PMC10273504 DOI: 10.1186/s12875-023-02079-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is moderate to strong evidence of the effectiveness of health-promotion interventions, but implementation in routine primary health care (PHC) has been slow. In the Act in Time project implementation support is provided for a health promotion practice using individually targeted lifestyle interventions in a PHC setting. Identifying health care professionals' (HCPs') perceptions of barriers and facilitators helps adapt implementation activities and achieve a more successful implementation. This study aimed, at a pre-implementation stage, to describe the expectations of managers, appointed internal facilitators (IFs) and HCPs on implementing a healthy lifestyle-promoting practice in PHC. METHODS In this qualitative study five focus group discussions with 27 HCPs and 16 individual interviews with managers and appointed IFs were conducted at five PHC centres in central Sweden. The PHC centres are participating in the Act in Time project, evaluating the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice. A deductive qualitative content analysis based on the Consolidated Framework for Implementation Research (CFIR) was followed using inductive analysis. RESULTS Twelve constructs from four of five CFIR domains were derived: Innovation characteristics, Outer setting, Inner setting, and Characteristics of individuals. These domains are related to the expectations of HCPs to implement a healthy lifestyle-promoting practice, which includes facilitating factors and barriers. The inductive analysis showed that the HCPs perceived a need for a health-promotion approach to PHC. It serves the needs of the patients and the expectations of the HCPs, but lifestyle interventions must be co-produced with the patient. The HCPs expected that changing routine practice into a healthy lifestyle-promoting practice would be challenging, requiring sustainability, improved structures, cooperation in inter-professional teams, and a common purpose. A collective understanding of the purpose of changing practice was vital to successful implementation. CONCLUSIONS The HCPs valued implementing a healthy lifestyle-promoting practice in a PHC setting. However, changing routine methods was challenging, implying that the implementation strategy should address obstacles and facilitating factors identified by the HCPs. TRIAL REGISTRATION This study is part of the Act in Time project, registered in ClinicalTrials.gov with the number NCT04799860 . Registered 03 March 2021.
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Affiliation(s)
- Emma Nilsing Strid
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Lars Wallin
- Department of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ylva Nilsagård
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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12
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Haș IM, Teleky BE, Vodnar DC, Ștefănescu BE, Tit DM, Nițescu M. Polyphenols and Cardiometabolic Health: Knowledge and Concern among Romanian People. Nutrients 2023; 15:nu15102281. [PMID: 37242164 DOI: 10.3390/nu15102281] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
The cardiometabolic health of the population is a crucial indicator of public health, considering the significant impact of cardiovascular disease (CVD) and diabetes on global mortality. Determining the population's knowledge and the predictors of these pathologies is essential in developing effective educational and clinical strategies for the prevention and management of cardiometabolic risk (CMR). Polyphenols are natural compounds with a multitude of beneficial effects on cardiometabolic health. This study explored the current knowledge, understanding, and awareness of CMR, the benefits of polyphenols among Romanians, and how sociodemographic and clinical characteristics influence this aspect. Five hundred forty-six subjects responded anonymously to an online questionnaire designed to assess their knowledge. The data were collected and analyzed based on gender, age, education level, and BMI status. Most respondents expressed concern to a great or very great extent about their health (78%) and food (60%), with significant differences (p < 0.05) depending on age, educational level, and BMI status. Of the respondents, 64.8% declared that they were familiar with the CMR term. Still, the results showed a weak correlation between the stated risk factors and the self-assessment of increased risk (r = 0.027) for CVD or diabetes. Only 35% of the respondents reported a good or very good knowledge of the term "polyphenols", 86% recognized the antioxidant effect, and significantly fewer (26%) recognized the prebiotic effect. Developing and implementing targeted educational strategies to enhance learning and individual behaviors related to CMR factors and the benefits of polyphenols is necessary.
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Affiliation(s)
- Ioana Mariana Haș
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
| | - Bernadette-Emőke Teleky
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
- Department of Food Science and Technology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Dan-Cristian Vodnar
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
- Department of Food Science and Technology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Bianca Eugenia Ștefănescu
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania
| | - Maria Nițescu
- Department of Preclinical-Complementary Sciences, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
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13
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Kalantzi V, Kalafati IP, Belitsi V, Tsiampalis T, Koutsonasios I, Androutsos O, Bonoti F, Panagiotakos DB, Kosti RI. Cardiometabolic Patient-Related Factors Influencing the Adherence to Lifestyle Changes and Overall Treatment: A Review of the Recent Literature. Life (Basel) 2023; 13:life13051153. [PMID: 37240798 DOI: 10.3390/life13051153] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
It is well acknowledged that most of the modifiable risk factors for Cardiovascular Diseases (CVDs) can be averted through lifestyle modifications beyond medication adherence. This review aims to critically evaluate the cardiometabolic (CM) patient-related factors that influence the adherence to lifestyle changes studied alone and/or in combination with medication. A comprehensive literature search of PubMed articles from 2000 to 2023 retrieved 379 articles. After removing the articles which were not relevant, a total of 28 cross-sectional studies was chosen (12 qualitative, and 16 quantitative). The findings confirmed that five groups of factors influence patients' adherence to overall treatment: (1) health beliefs, knowledge, and perceptions regarding the risks and challenges of disease and medication intake along with adherence process perceptions; (2) self-concept; (3) emotions; (4) patient-healthcare providers relationship/communication and (5) social and cultural interactions. It is worth mentioning that cultural issues, such as culinary particularities, ethnic identity, social life as well as patients' skills and abilities, play a profound role in the effectiveness of the recommended lifestyle modifications beyond the aforementioned common factors. The need for clear-cut culturally adapted guidelines along with personalized advice from physicians is imperative as it could improve patients' self-efficacy. These socio-psychological factors should be seriously considered as a means to increase the effectiveness of future community prevention programs.
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Affiliation(s)
- Vasiliki Kalantzi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Ioanna Panagiota Kalafati
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece
| | - Vasiliki Belitsi
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece
| | | | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Fotini Bonoti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17676 Athens, Greece
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Rena I Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece
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14
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Fontaine G, Cossette S. Development and Design of E_MOTIV: A Theory-Based Adaptive E-Learning Program to Support Nurses' Provision of Brief Behavior Change Counseling. Comput Inform Nurs 2023; 41:130-141. [PMID: 35796716 DOI: 10.1097/cin.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Brief counseling, when provided by adequately trained nurses, can motivate and support patient health behavior change. However, numerous barriers can impede nurses' capability and motivation to provide brief counseling. Theory-based interventions, as well as information and communication technologies, can support evidence-based practice by addressing these barriers. The purpose of this study was to document the development process of the E_MOTIV asynchronous, theory-based, adaptive e-learning program aimed at supporting nurses' provision of brief counseling for smoking cessation, healthy eating, and medication adherence. Development followed French's stepwise theory- and evidence-based approach: (1) identifying who needs to do what, differently, that is, provision of brief counseling in acute care settings by nurses; (2) identifying determinants of the provision of brief counseling; (3) identifying which intervention components and mode(s) of delivery could address determinants; and (4) developing and evaluating the program. The resulting E_MOTIV program, guided by the Theory of Planned Behavior, Cognitive Load Theory, and the concept of engagement, is unique in its adaptive functionality-personalizing program content and sequence to each learners' beliefs, motivation, and learning preferences. E_MOTIV is one of the first adaptive e-learning programs developed to support nurses' practice, and this study offers key insights for future work in the field.
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Affiliation(s)
- Guillaume Fontaine
- Author Affiliations: Clinical Epidemiology Program, Ottawa Hospital Research Institute; and Faculty of Medicine, University of Ottawa, Ontario; and Research Centre, Université de Montréal Hospital Centre (Dr Fontaine); and Faculty of Nursing, Université de Montréal; and Montreal Heart Institute Research Center (Dr Cossette), Quebec, Canada
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15
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Asher RC, Bucher T, Shrewsbury VA, Clarke ED, Herbert J, Roberts S, Meeder A, Collins CE. Facilitators and barriers to providing culinary nutrition, culinary medicine and behaviour change support: An online cross-sectional survey of Australian health and education professionals. J Hum Nutr Diet 2023; 36:252-265. [PMID: 35651300 PMCID: PMC10084112 DOI: 10.1111/jhn.13044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/04/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND An Australia wide cross-sectional online survey examined facilitators and barriers of health and education professionals to providing culinary nutrition (CN) and culinary medicine (CM) education and behaviour change support in usual practice, in addition to identifying continuing professional development (CPD) needs in this domain. METHODS Survey items included socio-demographic characteristics, cooking and food skills confidence, nutrition knowledge (PKB-7), fruit and vegetable intake (FAVVA) and CPD needs. Data were summarised descriptively. RESULTS Of 277 participants, 65% were likely/somewhat likely to participate in CN CPD. Mean (SD) cooking and food skill confidence scores were 73 (17.5) and 107.2 (24), out of 98 and 147, respectively. Mean PKB-7 score was 3.7 (1.4), out of 7. Mean FAVVA score was 98 (29), out of 190. CONCLUSIONS Gaps in knowledge and limited time were the greatest modifiable barriers to providing CM/CN education and behaviour change support in practice. Health and education professionals are interested in CPD conducted by dietitians and culinary professionals to enhance their knowledge of CM/CN and behaviour change support.
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Affiliation(s)
- Roberta C Asher
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia
| | - Tamara Bucher
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,School of Environmental and Life Sciences, College of Engineering, Science and Environment, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
| | - Vanessa A Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
| | - Erin D Clarke
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
| | - Jaimee Herbert
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia
| | - Steven Roberts
- Rijk Zwaan Australia Pty. Ltd., Daylesford, VIC, Australia
| | - Annette Meeder
- Rijk Zwaan Zaadteelt en Zaadhandel B.V., De Lier, The Netherlands
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
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16
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Anand VV, Goh RSJ, Nah B, Koh SWC, Lim J, Neo NWS, Chew J, Lee YY, Chin YH, Chong B, Kong G, Tan B, Low Z, Khoo CM, Goh LH, Loh PH, Chai P, Dalakoti M, Chan M, Foo R, Muthiah M, Chew NWS. General Public's knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population. Front Med (Lausanne) 2023; 10:1193829. [PMID: 37168269 PMCID: PMC10165106 DOI: 10.3389/fmed.2023.1193829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/06/2023] [Indexed: 05/13/2023] Open
Abstract
Background Health literacy and illness perception play crucial roles in tackling the cardiometabolic disease epidemic. We aim to compare the attitudes, knowledge, self-perceived risks and actions taken, between individuals with and without metabolic risk factors (MFs). Methods From 5 June to 5 October 2022, participants of the general public were invited to complete a self-administered questionnaire. MF status was defined as the presence of hypertension, hyperlipidemia, diabetes mellitus and/or current/previous smoking. Participants were assessed based on four categories (knowledge-based, attitude-based, perceived risk, and action-based) of questions pertaining to four cardiometabolic diseases - diabetes mellitus, hypertension, hyperlipidemia, and non-alcoholic fatty liver disease. Results A total of 345 participants were enrolled, of whom 34.5% had at least one MF. Compared to those without MFs, participants with MFs had lower knowledge scores, but higher perceived risk scores across all cardiometabolic diseases. The largest knowledge gap pertained to hypertension-related questions. After adjustment, linear regression demonstrated that the presence of MFs (β:2.752, 95%CI: 0.772-4.733, p = 0.007) and higher knowledge scores (β:0.418, 95%CI: 0.236-0.600, p < 0.001) were associated with higher perceived risk. Despite increased perceived risk in those with MFs, this translated to only few increased self-reported preventive actions, when compared to those without MFs, namely the reduction in red meat/processed food consumption (p = 0.045) and increase in fruits/vegetables consumption (p = 0.009). Conclusion This study identified a vulnerable subpopulation living with MFs, with high perceived risks, and discordant levels of knowledge and preventive actions taken. Nationwide efforts should be channeled into addressing the knowledge-to-action gap.
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Affiliation(s)
- Vickram Vijay Anand
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rachel Sze Jen Goh
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Benjamin Nah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Sky Wei Chee Koh
- National University Polyclinics, National University Health System, Singapore, Singapore
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jieyu Lim
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Nicholas W. S. Neo
- Nursing Department, National University Heart Centre, Singapore, Singapore
| | - Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Yuan Ying Lee
- Nursing Department, National University Heart Centre, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Bryan Tan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Zhiwen Low
- Faculty of Science, Monash University, Melbourne, VIC, Australia
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Endocrinology, National University Hospital, Singapore, Singapore
| | - Lay Hoon Goh
- National University Polyclinics, National University Health System, Singapore, Singapore
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Poay Huan Loh
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
- Division of Cardiology, Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Ping Chai
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Mayank Dalakoti
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Mark Chan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Nicholas W. S. Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
- *Correspondence: Nicholas W. S. Chew,
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17
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Sinaise MK, Tran A, Johnson HM, Vedder LS, Hoppe KK, Lauver D. Concepts from behavioral theories can guide clinicians in coaching for behavior change. PATIENT EDUCATION AND COUNSELING 2023; 106:188-193. [PMID: 36335082 PMCID: PMC10153998 DOI: 10.1016/j.pec.2022.10.013] [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: 07/07/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVES Many patients do not engage in health behaviors that can control common, chronic illnesses. Clinicians have opportunities to promote health behaviors yet may lack skills for coaching effectively about health behaviors. Our aims are to: present definitions of coaching, propose concepts for coaching about behavior change from two theories, share theory-guided research on behavior change relevant to ambulatory care settings, and delineate how concepts from these theories can guide coaching. METHODS In our discussion, we explain how two behavioral theories are complementary and applicable to coaching, present empirical support for these theories, and describe applications of these concepts for practice. CONCLUSIONS AND PRACTICE IMPLICATIONS Self-determination theory can guide clinicians in how to interact with patients to meet patients' psychological needs, to promote health behaviors, and subsequent health status. Self-regulation theory can guide coaches in what concepts to address for behavior change. These complementary theories have been supported in rigorous research with adult populations in ambulatory care settings.
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Affiliation(s)
- Megan Knutson Sinaise
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 1010 Mound Street, Madison, WI 53715, USA
| | - Abigail Tran
- Project Coordinator, System Cancer Service Line, Advocate-Aurora Health, 2900 W. Oklahoma Ave., Milwaukee, WI 53215, USA
| | - Heather M Johnson
- Clinical Affiliate Associate Professor, Christine E. Lynn Women's Health & Wellness Institute, Boca Raton Regional Hospital; Baptist Health South Florida, Florida Atlantic University, 690 Meadows Road, Boca Raton, FL 33486
| | - Lisa Sullivan Vedder
- Clinical Adjunct Associate Professor, Department of Family Medicine Advocate-Aurora University of Wisconsin Group, Aurora Sinai Medical Center, 945 N 12th Street, Milwaukee, WI 53233, USA
| | - Kara K Hoppe
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 1010 Mound Street, Madison, WI 53715, USA
| | - Diane Lauver
- School of Nursing & School of Medicine and Public Health University of Wisconsin, Madison, USA.
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18
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Mansour MBL, Crone MR, van Weert HC, Chavannes NH, van Asselt KM. Stop smoking advice by practice assistants after routine cervical screening in general practice: A qualitative exploration of potential barriers and enablers. Eur J Gen Pract 2022; 28:56-65. [PMID: 35394361 PMCID: PMC9004501 DOI: 10.1080/13814788.2022.2053105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Cervical screening could be an appropriate routine moment to provide female smokers with tailored stop smoking advice. In Dutch general practice, cervical smears are performed by practice assistants. Objectives This study was performed in preparation for a randomised trial to identify potential barriers and enablers for a brief stop smoking strategy performed by trained practice assistants after routine cervical screening. Methods Between December 2016 and March 2017 three focus group meetings were held with ten practice assistants, three nurses, and six general practitioners to explore their views and expectations towards the proposed approach. We analysed data using thematic analysis. Identified factors are presented within the framework of the Social-Ecological Model. Results Potential barriers and enablers were identified at individual, interpersonal, and workplace levels. Practice assistants, nurses and GPs did not consider assistants to have a role in stop smoking care. They believed it is feasible to register smoking status but had reservations towards providing advice by assistants, for which knowledge and skills are needed. Practice assistants’ own beliefs about smokers and smokers’ response to stop smoking advice might influence how assistants and smokers interact. An explanation of why advice is given could help, provided assistants have enough time and experience with the smear. The nurses’ availability and general practitioners’ view on prevention might affect the delivery of the strategy by the assistant. Conclusion At individual, interpersonal, and workplace levels, several factors could influence the provision of a stop smoking strategy by a practice assistant.
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Affiliation(s)
- Marthe B L Mansour
- Department of General Practice, Amsterdam UMC, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health, The Netherlands
| | - Matty R Crone
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
| | - Henk C van Weert
- Department of General Practice, Amsterdam UMC, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
| | - Kristel M van Asselt
- Department of General Practice, Amsterdam UMC, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health, The Netherlands
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19
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Smits G, Romeijnders A, Rozema H, Wijnands C, Hollander M, van Doorn S, Bots M. Stepwise implementation of a cardiovascular risk management care program in primary care. BMC PRIMARY CARE 2022. [PMCID: PMC8746647 DOI: 10.1186/s12875-021-01602-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Primary care plays a pivotal role in sustainable cardiovascular risk management (CVRM) but little is known about the organizational process of implementing the guidelines. The aim of the study was to describe the approach taken by a primary care group to implement the CVRM guideline. Methods Stepwise introduction and implementation of a programmatic CVRM care program was organized and facilitated by the care group between April 2010 and January 2013 in 137 affiliated general practices with 188 general practitioners (GPs), in the vicinity of Eindhoven, Netherlands. Care group support comprised sufficient staff, support with data extraction based on ICPC and ATC codes and with identification of eligible patients by scrutinizing patient health records and adequate coding of disease conditions. Results Patient selection based on availability of structured information on ICPC codes and risk factor levels from the electronic health records, led to 38,675 eligible patients in 2013. December 2019, the CVRM program was still running in 151 practices with 51,416 patients receiving programmatic CVRM care. Linking problems between 8 different electronic health record systems and the multidisciplinary information system for integrated care delayed adequate data collection until the beginning of 2013. Conclusion Commitment of affiliated GPs, a structured approach with adequate coding of diagnoses and risk factors, central data registration and additional funding for sufficient staff support are important conditions for the introduction and implementation of successful and sustainable programmatic CVRM care. This approach constitutes the basis for long-term follow up and annual evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01602-w.
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20
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Kromme NMH, Ahaus KTB, Gans ROB, van de Wiel HBM. Internists’ ambivalence toward their role in health counseling and promotion: A qualitative study on the internists’ beliefs and attitudes. PLoS One 2022; 17:e0273848. [PMID: 36048849 PMCID: PMC9436108 DOI: 10.1371/journal.pone.0273848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Crucial to its success is that physicians enhance their competence in Lifestyle Medicine and take on their role as Health Advocates in Health Counseling and Promotion (HC&P). However, studies on patients’ views of lifestyle counseling in clinical practice demonstrate that many patients neither perceived a need to adopt a healthy lifestyle nor having had any discussion with their physician about their lifestyle. This study is part of a participatory action research project focusing on identifying areas of improvement for health promotion in the practice of internists. Within this project, we interviewed 28 internists from six different subspecialties of an academic medical center in the Netherlands. This study aims to gain insight into how internists understand their role in HC&P by a qualitative analysis of their beliefs and attitudes in the interview data. Participants claimed that promoting a healthy lifestyle is important. However, they also reflected a whole system of beliefs that led to an ambivalent attitude toward their role in HC&P. We demonstrate that little belief in the success of HC&P nurtured ambivalence about the internists’ role and their tasks and responsibilities. Ambivalence appeared to be reinforced by beliefs about the ability and motivation of patients, the internists’ motivational skills, and the patient-doctor relationship, and by barriers such as lack of time and collaboration with General Practitioners. When participants viewed HC&P as a part of their treatment and believed patients were motivated, they were less ambivalent about their role in HC&P. Based on our data we developed a conceptual framework that may inform the development of the competences of the Health Advocate role of internists in education and practice.
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Affiliation(s)
- Nicolien M. H. Kromme
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Kees T. B. Ahaus
- Erasmus School of Health Policy & Management Health Services Management & Organization (HSMO), Rotterdam, The Netherlands
| | - Reinold O. B. Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry B. M. van de Wiel
- Wenckebach Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Strid EN, Wallin L, Nilsagård Y. Implementation of a Health Promotion Practice Using Individually Targeted Lifestyle Interventions in Primary Health Care: Protocol for the "Act in Time" Mixed Methods Process Evaluation Study. JMIR Res Protoc 2022; 11:e37634. [PMID: 35984700 PMCID: PMC9440414 DOI: 10.2196/37634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background There is growing evidence that noncommunicable diseases (NCDs) can be attributable to unhealthy lifestyle habits. However, there has been little application of this knowledge in primary health care (PHC). Objective This study aims to evaluate the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a PHC setting. This practice is based on national guidelines targeting unhealthy lifestyle habits with a potential risk for NCDs. Methods A pre-post implementation study design with a control group is used in a PHC setting in central Sweden. The Medical Research Council guidelines for process evaluation of complex interventions will be applied. The implementation process and outcomes will be assessed using a mix of qualitative and quantitative methods. A strategic sample of up to 6 PHC centers will be included as intervention centers, which will receive a 12-month multifaceted implementation strategy. Up to 6 matched PHC centers will serve as controls. Core components in the implementation strategy are external and internal facilitators in line with the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and the Astrakan change leadership model. Data will be collected at baseline, during the implementation phase, and 4-6 months after the implementation strategy. Questionnaires will be sent to roughly 500 patients in every PHC center and 200 health care professionals (HCPs) before and after implementation. In addition, purposeful sampling will be used for interviews and focus group discussions with managers, HCPs, patient representatives, and internal and external facilitators. Use of data from medical records and activity logs will be an additional data source. Results Recruitment of PHC centers began in March 2021 and ended in Spring 2022. Based on the planned timeline with the 12-month implementation strategy and 4-6-month follow-up, we expect to collect the final data in Summer 2023. Conclusions This study will explain implementation process and outcomes using a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a real-world PHC context. The study is expected to provide new knowledge about the role of facilitators and their contribution to implementation outcomes. These findings can guide policy makers, managers, and PHC staff to integrate health promotion and disease prevention in PHC and provide methodological support to facilitators. Trial Registration ClinicalTrials.gov NCT04799860; https://clinicaltrials.gov/ct2/show/NCT04799860 International Registered Report Identifier (IRRID) DERR1-10.2196/37634
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Affiliation(s)
- Emma Nilsing Strid
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lars Wallin
- Department of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ylva Nilsagård
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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22
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Siddiqi AD, Britton M, Chen TA, Carter BJ, Wang C, Martinez Leal I, Rogova A, Kyburz B, Williams T, Patel M, Reitzel LR. Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9647. [PMID: 35955001 PMCID: PMC9367734 DOI: 10.3390/ijerph19159647] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 05/11/2023]
Abstract
Tobacco use, and thus tobacco-related morbidity, is elevated amongst patients with behavioral health treatment needs. Consequently, it is important that centers providing health care to this group mandate providers' use of tobacco screenings to inform the need for tobacco use disorder intervention. This study examined the prevalence of mandated tobacco screenings in 80 centers providing health care to Texans with behavioral health needs, examined key factors that could enhance screening conduct, and delineated providers' perceived barriers to tobacco use intervention provision. The results indicated that 80% of surveyed centers mandated tobacco use screenings; those that did were significantly more likely than those that did not to have a hard stop for tobacco use status in health records and were marginally more likely to make training on tobacco screening available to providers. The most widespread barriers to tobacco use disorder care provision were relative perceived importance of competing diagnoses, lack of community resources to refer patients, perceived lack of time, lack of provider knowledge or confidence, and belief that patients do not comply with cessation treatment. Overall, the results suggest that there are opportunities for centers providing care to Texans with behavioral health needs to bolster their tobacco screening and intervention capacity to better address tobacco-related health disparities in this group. Health care centers can support their providers to intervene in tobacco use by mandating screenings, streamlining clinical workflows with hard stops in patient records, and educating providers about the importance of treating tobacco with brief evidence-based intervention strategies while providing accurate information about patients' interest in quitting and providers' potential impacts on a successful quit attempt.
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Affiliation(s)
- Ammar D. Siddiqi
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Maggie Britton
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Brian J. Carter
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Carol Wang
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Department of Health Disparities Research, MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | - Mayuri Patel
- Department of State Health Services, Tobacco Prevention and Control Branch, Austin, TX 78714, USA
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
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23
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Galyavich AS, Baleeva LV, Galeeva ZM, Sabirzyanova AA. Effective drug modification of risk factors in a patient with coronary artery disease: a case report. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The basis of conservative treatment of stable coronary artery disease is the elimination of modifiable risk factors and complex drug therapy for hypertension, diabetes, and dyslipidemia. The rates of awareness, treatment and control of these parameters in Russia remain low. In this regard, current guidelines suggest a step-by-step personalized approach to achieve optimal risk factor control. The aim of this work was to demonstrate that the modification of therapy to achieve the targets of blood pressure, low-density lipoprotein cholesterol and glycated hemoglobin, lifestyle change with smoking cessation, increased physical activity and weight loss led to improvement of coronary circulation and elimination of angina episodes.
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Drapkina OM, Kontsevaya AV, Kalinina AM, Avdeev SM, Agaltsov MV, Alexandrova LM, Antsiferova AA, Aronov DM, Akhmedzhanov NM, Balanova YA, Balakhonova TV, Berns SA, Bochkarev MV, Bochkareva EV, Bubnova MV, Budnevsky AV, Gambaryan MG, Gorbunov VM, Gorny BE, Gorshkov AY, Gumanova NG, Dadaeva VA, Drozdova LY, Egorov VA, Eliashevich SO, Ershova AI, Ivanova ES, Imaeva AE, Ipatov PV, Kaprin AD, Karamnova NS, Kobalava ZD, Konradi AO, Kopylova OV, Korostovtseva LS, Kotova MB, Kulikova MS, Lavrenova EA, Lischenko OV, Lopatina MV, Lukina YV, Lukyanov MM, Mayev IV, Mamedov MN, Markelova SV, Martsevich SY, Metelskaya VA, Meshkov AN, Milushkina OY, Mukaneeva DK, Myrzamatova AO, Nebieridze DV, Orlov DO, Poddubskaya EA, Popovich MV, Popovkina OE, Potievskaya VI, Prozorova GG, Rakovskaya YS, Rotar OP, Rybakov IA, Sviryaev YV, Skripnikova IA, Skoblina NA, Smirnova MI, Starinsky VV, Tolpygina SN, Usova EV, Khailova ZV, Shalnova SA, Shepel RN, Shishkova VN, Yavelov IS. 2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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25
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26
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Kumar N, Mohammadnezhad M. "Patients would probably be more compliant to therapy if encouraged by those around them": a qualitative study exploring primary care physicians' perceptions on barriers to CVD risk management. BMC PRIMARY CARE 2022; 23:61. [PMID: 35354388 PMCID: PMC8966863 DOI: 10.1186/s12875-022-01668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/17/2022] [Indexed: 02/08/2023]
Abstract
Background Public health prevention strategies have been developed to overcome the disease burden. Despite all the available resources, there have been several challenges in keeping up with the practices in Cardiovascular Diseases (CVD) risk management. The aim of this study is to explore Primary Care Physicians’ (PCP) perceptions on barriers to CVD risk management and strategies to overcome these barriers in Suva, Fiji. Methods This is a qualitative study conducted in the Suva Medical area among 7 health centers from August 1st to September 30th, 2021. Purposive sampling was used to recruit participants who provided in-depth and detailed information. From those physicians who worked in the Suva medical area as Primary Health Care (PHC) physicians, those who had at least 6 months experience and those who had some Special Outpatients Department (SOPD) exposure, in-depth interview was conducted using semi-structured questionnaire over the telephone and recorded in a mobile app. The interview content was then transcribed and thematic analysis was done. Results This study included 25 PHC physicians. From the thematic analysis, 2 major themes were developed including perceived barriers to CVD risk management and some of the strategies to overcome these barriers. Some of the barriers identified include patient factors such as non-compliance, physician factors such as time-constraints and lack of training, and health system factors such as poor medical records system and lack of basic resource. The strategic support systems include patient expectations, physician’s encouragement, utilization of resources, laws and legislations and continuing evidence-based medicine. Conclusions Physicians’ perceptions on the barriers and the strategies to overcome those barriers in CVD risk management plays an important role. The barriers include those of physician factors, patient factors and the health system as a whole. It is suggested to encourage shared-decision making in CVD management, enhance physician support and reinforce policies and research to bring about positive change and improvements in the quality of care.
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Affiliation(s)
- Nikansha Kumar
- School of Public Health and Primary Care, Fiji National University, Suva, Fiji
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27
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Gyawali R, Toomey M, Stapleton F, Keay L, Chun Ho K, Jalbert I. Multiple things going on at the same time: determinants of appropriate primary diabetic eyecare delivery. Ophthalmic Physiol Opt 2021; 42:71-81. [PMID: 34747047 DOI: 10.1111/opo.12912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE A recent nationwide medical record audit of optometry practices has identified an evidence-to-practice gap in primary diabetic eyecare delivery. This study aimed to explore the determinants (barriers and enablers) to appropriate diabetic eyecare delivery in Australia. METHODS A qualitative study involving focus-group discussions and interviews of a purposeful sample of Australian optometrists was conducted. Participants were asked about the perceived barriers to adherence to four underperforming clinical indicators related to primary diabetic eyecare identified by the recent national optometry practice audit. The Theoretical Domain Framework was used for thematic analysis and coding salience to identify key behavioural determinants. RESULTS Optometrists participated in eight focus groups (n = 27) and individual interviews (n = 4). The most salient barriers were related to Environmental resources (e.g., limited chair time); Beliefs about consequences (e.g., lack of perceived importance); Knowledge (e.g., poor understanding); Professional role/identity (e.g., the perceived role of optometry in care process); Social influences (e.g., the influence of senior optometrists) and Intentions (e.g., apathy). Key enablers were Environmental resources (e.g., electronic record system and practice aids); Knowledge (e.g., keeping up with knowledge/professional development); reinforcements (e.g., fear of legal actions) and behavioural regulations (e.g., self-monitoring/audit). CONCLUSIONS This study shows that the evidence-to-practice gap in primary diabetic eyecare delivery in Australia can be attributed in part to several interconnected factors related to optometrists' individual capability and motivation as well as the social and practice environment within which they sit. These behavioural determinants will inform the design of an intervention to improve the appropriateness of primary diabetic eyecare delivery.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia.,Better Vision Foundation Nepal, Kathmandu, Nepal
| | - Melinda Toomey
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia.,Singapore Eye Research Institute, Singapore City, Singapore
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
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28
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Naturopathic practitioners' approach to caring for people with cardiovascular disease risk factors: A cross-cultural cross-sectional study reporting the providers perspective. Complement Ther Clin Pract 2021; 46:101511. [PMID: 34768132 DOI: 10.1016/j.ctcp.2021.101511] [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] [Received: 02/17/2021] [Revised: 09/06/2021] [Accepted: 11/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND and purpose: Naturopathic practitioners (NPs) in the United States (US) and Australia are consulted for the prevention and management of a range of health conditions, including cardiovascular disease (CVD). Despite this, little is known about how NPs approach the management of CVD risk factors. The aim of this study was to explore NPs approach to the care of people with CVD risk factors. MATERIALS AND METHODS In 2018, Australian and US NPs were recruited via professional representative organisations. A survey was developed containing four domains; naturopathic approaches to the clinical management of CVD risk factors, communication and sharing of information; professional-client relationship factors; and demographic information. The data analysis was conducted using the appropriate statistical tests. RESULTS A total of 151 NPs completed the survey (Australia n = 75, US n = 76). NPs reported employing dietary, and multiple behavioural and natural product interventions to treat CVD risk factors. The most frequently recommended products by US and Australian NPs were fish oils (87%), magnesium (83%) and coenzyme Q10 (87%). Differences in what US and Australian NPs recommended were identified. NPs reported limited communication with medical doctors about their clients. NPs placed high importance on the relationship quality with their clients. CONCLUSION US and Australian NPs represent an aspect of primary care and disease prevention that warrants further research that evaluates the potential risks and benefits of NP care, and challenges and opportunities associated with NPs integration into the healthcare systems, for populations with CVD risk factors.
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29
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Douglas M, Kgatla N, Sodi T, Musinguzi G, Mothiba T, Skaal L, Makgahlela M, Bastiaens H. Facilitators and barriers in prevention of cardiovascular disease in Limpopo, South Africa: a qualitative study conducted with primary health care managers. BMC Cardiovasc Disord 2021; 21:492. [PMID: 34641818 PMCID: PMC8507214 DOI: 10.1186/s12872-021-02290-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background In the Southern African countries, cardiovascular disease burden is increasing and the second most prevalent cause of death after infectious diseases. The sustainable primary prevention of cardiovascular disease is associated with the engagement of facilitators that support it and hindered by barriers that undermine the support of a healthy lifestyle at the community level. The purpose of the study was to investigate facilitators and barriers at the level of primary health care facilities, on prevention of cardiovascular disease in Limpopo Province of South Africa. Methods This study is an exploratory and descriptive qualitative design, where open-ended key informant interviews were conducted among 20 primary health care managers conveniently sampled in their respective health care facilities. Coding and analysis were done using the thematic analysis method with the assistance of Atlas ti qualitative software. Results Various facilitators for the prevention of CVD were identified in this study. One of such facilitators is the availability and adherence to CVD treatment guidelines in the district. Other facilitators included top-down health education programme; collaboration with schools, traditional and religious leaders; the use of modern technology; and a structured healthcare system. Barriers were also identified as poor infrastructural development; shortage of medical supplies and equipment; lack of health promotion activities; shortage of nurses and other health care personnel; and poor accessibility to primary health care services. Conclusion This study has identified barriers and facilitators that may be harnessed to improve cardiovascular disease prevention, care, and management in a rural setting in South Africa. The facilitators should be strengthened, and barriers identified redressed. Trial registration number: REC-0310111-031. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02290-1.
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Affiliation(s)
- Mbuyiselo Douglas
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa.
| | - Nancy Kgatla
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa
| | - Tholene Sodi
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa
| | - Geofrey Musinguzi
- Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Tebogo Mothiba
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa
| | - Linda Skaal
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa
| | - Mpsanyana Makgahlela
- Faculty of Humanities and Health Sciences, University of Limpopo, Sovenga, South Africa
| | - Hilde Bastiaens
- Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
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30
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Kulmala J, Rosenberg A, Ngandu T, Hemiö K, Tenkula T, Hyytiä A, Vienola M, Huhtamäki-Kuoppala M, Saarinen A, Korkki S, Laatikainen T, Solomon A, Kivipelto M. Facilitators and barriers to implementing lifestyle intervention programme to prevent cognitive decline. Eur J Public Health 2021; 31:816-822. [PMID: 34448856 PMCID: PMC8505000 DOI: 10.1093/eurpub/ckab087] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Finnish Intervention Study to Prevent Cognitive Impairment and Disability is a randomized controlled trial that has tested the efficacy of a multidomain intervention targeting modifiable risk factors to prevent cognitive impairment/dementia. A combination of healthy diet, physical, social and cognitive activity, and management of cardiovascular risks was shown to be an effective model to promote brain health among older people. The aim of this qualitative study was to explore healthcare professionals' perceptions of facilitators and barriers to implementing this lifestyle programme into health care. METHODS Four semi-structured focus group interviews were conducted among healthcare professionals working in primary care and in non-governmental organizations (N=27). Participants were asked to discuss their perceptions of facilitators and barriers for implementing the multidomain intervention into clinical practice. Interviews were analyzed using content analysis. RESULTS Barriers and facilitators described by the healthcare professionals were related to infrastructure and resources, client's personal characteristics and the lifestyle intervention itself. These main categories included several sub-categories related to knowledge, motivation, resources, individualization and collaboration. The interviewees pointed out that more education on dementia prevention is needed, the work should be coordinated efficiently, resources to provide preventive health care should be adequate and multiprofessional collaboration is needed. CONCLUSIONS Transferring a lifestyle intervention from a trial-setting to real life requires knowledge about the factors that influence effective implementation. Identifying drivers and constraints of successful implementation helps to design and tailor future prevention programmes, increases motivation and adherence and supports system change.
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Affiliation(s)
- Jenni Kulmala
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University, Tampere, Finland.,Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Anna Rosenberg
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tiia Ngandu
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Katri Hemiö
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tarja Tenkula
- Southern Ostrobothnia Central Hospital, Seinäjoki, Finland
| | - Arja Hyytiä
- Southern Ostrobothnia Central Hospital, Seinäjoki, Finland
| | | | | | | | - Saana Korkki
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Tiina Laatikainen
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland
| | - Alina Solomon
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Miia Kivipelto
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Stockholms Sjukhem, Research & Development Unit, Stockholm, Sweden
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31
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Hanh TTD, Ngoc LB, Hoa LN, Gong E, Tao X, Yan LL, Minh HV. Improving prevention of cardiovascular diseases: Barriers and facilitators in primary care services in Vietnam. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1757858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Le Bich Ngoc
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Lam Ngoc Hoa
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Enying Gong
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
| | - Xuanchen Tao
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
- Global Health Institute, Duke University, Durham, NC, USA
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2021; 29:5-115. [PMID: 34558602 DOI: 10.1093/eurjpc/zwab154] [Citation(s) in RCA: 208] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA).,International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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Galaviz KI, Colasanti JA, Kalokhe AS, Ali MK, Ofotokun I, Fernandez A. Factors associated with adherence to guideline-recommended cardiovascular disease prevention among HIV clinicians. Transl Behav Med 2021; 12:6371214. [PMID: 34529051 PMCID: PMC8764988 DOI: 10.1093/tbm/ibab125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Integrating cardiovascular disease (CVD) prevention in routine HIV care remains a challenge. This study aimed to identify factors associated with adherence to guideline-recommended CVD preventive practices among HIV clinicians. Clinicians from eight HIV clinics in Atlanta were invited to complete an online survey. The survey was informed by the Consolidated Framework for Implementation Research and assessed the following: clinician CVD risk screening and advice frequency (never to always), individual characteristics (clinician beliefs, self-efficacy, and motivation), inner setting factors (clinic culture, learning climate, leadership engagement, and resources available), and outer setting factors (peer pressure and patient needs). Bivariate correlations examined associations between these factors and guideline adherence. Thirty-eight clinicians completed the survey (82% women, mean age 42 years, 50% infectious disease physicians). For risk screening, clinicians always check patient blood pressure (median score 7.0/7), while they usually ask about smoking or check their blood glucose (median score 6.0/7). For advice provision, clinicians usually recommend quitting smoking, controlling cholesterol or controlling blood pressure (median score 6.0/7), while they often recommend controlling blood glucose, losing weight, or improving diet/physical activity (median score 5.5/7). Clinician beliefs, motivation and self-efficacy were positively correlated with screening and advice practices (r = .55−.84), while inner setting factors negatively correlated with lifestyle-related screening and advice practices (r = −.51 to −.76). Peer pressure was positively correlated with screening and advice practices (r = .57–.89). Clinician psychosocial characteristics and perceived peer pressure positively influence adherence to guideline-recommended CVD preventive practices. These correlates along with leadership engagement could be targeted with proven implementation strategies.
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Affiliation(s)
- Karla I Galaviz
- Department of Applied Health Science, Indiana University School of Public Health Bloomington, Bloomington, IN, USA
| | - Jonathan A Colasanti
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Division of Infections Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Ameeta S Kalokhe
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Division of Infections Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Igho Ofotokun
- Division of Infections Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Alicia Fernandez
- School of Medicine, University of San Francisco California, San Francisco, CA, USA
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42:3227-3337. [PMID: 34458905 DOI: 10.1093/eurheartj/ehab484] [Citation(s) in RCA: 2180] [Impact Index Per Article: 726.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA)
- International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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Rogers HL, Pablo Hernando S, Núñez-Fernández S, Sanchez A, Martos C, Moreno M, Grandes G. Barriers and facilitators in the implementation of an evidence-based health promotion intervention in a primary care setting: a qualitative study. J Health Organ Manag 2021; ahead-of-print. [PMID: 34464035 PMCID: PMC9136863 DOI: 10.1108/jhom-12-2020-0512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aims to elucidate the health care organization, management and policy barriers and facilitators associated with implementation of an evidence-based health promotion intervention in primary care centers in the Basque Country, Spain. DESIGN/METHODOLOGY/APPROACH Seven focus groups were conducted with 49 health professionals from six primary care centers participating in the Prescribing Healthy Life program. Text was analyzed using the Consolidated Framework for Implementation Research (CFIR) focusing on those constructs related to health care organization, management and policy. FINDINGS The health promotion intervention was found to be compatible with the values of primary care professionals. However, professionals at all centers reported barriers to implementation related to: (1) external policy and incentives, (2) compatibility with existing workflow and (3) available resources to carry out the program. Specific barriers in these areas related to lack of financial and political support, consultation time constraints and difficulty managing competing day-to-day demands. Other barriers and facilitators were related to the constructs networks and communication, culture, relative priority and leadership engagement. A set of six specific barrier-facilitator pairs emerged. ORIGINALITY/VALUE Implementation science and, specifically, the CFIR constructs were used as a guide. Barriers and facilitators related to the implementation of a health promotion program in primary care were identified. Healthcare managers and policy makers can modify these factors to foster a more propitious implementation environment. These factors should be appropriately monitored, both in pre-implementation phases and during the implementation process, in order to ensure effective integration of health promotion into the primary care setting.
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Affiliation(s)
- Heather L Rogers
- Psychology and Health Research Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Ikerbasque Basque Foundation for Science, Bilbao, Spain
| | - Susana Pablo Hernando
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Basque Healthcare Service-Osakidetza, Barakaldo, Spain
| | - Silvia Núñez-Fernández
- Psychology and Health Research Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Basque Healthcare Service-Osakidetza, Barakaldo, Spain
| | - Carlos Martos
- Arrigorriaga Health Center, Integrated Health Organization Barrualde-Galdakao, Osakidetza, Arrigorriaga, Spain
| | - Maribel Moreno
- Integrated Health Organization Barrualde-Galdakao, Osakidetza, Galdakao, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Basque Healthcare Service-Osakidetza, Barakaldo, Spain
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36
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Hollis JL, Kocanda L, Seward K, Collins C, Tully B, Hunter M, Foureur M, Lawrence W, MacDonald-Wicks L, Schumacher T. The impact of Healthy Conversation Skills training on health professionals' barriers to having behaviour change conversations: a pre-post survey using the Theoretical Domains Framework. BMC Health Serv Res 2021; 21:880. [PMID: 34452634 PMCID: PMC8394191 DOI: 10.1186/s12913-021-06893-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/12/2021] [Indexed: 12/05/2022] Open
Abstract
Background Changing people’s behaviour by giving advice and instruction, as traditionally provided in healthcare consultations, is usually ineffective. Healthy Conversation Skills (HCS) training enhances health professionals’ communication skills and ability to empower and motivate people in health behaviour change. Guided by the Theoretical Domains Framework (TDF), this study examined the impact of HCS training on health professional barriers to conducting behaviour change conversations in both clinical and non-clinical settings. Secondary aims were to i) identify health professionals’ barriers to having behaviour change conversations, and explore the ii) effect of HCS training on health professionals’ competence and attitudes to adopting HCS, iii) feasibility, acceptability and appropriateness of using HCS in their clinical and non-clinical roles, and iv) acceptability and quality of HCS training. Methods HCS training was conducted in October-November 2019 and February 2020. Pre-training (T1), post-training (T2) and follow-up (T3; 6-10 weeks post-training) surveys collected data on demographics and changes in competence, confidence, importance and usefulness (10-point Likert scale, where 10 = highest score) of conducting behaviour change conversations. Validated items assessing barriers to having these conversations were based on eight TDF domains. Post-training acceptability and quality of training was assessed. Data were summarised using descriptive statistics, and differences between TDF domain scores at the specific time points were analysed using Wilcoxon matched-pairs signed-rank tests. Results Sixty-four participants consented to complete surveys (97% women; 16% identified as Aboriginal), with 37 employed in clinical settings and 27 in non-clinical settings. The training improved scores for the TDF domains of skills (T1: median (interquartile range) = 4.7(3.3-5.3); T3 = 5.7(5.3-6.0), p < 0.01), belief about capabilities (T1 = 4.7(3.3-6.0); T3 = 5.7(5.0-6.0), p < 0.01), and goals (T1 = 4.3(3.7-5.0); T3 = 4.7(4.3-5.3), p < 0.01) at follow-up. Competence in using ‘open discovery questions’ increased post-training (T1 = 25% of responses; T2 = 96% of responses; T3 = 87% of responses, p < 0.001), as did participants’ confidence for having behaviour change conversations (T1 = 6.0(4.7-7.6); T2 = 8.1(7.1-8.8), p < 0.001), including an increased confidence in having behaviour change conversations with Aboriginal clients (T1 = 5.0(2.7-6.3); T2 = 7.6(6.4-8.3), p < 0.001). Conclusions Provision of additional support strategies to address intentions; memory, attention and decision processes; and behavioural regulation may enhance adoption and maintenance of HCS in routine practice. Wider implementation of HCS training could be an effective strategy to building capacity and support health professionals to use a person-centred, opportunistic approach to health behaviour change. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06893-4.
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Affiliation(s)
- Jenna L Hollis
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia. .,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia. .,Hunter Medical Research Institute, Newcastle, New South Wales, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia. .,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.
| | - Lucy Kocanda
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Rural Health, University of Newcastle, Tamworth, New South Wales, Australia
| | - Kirsty Seward
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Clare Collins
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Mandy Hunter
- Hunter New England Local Health District Nursing and Midwifery Services, Newcastle, New South Wales, Australia
| | - Maralyn Foureur
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia.,Nursing and Midwifery Research Centre, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,NIHR, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lesley MacDonald-Wicks
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tracy Schumacher
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Rural Health, University of Newcastle, Tamworth, New South Wales, Australia
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Agrawal S, Gołębiowska J, Makuch S, Mazur G. Prevalence of Use of Preventive Services in Poland: Result from a Population-Based Nationwide Study. J Clin Med 2021; 10:jcm10102084. [PMID: 34066239 PMCID: PMC8150860 DOI: 10.3390/jcm10102084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
Systematic reviews of scientific evidence have identified clinical services that prevent or ameliorate illness and reduce mortality. This study aimed to assess the prevalence of all recommended evidence-based preventive services in a publicly funded healthcare setting. We conducted a population-based nationwide cross-sectional computer-assisted telephone survey of 1000 Polish adults (response rate 42%). The self-reported use of all recommended clinical preventive services was assessed, including mammography, colonoscopy, blood glucose screening, vaccination, blood pressure screening, and preventive counselling. The results showed that only 6.4% of adults had received all recommended preventive screening, whereas only 4.3% had received appropriate counselling. General practitioner (GP) visits, blood pressure screening, blood glucose screening, and cervical smear were among the most commonly provisioned interventions, while flu vaccination, PSA assessment, and preventive counselling were among the least prevalent services. Despite the low uptake of preventive interventions, over 75% is interested in remote access to preventive services using telemedicine platforms and e-consultations. Our findings suggest that there are significant gaps in the receipt of preventive interventions. Further improvements require not only changes in the incentive system for healthcare providers, but also system-level innovation such as telemedicine solutions to deliver preventive services remotely and engage individuals in the monitoring process.
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Affiliation(s)
- Siddarth Agrawal
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.G.); (G.M.)
- Department of Cancer Prevention and Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Department of Pathology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
- Correspondence:
| | - Justyna Gołębiowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.G.); (G.M.)
- Department of Cancer Prevention and Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Sebastian Makuch
- Department of Pathology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Grzegorz Mazur
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (J.G.); (G.M.)
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Relationship beetween Primary and Hospital Care in cardiovascular prevention and treatment of dyslipidemias. Derivation algorithm. Discharge criteria. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2021; 33 Suppl 1:65-70. [PMID: 33966816 DOI: 10.1016/j.arteri.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022]
Abstract
Effective cardiovascular prevention requires taking advantage of all opportunities for patient contact with the Health Services in order to detect risk factors (CVRF) and global cardiovascular risk stratification (CVR). This particularly involves the Primary Care (PC) services, which must be coordinated with the Hospital Care (HC) in order to make all health resources available to the population. In addition, it is necessary to take into account the contribution of Occupational Health and Pharmacy services. There are hopeful signs as regards the possibility of overcoming the barriers that limit the necessary exchange of information between PC and HC professionals, as a basis for adequate coordination between both levels of care. This includes the implementation of referral and discharge algorithms (in this review this means those related to dyslipidaemias) accepted by professionals at both levels, and currently facilitated by the availability of new corporate tools (mobile, email, virtual consultations). The challenge lies in seizing the opportunity they offer to make their implementation effective.
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Barriers and Facilitators in the Uptake of Integrated Care Pathways for Older Patients by Healthcare Professionals: A Qualitative Analysis of the French National "Health Pathway of Seniors for Preserved Autonomy" Pilot Program: Barriers and Facilitators for Adhesion of Healthcare Professionals in Integrated Care for Older Patients: A Qualitative Assessment Based on the French National Experiment: 'Health Pathway of Seniors for Preserved Autonomy' (PAERPA). Int J Integr Care 2021; 21:7. [PMID: 33976596 PMCID: PMC8064286 DOI: 10.5334/ijic.5483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Integrated care is a particularly promising approach in geriatrics – a field in which the medical, psychological and social issues are often complex. The uptake of integrated care by healthcare professionals (HCPs) is essential but varies markedly. The objective of the present study of healthcare professionals was to identify barriers to and facilitators of commitment to integrated care for seniors. Methods: We performed a two-step, qualitative study, comprising (i) six qualitative, semi-directive series of interviews with HCPs (hospital practitioners, family physicians, nurses and pharmacists) who agreed or disagreed to take part in the French national “Health Pathway of Seniors for Preserved Autonomy” (PAERPA) pilot program; and (ii) an analysis of the pooled results, in order to identify common concerns among the healthcare professionals. Results: We identified four key “barrier” and “facilitator” topics shared by HCPs who had committed to the pilot program and those who had not: (i) awareness of and/or interest in geriatric medicine and team working, (ii) the presence of a care coordinator; (iii) the provision of information about the program and about the patient, and communication between HCPs, and (iv) personal benefits for the HCPs and the patients. Key conclusions: The four key topics identified in this large qualitative study of several healthcare professions should be considered during the design and dissemination of integrated care pathways for older patients.
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Delivering Opportunistic Behavior Change Interventions: a Systematic Review of Systematic Reviews. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:319-331. [PMID: 32067156 PMCID: PMC7056685 DOI: 10.1007/s11121-020-01087-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Opportunities for healthcare professionals to deliver health behavior change interventions are often missed, but understanding the barriers and enablers to this activity is limited by a focus on defined specialisms/health conditions. This systematic review of systematic reviews collates all the evidence across professional groups to provide guidance to policy makers for implementing healthcare professional delivery of behavior change interventions. Eight electronic databases were searched for systematic reviews reporting patient-facing healthcare professionals’ (e.g., general practitioners, nurses) barriers and enablers to delivering behavior change interventions (diet, physical activity, alcohol reduction, smoking cessation, and weight management). A narrative synthesis was conducted. Thirty-six systematic reviews were included. Four themes emerged as both barriers and enablers: (1) perceptions of the knowledge or skills needed to support behavior change with patients, (2) perceptions of the healthcare professional role, (3) beliefs about resources and support needed, and (4) healthcare professionals’ own health behavior. There were four cross-disciplinary barriers: (1) perceived lack of time, (2) perceived lack of prioritization of health behavior change, (3) negative attitudes towards patients and perceptions of patient risk, and (4) perceptions of patient motivation. The three enablers were as follows: (1) training, (2) context, and (3) attitudes towards delivering interventions. To enhance healthcare professionals’ delivery of behavior change interventions, policy makers should (a) address perceptions about patient need for interventions, (b) support diverse professional groups to identify opportunities to deliver interventions, and (c) encourage professionals to focus on prevention and management of health conditions.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK.
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Rachel Calam
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9PL, Manchester, UK
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A National Survey Identifying the Factors Associated With Cardiovascular Care Nurses' Perceived Knowledge of International Practice Guidelines: The First Step in the Development of an Implementation Strategy. J Cardiovasc Nurs 2021; 36:E1-E10. [PMID: 33833191 DOI: 10.1097/jcn.0000000000000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The implementation of international guidelines within everyday practice remains problematic, which can have a detrimental impact on quality of care delivered. This study aimed to ascertain the factors associated with clinical nurses' perceived knowledge of international guidelines. METHODS In this cross-sectional survey, nurses from 45 hospitals across Ireland were recruited. A previously validated anonymous questionnaire that assessed guideline knowledge, use, and barriers to implementation was used. Data were analyzed using SPSS 23 and logistic regression. RESULTS Of the 542 responses, 54% had used international guidelines relevant to their practice and 50% had consulted within the last year. Most nurses perceived that poor patient follow-up, lack of time and resources, poor clinical leadership, workload, long guidelines, and not understanding guideline detail were barriers to guideline use and implementation. Forty-five percent rated their perceived knowledge of guidelines as "low." Logistic regression identified that "high" knowledge levels were significantly associated with having read guidelines in the last year and their use with practice. In contrast, low knowledge of the guidelines was associated with perceptions that they were lengthy and not easy to use, lack of confidence to challenge colleagues when guidelines are not implemented, or not being able to influence current practice. CONCLUSIONS This study identified the specific knowledge needs in this cohort of mainly basic grade registered nurses, with low perceived guideline knowledge. A whole unit or team approach led by nurse champions is needed to develop and establish practice and educational strategies that would increase the availability, application, and knowledge of guidelines within everyday practice.
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Toomey M, Gyawali R, Stapleton F, Ho KC, Keay L, Jalbert I. Facilitators and barriers to the delivery of eye care by optometrists: a systematic review using the theoretical domains framework. Ophthalmic Physiol Opt 2021; 41:782-797. [PMID: 33774856 DOI: 10.1111/opo.12801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/21/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE Evidence-based practice is fundamental to providing quality care, patient satisfaction and judicious use of limited healthcare resources. However, variability in evidence-based eye care delivery has been reported. Given the important role of optometrists in delivering primary eye care, a better understanding of the barriers and facilitators to providing optometric care is required. This systematic review aimed to identify determinants (barriers and facilitators) of eye care delivery by optometrists and interventions that may improve eye care delivery. RECENT FINDINGS PubMed, MEDLINE, EMBASE, CINAHL, SCOPUS, PsychINFO, ProQuest and Web of Science were searched for studies reporting barriers and facilitators to eye care delivery published between 1999 and 2020. The Theoretical Domains Framework (TDF) was used to analyse data (quotations, interpretive summaries, survey result) with barriers and facilitators coded to one or more of the 14 domains, and used to identify the key behavioural domains influencing eye care delivery based on frequency of coding, elaboration and stated importance in the study. Influential domains were mapped to the Behaviour Change Wheel to identify potential interventions to improve eye care delivery. Of the 802 studies retrieved from the search, 30 were included. Frequently identified barriers were time constraints, resources and equipment issues, patient factors, lack of awareness, skill proficiency deficits and negative attitudes and beliefs. Frequently identified facilitators were adequate time, resources and equipment, education, skill proficiency and understanding the relevancy of the eye care provided. The key TDF domains influencing eye care delivery were 'environmental context and resources' (time, resources, equipment issues, patient factors), 'knowledge' (awareness issues), 'skills' (skills proficiency) and 'belief about consequences' (beliefs and relevancy). Intervention functions that may improve eye care delivery were education, training, restriction, environmental restructuring, enablement, persuasion and modelling. SUMMARY The barriers and facilitators identified in this review were diverse and located at both the practitioner and organisational levels. Four TDF domains were found to be influential determinants of eye care practice. Intervention functions identified in this study can be used to improve the appropriateness of primary eye care delivery.
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Affiliation(s)
- Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Rajendra Gyawali
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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Lionis C, Anastasaki M, Bertsias A, Angelaki A, Carlsson AC, Gudjonsdottir H, Wändell P, Larrabee Sonderlund A, Thilsing T, Søndergaard J, Seifert B, Kral N, De Wit NJ, Hollander M, Korevaar J, Schellevis F. High Variability in Implementation of Selective-Prevention Services for Cardiometabolic Diseases in Five European Primary Care Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239080. [PMID: 33291815 PMCID: PMC7730804 DOI: 10.3390/ijerph17239080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 11/20/2022]
Abstract
(1) Background: Cardiometabolic diseases are the most common cause of death worldwide. As part of a collaborative European study, this paper aims to explore the implementation of primary care selective-prevention services in five European countries. We assessed the implementation process of the selective-prevention services, participants’ cardiometabolic profile and risk and participants’ evaluation of the services, in terms of feasibility and impact in promoting a healthy lifestyle. (2) Methods: Eligible participants were primary care patients, 40–65 years of age, without any diagnosis of cardiometabolic disease. Two hundred patients were invited to participate per country. The extent to which participants adopted and completed the implementation of selective-prevention services was recorded. Patient demographics, lifestyle-related cardiometabolic risk factors and opinions on the implementation’s feasibility were also collected. (3) Results: Acceptance rates varied from 19.5% (n = 39/200) in Sweden to 100% (n = 200/200) in the Czech Republic. Risk assessment completion rates ranged from 65.4% (n = 70/107) in Greece to 100% (n = 39/39) in Sweden. On a ten-point scale, the median (25–75% quartile) of participant-reported implementation feasibility ranged from 7.4 (6.9–7.8) in Greece to 9.2 (8.2–9.9) in Sweden. Willingness to change lifestyle exceeded 80% in all countries. (4) Conclusions: A substantial variation in the implementation of selective-prevention receptiveness and patient risk profile was observed among countries. Our findings suggest that the design and implementation of behavior change cardiometabolic programmes in each country should be informed by the local context and provide some background evidence towards this direction, which can be even more relevant during the current pandemic period.
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Affiliation(s)
- Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.A.); (A.B.); (A.A.)
- Correspondence:
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.A.); (A.B.); (A.A.)
| | - Antonios Bertsias
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.A.); (A.B.); (A.A.)
| | - Agapi Angelaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.A.); (A.B.); (A.A.)
| | - Axel C. Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183 Huddinge, Sweden; (A.C.C.); (P.W.)
- Academic Primary Health Care Centre, Stockholm Region, 11365 Stockholm, Sweden
| | | | - Per Wändell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14183 Huddinge, Sweden; (A.C.C.); (P.W.)
| | - Anders Larrabee Sonderlund
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark; (A.L.S.); (T.T.); (J.S.)
| | - Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark; (A.L.S.); (T.T.); (J.S.)
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark; (A.L.S.); (T.T.); (J.S.)
| | - Bohumil Seifert
- Institute of General Practice, First Faculty of Medicine, Charles University, 128 00 Prague 2, Czech Republic; (B.S.); (N.K.)
| | - Norbert Kral
- Institute of General Practice, First Faculty of Medicine, Charles University, 128 00 Prague 2, Czech Republic; (B.S.); (N.K.)
| | - Niek J De Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (N.J.D.W.); (M.H.)
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (N.J.D.W.); (M.H.)
| | - Joke Korevaar
- Nivel Netherlands Institute for Health Services Research, 3513 CR Utrecht, The Netherlands; (J.K.); (F.S.)
| | - François Schellevis
- Nivel Netherlands Institute for Health Services Research, 3513 CR Utrecht, The Netherlands; (J.K.); (F.S.)
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, 1081 HV Amsterdam, The Netherlands
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Cornish K, Fox G, Fyfe T, Koopmans E, Pousette A, Pelletier CA. Understanding physical literacy in the context of health: a rapid scoping review. BMC Public Health 2020; 20:1569. [PMID: 33076887 PMCID: PMC7570403 DOI: 10.1186/s12889-020-09583-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Physical literacy is a multidimensional concept that describes a holistic foundation for physical activity engagement. Understanding the utilization and effectiveness of physical literacy in the context of health and the health care setting will support clinical and population health programming. The purpose of this rapid scoping review was to: 1) map the conceptualization of physical literacy as it relates to health; 2) identify and describe the utilization of physical literacy in the context of health and engagement of health care providers; and 3) better understand the relationship between physical literacy, physical activity, and health. METHODS Following established scoping review methods adapted for a rapid review approach, we searched electronic databases Medline OVID, CINAHL Ebsco, PsycInfo Ebsco, Web of Science ISI, and ERIC Ebsco from conception until September 2019. Tabulation coding was used to identify the key themes across included articles and synthesize findings. The review follows an integrated knowledge translation approach based on a partnership between the health system, community organizations, and researchers. RESULTS Following removal of duplicates, our search identified 475 articles for title and abstract screening. After full text review, 17 articles were included (12 original research papers and five conceptual or review papers). There was near consensus among included papers with 16 of 17 using the Whiteheadian definition of physical literacy. There was limited involvement of health care providers in the concept of physical literacy. Physical literacy was connected to the following health indicators: BMI and body weight, waist circumference, cardiorespiratory fitness, physical activity, and sedentary behaviour. The primary demographic focus of included studies was children and there was a conceptual focus on the physical domain of physical literacy. CONCLUSIONS Despite growing popularity, the empirical evidence base linking physical literacy and health outcomes is limited and the relationship remains theoretical. Physical literacy may present a novel and holistic framework for health-enhancing physical activity interventions that consider factors vital to sustained participation in physical activity across the life course. Future work should continue to explore the nature and direction of the relationship between physical activity and physical literacy to identify appropriate focused approaches for health promotion.
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Affiliation(s)
- Katie Cornish
- Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Gloria Fox
- Population and Preventive Public Health, Northern Health, Prince George, British Columbia, Canada
| | - Trina Fyfe
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Erica Koopmans
- Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Anne Pousette
- Promotion of Wellness in Northern British Columbia (WINBC), Clinical Faculty, Northern Medical Program, University of British Columbia, Medical Staff, University Hospital of Northern British Columbia, Northern Health, Prince George, British Columbia, Canada
| | - Chelsea A Pelletier
- School of Health Sciences, University of Northern British Columbia 3333 University Way, Prince George, British Columbia V2N 4Z9, Canada.
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Bach-Mortensen AM, Verboom B. Barriers and facilitators systematic reviews in health: A methodological review and recommendations for reviewers. Res Synth Methods 2020; 11:743-759. [PMID: 32845574 DOI: 10.1002/jrsm.1447] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systematic reviews cataloguing the barriers to and facilitators of various outcomes are increasingly popular, despite criticisms of this type of review on philosophical, methodological, and practical grounds. The aims of this review are to appraise, analyze, and discuss the reporting and synthesis practices used in recently published barriers and facilitators reviews in health services research. METHODS All English-language peer-reviewed systematic reviews that synthesized research on barriers and facilitators in a health services context were eligible for inclusion. We searched 11 databases over a 13-month period (1 November 2017-30 November 2018) using an exhaustive list of search terms for "barrier(s)," "facilitator(s)," and "systematic review." RESULTS One hundred reviews were included. We found a high degree of variation in the synthesis practices used in these reviews, with the majority employing aggregative (rather than interpretive) approaches. The findings echo common critiques of this review type, including concerns about the reduction of complex phenomena to simplified, discrete factors. Although several reviews highlighted the "complexity" of barriers and facilitators, this was usually not analyzed systematically. Analysis of the subsample of reviews that explicitly discussed the barriers and facilitators approach revealed some common issues. These tended to be either conceptual/definitional (eg, ideas about interrelationships and overlap between factors) and methodological/practical (eg, challenges related to aggregating heterogeneous research). CONCLUSION Barriers and facilitators reviews should (a) clearly operationally define "barrier" and "facilitator," (b) explicitly describe how factors are extracted and subsequently synthesized, and (c) provide critical reflection on the contextual variability and reliability of identified factors.
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Affiliation(s)
| | - Ben Verboom
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Determinants of lifestyle counseling and current practices: A cross-sectional study among Dutch general practitioners. PLoS One 2020; 15:e0235968. [PMID: 32692740 PMCID: PMC7373284 DOI: 10.1371/journal.pone.0235968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022] Open
Abstract
This study aimed to examine the amount of lifestyle counseling that Dutch general practitioners (GPs) generally provide to their patients, as well as the behavioral determinants of their lifestyle counseling practices. Lifestyle counseling was defined and operationalized through the 5As model (i.e. Assess, Advise, Agree, Assist and Arrange), while determinants were based on an adapted version of the theory of planned behavior. A cross-sectional study was conducted among a sample of 198 GPs, using an online survey questionnaire for collecting data. The results showed that 79.3% of the GPs assessed patients' current lifestyle often or always, while 60.1% reported they often or always assessed patients' motivation to improve their lifestyle. Depending on the lifestyle behavior, Advising to improve lifestyle ranged from 42.5% (sleep) to 92.4% (smoking), while Agree to set goals ranged from 21.7% (sleep) to 46.9% (smoking). Assisting patients to overcome barriers to lifestyle changes varied per patient barrier, ranging from lack of financial resources (25.7%) to stress (81.8%). The findings from the linear hierarchical regression revealed that GPs' self-efficacy (β = .46, p < .001), patient norm (β = .21, p < .001), and attitude (β = .20, p < .05) were the determinants with the strongest associations with lifestyle counseling. The full model explained 47% of the variance in counseling lifestyle. Implications for supporting GPs to counsel patients about their lifestyle are discussed.
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Neale EP, Middleton J, Lambert K. Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review. BMC Nephrol 2020; 21:83. [PMID: 32160886 PMCID: PMC7066820 DOI: 10.1186/s12882-020-01731-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background Chronic kidney disease (CKD) is growing population health concern worldwide, and with early identification and effective management, kidney disease progression can be slowed or prevented. Most patients with risk factors for chronic kidney disease are treated within primary healthcare. Therefore, it is important to understand how best to support primary care providers (PC-P) to detect and manage chronic kidney disease. The aim of this systematic review was to evaluate barriers and enablers to the diagnosis and management of CKD in primary care. Methods A systematic review of qualitative research on the barriers and/or enablers to detection and/or management of CKD in adults within primary healthcare was conducted. The databases Medline (EBSCO), PubMed, Cochrane CENTRAL, CINAHL (EBSCO) and Joanna Briggs Institute Evidence Based Practice (Ovid) were searched until 27th August 2019. Barriers and/or enablers reported in each study were identified, classified into themes, and categorised according to the Theoretical Domains Framework. Results A total of 20 studies were included in this review. The most commonly reported barriers related to detection and management of CKD in primary care were categorised into the ‘Environmental context and resources’ domain (n = 16 studies). Overall, the most common barrier identified was a lack of time (n = 13 studies), followed by a fear of delivering a diagnosis of CKD, and dissatisfaction with CKD guidelines (both n = 10 studies). Overall, the most common enabler identified was the presence of supportive technology to identify and manage CKD (n = 7 studies), followed by the presence of a collaborative relationship between members of the healthcare team (n = 5 studies). Conclusion This systematic review identified a number of barriers and enablers which PC-P face when identifying and managing CKD. The findings of this review suggest a need for time-efficient strategies that promote collaboration between members of the healthcare team, and practice guidelines which consider the frequently co-morbid nature of CKD. Enhanced collaboration between PC-P and nephrology services may also support PC-Ps when diagnosing CKD in primary care, and facilitate improved patient self-management.
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Affiliation(s)
- Elizabeth P Neale
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia. .,Health Impacts Research Cluster, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Justin Middleton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia.,Health Impacts Research Cluster, University of Wollongong, Wollongong, NSW, 2522, Australia.,Department of Clinical Nutrition, Wollongong Hospital, Level 5, Block C, Crown St, Wollongong, NSW, 2500, Australia
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Godbee K, Gunn J, Lautenschlager NT, Curran E, Palmer VJ. Implementing dementia risk reduction in primary care: a preliminary conceptual model based on a scoping review of practitioners' views. Prim Health Care Res Dev 2019; 20:e140. [PMID: 31640836 PMCID: PMC6842648 DOI: 10.1017/s1463423619000744] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 12/22/2022] Open
Abstract
Primary care practitioners (PCPs) do not routinely promote dementia risk reduction. The purpose of this study was to map the published literature on the views of PCPs about dementia risk reduction, in order to identify implementation constructs and strategies crucial to the development of an implementation intervention to support dementia risk reduction in primary care. We undertook a scoping review of the PCPs' views about promoting brain health for reducing dementia risk. We searched MEDLINE, PsycINFO, CINAHL, and Embase for English-language articles published between 1995 and December 2017. We then applied the Consolidated Framework for Implementation Research (CFIR) and matched Expert Recommendations for Implementing Change to the scoping review findings in order to develop a preliminary implementation model. Eight articles reported views of PCPs about dementia prevention. Study findings were mapped to 5 of the 39 CFIR constructs: (i) knowledge and beliefs about dementia risk reduction, (ii) evidence strength and quality, (iii) relative priority, (iv) available resources, and (v) external policy and incentives. The findings suggest implementation strategies to consider in our preliminary model include (i) educational meetings, (ii) identifying and preparing champions, (iii) conducting local consensus discussions, (iv) altering incentive structures, and (v) capturing and sharing local knowledge. There have been few studies about the views of PCPs about dementia risk reduction. Implementation in the primary care setting is fundamental to early identification of risk and supporting preventive practices, but it needs to focus on more than just education for PCPs. We need more up-to-date and in-depth data on the views of PCPs about dementia risk reduction and context-specific analyses of implementation needs. Further research into effective primary care interventions to reduce dementia risk is expected to support implementation efforts.
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Affiliation(s)
- Kali Godbee
- Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Australia
| | - Jane Gunn
- Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, University of Melbourne, Carlton, Australia
| | - Eleanor Curran
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, University of Melbourne, Carlton, Australia
| | - Victoria J Palmer
- Department of General Practice, Melbourne Medical School, University of Melbourne, Carlton, Australia
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Gadenz SD, Harzheim E, Amaral HG, Drehmer M. Development and Assessment of a Mobile Nutritional Counseling Tool for Primary Care Physicians. Telemed J E Health 2019; 26:805-811. [PMID: 31556810 DOI: 10.1089/tmj.2019.0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Hypertension remains widely undetected, undertreated, and poorly controlled. Appropriate dietary changes can prevent and treat hypertension effectively. Primary care physicians (PCPs) have the opportunity to counsel patients about their diets and are able to facilitate long-term adherence to changes. However, they encounter several barriers to delivery of evidence-based counseling in daily medical practice. m-Health can make important contributions. Objective: To describe the development and assessment of a Brazilian mobile app for nutritional management of hypertension supported by evidence-based. Materials and Methods: App development used a user-centered approach that seeks to solve problems in a collective and collaborative way. The app was developed in Apache Cordova® (Adobe Systems, San Jose, CA) for iOS and Android mobile phone platforms. Beta testing was performed with a sample of Brazilian PCPs (n = 62), who were asked to use the app in routine practice and evaluate it. Results: The process involved researchers, government, PCPs, nutritionists, and designers. Dieta Dash® (Universidade Federal do Rio Grande do Sul-UFRGS, Porto Alegre, Brazil) app was divided into following sections: meal evaluation, Healthy meals, Healthy choices, and a database of Healthy recipes. The mean perceived usefulness and ease-of-use scores were 23.3 and 32.3 out of 42, respectively. Conclusions: It is a great source of up-to-date and summary guidelines, usable, acceptable, and positively impact clinical care. PCPs have identified improvements that could make the user experience better. The Dieta Dash app can be incorporated into Brazilian primary care practice.
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Affiliation(s)
- Sabrina Dalbosco Gadenz
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Telehealth Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Erno Harzheim
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Telehealth Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Herberth Giuliano Amaral
- Telehealth Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Computational Modelling and Systems, Montes Claros State University, Montes Claros, Brazil
| | - Michele Drehmer
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Nutrition, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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An evidence-based toolbox for the design and implementation of selective-prevention primary-care initiatives targeting cardio-metabolic disease. Prev Med Rep 2019; 16:100979. [PMID: 31508298 PMCID: PMC6722397 DOI: 10.1016/j.pmedr.2019.100979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/01/2019] [Accepted: 08/20/2019] [Indexed: 11/29/2022] Open
Abstract
Cardio-metabolic diseases (CMD; cardiovascular disease, type 2 diabetes, chronic kidney disease) represent a global public health problem. Worldwide, nearly half a billion people are currently diagnosed with diabetes, and cardiovascular disease is the leading cause of death. Most of these diseases can be assuaged/prevented through behavior change. However, the best way to implement preventive interventions is unclear. We aim to fill this knowledge gap by creating an evidence-based and adaptable “toolbox” for the design and implementation of selective prevention initiatives (SPI) targeting CMD. We built our toolbox based on evidence from a pan-European research project on primary-care SPIs targeting CMD. The evidence includes (1) two systematic reviews and two surveys of patient and general practitioner barriers and facilitators of engaging with SPIs, (2) a consensus meeting with leading experts to establish optimal SPI design, and (3) a feasibility study of a generic, evidence-based primary-care SPI protocol in five European countries. Our results related primarily to the five different national health-care contexts from which we derived our data. On this basis, we generated 12 general recommendations for how best to design and implement CMD-SPIs in primary care. We supplement our recommendations with practical, evidence-based suggestions for how each recommendation might best be heeded. The toolbox is generic and adaptable to various national and systemic settings by clinicians and policy makers alike. However, our product needs to be kept up-to-date to be effective and we implore future research to add relevant tools as they are developed.
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