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Nichol B, Haighton C, Wilson R, Rodrigues AM. Enhancing making every contact count (MECC) training and delivery for the third and social economy (TSE) sector: a strategic behavioural analysis. Psychol Health 2024:1-32. [PMID: 39086100 DOI: 10.1080/08870446.2024.2386289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 07/03/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE To enhance Making Every Contact Count (MECC, an opportunistic approach to health promotion), training in the Third and Social Economy (TSE, all groups and organisations primarily working towards social justice, outside of the government or household) by examining the degree to which the behavioural content of MECC training tackled significant factors influencing MECC delivery. METHODS AND MEASURES A strategic behavioural analysis design. Semi-structured interviews with service providers (n = 15) and users (n = 5) were coded for barriers and facilitators of MECC delivery using the Theoretical Domains Framework (TDF). Existing MECC training was coded for behaviour change techniques (BCTs) and intervention functions (IFs). The degree to which BCTs and IFs addressed the key TDF domains of influences on MECC delivery in the TSE were examined using prespecified tools. RESULTS Seven key TDF domains of influences in MECC delivery were identified. Overall, only 9/31 linked BCTs were utilised within MECC training, with percentage utilisation of relevant BCTs for each domain ranging from 0% to 66.7%. Training adequately addressed 2/7 key domains. CONCLUSION The TSE and healthcare share many common key TDF domains, although there are differences in how each are relevant. Limitations and recommendations for MECC training are discussed.
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Affiliation(s)
- Beth Nichol
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Catherine Haighton
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Rob Wilson
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, UK
| | - Angela M Rodrigues
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
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Rodrigues AM, Nichol B, Wilson R, Charlton C, Gibson B, Finch T, Haighton C, Maniatopoulos G, Giles E, Harrison D, Orange D, Robson C, Harland J. Mapping regional implementation of 'Making Every Contact Count': mixed-methods evaluation of implementation stage, strategies, barriers and facilitators of implementation. BMJ Open 2024; 14:e084208. [PMID: 39038864 PMCID: PMC11268057 DOI: 10.1136/bmjopen-2024-084208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The Making Every Contact Count (MECC) programme provides training and materials to support public-facing workers to encourage health-promoting behaviour change by using the day-to-day interactions between organisations and individuals. This project aimed to analyse MECC implementation through a comparative analysis of implementation stage, strategies used for implementation and enablers/barriers of the implementation process within a region in England-the North East and North Cumbria (NENC). METHODS A mixed-methods process evaluation was conducted applying normalisation process theory and theoretical domains framework. MECC programme documents were reviewed and mapped against specific criteria (eg, implementation strategies). An online mapping survey was conducted to establish current implementation/delivery of MECC within NENC settings (eg, local government, healthcare and voluntary community sector). Qualitative research, using individual interviews and group discussions, was conducted to establish further understanding of MECC implementation. RESULTS Our findings were informed by reviewing documents (n=5), surveying participants (n=34), interviews (n=18) and group discussions (n=48). Overall, the implementation of MECC within the region was at an early stage, with training mostly delivered between, rather than within, organisations. Qualitative findings highlighted factors that influence stakeholders to implement MECC (eg, organisational goals that were facilitated by MECC implementation, including the prevention agenda), supported resources that facilitate the implementation of MECC (eg, logic models) and enabling factors that promote MECC sustainability across the region (eg, buy-in from leadership and management). CONCLUSIONS The NENC MECC programme is built around regional leadership that supports the implementation process. This process evaluation identified key influences of MECC implementation across the region. We discuss evidence-based recommendation for policy and practice that can be taken forward to develop targeted strategies to support future MECC implementation. For example, a co-ordinated infrastructure and strategy is needed to combat delivery and implementation issues identified.
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Affiliation(s)
- Angela M Rodrigues
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Bethany Nichol
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Rob Wilson
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, UK
| | - Caroline Charlton
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Beckie Gibson
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | | | - Emma Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Deborah Harrison
- Newcastle University Business School, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Orange
- Office for Health Improvement & Disparities, Newcastle upon Tyne, UK
| | - Craig Robson
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Jill Harland
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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McGrath A, Lambe B, Matthews E, McDonnell K, Harrison M, Kehoe B. Determinants of physical activity promotion in primary care from the patient perspective of people at risk of or living with chronic disease: a COM-B analysis. BMC PRIMARY CARE 2024; 25:190. [PMID: 38807071 PMCID: PMC11134685 DOI: 10.1186/s12875-024-02440-2] [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: 01/04/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Chronic disease (CD) accounts for more than half of the overall global disease burden and physical activity (PA) is an established evidence-based strategy for the prevention and management of CD. Global policy emphasises the value of embedding PA into primary healthcare, highlighting the positive effects on PA behaviour. However, there is limited implementation of PA protocols in primary care, and research is needed to guide its integration into routine practice. The voice of the patient is underrepresented in the literature, resulting in the absence of critical insights into determinants of PA promotion in primary care. The purpose of the research was to identify the perspectives of people at risk of or living with CD on the determinants of PA promotion in primary care and to map these determinants across the six COM-B constructs. METHODS Semi-structured interviews (n = 22), guided by the COM-B model were conducted with people aged 35-60 years, at risk of or living with CD and not meeting the PA guidelines. A hybrid analytic approach of thematic inductive and deductive analysis was applied to the participant transcripts guided by a COM-B informed coding framework. RESULTS In total, 37 determinants across constructs related to capability, opportunity and motivation were prominent, examples include; physical capability constraints, the conflation of exercise with weight management, credibility of the health services in PA advice, communication styles in PA promotion, expectations of tailored support for PA, social support, accessibility, and integration of PA into routine habits. CONCLUSION Exploring the determinants of PA promotion through the lens of the COM-B model facilitated a systematic approach to understanding the primary care user perspective of the healthcare professional (HCP) broaching the topic of PA. Findings emphasise the value of HCPs being supported to broach the issue of PA in a therapeutic and patient-centred manner using diverse and flexible approaches, while highlighting the importance of tailored, accessible PA opportunities that build self-efficacy and foster social support. The research provides valuable learnings to support PA promotion and the development of strategies in primary care through encompassing the perspective of those living with or at risk of CD.
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Affiliation(s)
- Aisling McGrath
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
| | - Barry Lambe
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland.
| | - Evan Matthews
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
| | - Karolyn McDonnell
- National Centre for Men's Health, South East Technological University, Carlow, Ireland
| | - Michael Harrison
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
| | - Bróna Kehoe
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
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Nichol B, Kemp E, Wilson R, Rodrigues AM, Hesselgreaves H, Robson C, Haighton C. Establishing an updated consensus on the conceptual and operational definitions of Making Every Contact Count (MECC) across experts within research and practice: an international Delphi Study. Public Health 2024; 230:29-37. [PMID: 38484623 DOI: 10.1016/j.puhe.2024.01.023] [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: 11/01/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES The Making Every Contact Count (MECC) initiative is broadly defined as an opportunistic approach to prevention by making use of the thousands of conversations service providers have with service users every day. However, since its conception, the application of MECC has diverged and developed considerably. Thus, the current study aimed to revise the definition according to current research and practice to better describe what is and is not included. STUDY DESIGN A consensus building classic Delphi methodology, completed by an expert panel. METHODS Round 1 asked open questions around the definition of MECC. Content analysis of round 1 identified statements that were rated for agreement in round 2. Statements achieving ≥80% agreement were included in a short, long, or operational definition of MECC that were rated for agreement in round 3 (the minimum number required). An agreement of ≥80% indicated consensus. RESULTS Forty out of 100 contacted experts completed three rounds. Experts in practice and research were recruited internationally although most were from England. From round 1, 274 statements were generated, of which 96 achieved consensus and were included within round 3. The short and long definition received consensus in round 3, the operational definition required four rounds to reach consensus. CONCLUSIONS MECC is a person-centred approach to health behaviour change that, provided an individual possesses the relevant skills, can be delivered by anyone and anywhere. The distinguishing feature of MECC is not in its duration, target behaviour, or conditions for delivery, but rather in the approach taken and the mechanisms applied to conversations. Implications for research and practice are discussed, and the limits for applicability acknowledged.
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Affiliation(s)
- B Nichol
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom.
| | - E Kemp
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - R Wilson
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - A M Rodrigues
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - H Hesselgreaves
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - C Robson
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - C Haighton
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
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Keyworth C, Conner M, Johnson J, Epton T, Vogt KS, Armitage CJ. Impacts of the COVID-19 public health emergency on healthcare professional delivery of opportunistic behaviour change interventions: a retrospective cohort study. BMC Health Serv Res 2024; 24:167. [PMID: 38317160 PMCID: PMC10845453 DOI: 10.1186/s12913-023-10522-7] [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: 09/09/2022] [Accepted: 12/23/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The public health policy "Making Every Contact Count" (MECC) compels healthcare professionals to deliver health behaviour change interventions during routine consultations. As healthcare systems continue their recovery from the impacts of the COVID-19 public health emergency, supporting people to modify health behaviours is more important now than when the policy was introduced. The present study aims to: (a) examine changes in healthcare professionals' awareness of, and engagement with the policy over a five-year period, (b) examine the psychosocial drivers associated with delivering behaviour change interventions, and (c) identify targets to increase healthcare professionals' delivery of interventions. METHODS Comparison of data from two independent representative surveys of NHS healthcare professionals working in the UK. In both surveys (July-September 2017; N = 1387, and February-March 2022; N = 1008), participants were asked to report: (1) awareness of the MECC policy, (2) the prevalence of MECC-related practice (perceived patient benefit, how often interventions were delivered, and time spent delivering interventions), and (3) perceptions of capabilities, opportunities and motivations to deliver behaviour change interventions. T- tests (independent-samples), MANOVA, multiple linear regression, and chi-square analyses were used to generate comparisons between the surveys. RESULTS Awareness of the policy increased from 2017 (31.4%) to 2022 (52.0%). However, in 2022 compared with 2017, healthcare professionals reported (a) fewer patients would benefit from behaviour change interventions (49.1% versus 55.9%), (b) they delivered behaviour change interventions to a lower proportion of patients (38.0% versus 50.0%), and (c) they spent a lower proportion of the consultation time delivering interventions (26.5% versus 35.3%). Further, in 2022, compared with 2017, healthcare professionals reported fewer physical opportunities, fewer social opportunities, and fewer psychological capabilities to deliver behaviour change interventions. In the 2022 survey, perceptions of patient benefit and delivery of interventions was associated with greater perceptions of opportunities and motivations. CONCLUSIONS Health behaviour change interventions remain an important part of routine healthcare in the continued recovery from COVID-19 public health emergency, however reported engagement with MECC-related practices appears to have reduced over time. Future research should consider how healthcare professionals identify patients who might benefit from opportunistic behaviour change interventions, and to increase capabilities, opportunities, and motivations to deliver interventions during routine consultations.
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Affiliation(s)
- Chris Keyworth
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK.
| | - Mark Conner
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, Manchester, UK
| | - Katharina S Vogt
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9PL, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, M13 9PL, Manchester, UK
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