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Welfordsson P, Danielsson AK, Björck C, Grzymala-Lubanski B, Hambraeus K, Lidin M, Haugen Löfman I, Scheffel Birath C, Nilsson O, Braunschweig F, Wallhed Finn S. Feasibility of alcohol interventions in cardiology: A qualitative study of clinician perspectives in Sweden. Eur J Cardiovasc Nurs 2024:zvae033. [PMID: 38445448 DOI: 10.1093/eurjcn/zvae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/07/2024]
Abstract
AIM To identify barriers and facilitators to implementing alcohol screening and brief interventions (SBI) in cardiology services. METHODS AND RESULTS Qualitative study. Individual, semi-structured interviews were conducted with 24 clinical cardiology staff (doctors, nurses, assistant nurses) of varying experience levels, and from various clinical settings (high dependency unit, ward, outpatient clinic), in three regions of Sweden. Reflexive thematic analysis was used, with deductive coding applying the Capability, Opportunity, Motivation (COM-B) theoretical framework. A total of 41 barriers and facilitators were identified, including twelve related to capability, nine to opportunity, and 20 to motivation. Four themes were developed: 1. Uncharted territory, where clinicians expressed a need to address alcohol use but lacked knowledge and a roadmap for implementing SBI; 2. Cardiology as a cardiovascular specialty, where tasks were prioritized according to established roles; 3. Alcohol stigma, where alcohol was reported to be a sensitive topic that staff avoid discussing with patients; 4. Window of opportunity, where staff expressed potential for implementing SBI in routine cardiology care. CONCLUSION Findings suggest that opportunities exist for early identification and follow-up of hazardous alcohol use within routine cardiology care. Several barriers, including low knowledge, stigma, a lack of ownership, and a greater focus on other risk factors must be addressed prior to the implementation of SBI in cardiology. To meet current clinical guidelines, there is a need to increase awareness and to improve pathways to addiction care. In addition, there may be a need for clinicians dedicated to alcohol interventions within cardiology services. REGISTRATION OSF (osf.io/hx3ts).
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Affiliation(s)
- Paul Welfordsson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | | | - Caroline Björck
- Department of Women's and Children's Health, Akademiska sjukhuset, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Region Gävleborg, Gävle, Sweden
- Department of Caring Sciences, University of Gävle, Sweden
| | - Bartosz Grzymala-Lubanski
- Centre for Research and Development, Region Gävleborg, Gävle, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Cardiology, Gävle Hospital, Gävle, Sweden
| | | | - Matthias Lidin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | - Ida Haugen Löfman
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Olga Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Sara Wallhed Finn
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Stockholm Centre for Dependency Disorders, Sweden
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Gustavsson C, Nordqvist M, Bruhn ÅB, Bröms K, Jerdén L, Kallings LV, Wallin L. Process evaluation of an implementation intervention to facilitate the use of the Swedish Physical Activity on Prescription in primary healthcare. BMC Health Serv Res 2023; 23:996. [PMID: 37715160 PMCID: PMC10504760 DOI: 10.1186/s12913-023-09974-8] [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: 06/22/2022] [Accepted: 08/27/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The Swedish Physical Activity on Prescription (PAP-S) is a method for healthcare to promote physical activity for prevention and treatment of health disorders. Despite scientific support and education campaigns, the use has been low. The aim of this study was to perform a process evaluation of an implementation intervention targeting the use of the PAP-S method in primary healthcare (PHC). Specifically, we wanted to evaluate feasibility of the implementation intervention, and its effect on the implementation process and the outcome (number of PAP-S prescriptions). METHODS This was a longitudinal study using the Medical Research Council guidance for process evaluation of a 9-month implementation intervention among healthcare staff at three PHC centres in Sweden. Data was collected by: participatory observations of the implementation process; questionnaires to the staff before, after and 6 months after the implementation intervention; interviews after the implementation intervention; and number of PAP-S prescriptions. RESULTS During the implementation intervention, the workplaces' readiness-to-change and the healthcare staff's confidence in using the PAP-S method were favourably influenced, as was the number of PAP-S prescriptions. After the implementation intervention, the number of PAP-S prescriptions decreased to about the same number as before the implementation intervention, at two out of three PHC centres. Four of the six implementation strategies appeared to impact on the implementation process: external facilitation; leadership engagement by a committed workplace management; local PAP-S coordinator taking a leading role and acting as local champion; educational outreach concerning how to use the PAP-S method. CONCLUSION The implementation intervention was not sufficient to produce sustained change of the healthcare staff's behaviour, nor did it achieve favourable long-term outcome on the number of PAP-S prescriptions. The healthcare staffs' sparse knowledge of the PAP-S method prior to the implementation intervention hampered the implementation. More hands-on education in how to use the PAP-S method introduced early in the implementation process is imperative for successful implementation of the PAP-S method. The findings also suggest that committed workplace management and local PAP-S coordinators, taking leading roles and acting as local champions, need to be firmly established at the PHC centres before the external facilitator withdraws. TRIAL REGISTRATION Registered in the ISRCTN registry with study registration number: ISRCTN15551042 (Registration date: 12/01/2016).
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Affiliation(s)
- Catharina Gustavsson
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
| | - Maria Nordqvist
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
| | - Åsa Bergman Bruhn
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Kristina Bröms
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
| | - Lars Jerdén
- Center for Clinical Research Dalarna, Uppsala University, Nissers Vag 3, 79182 Falun, Sweden
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Lena V. Kallings
- Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, 751 22 Uppsala, Sweden
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences (GIH), Box 5626, 114 86 Stockholm, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
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Storz MA. Does Self-Perceived Diet Quality Align with Nutrient Intake? A Cross-Sectional Study Using the Food Nutrient Index and Diet Quality Score. Nutrients 2023; 15:2720. [PMID: 37375624 DOI: 10.3390/nu15122720] [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: 05/17/2023] [Revised: 06/02/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
A reliable diet quality (DQ) assessment is critical to empower individuals to improve their dietary choices. Controversies persist as to whether self-perceived DQ is accurate and correlated with actual DQ as assessed by validated nutrient intake indexes. We used National Health and Nutrition Examination Surveys data to examine whether a higher self-perceived DQ was positively associated with a more optimal nutrient intake as reflected by the Food Nutrient Index (FNI) and Diet Quality Score (DQS). Comparative analyses were performed for three self-perceived DQ groups: (I) "excellent or very good" DQ, (II) "good or fair" DQ, and (III) "poor" DQ. The FNI and DQS differed substantially across groups and sexes. FNI scores ranged from 65 to 69 in participants with a self-reported excellent or very good DQ, whereas participants with a self-perceived poor DQ scored significantly lower (53-59). We also observed age- and sex-specific patterns, with the lowest overall FNI scores found in males aged 18-30 years and females aged 31-50 years. DQ intergroup differences were more pronounced in females than in males. Our findings suggest that higher self-perceived DQ is associated with a more optimal nutrient intake and indicate potential helpfulness of self-perceived DQ as a quick and still underexplored indicator with intrinsic limitations.
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Affiliation(s)
- Maximilian Andreas Storz
- Center for Complementary Medicine, Department of Internal Medicine II, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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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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Hassett L, Jennings M, Brady B, Pinheiro M, Haynes A, Sidhu B, Christie L, Dennis S, Pearce A, Howard K, Greaves C, Sherrington C. Brief physical activity counselling by physiotherapists (BEHAVIOUR): protocol for an effectiveness-implementation hybrid type II cluster randomised controlled trial. Implement Sci Commun 2022; 3:39. [PMID: 35395933 PMCID: PMC8991667 DOI: 10.1186/s43058-022-00291-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/28/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical inactivity is a leading risk factor for chronic disease. Brief physical activity counselling delivered within healthcare systems has been shown to increase physical activity levels; however, implementation efforts have mostly targeted primary healthcare and uptake has been sub-optimal. The Brief Physical Activity Counselling by Physiotherapists (BEHAVIOUR) trial aims to address this evidence-practice gap by evaluating (i) the effectiveness of a multi-faceted implementation strategy, relative to usual practice for improving the proportion of patients receiving brief physical activity counselling as part of their routine hospital-based physiotherapy care and (ii) effectiveness of brief physical activity counselling embedded in routine physiotherapy care, relative to routine physiotherapy care, at improving physical activity levels among patients receiving physiotherapy care. METHODS Effectiveness-implementation hybrid type II cluster randomised controlled trial with embedded economic evaluation, qualitative study and culturally adapted patient-level outcome measures. The trial will be conducted across five hospitals in a local health district in Sydney, Australia, with a lower socioeconomic and culturally diverse population. The evidence-based intervention is brief physical activity counselling informed by the 5As counselling model and behavioural theory, embedded into routine physiotherapy care. The multi-faceted strategy to support the implementation of the counselling intervention was developed with key stakeholders guided by the Consolidated Framework for Implementation Research and the Capabilities, Opportunities, Motivation-Behaviour (COM-B) theoretical model, and consists of clinician education and training, creating a learning collaborative, tailored strategies to address community referral barriers, team facilitation, and audit and feedback. Thirty teams of physiotherapists will be randomised to receive the multi-faceted implementation strategy immediately or after a 9-month delay. Each physiotherapy team will recruit an average of 10 patients (n=300) to collect effectiveness outcomes at baseline and 6 months. The primary effectiveness outcome is self-reported planned physical activity using the Incidental and Planned Exercise Questionnaire, and the primary implementation outcome is reach (proportion of eligible new physiotherapy patients who receive brief physical activity counselling). Secondary effectiveness and implementation outcomes will also be collected. DISCUSSION This project focuses on physiotherapists as health professionals with the requisite skills and patterns of practice to tackle the increasing burden of chronic disease in a high-risk population. TRIAL REGISTRATION ANZCTR, ACTRN12621000194864 . Registered on 23 February 2021.
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Affiliation(s)
- Leanne Hassett
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia. .,Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. .,Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia.
| | - Matthew Jennings
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Bernadette Brady
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Marina Pinheiro
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Abby Haynes
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Balwinder Sidhu
- Multicultural Health Unit, South Western Sydney Local Health District, Sydney, Australia
| | - Lauren Christie
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia.,St Vincent's Health Network Sydney & Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Ingham Institute, South Western Sydney Local Health District, Sydney, Australia
| | - Alison Pearce
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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