1
|
Mersha AG, Bryant J, Rahman T, McGuffog R, Maddox R, Kennedy M. What Are the Effective Components of Group-Based Treatment Programs For Smoking Cessation? A Systematic Review and Meta-Analysis. Nicotine Tob Res 2023; 25:1525-1537. [PMID: 37104053 PMCID: PMC10439487 DOI: 10.1093/ntr/ntad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/12/2023] [Accepted: 04/26/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION There is significant variation in the format and delivery of group-based smoking cessation programs. To guide research and healthcare program implementation, it is important to understand the active components of interventions. AIMS AND METHODS This review aimed to (1) identify behavior change techniques (BCTs) used in effective group-based smoking cessation interventions, (2) determine the effectiveness of group-based smoking cessation interventions on smoking cessation at 6-month follow-up, and (3) identify the behavior change techniques (BCTs) related to effective group-based smoking cessation. The following databases were searched in January 2000 and March 2022: MEDLINE, EMBASE, CINAHL, PsycINFO, The Cochrane Library, and Web of Science. BCTs used in each study were extracted using the BCT Taxonomy. Studies that included identified BCTs were computed, and meta-analyses were conducted to evaluate smoking cessation at 6-month follow-up. RESULTS A total of 28 BCTs were identified from 19 randomized controlled trials. Studies included an average of 5.42 ± 2.0 BCTs. The most frequent BCTs were "information about health consequences" and "problem solving." The pooled 6-month smoking cessation was higher in the group-based intervention group (OR = 1.75, 95% CI = 1.12 to 2.72, p <.001). Inclusion of the following four BCTs: "Problem solving," "Information about health Consequences," "Information about social and environmental consequences," and "Reward (outcome)" were found to be significantly associated with increased rate of 6-month smoking cessation. CONCLUSIONS Group-based smoking cessation interventions doubles the rate of smoking cessation at 6-month follow-up. Implementing group-based smoking cessation programs, that incorporate multiple BCTs, is recommended for an effective smoking cessation care. IMPLICATIONS Group-based smoking cessation programs improves smoking cessation outcomes in clinical trials. There is a need to incorporate effective individual BCTs techniques to enhance smoking cessation treatment outcomes. A robust evaluation is required to assess the effectiveness of group-based cessation programs in real world settings. There is also a need to consider the differential effectiveness of group-based programs and BCT impacts on populations, for example, indigenous peoples.
Collapse
Affiliation(s)
- Amanual Getnet Mersha
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jamie Bryant
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Tabassum Rahman
- Centre for Epidemiology and Biostatistics, University of Melbourne, VIC, Australia
| | - Romany McGuffog
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Raglan Maddox
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT, Australia
| | - Michelle Kennedy
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
2
|
Pecoli PFG, Rosa ADS, Gabbay MAL, Dib SA. Psycho-Behavioral Characteristics Perceived as Facilitators by Brazilian Adults with Type 1 Diabetes Mellitus in a Public Health Service. Healthcare (Basel) 2023; 11:2300. [PMID: 37628498 PMCID: PMC10454162 DOI: 10.3390/healthcare11162300] [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: 07/21/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Type 1 diabetes imposes a complex and challenging routine on patients and caregivers. Therefore, considering individual experiences and personal facilitators to promote assertive interventions is crucial. However, no studies have addressed these perspectives in the Brazilian adult population. We aimed to identify psycho-behavioral characteristics perceived as facilitators for coping with the condition. We used a biographical method to conduct semi-structured, face-to-face, in-depth interviews for each participant. Transcripts were analyzed using inductive thematic analysis. Participants (n = 22) were aged 18-57 years (mean: 30.2; standard deviation (SD): 8.7), and the duration since diagnosis was approximately 20.6 years (SD: 4.6). A total of 12 (54.4%) were women, 13 (59.1%) used insulin pumps, 14 (63.6%) had at least a college degree, and 13 (59.1%) had HbA1C (glycated hemoglobin) levels above 58 mmol/mol (7.5%). Five major themes emerged: (1) peer learning, (2) ownership, (3) welcoming experiences, (4) equity, and (5) reframing the path (P.O.W.E.R.). All themes appeared in the lived experiences shared by participants with HbA1C levels below 58 mmol/mol (7.5%). Improved glycemic control can be achieved, and the challenges encountered in diabetes care within similar socioeconomic contexts can be addressed by an interdisciplinary care team that takes P.O.W.E.R. into consideration when providing person-centered care strategies.
Collapse
Affiliation(s)
| | | | - Mônica Andrade Lima Gabbay
- Diabetes and Endocrinology Center, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Sérgio Atala Dib
- Diabetes and Endocrinology Center, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| |
Collapse
|
3
|
Haff N, Choudhry NK, Isaac T, Bhatkhande G, Jackevicius CA, Fischer MA, Solomon DH, Sequist TD, Lauffenburger JC. Disagreement between pharmacy claims and direct interview to identify patients with non-adherence to chronic cardiometabolic medications. Am Heart J 2023; 256:51-59. [PMID: 36780373 PMCID: PMC10281352 DOI: 10.1016/j.ahj.2022.10.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND Accurate methods of identifying patients with suboptimal adherence to cardiometabolic medications are needed, and each approach has benefits and tradeoffs. METHODS We used data from a large trial of patients with poorly controlled cardiometabolic disease and evidence of medication non-adherence measured using pharmacy claims data whose adherence was subsequently assessed during a telephone consultation with a clinical pharmacist. We then evaluated if the pharmacist assessment agreed with the non-adherence measured using claims. When pharmacist and claims assessments disagreed, we identified reasons why claims were insufficient and used multivariable modified Poisson regression to identify patient characteristics associated with disagreement. RESULTS Of 1,069 patients identified as non-adherent using claims (proportion of days covered [PDC] <80%), 646 (60.4%) were confirmed as non-adherent on pharmacist interview. For the 423 patients (39.6%) where the interview disagreed with the claims, the most common reasons were paying cash or using an alternate insurance (36.6%), medication discontinuation or regimen change (32.8%), and recently becoming adherent (26.7%). Compared to patients whose claims and interview both showed non-adherence, patients whose interview disagreed with claims were less likely to miss outpatient office visits (RR:0.91, 95%CI:0.85-0.97) and more likely to have a baseline PDC above the median (RR:1.35, 95%CI:1.10-1.64). CONCLUSIONS Among patients identified as non-adherent by claims, 39.6% were observed to be adherent when assessed during pharmacist consultation. This discrepancy was largely driven by paying out-of-pocket, using alternative insurance, or medication discontinuation or change. These findings have important implications for using pharmacy claims to identify and intervene upon medication non-adherence.
Collapse
Affiliation(s)
- Nancy Haff
- Center for Healthcare Delivery Sciences (C4HDS), Brigham and Women's Hospital, Boston MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Niteesh K Choudhry
- Center for Healthcare Delivery Sciences (C4HDS), Brigham and Women's Hospital, Boston MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | - Gauri Bhatkhande
- Center for Healthcare Delivery Sciences (C4HDS), Brigham and Women's Hospital, Boston MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Cynthia A Jackevicius
- Western University of Health Sciences, Pomona, CA, and University of Toronto and ICES, Toronto, Ontario, Canada
| | - Michael A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Daniel H Solomon
- Division of Rheumatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Thomas D Sequist
- Division of General Internal Medicine and Department of Health Care Policy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Julie C Lauffenburger
- Center for Healthcare Delivery Sciences (C4HDS), Brigham and Women's Hospital, Boston MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
4
|
Ramírez-Trujillo MÁ, Villanueva-Vilchis MC, Gaitán-Cepeda LA, Aguilar-Díaz FC, Rojas-Russell ME, Fuente-Hernández J. Impact of a Maternal Motivational Interviewing on Oral Health in the Mother-Child Dyad. Healthcare (Basel) 2022; 10:healthcare10061044. [PMID: 35742095 PMCID: PMC9222260 DOI: 10.3390/healthcare10061044] [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] [Received: 04/16/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
Motivational Interviewing (MI) has been included in dentistry programs. There exists a need for interventions in the mother-child dyad. The aim of this paper was to compare the effects of a MI-based educational program on oral care knowledge, attitudes, and practices (KAP) in the mother-child dyad to a Traditional Education-based program (TE). A community intervention trial was carried out. The experimental and control groups were made up of women between 18 and 45 years of age in the sixth month of gestation. Both groups were provided with TE. The experimental group additionally received a session based on the principles of the MI. Socio-demographic data, children’s oral health KAP (COHKAP), that of the mother (MOHKAP), and maternal self-efficacy (MSE) in relation to children’s oral health (COHMSE) were recorded. A baseline measurement was made, as well as a six-month follow up. The participants included 135 women with an average age of 24.88 ± 6.00. After intervention, the experimental group’s COHKAP, MOHKAP, and COHMSE all increased (p < 0.001). When MI-based interventions are combined with TE, MSE and dental care KAP for the mother-child dyad in pregnant women can be improved.
Collapse
Affiliation(s)
- M. Á. Ramírez-Trujillo
- Department of Public Health, National School of Higher Studies, Leon Unit, National Autonomus University of Mexico, Leon CP 37684, Mexico; (M.Á.R.-T.); (F.C.A.-D.); (J.F.-H.)
| | - M. C. Villanueva-Vilchis
- Department of Public Health, National School of Higher Studies, Leon Unit, National Autonomus University of Mexico, Leon CP 37684, Mexico; (M.Á.R.-T.); (F.C.A.-D.); (J.F.-H.)
- Correspondence: ; Tel.: +52-477-194-0800 (ext. 43444)
| | - L. A. Gaitán-Cepeda
- Department of Oral pathology and Oral Medicine, Graduate and Research Division, Dental School, National Autonomous University of Mexico, Mexico City CP 04360, Mexico;
| | - F. C. Aguilar-Díaz
- Department of Public Health, National School of Higher Studies, Leon Unit, National Autonomus University of Mexico, Leon CP 37684, Mexico; (M.Á.R.-T.); (F.C.A.-D.); (J.F.-H.)
| | - M. E. Rojas-Russell
- School of Higher Studies (F.E.S.) Zaragoza, National Autonomous University of Mexico, Mexico City CP 09230, Mexico;
| | - J. Fuente-Hernández
- Department of Public Health, National School of Higher Studies, Leon Unit, National Autonomus University of Mexico, Leon CP 37684, Mexico; (M.Á.R.-T.); (F.C.A.-D.); (J.F.-H.)
| |
Collapse
|
5
|
Cordingley L, Nelson PA, Davies L, Ashcroft D, Bundy C, Chew-Graham C, Chisholm A, Elvidge J, Hamilton M, Hilton R, Kane K, Keyworth C, Littlewood A, Lovell K, Lunt M, McAteer H, Ntais D, Parisi R, Pearce C, Rutter M, Symmons D, Young H, Griffiths CEM. Identifying and managing psoriasis-associated comorbidities: the IMPACT research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2022. [DOI: 10.3310/lvuq5853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Psoriasis is a common, lifelong inflammatory skin disease, the severity of which can range from limited disease involving a small body surface area to extensive skin involvement. It is associated with high levels of physical and psychosocial disability and a range of comorbidities, including cardiovascular disease, and it is currently incurable.
Objectives
To (1) confirm which patients with psoriasis are at highest risk of developing additional long-term conditions and identify service use and costs to patient, (2) apply knowledge about risk of comorbid disease to the development of targeted screening services to reduce risk of further disease, (3) learn how patients with psoriasis cope with their condition and about their views of service provision, (4) identify the barriers to provision of best care for patients with psoriasis and (5) develop patient self-management resources and staff training packages to improve the lives of people with psoriasis.
Design
Mixed methods including two systematic reviews, one population cohort study, one primary care screening study, one discrete choice study, four qualitative studies and three mixed-methodology studies.
Setting
Primary care, secondary care and online surveys.
Participants
People with psoriasis and health-care professionals who manage patients with psoriasis.
Results
Prevalence rates for psoriasis vary by geographical location. Incidence in the UK was estimated to be between 1.30% and 2.60%. Knowledge about the cost-effectiveness of therapies is limited because high-quality clinical comparisons of interventions have not been done or involve short-term follow-up. After adjusting for known cardiovascular risk factors, psoriasis (including severe forms) was not found to be an independent risk factor for major cardiovascular events; however, co-occurrence of inflammatory arthritis was a risk factor. Traditional risk factors were high in patients with psoriasis. Large numbers of patients with suboptimal management of known risk factors were found by screening patients in primary care. Risk information was seldom discussed with patients as part of screening consultations, meaning that a traditional screening approach may not be effective in reducing comorbidities associated with psoriasis. Gaps in training of health-care practitioners to manage psoriasis effectively were identified, including knowledge about risk factors for comorbidities and methods of facilitating behavioural change. Theory-based, high-design-quality patient materials broadened patient understanding of psoriasis and self-management. A 1-day training course based on motivational interviewing principles was effective in increasing practitioner knowledge and changing consultation styles. The primary economic analysis indicated a high level of uncertainty. Sensitivity analysis indicated some situations when the interventions may be cost-effective. The interventions need to be assessed for long-term (cost-)effectiveness.
Limitations
The duration of patient follow-up in the study of cardiovascular disease was relatively short; as a result, future studies with longer follow-up are recommended.
Conclusions
Recognition of the nature of the psoriasis and its impact, knowledge of best practice and guideline use are all limited in those most likely to provide care for the majority of patients. Patients and practitioners are likely to benefit from the provision of appropriate support and/or training that broadens understanding of psoriasis as a complex condition and incorporates support for appropriate health behaviour change. Both interventions were feasible and acceptable to patients and practitioners. Cost-effectiveness remains to be explored.
Future work
Patient support materials have been created for patients and NHS providers. A 1-day training programme with training materials for dermatologists, specialist nurses and primary care practitioners has been designed. Spin-off research projects include a national study of responses to psoriasis therapy and a global study of the prevalence and incidence of psoriasis. A new clinical service is being developed locally based on the key findings of the Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Pauline A Nelson
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Linda Davies
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christine Bundy
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Anna Chisholm
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Jamie Elvidge
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matthew Hamilton
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rachel Hilton
- Bridgewater Community Healthcare NHS Foundation Trust, Wigan, UK
| | - Karen Kane
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Alison Littlewood
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | | | - Dionysios Ntais
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rosa Parisi
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christina Pearce
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Martin Rutter
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Deborah Symmons
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Helen Young
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Christopher EM Griffiths
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| |
Collapse
|
6
|
James S, Mcinnes S, Halcomb E, Desborough J. General practice nurses’ communication strategies for lifestyle risk reduction: A content analysis. J Adv Nurs 2020; 76:3082-3091. [DOI: 10.1111/jan.14518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/21/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Sharon James
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong Bega Australia
| | - Susan Mcinnes
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong & Illawarra Health & Medical Research Institute Wollongong Australia
| | - Elizabeth Halcomb
- School of Nursing Faculty of Science, Medicine & Health University of Wollongong & Illawarra Health & Medical Research Institute Wollongong Australia
| | - Jane Desborough
- Department of Health Services Research and Policy Research School of Population HealthCollege of Medicine, Biology and the EnvironmentAustralian National University Acton Australia
| |
Collapse
|
7
|
Griva K, Seow PS, Seow TYY, Goh ZS, Choo JCJ, Foo M, Newman S. Patient-Related Barriers to Timely Dialysis Access Preparation: A Qualitative Study of the Perspectives of Patients, Family Members, and Health Care Providers. Kidney Med 2019; 2:29-41. [PMID: 33015610 PMCID: PMC7525138 DOI: 10.1016/j.xkme.2019.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rational & Objective A key aspect of smooth transition to dialysis is the timely creation of a permanent access. Despite early referral to kidney care, initiation onto dialysis is still suboptimal for many patients, which has clinical and cost implications. This study aimed to explore perspectives of various stakeholders on barriers to timely access creation. Study Design Qualitative study. Setting & Participants Semi-structured interviews with 96 participants (response rate, 67%), including patients with stage 4 chronic kidney disease (n = 30), new hemodialysis patients with (n = 18) and without (n = 20) permanent access (arteriovenous fistula), family members (n = 19), and kidney health care providers (n = 9). Analytical Approach Thematic analysis. Results Patients reported differential levels of behavioral activation toward access creation: avoidance/denial, wait and see, or active intention. 6 core themes were identified: (1) lack of symptoms, (2) dialysis fears and practical concerns (exaggerated fear, pain, cost, lifestyle disruptions, work-related concerns, burdening their families), (3) evaluating value against costs/risks of access creation (benefits, threat of operation, viability, prompt for early initiation), (4) preference for alternatives, (5) social influences (hearsay, family involvement, experiences of others), and (6) health care provider interactions (mistrust, interpersonal tension, lack of clarity in information). Themes were common to all groups, whereas nuanced perspectives of family members and health care providers were noted in some subthemes. Limitations Response bias. Conclusions Individual, interpersonal, and psychosocial factors compromise dialysis preparation and contribute to suboptimal dialysis initiation. Our findings support the need for interventions to improve patient and family engagement and address emotional concerns and misperceptions about preparing for dialysis.
Collapse
Affiliation(s)
- Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | | | | | - Zhong Sheng Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | | | | | | |
Collapse
|
8
|
Benestad B, Karlsen TI, Småstuen MC, Lekhal S, Hertel JK, Steinsbekk S, Kolotkin RL, Ødegård RA, Hjelmesæth J. Health-related quality of life after camp-based family obesity treatment: an RCT. BMJ Paediatr Open 2019; 3:e000413. [PMID: 31206074 PMCID: PMC6542445 DOI: 10.1136/bmjpo-2018-000413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare the effects of a 2-year camp-based immersion family treatment for obesity with an outpatient family-based treatment for obesity on health-related quality of life (HRQoL) in two generations. DESIGN Randomised controlled trial. SETTING Rehabilitation clinic, tertiary care hospital and primary care. PATIENTS Families with at least one child (7-12 years) and one parent, both with obesity. INTERVENTIONS Summer camp for 2 weeks, with four repetition weekends, or lifestyle school, including four outpatient days over 4 weeks. Behavioural techniques to promote a healthier lifestyle. MAIN OUTCOME MEASURES Children's and parents' HRQoL were assessed using generic and obesity-specific measures. Outcomes were analysed using linear mixed models according to intention to treat, and multiple imputations were used for missing data. RESULTS Ninety children (50% girls) with a mean (SD) age of 9.7 (1.2) years and body mass index 28.7 (3.9) kg/m2 were included in the analyses. Summer camp children had an estimated mean (95% CI) of 5.3 (0.4 to 10.1) points greater improvement in adiposity-specific HRQoL score at 2 years compared with the lifestyle school children, and this improvement was even larger in the parent proxy-report, where mean difference was 7.3 (95% CI 2.3 to 12.2). Corresponding effect sizes were 0.33 and 0.44. Generic HRQoL questionnaires revealed no significant differences between treatment groups in either children or parents from baseline to 2 years. CONCLUSIONS A 2-year family camp-based immersion obesity treatment programme had significantly larger effects on obesity-specific HRQoL in children's self-report and parent proxy-reports in children with obesity compared with an outpatient family-based treatment programme. TRIAL REGISTRATION NUMBER NCT01110096.
Collapse
Affiliation(s)
- Beate Benestad
- Department of Medicine, Vestfold Hospital Trust, The Morbid Obesity Centre (MOC), Tønsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tor-Ivar Karlsen
- Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | | | - Samira Lekhal
- Department of Medicine, Vestfold Hospital Trust, The Morbid Obesity Centre (MOC), Tønsberg, Norway
| | - Jens Kristoffer Hertel
- Department of Medicine, Vestfold Hospital Trust, The Morbid Obesity Centre (MOC), Tønsberg, Norway
| | - Silje Steinsbekk
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Social Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ronette L Kolotkin
- Department of Medicine, Vestfold Hospital Trust, The Morbid Obesity Centre (MOC), Tønsberg, Norway.,Quality of Life Consulting, Durham, North Carolina, USA
| | - Rønnaug Astri Ødegård
- The Obesity Centre, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jøran Hjelmesæth
- Department of Medicine, Vestfold Hospital Trust, The Morbid Obesity Centre (MOC), Tønsberg, Norway.,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
9
|
Choudhry NK, Isaac T, Lauffenburger JC, Gopalakrishnan C, Lee M, Vachon A, Iliadis TL, Hollands W, Elman S, Kraft JM, Naseem S, Doheny S, Lee J, Barberio J, Patel L, Khan NF, Gagne JJ, Jackevicius CA, Fischer MA, Solomon DH, Sequist TD. Effect of a Remotely Delivered Tailored Multicomponent Approach to Enhance Medication Taking for Patients With Hyperlipidemia, Hypertension, and Diabetes: The STIC2IT Cluster Randomized Clinical Trial. JAMA Intern Med 2018; 178:1182-1189. [PMID: 30083727 PMCID: PMC6142966 DOI: 10.1001/jamainternmed.2018.3189] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Approximately half of patients with chronic conditions are nonadherent to prescribed medications, and interventions have been only modestly effective. OBJECTIVE To evaluate the effect of a remotely delivered multicomponent behaviorally tailored intervention on adherence to medications for hyperlipidemia, hypertension, and diabetes. DESIGN, SETTING, AND PARTICIPANTS Two-arm pragmatic cluster randomized controlled trial at a multispecialty group practice including participants 18 to 85 years old with suboptimal hyperlipidemia, hypertension, or diabetes disease control, and who were nonadherent to prescribed medications for these conditions. INTERVENTIONS Usual care or a multicomponent intervention using telephone-delivered behavioral interviewing by trained clinical pharmacists, text messaging, pillboxes, and mailed progress reports. The intervention was tailored to individual barriers and level of activation. MAIN OUTCOMES AND MEASURES The primary outcome was medication adherence from pharmacy claims data. Secondary outcomes were disease control based on achieved levels of low-density lipoprotein cholesterol, systolic blood pressure, and hemoglobin A1c from electronic health records, and health care resource use from claims data. Outcomes were evaluated using intention-to-treat principles and multiple imputation for missing values. RESULTS Fourteen practice sites with 4078 participants had a mean (SD) age of 59.8 (11.6) years; 45.1% were female. Seven sites were each randomized to intervention or usual care. The intervention resulted in a 4.7% (95% CI, 3.0%-6.4%) improvement in adherence vs usual care but no difference in the odds of achieving good disease control for at least 1 (odds ratio [OR], 1.10; 95% CI, 0.94-1.28) or all eligible conditions (OR, 1.05; 95% CI, 0.91-1.22), hospitalization (OR, 1.02; 95% CI, 0.78-1.34), or having a physician office visit (OR, 1.11; 95% CI, 0.91-1.36). However, intervention participants were significantly less likely to have an emergency department visit (OR, 0.62; 95% CI, 0.45-0.85). In as-treated analyses, the intervention was associated with a 10.4% (95% CI, 8.2%-12.5%) increase in adherence, a significant increase in patients achieving disease control for at least 1 eligible condition (OR, 1.24; 95% CI, 1.03-1.50), and nonsignificantly improved disease control for all eligible conditions (OR, 1.18; 95% CI, 0.99-1.41). CONCLUSIONS AND RELEVANCE A remotely delivered multicomponent behaviorally tailored intervention resulted in a statistically significant increase in medication adherence but did not change clinical outcomes. Future work should focus on identifying which groups derive the most clinical benefit from adherence improvement efforts. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02512276.
Collapse
Affiliation(s)
- Niteesh K Choudhry
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Julie C Lauffenburger
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chandrasekar Gopalakrishnan
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | - Jessica Lee
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julie Barberio
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lajja Patel
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nazleen F Khan
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cynthia A Jackevicius
- Western University of Health Sciences, Pomona, California.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Michael A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel H Solomon
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas D Sequist
- Division of General Internal Medicine and Department of Health Care Policy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
10
|
Surguladze S, Timms P, David AS. Teaching psychiatric trainees ‘compliance therapy’. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.26.1.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTraining workshops were organised to teach junior psychiatrists ‘compliance therapy’. A questionnaire was administered to 19 trainees before and after participation in the workshop. Data from 54 non-participating psychiatrists from the same NHS trust were also obtained for comparison.ResultsThose receiving training were similar to the comparison group except for having less confidence in dealing with non-compliant patients. After training, participants showed a broader awareness of the potential causes and costs of non-compliance and an increased confidence empathising with patients. Beliefs concerning management did not change significantly.Clinical ImplicationsA brief training programme is capable of changing trainee psychiatrists' attitudes towards patient non-compliance in the desired direction.
Collapse
|
11
|
Benestad B, Lekhal S, Småstuen MC, Hertel JK, Halsteinli V, Ødegård RA, Hjelmesæth J. Camp-based family treatment of childhood obesity: randomised controlled trial. Arch Dis Child 2017; 102:303-310. [PMID: 27806969 PMCID: PMC5466918 DOI: 10.1136/archdischild-2015-309813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/03/2016] [Accepted: 10/11/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare the effectiveness of a 2-year camp-based family treatment programme and an outpatient programme on obesity in two generations. DESIGN Pragmatic randomised controlled trial. SETTING Rehabilitation clinic, tertiary care hospital and primary care. PATIENTS Families with at least one child (7-12 years) and one parent with obesity. INTERVENTIONS Summer camp for 2 weeks and 4 repetition weekends or lifestyle school including 4 days family education. Behavioural techniques motivating participants to healthier lifestyle. MAIN OUTCOME MEASURES Children: 2-year changes in body mass index (BMI) SD score (SDS). Parents: 2-year change in BMI. Main analyses: linear mixed models. RESULTS Ninety children (50% girls) were included. Baseline mean (SD) age was 9.7 (1.2) years, BMI 28.7 (3.9) kg/m2 and BMI SDS 3.46 (0.75). The summer-camp children had a lower adjusted estimated mean (95% CI) increase in BMI (-0.8 (-3.5 to -0.2) kg/m2), but the BMI SDS reductions did not differ significantly (-0.11 (-0.49 to 0.05)). The 2-year baseline adjusted BMI and BMI SDS did not differ significantly between summer-camp and lifestyle-school completers, BMI 29.8 (29.1 to 30.6) vs 30.7 (29.8 to 31.6) kg/m2 and BMI SDS 2.96 (2.85 to 3.08) vs 3.11 (2.97 to 3.24), respectively. The summer-camp parents had a small reduction in BMI (-0.9 (-1.8 to -0.03) vs -0.8 (-2.1 to 0.4) in the lifestyle-school group), but the within-group changes did not differ significantly (0.3 (-1.7 to 2.2)). CONCLUSIONS A 2-year family camp-based obesity treatment programme had no significant effect on BMI SDS in children with severe obesity compared with an outpatient family-based treatment programme. TRIAL REGISTRATION NUMBER NCT01110096.
Collapse
Affiliation(s)
- Beate Benestad
- Department of Medicine, The Morbid Obesity Centre (MOC), Vestfold Hospital Trust, Tønsberg, Norway,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Samira Lekhal
- Department of Medicine, The Morbid Obesity Centre (MOC), Vestfold Hospital Trust, Tønsberg, Norway
| | - Milada Cvancarova Småstuen
- Department of Medicine, The Morbid Obesity Centre (MOC), Vestfold Hospital Trust, Tønsberg, Norway,Oslo and Akershus University College, Faculty of Social Sciences, Oslo, Norway
| | - Jens Kristoffer Hertel
- Department of Medicine, The Morbid Obesity Centre (MOC), Vestfold Hospital Trust, Tønsberg, Norway
| | - Vidar Halsteinli
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway,St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rønnaug Astri Ødegård
- St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jøran Hjelmesæth
- Department of Medicine, The Morbid Obesity Centre (MOC), Vestfold Hospital Trust, Tønsberg, Norway,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
12
|
Choudhry NK, Isaac T, Lauffenburger JC, Gopalakrishnan C, Khan NF, Lee M, Vachon A, Iliadis TL, Hollands W, Doheny S, Elman S, Kraft JM, Naseem S, Gagne JJ, Jackevicius CA, Fischer MA, Solomon DH, Sequist TD. Rationale and design of the Study of a Tele-pharmacy Intervention for Chronic diseases to Improve Treatment adherence (STIC2IT): A cluster-randomized pragmatic trial. Am Heart J 2016; 180:90-7. [PMID: 27659887 DOI: 10.1016/j.ahj.2016.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Approximately half of patients with chronic cardiometabolic conditions are nonadherent with their prescribed medications. Interventions to improve adherence have been only modestly effective because they often address single barriers to adherence, intervene at single points in time, or are imprecisely targeted to patients who may not need adherence assistance. OBJECTIVE To evaluate the effect of a multicomponent, behaviorally tailored pharmacist-based intervention to improve adherence to medications for diabetes, hypertension, and hyperlipidemia. TRIAL DESIGN The STIC2IT trial is a cluster-randomized pragmatic trial testing the impact of a pharmacist-led multicomponent intervention that uses behavioral interviewing, text messaging, mailed progress reports, and video visits. Targeted patients are those who are nonadherent to glucose-lowering, antihypertensive, or statin medications and who also have evidence of poor disease control. The intervention is tailored to patients' individual health barriers and their level of health activation. We cluster-randomized 14 practice sites of a large multispecialty group practice to receive either the pharmacist-based intervention or usual care. STIC2IT has enrolled 4,076 patients who will be followed up for 12months after randomization. The trial's primary outcome is medication adherence, assessed using pharmacy claims data. Secondary outcomes are disease control and health care resource utilization. CONCLUSION This trial will determine whether a technologically enabled, behaviorally targeted pharmacist-based intervention results in improved adherence and disease control. If effective, this strategy could be a scalable method of offering tailored adherence support to those with the greatest clinical need.
Collapse
|
13
|
Nelson PA, Kane K, Chisholm A, Pearce CJ, Keyworth C, Rutter MK, Chew-Graham CA, Griffiths CEM, Cordingley L. 'I should have taken that further' - missed opportunities during cardiovascular risk assessment in patients with psoriasis in UK primary care settings: a mixed-methods study. Health Expect 2016; 19:1121-37. [PMID: 26340682 PMCID: PMC5053232 DOI: 10.1111/hex.12404] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Unhealthy lifestyle is common in psoriasis, contributing to worsening disease and increased cardiovascular disease (CVD) risk. CVD risk communication should improve patients' understanding of risk and risk-reducing behaviours; however, the effectiveness of risk screening is debated and evaluation currently limited. OBJECTIVE To examine the process of assessing for and communicating about CVD risk in the context of psoriasis. DESIGN Mixed-methods study in English general practices to (i) determine proportions of CVD risk factors among patients with psoriasis at risk assessment and (ii) examine patient and practitioner experiences of risk communication to identify salient 'process' issues. Audio recordings of consultations informed in-depth interviews with patients and practitioners using tape-assisted recall, analysed with framework analysis. PARTICIPANTS Patients with psoriasis (n = 287) undergoing CVD risk assessment; 29 patients and 12 practitioners interviewed. RESULTS A high proportion of patients had risk factor levels apparent at risk assessment above NICE recommendations: very high waist circumference (52%), obesity (35%), raised blood pressure (29%), smoking (18%) and excess alcohol consumption (18%). There was little evidence of personalized discussion about CVD risk and behaviour change support in consultations. Professionals reported a lack of training in behaviour change, while patients wanted to discuss CVD risk/risk reduction and believed practitioners to be influential in supporting lifestyle management. CONCLUSIONS Despite high levels of risk factors identified, opportunities may be missed in consultations to support patients with psoriasis to understand CVD risk/risk reduction. Practitioners need training in behaviour change techniques to capitalize on 'teachable moments' and increase the effectiveness of risk screening.
Collapse
Affiliation(s)
- Pauline A Nelson
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK.
| | - Karen Kane
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Anna Chisholm
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
- Manchester Centre for Dermatology and Manchester Centre for Health Psychology, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Christina J Pearce
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Christopher Keyworth
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Martin K Rutter
- The Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- West Midlands CLAHRC, Keele, UK
| | - Christopher E M Griffiths
- Manchester Centre for Dermatology Research, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Lis Cordingley
- Manchester Centre for Dermatology Research, Institute of Inflammation & Repair, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
- Manchester Centre for Health Psychology, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
14
|
Developing Brief Opportunistic Interactions: practitioners facilitate patients to identify and change health risk behaviours at an early preventive stage. Prim Health Care Res Dev 2015; 17:319-32. [PMID: 26586240 DOI: 10.1017/s1463423615000511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
UNLABELLED Aim To identify shortcomings in existing models of patient behaviour change, and present the development and testing of a novel approach using practitioner facilitation and person-focussed conversations that identifies and addresses behaviours at an earlier stage than current models. BACKGROUND Systematic strategies used by health professionals to change patient behaviours began with motivational interviewing and brief intervention approaches for serious addictive behaviours. Practitioners typically presume they should drive the process of patient behaviour change. Attempts to transfer these approaches to primary care, and a broader range of health risk behaviours, have been less successful. The TADS programme (Tobacco, Alcohol and Other Drugs, later Training and Development Services) began teaching motivational interviewing and brief interventions to practitioners in New Zealand in 1996. Formal and informal evaluations showed that practitioners used screening tools that patients rejected and that led to incomplete disclosure, used language that did not engage patients, failed to identify the behaviours patients wished to address and therefore misdirected interventions. METHODS Iterative development of new tools with input from patients and primary care clinicians. Findings The TADS programme developed a questionnaire whose results remained private to the patient, which enabled the patient to identify personal behaviours that they might choose to change (the TADS Personal Assessment Choice Tool). This was assisted by a brief conversation that facilitated and supported any change prioritised by the patient (the TADS Brief Opportunistic Interaction). The need for this approach, and its effectiveness, appeared to be similar across adults, youth, different ethnic groups and people in different socio-economic circumstances. Behaviours patients identified were often linked to other health risk behaviours or early-stage mental health disorders that were not easily detected by practitioner-driven screening or inquiry. The long-term effectiveness of this approach in different populations in primary health care settings requires further evaluation.
Collapse
|
15
|
Facilitators and Barriers to Health-Seeking Behaviours among Filipino Migrants: Inductive Analysis to Inform Health Promotion. BIOMED RESEARCH INTERNATIONAL 2015; 2015:506269. [PMID: 26380277 PMCID: PMC4561863 DOI: 10.1155/2015/506269] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/22/2014] [Accepted: 01/22/2015] [Indexed: 12/29/2022]
Abstract
Understanding factors that influence health-seeking behaviour of migrants is necessary to intervene for behaviour change. This paper explores Filipino migrants' perceptions of facilitators and barriers to maintaining health in Australia. Open-ended survey item responses reflecting factors that assisted and hindered health following migration to Australia were inductively analysed. Three hundred and thirty-seven of the 552 survey respondents (61%) provided open-ended responses. Responses were grouped into two major categories: individual factors, including personal resources and cultural influences, and environmental factors encompassing both the physical conditions in the host country and health service access. Awareness of practices that enhance health was a major personal facilitator of health-seeking behaviour; however, competing priorities of daily living were perceived as barriers. Cultural beliefs and practices influenced health-seeking behaviour. Despite high self-rated English language skills in this population, new migrants and the elderly cited communication difficulties as barriers to accessing health services. Insight into facilitators and barriers to health-seeking behaviour in this less researched migrant population revealed tools for enhancing engagement in health promotion programs addressing healthy lifestyle.
Collapse
|
16
|
Huang FF, Jiao NN, Zhang LY, Lei Y, Zhang JP. Effects of a family-assisted smoking cessation intervention based on motivational interviewing among low-motivated smokers in China. PATIENT EDUCATION AND COUNSELING 2015; 98:984-990. [PMID: 25766731 DOI: 10.1016/j.pec.2015.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To test the efficacy of a family-assisted smoking cessation intervention based on Motivational interviewing (MI) among low-motivated Chinese smokers. METHODS A two-armed randomized controlled trial study design was utilized. 159 Smoker-supporter pairs were randomly allocated to the intervention (a family-assisted MI intervention-77) or control (an intensity-matched health education-82) group (IG & CG). Change in smoking characteristics, communication characteristics, Partner Intervention Questionnaire (PIQ), Decisional Balance Scale (DBL), and Situational Temptations Scale (STP) were measured at baseline, post-intervention, 3-month and 6-month follow-up. RESULTS Compared to CG, IG had more significant increase over time in self-report quitting attempts of at least 24h, biochemically verified 7-day smoking abstinence, the Positive dimension of PIQ and the Cons in DBL, whereas the daily cigarettes smoked, the Pros in DBL and STP were showed more significant decrease over time in IG (P<0.05). After intervention, the communication frequency and satisfactory were also improved by smokers (P<0.01). CONCLUSION The family-assisted MI intervention is more effective in changing the smoking behaviors and increasing the communication between smokers and family, than health education. PRACTICAL IMPLICATIONS Using the family-assisted smoking cessation intervention based on MI, community health service providers can influence and empower low-motivated smokers positively for quit smoking.
Collapse
Affiliation(s)
- Fei Fei Huang
- Xiang Ya School of Nursing, Central South University, Changsha, China.
| | - Na Na Jiao
- Xiang Ya School of Nursing, Central South University, Changsha, China.
| | - Liu Yi Zhang
- Xiang Ya School of Nursing, Central South University, Changsha, China
| | - Yang Lei
- Xiang Ya School of Nursing, Central South University, Changsha, China
| | - Jing Ping Zhang
- Xiang Ya School of Nursing, Central South University, Changsha, China.
| |
Collapse
|
17
|
Evaluating three methods to encourage mentally competent older adults to assess their driving behavior. J Trauma Acute Care Surg 2015; 79:125-31. [PMID: 26091325 DOI: 10.1097/ta.0000000000000695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fourteen percent (43.1 million) of the population in the United States was 65 years and older in 2012. This population is projected to reach 20% (88.5 million) by 2050. Older adults accounted for 17% of all traffic fatalities and 9% of all vehicle occupant injuries in 2012. We explored the effectiveness of three interventions to help older adults assess their current driving behaviors at a Level 1 trauma center. METHODS During 2010 to 2012, 1,216 inpatients 70 years and older admitted for surgical and medical services were screened for eligibility, and 120 were enrolled. Participants completed a driving assessment and preintervention questionnaires and were subsequently randomized to one of the following interventions: (1) brief negotiated interview plus an educational kit by the American Automobile Association about older driving plus an accompanying list of Web-based resources for older adult drivers; (2) American Automobile Association document and a list of Web-based resources; (3) online referral sheet of the list of Web-based resources only. A 3-month postintervention follow-up questionnaire was administered over the telephone to measure changes in (1) driving-related knowledge, attitudes, and beliefs as well as (2) driving-related behaviors and intended behaviors. RESULTS A total of 113 randomized patients were included in the analysis. The mean (SD) age was 76.8 (5.23) years; majority of patients were white (64%), followed by black African American (33%); and 51% were males and 49% were females. Multivariate analysis showed that older adults' driving knowledge, attitudes, and beliefs (p < 0.0001, R = 0.37) as well as behaviors and intentions (p < 0.0001, R = 0.27) toward driving were positively correlated, controlling for other predictors in the model. Intervention assignment did not affect changes in outcomes, although outcomes improved across experimental conditions. CONCLUSION Our pilot study suggests that older adults are likely to make changes in their driving behavior on the basis of minimal hospital-based intervention.
Collapse
|
18
|
Pietrabissa G, Ceccarini M, Borrello M, Manzoni GM, Titon A, Nibbio F, Montano M, Bertone G, Gondoni L, Castelnuovo G. Enhancing behavioral change with motivational interviewing: a case study in a Cardiac Rehabilitation Unit. Front Psychol 2015; 6:298. [PMID: 25852614 PMCID: PMC4364083 DOI: 10.3389/fpsyg.2015.00298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/02/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Psychological interventions in cardiac rehabilitation programs appear relevant in as much they significantly contribute to achieve the goals of rehabilitation, to reduce the risk of relapses and to improve patients' adherence to therapy. To this aim, motivational interviewing (MI) has shown promising results in improving motivation to change and individuals' confidence in their ability to do so. OBJECTIVE The purpose of this article is to integrate theory with practice by describing a three-session case scenario. It illustrates how MI's skills and strategies can be used to enhance heart-healthy habits. MI may be synergistic with other treatment approaches and it is used here in conjunction with brief strategic therapy. CONCLUSION By the use of MI principles and techniques, the patient reported an increase in his motivation and ability to change, developing a post discharge plan that incorporates self-care behaviors. CLINICAL IMPLICATIONS MI may be effective in motivating and facilitating health behavior change among obese patients suffering from heart failure.
Collapse
Affiliation(s)
- Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| | - Martina Ceccarini
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Faculty of Psychology, University of Bergamo, BergamoItaly
| | - Maria Borrello
- Faculty of Psychology, University of Bergamo, BergamoItaly
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| | - Annamaria Titon
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Ferruccio Nibbio
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Mariella Montano
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Gianandrea Bertone
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Luca Gondoni
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| |
Collapse
|
19
|
Wang D, Li XY, Zhang LN, Zhou L, Zhang KJ. WITHDRAWN: Effects of motivational interviewing on lifestyle modification and diabetes prevention in adults with pre-diabetes. Diabetes Res Clin Pract 2015:S0168-8227(15)00082-0. [PMID: 25748829 DOI: 10.1016/j.diabres.2015.01.042] [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] [Received: 07/23/2014] [Revised: 11/12/2014] [Accepted: 01/29/2015] [Indexed: 11/25/2022]
Abstract
This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Collapse
Affiliation(s)
- Dan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiu-Yun Li
- West Mofan Road Community Health Service Center, Nanjing, China
| | - Li-Na Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ling Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Kai-Jin Zhang
- School of Public Health, Southeast University, Nanjing, China.
| |
Collapse
|
20
|
Cascaes AM, Bielemann RM, Clark VL, Barros AJD. Effectiveness of motivational interviewing at improving oral health: a systematic review. Rev Saude Publica 2014; 48:142-53. [PMID: 24789647 PMCID: PMC4206116 DOI: 10.1590/s0034-8910.2014048004616] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 09/22/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To analyze the effectiveness of motivational interviewing (MI) at improving
oral health behaviors (oral hygiene habits, sugar consumption, dental
services utilization or use of fluoride) and dental clinical outcomes
(dental plaque, dental caries and periodontal status). METHODS A systematic search of PubMed, LILACS, SciELO, PsyINFO, Cochrane and Google
Scholar bibliographic databases was conducted looking for intervention
studies that investigated MI as the main approach to improving the oral
health outcomes investigated. RESULTS Of the 78 articles found, ten met the inclusion criteria, all based on
randomized controlled trials. Most studies (n = 8) assessed multiple
outcomes. Five interventions assessed the impact of MI on oral health
behaviors and nine on clinical outcomes (three on dental caries, six on
dental plaque, four on gingivitis and three on periodontal pockets). Better
quality of evidence was provided by studies that investigated dental caries,
which also had the largest population samples. The evidence of the effect of
MI on improving oral health outcomes is conflicting. Four studies reported
positive effects of MI on oral health outcomes whereas another four showed
null effect. In two interventions, the actual difference between groups was
not reported or able to be recalculated. CONCLUSIONS We found inconclusive effectiveness for most oral health outcomes. We need
more and better designed and reported interventions to fully assess the
impact of MI on oral health and understand the appropriate dosage for the
counseling interventions.
Collapse
|
21
|
Stawnychy M, Masterson Creber R, Riegel B. Using brief motivational interviewing to address the complex needs of a challenging patient with heart failure. J Cardiovasc Nurs 2014; 29:E1-6. [PMID: 24231890 PMCID: PMC4376356 DOI: 10.1097/jcn.0000000000000098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hospitals and healthcare providers are looking for methods to reduce hospitalization rates and improve patient outcomes for patients with heart failure (HF). Using behavioral approaches to increase patients' confidence in their abilities to perform self-care is 1 such approach. Motivational interviewing is an empirically validated modality that has shown promise in improving motivation to change and confidence in the ability to do so. OBJECTIVE This case represents a number of themes common in the management of care for a HF patient and explores a 4-session brief motivational interviewing approach to address these themes. The manner in which patient frustration is linked to hospitalization is discussed along with possible ways to address problems in self-care behaviors. CONCLUSIONS With the use of this brief motivational interviewing approach, the patient reported an increase in her motivation and ability to change and developed a postdischarge plan for incorporating self-care behaviors in her daily routine. CLINICAL IMPLICATIONS Motivational interviewing may be an effective method of increasing the self-care behaviors of patients with HF.
Collapse
Affiliation(s)
- Michael Stawnychy
- Michael Stawnychy, MSN, RN Nurse Interventionist, School of Nursing, University of Pennsylvania, Philadelphia. Ruth Masterson Creber, MSc, RN Predoctoral Fellow, University of Pennsylvania School of Nursing; Patricia G. Archbold Scholar, National Hartford Centers of Gerontological Nursing Excellence, School of Nursing, University of Pennsylvania, Philadelphia. Barbara Riegel, DNSc, RN, FAHA, FAAN Professor of Nursing, Edith Clemmer Steinbright Chair of Gerontology, Director, Biobehavioral Research Center, School of Nursing, University of Pennsylvania, Philadelphia
| | | | | |
Collapse
|
22
|
Mash RJ, Allen S. Managing chronic conditions in a South African primary care context: exploring the applicability of Brief Motivational Interviewing. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2004.10873138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
23
|
Jansen Van Vuuren A, Learmonth D. Spirit(ed) away: preventing foetal alcohol syndrome with motivational interviewing and cognitive behavioural therapy. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2013.10874304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
24
|
Motivational interviewing as a smoking cessation strategy with nurses: An exploratory randomised controlled trial. Int J Nurs Stud 2014; 51:1074-82. [DOI: 10.1016/j.ijnurstu.2013.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/05/2013] [Accepted: 12/06/2013] [Indexed: 11/21/2022]
|
25
|
Jones A, Gladstone BP, Lübeck M, Lindekilde N, Upton D, Vach W. Motivational interventions in the management of HbA1c levels: a systematic review and meta-analysis. Prim Care Diabetes 2014; 8:91-100. [PMID: 24525286 DOI: 10.1016/j.pcd.2014.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/15/2014] [Accepted: 01/18/2014] [Indexed: 11/28/2022]
Abstract
AIMS To review the diabetes literature in order to examine the effect of motivational interventions on treatment outcome as measured by changes in glycated haemoglobin. METHODS Relevant databases were systematically searched for randomised controlled trials in which motivational interventions were examined in relation to treatment outcome in people with type 1 and type 2 diabetes mellitus. RESULTS The 13 studies identified for review included 1223 participants diagnosed with type 1 diabetes and 1895 participants diagnosed with type 2 diabetes. The analysis showed a 0.17% (95% CI: -0.09, 0.43%) improvement in glycemic control in people who received a motivational intervention compared to a control group, however, the effect was not statistically significant. CONCLUSIONS The impact of motivational interventions in the management of blood glucose levels appears to be limited. However, due to the small number of studies and issues of heterogeneity caution in interpreting the present findings is advised. Moreover, the unique contribution of motivational interventions may be better assessed by outcomes such as behaviour change and other intermediate outcomes. Further research examining the delivery and focus of motivational interventions in helping people manage their diabetes is recommended. The clinical implications of the present findings are therefore uncertain pending further research.
Collapse
MESH Headings
- Biomarkers/blood
- Blood Glucose/metabolism
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Glycated Hemoglobin/metabolism
- Health Behavior
- Health Knowledge, Attitudes, Practice
- Humans
- Motivation
- Motivational Interviewing
- Patients/psychology
- Treatment Outcome
Collapse
Affiliation(s)
- Allan Jones
- Institute of Psychology, University of Southern Denmark, Denmark.
| | - Beryl Primrose Gladstone
- Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Germany
| | - Marlene Lübeck
- Institute of Psychology, University of Southern Denmark, Denmark
| | - Nanna Lindekilde
- Institute of Psychology, University of Southern Denmark, Denmark
| | - Dominic Upton
- Institute of Health and Society, University of Worcester, UK
| | - Werner Vach
- Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Germany
| |
Collapse
|
26
|
Hollis JL, Williams LT, Collins CE, Morgan PJ. Does motivational interviewing align with international scope of practice, professional competency standards, and best practice guidelines in dietetics practice? J Acad Nutr Diet 2014; 114:676-87. [PMID: 24613708 DOI: 10.1016/j.jand.2013.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Indexed: 10/25/2022]
|
27
|
Dewing S, Mathews C, Schaay N, Cloete A, Louw J, Simbayi L. "It's important to take your medication everyday okay?" An evaluation of counselling by lay counsellors for ARV adherence support in the Western Cape, South Africa. AIDS Behav 2013; 17:203-12. [PMID: 22610373 DOI: 10.1007/s10461-012-0211-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
There is growing interest in standard care programmes for antiretroviral (ARV) adherence support. In South Africa, individual counselling following ARV initiation is a main strategy for supporting adherence in the public sector. Egan's client-centred "Skilled Helper" counselling model is the predominant model used in HIV counselling in this context. This study evaluated counselling delivered by lay ARV adherence counsellors in Cape Town in terms of adherence to Egan's model. Thirty-eight transcripts of counselling sessions with non-adherent patients were analysed based on the methods of content analysis. These sessions were conducted by 30 counsellors. Generally counsellors' practice adhered neither to Egan's model nor a client-centred approach. Inconsistent with evidence-based approaches to counselling for ARV adherence support, counsellors mainly used information-giving and advice as strategies for addressing clients' non-adherence. Recommendations for improving practice are made. The question as to how appropriate strategies from developed countries are for this setting is also raised.
Collapse
|
28
|
Chisholm A, Hart J, Mann KV, Harkness E, Peters S. Preparing medical students to facilitate lifestyle changes with obese patients: a systematic review of the literature. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:912-23. [PMID: 22622210 DOI: 10.1097/acm.0b013e3182580648] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE Doctors will increasingly encounter opportunities to support obese patients in lifestyle change efforts, but the extent to which medical schools prepare their students for this challenge is unknown. Further, despite evidence indicating theory-based techniques are effective in facilitating patients' behavioral changes, the methods taught to medical students and the means of content delivery are unclear. The authors reviewed the literature to investigate how effective educational interventions are in preparing medical students to facilitate lifestyle changes with obese patients. METHOD The authors systematically searched Excerpta Medica (EMBASE), PsycINFO, MEDLINE, and Scopus for educational interventions on obesity management for medical students published in English between January 1990 and November 2010 and matching PICOS (Population, Interventions, Comparators, Outcomes, Study design) inclusion criteria. RESULTS Results of a narrative synthesis are presented. Of 1,680 studies initially identified, 36 (2%) full-text articles were reviewed, and 12 (1%) were included in the final dataset. Eleven (92%) of these studies had quantitative designs; of these, 7 (64%) did not include control groups. Nine (75%) of the 12 studies were atheoretical, and 4 (33%) described behavior management strategies. Despite positive reported outcomes regarding intervention evaluations, procedures to control for bias were infrequently reported, and conclusions were often unsupported by evidence. CONCLUSIONS Evidence from this systematic review revealed data highly susceptible to bias; thus, intervention efficacy could not be determined. Additionally, evidence-based strategies to support patients' obesity-related behavior changes were not applied to these studies, and thus it remains unknown how best to equip medical students for this task.
Collapse
Affiliation(s)
- Anna Chisholm
- School of Psychological Sciences, University of Manchester, Manchester, United Kingdom.
| | | | | | | | | |
Collapse
|
29
|
Hollis JL, Williams LT, Collins CE, Morgan PJ. Effectiveness of Interventions using Motivational Interviewing for dietary and physical activity modification in Adults: A Systematic Review. ACTA ACUST UNITED AC 2012; 10:1-12. [DOI: 10.11124/jbisrir-2012-171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
30
|
Goddard E, Macdonald P, Sepulveda AR, Naumann U, Landau S, Schmidt U, Treasure J. Cognitive interpersonal maintenance model of eating disorders: intervention for carers. Br J Psychiatry 2011; 199:225-31. [PMID: 21727233 DOI: 10.1192/bjp.bp.110.088401] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Carers of people with eating disorders report high levels of distress. In addition, carers' responses to the illness may perpetuate eating disorder symptoms. A cognitive interpersonal maintenance model of eating disorders is proposed and interventions for carers may improve well-being in both carers and patients. Aims To examine an interpersonal maintenance model of eating disorders, using a self-help intervention for carers. METHOD A pre-test-post-test design was used with carers randomised into self-help or guided self-help, which included the Expert Carers Helping Others (ECHO) intervention. Carers' distress, well-being, proposed maintenance factors, and carer reports on the status of the patient were measured. RESULTS Carers' distress reduced and secondary outcomes improved. Improvement in carers' status and perceived improvements in patients were associated with reductions in expressed emotion and in accommodating and enabling behaviours. Self-help and guided self-help versions were comparable. CONCLUSIONS Changes in maintenance factors from the theoretical model were associated with a reduction in carers' distress and improvement in perceived patient functioning. Interventions which specifically target maintaining factors may be of benefit.
Collapse
Affiliation(s)
- Elizabeth Goddard
- Department of Psychological Medicine, 5th Floor Bermondsey Wing, Guy's Hospital, London SE1 9RT, UK.
| | | | | | | | | | | | | |
Collapse
|
31
|
Burke E, McCarthy B. The lifestyle behaviours and exercise beliefs of undergraduate student nurses. HEALTH EDUCATION 2011. [DOI: 10.1108/09654281111123501] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
32
|
Sinclair HK, Bond CM, Lennox AS. The long-term learning effect of training in stage of change for smoking cessation: a three-year follow up of community pharmacy staff's knowledge and attitudes. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.1999.tb00943.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Objective
A randomised controlled trial has already demonstrated that a training workshop on smoking cessation counselling for pharmacists and their assistants, based on the stage of change model, had a positive effect on the knowledge and attitudes of pharmacy personnel for at least a year, and was associated with increased and more useful counselling, and higher smoking cessation rates. An extension of the study aimed to monitor the duration of the training effect and so help to determine the optimum time span for refresher training. This paper reports the results of two further annual follow-ups.
Method
A previously developed and validated self-completion questionnaire assessing knowledge and attitudes was re-administered to intervention and control personnel at 24 and 36 months. One hundred and thirty-four questionnaires were completed at 24 months (85 per cent response rate) and 124 (83 per cent) at 36 months.
Setting
Community pharmacies in Grampian, Scotland, United Kingdom.
Key findings
The training had a significant effect on knowledge for at least three years, since at both 24 and 36 months the intervention pharmacy teams had a significantly greater knowledge and understanding of the model than the controls (24 months, P=0.0001; 36 months, P=0.031). At 24 months, the intervention pharmacy teams were significantly more confident in their ability to counsel smokers (P=0.021) and were more positive about the outcome of smoking cessation counselling provided in community pharmacies (P=0.043). These attitudinal differences were no longer statistically significant at 36 months.
Conclusion
This study has demonstrated the long-term benefit of the stage of change training over a three-year period, for both community pharmacists and their staff, on knowledge and attitudes.
Collapse
Affiliation(s)
- Hazel K Sinclair
- University Department of General Practice and Primary Care, Foresterhill Health Centre, Westburn Road, Aberdeen, Scotland AB25 2AY
| | - Christine M Bond
- University Department of General Practice and Primary Care, Foresterhill Health Centre, Westburn Road, Aberdeen, Scotland AB25 2AY
| | - A Scott Lennox
- University Department of General Practice and Primary Care, Foresterhill Health Centre, Westburn Road, Aberdeen, Scotland AB25 2AY
| |
Collapse
|
33
|
De Greef K, Deforche B, Tudor-Locke C, De Bourdeaudhuij I. A cognitive-behavioural pedometer-based group intervention on physical activity and sedentary behaviour in individuals with type 2 diabetes. HEALTH EDUCATION RESEARCH 2010; 25:724-36. [PMID: 20338978 PMCID: PMC2936553 DOI: 10.1093/her/cyq017] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 02/27/2010] [Indexed: 05/28/2023]
Abstract
The purpose of this study was to investigate the benefits of a pedometer and a cognitive-behavioural group intervention for promoting physical activity (PA) in type 2 diabetes patients. We recruited 41 participants and randomized them into an intervention group (IG) (n=20) and a control group (CG) (n = 21). The intervention consisted of five sessions within 12 weeks, a booster session after 22 weeks and a pedometer. Primary outcome was PA assessed by accelerometer (minutes per day) and pedometer (steps per day). Secondary outcomes were weight, body mass index, blood pressure, haemoglobin A1c and total cholesterol. After 12 weeks, the IG increased with more than 2000 steps day(-1) compared with the CG, whereas sedentary behaviour decreased more than 1 hour day(-1) in the IG and showed no change in the CG. There was no intervention effect on the accelerometer-based PA nor on health measurements. After 1 year, the increase in steps per day remained significant in the IG, but sedentary activity increased again to baseline levels. This pilot study showed that the combination of a 12-week cognitive-behavioural intervention and a pedometer has a significant short-term impact on daily steps and sedentary behaviour but that the effects on total PA and long-term effects were limited.
Collapse
Affiliation(s)
- K De Greef
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium.
| | | | | | | |
Collapse
|
34
|
Kosmala-Anderson J, Wallace LM, Turner A. Does the professional and working context of United Kingdom clinicians predict if they use practices to support patients with long term conditions to self manage? Arch Med Sci 2010; 6:815-21. [PMID: 22419944 PMCID: PMC3298354 DOI: 10.5114/aoms.2010.17100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 09/27/2009] [Accepted: 10/16/2009] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Our study examines how the professional and employment context may influence clinicians' practice self management support for patients with long term conditions (LTC). MATERIAL AND METHODS We surveyed clinicians working with patients with depression, chronic obstructive pulmonary disorder (COPD), chronic musculo skeletal pain and diabetes. RESULTS Clinicians most frequently endorsed items on a scale concerned with patient centeredness, and less frequently endorsed items concerned with clinical and organizational self management support. The most important factors predicting these latter activities were the intensity of working experience with patients with LTC and attending professional training addressing the principles and practice of self management support. Practicing patient centeredness was endorsed by nearly all respondents, and so was not sensitive to variation on work variables. CONCLUSIONS The interaction of training and intensity of work with patients with LTC seems to have the most powerful effect on undertaking clinical and organizational self management support practices. To facilitate clinicians' practice of self management support for patients with LTC it is very important to provide relevant professional training and to build specialized patient care teams with professionals having complimentary skills.
Collapse
Affiliation(s)
- Joanna Kosmala-Anderson
- Applied Research Centre in Health and Lifestyle Interventions, Coventry University, Coventry, United Kingdom
| | | | | |
Collapse
|
35
|
Kosmala-Anderson JP, Wallace LM, Turner A. Confidence matters: A Self-Determination Theory study of factors determining engagement in self-management support practices of UK clinicians. PSYCHOL HEALTH MED 2010; 15:478-91. [DOI: 10.1080/13548506.2010.487104] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
36
|
A randomized clinical trial to examine enhancing cognitive-behavioral group therapy for obsessive-compulsive disorder with motivational interviewing and thought mapping. Behav Cogn Psychother 2010; 38:319-36. [PMID: 20353621 DOI: 10.1017/s1352465810000111] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is characterized by repeated and persistent attempts to control thoughts and actions with rituals. These rituals are used in order to prevent feared or personally distressing outcomes. Cognitive behavioral group therapy (CBGT) has been reported to be effective for treating OCD patients. However, about one-third (30%) of patients do not benefit from CBGT. Some of these patients do not show significant improvement and continue to use rituals following CBGT, partially because they fail to complete the exposure and ritual prevention (ERP) exercises. Consequently, it is important to motivate patients to fully engage in CBGT treatment and complete the ERP exercises. AIMS A randomized behavioral trial examined 12 weeks of manual directed CBGT, with the addition of individual sessions of Motivational Interviewing (MI) and Thought Mapping (TM), and compared treatment outcome to the effectiveness of CBGT group alone. METHOD Subjects were randomized (n=93) into a CBGT group or a CBGT group with MI+TM. RESULTS When the two groups were compared, both groups reduced OCD symptoms. However, symptom reduction and remission were significantly higher in the MI+TM CBGT group. Positive outcomes were also maintained, with additional symptom reduction at the 3-month follow-up for the MI+TM CBGT group. CONCLUSIONS Adding two individual sessions of MI and TM before CBGT successfully reduced OCD symptoms and was more effective than using CBGT group alone.
Collapse
|
37
|
Ramos M, Ripoll J, Estrades T, Socias I, Fe A, Duro R, González MJ, Servera M. Effectiveness of intensive group and individual interventions for smoking cessation in primary health care settings: a randomized trial. BMC Public Health 2010; 10:89. [PMID: 20178617 PMCID: PMC2836298 DOI: 10.1186/1471-2458-10-89] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 02/23/2010] [Indexed: 11/25/2022] Open
Abstract
Objectives Primary: To compare the effectiveness of intensive group and individual interventions for smoking cessation in a primary health care setting; secondary: to identify the variables associated with smoking cessation. Methods Three-pronged clinical trial with randomisation at the individual level. We performed the following: an intensive individual intervention (III), an intensive group intervention (IGI) and a minimal intervention (MI). Included in the study were smokers who were prepared to quit smoking. Excluded from the study were individuals aged less than 18 years or with severe mental conditions or terminal illnesses. The outcome measure was continued abstinence at 12 months confirmed through CO-oximetry (CO). The analysis was based on intention to treat. Results In total, 287 smokers were recruited: 81 in the III, 111 in the IGI, and 95 in the MI. Continued abstinence at 12 months confirmed through CO was 7.4% in the III, 5.4% in the IGI, and 1% in the MI. No significant differences were noted between III and MI on the one hand, and between IGI and MI on the other [RR 7.04 (0.9-7.2) and RR 5.1 (0.6-41.9), respectively]. No differences were noted between IGI and III [RR 0.7 (0.2-2.2)]. In multivariate analysis, only overall visit length showed a statistically significant association with smoking cessation. Conclusions The effectiveness of intensive smoking interventions in this study was lower than expected. No statistically significant differences were found between the results of individual and group interventions. Trial registration number ISRCTN32323770
Collapse
Affiliation(s)
- Maria Ramos
- Deparment of Public Health, Balearic Department of Health, Palma, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Edvardsson K, Edvardsson D, Hörnsten Å. Raising issues about children’s overweight - maternal and child health nurses’ experiences. J Adv Nurs 2009; 65:2542-51. [DOI: 10.1111/j.1365-2648.2009.05127.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
39
|
Yevlahova D, Satur J. Models for individual oral health promotion and their effectiveness: a systematic review. Aust Dent J 2009; 54:190-7. [DOI: 10.1111/j.1834-7819.2009.01118.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
40
|
Heather N, Dallolio E, Hutchings D, Kaner E, White M. Implementing routine screening and brief alcohol intervention in primary health care: A Delphi survey of expert opinion. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890410001665014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nick Heather
- School of Psychology & Sport Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Emma Dallolio
- Formerly Centre for Alcohol & Drug Studies, Newcastle North Tyneside & Northumberland Mental Health NHS Trust, Newcastle upon Tyne, UK
| | - Deborah Hutchings
- School of Population & Health Sciences, University of Newcastle upon Tyne, UK
| | - Eileen Kaner
- School of Psychology & Sport Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Martin White
- Formerly Centre for Alcohol & Drug Studies, Newcastle North Tyneside & Northumberland Mental Health NHS Trust, Newcastle upon Tyne, UK
| |
Collapse
|
41
|
Lock CA. Screening and brief alcohol interventions: What, why, who, where and when? A review of the literature. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890410001665096] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
42
|
Rollnick S, Butler C, Hodgson R. Brief Alcohol Intervention in Medical Settings:Concerns from the Consulting Room. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/16066359709004347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
43
|
Abstract
Motivational interviewing is a directive, client-centred counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence. It is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship. This article seeks to define motivational interviewing and to characterize its essential nature, differentiating it from other approaches with which it may be confused. A brief update is also provided regarding (1) evidence for its efficacy and (2) new problem areas and populations to which it is being applied.
Collapse
|
44
|
Leontieva L, Horn K, Helmkamp J, Furbee M, Jarrett T, Williams J. Counselors' reflections on the administration of screening and brief intervention for alcohol problems in the emergency department and 3-month follow-up outcome. J Crit Care 2009; 24:273-9. [PMID: 19327303 DOI: 10.1016/j.jcrc.2008.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 06/23/2008] [Accepted: 07/06/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this paper was to explore how events that counselors endorsed occurring during an emergency department-based screening and brief intervention (SBI) for drinking discriminate patients who reported change in Alcohol Use Disorder Identification Test (AUDIT) domains at follow-up from those who did not. METHOD Patients who scored ">5" on the AUDIT were eligible for SBI. At the end of each intervention, counselors completed the questionnaire indicating which parts of the intervention they just used. RESULTS Discriminant function analyses indicated that "Referral made" discriminated for alcohol intake change (Wilks' lambda = 0.993, P < .05); "Did the patient set goals during intervention?" and "Referral made" discriminated for alcohol dependency change (Wilks' lambda = 0.940 and Wilks' lambda = 0.919, P < .05, respectively). "Intention to quit" (Wilks' lambda = 0.984, P < .05) discriminated for alcohol-related harm change. CONCLUSIONS Making referrals to addiction treatment during motivational intervention discriminated for alcohol intake and dependency change. Working on intention to quit is an important point in changing alcohol-related harm. When conducting the SBI in ED, counselors may be mindful in making appropriate referrals to address alcohol use and examine intention to quit to maximize the efficacy of the harm-reduction approach.
Collapse
Affiliation(s)
- Luba Leontieva
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA.
| | | | | | | | | | | |
Collapse
|
45
|
Martins RK, McNeil DW. Review of Motivational Interviewing in promoting health behaviors. Clin Psychol Rev 2009; 29:283-93. [PMID: 19328605 DOI: 10.1016/j.cpr.2009.02.001] [Citation(s) in RCA: 331] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2006] [Revised: 02/05/2009] [Accepted: 02/11/2009] [Indexed: 10/21/2022]
Abstract
There is considerable evidence for the effectiveness of Motivational Interviewing (MI) in the treatment of substance abuse, as well as a number of other health behavior areas. The present paper summarizes and critically reviews the research in three emerging areas in which (MI) is being applied: diet and exercise, diabetes, and oral health. Although 10 prior reviews focused in part on MI studies in the areas of diet, exercise, or diabetes, the present paper provides an up-to-date review, and includes oral health as another emerging area of MI research. Overall, 37 articles were reviewed: 24 in the areas of diet and exercise, 9 in the area of diabetes, and 4 in the oral health area. Research in these areas suggests that (MI) is effective in all these health domains, although additional research is needed, particularly in the oral health arena. Specifically, future research in the areas of diet and exercise should examine the clinical utility of MI by health care professionals (other than dietitians), studies in the area of diabetes should continue to examine long-term effects of MI on glycemic control, and research in the area of oral health should focus on developing additional trials in this field. Further, future studies should demonstrate improved research methodology, and investigate the effects of possible outcome mediators, such as client change talk, on behavior change.
Collapse
Affiliation(s)
- Renata K Martins
- West Virginia University, 53 Campus Drive, P.O. Box 6040, Morgantown, West Virginia 26506-6040, USA.
| | | |
Collapse
|
46
|
Rollman BL, Belnap BH, LeMenager MS, Mazumdar S, Schulberg HC, Reynolds CF. The Bypassing the Blues treatment protocol: stepped collaborative care for treating post-CABG depression. Psychosom Med 2009; 71:217-30. [PMID: 19188529 PMCID: PMC4573662 DOI: 10.1097/psy.0b013e3181970c1c] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To present the design of the Bypassing the Blues (BtB) study to examine the impact of a collaborative care strategy for treating depression among patients with cardiac disease. Coronary artery bypass graft (CABG) surgery is one of the most common and costly medical procedures performed in the US. Up to half of post-CABG patients report depressive symptoms, and they are more likely to experience poorer health-related quality of life (HRQoL), worse functional status, continued chest pains, and higher risk of cardiovascular morbidity independent of cardiac status, medical comorbidity, and the extent of bypass surgery. METHODS BtB was designed to enroll 450 post-CABG patients from eight Pittsburgh-area hospitals including: (1) 300 patients who expressed mood symptoms preceding discharge and at 2 weeks post hospitalization (Patient Health Questionnaire (PHQ-9) >or=10); and (2) 150 patients who served as nondepressed controls (PHQ-9 <5). Depressed patients were randomized to either an 8-month course of nurse-delivered telephone-based collaborative care supervised by a psychiatrist and primary care expert, or to their physicians' "usual care." The primary hypothesis will test whether the intervention can produce an effect size of >or=0.5 improvement in HRQoL at 8 months post CABG, as measured by the SF-36 Mental Component Summary score. Secondary hypotheses will examine the impact of our intervention on mood symptoms, cardiovascular morbidity, employment, health services utilization, and treatment costs. RESULTS Not applicable. CONCLUSIONS This effectiveness trial will provide crucial information on the impact of a widely generalizable evidence-based collaborative care strategy for treating depressed patients with cardiac disease.
Collapse
Affiliation(s)
- Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | | |
Collapse
|
47
|
Alonso-Cerezo MC, Martín JS, García Montes MA, de la Iglesia VM. Appropriate utilization of clinical laboratory tests. Clin Chem Lab Med 2009; 47:1461-5. [DOI: 10.1515/cclm.2009.335] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
48
|
Rivera Mercado S, Villouta Cassinelli MF, Ilabaca Grez A. [Motivational interviews: what are their effectiveness in prevalent primary care problems?]. Aten Primaria 2008; 40:257-61. [PMID: 18482546 PMCID: PMC7713456 DOI: 10.1157/13120020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 11/10/2007] [Indexed: 02/04/2023] Open
Affiliation(s)
- Solange Rivera Mercado
- Departamento de Medicina Familiar, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | | | | |
Collapse
|
49
|
Williams EC, Horton NJ, Samet JH, Saitz R. Do brief measures of readiness to change predict alcohol consumption and consequences in primary care patients with unhealthy alcohol use? Alcohol Clin Exp Res 2007; 31:428-35. [PMID: 17295727 DOI: 10.1111/j.1530-0277.2006.00324.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Assessing readiness to change is recommended as part of brief interventions for patients with unhealthy alcohol use. However, the utility and predictive validity of readiness measures have not been well established. METHODS In a prospective cohort study, we assessed primary care patients with unhealthy alcohol use (past-month drinking of risky amounts, or any amount and an affirmative response to CAGE alcohol screening questionnaire) and reassessed them 6 months later. At study entry, we assessed readiness to change using 1 multi-item measure of stage of change, and 5 single-item measures (readiness per se, importance of changing, confidence in ability to change, intention to cut down, intention to abstain). Outcomes included alcohol consumption and alcohol-related consequences. Multivariable regression models were fit for each measure of readiness and each outcome. RESULTS Of 312 patients with unhealthy alcohol use, 228 (73%) were assessed at study entry and 6 months later and had complete data. Among readiness measures, only confidence and intention to abstain (1 point changes on single-item measures) were associated with consumption 6 months later: less heavy episodic drinking [adjusted odds ratio (AOR) 0.88, 95% CI 0.80-0.98 and AOR 0.79, 0.64-0.98, respectively], and less drinking of risky amounts (AOR 0.89, 0.79-1.00 and AOR 0.78, 0.62-0.98, respectively). Intention to abstain was also associated with more abstinence (AOR 1.43, 1.09-1.88). Single-item measures of readiness, importance, and intention to cut down were significantly associated with higher odds of alcohol consequences. Greater confidence (single item) was associated with a lower odds of any consequences (AOR 0.88, 0.79-0.98). CONCLUSIONS Greater readiness, as measured by several brief assessments, was associated with more consequences and was not predictive of consumption. However, assessing confidence in the ability to change one's alcohol use may have a role in predicting subsequent decreases in both consumption and consequences in primary care patients.
Collapse
Affiliation(s)
- Emily C Williams
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Washington 98101, USA.
| | | | | | | |
Collapse
|
50
|
Farmer AJ, Gibson OJ, Dudley C, Bryden K, Hayton PM, Tarassenko L, Neil A. A randomized controlled trial of the effect of real-time telemedicine support on glycemic control in young adults with type 1 diabetes (ISRCTN 46889446). Diabetes Care 2005; 28:2697-702. [PMID: 16249542 DOI: 10.2337/diacare.28.11.2697] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether a system of telemedicine support can improve glycemic control in type 1 diabetes. RESEARCH DESIGN AND METHODS A 9-month randomized trial compared glucose self-monitoring real-time result transmission and feedback of results for the previous 24 h in the control group with real-time graphical phone-based feedback for the previous 2 weeks together with nurse-initiated support using a web-based graphical analysis of glucose self-monitoring results in the intervention group. All patients aged 18-30 years with HbA(1c) (A1C) levels of 8-11% were eligible for inclusion. RESULTS A total of 93 patients (55 men) with mean diabetes duration (means +/- SD) 12.1 +/- 6.7 years were recruited from a young adult clinic. In total, the intervention and control groups transmitted 29,765 and 21,400 results, respectively. The corresponding median blood glucose levels were 8.9 mmol/l (interquartile range 5.4-13.5) and 10.3 mmol/l (6.5-14.4) (P < 0.0001). There was a reduction in A1C in the intervention group after 9 months from 9.2 +/- 1.1 to 8.6 +/- 1.4% (difference 0.6% [95% CI 0.3-1.0]) and a reduction in A1C in the control group from 9.3 +/- 1.5 to 8.9 +/- 1.4% (difference 0.4% [0.03-0.7]). This difference in change in A1C between groups was not statistically significant (0.2% [-0.2 to 0.7, P = 0.3). CONCLUSIONS Real-time telemedicine transmission and feedback of information about blood glucose results with nurse support is feasible and acceptable to patients, but to significantly improve glycemic control, access to real-time decision support for medication dosing and changes in diet and exercise may be required.
Collapse
Affiliation(s)
- Andrew J Farmer
- Division of Public Health and Primary Health Care, University of Oxford, Oxford, UK.
| | | | | | | | | | | | | |
Collapse
|