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Mergelsberg ELP, de Ruijter D, Crone MR, Smit ES, Hoving C. Active Ingredients of Interventions Improving Smoking Cessation Support by Dutch Primary Care Providers: A Systematic Review. Eval Health Prof 2023; 46:3-22. [PMID: 35594377 DOI: 10.1177/01632787221099941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective was to assess active ingredients, change mechanisms, and fidelity in interventions aiming to increase the quality of smoking cessation care in the Dutch primary healthcare setting. We conducted a systematic review searching five scientific databases on August 2nd, 2019, updated on October 28th, 2021. We included effect data of behavioural interventions aiming at improving the provision of smoking cessation support by Dutch primary care providers to their patients. We excluded studies published before 2000 and those without a behavioural support intervention for primary care providers targeting smoking cessation in their patients. We found 1939 articles and included 15 distinct interventions in the review. We provided an overview of study characteristics, intervention effects, fidelity, active ingredients and change mechanisms using the Behaviour Change Techniques (BCT) Taxonomy and Mechanisms of Action (MoAs) protocols. Interventions seemed more effective when including a face-to-face component, using active learning strategies and providing a tool to help follow the guidelines in practice (e.g., physical cards with information). BCTs, MoAs, and fidelity were overall poorly reported on. To support the application of smoking cessation practices in Dutch primary care, we recommend implementation of face-to-face training programs incorporating active skill training elements combined with practical tools.
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Affiliation(s)
- Enrique L P Mergelsberg
- Department of Health Promotion, 5211Maastricht University, Maastricht, Limburg, The Netherlands.,EnBerg Analytics, Perth, WA, Australia
| | - Dennis de Ruijter
- Department of Health Promotion, 5211Maastricht University, Maastricht, Limburg, The Netherlands
| | - Mathilde R Crone
- Public Health and Primary Care, 4501Leiden University Medical Center, RC Leiden, Zuid-Holland, The Netherlands
| | - Eline S Smit
- Department of Communication Science, 1234University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Ciska Hoving
- Department of Health Promotion, 5211Maastricht University, Maastricht, Limburg, The Netherlands
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A scoping review of theories used to investigate clinician adherence to clinical practice guidelines. Int J Clin Pharm 2023; 45:52-63. [PMID: 36385205 PMCID: PMC9938823 DOI: 10.1007/s11096-022-01490-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Routine utilization of evidence-based clinical practice guidelines (CPGs) is an effective strategy to optimize patient care and reduce practice variation. Healthcare professionals' failure to adhere to CPGs introduces risks to both patients and the sustainability of healthcare systems. The integration of theory to investigate adherence provides greater insight into the often complex reasons for suboptimal behaviors. AIM To determine the coverage of literature surrounding the use of theory in studies of CPG adherence, report the key findings and identify the knowledge gaps. METHOD In April 2021, three bibliographic databases were searched for studies published since January 2010, adopting theory to investigate health professionals' adherence to CPGs. Two reviewers independently screened the articles for eligibility and charted the data. A narrative approach to synthesis was employed. RESULTS The review includes 12 articles. Studies were limited to primarily investigations of physicians, quantitative designs, single disease states and few countries. The use of behavioral theories facilitated pooling of data of barriers and facilitators of adherence. The domains and constructs of a number of the reported theories are captured within the Theoretical Domains Framework (TDF); the most common barriers aligned with the TDF domain of environmental context and resources, fewer studies reported facilitators. CONCLUSION There is emerging use of behavioral theories investigating physicians' adherence to CPGs. Although limited in number, these studies present specific insight into common barriers and facilitators, thus providing valuable evidence for refining existing and future implementation strategies. Similar investigations of other health professionals are warranted.
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How to persuade more primary care professionals to adopt a valued smoking cessation referral aid: a cross-sectional study of facilitators and barriers. BMC PRIMARY CARE 2022; 23:227. [PMID: 36071372 PMCID: PMC9454164 DOI: 10.1186/s12875-022-01843-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 08/10/2022] [Indexed: 11/23/2022]
Abstract
Background To study the factors associated with the intention of primary care professionals (PCPs) to use or not use a referral aid (RA) for selecting an evidence-based smoking cessation intervention (EBSCI). Methods Participants (n = 85) were recruited from June to September 2020 to complete an online questionnaire based on the I-Change Model to assess the factors associated with the adoption of RA. The differences between PCPs with (n = 37) and without (n = 48) the intention to adopt in terms of demographics, motivational factors, and post-motivational factors were subsequently assessed. Correlation and logistic regression analyses were conducted to investigate the factors associated with the intention to adopt. Results Both groups indicated that they highly appreciated the RA. However, PCPs without the intention to adopt expressed a more negative attitude towards the RA, experienced less social support, showed low self-efficacy, and encountered barriers such as lack of time and skills. The factors most strongly associated with the intention to adopt were advantages, disadvantages, self-efficacy, less barriers, working in a solo practice and age. Conclusions The adoption of RA can be facilitated in two ways. The first one is by increasing the added value of the tool through a second round of co-creation focusing on the adoptability of the RA in practice. The second approach is by communicating the added value of referring to EBSCIS and thereby using the RA by implementing it in smoking cessation training for PCPs, which could also help to improve the attitude, social support, self-efficacy, and perceived skills in terms of RA usage among PCPs. Impact This study is the first work in the Netherlands to investigate the willingness of PCPs to actively refer patients to other EBSCIs in addition to providing face-to-face counseling themselves. Trial registration The study was registered at the Netherlands Trial Register (NL7020, https://www.trialregister.nl/trial/7020).
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Westland H, Page SD, van Rijn M, Aryal S, Freedland KE, Lee C, Strömberg A, Vellone E, Wiebe DJ, Jaarsma T, Riegel B. Self-care management of bothersome symptoms as recommended by clinicians for patients with a chronic condition: A Delphi study. Heart Lung 2022; 56:40-49. [PMID: 35709644 DOI: 10.1016/j.hrtlng.2022.06.001] [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: 03/14/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronically medically ill patients often need clinical assistance with symptom management, as well as self-care interventions that can help to reduce the impact of bothersome symptoms. Experienced clinicians can help to guide the development of more effective self-care interventions. OBJECTIVE To create a consensus-based list of common bothersome symptoms of chronic conditions and of self-care management behaviors recommended to patients by clinicians to reduce the impact of these symptoms. METHODS A two-round Delphi study was performed among an international panel of 47 clinicians using online surveys to identify common and bothersome symptoms and related self-care management behaviors recommended to patients with heart failure, chronic obstructive pulmonary disease, asthma, type 2 diabetes, or arthritis. RESULTS A total of 30 common bothersome symptoms and 158 self-care management behaviors across the five conditions were listed. Each chronic condition has its own bothersome symptoms and self-care management behaviors. Consensus was reached on the vast majority of recommended behaviors. CONCLUSIONS The list of common bothersome symptoms and self-care management behaviors reflect consensus across four countries on many points but also disagreement on others, and a few recommendations are inconsistent with current guidelines. Efforts to encourage clinicians to recommend effective self-care management behaviors may reduce symptom impact in chronically ill patient populations.
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Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands.
| | | | - Michelle van Rijn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands
| | - Subhash Aryal
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | | | - Christopher Lee
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Anna Strömberg
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | | | | | - Tiny Jaarsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, the Netherlands; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Barbara Riegel
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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Sezai I, Taniguchi C, Yoshimi I, Hirano T, Wakao F. How Self-Efficacy Toward, Perceived Importance of, and Beliefs about Smoking Cessation Support Impact-Related Behaviors in Japanese Nursing Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042304. [PMID: 35206486 PMCID: PMC8872346 DOI: 10.3390/ijerph19042304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/03/2022]
Abstract
This study investigated the relationships among Japanese nursing professionals’ percetions of the importance of smoking cessation support (SCS), attitude toward SCS, SCS self-efficacy, and SCS behaviors. An anonymous, self-administered questionnaire was administered to 613 nursing professionals (valid response rate: 89.9%) who participated in SCS workshops in Japan between May 2019 and February 2020. The survey measured factors such as SCS behaviors (the 5 As) and attitude toward SCS. Participants responded that they “always” or “usually” performed the 5 As at the following rates: Ask, 65.6%; Advise, 46.7%; Assess, 34.4%; Assist, 19.7%; and Arrange, 20.9%. Significant differences in implementation rates between “non-engagers” and “engagers” were found for all steps except Ask. Those who engaged daily in SCS had significantly higher scores for SCS behaviors and SCS perceived importance, attitude, and self-efficacy than those who did not. Structural equation modeling yielded a model with 61% explanatory power, which demonstrated that beliefs about and perceived importance of SCS had a greater impact on SCS behaviors than self-efficacy. Promotion of SCS behaviors among nursing professionals in Japan requires the beliefs about and recognition of the importance of SCS to be improved. The importance of engaging in SCS daily is also recommended.
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Affiliation(s)
- Izumi Sezai
- Community Health Nursing Section, National Defense Medical College, Tokorozawa 359-8513, Japan
- Institute for Cancer Control, National Cancer Center, Tokyo 104-0045, Japan; (C.T.); (I.Y.); (T.H.); (F.W.)
- Correspondence:
| | - Chie Taniguchi
- Institute for Cancer Control, National Cancer Center, Tokyo 104-0045, Japan; (C.T.); (I.Y.); (T.H.); (F.W.)
- Chronic Illness Care Nursing, College of Nursing, Aichi Medical University, Nagakute 480-1195, Japan
| | - Ituro Yoshimi
- Institute for Cancer Control, National Cancer Center, Tokyo 104-0045, Japan; (C.T.); (I.Y.); (T.H.); (F.W.)
| | - Tomoyasu Hirano
- Institute for Cancer Control, National Cancer Center, Tokyo 104-0045, Japan; (C.T.); (I.Y.); (T.H.); (F.W.)
| | - Fumihiko Wakao
- Institute for Cancer Control, National Cancer Center, Tokyo 104-0045, Japan; (C.T.); (I.Y.); (T.H.); (F.W.)
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Zijlstra DN, Hoving C, Bolman C, Muris JWM, De Vries H. Do professional perspectives on evidence-based smoking cessation methods align? A Delphi study among researchers and healthcare professionals. HEALTH EDUCATION RESEARCH 2022; 36:434-445. [PMID: 34195810 PMCID: PMC8783547 DOI: 10.1093/her/cyab022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 04/02/2021] [Accepted: 05/20/2021] [Indexed: 06/13/2023]
Abstract
The use of evidence-based smoking cessation interventions (SCIs) can significantly increase the number of successful smoking cessation attempts. To obtain an overview of the knowledge and viewpoints on the effectiveness and use of SCIs, a three-round online Delphi study was conducted among researchers and primary care professionals (PCPs). The four objectives of this study are to gain an overview of (i) the criteria important for recommending SCIs, (ii) the perceptions of both groups on the effectiveness of SCIs, (iii) the factors to consider when counseling different (high-risk) groups of smokers and (iv) the perceptions of both groups on the use of e-cigarettes as an SCI. We found a high level of agreement within groups on which smoker characteristics should be considered when recommending an SCI to smokers. We also found that PCPs display a lower degree of consensus on the effectiveness of SCIs. Both groups see a value in the use of special protocols for different (high-risk) groups of patients, but the two groups did not reach consensus on the use of e-cigarettes as a means to quit. Making an inventory of PCPs' needs regarding SCIs and their usage may provide insight into how to facilitate a better uptake in the primary care setting.
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Affiliation(s)
| | - Ciska Hoving
- Department of Health Promotion, CAPHRI, Maastricht University, Peter Debyeplein 1, Maastricht 6229 HA, Netherlands
| | - Catherine Bolman
- Department of Psychology, Open University of the Netherlands, P.O. Box 2960, Heerlen 6401 DL, Netherlands
| | - Jean W M Muris
- Department of General Practice, CAPHRI, Maastricht University, Peter Debyeplein 1, Maastricht 6229 HA, Netherlands
| | - Hein De Vries
- Department of Health Promotion, CAPHRI, Maastricht University, Peter Debyeplein 1, Maastricht 6229 HA, Netherlands
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When primary care providers and smokers meet: a systematic review and metasynthesis. NPJ Prim Care Respir Med 2021; 31:31. [PMID: 34075057 PMCID: PMC8169673 DOI: 10.1038/s41533-021-00245-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients' motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.
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Zijlstra DN, Muris JW, Bolman C, Elling JM, Knapen VE, de Vries H. A referral aid for smoking cessation interventions in primary care: study protocol for a randomized controlled trial. Prim Health Care Res Dev 2021; 22:e22. [PMID: 34036929 PMCID: PMC8165454 DOI: 10.1017/s1463423621000244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/22/2021] [Accepted: 04/12/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To expedite the use of evidence-based smoking cessation interventions (EBSCIs) in primary care and to thereby increase the number of successful quit attempts, a referral aid was developed. This aid aims to optimize the referral to and use of EBSCIs in primary care and to increase adherence to Dutch guidelines for smoking cessation. METHODS Practice nurses (PNs) will be randomly allocated to an experimental condition or control condition, and will then recruit smoking patients who show a willingness to quit smoking within six months. PNs allocated to the experimental condition will provide smoking cessation guidance in accordance with the referral aid. Patients from both conditions will receive questionnaires at baseline and after six months. Cessation effectiveness will be tested via multilevel logistic regression analyses. Multiple imputations as well as intention to treat analysis will be performed. Intervention appreciation and level of informed decision-making will be compared using analysis of (co)variance. Predictors for appreciation and informed decision-making will be assessed using multiple linear regression analysis and/or structural equation modeling. Finally, a cost-effectiveness study will be conducted. DISCUSSION This paper describes the study design for the development and evaluation of an information and decision tool to support PNs in their guidance of smoking patients and their referral to EBSCIs. The study aims to provide insight into the (cost) effectiveness of an intervention aimed at expediting the use of EBSCIs in primary care.
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Affiliation(s)
- Daniëlle N. Zijlstra
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, the Netherlands
| | - Jean W.M. Muris
- Department of General Practice, Maastricht University/CAPHRI, Maastricht, the Netherlands
| | - Catherine Bolman
- Department of Psychology, Open University of the Netherlands, Heerlen, the Netherlands
| | - J. Mathis Elling
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, the Netherlands
| | - Vera E.R.A. Knapen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, the Netherlands
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Using Virtual Reality to Stimulate Healthy and Environmentally Friendly Food Consumption among Children: An Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031088. [PMID: 33530495 PMCID: PMC7908483 DOI: 10.3390/ijerph18031088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
Since habits formed during childhood are predictive of adult behaviour, children form an important target group when it comes to improving healthy and environmentally friendly food consumption. To explore the potential of immersive virtual reality (VR) in this respect, we conducted a semi-structured interview study (N = 22) among children aged 6–13 years. This study consisted of two parts: (1) a VR experience and (2) a semi-structured interview to investigate (1) to what extent children are able to recall and understand information about the impact of food products on their health and the environment when provided to them as pop-ups in a VR supermarket; (2) what rational and emotional processes are triggered by this information; and (3) what children’s expectations about the real-life application and impact of the pop-ups are, and why. Interview data were analysed using the framework method. Results showed that although all participants were able to recall the information, only children from an average age of ten years old also understood the information. When participants understood the information, they were often aware of and felt sorry for their negative behavioural impact. Most participants expected their behaviour to positively change when imagining real-life application of the pop-ups.
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Zhang L, Li J, Lv Y, Yang X, Bai L, Luo Y, Chen Y, Zhao Y. Impact of tobacco control auxiliary resources on the 5As behavior in nursing interns: Self-reports from students. Tob Induc Dis 2020; 18:65. [PMID: 32818028 PMCID: PMC7425755 DOI: 10.18332/tid/125231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/04/2020] [Accepted: 07/12/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The help of healthcare professionals for smokers to quit is critically important to increase quit rates. In the future, internship nursing students will potentially become the largest population of medical professionals. This study explored the impact of the use and awareness of universal tobacco control auxiliary resources on nursing students’ 5As behavior in helping patients to quit smoking during a 40-week clinical internship in the last year of nursing school in Chongqing, China. METHODS A survey was conducted in 13 teaching hospitals selected from 29 in Chongqing, China, in 2019, by a random cluster sampling method. It investigated, by self-reported questionnaires, student 5As behavior in helping patients to quit smoking and use and knowledge of tobacco cessation auxiliary resources (tobacco cessation self-education manual, tobacco cessation guidelines, tobacco cessation drugs, tobacco cessation websites, and hotline). The relationship between tobacco cessation auxiliary resources and 5As behavior in helping patients to quit smoking was analyzed with a multivariate linear mixed-effect model. RESULTS In all, 534 (39.3%) students, of a total of 1358, reported that the majority of internship units provided a tobacco control self-education manual; 674 (49.6%) ever skimmed through tobacco cessation guidelines; 641 (47.2%) browsed tobacco cessation websites; 738 (54.3%) knew some cessation-assistance drugs; and 93 (6.8%) knew of and could recall the tobacco cessation hotline. Except for tobacco cessation websites, tobacco cessation auxiliary resources affected nursing interns’ 5As behavior in helping patients to quit (p<0.05). CONCLUSIONS Tobacco cessation auxiliary resources influenced students’ 5As behavior in helping patients to quit smoking. Students knew a little of tobacco cessation auxiliary resources. To improve students’ 5As behavior for helping patients to quit, more tobacco cessation resources need to be developed and more students need to become acquainted with them.
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Affiliation(s)
- Li Zhang
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Jun Li
- The Office of Chongqing Medical University, Chongqing, China
| | - Yalan Lv
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Xia Yang
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Li Bai
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Yetao Luo
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Yong Zhao
- School of Public Health and Health Management, Chongqing Medical University, Chongqing, China
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Jun J, Kovner CT, Dickson VV, Stimpfel AW, Rosenfeld P. Does unit culture matter? The association between unit culture and the use of evidence-based practice among hospital nurses. Appl Nurs Res 2020; 53:151251. [PMID: 32451012 DOI: 10.1016/j.apnr.2020.151251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Jin Jun
- University of Michigan, School of Nursing and the Institute of Healthcare Policy and Innovation, 400 N. Ingalls St, Room 2183, Ann Arbor, MI 48109, United States of America.
| | - Christine T Kovner
- New York University, Rory Meyers College of Nursing, 433 First Ave, Room 644, New York, NY 40010, United States of America.
| | - Victoria Vaughan Dickson
- New York University, Rory Meyers College of Nursing, 433 First Ave, Office 742, New York, NY 10010, United States of America.
| | - Amy Witkoski Stimpfel
- New York University, Rory Meyers College of Nursing, 433 First Avenue, Office 658, New York, NY 10010, United States of America.
| | - Peri Rosenfeld
- NYU Langone Heath, Departments of Nursing, 545 First Avenue GH-SC1-164, New York, NY 10016, United States of America.
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Development and Validation of an Evaluation Tool to Measure the Effectiveness of a Smoking Cessation Training among Healthcare Providers in Malaysia: The Providers' Smoking Cessation Training Evaluation (ProSCiTE). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214297. [PMID: 31694286 PMCID: PMC6862003 DOI: 10.3390/ijerph16214297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 11/17/2022]
Abstract
Background: In line with Article 14 of the Framework Convention for Tobacco Control, we have witnessed vast developments in smoking cessation training for healthcare providers, offering help for smokers. However, there is no specific evaluation tool to monitor and evaluate the effectiveness of these programs for future enhancement and sustainability. Objective: To develop and validate a new tool for evaluating smoking cessation training programs for healthcare providers called the Providers' Smoking Cessation Training Evaluation (ProSCiTE). Methods: The 74-item ProSCiTE tool was developed based on a review of the literature and an expert panel review. The tool was validated in a sample of 403 healthcare providers using a cross-sectional study design from July to December 2016. Content validity was assessed by the Scale-Content Validity Index (S-CVI). The construct validity of the ProSCiTE was analyzed using exploratory factor analysis (EFA) to confirm psychometric properties. Internal consistency reliability was determined using Cronbach's alpha. Results: The content validity showed that the S-CVI ranged from 0.82 to 1.00 for consistency, representativeness, relevancy, and the clarity of each construct, resulting in 67 items for the questionnaire. The construct validity of the ProSCiTE (based on eigenvalues and factor loadings to confirm the four-factor structure (attitude, self-efficacy, behavior, and barriers) with 54.74% total variance) was acceptable (Kaiser-Mayer-Olkin = 0.923; Bartlett's test of sphericity was significant, p < 0.001). The internal consistency reliability of the four-factor structure was very good, with Cronbach's alpha values at 0.89, 0.94, 0.95, and 0.90, respectively. Conclusions: This study showed that 67 items of the ProSCiTE demonstrated good content and construct validity, as well as a high internal consistency reliability for the measurement of knowledge, attitudes, self-efficacy, behavior, and barriers to smoking cessation interventions among healthcare providers. Therefore, the ProSCiTE is a valid and reliable research tool with which to evaluate the effectiveness of smoking cessation training programs.
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Facilitating smoking cessation in patients who smoke: a large-scale cross-sectional comparison of fourteen groups of healthcare providers. BMC Health Serv Res 2019; 19:750. [PMID: 31653215 PMCID: PMC6815021 DOI: 10.1186/s12913-019-4527-x] [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] [Received: 11/21/2018] [Accepted: 09/11/2019] [Indexed: 01/10/2023] Open
Abstract
Background Although healthcare providers are well placed to help smokers quit, implementation of smoking cessation care is still suboptimal. The Ask-Advise-Refer tasks are important aspects of smoking cessation care. We examined to which extent a large and diverse sample of healthcare providers expressed the intention to implement smoking cessation care and which barriers they encountered. We moreover examined to which extent the Ask-Advise-Refer tasks were implemented as intended, and which determinants (in interaction) influenced intentions and the implementation of Ask-Advise-Refer. Methods Cross-sectional survey among addiction specialists, anaesthesiologists, cardiologists, general practitioners, internists, neurologists, paediatricians, pulmonologists, ophthalmologists, surgeons, youth specialists, dental hygienists, dentists, and midwives (N = 883). Data were analysed using multivariate linear and logistic regression analyses and regression tree analyses. Results The Ask-Advice-Refer tasks were best implemented among general practitioners, pulmonologists, midwives, and addiction specialists. Overall we found a large discrepancy between asking patients about smoking status and advising smokers to quit. Participants mentioned lack of time, lack of training, lack of motivation to quit in patients, and smoking being a sensitive subject as barriers to smoking cessation care. Regression analyses showed that the most important determinants of intentions and implementation of Ask-Advise-Refer were profession, role identity, skills, guideline familiarity and collaboration agreements for smoking cessation care with primary care. Determinants interacted in explaining outcomes. Conclusions There is much to be gained in smoking cessation care, given that implementation of Ask-Advise-Refer is still relatively low. In order to improve smoking cessation care, changes are needed at the level of the healthcare provider (i.e., facilitate role identity and skills) and the organization (i.e., facilitate collaboration agreements and guideline familiarity). Change efforts should be directed towards the specific barriers encountered by healthcare providers, the contexts that they work in, and the patients that they work with.
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de Ruijter D, Hoving C, Evers S, Hudales R, de Vries H, Smit E. An economic evaluation of a computer-tailored e-learning program to promote smoking cessation counseling guideline adherence among practice nurses. PATIENT EDUCATION AND COUNSELING 2019; 102:1802-1811. [PMID: 31395391 DOI: 10.1016/j.pec.2019.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/25/2019] [Accepted: 07/13/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To conduct an economic evaluation of a tailored e-learning program, which successfully improved practice nurses' smoking cessation guideline adherence. METHODS The economic evaluation was embedded in a randomized controlled trial, in which 269 practice nurses recruited 388 smoking patients. Cost-effectiveness was assessed using guideline adherence as effect measure on practice nurse level, and continued smoking abstinence on patient level. Cost-utility was assessed on patient level, using patients' Quality Adjusted Life Years (QALYs) as effect measure. RESULTS The e-learning program was likely to be cost-effective on practice nurse level, as adherence to an additional guideline step cost €1,586. On patient level, cost-effectiveness was slightly likely after six months (cost per additional quitter: €7,126), but not after twelve months. The cost-utility analysis revealed slight cost-effectiveness (cost per QALY gained: €18,431) on patient level. CONCLUSION Providing practice nurses with a tailored e-learning program is cost-effective to improve their smoking cessation counseling. Though, cost-effectiveness on patient level was not found after twelve months, potentially resulting from smoking relapse. PRACTICE IMPLICATIONS Widespread implementation of the e-learning program can improve the quality of smoking cessation care in general practice. Strategies to prevent patients' smoking relapse should be further explored to improve patients' long-term abstinence.
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Affiliation(s)
- Dennis de Ruijter
- Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Ciska Hoving
- Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Silvia Evers
- Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands; Centre of Economic Evaluation, Trimbos Institute, National Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS, Utrecht, the Netherlands
| | - Raesita Hudales
- Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Eline Smit
- Department of Communication Science, University of Amsterdam, P.O. Box 15791, 1001 NG Amsterdam, the Netherlands
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Meijer E, van der Kleij R, Segaar D, Chavannes N. Determinants of providing smoking cessation care in five groups of healthcare professionals: A cross-sectional comparison. PATIENT EDUCATION AND COUNSELING 2019; 102:1140-1149. [PMID: 30718091 DOI: 10.1016/j.pec.2019.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
Objective To investigate implementation of a tobacco dependence treatment guideline among five groups of healthcare professionals. Methods Data collected in The Netherlands (2016-2017) were compared among gynaecologists (N = 49), midwives (N = 68), respiratory nurses (N = 72), practice nurses (N = 84) and paediatricians (N = 38). Intentions to use the guideline, satisfaction with own implementation, and dosage delivered of quit-advice and assisting in quitting were predicted using linear regression analyses and regression tree analyses. Results Implementation of smoking cessation care (SCC) and barriers differed between the groups, with nurses reporting better implementation and fewer barriers. Main barriers were lacking training (gynecologists, pediatricians) and time (midwives). Regression tree analyses showed that self-efficacy and training interacted; participants with weaker self-efficacy provided more quit advice if they had participated in SCC training. Training was positively related to intentions to use the guideline, satisfaction, providing quit-advice, and assisting smokers in quitting. Conclusion Implementation of SCC is suboptimal, such that patients who smoke do not receive the highest quality of care. Profession and training in SCC are important determinants of implementation of SCC. Practice implications Efforts to improve implementation should be targeted at profession. Training is indicated, and may focus on skills for nurses, and knowledge for gynecologists, midwives and pediatricians.
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Affiliation(s)
- Eline Meijer
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
| | - Rianne van der Kleij
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Dewi Segaar
- Dutch Alliance for a Smokefree Society, Utrecht, the Netherlands
| | - Niels Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Meijer E, Chavannes N, Segaar D, Parlevliet J, Van Der Kleij R. Optimizing smoking cessation guideline implementation using text-messages and summary-sheets: A mixed-method evaluation. CLINICAL EHEALTH 2019. [DOI: 10.1016/j.ceh.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Meijer E, Kampman M, Geisler MS, Chavannes NH. "It's on everyone's plate": a qualitative study into physicians' perceptions of responsibility for smoking cessation. Subst Abuse Treat Prev Policy 2018; 13:48. [PMID: 30541580 PMCID: PMC6290505 DOI: 10.1186/s13011-018-0186-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little research has investigated in-depth how physicians perceive their role in smoking cessation care. This qualitative study sought to understand physicians' perceptions of responsibility for smoking cessation. METHODS Data were collected through individual semi-structured interviews and focus group interviews between June and November 2017 in The Netherlands. We interviewed 5 addiction specialists, 5 anesthesiologist, 4 cardiologists, 8 GPs, 5 internists, 5 neurologists, 2 pediatricians, 6 pulmonologists, 7 surgeons, and 8 youth healthcare physicians (N = 55). Data analysis followed the framework approach. RESULTS The analysis showed that three actors were perceived as responsible for smoking cessation: physicians, patients, and the government. Participants perceived physicians as responsible for facilitating smoking cessation -albeit to different extents-, patients as carrying the ultimate responsibility for quitting smoking, and the government as responsible for creating a society in which smoking uptake is more difficult and quitting smoking easier. Perceptions of smoking itself were found to be important for how participants viewed responsibility for smoking cessation. It remained unclear for many participants which healthcare provider is responsible for smoking cessation care. CONCLUSIONS The organization of smoking cessation care within health systems should be a focus of intervention, to better define physician roles and perceptions of responsibility. In addition, it seems important to target perceptions of smoking itself on the level of physicians and -as suggested by comments by several participants- the government.
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Affiliation(s)
- E. Meijer
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - M. Kampman
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - M. S. Geisler
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - N. H. Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
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de Ruijter D, Candel M, Smit ES, de Vries H, Hoving C. The Effectiveness of a Computer-Tailored E-Learning Program for Practice Nurses to Improve Their Adherence to Smoking Cessation Counseling Guidelines: Randomized Controlled Trial. J Med Internet Res 2018; 20:e193. [PMID: 29789278 PMCID: PMC5989061 DOI: 10.2196/jmir.9276] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background Improving practice nurses’ (PN) adherence to smoking cessation counseling guidelines will benefit the quality of smoking cessation care and will potentially lead to higher smoking abstinence rates. However, support programs to aid PNs in improving their guideline uptake and adherence do not exist yet. Objective The aim of this study was to assess the effects of a novel computer-tailored electronic learning (e-learning) program on PNs’ smoking cessation guideline adherence. Methods A Web-based randomized controlled trial (RCT) was conducted in which an intervention group (N=147) with full access to the e-learning program for 6 months was compared with a control group (N=122) without access. Data collection was fully automated at baseline and 6-month follow-up via online questionnaires, assessing PNs’ demographics, work-related factors, potential behavioral predictors based on the I-Change model, and guideline adherence. PNs also completed counseling checklists to retrieve self-reported counseling activities for each consultation with a smoker (N=1175). To assess the program’s effectiveness in improving PNs’ guideline adherence (ie, overall adherence and adherence to individual counseling guideline steps), mixed linear and logistic regression analyses were conducted, thus accommodating for the smokers being nested within PNs. Potential effect moderation by work-related factors and behavioral predictors was also examined. Results After 6 months, 121 PNs in the intervention group (82.3%, 121/147) and 103 in the control group (84.4%, 103/122) completed the follow-up questionnaire. Mixed linear regression analysis revealed that counseling experience moderated the program’s effect on PNs’ overall guideline adherence (beta=.589; 95% CI 0.111-1.068; PHolm-Bonferroni =.048), indicating a positive program effect on adherence for PNs with a more than average level of counseling experience. Mixed logistic regression analyses regarding adherence to individual guideline steps revealed a trend toward moderating effects of baseline levels of behavioral predictors and counseling experience. More specifically, for PNs with less favorable scores on behavioral predictors (eg, low baseline self-efficacy) and high levels of counseling experience, the program significantly increased adherence. Conclusions Results from our RCT showed that among PNs with more than average counseling experience, the e-learning program resulted in significantly better smoking cessation guideline adherence. Experienced PNs might have been better able to translate the content of our e-learning program into practically applicable counseling strategies compared with less experienced colleagues. Less favorable baseline levels of behavioral predictors among PNs possibly contributed to this effect, as there was more room for improvement by consulting the tailored content of the e-learning program. To further substantiate the effectiveness of e-learning programs on guideline adherence by health care professionals (HCPs), it is important to assess how to support a wider range of HCPs. Trial Registration Netherlands Trial Register NTR4436; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4436 (Archived by WebCite at http://www.webcitation.org/6zJQuSRq0)
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Affiliation(s)
- Dennis de Ruijter
- Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Math Candel
- Care and Public Health Research Institute, Department of Methodology & Statistics, Maastricht University, Maastricht, Netherlands
| | - Eline Suzanne Smit
- Amsterdam School of Communication Research, Department of Communication Science, University of Amsterdam, Amsterdam, Netherlands
| | - Hein de Vries
- Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Ciska Hoving
- Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, Netherlands
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