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McMullen B, Duncanson K, Collins C, MacDonald-Wicks L. A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes. Diabet Med 2024; 41:e15323. [PMID: 38829966 DOI: 10.1111/dme.15323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/02/2024] [Accepted: 03/20/2024] [Indexed: 06/05/2024]
Abstract
AIMS To identify barriers and enablers that influence engagement in and acceptability of diabetes prevention programmes for people with pre-diabetes. The results will provide insights for developing strategies and recommendations to improve design and delivery of diabetes prevention programmes with enhanced engagement and acceptability for people with pre-diabetes. METHODS This review used a critical realist approach to examine context and mechanisms of diabetes prevention programmes. Medline, Embase, PsycInfo, Cinahl, Web of Science, Scopus and Pre-Medline were searched for English language studies published between 2000 and 2023. A quality assessment was conducted using Joanna Briggs Institute critical appraisal tools. RESULTS A total of 90 papers met inclusion criteria. The included studies used a variety of quantitative and qualitative methodologies. Data extracted focused on barriers and enablers to engagement in and acceptability of diabetes prevention programmes, with seven key mechanisms identified. These included financial, environmental, personal, healthcare, social and cultural, demographic and programme mechanisms. Findings highlighted diverse factors that influenced engagement in preventive programmes and the importance of considering these factors when planning, developing and implementing future diabetes prevention programmes. CONCLUSIONS Mechanisms identified in this review can inform design and development of diabetes prevention programmes for people with pre-diabetes and provide guidance for healthcare professionals and policymakers. This will facilitate increased participation and engagement in preventive programmes, potentially reducing progression and/or incidence of pre-diabetes to type 2 diabetes and improving health outcomes.
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Affiliation(s)
- Britney McMullen
- Mid North Coast Local Health District, University of Newcastle, Coffs Harbour, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
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Nilsing Strid E, Wallin L, Nilsagård Y. Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals. Scand J Prim Health Care 2024; 42:201-213. [PMID: 38241166 PMCID: PMC10851800 DOI: 10.1080/02813432.2023.2301556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 12/28/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Prior to a multifaceted implementation strategy for a healthy lifestyle-promoting practice the expectations of primary health care managers, appointed internal facilitators and health care professionals on supporting change was explored. DESIGN This study had an explorative qualitative design using data gathered from individual interviews and focus groups. Qualitative content analysis with a deductive category development was applied using the Consolidated Framework for Implementation Research. SETTING AND PARTICIPANTS The study was conducted in a primary care setting in central Sweden as a part of the Act in Time research project. Prior to a multifaceted implementation strategy, we held 16 individual interviews with managers and appointed facilitators and five focus groups with 26 health care professionals. RESULTS Managers, facilitators, and professionals held similar expectations, where their expressed need for support corresponded to three constructs: Readiness for implementation, Implementation climate, and Engaging. Our findings indicate the need for strong leadership engagement to focus on how the healthy lifestyle-promoting practice can be anchored among the professionals. Managers at all levels should communicate the vision and goals, enable facilitators and professionals to improve their competencies, build inter-professional teams, and jointly plan the new practice. CONCLUSION To change to a healthy lifestyle promoting practice professionals request support from their managers, who in turn need support from the middle and top managers. The requested support includes helping to prioritise health promotion and enabling the primary care centres to build competence and take ownership of the implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT04799860.
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Affiliation(s)
- Emma Nilsing Strid
- University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ylva Nilsagård
- University Health Care Research Center, Örebro University, Örebro, Sweden
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Akeju DO, Okusanya BO, Ukah UV, Orimaye SO, Dirisu O. Editorial: Policy issues and perspectives in referrals and access to quality health care services. FRONTIERS IN HEALTH SERVICES 2023; 3:1323442. [PMID: 38107742 PMCID: PMC10721970 DOI: 10.3389/frhs.2023.1323442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Affiliation(s)
- D. O. Akeju
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - B. O. Okusanya
- College of Medicine, Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria
| | - U. V. Ukah
- Pregnancy and Child Research Centre, HealthPartners, Bloomington, MN, United States
| | - S. O. Orimaye
- College of Global Population Health, University of Health Sciences and Pharmacy in St. Louis, St. Louis, MO, United States
| | - O. Dirisu
- Nigerian Economic Summit Group, Abuja, Nigeria
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Zhao D, Chen S, Jin S, Chen L, Zheng C, Wang X, Huang Y. Predictors of referral behaviour and intention amongst physicians in a medical consortium based on the theory of planned behaviour: a cross-sectional study in China. Front Public Health 2023; 11:1159207. [PMID: 37655287 PMCID: PMC10466405 DOI: 10.3389/fpubh.2023.1159207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction To promote patients' referral across healthcare institutions and integrated care delivery, we identified predictors of physicians' behaviour and intention to refer patients in a county medical consortium in China on the basis of the theory of planned behaviour (TPB). Methods This census-based cross-sectional study was conducted in Yangxi Hospital Group (YHG). All physicians in county hospitals and township health centres were invited to participate. Structural equation modelling was employed to analyse the relationships between referral intention and behaviour and other TPB variables in the group of whole participants and in sub-groups. Results In total, 330 physicians participated in this study. One-third of participants were general practitioners, and half of them were from county hospitals. Referral behaviour of females (χ2 = 20.372, p < 0.001), who had lower education levels (χ2 = 17.859, p = 0.001), lower professional title (χ2 = 14.963, p = 0.005), and lower monthly salary (χ2 = 33.753, p < 0.001) were less frequent than the others. Among them, 116 (35.2%), 108 (32.7%), and 106 (32.1%) respondents reported that they had never referred patients, had referred patients 1-9 times, and had referred patients over 10 times during the past 3 months, respectively. The mean score of referral intention was 4.23/5 (SD = 0.71). In the model with all participants, a stronger referral intention (β = 0.218, 95% CI = 0.080-0.356) was associated with more frequent referral behaviour. The subjective norm (β = 0.703, 95% CI = 0.590-0.817) was the strongest predictor of physicians' referral intention, followed by perceived behavioural control (β = 0.234, 95% CI = 0.090-0.378). Mediated by referral intention, subjective norms (β = 0.153, p < 0.01) and perceived behavioural control (β = 0.190, p < 0.01) had significant indirect effects on physicians' referral behaviour. The model with participants in county hospitals showed similar results to the model with all participants. Meanwhile, in the model with participants in township health centres, there were no significant associations between referral behaviour and other TPB constructs. Conclusion Physicians' referral behaviour was influenced by intention, subjective norms, and perceived behavioural control in Chinese county hospitals.
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Serves N, Pazart L, Gabriel D, Mourot L, Ecarnot F. Adherence to rehabilitation and home exercise after myocardial infarction: a qualitative study of expectations, barriers and drivers. BMC Sports Sci Med Rehabil 2023; 15:98. [PMID: 37559143 PMCID: PMC10410787 DOI: 10.1186/s13102-023-00714-3] [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: 04/11/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Cardiac rehabilitation is a key component of secondary prevention, but uptake is often low, and motivation to pursue exercise and lifestyle changes may be lacking in patients who have suffered from acute myocardial infarction (AMI). We explored the intentions of patients hospitalized for AMI regarding attendance at cardiac rehabilitation and the future pursuit of regular physical exercise at home. METHODS We performed a qualitative study using semi-structured interviews. Eligible patients were those hospitalized for AMI in the cardiology unit of a large university hospital in Eastern France between 10/11/2021 and 7/3/2022, and who were deemed eligible for rehabilitation by the treating physician. Patients were interviewed before discharge. Interviews were transcribed and analysed by thematic analysis. We administered the Global Physical Activity Questionnaire (GPAQ) questionnaire to all participants. RESULTS Of 17 eligible patients, 15 were interviewed, at which point saturation was reached. The majority were males (n = 13, 86%), median age 54 years (41-61). Three key themes emerged: Firstly, there is a mismatch between patients' perceptions of their physical activity and actual level of activity as assessed by objective tools. Second, cardiac rehabilitation is seen as a vector for information about the return to home after AMI. Third, regarding the intention to change lifestyle, there are persisting obstacles, drivers, fears and expectations. CONCLUSION Patients with AMI often overestimate how physically active they are. Even close to discharge, patients have persisting informational needs, and many see cardiac rehabilitation as a means to obtain this information, rather than as a therapeutic intervention.
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Affiliation(s)
- Nina Serves
- Inserm CIC1431, Centre Hospitalier Universitaire de Besançon, Besançon, 25000, France
| | - Lionel Pazart
- Inserm CIC1431, Centre Hospitalier Universitaire de Besançon, Besançon, 25000, France
- UR LINC, Université de Franche-Comté, Besançon, 25000, France
| | - Damien Gabriel
- Inserm CIC1431, Centre Hospitalier Universitaire de Besançon, Besançon, 25000, France
- UR LINC, Université de Franche-Comté, Besançon, 25000, France
| | - Laurent Mourot
- Inserm CIC1431, Centre Hospitalier Universitaire de Besançon, Besançon, 25000, France
- Exercise Performance Health Innovation (EPHI), Université de Franche-Comté, Besançon, 25000, France
- EA3920, Université de Franche-Comté, Besançon, 25000, France
| | - Fiona Ecarnot
- EA3920, Université de Franche-Comté, Besançon, 25000, France.
- Department of Cardiology, University Hospital Besançon, Boulevard Fleming, Besançon, 25000, France.
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Strid EN, Wallin L, Nilsagård Y. Expectations on implementation of a health promotion practice using individually targeted lifestyle interventions in primary health care: a qualitative study. BMC PRIMARY CARE 2023; 24:122. [PMID: 37328813 PMCID: PMC10273504 DOI: 10.1186/s12875-023-02079-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is moderate to strong evidence of the effectiveness of health-promotion interventions, but implementation in routine primary health care (PHC) has been slow. In the Act in Time project implementation support is provided for a health promotion practice using individually targeted lifestyle interventions in a PHC setting. Identifying health care professionals' (HCPs') perceptions of barriers and facilitators helps adapt implementation activities and achieve a more successful implementation. This study aimed, at a pre-implementation stage, to describe the expectations of managers, appointed internal facilitators (IFs) and HCPs on implementing a healthy lifestyle-promoting practice in PHC. METHODS In this qualitative study five focus group discussions with 27 HCPs and 16 individual interviews with managers and appointed IFs were conducted at five PHC centres in central Sweden. The PHC centres are participating in the Act in Time project, evaluating the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice. A deductive qualitative content analysis based on the Consolidated Framework for Implementation Research (CFIR) was followed using inductive analysis. RESULTS Twelve constructs from four of five CFIR domains were derived: Innovation characteristics, Outer setting, Inner setting, and Characteristics of individuals. These domains are related to the expectations of HCPs to implement a healthy lifestyle-promoting practice, which includes facilitating factors and barriers. The inductive analysis showed that the HCPs perceived a need for a health-promotion approach to PHC. It serves the needs of the patients and the expectations of the HCPs, but lifestyle interventions must be co-produced with the patient. The HCPs expected that changing routine practice into a healthy lifestyle-promoting practice would be challenging, requiring sustainability, improved structures, cooperation in inter-professional teams, and a common purpose. A collective understanding of the purpose of changing practice was vital to successful implementation. CONCLUSIONS The HCPs valued implementing a healthy lifestyle-promoting practice in a PHC setting. However, changing routine methods was challenging, implying that the implementation strategy should address obstacles and facilitating factors identified by the HCPs. TRIAL REGISTRATION This study is part of the Act in Time project, registered in ClinicalTrials.gov with the number NCT04799860 . Registered 03 March 2021.
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Affiliation(s)
- Emma Nilsing Strid
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Lars Wallin
- Department of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ylva Nilsagård
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Sim XL, Kwa CX, He Y, Ng KL, Sim EY, Abdullah HR. Transforming the perioperative medicine care model: The Singapore experience. Anaesth Intensive Care 2023; 51:96-106. [PMID: 36688348 DOI: 10.1177/0310057x221114900] [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: 01/24/2023]
Abstract
More than 300 million surgeries are performed worldwide annually. Established perioperative centres in the UK, USA and Australia have demonstrated the impact of improving perioperative care in reducing costs, increasing patient satisfaction and improving population health. Likewise, the surgical burden of care in Asia is increasing, but with sociocultural, economic and epigenetic differences compared to the west. As Singapore's largest hospital, the Singapore General Hospital pre-admission perioperative clinic sees about 20,000 patients annually. We aim to illustrate Singapore General Hospital's perioperative model of care to contribute to the paucity of literature describing perioperative programme implementation within Asia, and to encourage the cross-sharing of perioperative practices internationally. Our perioperative framework navigates risk assessment, risk counselling, and mitigation of health, medical and functional risks to better patients' perioperative outcomes and population health. We have implemented evidence-based pathways for common conditions such as anaemia and malnutrition, including a multidisciplinary programme for the elderly to tackle frailty and reduce length of stay. We describe how we have enhanced local risk profiling with the Combined Assessment of Risk Encountered in Surgery surgical risk calculator derived locally using a gradient boosting machine learning model. Finally, we report clinical outcomes of these interventions and discuss further challenges and new initiatives at each tier of our perioperative model. Our perioperative care model provides a framework that other centres can adopt to promote value-driven care, while catering for differences in the Asian population, thereby promoting evidence-based improvements in the area of perioperative medicine.
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Affiliation(s)
- Xiu Lj Sim
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Charlene Xw Kwa
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Yingke He
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Kai L Ng
- Department of Anaesthesiology, Singapore General Hospital, Singapore.,Division of Nursing, Singapore General Hospital, Singapore
| | - Eileen Y Sim
- Department of Anaesthesiology, Singapore General Hospital, Singapore.,DukeNUS Medical School, Singapore
| | - Hairil R Abdullah
- Department of Anaesthesiology, Singapore General Hospital, Singapore.,DukeNUS Medical School, Singapore
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McHugh S, Riordan F, Shelton RC. Breaking the quality-equity cycle when implementing prevention programmes. BMJ Qual Saf 2022; 32:247-250. [PMID: 36598002 DOI: 10.1136/bmjqs-2022-015558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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Ryan JC, Barnes M, Cox DN. Identifying modifiable factors that could arrest progression to type 2 diabetes: A cluster analysis of Australian adults. Prev Med 2021; 153:106796. [PMID: 34509524 DOI: 10.1016/j.ypmed.2021.106796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
Lifestyle-based disease prevention and self-management strategies play an important role in the mitigation of health, social, and economic burdens associated with type 2 diabetes mellitus (T2DM) and other chronic diseases. However, there are significant implementation and translational challenges associated with the design and delivery of effective interventions. In this study, data-driven techniques for the identification of optimal target audiences and intervention targets for T2DM prevention interventions were applied. Australian adults (N = 3159) with differing T2DM status (no diabetes diagnosis, pre-diabetes, or T2DM) completed self-report assessments of diet quality, physical activity, psychological distress, future orientation, health literacy, and socio-demographic characteristics. K-medoids cluster analysis was conducted to identify homogenous groups within the research sample and proportional odds ordinal logistic regressions conducted to identify signficant predictors of T2DM status within each cluster. Results identified a two-factor optimal solution that stratified participants based on sex (male/female). Within each cluster, psychosocial variables explained approximately 25% of the variance in T2DM status, with future orientation identified as a significant modifiable predictor of T2DM. For the male cluster, health literacy was also significant (p ≤0.01). Findings indicate that men and women should be targeted separately in T2DM prevention or management programs and that future interventional research targeting future orientation is warranted.
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Affiliation(s)
- Jillian C Ryan
- Precision Health Future Science Platform and Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Gate 13 Kintore Avenue, Adelaide, South Australia 5000, Australia.
| | - Mary Barnes
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Sturt Rd, Bedford Park, South Australia 5042, Australia.
| | - David N Cox
- Precision Health Future Science Platform and Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Gate 13 Kintore Avenue, Adelaide, South Australia 5000, Australia.
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