Developing Targeted Health Service Interventions Using the PRECEDE-PROCEED Model: Two Australian Case Studies

Developing a Diet and Physical Activity Intervention for Hispanic/Latina Breast Cancer Survivors

Objectives

There is limited guidance on how to effectively educate cancer survivors to adopt and maintain specific diet and physical activity recommendations, especially among underserved and under-resourced populations. Here, the objective is to present the development of a behavioral and theoretically-based multi-modal diet and physical activity intervention program for Hispanic/Latina breast cancer survivors, Mi Vida Saludable (My Healthy Life).

Methods

The development process was based on the 6 steps of the Nutrition Education DESIGN Procedure: (1). Decide behaviors; (2). Explore determinants; (3). Select theory-based model; (4). Indicate objectives; (5). Generate plans; and (6). Nail down evaluation. The theoretical framework for the intervention is Social Cognitive Theory.

Results

The resulting behavioral intervention consists of 2 components. The first component is in-person group education consisting of 4 lessons over 1 month. Each 4-hour group lesson includes a hands-on cooking component, a physical activity component, and facilitator-led nutrition education and discussion, with 2 field trips to a local grocery store and farmers’ market. The second component is an e-Health program that includes weekly text messages, biweekly emailed newsletters, and ongoing website access.

Conclusion

The systematic DESIGN Procedure provided practical guidance for developing a behaviorally-focused, theory-based, and culturally sensitive program that addresses both dietary and physical activity behaviors for delivery both in-person education and through eHealth. The Procedure may be useful for developing other behaviorally focused and theory-based interventions.

Linkages between health systems and communities for chronic care: a scoping review protocol

INTRODUCTION

Linkages between health systems and communities may leverage community assets to address unmet needs and provide services for improved continuity and coordination of care. However, there are limited examples of specific strategies for such linkages for chronic disease management. Guided by a local need from stakeholders, this scoping review aims to clarify and map methods and strategies for linkages between communities and health systems across chronic diseases, to inform future implementation efforts.

METHODS AND ANALYSIS

The scoping review will be conducted following Arksey and O'Malley's methodological framework and latest Joanna Briggs Institute (JBI) guidelines, with continuous stakeholder engagement throughout. A structured literature search of records from January 2001 to April 2022 will be completed in MEDLINE/PubMed, CINAHL, EMBASE, PsycINFO, in addition to grey literature. Two reviewers will independently complete study selection following inclusion criteria reflecting population (chronic disease), concept (integrated care) and context (health systems and communities) and will chart the data. Data will be analysed using descriptive qualitative and quantitative methods, to map and operationalise the linkages between health systems and communities.

ETHICS AND DISSEMINATION

The scoping review does not require ethics approval as it will examine and collect data from publicly available materials, and all stakeholder engagement will follow guidelines for patient and public involvement. Findings will be reported through a summarising list of considerations for different linkage strategies between health systems and community resources and implications for future research, practice and policy will be discussed and presented. The results will also be used to inform an integrated knowledge translation project to implement community-health system linkages to support chronic pain management.

REGISTRATION NUMBER

10.17605/OSF.IO/UTSN9.

Effectiveness of checklist-based box system intervention (CBBSI) versus routine care on improving utilization of antenatal care visits in Northwest Ethiopia: a cluster randomized controlled trial

Background

In Ethiopia, the proportion of mothers who attend the fourth antenatal care visit is lower than the proportion who attend the first visit. Although the reasons for these dropouts were investigated, few studies introduced interventions to promote the fourth antenatal care visit. Hence, the aim of this study was to assess the effectiveness of checklist-based box system intervention on improving fourth antenatal care visit.

Method

This study employed a double-blind, parallel-group, two-arm cluster randomized controlled trial to compare the effectiveness of checklist-based box system intervention with the usual standard of care as a control arm. Study clusters are assigned to intervention and control arm in 1:1 allocation ratio using simple randomization technique. Pregnant mothers below 16 weeks of gestation were enrolled. Open data kit was used to collect data from the baseline and end-line surveys, and STATA version 15.0 was used to analyse the data. A difference-in-difference estimator was used to compare fourth antenatal care visit between the intervention and control groups across time. Mixed effect multi-level logistic regression was used to examine the relationship between the dependent and independent variables.

Result

Data were collected from 2224 mothers who belong to 15 intervention and 15 control clusters. The difference in difference estimation resulted in a significant difference (26.1, 95%CI: 18–34%, p < 0.0001) between the intervention and control groups. Similarly, as compared to controls, the fourth antenatal care visit was found significantly higher in the intervention clusters (432 (85.2%) Vs. 297 (53.7%), p < 0.0001)/(AOR:5.69, 95% CI:4.14–7.82). Mothers who were knowledgeable about the services given during antenatal care visits (AOR: 2.31, 95% CI:1.65–3.24) and mothers who had a high level of social support (AOR:1.47, 95% CI: 1.06–2.04) were more likely to attend the fourth antenatal care visit.

Conclusion

Implementation of checklist-based box system intervention resulted in a statistically significant effect in attendance of fourth antenatal care visit. Community-level variables were found to be more important in explaining variability in the fourth antenatal care visit. It is recommended that the intervention be implemented on a larger scale.

Trial registration

ClinicalTrials.gov, Retrospectively registered on 26/03/2019, with trial registration number-NCT03891030.

Effectiveness of checklist-based box system intervention (CBBSI) versus routine care on improving postnatal care utilization in Northwest Ethiopia: a cluster randomized controlled trial

Background

The period after childbirth poses a substantial risk both to the mother and the newborn. Yet, this period received less attention as compared to the cares provided during pregnancy and childbirth. Hence, this study aimed to assess the effectiveness of checklist-based box system intervention on improving three postnatal care visit utilization.

Methods

A double blind, parallel group, two-arm cluster randomized controlled trial design was used to assess effectiveness of checklist-based box system intervention on improving third postnatal care visit. Pregnant mothers below 16 weeks of gestation were recruited from 15 intervention and 15 control clusters, which were randomized using simple randomization. Data from baseline and end line surveys were collected using open data kit and analyzed using STATA version 15.0. The status of three postnatal care visit between intervention and control groups over time was assessed using difference in difference estimator. The predictors of the outcome variable were then analysed using mixed effects multilevel logistic regression model.

Result

Of 1200 mothers considered from each of the baseline and end line studies, this study included data from 1162 and 1062 mothers at baseline and end line surveys, respectively. As it is shown from the difference-in-difference estimation (14.8%, 95%CI 5.4–24.2%, p = 0.002) and the final model (AOR 4.45, 95%CI 2.31–8.54), checklist-based box system intervention was effective on improving third postnatal care visit. In addition, institutional delivery (AOR 1.62, 95%CI 1.15–2.28) and knowledge on danger signs during postnatal period (AOR 5.20, 95%CI 3.71–7.29) were found to be significant predictors of the outcome variable. In the contrary, mothers who got influenced by older generations of individuals were (AOR 0.32, 95%CI 0.18–0.59) less likely to attend three postnatal care visit.

Conclusions

The implementation of checklist-based box system intervention was found to be effective in improving utilization of the recommended three postnatal care visits. The contribution of the trial on improving third postnatal care visit can be enhanced by minimizing practical level challenges, as well as expanding health messages to reach unreached mothers and significant others who can influence the mother’s decision.

Trial registration: ClinicalTrials.gov, NCT03891030, Retrospectively registered on 26 March, 2019, https://clinicaltrials.gov/ct2/show/NCT03891030.

Postnatal care is a care that a delivered women and her newborn baby receive after delivery and up to 42 days of childbirth, regardless of place of delivery. This period is considered critical in minimizing morbidity and mortality of both the mother and the baby. In Ethiopia, the coverage of postnatal care utilization remained low. Recent studies showed only 33.8% of mothers received postnatal care, this becomes very low for mothers who delivered at home, of which only 8.2% of them received the care. On top of other factors that hinder maternal health care utilization, in Ethiopia there are widely accepted and persistent cultural ceremonies after childbirth that encourages a women to stay in door.

This study introduced a new intervention called Checklist-based box system intervention, which aimed to improve postnatal care utilization through demand creation and dropout tracing mechanisms. The intervention was carried out by health professionals in health centers and community health workers (health extension workers) who visited mothers in their homes. Despite some practical challenges, its implementation demonstrated an improvement over clusters that did not receive the intervention. This intervention is recommended to be implemented on a larger scale. Simultaneously, practical level challenges need to be addressed in order for the intervention’s effect to be seen in its best form.

The Effect of Educational Intervention Based on PRECEDE Model on Health Promotion Behaviors, Hope Enhancement, and Mental Health in Cancer Patients

In this experimental study, 200 cancer patients (100 subject in experimental group and 100 subjects in control group) referred to Amir Oncology Hospital in Shiraz were investigated. Educational intervention for experimental group consisted of 12 educational sessions for 50 to 55 minutes. A questionnaire including demographic information, PRECEDE constructs (knowledge, attitude, self-efficacy, enabling factors, and social support), was used to measure health promotion behaviors, patients' hope, and mental health before and 6 months after intervention. Six months after intervention, experimental group showed significant increase in knowledge, attitude, self-efficacy, enabling factors, social supports, health promotion behaviors, patients' hope, and mental health compared to the control group. This study showed the effectiveness of intervention based on PRECEDE constructs in mentioned factors 6 months after intervention. Hence, this model can act as a framework for designing and implementing educational intervention for health promotion behaviors of cancer patients.

Student-Led Motivational Interviewing for Physical Activity Promotion among Rural Adults: A Feasibility and Acceptability Trial

In many countries, rural residents have lower life expectancies and poorer health outcomes than urban residents. Adults living in rural Australia have lower physical activity levels than major city counterparts, contributing to this observed health disparity. As physical activity interventions in rural populations have shown minimal success, there is an urgent need for innovative and affordable interventions that facilitate active lifestyles in this vulnerable population. This study assessed the feasibility of physical activity-focused motivational interviewing, delivered by university health sciences undergraduates in a rural Australian region. “Health age” was assessed at baseline (n = 62) from physiological and behavioral measures, immediately followed by the motivational interview, with health age again assessed at 8 weeks follow-up. Mixed methods using a questionnaire (n = 41 at both time points) and one-on-one interview (n = 8) identified aspects of intervention acceptability and feasibility. A large majority rated the motivational interview as meaningful (98%), empathetic (96%), autonomy-focused (88%), and likely to lead to sustained behavior change (98%). Interviews highlighted several potential attitudinal and structural factors that might influence long-term behavior change. Further development of this strategy in rural regions will depend on a deeper understanding of individuals’ and communities’ awareness, attitudes, and beliefs in relation to active lifestyles.

Health needs assessment of workers in Kaveh industrial city

Background: Health needs assessment (HNA) is essential for allocation of limited resources to the most prioritized problems. HNA in work places has gained increasing importance. Kaveh industrial city is the largest and oldest industrial city in Iran, with a wide range of different industries, making it an exemplary industrial city in Iran. This study was done to conduct health needs assessment of workers in Kaveh industrial city.

Methods: In this study, intensive HNA approach and qualitative method were used. In-depth interviews and Focus Group Discussions (FGDs) were conducted to collect information related to health risk factors, and Delphi method was used to prioritize these risk factors. A total of 74 key informants participated in this study, which constituted more than 80% of the total related experts of Kaveh industrial city.

Results: The main identified health challenge was inefficiency of the existing Health, Safety and Environment (HSE) control and monitoring system. The most important physical health risk factors were smoking and obesity and the most prioritized psychosocial risk factors were stress and lack of appropriate management and organizational culture. Ergonomic issues and noise pollution were the prioritized work environmental factors and inappropriate placement of pollutant industries in the industrial city was the most prioritized bioenvironmental risk factor. Unsafe road to industrial zone and poor safety devices used by workers were the most prioritized occupational injuries risk factors.

Conclusion: Addressing the identified health needs of workers in Kaveh industrial city is of high importance. Also, redefining the HSE control and monitoring system should be prioritized

Challenges to Successful Community-based Integrated Approach to Dementia: A Qualitative Study

The aim of this study is to identify key challenges to successful community-based integrated team approach to the management of older adults with dementia. A nationwide community-based qualitative research strategy was applied. We purposively recruited 24 health-care providers and 13 family caregivers from selected 8 prefectures among 47 prefectures. Face to face interviews were conducted from May to September 2017. Qualitative content analysis was used to analyze the qualitative data. Ten themes regarding the challenges were emerged: Ignored wishes, Family caregivers' full responsibilities, Encouragement, Practical and easy-to-understand information, Essential skills of dementia diagnosis and assessment, Gratitude by helping others, Difference between being kind and overly-kind, Legal barrier against information sharing, Coordination between volunteers and clients, and Conflict avoidance in multidisciplinary collaboration. The findings highlight the need to provide practical and easy-to-understand information for family caregivers, educate physicians in dementia diagnosis and assessment, share personal dementia care information among health-care providers, promote platforms which aim to match dementia care volunteers with older adults with dementia and their families in need of help, and raise awareness of advance care planning among both older individuals and health-care providers.

Barriers to HIV Testing: Patient and Provider Perspectives in the Deep South

Although CDC guidelines call for universal, "opt-out" HIV testing, barriers to testing continue to exist throughout the United States, with the rural South particularly vulnerable to both HIV infection and decreased awareness of status. Therefore, the objectives of this study were to evaluate uptake of "opt-out" HIV testing and barriers to testing within the primary care setting in the South. A concurrent triangulation design guided the collection of quantitative data from patients (N = 250) and qualitative data from providers (N = 10) across three primary health clinics in Alabama. We found that 30% of patients had never been tested for HIV, with the highest ranked barrier among patients being perceived costs, access to specialty care, and not feeling at risk. Significant differences existed in perceived barriers between patients and providers. Increased provider-patient engagement and the routine implementation of "opt-out" HIV testing would effectively reveal and mitigate barriers to testing, thus, increasing awareness of status.

Malaria preventive behaviors among housewives in suburbs of Bandar-Abbas City, south of Iran: interventional design based on PRECEDE model

Suburban areas suffer from unfavorable conditions as a result of poor health standards, low income, illness, and slight levels of education. One of the most important components in malaria elimination programs is health education. Bandar-Abbas is a malaria endemic city. Therefore, this study aimed to promote malaria preventive behaviors among housewives in suburbs of Bandar-Abbas City, Iran, through a PRECEDE model-based intervention program. This quasi-experimental study was carried out on 172 housewives under the coverage of four healthcare centers in Bandar-Abbas in 2016. The participants were randomly divided into two experimental and control groups, based on the inclusion criteria. The data collection tools included ademographic questionnaire, aresearcher-made questionnaire based on the educational phase of the PRECEDE model and achecklist for assessing malaria preventive behaviors. After the pre-test, the educational intervention was implemented on the intervention group at the first stage and the same questionnaire was administered as the post-test for both groups two months after the intervention. In this study, after implementing the intervention using the PRECEDE educational program, asignificant difference was found between the intervention and control groups in the mean scores for predisposing factors (knowledge and attitude) (P< 0.001), enabling factors (P< 0.001) and reinforcing factors (P< 0.001), which contributed to the improvement of preventive behaviors (P< 0.001). The PRECEDE model-based health education was effective in increasing knowledge and attitude, enabling and reinforcing factors, and promoting malaria preventive behaviors in the studied endemic areas.

Development and Preliminary Testing of the Food Choice Priorities Survey (FCPS): Assessing the Importance of Multiple Factors on College Students' Food Choices

Understanding factors that influence food choice may help improve diet quality. Factors that commonly affect adults' food choices have been described, but measures that identify and assess food choice factors specific to college students are lacking. This study developed and tested the Food Choice Priorities Survey (FCPS) among college students. Thirty-seven undergraduates participated in two focus groups ( n = 19; 11 in the male-only group, 8 in the female-only group) and interviews ( n = 18) regarding typical influences on food choice. Qualitative data informed the development of survey items with a 5-point Likert-type scale (1 = not important, 5 = extremely important). An expert panel rated FCPS items for clarity, relevance, representativeness, and coverage using a content validity form. To establish test-retest reliability, 109 first-year college students completed the 14-item FCPS at two time points, 0-48 days apart ( M = 13.99, SD = 7.44). Using Cohen's weighted κ for responses within 20 days, 11 items demonstrated moderate agreement and 3 items had substantial agreement. Factor analysis revealed a three-factor structure (9 items). The FCPS is designed for college students and provides a way to determine the factors of greatest importance regarding food choices among this population. From a public health perspective, practical applications include using the FCPS to tailor health communications and behavior change interventions to factors most salient for food choices of college students.

A systematic approach to analyze the social determinants of cardiovascular disease

Cardiovascular diseases are the leading cause of human mortality worldwide. Among the many factors associated with the etiology, incidence, and evolution of such diseases; social and environmental issues constitute an important and often overlooked component. Understanding to a greater extent the scope to which such social determinants of cardiovascular diseases (SDCVD) occur as well as the connections among them would be useful for public health policy making. Here, we will explore the historical trends and associations among the main SDCVD in the published literature. Our aim will be finding meaningful relations among those that will help us to have an integrated view on this complex phenomenon by providing historical context and a relational framework. To uncover such relations, we used a data mining approach to the current literature, followed by network analysis of the interrelationships discovered. To this end, we systematically mined the PubMed/MEDLINE database for references of published studies on the subject, as outlined by the World Health Organization’s framework on social determinants of health. The analyzed structured corpus consisted in circa 1190 articles categorized by means of the Medical Subheadings (MeSH) content-descriptor. The use of data analytics techniques allowed us to find a number of non-trivial connections among SDCVDs. Such relations may be relevant to get a deeper understanding of the social and environmental issues associated with cardiovascular disease and are often overlooked by traditional literature survey approaches, such as systematic reviews and meta-analyses.

Development of a health education intervention strategy using an implementation research method to control taeniasis and cysticercosis in Burkina Faso

Background

Taeniasis and cysticercosis are two diseases caused by Taenia solium, a parasite transmitted between humans and pigs, leading to considerable economic loss and disabilities. Transmission of the parasite is linked to environmental and behavioural factors such as inadequate sanitation and hygiene, poor pig management, and consumption of infected pork. This study used implementation research method to design a health education intervention strategy for reducing T. solium infections in Burkina Faso, a country endemic for the parasite.

Methods

Eighteen group discussions were conducted with 8–18 participants each in three villages. In addition, structured interviews were conducted among 4 777 participants and 2 244 pig owners, who were selected through cluster random sampling in 60 villages of three provinces of Burkina Faso. Both approaches assessed knowledge and practices related to T. solium. The information obtained was used to develop a community-adapted health education intervention strategy to control taeniasis and cysticercosis in Burkina Faso.

Results

The group discussions revealed that participants had a poor quality of life due to the diseases as well as inadequate access to latrines, safe water, and healthcare services. In addition, it was found that pig production was an important economic activity, especially for women. Furthermore, financial and knowledge constraints were important limitations to improved pig management and latrine construction. The survey data also showed that open defecation and drinking unboiled water were common behaviours, enhanced by a lack of knowledge regarding the transmission of the parasite, perceived financial barriers to the implementation of control measures, lack of public sensitization, as well as a lack of self-efficacy towards control of the parasite. Nevertheless, the perceived financial benefits of controlling porcine cysticercosis could be emphasized by an education program that discourages open defecation and encourages drinking safe water. The final intervention strategy included a Participatory Hygiene and Sanitation Transformation (PHAST) approach, as well as a 52-min film and an accompanying comic booklet.

Conclusions

The main problem in the study communities regarding the transmission of T. solium cysticercosis is the random disposal of human faeces, which can be contaminated with parasite eggs. Prevention of open defecation requires the building of latrines, which can be quite problematic in economically challenged settings. Providing the community with the skills to construct durable latrines using low-cost locally available materials would likely help to resolve this problem. Further studies are required to implement and evaluate the T. solium control strategy developed in this study.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-017-0308-0) contains supplementary material, which is available to authorized users.

Evaluation of the effectiveness of an online transition planning program for adolescents on the autism spectrum: trial protocol

BACKGROUND

The transition from high school to post-secondary education and work is difficult for adolescents on the autism spectrum. Transition planning can be an effective way of supporting adolescents on the autism spectrum to prepare for leaving school and to succeed in obtaining employment; however, there is a need for an autism-specific transition planning program with proven effectiveness. This paper describes a trial protocol for evaluating the Better OutcOmes & Successful Transitions for Autism (BOOST-A™); an online interactive program that empowers adolescents on the autism spectrum to plan their transition from school to further study, training, or employment.

METHODS

The trial will involve adolescents on the autism spectrum in high school and their parents, who will be alternately assigned to a control group (regular practice) or an intervention group (using the BOOST-A™). The BOOST-A™ was developed using the PRECEDE-PROCEED model, and is based on the self-determination model, and the strengths- and technology-based approaches. It involves participants completing a series of online modules. The primary outcome will be self-determination, because high self-determination has been linked to successful transition to employment among adolescents on the autism spectrum. Secondary outcomes will include domain-specific self-determination, career planning and exploration, quality of life, and environmental support. Data will be obtained from questionnaires completed by the adolescent on the autism spectrum and their parent/s. Data collection will take place at baseline (Time point 1) and 12 months later (Time point 2).

DISCUSSION AND CONCLUSIONS

This trial will provide evidence of the effectiveness of the BOOST-A™ to assist adolescents on the autism spectrum to successfully transition from school. Trial registration #ACTRN12615000119594.

A PRECEDE-PROCEED based educational intervention in quality of life of women-headed households in Iran

Background: Women-headed households are more exposed to social damages than other women. Such condition remarkably influences the women's health-related life quality. The present study is aimed to investigate the effect of an educational intervention in quality of life of women-headed households under protection of Tehran Welfare Organization, in 2015. Methods: In this quasi-experimental study with control group, 180 women-headed households participated. Sampling method was random allocation. Data collection tools were Life Quality standard questionnaire (WHOQOL-BREF) and a researcher-made questionnaire about structures of ecological and educational diagnosis phase of PRECEDE-PROCEED model. Validity and reliability of the questionnaire approved in a primary study. Based on the results obtained from the primary study, the intervention was performed in the case group only. Participants were followed one and three months after intervention. Data were analyzed through SPSS v. 15 software using descriptive and analytical tests. Results: Before intervention no significant difference was observed among the mean scores of life quality, behavioral factors, and knowledge, enabling, and reinforcing factors in the two groups. But, one month and three months after intervention a significant difference was observed between the mean scores of these variables (in five instances p<0.001). Conclusion: Intervention through the PRECEDE-PROCEED model improved the women-headed households' quality of life. The innovation of this study is using such intervention on quality of life in women-headed households for the first time.

Adapting the nominal group technique for priority setting of evidence-practice gaps in implementation science

BACKGROUND

There are a variety of methods for priority setting in health research but few studies have addressed how to prioritise the gaps that exist between research evidence and clinical practice. This study aimed to build a suite of robust, evidence based techniques and tools for use in implementation science projects. We applied the priority setting methodology in lung cancer care as an example.

METHODS

We reviewed existing techniques and tools for priority setting in health research and the criteria used to prioritise items. An expert interdisciplinary consensus group comprised of health service, cancer and nursing researchers iteratively reviewed and adapted the techniques and tools. We tested these on evidence-practice gaps identified for lung cancer. The tools were pilot tested and finalised. A brief process evaluation was conducted.

RESULTS

We based our priority setting on the Nominal Group Technique (NGT). The adapted tools included a matrix for individuals to privately rate priority gaps; the same matrix was used for group discussion and reaching consensus. An investment exercise was used to validate allocation of priorities across the gaps. We describe the NGT process, criteria and tool adaptations and process evaluation results.

CONCLUSIONS

The modified NGT process, criteria and tools contribute to building a suite of methods that can be applied in prioritising evidence-practice gaps. These methods could be adapted for other health settings within the broader context of implementation science projects.

A workplace health promotion application of the Precede-Proceed model in a regional and remote mining company in Whyalla, South Australia

Purpose

– Workplace health promotion enables the dissemination of health-related information to a large portion of society and provides a vehicle for translating results of efficacy studies to effective lifestyle interventions under less controlled real-world conditions. To achieve effectiveness there needs to be a systematic approach to the design, implementation, and evaluation of workplace health promotion interventions. The purpose of this paper is to describe the development of a workplace programme in a mining and steel making town in regional South Australia.

Design/methodology/approach

– The Precede-Proceed model (PPM) was used as a framework to design the development, implementation, and evaluation of the programme.

Findings

– Quality of life issues and antecedents of modifiable behavioural and environmental factors to be targeted by interventions were identified. Relevant socio-behavioural theories were used to guide intervention development and evaluation. An intervention programme was planned to enable the delivery of educational and skills-development strategies by peers within structured organisational work units.

Originality/value

– This research utilises the PPM to develop, implement, and evaluate intervention strategies targeting the development of diabetes and cardiometabolic risk in a remotely located workplace population. Novel to this approach is the utilisation of the entire PPM in the research; the multiple baseline, interrupted time series design of the study; and its application in a workplace environment noted for increased health risk factors, within a community at high risk of development of type 2 diabetes.

Development and evaluation of a pilot nurse case management model to address multidrug-resistant tuberculosis (MDR-TB) and HIV in South Africa

Setting

Multidrug-resistant tuberculosis (MDR-TB) unit in KwaZulu-Natal, South Africa.

Objective

To develop and evaluate a nurse case management model and intervention using the tenets of the Chronic Care Model to manage treatment for MDR-TB patients with a high prevalence of human immunodeficiency virus (HIV) co-infection.

Design

A quasi-experimental pilot programme utilizing a nurse case manager to manage care for 40 hospitalized MDR-TB patients, 70% HIV co-infected, during the intensive phase of MDR-TB treatment. Patients were followed for six months to compare proximal outcomes identified in the model between the pre- and post-intervention period.

Results

The greatest percent differences between baseline and six-month MDR-TB proximal outcomes were seen in the following three areas: baseline symptom evaluation on treatment initiation (95% improvement), baseline and monthly laboratory evaluations completed per guidelines (75% improvement), and adverse drug reactions acted upon by medical and/or nursing intervention (75% improvement).

Conclusion

Improvements were identified in guideline-based treatment and monitoring of adverse drug reactions following implementation of the nurse case management intervention. Further study is required to determine if the intervention introduced in this model will ultimately result in improvements in final MDR-TB treatment outcomes.

Education based on precede-proceed on quality of life in elderly

Background and Objective:

One of the most important challenges in public health is to improve the quality of life in elders. Aging may cause various disorders such as disabilities, high risk conditions and some chronic disease. In this study the effect of educational intervention based on precede–proceed on quality of life in elders was examined.

Materials & Methods:

This semi experimental study was carried out on 128 elders over 60 years in Zahedan that were randomly selected by multi-stage sampling method and divided in to control and intervention groups. Data collection tool was a triploid questionnaire that included demographic data, questions of precede-proceed constructs and SF-36 questionnaire. The validity and reliability of questionnaire confirmed by experts and Cranach’s Alpha coefficient (76%). After primary data collecting, educational intervention was performed and after nine months data was collected again and analyzed in spss.16 soft-ware using descriptive and analytical statistics.

Results:

The results showed that mean score of quality of life in participants was low and more than 61% of them had a mean score less than 50%. After intervention the mean score of quality of life only in experimental group significantly increased from 47.72 to 58.90. Behavior and self-rated health were the strongest predictors for quality of life in this study.

Conclusion:

Implementation educational intervention based on precedes-proceed model can improve quality of life in elders. Elderly women and older elderly individuals compared with elderly men and younger elderly should be considering as an important risk factor for reducing HRQOL.