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Herath T, Perera M, Kasturiratne A. Under-utilisation of noncommunicable disease screening and healthy lifestyle promotion centres: A cross-sectional study from Sri Lanka. PLoS One 2024; 19:e0301510. [PMID: 38574085 PMCID: PMC10994285 DOI: 10.1371/journal.pone.0301510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Healthy Lifestyle Centres (HLCs) are state-owned, free-of-charge facilities that screen for major noncommunicable disease risks and promote healthy lifestyles among adults older than 35 years in Sri Lanka. The key challenge to their effectiveness is their underutilisation. This study aimed to describe the underutilisation and determine the factors associated, as a precedent of a bigger project that designed and implemented an intervention for its improvement. METHODS Data derived from a community-based cross-sectional study conducted among 1727 adults (aged 35 to 65 years) recruited using a multi-stage cluster sampling method from two districts (Gampaha and Kalutara) in Sri Lanka. A prior qualitative study was used to identify potential factors to develop the questionnaire which is published separately. Data were obtained using an interviewer-administered questionnaire and analysed using inferential statistics. RESULTS Forty-two percent (n = 726, 95% CI: 39.7-44.4) had a satisfactory level of awareness on HLCs even though utilisation was only 11.3% (n = 195, 95% CI: 9.80-12.8). Utilisation was significantly associated with 14 factors. The five factors with the highest Odds Ratios (OR) were perceiving screening as useful (OR = 10.2, 95% CI: 4.04-23.4), perceiving as susceptible to NCDs (OR = 6.78, 95% CI: 2.79-16.42) and the presence of peer support for screening and a healthy lifestyle (OR = 3.12, 95% CI: 1.54-6.34), belonging to the second (OR = 3.69, 95% CI: 1.53-8.89) and third lowest (OR = 2.84, 95% CI: 1.02-7.94) household income categories and a higher level of knowledge on HLCs (OR = 1.31, 95% CI: 1.24-1.38). When considering non-utilisation, being a male (OR = 0.18, 95% CI: 0.05-0.52), belonging to an extended family (OR = 0.43, 95% CI: 0.21-0.88), residing within 1-2 km (OR = 0.29, 95% CI: 0.14-0.63) or more than 3 km of the HLC (OR = 0.14, 95% CI: 0.04-0.53), having a higher self-assessed health score (OR = 0.97, 95% CI: 0.95-0.99) and low perceived accessibility to HLCs (OR = 0.12, 95% CI: 0.04-0.36) were significantly associated. CONCLUSION In conclusion, underutilisation of HLCs is a result of multiple factors operating at different levels. Therefore, interventions aiming to improve HLC utilisation should be complex and multifaceted designs based on these factors rather than merely improving knowledge.
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Affiliation(s)
- Thilini Herath
- Faculty of Health-Care Sciences, Department of Primary Health Care, Eastern University, Batticaloa, Sri Lanka
| | - Manuja Perera
- Faculty of Medicine, Department of Public Health, University of Kelaniya, Ragama, Sri Lanka
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Rotsaert A, Vanhamel J, Vanbaelen T, Vuylsteke B, van der Loeff MS, Hensen B, Kielmann K, Callens S, Reyniers T. HIV Pre-exposure Prophylaxis (PrEP) Care in Belgium: A mixed-methods Study on PrEP Users' Experiences and Service Delivery Preferences. AIDS Behav 2024; 28:393-407. [PMID: 38038778 DOI: 10.1007/s10461-023-04232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
In Belgium, HIV pre-exposure prophylaxis (PrEP) services are mainly provided through specialised HIV clinics. To optimise PrEP uptake and retention in care, we require insights into users' perspectives on PrEP care. We aimed to elicit experiences with, and preferences for, PrEP service delivery among PrEP users in Belgium, including willingness to involve their family physician (FP) in PrEP care. We adopted a sequential mixed-methods design. We used a web-based longitudinal study among 326 PrEP users that consisted of two questionnaires at six-month intervals, and complemented this with 21 semi-structured interviews (September 2020-January 2022). We conducted descriptive analyses and logistic regression to examine factors associated with willingness to involve their FP in PrEP care. Interviews were analysed using thematic analysis. Survey respondents reported high satisfaction with care received in HIV clinics [median score 9 (IQR 8-10), 10='very satisfied']. Interviews revealed the importance of regular HIV/STI screening, and the expertise and stigma-free environment of HIV clinics. Yet, they also contextualised service delivery barriers reported in the questionnaire, including the burden of cost and challenges integrating PrEP visits into their private and professional lives. Although 63.8% (n = 208/326) of baseline respondents preferred attending an HIV clinic for PrEP follow-up, 51.9% (n = 108/208) of participants in the follow-up questionnaire reported to be willing to have their FP involved in PrEP care. Participants reporting trust in FPs' PrEP and sexual health expertise, or who didn't feel judged by their FP, were more likely to be willing to involve them in PrEP care. Therefore, we recommend a differentiated PrEP service delivery approach, including involving FPs, to make PrEP care more client-centred.
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Affiliation(s)
- Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Jef Vanhamel
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium.
| | - Thibaut Vanbaelen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
| | - Bernadette Hensen
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Karina Kielmann
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Steven Callens
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
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Crawford C, Rand J, Rohlf V, Scotney R, Bennett P. Solutions-Based Approach to Urban Cat Management-Case Studies of a One Welfare Approach to Urban Cat Management. Animals (Basel) 2023; 13:3423. [PMID: 37958178 PMCID: PMC10648193 DOI: 10.3390/ani13213423] [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: 08/31/2023] [Revised: 10/07/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Urban free-roaming cats create concern about their impacts on wildlife and human health, leading to the use of trap-adopt-kill methods to manage these populations. This method is ineffective at decreasing the free-roaming cat population and has a negative impact on cat caregivers' well-being. Using semi-structured interviews, this study explored the relationship that semi-owners (people who feed cats but do not perceive ownership) and owners of multiple cats have with the cats they care for, and the social and psychological impacts of an alternative assistive-centered approach to urban cat management. This approach to semi-owned and owned cats provided free sterilization and preventative healthcare. Our findings demonstrate that the caregivers had a strong emotional bond with the cats they cared for. The caregivers also experienced a positive impact on their quality of life, and indicated an improvement in the cats' welfare after having the cats sterilized through this program. Additionally, the cat caregivers indicated that they had a negative view of agencies, such as the municipal council. It is recommended that an assistive-centered approach to urban cat management be prioritized by local councils and welfare agencies to improve caregivers' quality of life and psychological well-being, whilst also improving cat welfare. The implementation of this assistive-centered management approach could improve the relationship between communities and the agencies involved, leading to the continuous reporting of free-roaming cats for sterilization. This assistive-centered approach has the potential to reduce the free-roaming cat population, their effects on wildlife, nuisance complaints, and council impoundments, and is aligned with the One Welfare philosophy.
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Affiliation(s)
- Caitlin Crawford
- School of Biological Sciences, Queen’s University Belfast, Belfast BT9 5DL, UK
- Australian Pet Welfare Foundation, Kenmore, QLD 4064, Australia
| | - Jacquie Rand
- Australian Pet Welfare Foundation, Kenmore, QLD 4064, Australia
- School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
| | - Vanessa Rohlf
- School of Psychology and Public Health, La Trobe University, Bendigo, VIC 3552, Australia
| | - Rebekah Scotney
- School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
| | - Pauleen Bennett
- School of Psychology and Public Health, La Trobe University, Bendigo, VIC 3552, Australia
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Christoffersen NB, Nilou FE, Thilsing T, Larsen LB, Østergaard JN, Broholm-Jørgensen M. Exploring targeted preventive health check interventions - a realist synthesis. BMC Public Health 2023; 23:1928. [PMID: 37798691 PMCID: PMC10557298 DOI: 10.1186/s12889-023-16861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Preventive health checks are assumed to reduce the risk of the development of cardio-metabolic disease in the long term. Although no solid evidence of effect is shown on health checks targeting the general population, studies suggest positive effects if health checks target people or groups identified at risk of disease. The aim of this study is to explore why and how targeted preventive health checks work, for whom they work, and under which circumstances they can be expected to work. METHODS The study is designed as a realist synthesis that consists of four phases, each including collection and analysis of empirical data: 1) Literature search of systematic reviews and meta-analysis, 2) Interviews with key-stakeholders, 3) Literature search of qualitative studies and grey literature, and 4) Workshops with key stakeholders and end-users. Through the iterative analysis we identified the interrelationship between contexts, mechanisms, and outcomes to develop a program theory encompassing hypotheses about targeted preventive health checks. RESULTS Based on an iterative analysis of the data material, we developed a final program theory consisting of seven themes; Target group; Recruitment and participation; The encounter between professional and participants; Follow-up activities; Implementation and operation; Shared understanding of the intervention; and Unintended side effects. Overall, the data material showed that targeted preventive health checks need to be accessible, recognizable, and relevant for the participants' everyday lives as well as meaningful to the professionals involved. The results showed that identifying a target group, that both benefit from attending and have the resources to participate pose a challenge for targeted preventive health check interventions. This challenge illustrates the importance of designing the recruitment and intervention activities according to the target groups particular life situation. CONCLUSION The results indicate that a one-size-fits-all model of targeted preventive health checks should be abandoned, and that intervention activities and implementation depend on for whom and under which circumstances the intervention is initiated. Based on the results we suggest that future initiatives conduct thorough needs assessment as the basis for decisions about where and how the preventive health checks are implemented.
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Affiliation(s)
- Nanna Bjørnbak Christoffersen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Freja Ekstrøm Nilou
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Trine Thilsing
- Research Unit of General Practice, University of Southern, Odense, Denmark
| | - Lars Bruun Larsen
- Research Unit of General Practice, University of Southern, Odense, Denmark
- Steno Diabetes Center Zealand, Holbæk, Denmark
| | | | - Marie Broholm-Jørgensen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Herath T, Perera M, Kasturiratne A. Factors influencing the decision to use state-funded healthy lifestyle centres in a low-income setting: a qualitative study from Sri Lanka. BMJ Open 2023; 13:e067464. [PMID: 37407056 DOI: 10.1136/bmjopen-2022-067464] [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] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Healthy lifestyle centres (HLCs) in Sri Lanka provide screening and lifestyle modification services targeting major non-communicable diseases (NCDs). Even though the service is highly accessible and affordable, HLCs are underused by its target population (adults >35 years). We aimed to explore the factors that influence the decision-making process of utilisation of HLCs in Sri Lanka. SETTING Two districts (Gampaha and Kalutara) from the highest populous province (Western) located adjacent to the capital district of Sri Lanka. PARTICIPANTS Nine service providers, 37 HLC clients and 52 community participants were selected using judgemental, convenient and purposive sampling methods. Theoretical sampling method was used to decide the sample size for each category. METHOD A qualitative study design based on constructivist grounded theory was used. Data collected using in-depth interviews and focus group discussions during January to July 2019 and were analysed using the constant comparison method. RESULTS The decision-making process of utilisation of HLCs was found to be a chain of outcomes with three main steps, such as: intention, readiness and utilisation. Awareness of HLCs, positive attitudes on health, intrinsic or extrinsic motivators, positive attitudes on NCDs and screening were internal factors with a positive influence on intention. Readiness was positively influenced by positive characteristics of the HLCs. It was negatively influenced by negative attitudes on staff and services of HLCs and negative past experiences related to services in state healthcare institutions and HLCs, service provider-related barriers and employment-related barriers. Family-related factors, social support and norms influenced both intention and readiness, either positively or negatively. CONCLUSION The decision-making process of utilisation of HLCs links with factors originating from internal, family, service provider and societal levels. Thus, a multifactorial approach that addresses all these levels is needed to improve the utilisation of HLCs in Sri Lanka.
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Affiliation(s)
- Thilini Herath
- Department of Primary Health Care, Faculty of Health-Care Sciences, Eastern University Sri Lanka, Chenkalady, Eastern, Sri Lanka
| | - Manuja Perera
- Department of Public Health, Faculty of Medicine, University of Kelaniya Sri Lanka, Ragama, Western, Sri Lanka
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya Sri Lanka, Ragama, Western, Sri Lanka
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Anselma M, Altenburg TM, Twisk JWR, Wang X, Chinapaw MJM. How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research. HEALTH EDUCATION & BEHAVIOR 2023; 50:199-210. [PMID: 34628967 PMCID: PMC10021122 DOI: 10.1177/10901981211046533] [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] [Indexed: 11/15/2022]
Abstract
Most actions targeting children's health behaviors have limited involvement of children in the development, potentially contributing to disappointing effectiveness. Therefore, in the 3-year "Kids in Action" study, 9- to 12-year-old children from a lower-socioeconomic neighborhood were involved as coresearchers in the development, implementation, and evaluation of actions targeting health behaviors. The current study describes the controlled trial that evaluated the effects on children's energy balance-related behaviors, physical fitness, and self-rated health, as well as experienced challenges and recommendations for future evaluations. Primary school children from the three highest grades of four intervention and four control schools were eligible for participation. Outcome measures assessed at baseline, and at 1- and 2-year follow-up were as follows: motor fitness by the MOPER test (N = 656, N = 485, N = 608, respectively), physical activity and sedentary behavior by accelerometry (N = 223, N = 149, N = 164, respectively), and consumption of sugar sweetened beverages and snacks and self-rated health by a questionnaire (N = 322, N = 281, N = 275, respectively). Mixed-model analyses were performed adjusted for clustering within schools and relevant confounders. Significant beneficial intervention effects were found on self-reported consumption of energy/sports drinks at T2 versus T0, and on total time and ≥5-minute bouts of moderate-to-vigorous physical activity at T1 versus T0. Significant adverse effects were found on "speed and agility" and "coordination and upper-limb speed." No other significant effects were found. The inconsistent intervention effects may be explained by the dynamic cohort and suboptimal outcome measures. We advise future studies with a similar approach to apply alternative evaluation designs, such as the delayed baseline design.
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Affiliation(s)
- Manou Anselma
- Amsterdam UMC, Vrije Universiteit
Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health
research institute, Amsterdam, The Netherlands
- Manou Anselma, Department of Public and
Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam
Public Health research institute, Van der Boechorststraat 7, Amsterdam NL-1081
BT, Netherlands.
| | - Teatske M. Altenburg
- Amsterdam UMC, Vrije Universiteit
Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health
research institute, Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- Amsterdam UMC, Vrije Universiteit
Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health
research institute, Amsterdam, The Netherlands
| | - Xinhui Wang
- College of Computer Science, Qinghai
Normal University, Xining, Qinghai, China
| | - Mai J. M. Chinapaw
- Amsterdam UMC, Vrije Universiteit
Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health
research institute, Amsterdam, The Netherlands
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Bysted S, Overgaard C, Simpson SA, Curtis T, Bøggild H. Recruiting residents from disadvantaged neighbourhoods for community-based health promotion and disease prevention services in Denmark-How, why and under what circumstances does an active door-to-door recruitment approach work? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:937-948. [PMID: 33406289 DOI: 10.1111/hsc.13246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/16/2020] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
Residents living in disadvantaged neighbourhoods have higher mortality and morbidity and participate less in health services than people living in more prosperous areas. Studies on how and why different approaches work for recruiting residents from disadvantaged neighbourhoods to health services are needed. Conducting face-to-face meetings with obliging health professionals (HPs) as part of an active recruitment strategy increases interest in service use, particularly among the most vulnerable residents. The services offered must be free, flexible and easily accessible for residents from disadvantaged neighbourhoods to consider their use. Residents immediately consider and 'translate' the relevance and acceptability of health services presented to them in light of their current situation, which affects their response. Individual contextual circumstances such as current health issues or difficult life circumstances, either promote or dampen their interest in using the services. This study is a realist evaluation of active face-to-face recruitment where HPs go from door-to-door to visit residents in disadvantaged neighbourhoods and offer them community-based health promotion and disease prevention services. A programme theory explicating the assumptions behind this recruitment approach was tested empirically in the present study. Eight direct observations of the active recruitment process in three different neighbourhoods and 17 realist interviews with residents were conducted. Sampling of residents was purposeful and opportunistic. Data were collected between March and August 2018. The findings support the use of active face-to-face recruitment in disadvantaged neighbourhoods to increase participation in health interventions. A broad range of health services should be presented to residents to accommodate their different needs and interests. Refusal to have services presented during active recruitment was rare, but more knowledge about these reasons for declining services is needed.
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Affiliation(s)
- Sofie Bysted
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Charlotte Overgaard
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | | | - Tine Curtis
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Henrik Bøggild
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
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Inchai P, Tsai WC, Chiu LT, Kung PT. Inequality in the Utilization of Breast Cancer Screening between Women with and without Disabilities in Taiwan: A Propensity-Score-Matched Nationwide Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095280. [PMID: 35564676 PMCID: PMC9104314 DOI: 10.3390/ijerph19095280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/13/2022] [Accepted: 04/23/2022] [Indexed: 02/01/2023]
Abstract
Because of the difficulties in accessing medical care, the likelihood of receiving breast cancer screening may be low for women with disabilities. We aimed to investigate differences in the utilization of breast cancer screening among women with and without disabilities. Participants included women with and without disabilities from 2004 to 2010, and it was observed whether the participants had received a breast cancer screening during 2011 and 2012. Propensity-score matching was employed to match disabled women with non-disabled women (1:1). Data sources included the National Health Insurance Research Database, the Cancer Screening Database, and the Disability Registration File. Conditional logistic regression was performed to examine the odds ratios (ORs) that both groups would undergo breast cancer screening. The proportion of women with disabilities who received breast cancer screening was 18.33%, which was significantly lower than that of women without disabilities (25.52%) (p < 0.001). Women with dementia had the lowest probability of receiving a mammography examination (OR = 0.34; 95% CI: 0.28−0.43), followed by those with multiple disabilities (OR = 0.43; 95% CI: 0.40−0.47) and intellectual disabilities (OR = 0.45; 95% CI: 0.41−0.50). In conclusion, compared to women without disabilities, those with disabilities were less likely to undergo breast cancer screening.
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Affiliation(s)
- Puchong Inchai
- Graduate Institute of Public Health, College of Public Health, China Medical University, Taichung 406040, Taiwan;
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung 406040, Taiwan; (W.-C.T.); (L.-T.C.)
| | - Wen-Chen Tsai
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung 406040, Taiwan; (W.-C.T.); (L.-T.C.)
| | - Li-Ting Chiu
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung 406040, Taiwan; (W.-C.T.); (L.-T.C.)
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404332, Taiwan
- Correspondence: ; Tel.: +886-423329255; Fax: +886-424227393
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Møller S, Wissenberg M, Søndergaard K, Kragholm K, Folke F, Hansen CM, Ringgren KB, Andersen J, Lippert F, Møller AL, Køber L, Gerds TA, Torp-Pedersen C. Long-term outcomes after out-of-hospital cardiac arrest in relation to socioeconomic status. Resuscitation 2021; 167:336-344. [PMID: 34302925 DOI: 10.1016/j.resuscitation.2021.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 01/15/2023]
Abstract
AIMS This study aimed to examine whether socioeconomic differences exist in long-term outcomes after out-of-hospital cardiac arrest (OHCA). METHODS We included 2309 30-day OHCA survivors ≥ 30 years of age from the Danish Cardiac Arrest Registry, 2001-2014, divided in tertiles of household income (low, medium, high). Absolute probabilities were estimated using logistic regression for 1-year outcomes and cause-specific Cox regression for 5-year outcomes. Differences between income-groups were standardized with respect to age, sex, education and comorbidities. RESULTS High-income compared to low-income patients had highest 1-year (96.4% vs. 84.2%) and 5-year (87.6% vs. 64.1%) survival, and lowest 1-year (11.3% vs. 7.4%) and 5-year (13.7% vs. 8.6%) risk of anoxic brain damage/nursing home admission. The corresponding standardized probability differences were 8.2% (95%CI 4.7-11.6%) and 13.9% (95%CI 8.2-19.7%) for 1- and 5-year survival, respectively; and -4.5% (95%CI -8.2 to -1.2%) and -5.1% (95%CI -9.3 to -0.9%) for 1- and 5-year risk of anoxic brain damage/nursing home admission, respectively. Among 831 patients < 66 years working prior to OHCA, 72.1% returned to work within 1 year and 80.8% within 5 years. High-income compared to low-income patients had the highest chance of 1-year (76.4% vs. 58.8%) and 5-year (85.3% vs. 70.6%) return to work with the corresponding absolute probability difference of 18.0% (95%CI 3.8-32.7%) for 1-year and 9.4% (95%CI -3.4 to 22.3%) for 5-year. CONCLUSION Patients of high socioeconomic status had higher probability of long-term survival and return to work, and lower risk of anoxic brain damage/nursing home admission after OHCA compared to patients of low socioeconomic status.
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Affiliation(s)
- Sidsel Møller
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
| | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Kathrine Søndergaard
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Carolina Malta Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | | | - Julie Andersen
- Danish Heart Foundation, Department of Research, Copenhagen, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | | | - Lars Køber
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Alexander Gerds
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Thilsing T, Larsen LB, Sonderlund AL, Andreassen SS, Christensen JR, Svensson NH, Dahl M, Sondergaard J. Effects of a Co-Design-Based Invitation Strategy on Participation in a Preventive Health Check Program: Randomized Controlled Trial. JMIR Public Health Surveill 2021; 7:e25617. [PMID: 33688836 PMCID: PMC7991992 DOI: 10.2196/25617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/22/2021] [Accepted: 02/15/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Preventive primary care programs that aim to reduce morbidity and mortality from lifestyle-related diseases are often affected by low-to-moderate participation rates. Improving participation rates is essential for clinical effectiveness and cost-effectiveness. In 2016-2017, we conducted a pilot study (TOF pilot1) for a preventive primary care intervention (TOF is the Danish abbreviation for "Early Detection and Prevention"). Among 8814 invited patients, 3545 (40.22%) consented to participate, with the highest participation rates among women and patients with higher income, education, and employment. OBJECTIVE The aim of this study was to evaluate the effects of a revised invitation strategy on invitation comprehensibility, the overall participation rate, and participant demography. The new strategy specifically targeted men and patients of low educational attainment. METHODS This study was embedded in the second TOF pilot study (TOF pilot2, initiated in October 2018) that tested an adjusted intervention. The revised invitation strategy comprised a prenotification postcard and a new invitation that specifically targeted men and patients of low educational attainment. The new invitation was developed in a co-design process that included communication professionals and target-group representatives. The study sample consisted of 4633 patients aged between 29 and 59 years, who resided in one of two municipalities in the Region of Southern Denmark. Eligible patients were randomly assigned to one of four invitation groups. The control group (Group 1) received the original invitation used in TOF pilot1. The intervention groups received the original invitation and the prenotification postcard (Group 2), the new revised invitation and the prenotification postcard (Group 3), or the new invitation but no prenotification postcard (Group 4). RESULTS Overall, 2171 (46.86%) patients consented to participate. Compared to the control group, participation rates increased significantly in all three intervention groups (all P<.001). Participation across the three intervention groups increased for women and men, as well as for patients with high and low educational attainment and high and low family income. The largest relative increase in participation rates occurred among men, patients with low educational attainment, and patients with low family income. No increase in participation was detected for unemployed patients or patients of non-Danish origin. Most participants found the original (813/987, 82.37%) and new (965/1133, 85.17%) invitations easy to understand with no significant difference (P=.08) in comprehensibility between invitations. CONCLUSIONS The results suggest that participation in preventive primary care interventions can be greatly increased by implementing a co-design-based invitation strategy that includes prenotification postcards and targeted invitations. Although firm conclusions cannot be made from this study, the observed increased participation rates for men and patients of low socioeconomic status may be relevant in programs that aim to reduce social inequality in health. TRIAL REGISTRATION ClinicalTrials.gov NCT03913585; https://clinicaltrials.gov/ct2/show/NCT03913585.
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Affiliation(s)
- Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Lars Bruun Larsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Steno Diabetes Center Zealand, Holbaek, Denmark
| | - Anders Larrabee Sonderlund
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | | | - Jeanette Reffstrup Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Research unit of User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Nanna Herning Svensson
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Marie Dahl
- Vascular Research Unit, Department of Surgery, Regional Hospital Central Denmark, Viborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Sondergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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11
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Møller S, Wissenberg M, Starkopf L, Kragholm K, Hansen SM, Ringgren KB, Folke F, Andersen J, Malta Hansen C, Lippert F, Koeber L, Gislason GH, Torp-Pedersen C, Gerds TA. Socioeconomic disparities in prehospital factors and survival after out-of-hospital cardiac arrest. Heart 2021; 107:627-634. [PMID: 33419881 DOI: 10.1136/heartjnl-2020-317761] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE It remains unknown whether patient socioeconomic factors affect interventions and survival after out-of-hospital cardiac arrest (OHCA), and whether a socioeconomic effect on bystander interventions affects survival. Therefore, this study examined patient socioeconomic disparities in prehospital factors and survival. METHODS From the Danish Cardiac Arrest Registry, patients with OHCA ≥30 years were identified, 2001-2014, and divided into quartiles of household income (highest, high, low, lowest). Associations between income and bystander cardiopulmonary resuscitation (CPR) and 30-day survival with bystander CPR as mediator were analysed by logistic regression and mediation analysis in private witnessed, public witnessed, private unwitnessed and public unwitnessed arrests, adjusted for confounders. RESULTS We included 21 480 patients. Highest income patients were younger, had higher education and were less comorbid relative to lowest income patients. They had higher odds for bystander CPR with the biggest difference in private unwitnessed arrests (OR 1.74, 95% CI 1.47 to 2.05). For 30-day survival, the biggest differences were in public witnessed arrests with 26.0% (95% CI 22.4% to 29.7%) higher survival in highest income compared with lowest income patients. Had bystander CPR been the same for lowest income as for highest income patients, then survival would be 25.3% (95% CI 21.5% to 29.0%) higher in highest income compared with lowest income patients, resulting in elimination of 0.79% (95% CI 0.08% to 1.50%) of the income disparity in survival. Similar trends but smaller were observed in low and high-income patients, the other three subgroups and with education instead of income. From 2002 to 2014, increases were observed in both CPR and survival in all income groups. CONCLUSION Overall, lower socioeconomic status was associated with poorer prehospital factors and survival after OHCA that was not explained by patient or cardiac arrest-related factors.
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Affiliation(s)
- Sidsel Møller
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Mads Wissenberg
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Liis Starkopf
- Section of Biostatistics, Faculty of Health and Medical Sciences, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Steen M Hansen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Fredrik Folke
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.,Copenhagen Emergency Medical Services, Ballerup, Denmark
| | | | - Carolina Malta Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.,Copenhagen Emergency Medical Services, Ballerup, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Ballerup, Denmark
| | - Lars Koeber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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12
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Ajrouch KJ, Vega IE, Antonucci TC, Tarraf W, Webster NJ, Zahodne LB. Partnering with Middle Eastern/Arab American and Latino Immigrant Communities to Increase Participation in Alzheimer's Disease Research. Ethn Dis 2020; 30:765-774. [PMID: 33250623 DOI: 10.18865/ed.30.s2.765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose Recruitment and retention of US ethnic groups traditionally underrepresented in research continues to pose challenges. The Michigan Center for Contextual Factors in Alzheimer's Disease (MCCFAD) engages with two underserved immigrant communities in Michigan - Middle Eastern/Arab Americans in metro-Detroit and Latinos in the Grand Rapids area - to recruit and retain two Participant Resource Pools (PRP). Procedures We adapt an existing community-based participatory research (CBPR) approach to recruit Middle Eastern/Arab American and Latino adults of all ages for Alzheimer's disease and related dementia (ADRD) research. Using American Community Survey (2014-2018) data, we compare socio-demographic characteristics of Middle Eastern/Arab Americans and Latinos living in Michigan to our PRPs. Assessment tools and community advisory board feedback identified missteps and culturally sensitive solutions. Main Findings In the first year of MCCFAD activities, 100 Middle Eastern/Arab Americans and 117 Latinos joined the MCCFAD PRPs. Comparisons to state-level data showed that PRP participants were on average older and more likely to be female than the Middle Eastern/Arab American and Latino populations in Michigan. Further, Middle Eastern/Arab Americans in the PRP reported higher education levels while Latinos reported lower education levels than their respective statewide populations. Community partnerships/feedback identified the importance of connecting with community leaders, attending to matters of within-group diversity, as well as language and semantics. Conclusion Partnership with communities to develop culturally targeted and sensitive community health events can fill a significant gap in addressing ADRD health disparities by establishing sustainable relationships to increase participation in ADRD research.
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Affiliation(s)
- Kristine J Ajrouch
- Department of Sociology, Anthropology, Criminology, Eastern Michigan University, Ypsilanti, MI
| | - Irving E Vega
- Department of Translational Neuroscience, Michigan State University, Grand Rapids, MI
| | - Toni C Antonucci
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Wassim Tarraf
- Institute of Gerontology and Department of Healthcare Sciences, Wayne State University, Detroit, MI
| | - Noah J Webster
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI
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13
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Burton L, Curran K, Foweather L. Formative Evaluation of Open Goals: A UK Community-Based Multi-Sport Family Programme. CHILDREN-BASEL 2020; 7:children7090119. [PMID: 32882912 PMCID: PMC7552749 DOI: 10.3390/children7090119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022]
Abstract
Community parks provide opportunities for physical activity (PA) and facilitate social interactions. This formative evaluation assesses the implementation of ‘Open Goals’ (OG), a novel multi-sport programme aiming to increase family PA and community cohesion, delivered weekly by Liverpool Football Club’s charitable foundation to local parks in Liverpool, North West England. Three Open Goals parks were chosen for the evaluation settings. Formative evaluation measures included: System for Observing Play and Recreation in Communities (SOPARC) observations (n = 10), direct session observations (n = 8), semi-structured interviews with Open Goals coaching staff (n = 3), and informal feedback from families (n = 5) about their experiences of Open Goals. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Within the three evaluation parks, Open Goals reached 107 participants from May–July 2019, through 423 session attendances. Fidelity of the programme was high (M = 69% of session content delivered as intended). Overall park use when OG was offered compared to when it was not offered was not statistically significant (p = 0.051), however, target area use was significantly increased (p = 0.001). Overall physical activity levels in parks were significantly (p = 0.002) higher when Open Goals was being offered, compared to when it was not. Coaches reported that engagement in OG positively affected family co-participation and children’s behavioural development. Contextual issues included environmental and social barriers to programme engagement, including the co-participation element of the programme and criticism of the marketing of OG. It is evident that community-based multi-sport PA programmes endorsed by professional football clubs are well positioned to connect with local communities in deprived areas and to encourage PA and community engagement. This study suggests that such programmes may have the ability to improve park usage in specific areas, along with improving physical activity levels among families, although further research is required. Effective marketing strategies are needed for promotional purposes. Upskilling of coaches in the encouragement of family co-participation may support regular family engagement in PA in local parks.
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14
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Huys N, Van Stappen V, Shadid S, De Craemer M, Androutsos O, Wikström K, Makrilakis K, Moreno LA, Iotova V, Tankova T, Nánási A, Manios Y, Cardon G. Effectiveness of a family-, school- and community-based intervention on physical activity and its correlates in Belgian families with an increased risk for type 2 diabetes mellitus: the Feel4Diabetes-study. BMC Public Health 2020; 20:1231. [PMID: 32787943 PMCID: PMC7425007 DOI: 10.1186/s12889-020-09336-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The study aimed to investigate the effectiveness of the European Feel4Diabetes intervention, promoting a healthy lifestyle, on physical activity and its correlates among families at risk for type 2 diabetes mellitus (based on the Finnish Diabetes Risk Score) in Belgium. Methods The Feel4Diabetes intervention involved three components: family, school and community component, with the family component consisting of 6 counseling sessions for families at risk. Main outcomes were objectively measured physical activity levels and its subjectively measured correlates. The final sample consisted of 454 parents (mean age 39.4 years; 72.0% women) and 444 children (mean age 8.0 years; 50.1% girls). Multilevel repeated measures analyses were performed to assess intervention effectiveness after 1 year. Results In parents, there was no significant intervention effect. In children, there were only significant negative effects for moderate to vigorous physical activity (p = 0.05; ηp2 = 0.008) and steps (p = 0.03; ηp2 = 0.006%) on weekdays, with physical activity decreasing (more) in the intervention group. Conclusions The F4D-intervention lacks effectiveness on high-risk families’ physical activity and its correlates in Belgium. This could partially be explained by low attendance rates and a large drop-out. To reach vulnerable populations, future interventions should invest in more appropriate recruitment (e.g. more face-to-face contact) and more bottom-up development of the intervention (i.e. co-creation of the intervention with the target group). Trial registration The Feel4Diabetes-study was prospectively registered at clinicaltrials.gov as NCT02393872 on 20 March 2015.
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Affiliation(s)
- Nele Huys
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium.
| | - Vicky Van Stappen
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Samyah Shadid
- Department of Endocrinology and Metabolic Diseases, Ghent University Hospital, Corneel Heymanslaan, 10, Ghent, Belgium
| | - Marieke De Craemer
- Department of Rehabilitation Sciences, Ghent University, Corneel Heysmanslaan, 10, Ghent, Belgium.,Research Foundation Flanders, Egmontstraat 5, Brussels, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, El. Venizelou 70, Kallithea, Athens, Greece
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie, 166, Helsinki, Finland
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias str, Athens, Greece
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Calle Pedro Cerbuna, 12, Zaragoza, Spain
| | - Violeta Iotova
- Department of Paediatrics, Medical University of Varna, 55 Marin Drinov str, Varna, Bulgaria
| | - Tsvetalina Tankova
- Clinical Center of Endocrinology, Medical University of Sofia, Boulevard "Akademik Ivan Evstratiev Geshov, 15, Sofia, Bulgaria
| | - Anna Nánási
- Department of Family and Occupational Medicine, University of Debrecen, Egyeterm tér 1, Debrecen, Hungary
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, El. Venizelou 70, Kallithea, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
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15
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Whittaker PJ. Uptake of cardiovascular health checks in community pharmacy versus general practice. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Paula J. Whittaker
- Division of Population Health Health Services Research and Primary Care School of Health Sciences University of Manchester Manchester UK
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16
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Jancey J, James A, Lee A, Howat P, Hills AP, Anderson AS, Bordin C, Blackford K. Metabolic syndrome in rural Australia: An opportunity for primary health care. Aust J Rural Health 2019; 27:210-215. [PMID: 31062903 DOI: 10.1111/ajr.12500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 09/06/2018] [Accepted: 01/06/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To measure the impact of a 6-month home-based behaviour change intervention on reducing the risk of chronic disease as determined by metabolic syndrome status and cardiovascular risk score, and discuss implications for primary care in rural areas. DESIGN A two-arm randomised controlled trial of rural adults. SETTING The rural town of Albany in the Great Southern region of Western Australia. PARTICIPANTS Participants (n = 401) aged 50-69 years who were classified with or at risk of metabolic syndrome and randomly assigned to intervention (n = 201) or waitlisted control (n = 200) group. INTERVENTIONS A 6-month intervention program incorporating goal setting, self-monitoring and feedback, with motivational interviewing was conducted. MAIN OUTCOME MEASURES Change in metabolic syndrome status and cardiovascular risk. RESULTS Significant improvements in metabolic syndrome status and cardiovascular disease risk score (-0.82) were observed for the intervention group relative to control group from baseline to post-test. CONCLUSION This home-based physical activity and nutrition intervention reduced participants' risk of experiencing a cardiovascular event in the next 5 years by 1%. Incorporating such prevention orientated approaches in primary care might assist in reducing the burden of long-term chronic diseases. However, for realistic application in this setting, hurdles such as current national health billing system and availability of resources will need to be considered.
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Affiliation(s)
- Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Bentley, Western Australia, Australia.,School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Anthony James
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Andy Lee
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Peter Howat
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Bentley, Western Australia, Australia.,School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Andrew P Hills
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, Division of Cancer Research, Ninewells Medical School, University of Dundee, Aberdeen, Scotland
| | - Cassandra Bordin
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Bentley, Western Australia, Australia
| | - Krysten Blackford
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Bentley, Western Australia, Australia.,School of Public Health, Curtin University, Bentley, Western Australia, Australia
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17
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Lawlor ER, Cupples ME, Donnelly M, Tully MA. Promoting physical activity among community groups of older women in socio-economically disadvantaged areas: randomised feasibility study. Trials 2019; 20:234. [PMID: 31023329 PMCID: PMC6482492 DOI: 10.1186/s13063-019-3312-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 03/21/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Insufficient physical activity (PA) is a major public health issue. Whilst PA is an important contributor to disease prevention, engagement in PA decreases with age, particularly among women in socio-economically disadvantaged areas. Research using existing support networks to engage 'hard to reach' populations in PA interventions is sparse. We developed and tested the feasibility of a PA-promoting intervention for older women within existing community groups in socio-economically disadvantaged areas. METHODS The Medical Research Council guidelines for complex interventions were used to guide the intervention's development. We recruited participants (n = 40) from older (aged ≥50 years) women's groups from four different community centres. A 12-week programme was delivered during existing sessions, informed by Social Practice Theory. The sessions provided education about PA, social support in the form of a PA 'buddy', group discussion and follow-up telephone calls, as well as printed information about local opportunities to participate in PA. The main uncertainties tested were rates of participant recruitment, retention, and completion of assessments of PA by accelerometry and of mental health using the Hospital Anxiety and Depression Scale (HADS). Intervention acceptability was assessed by questionnaire, and focus group interviews elicited participants' views about the intervention. Qualitative data were subjected to framework analysis. RESULTS The recruitment rate was high; 87% (n = 40/46) of women consented to participate, and 78% (n = 31) attended all education sessions. Uptake of follow-up telephone calls and PA 'buddies' was low. Few participants provided valid accelerometer data, but 63% (n=25) completed the HADS questionnaire at all time points. The printed materials and education sessions were viewed positively; telephone calls and 'buddy' support were not valued. Participants believed that organised group activities would lead to increased PA engagement, and whilst participants disliked wearing a waist accelerometer, they thought that regular PA feedback would facilitate necessary goal-setting. CONCLUSIONS High recruitment and retention rates suggest that use of existing social support groups is an acceptable and attractive method of delivering a PA intervention to this population. A randomised controlled trial of the intervention appears feasible, but its design requires refinement of the social support component, facilitation of goal-setting and reconsideration of the assessment of PA. TRIAL REGISTRATION ClinicalTrials.gov, NCT02880449 . Registered on 26 August 2016.
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Affiliation(s)
- Emma R Lawlor
- UKCRC Centre of Excellence for Public Health (Northern Ireland), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland, UK.
| | - Margaret E Cupples
- UKCRC Centre of Excellence for Public Health (Northern Ireland), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland, UK.,Department of General Practice and Primary Care, Queen's University Belfast, 1 Dunluce Avenue, Belfast, BT9 7HR, Northern Ireland, UK
| | - Michael Donnelly
- UKCRC Centre of Excellence for Public Health (Northern Ireland), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland, UK
| | - Mark A Tully
- UKCRC Centre of Excellence for Public Health (Northern Ireland), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland, UK.,School of Health Sciences, Institute of Mental Health Sciences, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland, UK
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18
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Engaging with Socio-Economically Disadvantaged Communities and Their Cats: Human Behaviour Change for Animal and Human Benefit. Animals (Basel) 2019; 9:ani9040175. [PMID: 30999663 PMCID: PMC6523136 DOI: 10.3390/ani9040175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/20/2019] [Accepted: 04/12/2019] [Indexed: 11/17/2022] Open
Abstract
The overpopulation of free-roaming domestic cats (Felis catus) is fuelled by uncontrolled breeding of both owned and unowned populations and has been identified as a particular problem in socio-economically deprived areas. Consequently, for sustainable change, it is recommended that Trap-Neuter-Return activities are linked with community engagement to encourage positive behaviours towards cats. This paper assesses the acceptability and impact of a community-partnership program called "Bulwell Cat Watch" (BCW), set-up to control cat numbers in Bulwell, UK. The data are based on a (1) cross-sectional survey (n = 478); (2) pre-post analysis (n = 21); and (3) targeted survey of people known to engage with BCW (n = 34). We found significant associations between awareness of BCW and an increased likelihood of reporting unowned cats now compared to previous years. Respondents reported increased self-efficacy and confidence to help cats. Our pre-post study corroborated these findings with residents significantly more likely to report unowned cats compared to when surveyed pre-BCW. An indirect benefit to residents engaged with the program was the positive impact on confidence and self-esteem. Taken in combination these results show community partnerships can effectively engage often hard-to-reach populations and foster sustainable management by overcoming barriers to helping cats, alongside the potential for wider community benefits.
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19
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Kamimura A, Nourian MM, Chernenko A, Rathi N, Oslund MA, Ashby J. Beliefs and knowledge of cardiovascular-related disease among uninsured primary care patients: A cross-sectional study. Chronic Illn 2019; 15:41-50. [PMID: 29249169 DOI: 10.1177/1742395317746469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to examine cardiovascular disease-related health beliefs and how they are influenced by knowledge and a sense of community among uninsured primary care patients. METHOD This study was a cross-sectional study using a self-administered paper survey (January to April 2016). The study population included medically uninsured US-born English speakers, non-US-born English speakers, and Spanish speakers. RESULTS Medically uninsured adults utilizing a free clinic (N = 374) participated in the survey. Increasing knowledge about major risk factors for developing cardiovascular disease helped enhance levels of perceived severity of cardiovascular disease and benefits of healthy diet and physical activity. Spanish speakers reported higher levels of perceived severity of cardiovascular disease but lower levels of knowledge compared to US-born or non-US-born English speakers. CONCLUSION Spanish speakers may need different approaches to promote cardiovascular disease prevention due to their higher levels of perceived severity of cardiovascular disease but lower levels of cardiovascular disease-related knowledge compared to English speakers. Developing a healthy "community" in a clinic setting may be effective to promote cardiovascular disease-related health for underserved populations.
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Affiliation(s)
- Akiko Kamimura
- 1 Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Maziar M Nourian
- 2 School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Alla Chernenko
- 1 Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Naveen Rathi
- 1 Department of Sociology, University of Utah, Salt Lake City, UT, USA
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20
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Coupe N, Cotterill S, Peters S. Tailoring lifestyle interventions to low socio-economic populations: a qualitative study. BMC Public Health 2018; 18:967. [PMID: 30075716 PMCID: PMC6076398 DOI: 10.1186/s12889-018-5877-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background People living in deprived areas are more likely to be overweight or obese, have poorer health outcomes, and tend to benefit less from interventions than those from more affluent backgrounds. One approach to address such health inequalities is to tailor existing interventions to low socio-economic populations, yet there is limited evidence to inform their design. This study aims to identify how best to tailor lifestyle interventions to low socio-economic populations to improve outcomes. Methods Following direct observations of community-run weight loss groups, we interviewed 11 group facilitators and 14 service users from a health improvement service in a low socio-economic area in the North West of England. Audio-recorded interviews were transcribed verbatim and analysed thematically. Results We identified two overarching themes within the data. The first theme, managing diversity, included challenges faced in delivering a generic intervention to a diverse population in terms of knowledge, language and literacy skills, and cultural diversity. The second theme incorporated all issues relating to the environment, such as cost, access and availability of food and leisure facilities, and ‘life gets in the way’. Conclusions Tailoring interventions for this population is necessary, and more attention is needed to develop ways to ensure service providers and users engage with behaviour change techniques such as goal setting, rather than focusing on information provision alone. Interventions should also be mindful of cost, cultural diversity, and language and literacy barriers, as well as potential for disengaging this hard to reach population.
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Affiliation(s)
- Nia Coupe
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Manchester, UK.
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Sarah Peters
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Manchester, UK
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21
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de Waard AKM, Wändell PE, Holzmann MJ, Korevaar JC, Hollander M, Gornitzki C, de Wit NJ, Schellevis FG, Lionis C, Søndergaard J, Seifert B, Carlsson AC. Barriers and facilitators to participation in a health check for cardiometabolic diseases in primary care: A systematic review. Eur J Prev Cardiol 2018; 25:1326-1340. [PMID: 29916723 PMCID: PMC6097107 DOI: 10.1177/2047487318780751] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Health checks for cardiometabolic diseases could play a role in the identification of persons at high risk for disease. To improve the uptake of these health checks in primary care, we need to know what barriers and facilitators determine participation. Methods We used an iterative search strategy consisting of three steps: (a) identification of key-articles; (b) systematic literature search in PubMed, Medline and Embase based on keywords; (c) screening of titles and abstracts and subsequently full-text screening. We summarised the results into four categories: characteristics, attitudes, practical reasons and healthcare provider-related factors. Results Thirty-nine studies were included. Attitudes such as wanting to know of cardiometabolic disease risk, feeling responsible for, and concerns about one’s own health were facilitators for participation. Younger age, smoking, low education and attitudes such as not wanting to be, or being, worried about the outcome, low perceived severity or susceptibility, and negative attitude towards health checks or prevention in general were barriers. Furthermore, practical issues such as information and the ease of access to appointments could influence participation. Conclusion Barriers and facilitators to participation in health checks for cardiometabolic diseases were heterogeneous. Hence, it is not possible to develop a ‘one size fits all’ approach to maximise the uptake. For optimal implementation we suggest a multifactorial approach adapted to the national context with special attention to people who might be more difficult to reach. Increasing the uptake of health checks could contribute to identifying the people at risk to be able to start preventive interventions.
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Affiliation(s)
- Anne-Karien M de Waard
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | - Per E Wändell
- 2 Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden
| | - Martin J Holzmann
- 3 Functional Area of Emergency Medicine, Karolinska University Hospital, Sweden.,4 Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joke C Korevaar
- 5 NIVEL (Netherlands Institute for Health Services Research), the Netherlands
| | - Monika Hollander
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | | | - Niek J de Wit
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | - François G Schellevis
- 5 NIVEL (Netherlands Institute for Health Services Research), the Netherlands.,7 Department of General Practice and Elderly Care Medicine, VU University Medical Center, the Netherlands
| | - Christos Lionis
- 8 Clinic of Social and Family Medicine, University of Crete, Greece
| | - Jens Søndergaard
- 9 Research Unit for General Practice, University of Southern Denmark, Denmark
| | - Bohumil Seifert
- 10 Department of General Practice, Charles University, Czech Republic
| | - Axel C Carlsson
- 2 Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden.,11 Department of Medical Sciences, Uppsala University, Sweden
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22
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Crombie IK, Irvine L, Williams B, Sniehotta FF, Petrie DJ, Jones C, Norrie J, Evans JMM, Emslie C, Rice PM, Slane PW, Humphris G, Ricketts IW, Melson AJ, Donnan PT, McKenzie A, Huang L, Achison M. Text message intervention to reduce frequency of binge drinking among disadvantaged men: the TRAM RCT. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Socially disadvantaged men are more likely to binge drink frequently and to experience high levels of alcohol-related harm.
Objectives
To test the effectiveness and cost-effectiveness of a text message intervention in reducing the frequency of binge drinking among disadvantaged men.
Study design
A four-centre, parallel-group, pragmatic, individually randomised controlled trial was conducted. Randomisation was carried out using a secure remote web-based system. It was stratified by participating centre and recruitment method and restricted using block sizes of randomly varying lengths.
Setting
The study was conducted in the community. Members of the public helped to develop the study methods.
Participants
Participants were men aged 25–44 years who had ≥ 2 episodes of binge drinking (> 8 units of alcohol in a single session) in the preceding 28 days. Men were recruited from areas of high deprivation.
Interventions
An empirically and theoretically based text message intervention was delivered by 112 interactive text messages over a 12-week period. The control group received an attentional control comprising 89 text messages on general health.
Primary outcome measure
The primary outcome measure was the proportion of men consuming > 8 units of alcohol on ≥ 3 occasions (in the previous 28 days) at 12 months post intervention.
Results
The recruitment target of 798 was exceeded and 825 men were randomised. Retention was high and similar in the intervention (84.9%) and control (86.5%) groups. Most men in the intervention group engaged enthusiastically with the text messages: almost all (92%) replied to text messages and over two-thirds (67%) replied more than 10 times. The intervention was estimated to have had a modest, statistically non-significant effect on the primary outcome at the 12-month follow-up [odds ratio 0.79, 95% confidence interval (CI) 0.57 to 1.08]. This corresponds to a net reduction of 5.7% in regular binge drinking. Five secondary outcomes showed small non-significant and inconsistent effects on alcohol consumption, with one suggesting a positive effect and four suggesting an adverse effect. Both the short- and the long-term cost per quality-adjusted life-year (QALY) analysis suggested that the brief intervention was dominated by a ‘do-nothing’ option. The intervention’s impacts on patterns of alcohol consumption, QALYs and downstream costs were inconsistent and uncertain.
Limitations
The study used an active control that, combined with the recruitment procedures and baseline assessments, could have biased the treatment effect towards the null. The measurement of alcohol consumption relied on self-reported drinking.
Conclusions
The trial has demonstrated that it is possible to recruit and retain large numbers of socially disadvantaged men in a research study. The text messages delivered a complex theoretically and empirically based intervention that fostered enthusiastic engagement with the key components of the behaviour change sequence. The intervention produced a modest, statistically non-significant effect on the primary outcome, with wide CIs. Further research is needed to reduce uncertainty about the treatment effect. The methods developed for this study provide a platform for the design and testing of interventions to reduce inequalities in health.
Future work
A future trial could reduce the uncertainty around the treatment effect of the intervention.
Trial registration
Current Controlled Trials ISRCTN07695192.
Funding
This study was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 6. See NIHR Journals Library website for further information.
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Affiliation(s)
- Iain K Crombie
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Linda Irvine
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Falko F Sniehotta
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Dennis J Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Josie MM Evans
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Carol Emslie
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Peter M Rice
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Peter W Slane
- Erskine Practice, Arthurstone Medical Centre, Dundee, UK
| | - Gerry Humphris
- School of Medicine, Medical and Biological Sciences, University of St Andrews, St Andrews, UK
| | | | - Ambrose J Melson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter T Donnan
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Andrew McKenzie
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Li Huang
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marcus Achison
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
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23
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Craike M, Wiesner G, Hilland TA, Bengoechea EG. Interventions to improve physical activity among socioeconomically disadvantaged groups: an umbrella review. Int J Behav Nutr Phys Act 2018; 15:43. [PMID: 29764488 PMCID: PMC5952843 DOI: 10.1186/s12966-018-0676-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/06/2018] [Indexed: 01/08/2023] Open
Abstract
Background People from socioeconomically disadvantaged population groups are less likely to be physically active and more likely to experience adverse health outcomes than those who are less disadvantaged. In this umbrella review we examined across all age groups, (1) the effectiveness of interventions to improve physical activity among socioeconomically disadvantaged groups, (2) the characteristics of effective interventions, and (3) directions for future research. Methods PubMed/MEDLINE and Scopus were searched up to May 2017 to identify systematic reviews reporting physical activity interventions in socioeconomically disadvantaged populations or sub-groups. Two authors independently conducted study screening and selection, data extraction (one author, with data checked by two others) and assessment of methodological quality using the ‘Assessment of Multiple Systematic Reviews’ scale. Results were synthesized narratively. Results Seventeen reviews met our inclusion criteria, with only 5 (30%) reviews being assessed as high quality. Seven (41%) reviews focused on obesity prevention and an additional four focused on multiple behavioural outcomes. For pre school children, parent-focused, group-based interventions were effective in improving physical activity. For children, school-based interventions and policies were effective; few studies focused on adolescents and those that did were generally not effective; for adults, there was mixed evidence of effectiveness but characteristics such as group-based interventions and those that focused on physical activity only were associated with effectiveness. Few studies focused on older adults. Across all ages, interventions that were more intensive tended to be more effective. Most studies reported short-term, rather than longer-term, outcomes and common methodological limitations included high probability of selection bias, low response rates, and high attrition. Conclusions Interventions can be successful at improving physical activity among children from socioeconomically disadvantaged groups, with evidence for other age groups weak or inconclusive. More high-quality studies in this population group are needed, which adopt strategies to increase recruitment rates and reduce attrition, report longer term outcomes, and provide adequate intervention details, to allow determination of the characteristics of effective interventions. We recommend that the benefits of physical activity be recognised more broadly than obesity prevention in future studies, as this may have implications for the design and appeal of interventions. Electronic supplementary material The online version of this article (10.1186/s12966-018-0676-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melinda Craike
- Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
| | - Glen Wiesner
- Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Toni A Hilland
- Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.,School of Education, College of Design and Social Context, RMIT, PO Box 71, Bundoora, VIC, 3083, Australia
| | - Enrique Garcia Bengoechea
- Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.,Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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24
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Larsen LB, Sandbaek A, Thomsen JL, Bjerregaard AL. Uptake of health checks by residents from the Danish social housing sector - a register-based cross-sectional study of patient characteristics in the 'Your Life - Your Health' program. BMC Public Health 2018; 18:585. [PMID: 29720162 PMCID: PMC5932768 DOI: 10.1186/s12889-018-5506-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Poor uptake among socio-economically disadvantaged and susceptible populations is a well-known challenge of general health check interventions, and is widely cited as one of the reasons for the lack of population level effects seen in many studies. We report on patient characteristics among attendees and non-attendees of health checks made available to residents in the social housing sector of the municipality of Aarhus. We focus on this general population, as well as a particular sub-group living in an exceptionally deprived social housing area, and discuss the properties of intervention uptake that we need to be aware of to qualify and compare the effects of general versus targeted health checks in socially deprived areas. Methods Cross-sectionally in a sample of 6650 residents of the Aarhus social housing sector who were invited for a health check in the first year of the ‘Your Life – Your Health’ program. The analyses consisted of 1) descriptive analysis of the characteristics of attenders/non-attenders, 2) unadjusted and adjusted Poisson regression to examine associations of patient characteristics and uptake of health checks, and 3) decision tree analyses (CHAID) to examine interaction and homogeneity in patient characteristics among attenders. Results Of the overall population 30% attended. In a nested cohort of people residing in a particularly deprived social housing settlement, 25% attended. Further, in the overall population, we found an association between the likelihood of taking up a health check and age, sex, country of origin, educational attainment, cohabitation, occupational status, and past medical treatment. In the nested cohort the association between uptake and medical treatment was non-significant, while the association between uptake and occupation was limited to people who were employed. These results resonate with past evidence on health check attendance. Conclusions Attendance in the ‘Your Life – Your Health’ program is higher among people of a higher socio-economic status. This should be taken into consideration when analysing and interpreting the overall study effects. Moreover, the results suggest that a targeted approach in the social housing sector could be more effective than a mass screening approach. However, more information is required to make such assertion definitive. Electronic supplementary material The online version of this article (10.1186/s12889-018-5506-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars Bruun Larsen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.
| | - Annelli Sandbaek
- Department of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark.,The Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Janus Laust Thomsen
- Department of Clinical Medicine, Research Unit for General Practice, Aalborg University, Aalborg, Denmark
| | - Anne-Louise Bjerregaard
- Department of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark
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25
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Aziz Z, Riddell MA, Absetz P, Brand M, Oldenburg B. Peer support to improve diabetes care: an implementation evaluation of the Australasian Peers for Progress Diabetes Program. BMC Public Health 2018; 18:262. [PMID: 29454327 PMCID: PMC5816559 DOI: 10.1186/s12889-018-5148-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/02/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Several studies have now demonstrated the benefits of peer support in promoting diabetes control. The aim of this study is to evaluate the implementation of a cluster randomised controlled trial of a group-based, peer support program to improve diabetes self-management and thereby, diabetes control in people with Type 2 Diabetes in Victoria, Australia. METHODS The intervention program was designed to address four key peer support functions i.e. 1) assistance in daily management, 2) social and emotional support, 3) regular linkage to clinical care, and 4) ongoing and sustained support to assist with the lifelong needs of diabetes self-care management. The intervention participants attended monthly group meetings facilitated by a trained peer leader for 12 months. Data was collected on the intervention's reach, participation, implementation fidelity, groups' effectiveness and participants' perceived support and satisfaction with the intervention. The RE-AIM and PIPE frameworks were used to guide this evaluation. RESULTS The trial reached a high proportion (79%) of its target population through mailed invitations. Out of a total of 441 eligible individuals, 273 (61.9%) were willing to participate. The intervention fidelity was high (92.7%). The proportion of successful participants who demonstrated a reduction in 5 years cardiovascular disease risk score was 65.1 and 44.8% in the intervention and control arm respectively. Ninety-four percent (94%) of the intervention participants stated that the program helped them manage their diabetes on a day to day basis. Overall, attending monthly group meetings provided 'a lot of support' to 57% and 'moderate' support to 34% of the participants. CONCLUSION Peer support programs are feasible, acceptable and can be used to supplement treatment for patients motivated to improve behaviours related to diabetes. However, program planners need to focus on the participation component in designing future programs. The use of two evaluation frameworks allowed a comprehensive evaluation of the trial from the provider-, participant- and public health perspective. The learnings gained from this evaluation will guide and improve future implementation by improving program feasibility for adoption and acceptability among participants, and will ultimately increase the likelihood of program effectiveness for the participants. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12609000469213 . Registered 16 June 2009.
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Affiliation(s)
- Zahra Aziz
- Melbourne School of Population & Global Health, the University of Melbourne, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Michaela A Riddell
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Pilvikki Absetz
- School of Health Sciences, University of Tampere, FI-33014, Tampere, Finland.,Collaborative Care Systems Finland, Helsinki, Finland
| | - Margaret Brand
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Brian Oldenburg
- Melbourne School of Population & Global Health, the University of Melbourne, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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26
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Blackford K, Lee A, James AP, Waddell T, Hills AP, Anderson AS, Howat P, Jancey J. Process evaluation of the Albany Physical Activity and Nutrition (APAN) program, a home-based intervention for metabolic syndrome and associated chronic disease risk in rural Australian adults. Health Promot J Austr 2017; 28:8-14. [PMID: 27426475 DOI: 10.1071/he16027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/09/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed The Albany Physical Activity and Nutrition (APAN) study investigated the effects of the APAN program, a home-based intervention on dietary and physical activity behaviours and chronic disease risk for rural Australian adults. This paper reports on the process evaluation to gain insight into the link between intervention elements and outcomes. Methods The APAN program comprised resources to improve participants' diet and physical activity. Printed and online resources were provided to participants, complemented by motivational interviews via telephone. Process evaluation used mixed-methods, with a sample of 201 intervention participants residing in a disadvantaged rural area. Participants were aged 50 to 69 years with, or at risk of, metabolic syndrome. Quantitative data were collected using an online survey (n=73); qualitative data were collected via telephone exit interviews with intervention completers (n=8) and non-completers (n=8), and recruitment notes recorded by research assistants. Results The attrition rate of the program was 18%; major reasons for withdrawal were health and personal issues and a loss of interest. The majority of participants found the printed resources useful, attractive, and suitable to their age group. The website was the least preferred resource. Reasons for completing the program included the desired health benefits, wanting to honour the commitment, and wanting to assist with research. Conclusions Carefully planned recruitment will reduce the burden on resources and improve uptake. Understanding reasons for attrition such as family or personal barriers and health issues will assist practitioners to support participants overcome these barriers. Given participants' preference for printed resources, and the known effectiveness of these in combination with other strategies, investigating methods to encourage use of telephone and online support should be a priority. So what? This process evaluation provided an overview of recruitment challenges and preferred intervention components. It is desirable that future work determines the most effective intervention components for rural adults at risk of chronic disease.
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Affiliation(s)
- Krysten Blackford
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Andy Lee
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Anthony P James
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Tracy Waddell
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Andrew P Hills
- School of Health Sciences, University of Tasmania, Locked Bag 1322, Newnham Drive, Launceston, Tas. 7250, Australia
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, Division of Cancer Research, Level 7, Mailbox 7, Ninewells Medical School, Dundee DD1 9SY, Scotland
| | - Peter Howat
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia
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27
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Schröder SL, Fink A, Hoffmann L, Schumann N, Martin O, Frantz S, Richter M. Socioeconomic differences in the pathways to diagnosis of coronary heart disease: a qualitative study. Eur J Public Health 2017; 27:1055-1060. [DOI: 10.1093/eurpub/ckx147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Zenlea IS, Thompson B, Fierheller D, Green J, Ulloa C, Wills A, Mansfield E. Walking in the shoes of caregivers of children with obesity: supporting caregivers in paediatric weight management. Clin Obes 2017; 7:300-306. [PMID: 28703480 DOI: 10.1111/cob.12202] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/08/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
To incorporate the perspectives and experiences of family caregivers of children with obesity, the KidFit Health and Wellness Clinic, a paediatric weight management programme, embedded feedback opportunities into various stages of programme development. Caregivers were eligible to participate if their children had completed initial 4-week group-based pilot programming or were currently receiving treatment in 10 or 12 week group-based programming. Data were collected through feedback session discussions, audio-recorded, transcribed verbatim and analysed thematically. In total, 6 caregivers participated in the pilot group feedback session and 32 caregivers participated in the structured group feedback sessions. Caregivers reported that healthy lifestyle strategies first communicated by clinic staff to children during group sessions provided expert validation and reinforcement when discussing similar messages at home. Caregivers reported feeling isolated and blamed for causing their children's obesity and appreciated the supportive forum that group-based programming provided for sharing experiences. Since experiences of blame and isolation can burden caregivers of children with obesity, paediatric weight management programmes might consider including peer support opportunities and discussion forums for ongoing social support in addition to education about lifestyle change.
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Affiliation(s)
- I S Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - B Thompson
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - D Fierheller
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - J Green
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - C Ulloa
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - A Wills
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - E Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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29
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Kaleta D, Kalucka S, Szatko F, Makowiec-Dąbrowska T. Prevalence and Correlates of Physical Inactivity during Leisure-Time and Commuting among Beneficiaries of Government Welfare Assistance in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101126. [PMID: 28954440 PMCID: PMC5664627 DOI: 10.3390/ijerph14101126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 11/23/2022]
Abstract
Physical activity (PA) has well-documented health benefits helping to prevent development of non-communicable diseases. The aim of the study was to examine the prevalence and factors associated with physical inactivity during leisure-time (LTPA) and commuting (CPA) among adult social assistance beneficiaries in Piotrkowski district. The studied sample consisted of 1817 respondents. Over 73% of the study population did not meet the recommended levels of LTPA. Fifty two % of the respondents had none leisure-time physical activity and 21.5% exercised occasionally. Main reasons for not taking up LTPA included: high general physical activity (36.4%), lack of time (28.1%), no willingness to exercise (25.4%). Close to 82% of the surveyed population did not practice commuting physical activity (CPA). The men had higher risk for inactivity during LTPA compared to the women (OR = 1.35; 95% CI: 1.11–1.65; p ≤ 0.05). Higher odds of CPA inactivity were associated with unemployment, moderate and heavy drinking and having a number of health problems. The prevalence of physical inactivity among the social assistance recipients is much higher than it is in the general population. Promotion of an active lifestyle should take into consideration substantial differences between the general population and disadvantaged individuals and their various needs.
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Affiliation(s)
- Dorota Kaleta
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland.
| | - Sylwia Kalucka
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland.
| | - Franciszek Szatko
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland.
| | - Teresa Makowiec-Dąbrowska
- Department of Work Physiology and Ergonomics, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland.
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30
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Crombie IK, Irvine L, Falconer DW, Williams B, Ricketts IW, Jones C, Humphris G, Norrie J, Slane P, Rice P. Alcohol and disadvantaged men: A feasibility trial of an intervention delivered by mobile phone. Drug Alcohol Rev 2017; 36:468-476. [PMID: 28295794 PMCID: PMC5516166 DOI: 10.1111/dar.12455] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Disadvantaged men suffer substantial harm from heavy drinking. This feasibility study developed and evaluated the methods for a trial of a brief intervention delivered by text messages to disadvantaged men. It aimed to test the methods for recruitment and retention, to monitor engagement with the intervention and assess the overall acceptability of study methods. DESIGN AND METHODS Disadvantaged men aged 25-44 years who had ≥2 episodes of binge drinking (≥8 units in one session) in the preceding month were recruited. Two recruitment strategies were assessed: recruitment from general practice registers and by a community outreach strategy. Theoretically and empirically based text messages were tailored to the target group. RESULTS The study recruited 67 disadvantaged men at high risk of alcohol-related harm, exceeding the target of 60. Evaluation showed that 95% of text messages were delivered, and the men engaged enthusiastically with the intervention. Retention at follow up was 96%. Outcomes were successfully measured on all men followed up. This provided data for the sample size calculation for the full trial. Post-study evaluation showed high levels of satisfaction with the study. DISCUSSION AND CONCLUSIONS This study has shown that disadvantaged men can be recruited and follow-up data obtained in an alcohol intervention study. The study methods were acceptable to the participants. The men recruited were at high risk of alcohol-related harms. It also clarified ways in which the recruitment strategy, the baseline questionnaire and the intervention could be improved. The full trial is currently underway. [Crombie IK, Irvine L, Falconer DW, Williams B, Ricketts IW, Jones C, Humphris G, Norrie J, Slane P, Rice P. Alcohol and disadvantaged men: A feasibility trial of an intervention delivered by mobile phone. Drug Alcohol Rev 2017;36:468-476].
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Affiliation(s)
- Iain K. Crombie
- Division of Population Health SciencesUniversity of DundeeDundeeUnited Kingdom
| | - Linda Irvine
- Division of Population Health SciencesUniversity of DundeeDundeeUnited Kingdom
| | - Donald W. Falconer
- Division of Population Health SciencesUniversity of DundeeDundeeUnited Kingdom
| | - Brian Williams
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUnited Kingdom
| | | | - Claire Jones
- Health Informatics CentreUniversity of DundeeDundeeUnited Kingdom
| | - Gerry Humphris
- Bute Medical SchoolUniversity of St AndrewsSt AndrewsUnited Kingdom
| | - John Norrie
- Edinburgh Clinical Trials Unit (ECTU)University of EdinburghEdinburghUnited Kingdom
| | - Peter Slane
- Arthurstone Medical CentreNHS TaysideDundeeUnited Kingdom
| | - Peter Rice
- Division of Neuroscience, School of MedicineUniversity of DundeeDundeeUnited Kingdom
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Harrison A, Robinson C, Williams G, Clough G, Owusu MW, Verma A. Utilizing community and voluntary sector partnerships to survey and compare the health outcomes of hard-to- reach groups to the wider community-the EURO- URHIS 2 Hard-to-Reach Project. Eur J Public Health 2017; 27:50-55. [PMID: 26420845 DOI: 10.1093/eurpub/ckv140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background This article describes the Hard-to-Reach (HtR) Project that was developed to capture health and lifestyle data from groups who are HtR by postal surveys within the larger EURO-URHIS 2 project. By collaborating with partner organizations, data were collected using standard survey tools, allowing for comparison with the wider population. Following a scoping exercise to determine which groups were HtR in Greater Manchester, black and minority ethnic (BME) groups and students were selected. BME groups were surveyed through partnership with Community and Voluntary Sector Organizations (CVSOs). Language barriers were addressed through the recruitment of volunteer interpreters. Students were surveyed by accessing university premises. Fifteen survey visits took place at nine CVSOs and five visits to University facilities. In total, 144 eligible surveys were collected. There were significant differences for both HtR groups, compared with Greater Manchester and the EURO-URHIS 2 mean. Both HtR groups had worse outcomes than both Greater Manchester and EURO-URHIS 2 for psychological problems. In addition, students had worse outcomes for passive smoking, binge drinking, use of cannabis, lack of access to green spaces, less sense of belonging and social cohesion and damp or mildewed homes, and better outcomes for self-perceived health and overweight and obesity. BME had in addition worse outcomes than both Greater Manchester and EURO-URHIS 2 for long-standing restrictive illness. Despite the limitations of this study, the development of this methodology allowed for the collection of comparable data, showing up statistically significant differences between the HtR populations and the wider population which merits further investigation.
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Abstract
Little is known about long-term care workers’ cardiovascular disease (CVD) risk. Thus, the authors used baseline objective and subjective data from 98 long-term care staff participating in a worksite health promotion study to provide a comprehensive CVD assessment. The median age of the sample was 32 years ( SD = 13.38). Nine (12.2%) participants smoked and 27 (37.0%) participants reported exposure to secondhand smoke. The average nightly hours of sleep was 6.5 ( SD = 1.18), with 24 (32%) participants reporting sleeping at least fairly bad. Sixty-eight participants (73.1%) were overweight or obese. The median aerobic activity was 0 ( SD = 18.56). Participants ate on average 27 ( SD = 17.34) servings of high fatty and/or salty foods per week. Although blood pressure and cholesterol levels were within normal limits, this population demonstrated poor behavioral CVD risk factors. Given this finding and the young age of the sample, these workers may be ideal candidates for health promotion efforts before health risk factors are present.
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Doran K, Resnick B, Kim N, Lynn D, McCormick T. Applying the Social Ecological Model and Theory of Self-Efficacy in the Worksite Heart Health Improvement Project-PLUS. Res Theory Nurs Pract 2017; 31:8-27. [DOI: 10.1891/1541-6577.31.1.8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Long-term care (LTC) employees are at high risk for cardiovascular disease. Despite the documented benefits of worksite health promotion (WHP) programs for employees and employers and the potential benefits to residents in LTC facilities, LTC employees are rarely offered WHP programs. Purpose: The purpose of the intervention described in this article is to reduce cardiovascular disease risk factors among LTC workers using a physical activity, nutrition, and stress management WHP implemented during paid work time with 98 LTC staff members. Methods: This article describes a 9-month physical activity, nutrition, and stress management WHP intervention delivered during paid work time to reduce the cardiovascular disease risk of employees working in LTC. The intervention is rooted in the social ecological model and social cognitive theory. The intervention is based on formative research and evidence-based practice recommendations and is specifically designed to reduce barriers to intervention participation (e.g., inconsistent break times and unpredictable resident care needs) and enhance motivators to program participation (e.g., enhanced social support). Results: The intervention is ongoing, but measures are described. Conclusion: As more employers offer WHP programs, it is important that programs are tailored to meet specific employee groups and work environments. This article operationalizes a WHP research protocol with LTC employees that can be applied to reduce cardiovascular disease risk in LTC employees or similar employee groups in similar work environments.
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Cheong AT, Khoo EM, Tong SF, Liew SM. To Check or Not to Check? A Qualitative Study on How the Public Decides on Health Checks for Cardiovascular Disease Prevention. PLoS One 2016; 11:e0159438. [PMID: 27415432 PMCID: PMC4945067 DOI: 10.1371/journal.pone.0159438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 07/01/2016] [Indexed: 01/25/2023] Open
Abstract
Background More than half of the general population does not attend screening for cardiovascular diseases (CVD) hence they are unaware of their risks. The objective of this study was to explore the views and experiences of the public in deciding to undergo health checks for CVD prevention. Methods This was a qualitative study utilising the constructivist grounded theory approach. A total of 31 individuals aged 30 years and above from the community were sampled purposively. Eight interviews and six focus groups were involved, using a semi-structured topic guide. Results A conceptual framework was developed to explain the public’s decision-making process on health check participation for CVD prevention. The intention to participate in health checks was influenced by the interplay between perceived relevance and the individual’s readiness to face the outcome of health checks. Health checks were deemed relevant if people perceived themselves to be at risk of CVD and there was an advantage in knowing their cardiovascular status. People were ready to face the outcome of health checks if they wanted to know the results and were prepared to deal with the subsequent management. The decision to participate in health checks was also influenced by external factors such as the views of significant others, and the accessibility and availability of resources including time and finances. Conclusions The intention to screen for CVD is motivated by two internal factors: the perceived relevance of the disease and readiness to face screening outcomes. Strategies targeting the internal decision-making process may prove to be key in improving the uptake of screening.
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Affiliation(s)
- Ai Theng Cheong
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Attwood S, Morton KL, Mitchell J, Van Emmenis M, Sutton S. Reasons for non-participation in a primary care-based physical activity trial: a qualitative study. BMJ Open 2016; 6:e011577. [PMID: 27217288 PMCID: PMC4885436 DOI: 10.1136/bmjopen-2016-011577] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore reasons for non-participation in a primary care-based physical activity trial and understand how these may contribute to recruitment of non-representative research samples. We also aimed to elicit non-participants' own recommendations for enhancing trial uptake in primary care. DESIGN Semistructured telephone interviews with non-participants to a randomised controlled trial of a very brief intervention for promoting physical activity conducted in primary care (the Very Brief Interventions trial), with thematic analysis of interview transcripts. SETTING 5 general practice (GP) surgeries in the East of England, UK. PARTICIPANTS Interviews were completed with 10 female and 6 male non-participants of white ethnicity and aged between 40 and 71 years. 13 of the 16 interviewees were either active or moderately active according to the GP Physical Activity Questionnaire (GPPAQ). RESULTS Interviewees discussed a range of reasons for non-participation. These included beliefs surrounding the personal relevance of the trial based on preconceptions of intervention content. Many interviewees considered themselves either sufficiently active or too functionally limited to increase activity levels further, so rendering participation pointless in their view. Other identified barriers included a lack of free time, for trial participation and for increasing physical activity, and dissatisfaction with appointment scheduling systems in place at GP surgeries. Interviewees questioned the appropriateness of primary care as a context for delivering interventions to promote physical activity. In general, interviewees were positively disposed towards the idea of trial participation, especially if personal benefits are made salient, but suggested that interventions could be delivered in a different setting such as the internet. CONCLUSIONS To increase participation in physical activity promotion trials conducted in primary care, the content of invitation materials and procedures for contacting potential participants require reconsideration. Specific recommendations include streamlining intervention materials and enhancing their relevance to the health concerns of invitees. TRIAL REGISTRATION NUMBER ISRCTN72691150; Pre-results.
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Affiliation(s)
- S Attwood
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - K L Morton
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - J Mitchell
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - M Van Emmenis
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - S Sutton
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Shaw RL, Holland C, Pattison HM, Cooke R. Patients' perceptions and experiences of cardiovascular disease and diabetes prevention programmes: A systematic review and framework synthesis using the Theoretical Domains Framework. Soc Sci Med 2016; 156:192-203. [DOI: 10.1016/j.socscimed.2016.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 02/16/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022]
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Sallis A, Bunten A, Bonus A, James A, Chadborn T, Berry D. The effectiveness of an enhanced invitation letter on uptake of National Health Service Health Checks in primary care: a pragmatic quasi-randomised controlled trial. BMC FAMILY PRACTICE 2016; 17:35. [PMID: 27009045 PMCID: PMC4806508 DOI: 10.1186/s12875-016-0426-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/29/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The National Health Service Health Check (NHS HC) is a population level public health programme. It is a primary prevention initiative offering cardiovascular risk assessment and management for adults aged 40-74 years (every five years). It was designed to reduce the incidence of major vascular disease events by preventing or delaying the onset of diabetes, heart and kidney disease, stroke and vascular dementia . Effectiveness of the programme has been modelled on a national uptake of 75% however in 2012/13 uptake, nationally, was 49%. Ensuring a high percentage of those offered an NHS HC actually receive one is key to optimising the clinical and cost effectiveness of the programme. METHODS A pragmatic quasi-randomised controlled trial was conducted in four general practitioner practices in Medway, England with randomisation of 3511 patients. The aim was to compare attendance at the NHS HC using the standard national invitation template letter (control) compared to an enhanced invitation letter using insights from behavioural science (intervention). The intervention letter includes i) simplification - reducing letter content for less effortful processing ii) behavioural instruction - action focused language iii) personal salience - appointment due rather than invited and iv) addressing implementation intentions with a tear off slip to record the date, time and location of the appointment. Logistic Regression explored the association between control and intervention group and attendance at a health check. RESULTS 29.3% of patients who received the control letter and 33.5% of those who received the intervention letter attended their NHS HC (adjusted odds ratio 1.26, 95% confidence interval 1.09-1.47, p < 0.01). This was an absolute difference in uptake of 4.2 percentage points for those receiving the intervention letter. CONCLUSIONS An invitation letter applying behavioural insights was more effective than the existing national template letter at encouraging attendance at an NHS HC. Making small, no cost behaviourally informed changes to letter invitations can improve uptake of the NHS HC. Further research is required to replicate the effect with more robust methodology and powered for sub-group analysis including socio-economic status. TRIAL REGISTRATION Current Controlled Trials ISRCTN66757664 , date of registration 28/3/2014.
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Affiliation(s)
- Anna Sallis
- Public Health England, 2nd Floor Skipton house, 80 London Road, London, SE1 6LH, UK.
| | - Amanda Bunten
- Public Health England, 2nd Floor Skipton house, 80 London Road, London, SE1 6LH, UK
| | - Annabelle Bonus
- Department of Health, 5th Floor Richmond House, 79 Whitehall, London, SW1A 2NS, UK
| | - Andrew James
- Department of Health, 5th Floor Richmond House, 79 Whitehall, London, SW1A 2NS, UK
| | - Tim Chadborn
- Public Health England, 2nd Floor Skipton house, 80 London Road, London, SE1 6LH, UK
| | - Daniel Berry
- Department of Health, 5th Floor Richmond House, 79 Whitehall, London, SW1A 2NS, UK
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Returning to work after electrical injuries: workers' perspectives and advice to others. J Burn Care Res 2015; 35:498-507. [PMID: 25100540 DOI: 10.1097/bcr.0000000000000041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study was to gain an understanding of workers' experiences with returning to work, the challenges they experienced, and the supports they found most beneficial when returning to work after a workplace electrical injury. Thirteen semistructured qualitative telephone interviews were conducted with individuals who experienced an electrical injury at the workplace. Participants were recruited from specialized burns rehabilitation programs in Ontario, Canada. Interviews were transcribed verbatim and thematic analysis used to analyze the qualitative interviews. Data regarding workers' demographics, injury events, and occupational categories were also gathered to characterize the sample.Participants identified three distinct categories of challenges: 1) physical, cognitive, and psychosocial impairments and their effects on their work performance; 2) feelings of guilt, blame, and responsibility for the injury; and 3) having to return to the workplace or worksite where the injury took place. The most beneficial supports identified by the injured workers included: 1) support from family, friends, and coworkers; and 2) the receipt of rehabilitation services specialized in electrical injury. The most common advice to others after electrical injuries included: 1) avoiding electrical injury; 2) feeling ready to return to work; 3) filing a Workplace Safety and Insurance Board injury/claims report;4) proactive self-advocacy; and 5) garnering the assistance of individuals who understood electrical injuries to advocate on their behalf. Immediate and persistent physical, cognitive, psychosocial, and support factors can affect individuals' abilities to successfully return to work after an electrical injury. Specialized services and advocacy were viewed as beneficial to successful return to work.
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Mansfield E, Stergiou-Kita M, Cassidy JD, Bayley M, Mantis S, Kristman V, Kirsh B, Gomez M, Jeschke MG, Vartanian O, Moody J, Colantonio A. Return-to-work challenges following a work-related mild TBI: The injured worker perspective. Brain Inj 2015; 29:1362-9. [PMID: 26287754 DOI: 10.3109/02699052.2015.1053524] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To explore how individuals with work-related mild traumatic brain injury (wrMTBI) experience return-to-work (RTW) processes when returning to the workplace where the injury occurred. DESIGN RTW experiences were explored using in-depth interviews and an inductive analytic approach. Qualitative analysis guided by the research question moved through phases of line-by-line and thematic coding through which categories and the interaction between categories emerged. PARTICIPANTS Twelve workers diagnosed with a wrMTBI reported on their RTW experiences following wrMTBIs that occurred 3-5 years prior to the time of the interview. MAIN OUTCOMES AND RESULTS Participants perceived employer and workers' compensation factors as profoundly influencing their RTW experiences. Participants consistently reported that employers and workers' compensation representatives had an inadequate understanding of wrMTBI sequelae. Six of 12 participants were re-injured following their wrMTBI, with three of these injuries occurring at work. CONCLUSION Employers, co-workers and workers' compensation representatives should be aware of wrMTBI sequelae so injured workers can receive appropriate supports and both stigmatization and re-injury can be mitigated. Greater attention to the structural and social elements of workplace and compensation environments could inform strategies to break down barriers to successful return-to-work following a wrMTBI.
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Affiliation(s)
| | - Mary Stergiou-Kita
- a University of Toronto , Toronto , ON , Canada .,b Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada .,c Institute for Work & Health , Toronto , ON , Canada
| | | | - Mark Bayley
- a University of Toronto , Toronto , ON , Canada .,b Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada
| | - Steve Mantis
- e Ontario Network of Injured Workers' Groups , Kaministiquia , ON , Canada
| | - Vicki Kristman
- a University of Toronto , Toronto , ON , Canada .,c Institute for Work & Health , Toronto , ON , Canada .,f Lakehead University , Thunder Bay , ON , Canada
| | | | | | - Mark G Jeschke
- a University of Toronto , Toronto , ON , Canada .,g Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre , Toronto , ON , Canada .,h Sunnybrook Research Institute , Toronto , ON , Canada , and
| | | | - Joel Moody
- i Electrical Safety Authority , Mississauga , ON , Canada
| | - Angela Colantonio
- a University of Toronto , Toronto , ON , Canada .,b Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada
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Hammal F, Chappell A, Pohoreski K, Finegan BA. Expanding the reach of the Quitline by engaging volunteers to market it in hospitals and shopping venues - a pilot study. Tob Induc Dis 2015; 13:13. [PMID: 26074751 PMCID: PMC4465019 DOI: 10.1186/s12971-015-0040-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, although there are periodic media campaigns to raise awareness of Quitlines, these services are underused. We sought to determine if a dedicated kiosk, similar to that used in the retail industry but staffed by volunteers trained in smoking cessation techniques, would be effective method to enhance Quitline reach. METHODS We located a kiosk in the foyer of two hospitals and in two shopping malls in Edmonton, Canada between Feb/2012 and July/2014. The cessation intervention was based on the 5 A's approach. Outcome was assessed by number of visits to the kiosk and referral rates to the Quitline. A cross sectional survey among small sample of visitors was used for evaluation. Descriptive statistics were used to summarize visitors' data. RESULTS Of 1091 kiosk visitors, 53.3 % were current smokers, of whom 93.3 % indicated a willingness to quit. Of these, 32.1 % requested a Quitline referral at the time of the kiosk visit. Referral requests to the Quitline were greater when the kiosk was located in the non-hospital setting 39.1 % compared to 31.1 % in hospitals (P = 0.2). Referrals from the kiosk represented 6 % of total referrals received by the provincial Quitline during the study period. Following referral the Quitline was able to reach 50 % of those referred, of those, 17 % refused to proceed. At seven month follow up 30 day abstinence rate was 3.8 % of smokers who wished quit. Visitors agreed that the kiosk design was interesting (89.3 %) and increased their knowledge about tobacco and cessation options (88.8 %) and encouraged them to take action to quit (85.7 %). CONCLUSIONS A "volunteer manned kiosk" can increase awareness of smoking cessation resources in the community and increase referral rates to Quitline services.
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Affiliation(s)
- Fadi Hammal
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
| | - Alyssa Chappell
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
| | - Katherine Pohoreski
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
| | - Barry A. Finegan
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
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Stergiou-Kita M, Mansfield E, Sokoloff S, Colantonio A. Gender Influences on Return to Work After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2015; 97:S40-5. [PMID: 25921979 DOI: 10.1016/j.apmr.2015.04.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/28/2015] [Accepted: 04/03/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the influence of gender on the return to work experience of workers who sustained a work-related mild traumatic brain injury (TBI). DESIGN Qualitative study using in-depth telephone interviews. SETTING Community. PARTICIPANTS Purposive sampling was used to recruit participants. Participants were adults (N=12; males, n=6, females, n=6) with a diagnosis of mild TBI sustained through a workplace injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Not applicable. RESULTS Our findings suggest that gender impacts return to work experiences in multiple ways. Occupational and breadwinner roles were significant for both men and women after work-related mild TBI. Women in this study were more proactive than men in seeking and requesting medical and rehabilitation services; however, the workplace culture may contribute to whether and how health issues are discussed. Among our participants, those who worked in supportive, nurturing (eg, feminine) workplaces reported more positive return to work (RTW) experiences than participants employed in traditionally masculine work environments. For all participants, employer and coworker relations were critical elements in RTW outcomes. CONCLUSIONS The application of a gender analysis in this preliminary exploratory study revealed that gender is implicated in the RTW process on many levels for men and women alike. Further examination of the work reintegration processes that takes gender into account is necessary for the development of successful policy and practice for RTW after work-related MTBI.
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Affiliation(s)
- Mary Stergiou-Kita
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Institute of Work and Health, Toronto, ON, Canada
| | - Elizabeth Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Sandra Sokoloff
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Angela Colantonio
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
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Ellis N, Gidlow C, Cowap L, Randall J, Iqbal Z, Kumar J. A qualitative investigation of non-response in NHS health checks. ACTA ACUST UNITED AC 2015; 73:14. [PMID: 25825674 PMCID: PMC4377903 DOI: 10.1186/s13690-015-0064-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/24/2015] [Indexed: 11/28/2022]
Abstract
Background Improving uptake of NHS Health Checks has become a priority in England, but there is a lack of data on the perceptions of programme non-attenders. This study aimed to explore how non-attenders of NHS Health Checks perceive the programme, identify reasons for non-attendance and inform strategies to improve uptake. Method This qualitative study involved individuals registered at four general practices in Stoke-on-Trent, UK, who had not taken up their invitation to a NHS Health Check. Semi-structured face-to-face and telephone interviews were audio-recorded and transcribed verbatim for Thematic Analysis. Results Interviews were completed with 19 males and 22 females (mean age 52.9 ± 8.5 years), who were socio-demographically representative of the non-attender population. Four main themes identified related to: the positive perception of the Health Check concept among non-attenders; the perceived lack of personal relevance; ineffective invitation method and appointment inconvenience were common barriers; previous experience of primary care can influence uptake. Conclusions Fundamental requirements for improving uptake are that individuals recognise the personal relevance of Health Checks and that attendance is convenient. Incorporating more sophisticated and personalised risk communication as part of the invitation could increase impact and promote candidacy. Flexibility and convenience of appointments should be considered by participating general practices.
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Affiliation(s)
- Naomi Ellis
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Christopher Gidlow
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Lisa Cowap
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Jason Randall
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK
| | - Zafar Iqbal
- Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK ; Stoke-on-Trent City Council Public Health Directorate, Civic Centre, Glebe Street, Stoke-on-Trent, ST4 1HH UK
| | - Jagdish Kumar
- Havering Public Health, Mercury House, 12th Floor, Mercury Gardens, Romford, Essex RM1 3DW UK
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Be SMART: examining the experience of implementing the NHS Health Check in UK primary care. BMC FAMILY PRACTICE 2015; 16:1. [PMID: 25608667 PMCID: PMC4308836 DOI: 10.1186/s12875-014-0212-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/15/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The NHS Health Check was designed by UK Department of Health to address increased prevalence of cardiovascular disease by identifying risk levels and facilitating behaviour change. It constituted biomedical testing, personalised advice and lifestyle support. The objective of the study was to explore Health Care Professionals' (HCPs) and patients' experiences of delivering and receiving the NHS Health Check in an inner-city region of England. METHODS Patients and HCPs in primary care were interviewed using semi-structured schedules. Data were analysed using Thematic Analysis. RESULTS Four themes were identified. Firstly, Health Check as a test of 'roadworthiness' for people. The roadworthiness metaphor resonated with some patients but it signified a passive stance toward illness. Some patients described the check as useful in the theme, Health check as revelatory. HCPs found visual aids demonstrating levels of salt/fat/sugar in everyday foods and a 'traffic light' tape measure helpful in communicating such 'revelations' with patients. Being SMART and following the protocolrevealed that few HCPs used SMART goals and few patients spoke of them. HCPs require training to understand their rationale compared with traditional advice-giving. The need for further follow-up revealed disparity in follow-ups and patients were not systematically monitored over time. CONCLUSIONS HCPs' training needs to include the use and evidence of the effectiveness of SMART goals in changing health behaviours. The significance of fidelity to protocol needs to be communicated to HCPs and commissioners to ensure consistency. Monitoring and measurement of follow-up, e.g., tracking of referrals, need to be resourced to provide evidence of the success of the NHS Health Check in terms of healthier lifestyles and reduced CVD risk.
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Yom Din G, Zugman Z, Khashper A. The impact of preventive health behaviour and social factors on visits to the doctor. Isr J Health Policy Res 2014; 3:41. [PMID: 25584186 PMCID: PMC4290136 DOI: 10.1186/2045-4015-3-41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 12/02/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The aim of this study is to examine the joint impact of preventive health behavior (PHB) and social and demographic factors on the utilization of primary and secondary medical care under a universal health care system, as measured by visits to the doctor, who were categorized as either a General Practitioner (GP) or Specialist Doctor (SD). METHODS An ordered probit model was utilized to analyze data obtained from the 2009 Israeli National Health Survey. The problem of endogeneity between PHB factors and visits to GP was approached using the two-stage residuals inclusion and instrumental variables method. RESULTS We found a positive effect of PHB on visits to the doctor while the addition of the PHB factors to the independent variables resulted in important changes in explaining visits to GP (in values of the estimates, in their sign, and in their statistical significance), and only in slight changes for visits to SD. A 1% increase in PHB factors results in increasing the probability to visit General Practitioner in the last year in 0.6%. The following variables were identified as significant in explaining frequency of visits to the doctor: PHB, socio-economic status (pro-poor for visits to GP, pro-rich for visits to SD), location (for visits to SD), gender, age (age 60 or greater being a negative factor for visits to GP and a positive factor for visits to SD), chronic diseases, and marital status (being married was a negative factor for visits to GP and a positive factor for visits to SD). CONCLUSIONS There is a need for allowing for endogeneity in examining the impact of PHB, social and demographic factors on visits to GP in a population under universal health insurance. For disadvantaged populations with low SES and those living in peripheral districts, the value of IndPrev is lower than for populations with high SES and living in the center of the country. Examining the impact of these factors, significant differences in the importance and sometimes even in the sign of their influence on visits to different categories of doctors - GP and SD, are found.
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Affiliation(s)
- Gregory Yom Din
- />The Open University of Israel, Raanana, Israel, Faculty of Exact Sciences, Tel-Aviv University, Tel-Aviv, Israel
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Ulbricht S, Groß S, Meyer C, Hannöver W, Nauck M, John U. Reducing tobacco smoke exposure in children aged below 4 years - a randomized controlled trial. Prev Med 2014; 69:208-13. [PMID: 25456808 DOI: 10.1016/j.ypmed.2014.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/09/2014] [Accepted: 10/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore the reach of a German population-based household sample using proactive recruitment and to test the efficacy of a behavioral change counseling intervention including feedback about children's urine cotinine level (CUCL). METHODS A randomized controlled trial (2008-2010) was conducted in households with at least one child aged below 4years and at least one current smoker. The study area comprised of 3570 households. A screening assessment was provided in 2641 households; 1282 included one current smoker and 852 completed the study protocol. The intervention group (IG; n=428) received feedback about CUCL and up to two counseling sessions. The control group (CG; n=424) received a leaflet. Assessments were provided at baseline and 12-month follow-up. Heckman's selection model analysis was used to consider the detection limit of cotinine in urine (10ng/ml). RESULTS CUCL below the detection limit in the IG was found in 43.2% at baseline and 44.6% at follow-up and in 44.8% of the CG at baseline and 47.2% at follow-up. The CUCL difference between follow-up and baseline was smaller in the CG than in the IG. The effect was not significant. CONCLUSIONS Data revealed a high reach of the target population but failed to identify an intervention effect. Clinical Trial Registration www.clinicaltrials.gov (NCT00647413).
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Affiliation(s)
- Sabina Ulbricht
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany.
| | - Stefan Groß
- Department for Internal Medicine B, University Medicine Greifswald, Sauerbruchstr., 17475 Greifswald, Germany.
| | - Christian Meyer
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany.
| | - Wolfgang Hannöver
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 46, 17475 Greifswald, Germany.
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Sauerbruchstr., 17475 Greifswald, Germany.
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany.
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Burgess C, Wright AJ, Forster AS, Dodhia H, Miller J, Fuller F, Cajeat E, Gulliford MC. Influences on individuals' decisions to take up the offer of a health check: a qualitative study. Health Expect 2014; 18:2437-48. [PMID: 24889817 DOI: 10.1111/hex.12212] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Health checks are promoted to evaluate individuals' risk of developing disease and to initiate health promotion and disease prevention interventions. The NHS Health Check is a cardiovascular risk assessment programme introduced in the UK aimed at preventing cardiovascular disease (CVD). Uptake of health checks is lower than anticipated. This study aimed to explore influences on people's decisions to take up the offer of a health check. METHODS Semi-structured interviews were conducted with people registered at four general practices in South London. The interview schedule was informed by the Theoretical Domains Framework. Data were analysed qualitatively using the Framework method using NVivo for data management. RESULTS Twenty-seven participants invited for a health check were included in the study. Seventeen received the health check while 10 either did not attend or failed to complete the check. Five themes emerging from the data included a lack of awareness of the health check programme, beliefs about susceptibility to CVD, beliefs about civic responsibility, issues concerning access to appointments, and beliefs about the consequences of having a check. CONCLUSIONS Health check programmes need to raise public awareness to ensure that people are informed about the objectives and nature of the programme in order to reach an informed decision about taking up the invitation. Emphasizing the benefits of prevention and early detection might encourage attendance in those who are reluctant to burden the public health-care systems. Extending outreach initiatives and increasing 'out of hours' provision at local community sites could facilitate access.
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Affiliation(s)
- Caroline Burgess
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Alison J Wright
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Alice S Forster
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Hiten Dodhia
- Lambeth & Southwark Public Health, Southwark Council, London, UK
| | - Jane Miller
- Lewisham Clinical Commissioning Group, London, UK
| | | | - Eric Cajeat
- Lambeth & Southwark Public Health, Southwark Council, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Reaching families at their homes for an intervention to reduce tobacco smoke exposure among infants. J Community Health 2013; 38:215-20. [PMID: 22864794 DOI: 10.1007/s10900-012-9602-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The methods of reaching families for a home intervention trial (HIT) were analyzed in this study. The study aimed to reduce environmental tobacco smoke exposure among infants in one region of Germany. The systematic screening data of smoking among families in their homes were compared with reference data of a representative household sample of the state in which the study was conducted. The characteristics of participating and non-participating families were analyzed. All households (N = 3,570) containing at least one infant age 3 years or younger were selected using the residents` registration files and invited to participate in a screening assessment. Among these families, 3,293 (92.2 %) were contacted and from that group, 2,641 families participated in the screening. Compared with the reference sample, the screened sample included a higher proportion of families with employment and with more than 10 years of education. Participation in the HIT was recommended if at least one parent reported smoking one or more cigarettes per day during the previous 4 weeks. Among the 1,282 families that met the inclusion criteria, 71.5 % took part in the screening. Participating families, compared with non-participating families, were older, included more families with two parents living in the household, and had higher rates of employment. The effect size of the final regression model was small (Cohen's f (2) = 0.01). In conclusion, proactive approaches that are delivered at home may yield a high reach of the target population and particularly of socioeconomically disadvantaged populations.
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Winsor S, Smith A, Vanstone M, Giacomini M, Brundisini FK, DeJean D. Experiences of patient-centredness with specialized community-based care: a systematic review and qualitative meta-synthesis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2013; 13:1-33. [PMID: 24228080 PMCID: PMC3817855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Specialized community-based care (SCBC) endeavours to help patients manage chronic diseases by formalizing the link between primary care providers and other community providers with specialized training. Many types of health care providers and community-based programs are employed in SCBC. Patient-centred care focuses on patients' psychosocial experience of health and illness to ensure that patients' care plans are modelled on their individual values, preferences, spirituality, and expressed needs. OBJECTIVES To synthesize qualitative research on patient and provider experiences of SCBC interventions and health care delivery models, using the core principles of patient-centredness. DATA SOURCES This report synthesizes 29 primary qualitative studies on the topic of SCBC interventions for patients with chronic conditions. Included studies were published between 2002 and 2012, and followed adult patients in North America, Europe, Australia, and New Zealand. REVIEW METHODS Qualitative meta-synthesis was used to integrate findings across primary research studies. RESULTS Three core themes emerged from the analysis: patients' health beliefs affect their participation in SCBC interventions;patients' experiences with community-based care differ from their experiences with hospital-based care;patients and providers value the role of nurses differently in community-based chronic disease care. LIMITATIONS Qualitative research findings are not intended to generalize directly to populations, although meta-synthesis across several qualitative studies builds an increasingly robust understanding that is more likely to be transferable. The diversity of interventions that fall under SCBC and the cross-interventional focus of many of the studies mean that findings might not be generalizable to all forms of SCBC or its specific components. CONCLUSIONS Patients with chronic diseases who participated in SCBC interventions reported greater satisfaction when SCBC helped them better understand their diagnosis, facilitated increased socialization, provided them with a role in managing their own care, and assisted them in overcoming psychological and social barriers. PLAIN LANGUAGE SUMMARY More and more, to reduce bed shortages in hospitals, health care systems are providing programs called specialized community-based care (SCBC) to patients with chronic diseases. These SCBC programs allow patients with chronic diseases to be managed in the community by linking their family physicians with other community-based health care providers who have specialized training. This report looks at the experiences of patients and health care providers who take part in SCBC programs, focusing on psychological and social factors. This kind of lens is called patient-centred. Three themes came up in our analysis: patients' health beliefs affect how they take part in SCBC interventions; patients' experiences with care in the community differ from their experiences with care in the hospital; patients and providers value the role of nurses differently. The results of this analysis could help those who provide SCBC programs to better meet patients' needs.
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Crombie IK, Falconer DW, Irvine L, Williams B, Ricketts IW, Humphris G, Norrie J, Rice P, Slane PW. Reducing alcohol-related harm in disadvantaged men: development and feasibility assessment of a brief intervention delivered by mobile telephone. PUBLIC HEALTH RESEARCH 2013. [DOI: 10.3310/phr01030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AbstractBackgroundSocially disadvantaged men suffer substantial harm from heavy drinking. Brief alcohol interventions are effective in reducing consumption when delivered via health care. There is a need for tailored brief interventions for disadvantaged men who seldom attend health care.Objectives(1) To investigate the best ways to recruit and retain disadvantaged men in a study aimed at reducing the frequency of heavy drinking. (2) To identify the type of content and timing of the delivery that is most likely to engage disadvantaged young to middle-aged men in an intervention delivered by text messages. (3) To determine whether or not the intervention is likely to be an acceptable way to influence the frequency of heavy drinking.DesignA three-phase study involving the development of the recruitment strategy and the intervention, an assessment of the feasibility of a randomised controlled trial, and a post-study evaluation.SettingCommunity-based study, conducted in Dundee, UK.ParticipantsDisadvantaged men aged 25–44 years who had two or more episodes of heavy drinking (≥ 8 units in a single session) in the preceding month. Two recruitment strategies were employed: recruitment through general practice (GP) registers and recruitment through a community outreach strategy.InterventionsFocus groups explored drinking motives and behaviours of the target group. The intervention also drew on reviews of the literature on: alcohol brief interventions, text message studies, communication theory and behaviour change theories and techniques. The intervention group received 36 text messages with images sent over a 28-day period.Main outcome measuresThe outcome measures evaluated the likely success of a full trial: recruitment of the participants; construction and delivery of a theoretically and empirically based intervention that successfully engages disadvantaged men; potential for the intervention to influence binge drinking.ResultsThe focus group analyses identified that personal experience and knowledge of the harmful effects of alcohol was widespread. Furthermore, there was a discrepancy between frequent binge drinking and perceived social expectations and duties. This could usefully be targeted in the intervention. Theoretically and empirically based behaviour change strategies were successfully rendered in attractive, colourful, brief text messages. Both recruitment strategies (GP registers and community outreach) proved successful and a total of 67 men were recruited, exceeding the target of 60. The participants were at high risk of harm because of frequent episodes of heavy binge drinking. Baseline interviews established that those recruited through community outreach drank substantially more and had more frequent binge drinking sessions than those recruited through GP registers. Retention at follow-up was 96%. Extensive process evaluation was conducted. The evaluation showed that 95% of text messages were successfully delivered to participants' telephones. Furthermore, there was a high level of engagement with text messages which sought responses. Most men replied to these texts, often giving carefully structured personal responses. Analyses of the responses indicated a high level of engagement with key components of the behaviour change strategy. Post-trial evaluation showed high levels of satisfaction with the intervention.ConclusionsThis study has shown that disadvantaged men can be recruited and retained in an alcohol intervention trial. A theoretically and empirically based intervention was successfully delivered by text message. Furthermore, the messages were well received and elicited the types of response intended. A full trial of the intervention, incorporating a cost-effectiveness study, should be carried out.Study registrationThis study is registered as ISRCTN10515845.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- IK Crombie
- School of Medicine, University of Dundee, Dundee, UK
| | - DW Falconer
- School of Medicine, University of Dundee, Dundee, UK
| | - L Irvine
- School of Medicine, University of Dundee, Dundee, UK
| | - B Williams
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - IW Ricketts
- School of Computing, University of Dundee, Dundee, UK
| | - G Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | - J Norrie
- Centre for Health Care Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - P Rice
- NHS Substance Abuse Services, Stracathro Hospital, Brechin, UK
| | - PW Slane
- The Erskine Practice, Arthurstone Medical Centre, Dundee, UK
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Cohen D, Manuel DG, Tugwell P, Ramsay T, Sanmartin C. Inequity in primary and secondary preventive care for acute myocardial infarction? Use by socioeconomic status across middle-aged and older patients. Can J Cardiol 2013; 29:1579-85. [PMID: 23948088 DOI: 10.1016/j.cjca.2013.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/05/2013] [Accepted: 06/10/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There has been limited research exploring socioeconomic inequity in targeted preventive care for acute myocardial infarction (AMI). The objective of this study was to examine socioeconomic disparities in the use of primary and secondary preventive services relevant to the identification and management of heart disease in a cohort of patients with AMI. METHODS Preventive services used before the AMI event were examined in a cohort of 30,491 patients with first-time AMI in Ontario, Canada from 2010 to 2012. Using logistic regression, socioeconomic differences in lipid testing, glucose testing, stress testing, electrocardiography (ECG), and echocardiography in middle-aged and older patients were examined. RESULTS For many of the services, there were no differences in the use of primary and secondary preventive services between patients according to socioeconomic status; however, a number of exceptions were found. Controlling for other factors, we found that for primary preventive services, low-income middle-aged patients had 13% (95% confidence interval [CI], 0.790-0.967) and 10% (95% CI, 0.812-0.997) lower odds of receiving lipid and glucose testing, respectively, when compared with high-income middle-aged patients. Controlling for other factors, we found that for secondary preventive services, low-income middle-aged and older patients had 24% (95% CI, 1.087-1.415) and 10% (95% CI, 1.012-1.202) higher odds of receiving echocardiography when compared with their high-income counterparts. CONCLUSIONS Socioeconomic disparities in primary and secondary preventive services for patients with AMI could not be demonstrated in many instances. However, inequities in primary preventive care were found in middle-aged patients receiving lipid and glucose testing, which may have implications for Canadian health policy to ensure healthy aging across the age spectrum.
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Affiliation(s)
- Deborah Cohen
- Department of Population Health, University of Ottawa, Ontario, Canada.
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