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Almeida FA, You W, Brito FA, Alves TF, Goessl C, Wall SS, Seidel RW, Davy BM, Greenawald MH, Hill JL, Estabrooks PA. A randomized controlled trial to test the effectiveness of two technology-enhanced diabetes prevention programs in primary care: The DiaBEAT-it study. Front Public Health 2023; 11:1000162. [PMID: 36908422 PMCID: PMC9998510 DOI: 10.3389/fpubh.2023.1000162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
Objective To evaluate the effectiveness of two technology-enhanced interventions for diabetes prevention among adults at risk for developing diabetes in a primary care setting. Methods The DiaBEAT-it study employed a hybrid 2-group preference (Choice) and 3-group randomized controlled (RCT) design. This paper presents weight related primary outcomes of the RCT arm. Patients from Southwest Virginia were identified through the Carilion Clinic electronic health records. Eligible participants (18 and older, BMI ≥ 25, no Type 2 Diabetes) were randomized to either Choice (n = 264) or RCT (n = 334). RCT individuals were further randomized to one of three groups: (1) a 2-h small group class to help patients develop a personal action plan to prevent diabetes (SC, n = 117); (2) a 2-h small group class plus automated telephone calls using an interactive voice response system (IVR) to help participants initiate weight loss through a healthful diet and regular physical activity (Class/IVR, n = 110); or (3) a DVD with same content as the class plus the same IVR calls over a period of 12 months (DVD/IVR, n = 107). Results Of the 334 participants that were randomized, 232 (69%) had study measured weights at 6 months, 221 (66%) at 12 months, and 208 (62%) at 18 months. Class/IVR participants were less likely to complete weight measures than SC or DVD/IVR. Intention to treat analyses, controlling for gender, race, age and baseline BMI, showed that DVD/IVR and Class/IVR led to reductions in BMI at 6 (DVD/IVR -0.94, p < 0.001; Class/IVR -0.70, p < 0.01), 12 (DVD/IVR -0.88, p < 0.001; Class/IVR-0.82, p < 0.001) and 18 (DVD/IVR -0.78, p < 0.001; Class/IVR -0.58, p < 0.01) months. All three groups showed a significant number of participants losing at least 5% of their body weight at 12 months (DVD/IVR 26.87%; Class/IVR 21.62%; SC 16.85%). When comparing groups, DVD/IVR were significantly more likely to decrease BMI at 6 months (p < 0.05) and maintain the reduction at 18 months (p < 0.05) when compared to SC. There were no differences between the other groups. Conclusions The DiaBEAT-it interventions show promise in responding to the need for scalable, effective methods to manage obesity and prevent diabetes in primary care settings that do not over burden primary care clinics and providers. Registration https://clinicaltrials.gov/ct2/show/NCT02162901, identifier: NCT02162901.
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Affiliation(s)
- Fabio A Almeida
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| | - Wen You
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Fabiana A Brito
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| | - Thais F Alves
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| | - Cody Goessl
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Sarah S Wall
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Richard W Seidel
- Department of Psychiatry, Carilion Clinic, Roanoke, VA, United States
| | - Brenda M Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Mark H Greenawald
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA, United States
| | - Jennie L Hill
- Department of Populational Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Paul A Estabrooks
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
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Goodney P, Shah S, Hu YD, Suckow B, Kinlay S, Armstrong DG, Geraghty P, Patterson M, Menard M, Patel MR, Conte MS. A systematic review of patient-reported outcome measures patients with chronic limb-threatening ischemia. J Vasc Surg 2022; 75:1762-1775. [PMID: 35085747 PMCID: PMC9524582 DOI: 10.1016/j.jvs.2021.11.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/08/2021] [Indexed: 01/23/2023]
Abstract
Chronic limb-threatening ischemia (CLTI) causes significant morbidity with profound negative effects on health-related quality of life. As the prevalence of peripheral artery disease and diabetes continue to rise in our aging population, the public health impact of CLTI has escalated. Patient-reported outcome measures (PROMs) have become common and important measures for clinical evaluation in both clinical care and research. PROMs are important for the measurement of clinical effectiveness and cost effectiveness and for shared decision-making on treatment options. However, the PROMs used to describe the experience of patients with CLTI are heterogeneous, incomplete, and lack specific applicability to the underlying disease processes and diverse populations. For example, certain PROMs exist for patients with extremity wounds, and other PROMs exist for patients with pain, and still others exist for patients with vascular disease. Despite this multiplicity of tools, no single PROM encompasses all of the components necessary to describe the experiences of patients with CLTI. This significant unmet need is evident from both published reports and contemporary large-scale clinical trials in the field. In this systematic review, we review the current use of PROMs for patients with CLTI in clinical practice and in research trials and highlight the gaps that need to be addressed to develop a unifying PROM instrument for CLTI.
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Affiliation(s)
- Philip Goodney
- Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
| | - Samir Shah
- Vascular Surgery, University of Florida, Gainesville, Fla
| | - Yiyuan David Hu
- Geisel School of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Bjoern Suckow
- Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Scott Kinlay
- Cardiovascular Medicine, Boston Medical Center, Boston, Mass
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, Calif
| | - Patrick Geraghty
- Vascular Surgery, Washington University in St. Louis, St. Louis, Mo
| | | | - Matthew Menard
- Vascular Surgery, Brigham and Women's Hospital, Boston, Mass
| | | | - Michael S Conte
- Vascular Surgery, University of California, San Francisco, San Francisco, Calif
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Gallegos-Carrillo K, Reyes-Morales H, Pelcastre-Villafuerte B, García-Peña C, Lobelo F, Salmeron J, Salgado-de-Snyder N. Understanding adherence of hypertensive patients in Mexico to an exercise-referral scheme for increasing physical activity. Health Promot Int 2021; 36:952-963. [PMID: 33270847 DOI: 10.1093/heapro/daaa110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Among the strategies developed thus far for promoting physical activity (PA), exercise-referral schemes (ERs) have gained in popularity as an effective means of preventing secondary health conditions such as hypertension. However, information on the factors affecting adherence to these programs is limited. Using a mixed-methods approach, we undertook the present study to determine the factors associated with adherence to a specific ER aimed at increasing PA among the hypertensive patients in a Social Security institution in Mexico. Data were obtained through semi-structured questionnaires and interviews as well as from the clinical records of participants. For the quantitative component, multinomial regression analysis estimated the factors behind the varying levels of adherence. For the qualitative component, we performed a content analysis based on the health belief model. According to our findings, 80% of participants who began the ER exhibited high levels of adherence. Older age and being female were the key demographic characteristics of those showing increased adherence. Meanwhile, financial issues, the investment of time required, low perception of the benefits of PA, lack of confidence in being able to achieve changes in lifestyle, and a reluctance to acknowledge the seriousness of their health condition were the principal factors among those who did not join the program or exhibited low levels of adherence. Our findings can serve as a basis for designing PA interventions that take into account individual, cultural and administrative elements in their efforts to improve adherence to PA programs for those suffering from chronic conditions such as hypertension.
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Affiliation(s)
| | - Hortensia Reyes-Morales
- Information Center for Decisions in Public Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Carmen García-Peña
- Research Department, National Institute of Geriatrics, Mexico City, Mexico
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jorge Salmeron
- Academic Unit of Epidemiological Research, National Autonomous University of Mexico, Mexico City, Mexico
| | - Nelly Salgado-de-Snyder
- Health Systems Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Zurynski Y, Smith C, Siette J, Nic Giolla Easpaig B, Simons M, Knaggs GT. Identifying enablers and barriers to referral, uptake and completion of lifestyle modification programmes: a rapid literature review. BMJ Open 2021; 11:e045094. [PMID: 33771830 PMCID: PMC8006838 DOI: 10.1136/bmjopen-2020-045094] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To identify current, policy-relevant evidence about barriers and enablers associated with referral, uptake and completion of lifestyle modification programmes (LMPs) for secondary prevention of chronic disease in adults. DESIGN A rapid review, co-designed with policymakers, of peer-reviewed and grey literature using a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. DATA SOURCES Medline, Embase, Scopus, PsycINFO and CINAHL were searched for relevant studies and literature reviews. Grey literature was identified through Advanced Google searching and targeted searching of international health departments' and non-government organisations' websites. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Documents published 2010-2020, from high-income countries, reporting on programmes that included referral of adults with chronic disease to an LMP by a health professional (HP). DATA EXTRACTION AND SYNTHESIS Data from grey and peer-reviewed literature were extracted by two different reviewers. Extracted data were inductively coded around emergent themes. Regular meetings of the review group ensured consistency of study selection and synthesis. RESULTS Twenty-nine documents were included: 14 grey literature, 11 empirical studies and four literature reviews. Key barriers to HPs referring patients included inadequate HP knowledge about LMPs, perceptions of poor effectiveness of LMPs and perceptions that referral to LMPs was not part of their role. Patient barriers to uptake and completion included poor accessibility and lack of support to engage with the LMPs. Enablers to HP referral included training/education, effective interdisciplinary communication and influential programme advocates. Support to engage with LMPs after HP referral, educational resources for family members and easy accessibility were key enablers to patient engagement with LMPs. CONCLUSIONS Factors related to HPs' ability and willingness to make referrals are important for the implementation of LMPs, and need to be coupled with support for patients to engage with programmes after referral. These factors should be addressed when implementing LMPs to maximise their impact.
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Affiliation(s)
- Yvonne Zurynski
- NHRMC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, New South Wales, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Carolynn Smith
- NHRMC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, New South Wales, Australia
| | - Joyce Siette
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mary Simons
- Library, Macquarie University, Sydney, New South Wales, Australia
| | - Gilbert Thomas Knaggs
- NHRMC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, New South Wales, Australia
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Collopy CM, Cosh SM, Tully PJ. Screening and referral is not enough: a qualitative exploration of barriers to access and uptake of mental health services in patients with cardiovascular diseases. BMC Health Serv Res 2021; 21:49. [PMID: 33419443 PMCID: PMC7796597 DOI: 10.1186/s12913-020-06030-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/18/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) are commonly comorbid with mental health disorders, portending poorer cardiac prognosis. Despite the high prevalence of depression and anxiety, and guidelines recommending routine depression screening and referral, uptake of mental healthcare in CVD populations remains low. Reasons for the underutilisation of mental health and psychological services for this population remain largely unknown. METHODS Thirteen CVD patients with clinically significant psychological symptoms (depression, anxiety and/or stress) participated in one-on-one in-depth semi-structured interviews. Data were analysed using inductive thematic analysis. RESULTS Barriers to uptake included the timing of referral and screening, with patients reporting a need for longer term follow-up. A lack of information provision and understanding around mental health and services, especially following cardiac-events were further barriers. A reluctance to report mental health or engage in services was also identified, with patients indicating a preference for informal peer support networks. A range of practical barriers such as mobility, transport and cost were also reported. CONCLUSIONS Longer term follow-up and routine mental health assessment may be beneficial to facilitate use of mental health services. Upskilling of practitioners around mental health may be a further avenue to promote information provision and enhance service use. Further focus on enhancing informal peer support may be a valuable initial approach for the CVD population. The implications for improving services and enhancing service use are discussed.
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Affiliation(s)
- C M Collopy
- School of Psychology, University of New England, Armidale, NSW, 2351, Australia
| | - S M Cosh
- School of Psychology, University of New England, Armidale, NSW, 2351, Australia.
| | - P J Tully
- Freemasons Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, SA, Australia
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Kuriakose L, Kuczynska P, Timpel P, Yakub F, Bayley A, Papachristou Nadal I. Effectiveness of behaviour change techniques on lifestyle interventions of patients with a high risk of developing cardiovascular disease. Using a qualitative approach. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:998-1009. [PMID: 31965675 DOI: 10.1111/hsc.12933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/29/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to identify key active ingredients on the maintenance of behaviour change for lifestyle interventions of patients with a high risk of developing cardiovascular disease (CVD) who participated in a MOtiVational intErviewing InTervention (MOVE IT) randomised control trial (RCT). A process evaluation was carried out using focus groups. Twenty-six participants of the MOVE IT RCT were purposively recruited and split into six focus groups. Four groups had attended six or more sessions of the intensive phase (completers) and two groups had withdrawn before the end of the intensive phase or had not attended any sessions (non-completers). Focus groups were audio recorded, transcribed verbatim and analysed inductively using thematic analysis. Three overall themes were generated from the six focus groups: (a) long-term benefits from diet and physical activity education, (b) group versus individual structure and adherence and (c) impact on health beliefs and risk of CVD. A fourth theme was generated from the two groups of non-completers only: (d) need for professional rapport building and feedback. We found that the key active ingredients for effective behavioural change in lifestyle interventions are having well-developed rapport between facilitators and patients; and providing alternative forms of feedback to encourage maintenance of behaviour change. Furthermore, such programmes also need to have established and strong relationships with associated health professionals (i.e. the General Practitioner) to increase participation and maintenance of engagement.
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Affiliation(s)
- Lisa Kuriakose
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paulina Kuczynska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Division of Health Services and Management, School of Health Sciences, University of London, London, UK
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Farah Yakub
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam Bayley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iliatha Papachristou Nadal
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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7
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Katangwe T, Family H, Sokhi J, Kirkdale CL, Twigg MJ. The community pharmacy setting for diabetes prevention: A mixed methods study in people with 'pre-diabetes'. Res Social Adm Pharm 2019; 16:1067-1080. [PMID: 31734102 DOI: 10.1016/j.sapharm.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 09/26/2019] [Accepted: 11/03/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetes Prevention Programs (DPPs) comprising intensive lifestyle interventions may delay or even prevent the onset of type 2 diabetes in people with pre-diabetes. However, engagement with DPPs is variable with session times and transportation being reported amongst barriers; this may be addressed by community pharmacy (CP) involvement given its recognition for accessibility. OBJECTIVES To explore factors influencing engagement with the National Health Service (NHS) DPP and the role of CP in diabetes prevention. METHODS Nine hundred and sixty-two questionnaires were posted to people with pre-diabetes identified from five general practices in Norfolk, England between November 2017 and May 2018. Follow-up semi-structured interviews (n = 10) and a focus group (n = 6) were conducted with a sample of questionnaire respondents. Questionnaire data were analysed quantitatively using SPSS and qualitative data analysed inductively using thematic analysis. Themes relating to engagement and the role of CP in pre-diabetes were further analysed using the COM-B model of behaviour change. RESULTS A total of 181 (18.8%) questionnaire responses were received, a quarter of whom reported to have either dropped out or declined attending the national DPP. DPP engagers were more likely to report the program location and session times as convenient. Community pharmacy was perceived as an acceptable setting for delivering diabetes prevention services (DPS) and a preferable alternative for regular pharmacy users and people with work and social commitments. Participants felt that opportunity to engage with CP DPS is enhanced by its accessibility and flexibility in making appointments. Knowledge about the DPS provided in CP and previous experience with CP services were central influences of capability and motivation to engage respectively. CONCLUSIONS This research outlines factors that could influence engagement with community pharmacy-based DPS and provides evidence to inform intervention development. Further research would be required to determine the feasibility and cost-effectiveness of such interventions.
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Affiliation(s)
- Thando Katangwe
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.
| | - Hannah Family
- Medical School, University of Bristol, Bristol, United Kingdom
| | - Jeremy Sokhi
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | | | - Michael J Twigg
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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Katangwe T, Family H, Sokhi J, Al-Jabr H, Kirkdale CL, Twigg MJ. The community pharmacy setting for diabetes prevention: Views and perceptions of stakeholders. PLoS One 2019; 14:e0219686. [PMID: 31318897 PMCID: PMC6638927 DOI: 10.1371/journal.pone.0219686] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/30/2019] [Indexed: 11/23/2022] Open
Abstract
Background Diabetes prevention programmes delay or prevent the onset of type 2 diabetes in people with pre-diabetes. To increase accessibility, national guidelines recommend delivering diabetes prevention programmes in primary care settings, including community pharmacy. This study aimed to explore the English community pharmacy setting as an option for delivering diabetes prevention services. Methods Two focus groups and nine semi-structured interviews were conducted with stakeholders including, community pharmacists, general practitioners and commissioners. The topic guide was framed using the COM-B theoretical model for behaviour change to elicit practitioners’ capability, opportunity and motivation to engage with providing or referring to community pharmacy diabetes prevention services. Data were analysed thematically, and barriers/facilitators mapped to the COM-B framework. Results Five themes were identified: ‘Pre-diabetes management and associated challenges’, ‘The community pharmacy setting’, ‘Awareness of community pharmacy services’, ‘Relationships and communication’ and ‘Delivery of community pharmacy services’. Community pharmacy was highlighted as an accessible setting for delivering screening and follow-on lifestyle interventions. Key factors for enhancing the capability of community pharmacy teams to deliver the interventions included training and appropriate use of skill mix. Delivering diabetes prevention services in collaboration with general practices was identified as key to the provision of integrated primary care services. Whilst financial incentives were identified as a motivating factor for delivery, service promotion to patients, public and healthcare professionals was perceived as crucial for enhancing engagement. Conclusions This research highlights a role for community pharmacy in diabetes prevention. New service models should seek to integrate community pharmacy services in primary care to facilitate patient engagement and better communication with general practices.
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Affiliation(s)
- Thando Katangwe
- School of Pharmacy, University of East Anglia, Norwich, United Kingdom
- Boots UK, Nottingham, United Kingdom
- * E-mail:
| | - Hannah Family
- Medical School, University of Bristol, Bristol, United Kingdom
| | - Jeremy Sokhi
- School of Pharmacy, University of East Anglia, Norwich, United Kingdom
| | - Hiyam Al-Jabr
- School of Pharmacy, University of East Anglia, Norwich, United Kingdom
| | | | - Michael J. Twigg
- School of Pharmacy, University of East Anglia, Norwich, United Kingdom
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Larsen LB, Sondergaard J, Thomsen JL, Halling A, Sønderlund AL, Christensen JR, Thilsing T. Digital Recruitment and Acceptance of a Stepwise Model to Prevent Chronic Disease in the Danish Primary Care Sector: Cross-Sectional Study. J Med Internet Res 2019; 21:e11658. [PMID: 30664466 PMCID: PMC6360391 DOI: 10.2196/11658] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 12/12/2022] Open
Abstract
Background During recent years, stepwise approaches to health checks have been advanced as an alternative to general health checks. In 2013, we set up the Early Detection and Prevention project (Tidlig Opsporing og Forebyggelse, TOF) to develop a stepwise approach aimed at patients at high or moderate risk of a chronic disease. A novel feature was the use of a personal digital mailbox for recruiting participants. A personal digital mailbox is a secure digital mailbox provided by the Danish public authorities. Apart from being both safe and secure, it is a low-cost, quick, and easy way to reach Danish residents. Objective In this study we analyze the association between the rates of acceptance of 2 digital invitations sent to a personal digital mailbox and the sociodemographic determinants, medical treatment, and health care usage in a stepwise primary care model for the prevention of chronic diseases. Methods We conducted a cross-sectional analysis of the rates of acceptance of 2 digital invitations sent to randomly selected residents born between 1957 and 1986 and residing in 2 Danish municipalities. The outcome was acceptance of the 2 digital invitations. Statistical associations were determined by Poisson regression. Data-driven chi-square automatic interaction detection method was used to generate a decision tree analysis, predicting acceptance of the digital invitations. Results A total of 8814 patients received an invitation in their digital mailbox from 47 general practitioners. A total of 40.22% (3545/8814) accepted the first digital invitation, and 30.19 % (2661/8814) accepted both digital invitations. The rates of acceptance of both digital invitations were higher among women, older patients, patients of higher socioeconomic status, and patients not diagnosed with or being treated for diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular disease. Conclusions To our knowledge, this is the first study to report on the rates of acceptance of digital invitations to participate in a stepwise model for prevention of chronic diseases. More studies of digital invitations are needed to determine if the acceptance rates seen in this study should be expected from future studies as well. Similarly, more research is needed to determine whether a multimodal recruitment approach, including digital invitations to personal digital mailboxes will reach hard-to-reach subpopulations more effectively than digital invitations only.
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Affiliation(s)
- Lars Bruun Larsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Sondergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Janus Laust Thomsen
- Research Unit for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anders Halling
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden
| | - Anders Larrabee Sønderlund
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Trine Thilsing
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Vörös K, Márkus B, Hargittay C, Sisak O, Kalabay L. Perceived cardiovascular risk and attitude towards lifestyle change. Fam Pract 2018; 35:712-717. [PMID: 29897431 DOI: 10.1093/fampra/cmy028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are prominent cause of death. Lifestyle change is effective in decreasing mortality. Perception of patients' cardiovascular risk by physicians is a drive for following preventive recommendations. Whether the hazard perceived by patients influences their attitude towards lifestyle is uncertain. OBJECTIVE We hypothesized that high perceived risk would be associated with a stronger determination for lifestyle change, while incorrectly optimistic patients would be less motivated. METHODS Two hundred patients visiting their family physicians were asked to fill out a questionnaire about demographic, clinical and lifestyle characteristics, about their attitude towards lifestyle change and their estimation of their cardiovascular risk. Actual risk was estimated by family physicians based on the national guideline. RESULTS Questionnaires were completed by 80.5% (161/200) of patients approached. Patients underestimated their risk (P < 0.001), mainly because high-/very high-risk patients classified themselves into lower risk categories. The majority of patients were planning a lifestyle change, losing weight being the most popular goal. It was the priority even for some normal weight subjects and for smokers, too. Perceived risk played a marginal role as a determinant of lifestyle change. Underestimation of perceived risk had no effect on patients' motivation. Self-rated obesity was the predictor of three out of five means of change (weight loss, diet, physical activity). CONCLUSION Perceived cardiovascular risk and incorrect optimism about this hazard have minimal, if any, influence on attitude towards lifestyle change. Patients' motivation seems not to be primarily health related.
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Affiliation(s)
- Krisztián Vörös
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Bernadett Márkus
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Csenge Hargittay
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Orsolya Sisak
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - László Kalabay
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
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Local authority commissioning of NHS Health Checks: A regression analysis of the first three years. Health Policy 2018; 122:1035-1042. [PMID: 30055899 DOI: 10.1016/j.healthpol.2018.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 05/24/2018] [Accepted: 07/12/2018] [Indexed: 11/21/2022]
Abstract
In April 2013, the public health function was transferred from the NHS to local government, making local authorities (LAs) responsible for commissioning the NHS Health Check programme. The programme aims to reduce preventable mortality and morbidity in people aged 40-74. The national five-year ambition is to invite all eligible individuals and to achieve an uptake of 75%. This study evaluates the effects of LA expenditure on the programme's invitation rates (the proportion of the eligible population invited to a health check), coverage rates (the proportion of the eligible population who received a health check) and uptake rates (attendance by those who received a formal invitation letter) in the first three years of the reforms. We ran negative binomial panel models and controlled for a range of confounders. Over 2013/14-2015/16, the invitation rate, coverage rate and uptake rate averaged 57% 28% and 49% respectively. Higher per capita spend on the programme was associated with increases in both the invitation rate and coverage rate, but had no effect on the uptake rate. When we controlled for the LA invitation rate, the association between spend and coverage rate was smaller but remained statistically significant. This suggests that alternatives to formal invitation, such as opportunistic approaches in work places or sports centres, may be effective in influencing attendance.
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Gilis-Januszewska A, Lindström J, Barengo NC, Tuomilehto J, Schwarz PEH, Wójtowicz E, Piwońska-Solska B, Szybiński Z, Windak A, Hubalewska-Dydejczyk A. Predictors of completing a primary health care diabetes prevention intervention programme in people at high risk of type 2 diabetes: Experiences of the DE-PLAN project. Medicine (Baltimore) 2018; 97:e9790. [PMID: 29384876 PMCID: PMC5805448 DOI: 10.1097/md.0000000000009790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/23/2017] [Accepted: 01/14/2018] [Indexed: 11/25/2022] Open
Abstract
It has been shown that real-life implementation studies for the prevention of type 2 diabetes (DM2) performed in different settings and populations can be effective. However, not enough information is available on factors influencing the reach of DM2 prevention programmes. This study examines the predictors of completing an intervention programme targeted at people at high risk of DM2 in Krakow, Poland as part of the DE-PLAN project.A total of 262 middle-aged people, everyday patients of 9 general practitioners' (GP) practices, at high risk of DM2 (Finnish Diabetes Risk Score (FINDRISK) >14) agreed to participate in the lifestyle intervention to prevent DM2. Intervention consisted of 11 lifestyle counseling sessions, organized physical activity sessions followed by motivational phone calls and letters. Measurements were performed at baseline and 1 year after the initiation of the intervention.Seventy percent of the study participants enrolled completed the core curriculum (n = 184), 22% were men. When compared to noncompleters, completers had a healthier baseline diabetes risk profile (P <.05). People who completed the intervention were less frequently employed versus noncompleters (P = .037), less often had hypertension (P = .043), and more frequently consumed vegetables and fruit daily (P = .055).In multiple logistic regression model, employment reduced the likelihood of completing the intervention 2 times (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25-0.81). Higher glucose 2 hours after glucose load and hypertension were the independent factors decreasing the chance to participate in the intervention (OR 0.79, 95% 0.69-0.92 and OR 0.52, 95% CI 0.27-0.99, respectively). Daily consumption of vegetables and fruits increased the likelihood of completing the intervention (OR 1.86, 95% 1.01-3.41).In conclusion, people with healthier behavior and risk profile are more predisposed to complete diabetes prevention interventions. Male, those who work and those with a worse health profile, are less likely to participate and complete interventions. Targeted strategies are needed in real-life diabetes prevention interventions to improve male participation and to reach those who are working as well as people with a higher risk profile.
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Affiliation(s)
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Noël C Barengo
- Department of Medical and Population Health Science, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Jaakko Tuomilehto
- Dasman Diabetes Institute, Dasman, Kuwait
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria
- Department of Chronic Disease Prevention, National Institute for Health and Welfare
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Peter EH Schwarz
- Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic, Carl Gustav Carus at Technical University Dresden
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technical University Dresden, Dresden
- German Center for Diabetes Research, Neuherberg, Germany
| | | | | | | | - Adam Windak
- Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
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13
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Gilis-Januszewska A, Piwońska-Solska B, Lindström J, Wójtowicz E, Tuomilehto J, Schwarz PEH, Kissimova-Skarbek K, Szybiński Z, Windak A, Hubalewska-Dydejczyk A. Determinants of weight outcomes in type 2 diabetes prevention intervention in primary health care setting (the DE-PLAN project). BMC Public Health 2018; 18:97. [PMID: 29291708 PMCID: PMC5749019 DOI: 10.1186/s12889-017-4977-1] [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: 10/27/2016] [Accepted: 12/05/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Real life implementation studies performed in different settings have proved that lifestyle interventions in the prevention of type 2 diabetes (DM2) can be effective, although the weight reduction results are typically modest compared to randomized control trials. Our objective was to identify the factors that predict successful weight loss in a less intensive, lower budget, real life setting lifestyle diabetes prevention intervention. METHODS Study participants (n = 175) with increased DM2 risk (Finnish Diabetes Risk Score (FINDRISC) > 14) but no diabetes at baseline received ten group lifestyle counselling sessions, physical activity and motivation sessions during a ten-month intervention. Stepwise regression analysis was used to determine demographic, clinical, and lifestyle predictors of successful weight reduction defined as a reduction of ≥5% of the initial body weight. RESULTS At 12 months following the initiation of the intervention, 23.4% of study participants lost ≥5% weight (mean loss of 7.9 kg, SD = 5.8). Increased physical activity (44% vs 25%, p = 0.03), decreased total fat consumption (88% vs 65%, p = 0.006) and adherence to four-five lifestyle goals (71% vs 46%, p = 0.007) were more often reported among those who managed to lose ≥5% weight versus those who did not. In a multivariate analysis, meeting the ≥5% weight loss goal was most effective in individuals with a higher baseline BMI (OR 1.1, 95%CI 1.0-1.2), baseline and medium versus higher education (OR 5.4, 95% CI 1.2-24.7) and a history of increased glucose (OR 2.6, 95%CI 1.1-1.3). A reduction of total fat in the diet was an independent lifestyle predictor, increasing the probability of successful weight loss by 3.8 times (OR 3.8, 95% CI 1.2-11.4). CONCLUSION Baseline higher BMI, lower education and a history of increased glucose predicted the successful weight loss among individuals with a high risk for the DM2 following lifestyle intervention in a real life primary health care setting. People who manage to lose weight more often adhere to lifestyle changes, while the reduction of total fat in diet independently predicts successful weight loss. Further studies exploring the predictors of success in implementation studies in DM2 prevention should help health care providers redesign interventions to improve their effectiveness and outcomes. TRIAL REGISTRATION ISRCTN, ID ISRCTN96692060 , registered 03.08.2016 retrospectively.
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Affiliation(s)
- Aleksandra Gilis-Januszewska
- Department of Endocrinology, Jagiellonian University, Medical College, ul. Kopernika 17, 31-501, Krakow, Poland.
| | - Beata Piwońska-Solska
- Department of Endocrinology, Jagiellonian University, Medical College, ul. Kopernika 17, 31-501, Krakow, Poland
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare(THL), Helsinki, Finland
| | - Ewa Wójtowicz
- Department of Endocrinology, Jagiellonian University, Medical College, ul. Kopernika 17, 31-501, Krakow, Poland
| | - Jaakko Tuomilehto
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria.,Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Dasman Diabetes Institute, Dasman, Kuwait
| | - Peter E H Schwarz
- Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic Carl Gustav Carus at Technical University Dresden, Dresden, Germany
| | - Katarzyna Kissimova-Skarbek
- Department of Health Economics and Social Security, Institute of Public Health, Jagiellonian University, Medical College, Krakow, Poland
| | - Zbigniew Szybiński
- Department of Endocrinology, Jagiellonian University, Medical College, ul. Kopernika 17, 31-501, Krakow, Poland
| | - Adam Windak
- Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Alicja Hubalewska-Dydejczyk
- Department of Endocrinology, Jagiellonian University, Medical College, ul. Kopernika 17, 31-501, Krakow, Poland
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Bian RR, Piatt GA, Sen A, Plegue MA, De Michele ML, Hafez D, Czuhajewski CM, Buis LR, Kaufman N, Richardson CR. The Effect of Technology-Mediated Diabetes Prevention Interventions on Weight: A Meta-Analysis. J Med Internet Res 2017; 19:e76. [PMID: 28347972 PMCID: PMC5387112 DOI: 10.2196/jmir.4709] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 12/02/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lifestyle interventions targeting weight loss, such as those delivered through the Diabetes Prevention Program, reduce the risk of developing type 2 diabetes. Technology-mediated interventions may be an option to help overcome barriers to program delivery, and to disseminate diabetes prevention programs on a larger scale. OBJECTIVE We conducted a meta-analysis to evaluate the effect of such technology-mediated interventions on weight loss. METHODS In this meta-analysis, six databases were searched to identify studies reporting weight change that used technology to mediate diet and exercise interventions, and targeted individuals at high risk for developing type 2 diabetes. Studies published between January 1, 2002 and August 4, 2016 were included. RESULTS The search identified 1196 citations. Of those, 15 studies met the inclusion criteria and evaluated 18 technology-mediated intervention arms delivered to a total of 2774 participants. Study duration ranged from 12 weeks to 2 years. A random-effects meta-analysis showed a pooled weight loss effect of 3.76 kilograms (95% CI 2.8-4.7; P<.001) for the interventions. Several studies also reported improved glycemic control following the intervention. The small sample sizes and heterogeneity of the trials precluded an evaluation of which technology-mediated intervention method was most efficacious. CONCLUSIONS Technology-mediated diabetes prevention programs can result in clinically significant amounts of weight loss, as well as improvements in glycaemia in patients with prediabetes. Due to their potential for large-scale implementation, these interventions will play an important role in the dissemination of diabetes prevention programs.
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Affiliation(s)
- Rachel R Bian
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Gretchen A Piatt
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Ananda Sen
- University of Michigan, Department of Family Medicine, Ann Arbor, MI, United States.,University of Michigan, Department of Biostatistics, School of Public Health, Ann Arbor, MI, United States
| | - Melissa A Plegue
- University of Michigan, Department of Family Medicine, Ann Arbor, MI, United States
| | - Mariana L De Michele
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI, United States
| | - Dina Hafez
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI, United States
| | | | - Lorraine R Buis
- University of Michigan, Department of Family Medicine, Ann Arbor, MI, United States.,University of Michigan, School of Information, Ann Arbor, MI, United States
| | - Neal Kaufman
- Geffen School of Medicine and Fielding School of Public Health, Departments of Pediatrics and Public Health, University of California, Los Angeles, CA, United States
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15
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Beishuizen CRL, Coley N, Moll van Charante EP, van Gool WA, Richard E, Andrieu S. Determinants of Dropout and Nonadherence in a Dementia Prevention Randomized Controlled Trial: The Prevention of Dementia by Intensive Vascular Care Trial. J Am Geriatr Soc 2017; 65:1505-1513. [PMID: 28263374 DOI: 10.1111/jgs.14834] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore and compare sociodemographic, clinical, and neuropsychiatric determinants of dropout and nonadherence in older people participating in an open-label cluster-randomized controlled trial-the Prevention of Dementia by Intensive Vascular care (preDIVA) trial-over 6 years. DESIGN Secondary analysis. SETTING One hundred sixteen general practices in the Netherlands. PARTICIPANTS Community-dwelling individuals aged 70 to 78 (N = 2,994). INTERVENTION Nurse-led multidomain intervention targeting cardiovascular risk factors to prevent dementia. MEASUREMENTS The associations between participant baseline sociodemographic (age, sex, education), clinical (medical history, disability, cardiovascular risk), neuropsychiatric (depressive symptoms (Geriatric Depression Scale-15), and cognitive (Mini-Mental State Examination)) characteristics and dropout from the trial and nonadherence to the trial intervention were explored using multilevel logistic regression models. RESULTS Older age, poorer cognitive function, more symptoms of depression, and greater disability were the most important determinants of dropout of older people. The presence of cardiovascular risk factors was not associated with dropout but was associated with nonadherence. Being overweight was a risk factor for nonadherence, whereas people with high blood pressure or a low level of physical exercise adhered better to the intervention. The association between poorer cognitive function and symptoms of depression and dropout was stronger in the control group than in the intervention group, and vice versa for increased disability. CONCLUSION In a large dementia prevention trial with 6-year follow-up, dropout was associated with older age, poorer cognitive function, symptoms of depression, and disability at baseline. These findings can help to guide the design of future dementia prevention trials in older adults. The associations found between cardiovascular risk factors and nonadherence need to be confirmed in other older populations receiving cardiovascular prevention interventions.
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Affiliation(s)
- Cathrien R L Beishuizen
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicola Coley
- Department of Epidemiology and Public Health, UMR1027, Université de Toulouse, Université Paul Sabatier, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Eric P Moll van Charante
- Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem A van Gool
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Edo Richard
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Donders Centre for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Sandrine Andrieu
- Department of Epidemiology and Public Health, UMR1027, Université de Toulouse, Université Paul Sabatier, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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16
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Block RC, Abdolahi A, Niemiec CP, Rigby CS, Williams GC. Effects of an evidence-based computerized virtual clinician on low-density lipoprotein and non-high-density lipoprotein cholesterol in adults without cardiovascular disease: The Interactive Cholesterol Advisory Tool. Health Informatics J 2016; 22:897-910. [PMID: 26297222 PMCID: PMC4761531 DOI: 10.1177/1460458215600040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a lack of research on the use of electronic tools that guide patients toward reducing their cardiovascular disease risk. We conducted a 9-month clinical trial in which participants who were at low (n = 100) and moderate (n = 23) cardiovascular disease risk-based on the National Cholesterol Education Program III's 10-year risk estimator-were randomized to usual care or to usual care plus use of an Interactive Cholesterol Advisory Tool during the first 8 weeks of the study. In the moderate-risk category, an interaction between treatment condition and Framingham risk estimate on low-density lipoprotein and non-high-density lipoprotein cholesterol was observed, such that participants in the virtual clinician treatment condition had a larger reduction in low-density lipoprotein and non-high-density lipoprotein cholesterol as their Framingham risk estimate increased. Perceptions of the Interactive Cholesterol Advisory Tool were positive. Evidence-based information about cardiovascular disease risk and its management was accessible to participants without major technical challenges.
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Affiliation(s)
- Robert C Block
- University of Rochester, USA
- Self-Determined Health, Inc., USA
- University of Rochester, USA
| | - Amir Abdolahi
- University of Rochester, USA
- Self-Determined Health, Inc., USA
- University of Rochester, USA
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17
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Laws R, Hesketh KD, Ball K, Cooper C, Vrljic K, Campbell KJ. Translating an early childhood obesity prevention program for local community implementation: a case study of the Melbourne InFANT Program. BMC Public Health 2016; 16:748. [PMID: 27502184 PMCID: PMC4977772 DOI: 10.1186/s12889-016-3361-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background While there is a growing interest in the field of research translation, there are few published examples of public health interventions that have been effectively scaled up and implemented in the community. This paper provides a case study of the community-wide implementation of the Melbourne Infant, Feeding, Activity and Nutrition Trial (InFANT), an obesity prevention program for parents with infants aged 3–18 months. The study explored key factors influencing the translation of the Program into routine practice and the respective role of policy makers, researchers and implementers. Methods Case studies were conducted of five of the eight prevention areas in Victoria, Australia who implemented the Program. Cases were selected on the basis of having implemented the Program for 6 months or more. Data were collected from January to June 2015 and included 18 individual interviews, one focus group and observation of two meetings. A total of 28 individuals, including research staff (n = 4), policy makers (n = 2) and implementers (n = 22), contributed to the data collected. Thematic analysis was conducted using cross case comparisons and key themes were verified through member checking. Results Key facilitators of implementation included availability of a pre-packaged evidence based program addressing a community need, along with support and training provided by research staff to local implementers. Partnerships between researchers and policy makers facilitated initial program adoption, while local partnerships supported community implementation. Community partnerships were facilitated by local coordinators through alignment of program goals with existing policies and services. Workforce capacity for program delivery and administration was a challenge, largely overcome by embedding the Program into existing roles. Adapting the Program to fit local circumstance was critical for feasible and sustainable delivery, however balancing this with program fidelity was a critical issue. The lack of ongoing funding to support translation activities was a barrier for researchers continued involvement in community implementation. Conclusion Policy makers, researchers and practitioners have important and complementary roles to play in supporting the translation of effective research interventions into practice. New avenues need to be explored to strengthen partnerships between researchers and end users to support the integration of effective public health research interventions into practice. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3361-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia. .,Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, Australia. .,Centre of Research Excellence in Early Prevention of Obesity in Childhood, Sydney, Australia.
| | - K D Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia.,Centre of Research Excellence in Early Prevention of Obesity in Childhood, Sydney, Australia
| | - K Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia.,Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, Australia
| | - C Cooper
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - K Vrljic
- Prevention and Population Health, Department of Health and Human Services, Melbourne, Australia
| | - K J Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia.,Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, Australia.,Centre of Research Excellence in Early Prevention of Obesity in Childhood, Sydney, Australia
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18
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Nobles J, Griffiths C, Pringle A, Gately P. Design programmes to maximise participant engagement: a predictive study of programme and participant characteristics associated with engagement in paediatric weight management. Int J Behav Nutr Phys Act 2016; 13:76. [PMID: 27430218 PMCID: PMC4949908 DOI: 10.1186/s12966-016-0399-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 06/15/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Approximately 50% of paediatric weight management (WM) programme attendees do not complete their respective programmes. High attrition rates compromise both programme effectiveness and cost-efficiency. Past research has examined pre-intervention participant characteristics associated with programme (non-)completion, however study samples are often small and not representative of multiple demographics. Moreover, the association between programme characteristics and participant engagement is not well known. This study examined participant and programme characteristics associated with engagement in a large, government funded, paediatric WM programme. Engagement was defined as the family's level of participation in the WM programme. METHODS Secondary data analysis of 2948 participants (Age: 10.44 ± 2.80 years, BMI: 25.99 ± 5.79 kg/m(2), Standardised BMI [BMI SDS]: 2.48 ± 0.87 units, White Ethnicity: 70.52%) was undertaken. Participants attended a MoreLife programme (nationwide WM provider) between 2009 and 2014. Participants were classified into one of five engagement groups: Initiators, Late Dropouts, Low- or High- Sporadic Attenders, or Completers. Five binary multivariable logistic regression models were performed to identify participant (n = 11) and programmatic (n = 6) characteristics associated with an engagement group. Programme completion was classified as ≥70% attendance. RESULTS Programme characteristics were stronger predictors of programme engagement than participant characteristics; particularly small group size, winter/autumn delivery periods and earlier programme years (proxy for scalability). Conversely, participant characteristics were weak predictors of programme engagement. Predictors varied between engagement groups (e.g. Completers, Initiators, Sporadic Attenders). 47.1% of participants completed the MoreLife programme (mean attendance: 59.4 ± 26.7%, mean BMI SDS change: -0.15 ± 0.22 units), and 21% of those who signed onto the programme did not attend a session. CONCLUSIONS As WM services scale up, the efficacy and fidelity of programmes may be reduced due to increased demand and lower financial resource. Further, limiting WM programme groups to no more than 20 participants could result in greater engagement. Baseline participant characteristics are poor and inconsistent predictors of programme engagement. Thus, future research should evaluate participant motives, expectations, and barriers to attending a WM programme to enhance our understanding of participant WM engagement. Finally, we suggest that session-by-session attendance is recorded as a minimum requirement to improve reporting transparency and enhance external validity of study findings.
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Affiliation(s)
- James Nobles
- />Institute of Sport, Physical Activity and Leisure, Centre of Active Lifestyles, Carnegie Faculty, Leeds Beckett University, Headingley Campus, Leeds, UK
| | - Claire Griffiths
- />Institute of Sport, Physical Activity and Leisure, Centre of Active Lifestyles, Carnegie Faculty, Leeds Beckett University, Headingley Campus, Leeds, UK
| | - Andy Pringle
- />Institute of Sport, Physical Activity and Leisure, Centre of Active Lifestyles, Carnegie Faculty, Leeds Beckett University, Headingley Campus, Leeds, UK
| | - Paul Gately
- />Institute of Sport, Physical Activity and Leisure, Centre of Active Lifestyles, Carnegie Faculty, Leeds Beckett University, Headingley Campus, Leeds, UK
- />MoreLife (UK) Ltd., Churchwood Hall, Leeds Beckett University, Headingley Campus, Leeds, UK
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19
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Damman OC, van der Beek AJ, Timmermans DRM. Employees are ambivalent about health checks in the occupational setting. Occup Med (Lond) 2015; 65:451-8. [DOI: 10.1093/occmed/kqv048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Petter J, Reitsma-van Rooijen MM, Korevaar JC, Nielen MMJ. Willingness to participate in prevention programs for cardiometabolic diseases. BMC Public Health 2015; 15:44. [PMID: 25637105 PMCID: PMC4323020 DOI: 10.1186/s12889-015-1379-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 01/08/2015] [Indexed: 11/13/2022] Open
Abstract
Background Cardiometabolic diseases are the leading cause of death worldwide and result in decreased quality of life for patients and increased healthcare costs. Population-based prevention programs may prevent the onset and development of cardiometabolic diseases. The effectiveness of these programs depends on participation rates. This study identified factors related to willingness to participate in health checks and lifestyle intervention programs to prevent cardiometabolic diseases. Methods A questionnaire was sent to 1,500 Dutch adults, participating in the Dutch Health Care Consumer Panel of NIVEL. The questionnaire was developed by NIVEL. Predictors of willingness to participate were identified with logistic regression analyses. Predictors investigated were socio-demographic variables, risk factors for cardiometabolic diseases and motivational aspects. Results The response rate was 63%. 56% of the participants in our study were willing to participate in a health check. Higher age was associated with increased willingness to participate, as was the desire to know the actual risk for cardiometabolic diseases (OR = 4.6). Becoming unnecessarily worried was identified as a barrier (OR = 0.3). 47% were willing to participate in a lifestyle intervention program. People aged 39–65 were most willing to participate. Attention for prevention relapse behavior (OR = 3.3), informing the general practitioner about results (OR = 2.6) and conducting the program in a group (OR = 2.0) were positively associated with willingness to participate in lifestyle interventions. Conclusions Willingness to participate in a health check depended on personal beliefs, whereas social aspects contributed most to willingness to participate in a lifestyle intervention program. This information can be used to optimize and tailor the promotion of prevention programs.
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Affiliation(s)
- Jessica Petter
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
| | | | - Joke C Korevaar
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Markus M J Nielen
- NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
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21
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Dinglas VD, Huang M, Sepulveda KA, Pinedo M, Hopkins RO, Colantuoni E, Needham DM. Personalized contact strategies and predictors of time to survey completion: analysis of two sequential randomized trials. BMC Med Res Methodol 2015; 15:5. [PMID: 25575599 PMCID: PMC4407535 DOI: 10.1186/1471-2288-15-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 01/02/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Effective strategies for contacting and recruiting study participants are critical in conducting clinical research. In this study, we conducted two sequential randomized controlled trials of mail- and telephone-based strategies for contacting and recruiting participants, and evaluated participant-related variables' association with time to survey completion and survey completion rates. Subjects eligible for this study were survivors of acute lung injury who had been previously enrolled in a 12-month observational follow-up study evaluating their physical, cognitive and mental health outcomes, with their last study visit completed at a median of 34 months previously. METHODS Eligible subjects were contacted to complete a new research survey as part of two randomized trials, initially using a randomized mail-based contact strategy, followed by a randomized telephone-based contact strategy for non-responders to the mail strategy. Both strategies focused on using either a personalized versus a generic approach. In addition, 18 potentially relevant subject-related variables (e.g., demographics, last known physical and mental health status) were evaluated for association with time to survey completion. RESULTS Of 308 eligible subjects, 67% completed the survey with a median (IQR) of 3 (2, 5) contact attempts required. There was no significant difference in the time to survey completion for either randomized trial of mail- or phone-based contact strategy. Among all subject-related variables, age ≤40 years and minority race were independently associated with a longer time to survey completion. CONCLUSION We found that age ≤40 years and minority race were associated with a longer time to survey completion, but personalized versus generic approaches to mail- and telephone-based contact strategies had no significant effect. Repeating both mail and telephone contact attempts was important for increasing survey completion rate. TRIAL REGISTRATION NCT00719446.
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Affiliation(s)
- Victor D Dinglas
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
| | - Minxuan Huang
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
| | - Kristin A Sepulveda
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
| | - Mariela Pinedo
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
| | - Ramona O Hopkins
- />Pulmonary and Critical Care Division, Department of Medicine, Intermountain Medical Center, 5121 Cottonwood Street, 84157 Murray, UT USA
- />Psychology Department and Neuroscience Center, Brigham Young University, 84602 Provo, UT USA
| | - Elizabeth Colantuoni
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, 21205 Baltimore, MD USA
| | - Dale M Needham
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Department of Physical Medicine and Rehabilitation, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
| | - the NIH NHLBI ARDS Network
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Pulmonary and Critical Care Division, Department of Medicine, Intermountain Medical Center, 5121 Cottonwood Street, 84157 Murray, UT USA
- />Psychology Department and Neuroscience Center, Brigham Young University, 84602 Provo, UT USA
- />Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, 21205 Baltimore, MD USA
- />Department of Physical Medicine and Rehabilitation, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
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Tonnon SC, Proper KI, van der Ploeg HP, Westerman MJ, Sijbesma E, van der Beek AJ. A qualitative study of the anticipated barriers and facilitators to the implementation of a lifestyle intervention in the Dutch construction industry. BMC Public Health 2014; 14:1317. [PMID: 25539630 PMCID: PMC4326182 DOI: 10.1186/1471-2458-14-1317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/16/2014] [Indexed: 11/22/2022] Open
Abstract
Background Lifestyle interventions have proven effective for lowering a cardiovascular risk profile by improving lifestyle behaviors, blood glucose and blood cholesterol levels. However, implementation of lifestyle interventions is often met with barriers. This qualitative study sought to determine anticipated barriers and facilitators to the nationwide implementation of an effective lifestyle intervention in the construction industry in the Netherlands. Methods Prior to implementation, focus groups were held with 8 lifestyle counselors and semi-structured interviews with 20 employees of the construction industry, 4 occupational physicians, 4 medical assistants, and 1 manager of an occupational health service. The transcripts were coded by two coders and analyzed by constant comparison. Results Hypothetical employee willingness to sign up for the intervention was facilitated by a high level of perceived risk, perceived added value of the intervention, and perceived social support. It was hampered by a preference for independence and perceived interference with their work. All professionals named a lack of time as an anticipated barrier to implementation. Lifestyle counselors suggested several strategies to improve the proficiency of their counseling technique, such as training in small groups and a continuous stream of employee referrals. Occupational physicians thought they would be hampered in screening employees and referring them to a lifestyle counselor by the perception that addressing employee lifestyles was not their task, and by a counter-productive relationship with other stakeholders. The manager addressed financial incentives and a good intervention fit with the current approach of the OHS. Conclusion The findings suggest that employees can be motivated to sign up for a lifestyle intervention by tailoring the implementation strategy to various subgroups within the target group. Occupational physicians can be motivated to refer employees for the intervention by making a referral personally and professionally rewarding. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1317) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - K I Proper
- Department of Public and Occupational Health, EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Bardus M, Blake H, Lloyd S, Suzanne Suggs L. Reasons for participating and not participating in a e-health workplace physical activity intervention. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2014. [DOI: 10.1108/ijwhm-11-2013-0040] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to investigate the reasons for participating and not participating in an e-health workplace physical activity (PA) intervention.
Design/methodology/approach
– Semi-structured interviews and two focus groups were conducted with a purposive sample of employees who enrolled and participated in the intervention and with those who did not complete enrolment, hence did not participate in it. Data were examined using thematic analysis according to the clusters of “reasons for participation” and for “non-participation”.
Findings
– Reported reasons for participation included a need to be more active, to increase motivation to engage in PA, and to better manage weight. Employees were attracted by the perceived ease of use of the programme and by the promise of receiving reminders. Many felt encouraged to enrol by managers or peers. Reported reasons for non-participation included lack of time, loss of interest towards the programme, or a lack of reminders to complete enrolment.
Practical implications
– Future e-health workplace behavioural interventions should consider focusing on employees’ needs and motivators to behaviour change, provide regular reminders for participants to complete enrolment and ensure that procedures are completed successfully. Barriers to participation could be identified through formative research with the target population and feasibility studies.
Originality/value
– This study combines a qualitative analysis of the reasons why some employees decided to enrol in a workplace PA intervention and why some others did not. This study highlights factors to consider when designing, implementing and promoting similar interventions and that could inform strategies to enhance participation in workplace PA interventions.
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McKenzie SH, Harris MF. Understanding the relationship between stress, distress and healthy lifestyle behaviour: a qualitative study of patients and general practitioners. BMC FAMILY PRACTICE 2013; 14:166. [PMID: 24175998 PMCID: PMC3817353 DOI: 10.1186/1471-2296-14-166] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/30/2013] [Indexed: 12/30/2022]
Abstract
Background The process of initiating and maintaining healthy lifestyle behaviours is complex, includes a number of distinct phases and is not static. Theoretical models of behaviour change consider psychological constructs such as intention and self efficacy but do not clearly consider the role of stress or psychological distress. General practice based interventions addressing lifestyle behaviours have been demonstrated to be feasible and effective however it is not clear whether general practitioners (GPs) take psychological health into consideration when discussing lifestyle behaviours. This qualitative study explores GPs’ and patients’ perspectives about the relationship between external stressors, psychological distress and maintaining healthy lifestyle behaviours. Methods Semi-structured telephone interviews were conducted with 16 patients and 5 GPs. Transcripts from the interviews were thematically analysed and a conceptual model developed to explain the relationship between external stressors, psychological distress and healthly lifestyle behaviours. Results Participants were motivated to maintain a healthy lifestyle however they described a range of external factors that impacted on behaviour in both positive and negative ways, either directly or via their impact on psychological distress. The impact of external factors was moderated by coping strategies, beliefs, habits and social support. In some cases the process of changing or maintaining healthy behaviour also caused distress. The concept of a threshold level of distress was evident in the data with patients and GPs describing a certain level of distress required before it negatively influenced behaviour. Conclusion Maintaining healthy lifestyle behaviours is complex and constantly under challenge from external stressors. Practitioners can assist patients with maintaining healthy behaviour by providing targeted support to moderate the impact of external stressors.
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Affiliation(s)
- Suzanne H McKenzie
- School of Medicine and Dentistry, James Cook University, Townsville, Australia.
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