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Calvo Álvarez de Arkaia A, Benedé Azagra CB, Gandarias Jaio M, Cardo Miota A, Hernán García M. [What do we need to work with community orientation in Primary Health Care? Twenty-five measures for management and teams]. GACETA SANITARIA 2024; 38:102403. [PMID: 38850587 DOI: 10.1016/j.gaceta.2024.102403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Identify and clarify what practical organizational measures would promote the development of level 2 (community-oriented group health education) and level 3 (community action) community activities in Primary Health Care (PHC) from the perspective of medical professionals with training and experience in this area. METHOD Exploratory, descriptive and cross-sectional study carried out using qualitative methodology using two techniques: 3 focus groups (24 participants) and 12 open questionnaires (12 participants). RESULTS 25 measures are defined to promote the development of these activities that are the responsibility of management and Primary Care Teams (PCT). The most notable proposals are: enhance training in community health, incorporate community activity into the work agendas of professionals, political prioritization and support from management, ensure the job stability of the teams, strengthen the recognition of activities community, resize the patient population of professionals, strengthen multidisciplinary work, cohesion and an autonomous and flexible organization in the PCT, and have the support of the coordinations-directions of the PCT. CONCLUSIONS Three proposals have been considered fundamental to promote the development of level 2 and level 3 community activities in PHC: 1) promote training in community health; 2) incorporate community activity into the work agendas of professionals; 3) political prioritization and support from management for the development of these two levels of work in PHC. Six other proposals have been recognized as being of special importance.
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Affiliation(s)
- Asier Calvo Álvarez de Arkaia
- Centro de Salud de Barañain II, Servicio Navarro de Salud, Barañain (Navarra), España; Servicio de Promoción de la Salud Comunitaria, Instituto de Salud Pública y Laboral de Navarra, Pamplona-Iruña, España.
| | - Carmen Belén Benedé Azagra
- Centro de Salud Canal Imperial - San José Sur, Servicio Aragonés de Salud, Zaragoza, España; Programa de Actividades Comunitarias en Atención Primaria (PACAC) , España; Observatorio de Salud Comunitaria, Alianza de Salud Comunitaria, España
| | - Mikel Gandarias Jaio
- Centro de Salud de Elgoibar, Servicio Vasco de Salud, Elgoibar (Guipuzkoa), España
| | - Adrián Cardo Miota
- Centro de Salud de Órgiva, AGS Sur de Granada, Servicio Andaluz de Salud, Órgiva (Granada), España
| | - Mariano Hernán García
- Observatorio de Salud Comunitaria, Alianza de Salud Comunitaria, España; Escuela Andaluza de Salud Pública, Granada, España
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Zanini B, Benini F, Marullo M, Simonetto A, Rossi A, Cavagnoli P, Bonalumi A, Marconi S, Pigozzi MG, Gilioli G, Valerio A, Donato F, Castellano M, Ricci C. Mediterranean-Oriented Dietary Intervention Is Effective to Reduce Liver Steatosis in Patients with Nonalcoholic Fatty Liver Disease: Results from an Italian Clinical Trial. Int J Clin Pract 2024; 2024:8861126. [PMID: 38303926 PMCID: PMC10834092 DOI: 10.1155/2024/8861126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 02/03/2024] Open
Abstract
Results One hundred and fifty five subjects aged 20-59 years underwent (i) liver ultrasound (US), (ii) clinical and anthropometric evaluations, (iii) blood tests, and (iv) assessment of dietary habits. According to US evaluation, 73 of them had severe, moderate, or mild liver steatosis (NAFLD patients) and 82 had no liver steatosis (healthy controls). Fifty-eight NAFLD patients and 73 controls completed the study. Among NAFLD patients, 26 (45%) downgraded steatosis severity, 12 of which achieved complete steatosis regression (21%). Three of the healthy controls developed NAFLD. The NAFLD patients improved their dietary habits and reduced BMI and waist circumference, during the study period, more than healthy controls. Liver steatosis remission/regression was independent of changes in BMI or liver enzymes and was more frequent among patients with mild steatosis at baseline. Conclusions Mediterranean dietary advices, without a personalised meal planning, were efficient in reducing/remitting NAFLD, especially among patients with mild disease, which argues in favour of early identification and lifestyle intervention. This trial is registered with NCT03300661.
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Affiliation(s)
- Barbara Zanini
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Federica Benini
- Department of Medicine, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Monica Marullo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Anna Simonetto
- Department of Civil Engineering, Architecture, Land and Environment, and Mathematics, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Angelo Rossi
- Health Protection Agency, ATS Brescia, Lombardy, Italy
| | - Paola Cavagnoli
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Alessia Bonalumi
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Silvia Marconi
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Marie Graciella Pigozzi
- Department of Medicine, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Gianni Gilioli
- Department of Civil Engineering, Architecture, Land and Environment, and Mathematics, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Alessandra Valerio
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Francesco Donato
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Viale Europa 11, Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, Brescia, Italy
- Department of Medicine, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Chiara Ricci
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, Brescia, Italy
- Department of Medicine, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, Brescia, Italy
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Bytyçi-Katanolli A, Obas KA, Ramadani Q, Fota N, Jerliu N, Merten S, Gerold J, Zahorka M, Kwiatkowski M, Probst-Hensch N. Effectiveness of behavioural change interventions on physical activity, diet and body mass index of public primary healthcare users in Kosovo: the KOSCO cohort. BMJ Open 2023; 13:e071100. [PMID: 37813529 PMCID: PMC10565199 DOI: 10.1136/bmjopen-2022-071100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/13/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Prevalent physical inactivity and poor nutrition contribute to high non-communicable disease (NCD) morbidity and mortality in Kosovo. To improve health services for patients with NCD the Accessible Quality Healthcare project developed behaviour change interventions following the principles of the WHO Package of Essential NCD (PEN) protocol. They were implemented into the public primary healthcare (PHC) system of five early-stage implementation municipalities (ESIM, 2018) and seven late-stage implementation municipalities (2020). OBJECTIVE To assess the effect of the behaviour change interventions; motivational stages of behaviour change for physical activity and nutrition; and body mass index (BMI). DESIGN Prospective cohort study. DATA COLLECTION AND ANALYSIS We included 891 public PHC users aged 40 years and above, who were enrolled in the KOSCO (Kosovo Non-Communicable Disease Cohort) cohort in 2019 and followed-up biannually until February 2021. The PHC users who consulted for themselves any health service were approached and recruited for cohort participation. Each participant contributed up to four self-reports of nutrition and physical activity, and up to three reports of motivation to change for a better lifestyle. These outcomes were modelled prospectively with robust mixed-effects Poisson regressions. The association between behaviour change interventions and BMI was quantified using linear regression. RESULTS There was a high rate of smokers 20.5% and obesity 53.1%, and high rates of self-reported diagnoses of diabetes: 57.1%; hypertension 62.6%. We found no effect of residing in an ESIM, but adherence to both guidelines was higher in ESIM at the latest follow-up time point. ESIM residence was also associated with a twofold increase in the probability of reporting a high motivation for a better lifestyle and with a statistically non-significant decrease in BMI of -0.14 kg/m2 (95% CI: -0.46 to 0.19) at the latest follow-up. CONCLUSION The longitudinal results extend evidence on the effect of WHO PEN protocol in promoting physical activity and nutritional behaviour in the Kosovo context.
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Affiliation(s)
- Ariana Bytyçi-Katanolli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Katrina Ann Obas
- Qualitätsmanagement & Patientensicherheit, Universitätsspital Zürich, Zurich, Switzerland
| | | | - Nicu Fota
- Accessible Quality Healthcare Project, Prishtina, Kosovo
| | - Naim Jerliu
- National Institute of Public Health Kosovo, Prishtina, Kosovo
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Sonja Merten
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Jana Gerold
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | - Marek Kwiatkowski
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Mansoury O, Essoli S, Kachkouch H, Mansouri A, Adarmouch L, Amine M, Sebbani M. General practitioners' knowledge, attitudes and practices towards health promotion in Morocco. Niger Postgrad Med J 2023; 30:226-231. [PMID: 37675699 DOI: 10.4103/npmj.npmj_83_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background Health promotion (HP) is a part of the general practitioners' (GPs) competencies defined by the World Organization of Family Doctors. The implementation of HP in their practice is unsatisfactory. Aims The aim of this study was to explore GPs knowledge, attitudes and practices in Morocco about HP at the primary healthcare services. Methods A cross-sectional study was conducted using an online self-administrated questionnaire including, knowledge, attitudes and practices of GPs toward HP. Descriptive and bivariate analyses were conducted. Results Two hundred and forty GPs responded to our questionnaires, the sex ratio was 1.12 with an average age of 40.46 ± 9.05 years. More than half of our participants perceived HP as a concept indistinct from prevention, 70.4% believed that HP refers to the biomedical model. On a Likert scale of 1-5, the level of HP knowledge was 2.71 ± 1.13. The most discussed topics with the population were tobacco, alcohol, overweight and obesity. Statistically significant association was found between the competencies of GPs in lifestyle behaviours and the practice of this competence. Conclusion The knowledge of GPs remains insufficient, and their practices focus more on the areas in which they feel competent, which requires the implementation of specific training for the development of GPs skills in HP.
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Affiliation(s)
- Ouassim Mansoury
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco
| | - Samira Essoli
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco
| | - Hamza Kachkouch
- Faculty of Medicine and Pharmacy, University Cadi Ayyad, Marrakesh, Morocco
| | - Adil Mansouri
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco
| | - Latifa Adarmouch
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco
| | - Mohamed Amine
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco
| | - Majda Sebbani
- Department of Public Health, Epidemiology and Community Medicine, Laboratory of Biosciences and Health, Faculty of Medicine and Pharmacy, Cadi Ayyad University; Clinical Research Service, Mohammed VI University Hospital Centre, Marrakesh, Morocco; Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Meer R, van de Pol J, van den Brandt PA, Schouten LJ. The association of healthy lifestyle index score and the risk of renal cell cancer in the Netherlands cohort study. BMC Cancer 2023; 23:156. [PMID: 36797692 PMCID: PMC9933336 DOI: 10.1186/s12885-023-10627-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Diet, alcohol, cigarette smoking, physical inactivity, and body mass index have been studied as risk factors for renal cell cancer (RCC). The joint effects of these lifestyle factors, captured as Healthy Lifestyle Index (HLI), were examined in one previous study. This study aims to investigate the association between HLI score and RCC risk in the prospective Netherlands Cohort Study (NLCS). METHODS A case-cohort analysis (3,767 subcohort members, 485 cases) was conducted using NLCS data (n = 120,852). Data on aforementioned risk factors was used to calculate HLI score, ranging 0-20, with higher scores reflecting healthier lifestyles. RCC occurrence was obtained by record linkage to cancer registries. Multivariable-adjusted proportional hazard models were used to calculate Hazard Ratios (HR) and 95% Confidence Intervals (95%CI). RESULTS Compared to participants in the unhealthiest HLI category, participants within the healthiest category had a lower RCC risk (HR = 0.79, 95%CI = 0.56-1.10, p for trend 0.045). A standard deviation (± 3-unit) increase in HLI score was not statistically significantly associated with a lower RCC risk (HR = 0.92, 95%CI = 0.83-1.01). This association was stronger after excluding diet or alcohol from the score, although confidence intervals overlap. CONCLUSIONS Adherence to a healthy lifestyle was weakly, though not statistically significantly, associated with a lower RCC risk.
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Affiliation(s)
- Romain Meer
- grid.5012.60000 0001 0481 6099Department of Epidemiology, GROW- School for Oncology and Reproduction, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands
| | - Jeroen van de Pol
- grid.5012.60000 0001 0481 6099Department of Epidemiology, GROW- School for Oncology and Reproduction, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands
| | - Piet A. van den Brandt
- grid.5012.60000 0001 0481 6099Department of Epidemiology, GROW- School for Oncology and Reproduction, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Leo J. Schouten
- grid.5012.60000 0001 0481 6099Department of Epidemiology, GROW- School for Oncology and Reproduction, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands
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Cardo Miota A, Valls Pérez B, Gil García E, Hernán García M. [Proposals for the community orientation of primary health care: to identify key agents for training]. GACETA SANITARIA 2022; 37:102269. [PMID: 36399988 DOI: 10.1016/j.gaceta.2022.102269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the strengths available for the community orientation of primary health care (PHC) in the context of the evaluation of the piloting of a training program in Community Health for Resident Internal Specialists in Andalusia (Spain). METHOD We will conduct a qualitative, phenomenologically-oriented, explanatory research in which the opinion of the participants is analyzed. Sixty-seven professionals from six PHC Districts of Andalusia which were part of the training program called Project to Support the Revitalization of Primary Care Assets for Community Health (PARAC) were interviewed. RESULTS There is consensus in giving training a key weight in the community orientation of PHC. For this reason, those agents linked to training are identified as assets: general practice (GP) trainers, young professionals in training who bring updated perspectives and approaches to accredited PHC training centers, whose professionals must respond to the needs of their GP trainees, the multi-professional teaching units responsible for the GP trainees training and a medium and long-term health system thinking along with structures that coordinate and support the community work at the PHC centers. CONCLUSIONS The community orientation of PHC is an objective that requires the participation of all levels of the health system. Knowing its assets and working with them can contribute to provide proposals to advance towards a community-oriented PHC system.
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Steel A. Naturopathic patient care during different life stages: an international observational study of naturopathic practitioners and their patients. BMC Health Serv Res 2022; 22:947. [PMID: 35883061 PMCID: PMC9316703 DOI: 10.1186/s12913-022-08344-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An individual's health status varies with age, with most health problems increasing through different life stages. Yet, a key feature of the majority of conditions contributing burden to society globally, irrespective of life stage, is the predominance of chronic, non-communicable diseases (NCDs). An important response to this growing burden is the increasing recognition of addressing NCD prevention through a life-course perspective through primary care and public health. Naturopathy is a traditional medicine system originating from Europe, and its practitioners commonly provide primary care and focus on prevention and wellness. However, little is known about naturopathic practitioners (NPs) contribution to health care across different life stages. METHODS This secondary analysis of a cross-sectional study aimed to describe the approach to the care of NPs based on the life stage of their patients. The primary study recruited NPs from 14 regions or countries, who were invited to complete a short survey about 20 consecutive patients. The multilingual survey included the following domains: patient demographics, reason for visit, prescribed or recommended treatments, and naturopathic interpretation of the health conditions. Descriptive statistics were tabulated as frequencies and percentages and chi square tests were used to test associations and compare groups. Effect size was determined by Cramer's V. RESULTS Participant NPs (n = 56) provided consultation details for 854 patients encounters. There were differences in the patient's primary reason for visiting, the additional physiological systems the NP considered important in the management of the patient's health, and the treatments prescribed across all life stages. However, diet (45.1-70.0%) and lifestyle (14.3-60.0%) prescription were the most common categories of treatments across all patient groups. CONCLUSION NPs provide care to patients across all life stages, and diverse conditions pertinent to those life stages while also demonstrating a holistic approach that considers broader health concerns and long term treatment practices. While there may be emerging evidence supporting and informing NP clinical outcomes, the breadth and diversity of health conditions, populations and treatments within the scope of naturopathic practice underscores a need for urgent and widescale research investigating naturopathic care across the life course.
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Affiliation(s)
- Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, 2006, Australia.
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Huynh N, Tariq S, Charron C, Hayes T, Bhanushali O, Kaur T, Jama S, Ambade P, Bignell T, Hegarty T, Shorr R, Pakhale S. Personalised multicomponent interventions for tobacco dependence management in low socioeconomic populations: a systematic review and meta-analysis. J Epidemiol Community Health 2022; 76:jech-2021-216783. [PMID: 35623792 PMCID: PMC9279829 DOI: 10.1136/jech-2021-216783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There remains a disproportionally high tobacco smoking rate in low-income populations. Multicomponent tobacco dependence interventions in theory are effective. However, which intervention components are necessary to include for low socioeconomic status (SES) populations is still unknown. OBJECTIVE To assess the effectiveness of multicomponent tobacco dependence interventions for low SES and create a checklist tool examining multicomponent interventions. METHODS EMBASE and MEDLINE databases were searched to identify randomised controlled trials (RCTs) published with the primary outcome of tobacco smoking cessation measured at 6 months or post intervention. RCTs that evaluated tobacco dependence management interventions (for reduction or cessation) in low SES (experience of housing insecurity, poverty, low income, unemployment, mental health challenges, illicit substance use and/or food insecurity) were included. Two authors independently abstracted data. Random effects meta-analysis and post hoc sensitivity analysis were performed. RESULTS Of the 33 included studies, the number of intervention components ranged from 1 to 6, with smoking quit rates varying between 1% and 36.6%. Meta-analysis revealed that both the 6-month and 12-month outcome timepoints, multicomponent interventions were successful in achieving higher smoking quit rates than the control (OR 1.64, 95% Cl 1.41 to 1.91; OR 1.74, 95% Cl 1.30 to 2.33). Evidence of low heterogeneity in the effect size was observed at 6-month (I2=26%) and moderate heterogeneity at 12-month (I2=56%) outcomes. CONCLUSION Multicomponent tobacco dependence interventions should focus on inclusion of social support, frequency and duration of components. Employing community-based participatory-action research approach is essential to addressing underlying psychosocioeconomic-structural factors, in addition to the proven combination pharmacotherapies. PROSPERO REGISTRATION NUMBER CRD42017076650.
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Affiliation(s)
- Nina Huynh
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Saania Tariq
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Tavis Hayes
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Onkar Bhanushali
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tina Kaur
- Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sadia Jama
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Preshit Ambade
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ted Bignell
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
| | - Terry Hegarty
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
| | - Risa Shorr
- Learning Services, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Smita Pakhale
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
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Arietaleanizbeaskoa MS, Gil Rey E, Mendizabal Gallastegui N, García-Álvarez A, De La Fuente I, Domínguez-Martinez S, Pablo S, Coca A, Gutiérrez Santamaría B, Grandes G. Implementing Exercise in Standard Cancer Care (Bizi Orain Hybrid Exercise Program): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e24835. [PMID: 34383676 PMCID: PMC8386357 DOI: 10.2196/24835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 04/19/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite the established benefits of regular exercise for patients with cancer to counteract the deleterious effects of the disease itself and treatment-related adverse effects, most of them do not engage in sufficient levels of physical activity and there is a paucity of data on the integration of efficacious exercise programs that are accessible and generalizable to a large proportion of patients with cancer into routine cancer care. OBJECTIVE We intend to examine the effects attributable to the implementation of a community-based exercise program on cardiorespiratory functional capacity and quality of life for patients with cancer. METHODS This will be a hybrid study. In the first experimental phase, patients diagnosed with any type of cancer will be randomized into two parallel groups. One group immediately performs Bizi Orain, a 3-month supervised exercise program (3 times a week), in addition to behavioral counseling in a primary health care setting; the other is a reference group that starts the exercise program 3 months later (delayed treatment). In the second observational phase, the entire cohort of participants will be followed-up for 5 years. Any person diagnosed with cancer in the previous 2 years is eligible for the program. The program evaluation involves the uptake, safety, adherence, and effectiveness assessed after completion of the program and with follow-ups at 3, 6, 12, 24, 36, 48, and 60 months. The primary outcomes of the experimental study, to be compared between groups, are improved physical function and quality of life, whereas overall survival is the main objective of the prospective study. To analyze the association between changes in physical activity levels and overall survival, longitudinal mixed-effects models will be used for repeated follow-up measures. RESULTS A total of 265 patients have been enrolled into the study since January 2019, with 42 patients from the hematology service and 223 from the oncology service. CONCLUSIONS Bizi Orain is the first population-based exercise program in Spain that will offer more insight into the implementation of feasible, generalizable, and sustainable supportive care services involving structured exercise to extend survival of patients with cancer, improve their physical function and quality of life, and reverse the adverse effects of their disease and related treatments, thereby reducing the clinical burden. TRIAL REGISTRATION ClinicalTrials.gov NCT03819595; http://clinicaltrials.gov/ct2/show/NCT03819595. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/24835.
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Affiliation(s)
| | | | | | | | | | | | - Susana Pablo
- Biocruces Health Research Institute, Barakaldo, Spain
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"My Patients Asked Me If I Owned a Fruit Stand in Town or Something." Barriers and Facilitators of Personalized Dietary Advice Implemented in a Primary Care Setting. J Pers Med 2021; 11:jpm11080747. [PMID: 34442392 PMCID: PMC8399817 DOI: 10.3390/jpm11080747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/16/2022] Open
Abstract
Primary care is especially well positioned to address prevention of non-communicable diseases. However, implementation of health promotion activities such as personalized dietary advice is challenging. The study aim was to understand barriers and facilitators of the personalized dietary advice component of a lifestyle intervention in primary care, as perceived by health center professionals and program participants. Thirteen focus groups were conducted with 49 professionals and 47 participants. Audio recordings were transcribed. Professional group text was coded using the Consolidated Framework for Implementation Research (CFIR). Participant group text was coded via an inductive approach with thematic analysis. Across most CFIR domains, both barriers and facilitators were equally present, except for ‘characteristics of individuals’, which were primarily facilitators. Intervention characteristics was the most important domain, with barriers in design and packaging (e.g., the ICT tool) and complexity. Facilitators included high evidence strength and quality, adaptability, and relative advantage. Participants described the importance of more personalized advice, the value of follow-up with feedback, and the need to see outcomes. Both professionals and patients stated that primary care was the place for personalized dietary advice intervention, but that lack of time, workload, and training were barriers to effective implementation. Implementation strategies targeting these modifiable barriers could potentially increase intervention adoption and intervention effectiveness.
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Arakawa N, Bader LR. Consensus development methods: Considerations for national and global frameworks and policy development. Res Social Adm Pharm 2021; 18:2222-2229. [PMID: 34247949 DOI: 10.1016/j.sapharm.2021.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/28/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND key decisions have to be made in healthcare systems and policies often under uncertain conditions or without complete objective evidence. Decisions made on the health system and policy levels affect national and global population, which requires transparency and accountability to ensure the best impact to population's health. Consensus development methods assist complex process of the decision making combining existing evidence and expert opinions. Variety of challenges affect the selection, application and use of the consensus development methods, which requires careful consideration to keep rigour, validity and transparency. OBJECTIVE To identify and review studies which have used consensus development methods in order to develop national or international policy or framework in health field. METHODS A literature review was conducted searching the databases PubMed, EMBASE and PsycINFO. Studies using a consensus development approach to develop tools or frameworks for health system and policy enhancement were eligible for the review. Key elements of consensus development process were extracted and reported using content analysis and narrative synthesis. RESULTS The review included 26 studies in total either in national or international settings. Over 60% of studies extracted did not apply typical consensus development methods; however, stated as consensus meetings instead. Delphi technique was the most used method from the consensus development methods, which often combined with some face-to-face meeting features. CONCLUSIONS This review summarised the use of consensus development methods in health system and policy development. The review identified a wide range of variations in the selection, use and application of the methods in studies. For better utilisation and application of the consensus development methods in the field, some standardisation of the methods and reporting would be warranted.
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Affiliation(s)
- Naoko Arakawa
- School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Lina R Bader
- International Pharmaceutical Federation, Andries Bickerweg 5, 2517 JP, The Hague, the Netherlands.
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12
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Rietkerk W, de Jonge-de Haan J, Slaets JPJ, Zuidema SU, Gerritsen DL. Increasing Older Adult Involvement in Geriatric Assessment: A Mixed-Methods Process Evaluation. J Aging Health 2021; 33:482-492. [PMID: 33625262 PMCID: PMC8236665 DOI: 10.1177/0898264321993321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Goal setting and motivational interviewing (MI) may increase well-being by promoting healthy behavior. Since we failed to show improved well-being in a proactive assessment service for community-dwelling older adults applying these techniques, we studied whether implementation processes could explain this. Methods: Goals set during the comprehensive geriatric assessment were evaluated on their potential for behavior change. MI and goal setting adherence wasassessed by reviewing audiotaped interactions and interviewing care professionals. Results: Among the 280 goals set with 230 frail older adults (mean age 77 ± 6.9 years, 59% women), more than 90% had a low potential for behavior change. Quality thresholds for MI were reached in only one of the 11 interactions. Application was hindered by the context and the limited proficiency of care professionals. Discussion: Implementation was suboptimal for goal setting and MI. This decreased the potential for improved well-being in the participating older adults.
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Affiliation(s)
- Wanda Rietkerk
- Department of General Practice and Elderly Care Medicine, 3647University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Joris P J Slaets
- Faculty of Medical Sciences, 3647University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.,443696Leyden Academy on Vitality and Ageing, Leiden, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, 3647University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Debby L Gerritsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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13
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Trevisi L, Orav JE, Atwood S, Brown C, Curley C, King C, Muskett O, Sehn H, Nelson AK, Begay MG, Shin SS. Community Outreach for Navajo People Living with Diabetes: Who Benefits Most? Prev Chronic Dis 2020; 17:E68. [PMID: 32701432 PMCID: PMC7380292 DOI: 10.5888/pcd17.200068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The Community Outreach and Patient Empowerment (COPE) intervention provides integrated outreach through community health representatives (CHRs) to people living with diabetes in Navajo Nation. The aim of this study was to identify groups for whom the intervention had the greatest effect on glycated hemoglobin A1c (HbA1c). METHODS We analyzed de-identified data extracted from routine health records dated from December 1, 2010, through August 31, 2014, to compare net change in HbA1c among COPE patients and non-COPE patients. We used linear mixed models to assess whether the intervention was modified by age, sex, preferred language, having a primary care provider, baseline HbA1c, or having a mental health condition. RESULTS Age, having a primary care provider, and baseline HbA1c significantly modified HbA1c levels. Among patients aged 64 or younger, COPE participation was associated with a net decrease in HbA1c of 0.77%; among patients aged 65 or older, the net decrease was 0.49% (P = .03). COPE participation was associated with a steeper decrease in HbA1c among patients without a primary care physician (net decrease, 0.99%) than among patients with a primary care provider (net decrease, 0.57%) (P = .03). COPE patients with a baseline HbA1c >9% had a net decrease of 0.70%, while those with a baseline HbA1c ≤9% had a net decrease of 0.34% (P = .01). We found no significant differences based on sex, preferred language, or having a mental health condition. CONCLUSION Findings suggest that the COPE intervention was robust and equitable, benefiting all groups living with diabetes in Navajo Nation, but conferring the greatest benefit on the most vulnerable.
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Affiliation(s)
- Letizia Trevisi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - John E Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christian Brown
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Caroline King
- School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hannah Sehn
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,Partners in Health, Boston, Massachusetts
| | | | - Mae-Gilene Begay
- Navajo Nation Department of Health, Navajo Department of Health, Window Rock, Navajo Nation
| | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
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14
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Lloyd HM, Ekman I, Rogers HL, Raposo V, Melo P, Marinkovic VD, Buttigieg SC, Srulovici E, Lewandowski RA, Britten N. Supporting Innovative Person-Centred Care in Financially Constrained Environments: The WE CARE Exploratory Health Laboratory Evaluation Strategy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3050. [PMID: 32353939 PMCID: PMC7246834 DOI: 10.3390/ijerph17093050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 12/24/2022]
Abstract
The COST CARES project aims to support healthcare cost containment and improve healthcare quality across Europe by developing the research and development necessary for person-centred care (PCC) and health promotion. This paper presents an overview evaluation strategy for testing 'Exploratory Health Laboratories' to deliver these aims. Our strategy is theory driven and evidence based, and developed through a multi-disciplinary and European-wide team. Specifically, we define the key approach and essential criteria necessary to evaluate initial testing, and on-going large-scale implementation with a core set of accompanying methods (metrics, models, and measurements). This paper also outlines the enabling mechanisms that support the development of the "Health Labs" towards innovative models of ethically grounded and evidenced-based PCC.
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Affiliation(s)
- Helen M. Lloyd
- School of Psychology, University of Plymouth, Plymouth PL6 8BX, UK
| | - Inger Ekman
- Institute of Health and Care Sciences, Gothenburg University Centre for Person-Centred Care (GPCC), 405 30 Gothenburg, Sweden;
| | - Heather L. Rogers
- Biocruces Bizkaia Health Research Institute, Barakaldo, 48903 Bizkaia, Spain;
- IKERBASQUE, Basque Foundation for Science, Bilbao, 48013 Bizkaia, Spain
| | - Vítor Raposo
- Centre for Business and Economics Research (CeBER), Centre of Health Studies and Research of the University of Coimbra, Faculty of Economics, University of Coimbra, Av. Dr. Dias da Silva 165, 3004-512 Coimbra, Portugal;
| | - Paulo Melo
- Centre for Business and Economics Research, Faculty of Economics, INESC Coimbra, University of Coimbra, Av. Dr. Dias da Silva 165, 3004-512 Coimbra, Portugal;
| | - Valentina D. Marinkovic
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmaceutical Legislation, University of Belgrade, Vojvode Stepe 450, 11000 Belgrade, Serbia;
| | - Sandra C. Buttigieg
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, MSD2080 Msida, Malta;
| | - Einav Srulovici
- Department of Nursing, University of Haifa, Haifa 3498838, Israel;
| | | | - Nicky Britten
- Institute of Health Research, University of Exeter Medical School, St Luke’s Campus, Exeter EX1 2LU, UK;
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15
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Trevisi L, Orav JE, Atwood S, Brown C, Curley C, King C, Muskett O, Sehn H, Nelson KA, Begay MG, Shin SS. Integrating community health representatives with health care systems: clinical outcomes among individuals with diabetes in Navajo Nation. Int J Equity Health 2019; 18:183. [PMID: 31771603 PMCID: PMC6880375 DOI: 10.1186/s12939-019-1097-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/18/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We studied the impact of Community Outreach and Patient Empowerment (COPE) intervention to support Community Health Representatives (CHR) on the clinical outcomes of patients living with diabetes in the Navajo Nation extending into the States of Arizona, Utah, and New Mexico. The COPE intervention integrated CHRs into healthcare teams by providing a structured approach to referrals and home visits. METHODS We abstracted routine clinical data from the Indian Health Service's information system on individuals with diabetes mellitus seen at participating clinical sites from 2010 to 2014. We matched 173 COPE participants to 2880 patients with similar demographic and clinical characteristics who had not participated in COPE. We compared the changes in clinical outcomes between the two groups using linear mixed models. RESULTS Over the four years of the study, COPE patients had greater improvements in glycosylated hemoglobin (- 0.56%) than non-COPE participants (+ 0.07%) for a difference in differences of 0.63% (95% confidence interval (CI): 0.50, 0.76). Low-density lipoprotein fell more steeply in the COPE group (- 10.58 mg/dl) compared to the non-COPE group (- 3.18 mg/dl) for a difference in differences of 7.40 mg/dl (95%CI: 2.00, 12.80). Systolic blood pressure increased slightly more among COPE (2.06 mmHg) than non-COPE patients (0.61 mmHg). We noted no significant change for body mass index in either group. CONCLUSION Structured outreach by Community Health Representatives as part of an integrated care team was associated with improved glycemic and lipid levels in the target Navajo population. TRIAL REGISTRATION Trial registration: NCT03326206. Registered 31 October 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT03326206.
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Affiliation(s)
- Letizia Trevisi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - John E Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian Brown
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Caroline King
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Katrina A Nelson
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
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16
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Wolfenden L, Ezzati M, Larijani B, Dietz W. The challenge for global health systems in preventing and managing obesity. Obes Rev 2019; 20 Suppl 2:185-193. [PMID: 31317659 DOI: 10.1111/obr.12872] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 12/12/2022]
Abstract
Few health crises have been as predictable as the unfolding obesity pandemic. Clinical and public health services remain the front line of efforts to reduce the burden of obesity. While a range of clinical practice guidelines exist, the need for clinical interventions exceeds the capacity of health systems to provide care for those affected with obesity, and routine clinical practices fall far short of guidelines recommendations even in high-income countries. In this manuscript, we discuss current recommendations regarding obesity interventions and key challenges facing global health systems in managing the health needs of people with obesity. Improving the provision of obesity-related health care is a considerable challenge and will require changing existing perceptions of obesity as a matter of personal failure to its recognition as a disease, innovative approaches to health system reform, clinician capacity building and implementation support, a focus on prevention, and wise resource allocation. Leadership from governments, the medical profession, and patient and community groups to address the issues raised in this manuscript is urgently needed to address the growing health concern.
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Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Local Health District, Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.,WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| | - Bagher Larijani
- Diabetes Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - William Dietz
- Redstone Global Centre for Prevention and Wellness, George Washington University, Washington, DC, US
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17
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Schakel L, Veldhuijzen DS, Manai M, Beugen SV, Vaart RVD, Middendorp HV, Evers AWM. Editor's choice: Optimizing healthy food preferences by serious gaming. Psychol Health 2019; 35:405-424. [PMID: 31607172 DOI: 10.1080/08870446.2019.1675657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Serious gaming is an upcoming and promising tool in prevention and health promotion. The aim of this experimental study was to examine whether health-related serious gaming could optimize food-related outcomes and physical activity.Design: Eighty-one healthy participants (80% female) were randomly allocated to an experimental condition, in which participants played serious games based on transferring information, priming and evaluative conditioning, for half an hour, or a control condition, in which participants played non-health-related computer games.Main outcome measures: The primary study outcome was self-reported food preference and self-reported food choice, assessed by the Food Choice Task with food pairs differing in healthiness, or in both healthiness and attractiveness. Secondary outcomes were actual food choice and physical activity.Results: A significantly healthier food preference for pairs differing in healthiness was found on the Food Choice Task in the experimental compared to the control condition. No significant differences were found on the other outcomes.Conclusions: This study provides preliminary support for the effects of serious gaming based on optimizing food preferences. More research is needed to confirm the present findings and to further elucidate and optimize the effects of serious gaming on health behaviours.
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Affiliation(s)
- Lemmy Schakel
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Dieuwke S Veldhuijzen
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Meriem Manai
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Sylvia van Beugen
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Rosalie van der Vaart
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Henriët van Middendorp
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Andrea W M Evers
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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18
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Cohidon C, Imhof F, Bovy L, Birrer P, Cornuz J, Senn N. Patients' and General Practitioners' Views About Preventive Care in Family Medicine in Switzerland: A Cross-sectional Study. J Prev Med Public Health 2019; 52:323-332. [PMID: 31588702 PMCID: PMC6780292 DOI: 10.3961/jpmph.19.184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives The aim of this study was to describe general practitioners (GPs)’ opinions and practices of preventive care and patients’ opinions, attitudes, and behaviors towards prevention. Methods The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices. Results Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role. Conclusions Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.
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Affiliation(s)
- Christine Cohidon
- Department of Family Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Fabienne Imhof
- Department of Family Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Laure Bovy
- Department of Family Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Priska Birrer
- Department of Family Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jacques Cornuz
- Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- Department of Family Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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19
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Mäntyselkä P, Kautiainen H, Miettola J. Beliefs and attitudes towards lifestyle change and risks in primary care - a community-based study. BMC Public Health 2019; 19:1049. [PMID: 31382938 PMCID: PMC6683394 DOI: 10.1186/s12889-019-7377-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background Promoting a positive lifestyle change is a challenge for primary health care. The aim of this study was to analyze health and risk-related beliefs and attitudes in relation to lifestyle and lifestyle change in a rural community. Methods The study was based on a five-year follow-up data of the Lapinlahti study (N = 361). The same structured questionnaire was used at baseline and follow-up with lifestyle items. These were ranked as unhealthy (− 1), neutral (0) or healthy (+ 1). At baseline, participants took a stand on 29 statements related to beliefs and attitudes towards health and health promotion on a 5-point Likert scale. A factor analysis yielded two attitude factors (Factor 1 = underrating risks/resistant to change); (Factor 2 = helplessness/pessimism). The factors were divided into tertiles. Results There was a linear positive trend (P < 0.001) in baseline lifestyle scores between the tertiles of Factor 1. A positive follow-up change of lifestyle score was found in all tertiles of Factor 1. For Factor 2, the difference between tertiles at baseline was non-significant. There was a significant positive change in all tertiles of Factor 2. Those who were underrating/ resistant but not helpless/pessimistic had the most significant positive lifestyle change. Those who were underrating/resistant and helpless/pessimistic did not improve their lifestyles. Conclusions Beliefs and attitudes are related to lifestyle. Subjects with underrating and resistant attitudes with pessimism/helplessness seem to have a low potential for lifestyle change while those with resistant attitudes without pessimism and helplessness may have the most significant potential for lifestyle change. These findings suggest that it is possible to identify different groups of people with different needs and readiness and ability for health behavior change.
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Affiliation(s)
- Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition (General Practice), School of Medicine, University of Eastern Finland, 70211-FIN, P.O.Box 1627, Kuopio, Finland. .,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Juhani Miettola
- Institute of Public Health and Clinical Nutrition (General Practice), School of Medicine, University of Eastern Finland, 70211-FIN, P.O.Box 1627, Kuopio, Finland
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20
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Reis F, Sá-Moura B, Guardado D, Couceiro P, Catarino L, Mota-Pinto A, Veríssimo MT, Teixeira AM, Ferreira PL, Lima MP, Palavra F, Rama L, Santos L, van der Heijden RA, Gonçalves CE, Cunha A, Malva JO. Development of a Healthy Lifestyle Assessment Toolkit for the General Public. Front Med (Lausanne) 2019; 6:134. [PMID: 31316985 PMCID: PMC6610478 DOI: 10.3389/fmed.2019.00134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/30/2019] [Indexed: 01/07/2023] Open
Abstract
The prevalence of age-related non-communicable chronic diseases has increased worldwide, being the leading causes of morbidity and death in many world regions, including in Europe. Innovative models and strategies focused on preventive care, including early identification of risk factors underlying disease onset and progression, and proper modification of lifestyle habits and behaviors, might contribute to promote quality of life, healthy living and active aging. Healthy Lifestyle Innovative Quarters for Cities and Citizens (HeaLIQs4cities) is an EIT Health-funded project aiming to engage, empower and educate citizens toward healthy lifestyles. One of the major objectives of this project was to develop a toolkit for a rapid and informal assessment of healthy lifestyles, to be used at different levels of care pathways, including in informal public environments. In this paper, we describe the methodology underlying the development of the toolkit, which resulted from the collaboration of an interdisciplinary focus group of academic experts, from medicine, sport sciences, psychology, health economics, and innovative technologies applied to health. The following eight components were included in the toolkit: (1) anthropometric assessment and cardiometabolic parameters; (2) physical activity and exercise; (3) well-being, social cohesion, and functional independence; (4) nutrition; (5) mental health; (6) smoking, drinking, and use of illicit substances; (7) sleep habits and quality; and (8) health and disease. A traffic light rating system indicating the risk score was used (low: green; moderate: yellow; and relevant: orange) for each of the 8 components, together with recommendations for the toolkit users. After completing the reduced version of the toolkit, individuals showing moderate or relevant risk in one or more of the 8 dimensions, were invited to participate in a more detailed assessment (toolkit long version), based on deeper and scientifically validated tools. The toolkit was incorporated in eVida, a web-based platform that focuses on delivering services to personalized health and well-being. The validation of the current toolkit has been applied in wide-ranging public events in three different European Regions. Large scale deployment of the toolkit is expected to profit from the Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Aging (EIP on AHA).
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Affiliation(s)
- Flávio Reis
- Faculty of Medicine, Institute of Pharmacology & Experimental Therapeutics, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal
| | - Bebiana Sá-Moura
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal
| | - Diana Guardado
- Laboratory of Automatics and Systems, Pedro Nunes Institute (IPN), Coimbra, Portugal
| | - Patrícia Couceiro
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal
| | - Luis Catarino
- Faculty of Sport Sciences and Physical Education, Research Center for Sport and Physical Activity (CIDAF), University of Coimbra, Coimbra, Portugal
| | - Anabela Mota-Pinto
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, General Pathology Institute, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, Center for Research in the Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, Coimbra, Portugal
| | - Manuel T Veríssimo
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Ageing@Coimbra, EIP on AHA Reference Site, Coimbra, Portugal.,Service of Internal Medicine, University of Coimbra Hospital (CHUC), Coimbra, Portugal
| | - Ana Maria Teixeira
- Faculty of Sport Sciences and Physical Education, Research Center for Sport and Physical Activity (CIDAF), University of Coimbra, Coimbra, Portugal.,Ageing@Coimbra, EIP on AHA Reference Site, Coimbra, Portugal
| | - Pedro L Ferreira
- Faculty of Economics, Centre for Health Studies and Research, University of Coimbra, Coimbra, Portugal
| | - Margarida P Lima
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Filipe Palavra
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Neuropediatrics Unit, Centre for Child Development, Pediatrics Hospital, University of Coimbra Hospital (CHUC), Coimbra, Portugal
| | - Luis Rama
- Faculty of Sport Sciences and Physical Education, Research Center for Sport and Physical Activity (CIDAF), University of Coimbra, Coimbra, Portugal
| | - Lelita Santos
- Faculty of Medicine, Center for Research in the Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra, Coimbra, Portugal.,Service of Internal Medicine, University of Coimbra Hospital (CHUC), Coimbra, Portugal.,Unit of Nutrition and Dietetics, University of Coimbra Hospital (CHUC), Coimbra, Portugal
| | - Roel A van der Heijden
- Center for Development and Innovation (CDI), University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands.,Healthy Ageing Network Northern Netherlands (HANNN), Groningen, Netherlands
| | - Carlos E Gonçalves
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - António Cunha
- Laboratory of Automatics and Systems, Pedro Nunes Institute (IPN), Coimbra, Portugal.,Ageing@Coimbra, EIP on AHA Reference Site, Coimbra, Portugal
| | - João O Malva
- Faculty of Medicine, Institute of Pharmacology & Experimental Therapeutics, University of Coimbra, Coimbra, Portugal.,Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.,Ageing@Coimbra, EIP on AHA Reference Site, Coimbra, Portugal
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Sorensen J, Johansson H, Jerdén L, Dalton J, Sheikh H, Jenkins P, May J, Weinehall L. Health-Care Administrator Perspectives on Prevention Guidelines and Healthy Lifestyle Counseling in a Primary Care Setting in New York State. Health Serv Res Manag Epidemiol 2019; 6:2333392819862122. [PMID: 31384624 PMCID: PMC6657119 DOI: 10.1177/2333392819862122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The incidence of chronic disease and treatment costs have been steadily increasing in the United States over the past few decades. Primary prevention and healthy lifestyle counseling have been identified as important strategies for reducing health-care costs and chronic disease prevalence. This article seeks to examine decision-makers' experiences and self-perceived roles in guideline and lifestyle counseling implementation in a primary care setting in the United States. METHODS Qualitative interviews were conducted with administrators at a health-care network in Upstate New York and with state-level administrators, such as insurers. Decision-makers were asked to discuss prevention guidelines and healthy lifestyle counseling, as well as how they support implementation of these initiatives. Interviews were analyzed using a thematic analysis framework and relevant sections of text were sorted using a priori codes. RESULTS Interviews identified numerous barriers to guideline implementation. These included the complexity and profusion of guidelines, the highly politicized nature of health-care provision, and resistance from providers who sometimes prefer to make decisions autonomously. Barriers to supporting prevention counseling included relatively time-limited patient encounters, the lack of reimbursement mechanisms for counseling, lack of patient resources, and regulatory complexities. CONCLUSIONS Our research indicates that administrators and administrative structures face barriers to supporting prevention activities such as guideline implementation and healthy lifestyle counseling in primary care settings. They also identified several solutions for addressing existing primary prevention barriers, such as relying on nurses to provide healthy lifestyle support to patients. This article provides an important assessment of institutional readiness to support primary prevention efforts.
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Affiliation(s)
- Julie Sorensen
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | - Helene Johansson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Lars Jerdén
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Faculty of Medicine, Umeå University, Umeå, Sweden
- Center for Clinical Research Dalarna, Falun, Sweden
| | - James Dalton
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | - Henna Sheikh
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | - Paul Jenkins
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | - John May
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | - Lars Weinehall
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Faculty of Medicine, Umeå University, Umeå, Sweden
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Lohmann H, Kulessa F, Holling H, Johnen A, Reul S, Lueg G, Duning T. [Implementation of the German S3 guidelines on dementia in clinical practice: wish or reality?]. DER NERVENARZT 2018; 88:895-904. [PMID: 28429077 DOI: 10.1007/s00115-017-0325-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Published in 2009, the German S3 guidelines on dementia define a milestone in quality improvement of the diagnostics and treatment of dementia. In clinical practice patients suffering from dementia are primarily treated by physicians in private practice; therefore, this study examined how the guidelines are implemented in outpatient clinical settings. Furthermore, it aimed at the identification of behavioral determinants that govern the actual diagnostic and therapeutic approach in clinical practice. METHODS Physicians involved in the primary care of dementia patients were asked to participate in a nationwide internet survey. The questionnaire covered aspects on the diagnostic and therapeutic care of dementia patients as recommended by the S3 guidelines. Behavioral determinants of the implementation of the guidelines (e. g. treatment decisions) were derived from an established psychological prediction model. RESULTS Out of a total of 2755 physicians contacted, the data of 225 participants could be used in this study. The diagnostic recommendations of the S3 guidelines were implemented in satisfactory measures (e.g. combined cognitive screening in at least 68%, cerebral neuroimaging in at least 93% and specific laboratory diagnostics in at least 27% of cases); however, only two thirds of the patients with indications for a guideline-conform therapy were treated in accordance with the S3 guidelines. There was a substantial prescription of non-recommended drugs and a notable long-term use of antipsychotic drugs (prescription by at least 14% of non-neurological medical specialists and by 8% of neurologists and psychiatrists). When considering the behavioral determinants in the implementation of the guidelines, normative assumptions ("my colleagues and patients expect me to comply with the guidelines") surprisingly had the highest impact, which was then followed by attitudes towards the behavior ("utilization of the guidelines improves diagnostics and therapy"). CONCLUSION The German S3 guidelines on dementia were satisfactorily implemented in outpatient clinical practice; however, deficits existed in the frequency of the pharmaceutical treatment of patients with indications for therapy, the prescription of non-recommended drugs and the relatively common use of permanent neuroleptic medications. Interestingly, the motivation for implementation of the guidelines was not primarily influenced by the physicians' personal convictions but mainly stimulated by the expectations of others.
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Affiliation(s)
- H Lohmann
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
| | - F Kulessa
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
- Institut für Psychologie, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - H Holling
- Institut für Psychologie, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - A Johnen
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - S Reul
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - G Lueg
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - T Duning
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
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Grandes G, Sanchez A, Cortada JM, Pombo H, Martinez C, Balagué L, Corrales MH, de la Peña E, Mugica J, Gorostiza E. Collaborative modeling of an implementation strategy: a case study to integrate health promotion in primary and community care. BMC Res Notes 2017; 10:699. [PMID: 29208052 PMCID: PMC5717849 DOI: 10.1186/s13104-017-3040-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/30/2017] [Indexed: 02/08/2023] Open
Abstract
Background Evidence-based interventions are more likely to be adopted if practitioners collaborate with researchers to develop an implementation strategy. This paper describes the steps to plan and execute a strategy, including the development of structure and supports needed for implementing proven health promotion interventions in primary and community care. Results Between 10 and 13 discussion and consensus sessions were performed in four highly-motivated primary health care centers involving 80% of the primary care staff and 21 community-based organizations. All four centers chose to address physical activity, diet, and smoking. They selected the 5 A’s evidence-based clinical intervention to be adapted to the context of the health centers. The planned implementation strategy worked at multiple levels: bottom-up primary care organizational change, top-down support from managers, community involvement, and the development of innovative e-health information and communication tools. Shared decision making and practice facilitation were perceived as the most positive aspects of the collaborative modeling process, which took more time than expected, especially the development of the new e-health tools integrated into electronic health records. Conclusions Collaborative modeling of an implementation strategy for the integration of health promotion in primary and community care was feasible in motivated centers. However, it was difficult, being hindered by the heavy workload in primary care and generating uncertainty inherent to a bottom-up decision making processes. Lessons from this experience could be useful in diverse settings and for other clinical interventions. Two companion papers report the evaluation of its feasibility and assess quantitatively and qualitatively the implementation process.
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Affiliation(s)
- Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain.
| | - Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain
| | - Josep M Cortada
- Deusto Primary Health Care Center, Bilbao-Basurto Integrated Care Organization-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain
| | - Haizea Pombo
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain
| | - Catalina Martinez
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain
| | - Laura Balagué
- Iztieta Primary Care Center, Donostialdea Integrated Care Organization-Osakidetza, Avenida de Lezo, s/n, 20100, Renteria, Spain
| | - Mary Helen Corrales
- La Merced Primary Health Care Center, Bilbao-Basurto Integrated Care Organization-Osakidetza, Luis Iraurrizaga 1, 48003, Bilbao, Spain
| | - Enrique de la Peña
- Sondika Primary Health Care Center, Uribe Integrated Care Organization-Osakidetza, Lehendakari Agirre 41, 48160, Sondika, Spain
| | - Justo Mugica
- Beasain Primary Health Care Center, Goieri-Alto Urola Integrated Care Organization-Osakidetza, Bernedo s/n, 20200, Beasain, Spain
| | - Esther Gorostiza
- Matiena Primary Health Care Center, Barrualde-Galdakao Integrated Care Organization-Osakidetza, BioCruces Health Research Institute, Trañabarren 13-Bajo, 48220, Abadiño, Spain
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Grandes G, Bully P, Martinez C, Gagnon MP. Validity and reliability of the Spanish version of the Organizational Readiness for Knowledge Translation (OR4KT) questionnaire. Implement Sci 2017; 12:128. [PMID: 29126428 PMCID: PMC5681775 DOI: 10.1186/s13012-017-0664-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organizational readiness to change healthcare practice is a major determinant of successful implementation of evidence-based interventions. However, we lack of comprehensive, valid, and reliable instruments to measure it. We assessed the validity and reliability of the Spanish version of the Organizational Readiness for Knowledge Translation (OR4KT) questionnaire in the context of the implementation of the Prescribe Vida Saludable III project, which seeks to strengthen health promotion and chronic disease prevention in primary healthcare organizations of the Osakidetza (Basque Health Service, Spain). METHODS A cross-sectional study was conducted including 127 professionals from 20 primary care centers within Osakidetza. They filled in the OR4KT questionnaire twice in a 15- to 30-day period to test repeatability. In addition, we used the Survey of Organizational Attributes for Primary Care (SOAPC) and we documented the number of healthcare professionals who formally engaged in the Prescribe Vida Saludable III project within each participating center to assess concurrent validity. RESULTS Cronbach's alpha for the overall OR4KT was .95, and the overall repeatability coefficient was 6.95%, both excellent results. Confirmatory factor analysis supported the underlying theoretical structure of 6 dimensions and 23 sub-dimensions. There were positive moderate-to-high internal correlations between these six dimensions, and there was evidence of good concurrent validity (correlation coefficient of .76 with SOAPC, and .80 with the proportion of professionals engaged by center). A score higher than 64 (out of 100) would be indicative of an organization with high level of readiness to implement the intervention (sensitivity = .75, specificity = 1). CONCLUSIONS The Spanish version of the OR4KT exhibits very strong reliability and good validity, although it needs to be validated in a larger sample and in different implementation contexts.
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Affiliation(s)
- Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power 18, 4a planta, E-48014, Bilbao, Spain. .,BioCruces Health Research Institute, Plaza de Cruces 12, E-48903, Barakaldo, Bizkaia, Spain.
| | - Paola Bully
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power 18, 4a planta, E-48014, Bilbao, Spain.,BioCruces Health Research Institute, Plaza de Cruces 12, E-48903, Barakaldo, Bizkaia, Spain
| | - Catalina Martinez
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power 18, 4a planta, E-48014, Bilbao, Spain.,BioCruces Health Research Institute, Plaza de Cruces 12, E-48903, Barakaldo, Bizkaia, Spain
| | - Marie-Pierre Gagnon
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, QC, Québec, G1V 0A6, Canada.,Faculty of Nursing, Université Laval, 2325 Rue de l'Université, Ville de Québec, QC, G1V 0A6, Canada
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Gray E, Shields C, Fowles JR. Building Competency and Capacity for Promotion of Effective Physical Activity in Diabetes Care in Canada. Can J Diabetes 2017; 41:491-498. [PMID: 28392023 DOI: 10.1016/j.jcjd.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of the present study was to examine the impact of the Canadian Diabetes Association's (CDA) resource titled Building Competency in Diabetes Education: Physical Activity and Exercise and associated workshops, on diabetes care providers' (DCPs) confidence and practices regarding physical-activity promotion 8 to 12 months after attending a workshop. METHODS In this action research study, 2 separate cross-sectional samples of DCPs were recruited. DCPs at baseline (N=462) completed a questionnaire assessing their current physical-activity promotion practices, intended changes in practice and intended implementation of the toolkit. At follow up, DCPs (n=132) completed an online questionnaire assessing their physical-activity counselling practices, confidence in their physical-activity counselling, use of the specific CDA resources as well as changes to practice and ongoing challenges. RESULTS At baseline, 58% of DCPs incorporated physical-activity content in the majority of their sessions; however, 66% of DCPs discussed physical activity in >50% of their sessions following the launch of the training initiative. Following the training, DCPs reported increased confidence across all 6 aspects of physical-activity counselling that were examined. Improvements were most frequently found in providing advice regarding the benefits of activity (86%) and providing instruction regarding resistance training (86%). DCPs most often changed their practices by discussing physical activity more frequently and confidently (27%); however, lack of time was frequently reported (37%) as an ongoing challenge to providing physical-activity counselling. CONCLUSIONS This evaluation highlights the impact of this national initiative and suggests that the resource is effective in improving physical-activity promotion in diabetes care.
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Affiliation(s)
- Emily Gray
- Acadia University, Wolfville, Nova Scotia, Canada
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Sanchez A, Grandes G, Cortada JM, Pombo H, Martinez C, Corrales MH, de la Peña E, Mugica J, Gorostiza E. Feasibility of an implementation strategy for the integration of health promotion in routine primary care: a quantitative process evaluation. BMC FAMILY PRACTICE 2017; 18:24. [PMID: 28212621 PMCID: PMC5316192 DOI: 10.1186/s12875-017-0585-5] [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] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 01/19/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Process evaluation is recommended to improve the understanding of underlying mechanisms related to clinicians, patients, context and intervention delivery that may impact on trial or program results, feasibility and transferability to practice. The aim of this study was to assess the feasibility of the Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable") implementation strategy for enhancing the adoption and implementation of an evidence-based health promotion intervention in primary health care. METHODS A descriptive study of 2-year implementation indicators for the PVS clinical intervention was conducted in four primary health care centers. A multifaceted collaborative modeling implementation strategy was developed to enhance the integration of a clinical intervention to promote healthy lifestyles into clinical practice. Process indicators were assessed for intervention reach, adoption, implementation, sustainability and their variability at center, practice, and patient levels. RESULTS Mean rates of adoption by means of active collaboration among the three main professional categories (family physicians, nurses and administrative personnel) were 75% in all centers. Just over half of the patients that attended (n = 11650; 51.9%) were reached in terms of having their lifestyle habits assessed, while more than a third (33.7%; n = 7433) and almost 10% (n = 2175) received advice or a printed prescription for at least one lifestyle change, respectively. Only 3.7% of the target population received a repeat prescription. These process indicators significantly (p < 0.001) varied by center, lifestyle habit and patient characteristics. Sustainability of intervention components changed thorough the implementation period within centers. CONCLUSIONS The implementation strategy used showed moderate-to-good performance on process indicators related to adoption, reach, and implementation of the evidence-based healthy lifestyle promotion intervention in the context of routine primary care. Sources of heterogeneity and instability in these indicators may improve our understanding of factors required to attain adequate program adoption and implementation through improved implementation strategies.
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Affiliation(s)
- Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18, 4ª planta, E48014 Bilbao, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18, 4ª planta, E48014 Bilbao, Spain
| | - Josep M. Cortada
- Deusto Primary Health Care Center, Bilbao-Basurto Integrated Care Organization– Osakidetza, BioCruces Health Research Institute, Luis Power 18, E48014 Bilbao, Spain
| | - Haizea Pombo
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18, 4ª planta, E48014 Bilbao, Spain
| | - Catalina Martinez
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18, 4ª planta, E48014 Bilbao, Spain
| | - Mary Helen Corrales
- La Merced Primary Health Care Center, Bilbao-Basurto Integrated Care Organization – Osakidetza, Luis Iraurrizaga 1, 48003 Bilbao, Spain
| | - Enrique de la Peña
- Sondika Primary Health Care Center, Uribe Integrated Care Organization – Osakidetza, Lehendakari Agirre 41, 48160 Sondika, Spain
| | - Justo Mugica
- Beasain Primary Health Care Center, Goieri-Alto Urola Integrated Care Organization – Osakidetza, Bernedo s/n, 20200 Beasain, Spain
| | - Esther Gorostiza
- Matiena Primary Health Care Center, Barrualde-Galdakao Integrated Care Organization – Osakidetza, BioCruces Health Research Institute, Trañabarren 13-Bajo, 48220 Abadiño, Spain
| | - on behalf of the PVS group
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18, 4ª planta, E48014 Bilbao, Spain
- Deusto Primary Health Care Center, Bilbao-Basurto Integrated Care Organization– Osakidetza, BioCruces Health Research Institute, Luis Power 18, E48014 Bilbao, Spain
- La Merced Primary Health Care Center, Bilbao-Basurto Integrated Care Organization – Osakidetza, Luis Iraurrizaga 1, 48003 Bilbao, Spain
- Sondika Primary Health Care Center, Uribe Integrated Care Organization – Osakidetza, Lehendakari Agirre 41, 48160 Sondika, Spain
- Beasain Primary Health Care Center, Goieri-Alto Urola Integrated Care Organization – Osakidetza, Bernedo s/n, 20200 Beasain, Spain
- Matiena Primary Health Care Center, Barrualde-Galdakao Integrated Care Organization – Osakidetza, BioCruces Health Research Institute, Trañabarren 13-Bajo, 48220 Abadiño, Spain
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Martinez C, Bacigalupe G, Cortada JM, Grandes G, Sanchez A, Pombo H, Bully P. The implementation of health promotion in primary and community care: a qualitative analysis of the 'Prescribe Vida Saludable' strategy. BMC FAMILY PRACTICE 2017; 18:23. [PMID: 28212606 PMCID: PMC5316200 DOI: 10.1186/s12875-017-0584-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 01/19/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The impact of lifestyle on health is undeniable and effective healthy lifestyle promotion interventions do exist. However, this is not a fundamental part of routine primary care clinical practice. We describe factors that determine changes in performance of primary health care centers involved in piloting the health promotion innovation 'Prescribe Vida Saludable' (PVS) phase II. METHODS We engaged four primary health care centers of the Basque Healthcare Service in an action research project aimed at changing preventive health practices. Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable) is focused on designing, planning, implementing and evaluating innovative programs to promote multiple healthy habits, feasible to be performed in routine primary health care conditions. After 2 years of piloting, centers were categorized as having high, medium, or low implementation effectiveness. We completed qualitative inductive and deductive analysis of five focus groups with the staff of the centers. Themes generated through consensual grounded qualitative analysis were compared between centers to identify the dimensions that explain the variation in actual implementation of PVS, and retrospectively organized and assessed against the Consolidated Framework for Implementation Research (CFIR). RESULTS Of the 36 CFIR constructs, 11 were directly related to the level of implementation performance: intervention source, evidence strength and quality, adaptability, design quality and packaging, tension for change, learning climate, self-efficacy, planning, champions, executing, and reflecting and evaluating, with -organizational tracking added as a new sub-construct. Additionally, another seven constructs emerged in the participants' discourse but were not related to center performance: relative advantage, complexity, patients' needs and resources, external policy and incentives, structural characteristics, available resources, and formally appointed internal implementation leaders. Our findings indicate that the success of the implementation seems to be associated with the following components: the context, the implementation process, and the collaborative modelling. CONCLUSIONS Identifying barriers and enablers is useful for designing implementation strategies for health promotion in primary health care centers that are essential for innovation success. An implementation model is proposed to highlight the relationships between the CFIR constructs in the context of health promotion in primary care.
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Affiliation(s)
- Catalina Martinez
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18 4th floor, Bilbao, 48014, Spain
| | - Gonzalo Bacigalupe
- University of Massachusetts Boston, College of Education and Human Development, 100 Morrissey Bvld, Boston, MA, 02125, USA
| | - Josep M Cortada
- Deusto Primary Health Care Center. Bilbao-Basurto Integrated Care Organisation. Basque Healthcare Service - Osakidetza. BioCruces Health Research Institute, Luis Power 18, Bilbao, 48014, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18 4th floor, Bilbao, 48014, Spain.
| | - Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18 4th floor, Bilbao, 48014, Spain
| | - Haizea Pombo
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18 4th floor, Bilbao, 48014, Spain
| | - Paola Bully
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18 4th floor, Bilbao, 48014, Spain
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Efficiency of "Prescribe Vida Saludable", a health promotion innovation. Pilot phase. GACETA SANITARIA 2017; 31:404-409. [PMID: 28196752 DOI: 10.1016/j.gaceta.2016.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE "Prescribe Vida Saludable" (PVS) is an organisational innovation designed to optimise the promotion of multiple healthy habits in primary healthcare. It aims to estimate the cost effectiveness and cost-utility of prescribing physical activity in the pilot phase of the PVS programme, compared to the routine clinical practice of promoting physical activity in primary healthcare. METHODS An economic evaluation of the quasi-experimental pilot phase of PVS was carried out. In the four control centres, a systematic sample was selected of 194 patients who visited the centre in a single year and who did not comply with physical activity recommendations. In the four intervention centres, 122 patients who received their first physical activity prescription were consecutively enrolled. The costs were evaluated from the perspective of the PVS programme using bottom-up methodology. The effectiveness (proportion of patients who changed their physical activity) as well as the utility were evaluated at baseline and after 3 months. The incremental cost-utility ratio (ICUR) and the incremental cost-effectiveness ratio (ICER) were calculated and a sensitivity analysis was performed with bootstrapping and 1,000 replications. RESULTS Information was obtained from 35% of control cases and 62% of intervention cases. The ICUR was €1,234.66/Quality Adjusted Life Years (QALY) and the ICER was €4.12. In 98.3% of the simulations, the ICUR was below the €30,000/QALY threshold. CONCLUSIONS The prescription of physical activity was demonstrably within acceptable cost-utility limits in the pilot PVS phase, even from a conservative perspective.
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O'Brien MW, Shields CA, Oh PI, Fowles JR. Health care provider confidence and exercise prescription practices of Exercise is Medicine Canada workshop attendees. Appl Physiol Nutr Metab 2016; 42:384-390. [PMID: 28177736 DOI: 10.1139/apnm-2016-0413] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The Exercise is Medicine Canada (EIMC) initiative promotes physical activity counselling and exercise prescription within health care. The purpose of this study was to evaluate perceptions and practices around physical activity counselling and exercise prescription in health care professionals before and after EIMC training. Prior to and directly following EIMC workshops, 209 participants (physicians (n = 113); allied health professionals (AHPs) (n = 54), including primarily nurses (n = 36) and others; and exercise professionals (EPs) (n = 23), including kinesiologists (n = 16), physiotherapists (n = 5), and personal trainers (n = 2)) from 7 provinces completed self-reflection questionnaires. Compared with AHPs, physicians saw more patients (78% > 15 patients/day vs 93% < 15 patients/day; p < 0.001) and reported lower frequencies of exercise counselling during routine client encounters (48% vs 72% in most sessions; p < 0.001). EPs had higher confidence providing physical activity information (92 ± 11%) compared with both physicians (52 ± 25%; p < 0.001) and AHPs (56 ± 24%; p < 0.001). Physicians indicated that they experienced greater difficulty including physical activity and exercise counselling into sessions (2.74 ± 0.71, out of 5) compared with AHPs (2.17 ± 0.94; p = 0.001) and EPs (1.43 ± 0.66; p < 0.001). Physicians rated the most impactful barriers to exercise prescription as lack of patient interest (2.77 ± 0.85 out of 4), resources (2.65 ± 0.82 out of 4), and time (2.62 ± 0.71 out of 4). The majority of physicians (85%) provided a written prescription for exercise in <10% of appointments. Following the workshop, 87% of physician attendees proposed at least one change to practice; 47% intended on changing their practice by prescribing exercise routinely, and 33% planned on increasing physical activity and exercise counselling, measured through open-ended responses.
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Affiliation(s)
- Myles W O'Brien
- a School of Kinesiology, Acadia University, 550 Main Street, Wolfville, NS B4P 2R6, Canada
| | - Christopher A Shields
- a School of Kinesiology, Acadia University, 550 Main Street, Wolfville, NS B4P 2R6, Canada
| | - Paul I Oh
- b Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute/University Health Network, Toronto, ON, Canada
| | - Jonathon R Fowles
- a School of Kinesiology, Acadia University, 550 Main Street, Wolfville, NS B4P 2R6, Canada
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Metric properties of the "prescribe healthy life" screening questionnaire to detect healthy behaviors: a cross-sectional pilot study. BMC Public Health 2016; 16:1228. [PMID: 27923356 PMCID: PMC5142282 DOI: 10.1186/s12889-016-3898-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/01/2016] [Indexed: 01/24/2023] Open
Abstract
Background Feasible and valid assessment of healthy behaviors is the first step for integrating health promotion in routine primary care. Therefore, the aim of this study was to develop and evaluate the validity and reliability of the “prescribe healthy life” screening questionnaire, a brief tool for detecting physical activity levels, consumption of fruit and vegetables, tobacco use and patients’ compliance with minimal recommendations. Methods An observational cross-sectional study to determine the reliability and validity of this questionnaire by means of mixed (qualitative and quantitative) methods. Thirteen healthcare professionals designed the questionnaire. One hundred and twenty-six patients from three primary care health centers within Osakidetza (Basque Health Service, Spain) filled in the “Prescribe Healthy Life” Screening Questionnaire and completed an accelerometry record, the PREDIMED Food Frequency Questionnaire and a co-oximetry as gold standards for physical activity, dietary intake and tobacco use, respectively. Correlations, sensitivities, specificities, likelihood ratios and test-retest reliability were calculated. Additionally, the feasibility and utility of the questionnaire were evaluated. Results Both reliability and concurrent validity for the consumption of fruit and vegetables (rspearman = 0.59, rspearman = 0.50) and tobacco use (rspearman = 0.76, r = 0.69) as their overall performance in the detection of unhealthy diet (accuracy = 76.8%, LR + = 3.1 and LR- = 0.31) and smokers (accuracy = 86.8%, LR + = 6.1 and LR- = 0.05) were good. Meanwhile, the reproducibility (0.38), the correlation between the minutes of physical activity (0.34) and LR+ (1.00) for detection of physical activity were low. On average the questionnaire was considered by patients easy to understand, easy to fill in, short (5–6 min) and useful. Conclusion The “Prescribe Healthy Life” Screening Questionnaire, PVS-SQ, has proved to be a simple and practical tool for use in the actual context of primary care, with guarantees of validity and reliability for the diet and tobacco scales. However, the physical activity scale show unsatisfactory results, and alternative questions ought to be tested. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3898-8) contains supplementary material, which is available to authorized users.
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McKenzie F, Biessy C, Ferrari P, Freisling H, Rinaldi S, Chajès V, Dahm CC, Overvad K, Dossus L, Lagiou P, Trichopoulos D, Trichopoulou A, Bueno-de-Mesquita HB, May A, Peeters PH, Weiderpass E, Sanchez MJ, Navarro C, Ardanaz E, Ericson U, Wirfält E, Travis RC, Romieu I. Healthy Lifestyle and Risk of Cancer in the European Prospective Investigation Into Cancer and Nutrition Cohort Study. Medicine (Baltimore) 2016; 95:e2850. [PMID: 27100409 PMCID: PMC4845813 DOI: 10.1097/md.0000000000002850] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/10/2015] [Accepted: 01/22/2016] [Indexed: 12/31/2022] Open
Abstract
It has been estimated that at least a third of the most common cancers are related to lifestyle and as such are preventable. Key modifiable lifestyle factors have been individually associated with cancer risk; however, less is known about the combined effects of these factors. This study generated a healthy lifestyle index score (HLIS) to investigate the joint effect of modifiable factors on the risk of overall cancers, alcohol-related cancers, tobacco-related cancers, obesity-related cancers, and reproductive-related cancers. The study included 391,608 men and women from the multinational European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The HLIS was constructed from 5 factors assessed at baseline (diet, physical activity, smoking, alcohol consumption, and anthropometry) by assigning scores of 0 to 4 to categories of each factor, for which higher values indicate healthier behaviors. Hazard ratios (HR) were estimated by Cox proportional regression and population attributable fractions (PAFs) estimated from the adjusted models. There was a 5% lower risk (adjusted HR 0.952, 95% confidence interval (CI): 0.946, 0.958) of all cancers per point score of the index for men and 4% (adjusted HR 0.961, 95% CI: 0.956, 0.966) for women. The fourth versus the second category of the HLIS was associated with a 28% and 24% lower risk for men and women respectively across all cancers, 41% and 33% for alcohol-related, 49% and 46% for tobacco-related, 41% and 26% for obesity-related, and 21% for female reproductive cancers. Findings suggest simple behavior modifications could have a sizeable impact on cancer prevention, especially for men.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Dimitrios Trichopoulos
- From the International Agency for Research on Cancer (IARC), Lyon (FM, CB, PF, HF, SR, VC, IR), INSERM, Centre for Research in Epidemiology and Population Health (CESP) (LD), Paris South University, UMRS 1018 (LD), Department of Public Health, Aarhus University, Aarhus, Denmark (CCD, KO), Institute Gustave Roussy (LD), INSERM, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France (LD), Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School (PL), Bureau of Epidemiologic Research, Academy of Athens (PL, DT), Hellenic Health Foundation, Athens, Greece (DT, AT), Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT), National Institute for Public Health and the Environment (RIVM), Bilthoven (HBBM), Department of Gastroenterology and Hepatology, University Medical Centre (HBBM), Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands (AM, PHP), School of Public Health, Imperial College, London (HBBM, PHP), Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom (RCT), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBM), Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø (EW), Department of Research, Cancer Registry of Norway, Oslo, Norway (EW), Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (EW), Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden (UE, EW), Samfundet Folkhälsan, Helsinki, Finland (EW), CIBER Epidemiology and Public Health (CIBERESP), España (M-JS, CN, EA), Andalusian School of Public Health, University of Granada, Granada (M-JS), Department of Epidemiology, Murcia Regional Health Council (CN), Department of Health and Social Sciences, Universidad de Murcia, Murcia (CN), Navarra Public Health Institute (EA), and Navarra Institute for Health Research (IdiSNA), Pamplona, Spain (EA)
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Martín Cantera C, Puigdomènech E, Ballvé JL, Arias OL, Clemente L, Casas R, Roig L, Pérez-Tortosa S, Díaz-Gete L, Granollers S. Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults: a systematic review. BMJ Open 2015; 5:e008807. [PMID: 26428333 PMCID: PMC4606220 DOI: 10.1136/bmjopen-2015-008807] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers. DESIGN A systematic review of randomised and non-randomised controlled trials was undertaken. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-to-treat analysis and results published in English/Spanish. METHODS We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted. RESULTS Of 1147 references identified, 9 studies were selected (10,204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quit-smoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences. CONCLUSIONS Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results.
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Affiliation(s)
- Carlos Martín Cantera
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Centre d'Atenció Primària (CAP) Passeig de Sant Joan, Institut Català de la Salut (ICS), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisa Puigdomènech
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Jose Luis Ballvé
- Centre d'Atenció Primària (CAP) Florida Nord, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Lucía Arias
- Centre d'Atenció Primària (CAP) Florida Nord, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
| | | | - Ramon Casas
- Centre d'Atenció Primària (CAP) Sant Antoni, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Lydia Roig
- Centre d'Atenció Primària (CAP) La Garriga, Institut Català de la Salut (ICS), La Garriga, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sabadell, Spain
| | - Santiago Pérez-Tortosa
- Centre d'Atenció Primària (CAP) La Llagosta, Institut Català de la Salut (ICS), La Llagosta, Spain
| | - Laura Díaz-Gete
- Centre d'Atenció Primària (CAP) la Sagrera, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Sílvia Granollers
- Centre d'Atenció Primària (CAP) Esplugues de Llobregat, Institut Català de la Salut (ICS), Esplugues de Llobregat, Spain
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Malan Z, Mash R, Everett-Murphy K. Qualitative evaluation of primary care providers experiences of a training programme to offer brief behaviour change counselling on risk factors for non-communicable diseases in South Africa. BMC FAMILY PRACTICE 2015; 16:101. [PMID: 26286591 PMCID: PMC4545565 DOI: 10.1186/s12875-015-0318-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/06/2015] [Indexed: 11/13/2022]
Abstract
Background The global epidemic of non-communicable disease (NCDs) has been linked with four modifiable risky lifestyle behaviours, namely smoking, unhealthy diet, physical inactivity and alcohol abuse. Primary care providers (PCPs) can play an important role in changing patient’s risky behaviours. It is recommended that PCPs provide individual brief behaviour change counselling (BBCC) as part of everyday primary care. This study is part of a larger project that re-designed the current training for PCPs in South Africa, to offer a standardized approach to BBCC based on the 5 As and a guiding style. This article reports on a qualitative sub-study, which explored whether the training intervention changed PCPs perception of their confidence in their ability to offer BBCC, whether they believed that the new approach could overcome the barriers to implementation in clinical practice and be sustained, and their recommendations on future training and integration of BBCC into curricula and clinical practice. Methods This was a qualitative study that used verbal feedback from participants at the beginning and end of the training course, and twelve individual in-depth interviews with participants once they had returned to their clinical practice. Results Although PCP’s confidence in their ability to counselling improved, and some thought that time constraints could be overcome, they still reported that understaffing, lack of support from within the facility and poor continuity of care were barriers to counselling. However, the current organisational culture was not congruent with the patient-centred guiding style of BBCC. Training should be incorporated into undergraduate curricula of PCPs for both nurses and doctors, to ensure that counselling skills are embedded from the start. Existing PCPs should be offered training as part of continued professional development programmes. Conclusions This study showed that although training changed PCPs perception of their ability to offer BBCC, and increased their confidence to overcome certain barriers to implementation, significant barriers remained. It is clear that to incorporate BBCC into everyday care, not only training, but also a whole systems approach is needed, that involves the patient, provider, and service organisation at different levels.
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Affiliation(s)
- Zelra Malan
- Family Medicine and Primary Care, Stellenbosch University, Box 19063, Tygerberg, 7505, South Africa.
| | - Robert Mash
- Family Medicine and Primary Care, Stellenbosch University, Box 19063, Tygerberg, 7505, South Africa.
| | - Katherine Everett-Murphy
- Chronic Diseases Initiative in Africa (CDIA), Faculty of Health Sciences, University of Cape Town, P/Bag X 3, Observatory, Cape Town, 7935, South Africa.
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van de Glind I, Heinen M, Geense W, Mesters I, Wensing M, van Achterberg T. Making the connection-factors influencing implementation of evidence supported and non-evaluated lifestyle interventions in healthcare: a multiple case study. HEALTH EDUCATION RESEARCH 2015; 30:521-541. [PMID: 26025211 DOI: 10.1093/her/cyv020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 04/28/2015] [Indexed: 06/04/2023]
Abstract
Many implementation barriers relate to lifestyle interventions (LIs) being developed by scientists. Exploring whether implementation of non-evaluated LIs is less complicated, might offer insight how to improve the use of effective interventions. This study aimed to identify influencing factors for implementation and compare factors between evidence supported and non-evaluated LIs. Evidence-supported (n = 7) and non-evaluated LIs (n = 7) in hospitals, general practices and community care organizations were included as cases. Semi-structured interviews (n = 46) were conducted. Additionally, documents (n = 207) were collected describing intervention, implementation process, and policy. We used a stepwise approach to inductively identify factors, organize them by diffusion phase, and an existing framework. A total of 37 factors were identified. 'Dissemination' factors were mainly observed in evidence-supported LIs. 'Compatibility to existing structures' ('adoption'), 'funding' and 'connection to existing care processes' ('implementation') was factors identified in all cases. 'Quality control' and 'ongoing innovation' ('maintenance') were reported in evidence-supported interventions. In all domains of the framework factors were observed. Factors identified in this study are in line with the literature. The findings do not support the assumption that implementation of non-evaluated LIs is perceived as less complex.
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Affiliation(s)
- Irene van de Glind
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maud Heinen
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wytske Geense
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilse Mesters
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Theo van Achterberg
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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McKenzie F, Ferrari P, Freisling H, Chajès V, Rinaldi S, de Batlle J, Dahm CC, Overvad K, Baglietto L, Dartois L, Dossus L, Lagiou P, Trichopoulos D, Trichopoulou A, Krogh V, Panico S, Tumino R, Rosso S, Bueno-de-Mesquita HBA, May A, Peeters PH, Weiderpass E, Buckland G, Sanchez MJ, Navarro C, Ardanaz E, Andersson A, Sund M, Ericson U, Wirfält E, Key TJ, Travis RC, Gunter M, Riboli E, Vergnaud AC, Romieu I. Healthy lifestyle and risk of breast cancer among postmenopausal women in the European Prospective Investigation into Cancer and Nutrition cohort study. Int J Cancer 2015; 136:2640-8. [PMID: 25379993 DOI: 10.1002/ijc.29315] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 09/19/2014] [Indexed: 01/15/2023]
Abstract
Breast cancer is the most common cancer among women and prevention strategies are needed to reduce incidence worldwide. A healthy lifestyle index score (HLIS) was generated to investigate the joint effect of modifiable lifestyle factors on postmenopausal breast cancer risk. The study included 242,918 postmenopausal women from the multinational European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, with detailed information on diet and lifestyle assessed at baseline. The HLIS was constructed from five factors (diet, physical activity, smoking, alcohol consumption and anthropometry) by assigning scores of 0-4 to categories of each component, for which higher values indicate healthier behaviours. Hazard ratios (HR) were estimated by Cox proportional regression models. During 10.9 years of median follow-up, 7,756 incident breast cancer cases were identified. There was a 3% lower risk of breast cancer per point increase of the HLIS. Breast cancer risk was inversely associated with a high HLIS when fourth versus second (reference) categories were compared [adjusted HR = 0.74; 95% confidence interval (CI): 0.66-0.83]. The fourth versus the second category of the HLIS was associated with a lower risk for hormone receptor double positive (adjusted HR = 0.81, 95% CI: 0.67-0.98) and hormone receptor double negative breast cancer (adjusted HR = 0.60, 95% CI: 0.40-0.90). Findings suggest having a high score on an index of combined healthy behaviours reduces the risk of developing breast cancer among postmenopausal women. Programmes which engage women in long term health behaviours should be supported.
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Affiliation(s)
- Fiona McKenzie
- International Agency for Research on Cancer (IARC), Lyon, France; Centre for Public Health Research, Massey University, Wellington, New Zealand
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Neipp MC, Quiles MJ, León E, Tirado S, Rodríguez-Marín J. [Applying the Theory of Planned Behavior: Which factors influence on doing physical exercise?]. Aten Primaria 2015; 47:287-93. [PMID: 25159024 PMCID: PMC6985607 DOI: 10.1016/j.aprim.2014.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/02/2014] [Accepted: 07/14/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The purpose of this study was analyzed the influence of attitude, subjective norm, and Perceived behavioral control (PBC) on intention of doing physical exercise in a group of people. DESIGN Cross-sectional and observational study. LOCATION Questionnaire was applied to general population in the province of Alicante PARTICIPANTS 679 people who practiced physical exercise in the province of Alicante. MAIN MEASUREMENTS It was applied a questionnaire measuring the components of the Theory of Plan Behavior model (TPB). RESULTS Results showed that variables of the model (TPB) had good fit to the data. Moreover, subjective norm and perceived behavioural control had a significant impact on intention and the three variables explained 61% of its variance. CONCLUSIONS Findings supported the important role of TPB in the context of physical exercise. Perceived behavioral control was the strongest predictor of intention to practice physical exercise. A possible intervention might lead to implement programs focused in increasing control perception of people to engage in physical exercise.
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Affiliation(s)
- Mari Carmen Neipp
- Departamento de Psicología de la Salud, Universidad Miguel Hernández, Elche, Alicante, España.
| | - María José Quiles
- Departamento de Psicología de la Salud, Universidad Miguel Hernández, Elche, Alicante, España
| | - Eva León
- Departamento de Psicología de la Salud, Universidad Miguel Hernández, Elche, Alicante, España
| | - Sonia Tirado
- Departamento de Psicología de la Salud, Universidad Miguel Hernández, Elche, Alicante, España
| | - Jesús Rodríguez-Marín
- Departamento de Psicología de la Salud, Universidad Miguel Hernández, Elche, Alicante, España
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Thomas K, Krevers B, Bendtsen P. Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative. BMC Health Serv Res 2015; 15:31. [PMID: 25608734 PMCID: PMC4312445 DOI: 10.1186/s12913-015-0688-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/09/2015] [Indexed: 01/10/2023] Open
Abstract
Background Non-communicable diseases are a leading cause of death and can largely be prevented by healthy lifestyles. Health care organizations are encouraged to integrate healthy lifestyle promotion in routine care. This study evaluates the impact of a team initiative on healthy lifestyle promotion in primary care. Methods A quasi-experimental, cross-sectional design compared three intervention centres that had implemented lifestyle teams with three control centres that used a traditional model of care. Outcomes were defined using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting regular practice of lifestyle promotion; implementation, fidelity to the original lifestyle team protocol. Data collection methods included a patient questionnaire (n = 888), a staff questionnaire (n = 120) and structured interviews with all practice managers and, where applicable, team managers (n = 8). The chi square test and problem-driven content analysis was used to analyse the questionnaire and interview data, respectively. Results Reach: patients at control centres (48%, n = 211) received lifestyle promotion significantly more often compared with patients at intervention centres (41%, n = 169). Effectiveness: intervention staff was significantly more positive towards the effectiveness of lifestyle promotion, shared competency and how lifestyle promotion was prioritized at their centre. Adoption: 47% of staff at intervention centres and 58% at control centres reported that they asked patients about their lifestyle on a daily basis. Implementation: all intervention centres had implemented multi-professional teams and team managers and held regular meetings but struggled to implement in-house referral structures for lifestyle promotion, which was used consistently among staff. Conclusions Intervention centres did not show higher rates than control centres on reach of patients or adoption among staff at this stage. All intervention centres struggled to implement working referral structures for lifestyle promotion. Intervention centres were more positive on effectiveness outcomes, attitudes and competency among staff, however. Thus, lifestyle teams may facilitate lifestyle promotion practice in terms of increased responsiveness among staff, illustrated by positive attitudes and perceptions of shared competency. More research is needed on lifestyle promotion referral structures in primary care regarding their configuration and implementation.
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Affiliation(s)
- Kristin Thomas
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Barbro Krevers
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Preben Bendtsen
- Department of Medical Specialist and Department of Medical and Health Sciences, Linköping University, Motala, Sweden.
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Ashcroft R. Health promotion and primary health care: examining the discourse. SOCIAL WORK IN PUBLIC HEALTH 2015; 30:107-16. [PMID: 25375065 DOI: 10.1080/19371918.2014.938395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.
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Affiliation(s)
- Rachelle Ashcroft
- a School of Social Work, Renison University College , University of Waterloo , Waterloo , Canada
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Thomas K, Krevers B, Bendtsen P. Long-term impact of a real-world coordinated lifestyle promotion initiative in primary care: a quasi-experimental cross-sectional study. BMC FAMILY PRACTICE 2014; 15:201. [PMID: 25512086 PMCID: PMC4305248 DOI: 10.1186/s12875-014-0201-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/18/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Integration of lifestyle promotion in routine primary care has been suboptimal. Coordinated care models (e.g. screening, brief advice and referral to in-house specialized staff) could facilitate lifestyle promotion practice; they have been shown to increase the quality of services and reduce costs in other areas of care. This study evaluates the long-term impact of a coordinated lifestyle promotion intervention with a multidisciplinary team approach in a primary care setting. METHODS A quasi-experimental, cross-sectional design was used to compare three intervention centres using a coordinated care model and three control centres using a traditional model of lifestyle promotion care. Outcomes were inspired by using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting daily practice of lifestyle promotion and referral; and implementation, of the coordinated care model. The impact was investigated after 3 and 5 years. Data collection involved a patient questionnaire (intervention, n = 433-497; control, n = 455-497), a staff questionnaire (intervention, n = 77-76; control, n = 43-56) and structured interviews with managers (n = 8). The χ(2) test or Fisher exact test with adjustment for clustering by centre was used for the analysis. Problem-driven content analysis was used to analyse the interview data. RESULTS The findings were consistent over time. Intervention centres did not show higher rates for reach of patients or adoption among staff at the 3- or 5-year follow-up. Some conceptual differences between intervention and control staff remained over time in that the intervention staff were more positive on two of eight effectiveness outcomes (one attitude and one competency item) compared with control staff. The Lifestyle team protocol, which included structural opportunities for coordinated care, was implemented at all intervention centres. Lifestyle teams were perceived to have an important role at the centres in driving the lifestyle promotion work forward and being a forum for knowledge exchange. However, resources to refer patients to specialized staff were used inconsistently. CONCLUSIONS The Lifestyle teams may have offered opportunities for lifestyle promotion practice and contributed to enabling conditions at centre level but had limited impact on lifestyle promotion practices.
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Affiliation(s)
- Kristin Thomas
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | - Barbro Krevers
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | - Preben Bendtsen
- Department of Medical Specialist and Department of Medical and Health Sciences, Linköping University, Motala, Sweden.
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Solberg HS, Steinsbekk A, Solbjør M, Granbo R, Garåsen H. Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions. BMC Health Serv Res 2014; 14:562. [PMID: 25380808 PMCID: PMC4229612 DOI: 10.1186/s12913-014-0562-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/24/2014] [Indexed: 11/17/2022] Open
Abstract
Background Development of more self-management support programmes in primary health care has been one option used to enhance positive outcomes in chronic disease management. At present, research results provide no consensus on what would be the best way to develop support programmes into new settings. The aim of the present study was therefore to explore users’ and health professionals’ perceptions of what would be the vital elements in a self - management support programme applicable in primary health care, how to account for them, and why. Methods Four qualitative, semi-structured focus group interviews were conducted in Central Norway. The informants possessed experience in development, provision, or participation in a self-management support programme. Data was analysed by the Systematic Text Condensation method. Results The results showed an overall positive expectation to the potential benefits of development of a self-management support programme in primary health care. Despite somewhat different arguments and perspectives, the users and the health professionals had a joint agreement on core characteristics; a self-management support programme in primary health care should therefore be generic, not disease specific, and delivered in a group- based format. A special focus should be on the everyday- life of the participants. The most challenging aspect was a present lack of competence and experience among health professionals to moderate self-management support programmes. Conclusions The development and design of a relevant and applicable self-management support programme in primary health care should balance the interests of the users with the possibilities and constraints within each municipality. It would be vital to benefit from the closeness of the patients’ every-day life situations. The user informants’ perception of a self-management support programme as a supplement to regular medical treatment represented an expanded understanding of the self-management support concept. An exploring approach should be applied in the development of the health professionals’ competence in practice. The effect of a self-management support programme based on the core characteristics found in this study needs to be evaluated.
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Holmberg C, Sarganas G, Mittring N, Braun V, Dini L, Heintze C, Rieckmann N, Muckelbauer R, Müller-Nordhorn J. Primary prevention in general practice - views of German general practitioners: a mixed-methods study. BMC FAMILY PRACTICE 2014; 15:103. [PMID: 24885100 PMCID: PMC4046439 DOI: 10.1186/1471-2296-15-103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 05/16/2014] [Indexed: 11/29/2022]
Abstract
Background Policy efforts focus on a reorientation of health care systems towards primary prevention. To guide such efforts, we analyzed the role of primary prevention in general practice and general practitioners’ (GPs) attitudes toward primary prevention. Methods Mixed-method study including a cross-sectional survey of all community-based GPs and focus groups in a sample of GPs who collaborated with the Institute of General Practice in Berlin, Germany in 2011. Of 1168 GPs 474 returned the mail survey. Fifteen GPs participated in focus group discussions. Survey and interview guidelines were developed and tested to assess and discuss beliefs, attitudes, and practices regarding primary prevention. Results Most respondents considered primary prevention within their realm of responsibility (70%). Primary prevention, especially physical activity, healthy eating, and smoking cessation, was part of the GPs’ health care recommendations if they thought it was indicated. Still a quarter of survey respondents discussed reduction of alcohol consumption with their patients infrequently even when they thought it was indicated. Similarly 18% claimed that they discuss smoking cessation only sometimes. The focus groups revealed that GPs were concerned about the detrimental effects an uninvited health behavior suggestion could have on patients and were hesitant to take on the role of “health policing”. GPs saw primary prevention as the responsibility of multiple actors in a network of societal and municipal institutions. Conclusions The mixed-method study showed that primary prevention approaches such as lifestyle counseling is not well established in primary care. GPs used a selective approach to offer preventive advice based upon indication. GPs had a strong sense that a universal prevention approach carried the potential to destroy a good patient-physician relationship. Other approaches to public health may be warranted such as a multisectoral approach to population health. This type of restructuring of the health care sector may benefit patients who are unable to afford specific prevention programmes and who have competing demands that hinder their ability to focus on behavior change.
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Affiliation(s)
- Christine Holmberg
- Berlin School of Public Health, Charité Universitätsmedizin Berlin, Seestr, 73, 13347 Berlin, Germany.
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Ekhtiari YS, Majlessi F, Foroushani AR, Shakibazadeh E. Effect of a Self-care Educational Program Based on the Health Belief Model on Reducing Low Birth Weight Among Pregnant Iranian Women. Int J Prev Med 2014; 5:76-82. [PMID: 24554995 PMCID: PMC3915477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 02/14/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Low birth weight (LBW) is considered as an important outcome of birth and pregnancy, which is associated with long-term consequences and health-care problems. Maternal lifestyle and health care during pregnancy are powerful predictors of BW of infants. The purpose of this study was to assess the effect of a self-care educational program based on the Health Belief Model (HBM) on reducing LBW among a sample of pregnant Iranian women. METHODS In this randomized controlled trial, we recruited 270 pregnant women referred to prenatal clinics in the south of Tehran, Iran. The participants were randomly allocated to two intervention and control groups. Women in the intervention group received an educational program to promote self-care behaviors during pregnancy. The control group received routine care. BW was compared between the two groups. Baseline demographic characteristics and knowledge and attitude scores before the intervention in both groups were compared using the Chi-square test for categorical variables. Logistic regression analysis was conducted to control the effect of demographic variables on BW. RESULTS The results showed that LBW was reduced significantly in the intervention group at the follow-up measurement (5.6 vs. 13.2%, P = 0.03). After controlling for demographic characteristics, we found a significant decrease in the risk of LBW in the intervention group [odds ratio (OR): 0.333; 95% confidence interval (CI): 0.12-0.88, P = 0.02]. CONCLUSIONS Implementation of a self-care educational program designed on the basis of an HBM on pregnant women was effective in reducing the rate of LBW.
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Affiliation(s)
- Yalda Soleiman Ekhtiari
- Departments of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Majlessi
- Departments of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Dr. Fereshteh Majlessi, Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Keshavarz Boulevard, P.O. Box 14155-6446, Tehran, Iran. E-mail:
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Shakibazadeh
- Department of Midwifery, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
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Vuori IM, Lavie CJ, Blair SN. Physical activity promotion in the health care system. Mayo Clin Proc 2013; 88:1446-61. [PMID: 24290119 DOI: 10.1016/j.mayocp.2013.08.020] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/29/2013] [Accepted: 08/27/2013] [Indexed: 12/17/2022]
Abstract
Physical activity (PA) and exercise training (ET) have great potential in the prevention, management, and rehabilitation of a variety of diseases, but this potential has not been fully realized in clinical practice. The health care system (HCS) could do much more to support patients in increasing their PA and ET. However, counseling on ET is not used widely by the HCS owing partly to attitudes but mainly to practical obstacles. Extensive searches of MEDLINE, the Cochrane Library, the Database of Abstracts of Reviews of Effects, and ScienceDirect for literature published between January 1, 2000, and January 31, 2013, provided data to assess the critical characteristics of ET counseling. The evidence reveals that especially brief ET counseling is an efficient, effective, and cost-effective means to increase PA and ET and to bring considerable clinical benefits to various patient groups. Furthermore, it can be practiced as part of the routine work of the HCS. However, there is a need and feasible means to increase the use and improve the quality of ET counseling. To include PA and ET promotion as important means of comprehensive health care and disease management, a fundamental change is needed. Because exercise is medicine, it should be seen and dealt with in the same ways as pharmaceuticals and other medical interventions regarding the basic and continuing education and training of health care personnel and processes to assess its needs and to prescribe and deliver it, to reimburse the services related to it, and to fund research on its efficacy, effectiveness, feasibility, and interactions and comparability with other preventive, therapeutic, and rehabilitative modalities. This change requires credible, strong, and skillful advocacy inside the medical community and the HCS.
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Basic concepts in the taxonomy of health-related behaviors, habits and lifestyle. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:1963-76. [PMID: 23670578 PMCID: PMC3709359 DOI: 10.3390/ijerph10051963] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/22/2013] [Accepted: 04/28/2013] [Indexed: 11/28/2022]
Abstract
Background: Health-related Habits (HrH) are a major priority in healthcare. However there is little agreement on whether exercise, diet, smoking or dental hygiene are better described as lifestyles, habits or behaviors, and on what is their hierarchical relationship. This research is aimed at representing the basic concepts which are assumed to constitute the conceptual framework enabling us to interpret and organize the field of HrH. Methods: A group of 29 experts with different backgrounds agreed on the definition and hierarchy of HrH following an iterative process which involved framing analysis and nominal group techniques. Results: Formal definitions of health-related behavior, habit, life-style and life-style profile were produced. In addition a series of basic descriptors were identified: health reserve, capital, risk and load. Six main categories of HrH were chosen based on relevance to longevity: diet/exercise, vitality/stress, sleep, cognition, substance use and other risk. Attributes of HrH are clinical meaningfulness, quantifiability, temporal stability, associated morbidity, and unitarity (non-redundancy). Two qualifiers (polarity and stages of change) have also been described. Conclusions: The concepts represented here lay the groundwork for the development of clinical and policy tools related to HrH and lifestyle. An adaptation of this system to define targets of health interventions and to develop the classification of person factors in ICF may be needed in the future.
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Salvador-Carulla L, Walsh CO, Alonso F, Gómez R, de Teresa C, Cabo-Soler JR, Cano A, Ruiz M. eVITAL: a preliminary taxonomy and electronic toolkit of health-related habits and lifestyle. ScientificWorldJournal 2012; 2012:379752. [PMID: 22545016 PMCID: PMC3322620 DOI: 10.1100/2012/379752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/28/2011] [Indexed: 11/21/2022] Open
Abstract
Objectives. To create a preliminary taxonomy and related toolkit of health-related habits (HrH) following a person-centered approach with a focus on primary care. Methods. From 2003–2009, a working group (n = 6 physicians) defined the knowledge base, created a framing document, and selected evaluation tools using an iterative process. Multidisciplinary focus groups (n = 29 health professionals) revised the document and evaluation protocol and participated in a feasibility study and review of the model based on a demonstration study with 11 adult volunteers in Antequera, Spain. Results. The preliminary taxonomy contains 6 domains of HrH and 1 domain of additional health descriptors, 3 subdomains, 43 dimensions, and 141 subdimensions. The evaluation tool was completed by the 11 volunteers. The eVITAL toolkit contains history and examination items for 4 levels of engagement: self-assessment, basic primary care, extended primary care, and specialty care. There was positive feedback from the volunteers and experts, but concern about the length of the evaluation. Conclusions. We present the first taxonomy of HrH, which may aid the development of the new models of care such as the personal contextual factors of the International Classification of Functioning (ICF) and the positive and negative components of the multilevel person-centered integrative diagnosis model.
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Affiliation(s)
- Luis Salvador-Carulla
- Asociación Española para el Estudio Científico del Envejecimiento Saludable (AECES), Calle Infante Don Fernando 17, Málaga, 29200 Antequera, Spain.
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Ashby S, James C, Plotnikoff R, Collins C, Guest M, Kable A, Snodgrass S. Survey of Australian practitioners' provision of healthy lifestyle advice to clients who are obese. Nurs Health Sci 2012; 14:189-96. [PMID: 22435756 DOI: 10.1111/j.1442-2018.2012.00677.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Obesity is a global issue, with healthcare practitioners increasingly involved in clinical interactions with people who are overweight or obese. These interactions are opportunities to provide evidence-based healthy lifestyle advice, and impact on public health. This study used a cross-sectional survey of Australian healthcare practitioners to investigate what influenced the provision of healthy lifestyle advice to obese and overweight clients. A modified theory of planned behavior was used to explore knowledge translation processes. Knowledge translation was linked to three factors: (i) a healthcare practitioner's education and confidence in the currency of their knowledge; (ii) personal characteristics - whether they accepted that providing this advice was within their domain of practice; and (iii) the existence of organizational support structures, such as access to education, and best practice guidelines. To fulfill the potential role healthcare practitioners can play in the provision of evidence-based health promotion advice requires organizations to provide access to practice guidelines and to instill a belief in their workforce that this is a shared professional domain.
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Affiliation(s)
- Samantha Ashby
- Faculty of Health, School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia.
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Grandes G, Sanchez A, Montoya I, Ortega Sanchez-Pinilla R, Torcal J. Two-year longitudinal analysis of a cluster randomized trial of physical activity promotion by general practitioners. PLoS One 2011; 6:e18363. [PMID: 21479243 PMCID: PMC3066231 DOI: 10.1371/journal.pone.0018363] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 03/04/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We evaluate the effectiveness of a physical activity promotion programme carried out by general practitioners with inactive patients in routine care. METHODS AND FINDINGS Pragmatic, cluster randomised clinical trial conducted in eleven public primary care centres in Spain. Fifty-six general practitioners (GPs) were randomly assigned to intervention (29) or standard care (27) groups. They assessed the physical activity level of a systematic sample of patients in routine practice and recruited 4317 individuals (2248 intervention and 2069 control) who did not meet minimum physical activity recommendations. Intervention GPs provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment (30%). A third of these prescriptions were opportunistically repeated. Control GPs provided standard care. Primary outcome measure was the change in self-reported physical activity from baseline to six, 12 and 24 months. Secondary outcomes included cardiorespiratory fitness and health-related quality of life. A total of 3691 patients (85%) were included in the longitudinal analysis and overall trends over the whole 24 month follow-up were significantly better in the intervention group (p<0.01). The greatest differences with the control group were observed at six months (adjusted difference 1.7 MET*hr/wk [95% CI, 0.8 to 2.6], 25 min/wk [95% CI, 11.3 to 38.4], and a 5.3% higher percentage of patients meeting minimum recommendations [95% CI: 2.1% to 8.8%] NNT = 19). These differences were not statistically significant at 12 and 24 months. No differences were found in secondary outcomes. A significant difference was maintained until 24 months in the proportion of patients achieving minimum recommendation in the subgroup that received a repeat prescription (adjusted difference 10.2%, 95% CI 1.5% to 19.4%). CONCLUSIONS General practitioners are effective at increasing the level of physical activity among their inactive patients during the initial six-months of an intervention but this effect wears off at 12 and 24 months. Only in the subgroup of patients receiving repeat prescriptions of physical activity is the effect maintained in long-term. TRIAL REGISTRATION clinicaltrials.gov NCT00131079.
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Affiliation(s)
- Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service, Bilbao, Spain.
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Calderón C, Balagué L, Cortada JM, Sánchez A. Health promotion in primary care: how should we intervene? A qualitative study involving both physicians and patients. BMC Health Serv Res 2011; 11:62. [PMID: 21426590 PMCID: PMC3070625 DOI: 10.1186/1472-6963-11-62] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 03/23/2011] [Indexed: 12/04/2022] Open
Abstract
Background The effects of tobacco, physical exercise, diet, and alcohol consumption on morbidity and mortality underline the importance of health promotion and prevention (HPP) at the primary health care (PHC) level. Likewise, the deficiencies when putting such policies into practice and assessing their effectiveness are also widely recognised. The objectives of this research were: a) to gain an in-depth understanding of general practitioners' (GPs) and patients' perceptions about HPP in PHC, and b) to define the areas that could be improved in future interventions. Methods Qualitative methodology focussed on the field of health services research. Information was generated on the basis of two GP-based and two patient-based discussion groups, all of which had previously participated in two interventions concerning healthy lifestyle promotion (tobacco and physical exercise). Transcripts and field notes were analysed on the basis of a sociological discourse-analysis model. The results were validated by triangulation between researchers. Results GPs and patients' discourses about HPP in PHC were different in priorities and contents. An overall explanatory framework was designed to gain a better understanding of the meaning of GP-patient interactions related to HPP, and to show the main trends that emerged from their discourses. GPs linked their perceptions of HPP to their working conditions and experience in health services. The dimensions in this case involved the orientation of interventions, the goal of actions, and the evaluation of results. For patients, habits were mainly related to ways of life particularly influenced by close contexts. Health conceptions, their role as individuals, and the orientation of their demands were the most important dimensions in patients' sphere. Conclusions HPP activities in PHC need to be understood and assessed in the context of their interaction with the conditioning trends in health services and patients' social micro-contexts. On the basis of the explanatory framework, three development lines are proposed: the incorporation of new methodological approaches according to the complexity of HPP in PHC; the openness of habit change policies beyond the medical services; and the effective commitments in the medium to long term by the health services themselves at the policy management level.
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Affiliation(s)
- Carlos Calderón
- Centro de Salud de Alza, Comarca Ekialde, Servicio Vasco de Salud-Osakidetza, San Sebastián, Spain.
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Sánchez-Zamorano LM, Flores-Luna L, Angeles-Llerenas A, Romieu I, Lazcano-Ponce E, Miranda-Hernández H, Mainero-Ratchelous F, Torres-Mejía G. Healthy lifestyle on the risk of breast cancer. Cancer Epidemiol Biomarkers Prev 2011; 20:912-22. [PMID: 21335508 DOI: 10.1158/1055-9965.epi-10-1036] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many studies have analyzed the effect of behavioral risk factors such as common lifestyle patterns on the risk of disease. The aim of this study was to assess the effect of a healthy lifestyle index on the risk of breast cancer. METHODS A population-based case-control study was conducted in Mexico from 2004 to 2007. One thousand incident cases and 1,074 controls, matched to cases by 5-year age category, region, and health institution, participated in the study. A healthy lifestyle index was developed by means of principal components by using dietary pattern, physical activity, alcohol consumption, and tobacco smoking. A conditional logistic regression model was used to assess this association. RESULTS The healthy lifestyle index was defined as the combined effect of moderate and/or vigorous-intensity physical activity, low consumption of fat, processed foods, refined cereals, complex sugars, and the avoidance of tobacco smoking and alcohol consumption. Results showed a protective effect on both pre- (OR = 0.50, 95% CI: 0.29-0.84) and postmenopausal women (OR = O.20, 95% CI: 0.11-0.37) when highest versus lowest index quintiles were compared. CONCLUSIONS Healthy lifestyle was associated with a reduction in the odds of having breast cancer. Primary prevention of this disease should be promoted in an integrated manner. Effective strategies need to be identified to engage women in healthy lifestyles. IMPACT This study is the first to assess a healthy lifestyle index in relation to the risk of breast cancer.
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A preliminary taxonomy and a standard knowledge base for mental-health system indicators in Spain. Int J Ment Health Syst 2010; 4:29. [PMID: 21122091 PMCID: PMC3014871 DOI: 10.1186/1752-4458-4-29] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 12/01/2010] [Indexed: 01/05/2023] Open
Abstract
Background There are many sources of information for mental health indicators but we lack a comprehensive classification and hierarchy to improve their use in mental health planning. This study aims at developing a preliminary taxonomy and its related knowledge base of mental health indicators usable in Spain. Methods A qualitative method with two experts panels was used to develop a framing document, a preliminary taxonomy with a conceptual map of health indicators, and a knowledge base consisting of key documents, glossary and database of indicators with an evaluation of their relevance for Spain. Results A total of 661 indicators were identified and organised hierarchically in 4 domains (Context, Resources, Use and Results), 12 subdomains and 56 types. Among these the expert panels identified 200 indicators of relevance for the Spanish system. Conclusions The classification and hierarchical ordering of the mental health indicators, the evaluation according to their level of relevance and their incorporation into a knowledge base are crucial for the development of a basic list of indicators for use in mental health planning.
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