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Nouira M, Souayeh N. Towards implementing telemedicine in Tunisia: A knowledge, attitude and practice study among medical doctors. F1000Res 2024; 12:1025. [PMID: 39246588 PMCID: PMC11377923 DOI: 10.12688/f1000research.138320.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 09/10/2024] Open
Abstract
Background: The use of information and communication technology such as telemedicine occupies nowadays a huge place in modern medicine practice all over the world, mainly after the COVID-19 pandemic. However, its implementation in Tunisia and other developing countries has achieved little success with low utilization and can be challenging for several reasons. In this study, our aim was to assess the knowledge, attitudes and practice of Tunisian medical doctors regarding telemedicine. Methods: This was a cross-sectional web survey, administered to medical doctors in Tunisia in October 2022. Respondents' level of knowledge of telemedicine was assessed by calculating a knowledge score (0 to 12). Attitude subsections were about perceived telemedicine attributes of relative advantage, compatibility, trial ability and complexity. Results: A total of 243 participants were included. The mean age was 45 ± 9.6 years old, and 57.2% were female, with a mean of 14.3 ± 10.3 years of professional experience. The majority (95.9%) had an average or high level of computer skills. More than half (59.3%) had a poor level of telemedicine knowledge. A good level of knowledge was significantly associated with age category over 50 years (p = 0.02) and with years of experience over 10 (p = 0.03). The majority (89.3%) had a moderate or high score about perceived advantages. The majority (88.5%) accepted use of telemedicine in their future practice. Almost half (46.9%) had practiced telemedicine activities before using a mobile phone (91%) or social media (64%). The principal limitations of applying telemedicine were challenges of organization and implementation, and incomplete patient examination. Conclusions: Although Tunisian doctors' knowledge and practice of telemedicine were unsatisfactory, their positive attitude and willingness to try it in their future practice were encouraging. There is an urgent need for implementing telemedicine in Tunisia to improve health care coverage in some unprivileged areas.
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Affiliation(s)
- Mariem Nouira
- Epidemiology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, 1006, Tunisia
| | - Nesrine Souayeh
- Gynaecology and Obstetrics Department, Regional Hospital of Ben Arous, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, 1006, Tunisia
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Chorya H, Coloma HS, Cortiana V, Joshi M, Menon GP, Balasubramanian M, Park CH, Leyfman Y. The Potential of Lifestyle Medicine: Strategies to Optimize Health and Well-Being in Oncology Care with Dr. Amy Comander. Cancers (Basel) 2023; 15:5323. [PMID: 38001584 PMCID: PMC10670222 DOI: 10.3390/cancers15225323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
The field of lifestyle medicine in cancer care and survivorship is undergoing significant transformation, presenting both challenges and opportunities. This collection of insights and reflections by an esteemed speaker aims to address critical facets of this evolving landscape and the intersection of healthcare, lifestyle, and cancer. With a focus on optimizing the health of cancer survivors, the speaker emphasizes the correlation between general population health and strategies for mitigating cancer risk. Evidence-based resources have a key role in their comprehensive insights into lifestyle changes' role in cancer prevention and survivorship. Lifestyle interventions also have a promising role in mitigating the late effects in the pediatric context. Therefore, encouraging the early adoption of healthy practices in childhood cancer survivors emerges as a pivotal strategy. Furthermore, challenges in enhancing education and access to lifestyle medicine are addressed. This highlights the importance of patient-centered communication, motivational interviewing, and personalized guidance in facilitating lifestyle changes with patients. Finally, the role of nutritionists in advising breast cancer patients to consider calorie restriction to lower IGF-1 levels is explored. This collection underscores the multifaceted nature of lifestyle medicine in cancer care, highlighting challenges, opportunities, and the transformative power of passion and curiosity in shaping healthcare careers.
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Affiliation(s)
| | | | - Viviana Cortiana
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
| | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi 0186, Georgia
| | | | | | | | - Yan Leyfman
- Icahn School of Medicine at Mount Sinai South Nassau, Oceanside, NY 11572, USA
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3
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McCleary N, Desveaux L, Presseau J, Reis C, Witteman HO, Taljaard M, Linklater S, Thavorn K, Dobell G, Mulhall CL, Lam JMC, Grimshaw JM, Ivers NM. Engagement is a necessary condition to test audit and feedback design features: results of a pragmatic, factorial, cluster-randomized trial with an embedded process evaluation. Implement Sci 2023; 18:13. [PMID: 37165413 PMCID: PMC10173488 DOI: 10.1186/s13012-023-01271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/06/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND While audit & feedback (A&F) is an effective implementation intervention, the design elements which maximize effectiveness are unclear. Partnering with a healthcare quality advisory organization already delivering feedback, we conducted a pragmatic, 2 × 2 factorial, cluster-randomized trial to test the impact of variations in two factors: (A) the benchmark used for comparison and (B) information framing. An embedded process evaluation explored hypothesized mechanisms of effect. METHODS Eligible physicians worked in nursing homes in Ontario, Canada, and had voluntarily signed up to receive the report. Groups of nursing homes sharing physicians were randomized to (A) physicians' individual prescribing rates compared to top-performing peers (the top quartile) or the provincial median and (B) risk-framed information (reporting the number of patients prescribed high-risk medication) or benefit-framed information (reporting the number of patients not prescribed). We hypothesized that the top quartile comparator and risk-framing would lead to greater practice improvements. The primary outcome was the mean number of central nervous system-active medications per resident per month. Primary analyses compared the four arms at 6 months post-intervention. Factorial analyses were secondary. The process evaluation comprised a follow-up questionnaire and semi-structured interviews. RESULTS Two hundred sixty-seven physicians (152 clusters) were randomized: 67 to arm 1 (median benchmark, benefit framing), 65 to arm 2 (top quartile benchmark, benefit framing), 75 to arm 3 (median benchmark, risk framing), and 60 to arm 4 (top quartile benchmark, risk framing). There were no significant differences in the primary outcome across arms or for each factor. However, engagement was low (27-31% of physicians across arms downloaded the report). The process evaluation indicated that both factors minimally impacted the proposed mechanisms. However, risk-framed feedback was perceived as more actionable and more compatible with current workflows, whilst a higher target might encourage behaviour change when physicians identified with the comparator. CONCLUSIONS Risk framing and a top quartile comparator have the potential to achieve change. Further work to establish the strategies most likely to enhance A&F engagement, particularly with physicians who may be most likely to benefit from feedback, is required to support meaningfully addressing intricate research questions concerning the design of A&F. TRIAL REGISTRATION ClinicalTrials.gov, NCT02979964 . Registered 29 November 2016.
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Affiliation(s)
- Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
| | - Laura Desveaux
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Catherine Reis
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Holly O Witteman
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- Department of Family and Emergency Medicine, Laval University, Québec City, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Stefanie Linklater
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
| | - Kednapa Thavorn
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Gail Dobell
- Health System Performance, Ontario Health, Toronto, Canada
| | - Cara L Mulhall
- Health System Performance, Ontario Health, Toronto, Canada
| | | | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
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Patey AM, Fontaine G, Francis JJ, McCleary N, Presseau J, Grimshaw JM. Healthcare professional behaviour: health impact, prevalence of evidence-based behaviours, correlates and interventions. Psychol Health 2022; 38:766-794. [PMID: 35839082 DOI: 10.1080/08870446.2022.2100887] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Healthcare professional (HCP) behaviours are actions performed by individuals and teams for varying and often complex patient needs. However, gaps exist between evidence-informed care behaviours and the care provided. Implementation science seeks to develop generalizable principles and approaches to investigate and address care gaps, supporting HCP behaviour change while building a cumulative science. We highlight theory-informed approaches for defining HCP behaviour and investigating the prevalence of evidence-based care and known correlates and interventions to change professional practice. Behavioural sciences can be applied to develop implementation strategies to support HCP behaviour change and provide valid, reliable tools to evaluate these strategies. There are thousands of different behaviours performed by different HCPs across many contexts, requiring different implementation approaches. HCP behaviours can include activities related to promoting health and preventing illness, assessing and diagnosing illnesses, providing treatments, managing health conditions, managing the healthcare system and building therapeutic alliances. The key challenge is optimising behaviour change interventions that address barriers to and enablers of recommended practice. HCP behaviours may be determined by, but not limited to, Knowledge, Social influences, Intention, Emotions and Goals. Understanding HCP behaviour change is a critical to ensuring advances in health psychology are applied to maximize population health.
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Affiliation(s)
- Andrea M. Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
| | - Guillaume Fontaine
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jillian J. Francis
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
- School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicola McCleary
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Presseau
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeremy M. Grimshaw
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Allen T, Gyrd-Hansen D, Kristensen SR, Oxholm AS, Pedersen LB, Pezzino M. Physicians under Pressure: Evidence from Antibiotics Prescribing in England. Med Decis Making 2022; 42:303-312. [PMID: 35021900 PMCID: PMC8918864 DOI: 10.1177/0272989x211069931] [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: 11/15/2022]
Abstract
BACKGROUND Many physicians are experiencing increasing demands from both their patients and society. Evidence is scarce on the consequences of the pressure on physicians' decision making. We present a theoretical framework and predict that increasing pressure may make physicians disregard societal welfare when treating patients. SETTING We test our prediction on general practitioners' antibiotic-prescribing choices. Because prescribing broad-spectrum antibiotics does not require microbiological testing, it can be performed more quickly than prescribing for narrow-spectrum antibiotics and is therefore often preferred by the patient. In contrast, from a societal perspective, inappropriate prescribing of broad-spectrum antibiotics should be minimized as it may contribute to antimicrobial resistance in the general population. METHODS We combine longitudinal survey data and administrative data from 2010 to 2017 to create a balanced panel of up to 1072 English general practitioners (GPs). Using a series of linear models with GP fixed effects, we estimate the importance of different sources of pressure for GPs' prescribing. RESULTS We find that the percentage of broad-spectrum antibiotics prescribed increases by 6.4% as pressure increases on English GPs. The link between pressure and prescribing holds for different sources of pressure. CONCLUSIONS Our findings suggest that there may be societal costs of physicians working under pressure. Policy makers need to take these costs into account when evaluating existing policies as well as when introducing new policies affecting physicians' work pressure. An important avenue for further research is also to determine the underlying mechanisms related to the different sources of pressure.JEL-code: I11, J28, J45. HIGHLIGHTS Many physicians are working under increasing pressure.We test the importance of pressure on physicians' prescribing of antibiotics.The prescribed rate of broad-spectrum antibiotics increases with pressure.Policy makers should be aware of the societal costs of pressured physicians.[Formula: see text].
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Affiliation(s)
- Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK.,Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Dorte Gyrd-Hansen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Søren Rud Kristensen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark.,Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Anne Sophie Oxholm
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Line Bjørnskov Pedersen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark.,Research Unit for General Practice, University of Southern Denmark, J..B, Odense C, Denmark
| | - Mario Pezzino
- School of Social Sciences, University of Manchester, Manchester, UK
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6
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Bromley PA, Müller FO, Malan J, Torres J, Vanderbeke O. An Intervention Mapping Study: Developing the Choosing Health digital weight loss and maintenance intervention (Preprint). J Med Internet Res 2021; 24:e34089. [PMID: 362568 PMCID: PMC9627465 DOI: 10.2196/34089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/10/2022] [Accepted: 05/29/2022] [Indexed: 12/01/2022] Open
Abstract
Background Digital health promotion programs tailored to the individual are a potential cost-effective and scalable solution to enable self-management and provide support to people with excess body weight. However, solutions that are widely accessible, personalized, and theory- and evidence-based are still limited. Objective This study aimed to develop a digital behavior change program, Choosing Health, that could identify modifiable predictors of weight loss and maintenance for each individual and use these to provide tailored support. Methods We applied an Intervention Mapping protocol to design the program. This systematic approach to develop theory- and evidence-based health promotion programs consisted of 6 steps: development of a logic model of the problem, a model of change, intervention design and intervention production, the implementation plan, and the evaluation plan. The decisions made during the Intervention Mapping process were guided by theory, existing evidence, and our own research—including 4 focus groups (n=40), expert consultations (n=12), and interviews (n=11). The stakeholders included researchers, public representatives (including individuals with overweight and obesity), and experts from a variety of relevant backgrounds (including nutrition, physical activity, and the health care sector). Results Following a structured process, we developed a tailored intervention that has the potential to reduce excess body weight and support behavior changes in people with overweight and obesity. The Choosing Health intervention consists of tailored, personalized text messages and email support that correspond with theoretical domains potentially predictive of weight outcomes for each participant. The intervention content includes behavior change techniques to support motivation maintenance, self-regulation, habit formation, environmental restructuring, social support, and addressing physical and psychological resources. Conclusions The use of an Intervention Mapping protocol enabled the systematic development of the Choosing Health intervention and guided the implementation and evaluation of the program. Through the involvement of different stakeholders, including representatives of the general public, we were able to map out program facilitators and barriers while increasing the ecological validity of the program to ensure that we build an intervention that is useful, user-friendly, and informative. We also summarized the lessons learned for the Choosing Health intervention development and for other health promotion programs. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-040183
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7
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Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. Framework for the development and evaluation of complex interventions: gap analysis, workshop and consultation-informed update. Health Technol Assess 2021; 25:1-132. [PMID: 34590577 PMCID: PMC7614019 DOI: 10.3310/hta25570] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Medical Research Council published the second edition of its framework in 2006 on developing and evaluating complex interventions. Since then, there have been considerable developments in the field of complex intervention research. The objective of this project was to update the framework in the light of these developments. The framework aims to help research teams prioritise research questions and design, and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods. METHODS There were four stages to the update: (1) gap analysis to identify developments in the methods and practice since the previous framework was published; (2) an expert workshop of 36 participants to discuss the topics identified in the gap analysis; (3) an open consultation process to seek comments on a first draft of the new framework; and (4) findings from the previous stages were used to redraft the framework, and final expert review was obtained. The process was overseen by a Scientific Advisory Group representing the range of relevant National Institute for Health Research and Medical Research Council research investments. RESULTS Key changes to the previous framework include (1) an updated definition of complex interventions, highlighting the dynamic relationship between the intervention and its context; (2) an emphasis on the use of diverse research perspectives: efficacy, effectiveness, theory-based and systems perspectives; (3) a focus on the usefulness of evidence as the basis for determining research perspective and questions; (4) an increased focus on interventions developed outside research teams, for example changes in policy or health services delivery; and (5) the identification of six 'core elements' that should guide all phases of complex intervention research: consider context; develop, refine and test programme theory; engage stakeholders; identify key uncertainties; refine the intervention; and economic considerations. We divide the research process into four phases: development, feasibility, evaluation and implementation. For each phase we provide a concise summary of recent developments, key points to address and signposts to further reading. We also present case studies to illustrate the points being made throughout. LIMITATIONS The framework aims to help research teams prioritise research questions and design and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods. In many of the areas of innovation that we highlight, such as the use of systems approaches, there are still only a few practical examples. We refer to more specific and detailed guidance where available and note where promising approaches require further development. CONCLUSIONS This new framework incorporates developments in complex intervention research published since the previous edition was written in 2006. As well as taking account of established practice and recent refinements, we draw attention to new approaches and place greater emphasis on economic considerations in complex intervention research. We have introduced a new emphasis on the importance of context and the value of understanding interventions as 'events in systems' that produce effects through interactions with features of the contexts in which they are implemented. The framework adopts a pluralist approach, encouraging researchers and research funders to adopt diverse research perspectives and to select research questions and methods pragmatically, with the aim of providing evidence that is useful to decision-makers. FUTURE WORK We call for further work to develop relevant methods and provide examples in practice. The use of this framework should be monitored and the move should be made to a more fluid resource in the future, for example a web-based format that can be frequently updated to incorporate new material and links to emerging resources. FUNDING This project was jointly funded by the Medical Research Council (MRC) and the National Institute for Health Research (Department of Health and Social Care 73514).
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Affiliation(s)
- Kathryn Skivington
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsay Matthews
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Anne Simpson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Craig
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jane M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Laurence Moore
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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8
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Presseau J, Byrne-Davis LMT, Hotham S, Lorencatto F, Potthoff S, Atkinson L, Bull ER, Dima AL, van Dongen A, French D, Hankonen N, Hart J, Ten Hoor GA, Hudson K, Kwasnicka D, van Lieshout S, McSharry J, Olander EK, Powell R, Toomey E, Byrne M. Enhancing the translation of health behaviour change research into practice: a selective conceptual review of the synergy between implementation science and health psychology. Health Psychol Rev 2021; 16:22-49. [PMID: 33446062 DOI: 10.1080/17437199.2020.1866638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Health psychology is at the forefront of developing and disseminating evidence, theories, and methods that have improved the understanding of health behaviour change. However, current dissemination approaches may be insufficient for promoting broader application and impact of this evidence to benefit the health of patients and the public. Nevertheless, behaviour change theory/methods typically directed towards health behaviours are now used in implementation science to understand and support behaviour change in individuals at different health system levels whose own behaviour impacts delivering evidence-based health behaviour change interventions. Despite contributing to implementation science, health psychology is perhaps doing less to draw from it. A redoubled focus on implementation science in health psychology could provide novel prospects for enhancing the impact of health behaviour change evidence. We report a Health Psychology Review-specific review-of-reviews of trials of health behaviour change interventions published from inception to April 2020. We identified 34 reviews and assessed whether implementation readiness of behaviour change interventions was discussed. We then narratively review how implementation science has integrated theory/methods from health psychology and related discipline. Finally, we demonstrate how greater synergy between implementation science and health psychology could promote greater follow-through on advances made in the science of health behaviour change.
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Affiliation(s)
- Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
| | | | - Sarah Hotham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Sebastian Potthoff
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Lou Atkinson
- School of Psychology, Aston University, Birmingham, UK
| | - Eleanor R Bull
- Research Centre for Health, Psychology and Communities, Manchester Metropolitan University, Manchester, UK
| | - Alexandra L Dima
- Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
| | | | - David French
- School of Health Sciences & Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Nelli Hankonen
- Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jo Hart
- Division of Medical Education, University of Manchester, Manchester, UK
| | - Gill A Ten Hoor
- Dept of Work & Social Psychology, Maastricht University, Maastricht, The Netherlands.,Dept of Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, Houston, TX, USA
| | - Kristian Hudson
- Centre for Aging and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland.,NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sanne van Lieshout
- Team Advies & Onderzoek, Municipal Health Service (GGD) Kennemerland, Haarlem, the Netherlands
| | - Jennifer McSharry
- Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Rachael Powell
- School of Health Sciences & Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Elaine Toomey
- Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland.,School of Allied Health, University of Limerick, Limerick, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland
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9
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Kwasnicka D, Luszczynska A, Hagger MS, Quested E, Pagoto SL, Verboon P, Robinson S, Januszewicz A, Idziak P, Palacz I, Naughton F. Theory-based digital intervention to promote weight loss and weight loss maintenance (Choosing Health): protocol for a randomised controlled trial. BMJ Open 2020; 10:e040183. [PMID: 33234638 PMCID: PMC7684829 DOI: 10.1136/bmjopen-2020-040183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Digital behavioural weight loss interventions have the potential to improve public health; however, these interventions are often not adequately tailored to the needs of the participants. This is the protocol for a trial that aims to determine the effectiveness and cost-effectiveness of the Choosing Health programme as a means to promote weight loss and weight loss maintenance among overweight/obese adults. METHODS AND ANALYSIS The proposed study is a two-group randomised controlled trial with a nested interrupted time series (ITS) within-person design. Participants (n=285) will be randomly assigned to either the Choosing Health digital intervention or a control group. For intervention participants, ecological momentary assessment will be used to identify behavioural determinants for each individual in order to tailor evidence-based behaviour change techniques and intervention content.Control group participants will receive non-tailored weight loss advice via e-book and generic emails. The primary outcome is the mean difference in weight loss between groups at 6 months controlled for baseline. Secondary outcomes include blood pressure and percentage of body fat; self-reported measures of physical activity, sitting time, quality of life, cost and theory-derived correlates of weight loss. Secondary outcomes will be measured at baseline, 3, 6 and 12 months. The primary outcome for ITS will be daily weight loss plan adherence. Data will be analysed using regression and time series analyses. ETHICS AND DISSEMINATION Ethics approval was granted by Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland, approval number 03/P/12/2019. The project results will be disseminated through structured strategy implemented in collaboration with the Ministry of Health. TRIAL REGISTRATION DETAILS This trial was registered with www.clinicaltrials.gov; registration number NCT04291482.
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Affiliation(s)
- Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Aleksandra Luszczynska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Martin S Hagger
- Psychological Sciences, University of California, Merced, Merced, California, United States
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eleanor Quested
- Physical Activity and Well-being Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Sherry L Pagoto
- Department of Allied Health Sciences, The UConn Center for mHealth and Social Media, University of Connecticut, Connecticut, New England, United States
| | - Peter Verboon
- Department of Psychology and Educational Sciences, Open Universiteit Nederland Faculteit Managementwetenschappen, Heerlen, Limburg, The Netherlands
| | - Suzanne Robinson
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Anna Januszewicz
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Paulina Idziak
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Iga Palacz
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Felix Naughton
- School of Health Sciences, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, Norfolk, UK
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10
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McCleary N, Desveaux L, Reis C, Linklater S, Witteman HO, Taljaard M, Thavorn K, Grimshaw JM, Ivers NM, Presseau J. A multiple-behaviour investigation of goal prioritisation in physicians receiving audit and feedback to address high-risk prescribing in nursing homes. Implement Sci Commun 2020; 1:33. [PMID: 32885191 PMCID: PMC7427855 DOI: 10.1186/s43058-020-00019-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background As part of their professional role, healthcare providers enact multiple competing goal-directed behaviours in time-constrained environments. Better understanding healthcare providers’ motivation to engage in the pursuit of particular goals may help inform the development of implementation interventions. We investigated healthcare providers’ pursuit of multiple goals as part of a trial evaluating the effectiveness of an audit and feedback intervention in supporting appropriate adjustment of high-risk medication prescribing by physicians working in nursing homes. Our objectives were to determine whether goal priority and constructs from Social Cognitive Theory (self-efficacy, outcome expectations, and descriptive norms) predicted intention to adjust prescribing of multiple high-risk medications and to investigate how physicians in nursing homes prioritise their goals related to high-risk medication prescribing. Methods Physicians in Ontario, Canada, who signed up for and accessed the audit and feedback report were invited to complete a questionnaire assessing goal priority, self-efficacy, outcome expectations, descriptive norms, and intention in relation to the three targeted behaviours (adjusting prescribing of antipsychotics, benzodiazepines, and antidepressants) and a control behaviour (adjusting statin prescribing). We conducted multiple linear regression analyses to identify predictors of intention. We also conducted semi-structured qualitative interviews to investigate how physicians in nursing homes prioritise their goals in relation to appropriately adjusting prescribing of the medications included in the report: analysis was informed by the framework analysis method. Results Thirty-three of 89 (37%) physicians completed the questionnaire. Goal priority was the only significant predictor of intention for each medication type; the greater a priority it was for physicians to appropriately adjust their prescribing, the stronger was their intention to do so. Across five interviews, physicians reported prioritising adjustment of antipsychotic prescribing specifically. This was influenced by negative media coverage of antipsychotic prescribing in nursing homes, the provincial government’s mandate to address antipsychotic prescribing, and by the deprescribing initiatives or best practice routines in place in their nursing homes. Conclusions Goal priority predicted nursing home physicians’ intention to adjust prescribing. Targeting goal priority through implementation interventions therefore has the potential to influence behaviour via increased motivation. Implementation intervention developers should consider the external factors that may drive physicians’ prioritization.
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Affiliation(s)
- Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Laura Desveaux
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Catherine Reis
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Stefanie Linklater
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada
| | - Holly O Witteman
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,Department of Family and Emergency Medicine, and Office of Education and Continuing Professional Development, Laval University, Québec City, Canada.,Laval University Research Institute for Primary Care and Health Services, Laval University, Québec City, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kednapa Thavorn
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
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11
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Silva CC, Gouveia MJ, Marques MM. Adaptação e validação cultural de questionário de aconselhamento na diabetes do tipo 2. PSYCHOLOGY, COMMUNITY & HEALTH 2020. [DOI: 10.5964/pch.v8i1.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo
O objetivo do estudo é contribuir para a validação do Questionário de Avaliação dos Fatores Associados ao Aconselhamento na Diabetes do Tipo 2 (CSRBQ), que avalia os fatores psicossociais envolvidos na prestação de aconselhamento nutricional, de atividade física e de educação continuada (e.g., autoeficácia).
Método
Foi utilizada uma metodologia mista, com recurso a questionário e entrevistas individuais com profissionais de saúde. Primeiro foram feitas análises à sensibilidade e fiabilidade do instrumento numa amostra de 74 profissionais de saúde envolvidos diretamente na consulta de Diabetes do Tipo 2 (médicos e enfermeiros); posteriormente, foi feita uma análise facial do instrumento através da análise de conteúdo de 17 entrevistas individuais.
Resultados
A versão portuguesa do CSRBQ apresenta medidas descritivas e consistência interna aceitáveis para quase todas as escalas e, de um modo geral, foi bem aceite e interpretada pelos profissionais de saúde. A análise das entrevistas sugere a necessidade de ajustamento do questionário ao nível da sua organização e clarificação.
Conclusão
O CSRBQ pode oferecer informação relevante acerca das barreiras e facilitadores à prestação de aconselhamento pelos profissionais de saúde na diabetes do tipo 2.
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12
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Bissett SM, Preshaw PM, Presseau J, Rapley T. A qualitative study exploring strategies to improve the inter-professional management of diabetes and periodontitis. Prim Care Diabetes 2020; 14:126-132. [PMID: 31831377 PMCID: PMC7059110 DOI: 10.1016/j.pcd.2019.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/05/2019] [Accepted: 11/20/2019] [Indexed: 12/31/2022]
Abstract
AIMS To explore inter-professional communication and collaboration in guideline-concordant diabetes and periodontitis care. METHODS Qualitative design using iterations of workshops to identify ways to improve multidisciplinary working attended by staff from medical and dental primary care practices, and people with diabetes (n=43). Workshops were semi-structured around a topic guide. Recruitment was via the UK Clinical Research Network, and a patient and public involvement group in the North of England. RESULTS Medical practice participants were unaware of the bidirectional evidence linking diabetes and periodontitis and stated that they had never received a referral from a dental professional in this context. The patient participants with diabetes reported never having been informed about the links between diabetes and periodontitis from either their family physician or dentist. Medical and dental practice participants gave negative accounts of inter-professional communication, with claims of inappropriate requests and defensive or non-responses that stymied future interaction. Indirect communication through the patient was suggested as an alternative to direct communication. CONCLUSIONS Indirect referral, whereby the patient is signposted to a healthcare professional, was suggested by medical and dental professionals as a useful alternative to the traditional (and time consuming) letter or telephone call, particularly in the case of suspected diabetes or periodontitis.
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Affiliation(s)
- Susan M Bissett
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Philip M Preshaw
- National University Centre for Oral Health, National University of Singapore, Singapore
| | - Justin Presseau
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Tim Rapley
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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13
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Kwasnicka D, Dombrowski SU, White M, Sniehotta FF. 'It's not a diet, it's a lifestyle': a longitudinal, data-prompted interview study of weight loss maintenance. Psychol Health 2019; 34:963-982. [PMID: 30905184 DOI: 10.1080/08870446.2019.1579913] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To advance understanding of the individual and environmental factors underpinning weight loss maintenance. Design: Semi-structured, data-prompted interviews were conducted with twelve overweight adult participants (three men, nine women) who had lost over 5% of their body weight in the year before baseline. Participants gathered daily data through wireless scales, activity monitors (Fitbit™), ecological momentary assessment and experience sampling (taking photographs, writing notes). They were interviewed at 3- and 6-months post baseline. Interview stimuli included personal data of weight and activity graphs, correlations of psychological factors, and self-generated notes and photographs. Interview data were analysed using the Framework Method, applying pre-specified maintenance-relevant theoretical themes. Results: The theoretical Framework provided a good fit for the narratives, with five main themes underpinning successful weight loss maintenance: sustained motivation, effective self-regulation, plentiful resources, habit formation and a supportive environment. Additionally, participants reported an identity shift from being a dieter to accepting a new healthy lifestyle. Goal prioritising and allowing for occasional controlled lapses enhanced weight loss maintenance. Conclusions: This study successfully used the novel method of data-prompted interviews to explore weight loss maintenance experiences with new explanations emerging from the data. Future research should further develop behaviour change maintenance theory and data-prompted interview method.
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Affiliation(s)
- Dominika Kwasnicka
- a School of Psychology , Curtin University , Perth , Australia.,b SWPS University of Social Sciences and Humanities , Wroclaw , Poland.,c Institute of Health and Society , Newcastle University, Newcastle upon Tyne, and Fuse, UKCRC Centre for Translational Research in Public Health , Newcastle , UK
| | - Stephan U Dombrowski
- c Institute of Health and Society , Newcastle University, Newcastle upon Tyne, and Fuse, UKCRC Centre for Translational Research in Public Health , Newcastle , UK.,d Faculty of Kinesiology , University of New Brunswick , Fredericton , NB , Canada
| | - Martin White
- c Institute of Health and Society , Newcastle University, Newcastle upon Tyne, and Fuse, UKCRC Centre for Translational Research in Public Health , Newcastle , UK.,e UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit , School of Clinical Medicine, University of Cambridge , Cambridge , UK
| | - Falko F Sniehotta
- c Institute of Health and Society , Newcastle University, Newcastle upon Tyne, and Fuse, UKCRC Centre for Translational Research in Public Health , Newcastle , UK
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14
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Potthoff S, Presseau J, Sniehotta FF, Breckons M, Rylance A, Avery L. Exploring the role of competing demands and routines during the implementation of a self-management tool for type 2 diabetes: a theory-based qualitative interview study. BMC Med Inform Decis Mak 2019; 19:23. [PMID: 30678684 PMCID: PMC6345053 DOI: 10.1186/s12911-019-0744-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 01/10/2019] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The implementation of new medical interventions into routine care involves healthcare professionals adopting new clinical behaviours and changing existing ones. Whilst theory-based approaches can help understand healthcare professionals' behaviours, such approaches often focus on a single behaviour and conceptualise its performance in terms of an underlying reflective process. Such approaches fail to consider the impact of non-reflective influences (e.g. habit and automaticity) and how the myriad of competing demands for their time may influence uptake. The current study aimed to apply a dual process theoretical approach to account for reflective and automatic determinants of healthcare professional behaviour while integrating a multiple behaviour approach to understanding the implementation and use of a new self-management tool by healthcare professionals in the context of diabetes care. METHODS Following Diabetes UK's national release of the 'Information Prescription' (DUK IP; a self-management tool targeting the management of cholesterol, blood pressure and HbA1c) in January 2015, we conducted semi-structured interviews with 13 healthcare professionals (general practitioners and nurses) who had started to use the DUK IP during consultations to provide self-management advice to people with type 2 diabetes. A theory-based topic guide included pre-specified constructs from a previously developed logic model. We elicited healthcare professionals' views on reflective processes (outcome expectations, self-efficacy, intention, action and coping planning), automatic processes (habit), and multiple behaviour processes (goal priority, goal conflict and goal facilitation). All interviews were audio recorded and transcribed verbatim and all transcripts were independently double coded and analysed using content analysis. RESULTS The majority of healthcare professionals interviewed reported strong intentions to use the DUK IP and having formed a habit of using them after a minimum of one month continuous use. Pop-up cues in the electronic patient records were perceived to facilitate the use of the tool. Factors that conflicted with the use of the DUK IP included existing pathways of providing self-management advice. CONCLUSION Data suggests that constructs from dual process and multiple behaviour approaches are useful to provide supplemental understanding of the implementation of new self-management tools such as the DUK IP and may help to advance behavioural approaches to implementation science.
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Affiliation(s)
- Sebastian Potthoff
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, NE7 7TR UK
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, NE2 4AX UK
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, K1H 8L6 Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, K1N 6N5 Canada
| | - Falko F. Sniehotta
- NIHR Policy Research Unit Behavioural Science, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX UK
| | - Matthew Breckons
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, NE2 4AX UK
| | | | - Leah Avery
- School of Health & Social Care, Teesside University, Middlesbrough, TS1 3BA UK
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15
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Araújo-Soares V, Hankonen N, Presseau J, Rodrigues A, Sniehotta FF. Developing Behavior Change Interventions for Self-Management in Chronic Illness: An Integrative Overview. EUROPEAN PSYCHOLOGIST 2018; 24:7-25. [PMID: 31496632 PMCID: PMC6727632 DOI: 10.1027/1016-9040/a000330] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 02/21/2018] [Accepted: 04/19/2018] [Indexed: 12/24/2022]
Abstract
More people than ever are living longer with chronic conditions such as obesity, type 2 diabetes, and heart disease. Behavior change for effective self-management can improve health outcomes and quality of life in people living with such chronic illnesses. The science of developing behavior change interventions with impact for patients aims to optimize the reach, effectiveness, adoption, implementation, and maintenance of interventions and rigorous evaluation of outcomes and processes of behavior change. The development of new services and technologies offers opportunities to enhance the scope of delivery of interventions to support behavior change and self-management at scale. Herein, we review key contemporary approaches to intervention development, provide a critical overview, and integrate these approaches into a pragmatic, user-friendly framework to rigorously guide decision-making in behavior change intervention development. Moreover, we highlight novel emerging methods for rapid and agile intervention development. On-going progress in the science of intervention development is needed to remain in step with such new developments and to continue to leverage behavioral science's capacity to contribute to optimizing interventions, modify behavior, and facilitate self-management in individuals living with chronic illness.
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Affiliation(s)
- Vera Araújo-Soares
- Institute of Health & Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,School of Psychology, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nelli Hankonen
- Faculty of Social Sciences, University of Tampere, Finland
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Canada.,School of Psychology, University of Ottawa, Canada
| | - Angela Rodrigues
- Institute of Health & Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Fuse. The UK Clinical Research Collaboration Centre for Translational Research in Public Health
| | - Falko F Sniehotta
- Institute of Health & Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Fuse. The UK Clinical Research Collaboration Centre for Translational Research in Public Health
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16
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Jeong D, Presseau J, ElChamaa R, Naumann DN, Mascaro C, Luconi F, Smith KM, Kitto S. Barriers and Facilitators to Self-Directed Learning in Continuing Professional Development for Physicians in Canada: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1245-1254. [PMID: 29642101 PMCID: PMC6092094 DOI: 10.1097/acm.0000000000002237] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE This scoping review explored the barriers and facilitators that influence engagement in and implementation of self-directed learning (SDL) in continuing professional development (CPD) for physicians in Canada. METHOD This review followed the six-stage scoping review framework of Arksey and O'Malley and of Daudt et al. In 2015, the authors searched eight online databases for English-language Canadian articles published January 2005-December 2015. To chart and analyze data from the 17 included studies, they employed a two-step analysis process composed of conventional content analysis followed by directed coding applying the Theoretical Domains Framework (TDF). RESULTS Conventional content analysis generated five categories of barriers and facilitators: individual, program, technological, environmental, and workplace/organizational. Directed coding guided by the TDF allowed analysis of barriers and facilitators to behavior change according to two key groups: physicians engaging in SDL, and SDL developers designing and implementing SDL programs. Of the 318 total barriers and facilitators coded, 290 (91.2%) were coded for physicians and 28 (8.8%) for SDL developers. The majority (209; 65.7%) were coded in four key TDF domains: environmental context and resources, social influences, beliefs about consequences, and behavioral regulation. CONCLUSIONS This scoping review identified five categories of barriers and facilitators in the literature and four key TDF domains where most factors related to behavior change of physicians and SDL developers regarding SDL programs in CPD were coded. There was a significant gap in the literature about factors that may contribute to SDL developers' capacity to design and implement SDL programs in CPD.
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Affiliation(s)
- Dahn Jeong
- D. Jeong is a research associate, Department of Innovation in Medical Education and Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Presseau
- J. Presseau is a scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute, and assistant professor, School of Epidemiology and Public Health and School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rima ElChamaa
- R. ElChamaa is a research associate, Department of Innovation in Medical Education and Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Danielle N. Naumann
- D.N. Naumann is a research associate, Continuing Professional Development, and doctorate candidate, Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Colin Mascaro
- C. Mascaro is a fourth-year resident, Department of Physical Medicine and Rehabilitation, School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Francesca Luconi
- F. Luconi is assistant dean, Continuing Professional Development, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Karen M. Smith
- K.M. Smith is associate dean, Continuing Professional Development, Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Simon Kitto
- S. Kitto is professor, Department of Innovation in Medical Education and the Faculty of Education, and director of research, Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; and assistant professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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17
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Glynn LG, Glynn F, Casey M, Wilkinson LG, Hayes PS, Heaney D, Murphy AWM. Implementation of the SMART MOVE intervention in primary care: a qualitative study using normalisation process theory. BMC FAMILY PRACTICE 2018; 19:48. [PMID: 29720084 PMCID: PMC5932852 DOI: 10.1186/s12875-018-0737-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/18/2018] [Indexed: 12/04/2022]
Abstract
Background Problematic translational gaps continue to exist between demonstrating the positive impact of healthcare interventions in research settings and their implementation into routine daily practice. The aim of this qualitative evaluation of the SMART MOVE trial was to conduct a theoretically informed analysis, using normalisation process theory, of the potential barriers and levers to the implementation of a mhealth intervention to promote physical activity in primary care. Methods The study took place in the West of Ireland with recruitment in the community from the Clare Primary Care Network. SMART MOVE trial participants and the staff from four primary care centres were invited to take part and all agreed to do so. A qualitative methodology with a combination of focus groups (general practitioners, practice nurses and non-clinical staff from four separate primary care centres, n = 14) and individual semi-structured interviews (intervention and control SMART MOVE trial participants, n = 4) with purposeful sampling utilising the principles of Framework Analysis was utilised. The Normalisation Process Theory was used to develop the topic guide for the interviews and also informed the data analysis process. Results Four themes emerged from the analysis: personal and professional exercise strategies; roles and responsibilities to support active engagement; utilisation challenges; and evaluation, adoption and adherence. It was evident that introducing a new healthcare intervention demands a comprehensive evaluation of the intervention itself and also the environment in which it is to operate. Despite certain obstacles, the opportunity exists for the successful implementation of a novel healthcare intervention that addresses a hitherto unresolved healthcare need, provided that the intervention has strong usability attributes for both disseminators and target users and coheres strongly with the core objectives and culture of the health care environment in which it is to operate. Conclusion We carried out a theoretical analysis of stakeholder informed barriers and levers to the implementation of a novel exercise promotion tool in the Irish primary care setting. We believe that this process amplifies the implementation potential of such an intervention in primary care. The SMART MOVE trial is registered at Current Controlled Trials (ISRCTN99944116; Date of registration: 1st August 2012).
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Affiliation(s)
- Liam G Glynn
- Graduate Entry Medical School and Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Fergus Glynn
- Graduate Entry Medical School and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Monica Casey
- Graduate Entry Medical School and Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Patrick S Hayes
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - David Heaney
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland
| | - Andrew W M Murphy
- Discipline of General Practice, National University of Ireland, Galway, Ireland
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18
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Presseau J, Mackintosh J, Hawthorne G, Francis JJ, Johnston M, Grimshaw JM, Steen N, Coulthard T, Brown H, Kaner E, Elovainio M, Sniehotta FF. Cluster randomised controlled trial of a theory-based multiple behaviour change intervention aimed at healthcare professionals to improve their management of type 2 diabetes in primary care. Implement Sci 2018; 13:65. [PMID: 29720209 PMCID: PMC5930437 DOI: 10.1186/s13012-018-0754-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/19/2018] [Indexed: 11/17/2022] Open
Abstract
Background National diabetes audits in the UK show room for improvement in the quality of care delivered to people with type 2 diabetes in primary care. Systematic reviews of quality improvement interventions show that such approaches can be effective but there is wide variability between trials and little understanding concerning what explains this variability. A national cohort study of primary care across 99 UK practices identified modifiable predictors of healthcare professionals’ prescribing, advising and foot examination. Our objective was to evaluate the effectiveness of an implementation intervention to improve six guideline-recommended health professional behaviours in managing type 2 diabetes in primary care: prescribing for blood pressure and glycaemic control, providing physical activity and nutrition advice and providing updated diabetes education and foot examination. Methods Two-armed cluster randomised trial involving 44 general practices. Primary outcomes (at 12 months follow-up): from electronic medical records, the proportion of patients receiving additional prescriptions for blood pressure and insulin initiation for glycaemic control and having a foot examination; and from a patient survey of a random sample of 100 patients per practice, reported receipt of updated diabetes education and physical activity and nutrition advice. Results The implementation intervention did not lead to statistically significant improvement on any of the six clinical behaviours. 1,138,105 prescriptions were assessed. Intervention (29% to 37% patients) and control arms (31% to 35%) increased insulin initiation relative to baseline but were not statistically significantly different at follow-up (IRR 1.18, 95%CI 0.95–1.48). Intervention (45% to 53%) and control practices (45% to 50%) increased blood pressure prescription from baseline to follow-up but were not statistically significantly different at follow-up (IRR 1.05, 95%CI 0.96 to 1.16). Intervention (75 to 78%) and control practices (74 to 79%) increased foot examination relative to baseline; control practices increased statistically significantly more (OR 0.84, 95%CI 0.75–0.94). Fewer patients in intervention (33%) than control practices (40%) reported receiving updated diabetes education (OR = 0.74, 95%CI 0.57–0.97). No statistically significant differences were observed in patient reports of having had a discussion about nutrition (intervention = 73%; control = 72%; OR = 0.98, 95%CI 0.59–1.64) or physical activity (intervention = 57%; control = 62%; OR = 0.79, 95%CI 0.56–1.11). Development and delivery of the intervention cost £1191 per practice. Conclusions There was no measurable benefit to practices’ participation in this intervention. Despite widespread use of outreach interventions worldwide, there is a need to better understand which techniques at which intensity are optimally suited to address the multiple clinical behaviours involved in improving care for type 2 diabetes. Trial registration ISRCTN, ISRCTN66498413. Registered April 4, 2013 Electronic supplementary material The online version of this article (10.1186/s13012-018-0754-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Justin Presseau
- Ottawa Hospital Research Institute, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Joan Mackintosh
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Hawthorne
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jill J Francis
- School of Health Sciences, City, University of London, London, UK
| | - Marie Johnston
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Nick Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Tom Coulthard
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Benfield Park Medical Group, Newcastle upon Tyne, UK
| | - Heather Brown
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Marko Elovainio
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Fuse, The UK CRC Centre of Excellence for Translational Research in Public Health, Newcastle upon Tyne, UK
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19
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Gude WT, Roos-Blom MJ, van der Veer SN, Dongelmans DA, de Jonge E, Francis JJ, Peek N, de Keizer NF. Health professionals' perceptions about their clinical performance and the influence of audit and feedback on their intentions to improve practice: a theory-based study in Dutch intensive care units. Implement Sci 2018; 13:33. [PMID: 29454393 PMCID: PMC5816547 DOI: 10.1186/s13012-018-0727-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/06/2018] [Indexed: 11/18/2022] Open
Abstract
Background Audit and feedback aims to guide health professionals in improving aspects of their practice that need it most. Evidence suggests that feedback fails to increase accuracy of professional perceptions about clinical performance, which likely reduces audit and feedback effectiveness. This study investigates health professionals’ perceptions about their clinical performance and the influence of feedback on their intentions to change practice. Methods We conducted an online laboratory experiment guided by Control Theory with 72 intensive care professionals from 21 units. For each of four new pain management indicators, we collected professionals’ perceptions about their clinical performance; peer performance; targets; and improvement intentions before and after receiving first-time feedback. An electronic audit and feedback dashboard provided ICU’s own performance, median and top 10% peer performance, and improvement recommendations. The experiment took place approximately 1 month before units enrolled into a cluster-randomised trial assessing the impact of adding a toolbox with suggested actions and materials to improve intensive care pain management. During the experiment, the toolbox was inaccessible; all participants accessed the same version of the dashboard. Results We analysed 288 observations. In 53.8%, intensive care professionals overestimated their clinical performance; but in only 13.5%, they underestimated it. On average, performance was overestimated by 22.9% (on a 0–100% scale). Professionals similarly overestimated peer performance, and set targets 20.3% higher than the top performance benchmarks. In 68.4% of cases, intentions to improve practice were consistent with actual gaps in performance, even before professionals had received feedback; which increased to 79.9% after receiving feedback (odds ratio, 2.41; 95% CI, 1.53 to 3.78). However, in 56.3% of cases, professionals still wanted to improve care aspects at which they were already top performers. Alternatively, in 8.3% of cases, they lacked improvement intentions because they did not consider indicators important; did not trust the data; or deemed benchmarks unrealistic. Conclusions Audit and feedback helps health professionals to work on aspects for which improvement is recommended. Given the abundance of professionals’ prior good improvement intentions, the limited effects typically found by audit and feedback studies are likely predominantly caused by barriers to translation of intentions into actual change in clinical practice. Trial registration ClinicalTrials.govNCT02922101. Registered 26 September 2016. Electronic supplementary material The online version of this article (10.1186/s13012-018-0727-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wouter T Gude
- Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
| | - Marie-José Roos-Blom
- Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.,National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Dave A Dongelmans
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Evert de Jonge
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jill J Francis
- Centre for Health Services Research, City University of London, London, UK
| | - Niels Peek
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nicolette F de Keizer
- Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.,National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
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20
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Nathan N, Elton B, Babic M, McCarthy N, Sutherland R, Presseau J, Seward K, Hodder R, Booth D, Yoong SL, Wolfenden L. Barriers and facilitators to the implementation of physical activity policies in schools: A systematic review. Prev Med 2018; 107:45-53. [PMID: 29155228 DOI: 10.1016/j.ypmed.2017.11.012] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Research consistently indicates that schools fail to implement mandatory physical activity policies. This review aimed to describe factors (barriers and facilitators) that may influence the implementation of school physical activity policies which specify the time or intensity that physical activity should be implemented and to map these factors to a theoretical framework. A systematic search was undertaken in six databases for quantitative or qualitative studies published between 1995-March 2016 that examined teachers', principals' or school administrators' reported barriers and/or facilitators to implementing mandated school physical activity policies. Two independent reviewers screened texts, extracted and coded data from identified articles using the Theoretical Domains Framework (TDF). Of the 10,346 articles identified, 17 studies met the inclusion criteria (8 quantitative, 9 qualitative). Barriers and facilitators identified in qualitative studies covered 9 and 10 TDF domains respectively. Barriers and facilitators reported in quantitative studies covered 8 TDF domains each. The most common domains identified were: 'environmental context and resources' (e.g., availability of equipment, time or staff), 'goals' (e.g., the perceived priority of the policy in the school), 'social influences' (e.g., support from school boards), and 'skills' (e.g., teachers' ability to implement the policy). Implementation support strategies that target these factors may represent promising means to improve implementation of physical activity policies and increase physical activity among school-aged children. Future studies assessing factors that influence school implementation of physical activity policies would benefit from using a comprehensive framework to help identify if any domains have been overlooked in the current literature. REGISTRATION This review was prospectively registered with PROSPERO (CRD42016051649) on the 8th December 2016.
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Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Ben Elton
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia.
| | - Mark Babic
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Nicole McCarthy
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia; Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario K1H 8L6, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
| | - Kirsty Seward
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Rebecca Hodder
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Debbie Booth
- University Library, Academic Division, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No. 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
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21
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Ivers NM, Desveaux L, Presseau J, Reis C, Witteman HO, Taljaard MK, McCleary N, Thavorn K, Grimshaw JM. Testing feedback message framing and comparators to address prescribing of high-risk medications in nursing homes: protocol for a pragmatic, factorial, cluster-randomized trial. Implement Sci 2017; 12:86. [PMID: 28705208 PMCID: PMC5512954 DOI: 10.1186/s13012-017-0615-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/26/2017] [Indexed: 11/17/2022] Open
Abstract
Background Audit and feedback (AF) interventions that leverage routine administrative data offer a scalable and relatively low-cost method to improve processes of care. AF interventions are usually designed to highlight discrepancies between desired and actual performance and to encourage recipients to act to address such discrepancies. Comparing to a regional average is a common approach, but more recipients would have a discrepancy if compared to a higher-than-average level of performance. In addition, how recipients perceive and respond to discrepancies may depend on how the feedback itself is framed. We aim to evaluate the effectiveness of different comparators and framing in feedback on high-risk prescribing in nursing homes. Methods This is a pragmatic, 2 × 2 factorial, cluster-randomized controlled trial testing variations in the comparator and framing on the effectiveness of quarterly AF in changing high-risk prescribing in nursing homes in Ontario, Canada. We grouped homes that share physicians into clusters and randomized these clusters into the four experimental conditions. Outcomes will be assessed after 6 months; all primary analyses will be by intention-to-treat. The primary outcome (monthly number of high-risk medications received by each patient) will be analysed using a general linear mixed effects regression model. We will present both four-arm and factorial analyses. With 160 clusters and an average of 350 beds per cluster, assuming no interaction and similar effects for each intervention, we anticipate 90% power to detect an absolute mean difference of 0.3 high-risk medications prescribed. A mixed-methods process evaluation will explore potential mechanisms underlying the observed effects, exploring targeted constructs including intention, self-efficacy, outcome expectations, descriptive norms, and goal prioritization. An economic analysis will examine cost-effectiveness analysis from the perspective of the publicly funded health care system. Discussion This protocol describes the rationale and methodology of a trial testing manipulations of theory-informed components of an audit and feedback intervention to determine how to improve an existing intervention and provide generalizable insights for implementation science. Trial registration NCT02979964 Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0615-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Noah M Ivers
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Canada. .,Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada. .,Institute for Clinical Evaluative Studies, Toronto, Canada. .,Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Laura Desveaux
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.,Institut de recherche de l'hôpital Montfort, Ottawa, Canada
| | - Catherine Reis
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Canada
| | - Holly O Witteman
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Family and Emergency Medicine, Laval University, Québec, Canada.,Office of Education and Continuing Professional Development, Laval University, Québec, Canada.,Laval University Research Institute for Primary Care and Health Services, Québec, Canada.,Population Health and Optimal Health Practices, CHU de Québec, Québec, Canada
| | - Monica K Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kednapa Thavorn
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
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22
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Kwasnicka D, Vandelanotte C, Rebar A, Gardner B, Short C, Duncan M, Crook D, Hagger MS. Comparing motivational, self-regulatory and habitual processes in a computer-tailored physical activity intervention in hospital employees - protocol for the PATHS randomised controlled trial. BMC Public Health 2017; 17:518. [PMID: 28549476 PMCID: PMC5446723 DOI: 10.1186/s12889-017-4415-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 05/11/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Most people do not engage in sufficient physical activity to confer health benefits and to reduce risk of chronic disease. Healthcare professionals frequently provide guidance on physical activity, but often do not meet guideline levels of physical activity themselves. The main objective of this study is to develop and test the efficacy of a tailored intervention to increase healthcare professionals' physical activity participation and quality of life, and to reduce work-related stress and absenteeism. This is the first study to compare the additive effects of three forms of a tailored intervention using different techniques from behavioural theory, which differ according to their focus on motivational, self-regulatory and/or habitual processes. METHODS/DESIGN Healthcare professionals (N = 192) will be recruited from four hospitals in Perth, Western Australia, via email lists, leaflets, and posters to participate in the four group randomised controlled trial. Participants will be randomised to one of four conditions: (1) education only (non-tailored information only), (2) education plus intervention components to enhance motivation, (3) education plus components to enhance motivation and self-regulation, and (4) education plus components to enhance motivation, self-regulation and habit formation. All intervention groups will receive a computer-tailored intervention administered via a web-based platform and will receive supporting text-messages containing tailored information, prompts and feedback relevant to each condition. All outcomes will be assessed at baseline, and at 3-month follow-up. The primary outcome assessed in this study is physical activity measured using activity monitors. Secondary outcomes include: quality of life, stress, anxiety, sleep, and absenteeism. Website engagement, retention, preferences and intervention fidelity will also be evaluated as well as potential mediators and moderators of intervention effect. DISCUSSION This is the first study to examine a tailored, technology-supported intervention aiming to increase physical activity in healthcare professionals. The study will evaluate whether including additional theory-based behaviour change techniques aimed at promoting motivation, self-regulation and habit will lead to increased physical activity participation relative to information alone. The online platform developed in this study has potential to deliver efficient, scalable and personally-relevant intervention that can be translated to other occupational settings. TRIAL REGISTRATION Australian New-Zealand Clinical Trial Registry: ACTRN12616000462482, submitted 29/03/2016, prospectively registered 8/04/2016.
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Affiliation(s)
- Dominika Kwasnicka
- Health Psychology & Behavioural Medicine, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia
- Physical Activity Research Group, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Corneel Vandelanotte
- Health Psychology & Behavioural Medicine, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia.
- Physical Activity Research Group, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia.
| | - Amanda Rebar
- Health Psychology & Behavioural Medicine, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia
- Physical Activity Research Group, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Camille Short
- Freemasons Foundation Centre for Men's Health, South Australian Health and Medical Research Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia
| | - Mitch Duncan
- Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, School of Medicine & Public Health, The University of Newcastle, Callaghan, Australia
| | - Dawn Crook
- St John of God Subiaco Hospital, Perth, Australia
| | - Martin S Hagger
- Health Psychology & Behavioural Medicine, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia
- Physical Activity Research Group, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
- Faculty of Sport and Health Sciences, University of Jyväkylä, Jyväkylä, Finland
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23
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Leenaars KEF, Florisson AME, Smit E, Wagemakers A, Molleman GRM, Koelen MA. The connection between the primary care and the physical activity sector: professionals' perceptions. BMC Public Health 2016; 16:1001. [PMID: 27655426 PMCID: PMC5031288 DOI: 10.1186/s12889-016-3665-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To stimulate physical activity (PA) and guide primary care patients towards local PA facilities, Care Sport Connectors (CSC), to whom a broker role has been ascribed, were introduced in 2012 in the Netherlands. The aim of this study is to assess perceptions of primary care, welfare, and sport professionals towards the CSC role and the connection between the primary care and the PA sector. METHODS Nine focus groups were held with primary care, welfare and sport professionals within the CSC network. In these focus groups the CSC role and the connection between the sectors were discussed. Both top-down and bottom-up codes were used to analyse the focus groups. RESULTS Professionals ascribed three roles to the CSC: 1) broker role, 2) referral, 3) facilitator. Professionals were enthusiastic about how the current connection was established. However, barriers relating to their own sector were currently hindering the connection: primary care professionals' lack of time, money and knowledge, and the lack of suitable PA activities and instructors for the target group. CONCLUSIONS This study provides further insight into the CSC role and the connection between the sectors from the point of view of primary care, welfare, and sport professionals. Professionals found the CSC role promising, but barriers are currently hindering the collaboration between both sectors. More time for the CSC and changes in the way the primary care and PA sector are organized seem to be necessary to overcome the identified barriers and to make a success of the connection. TRIAL REGISTRATION Dutch Trial register NTR4986 . Registered 14 December 2014.
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Affiliation(s)
- Karlijn E F Leenaars
- Wageningen University & Research Centre, Department of Social Sciences, Health and Society Group, P.O. Box 8130, EW, Wageningen, The Netherlands.
| | - Annemiek M E Florisson
- Wageningen University & Research Centre, Department of Social Sciences, Health and Society Group, P.O. Box 8130, EW, Wageningen, The Netherlands
| | - Eva Smit
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Annemarie Wagemakers
- Wageningen University & Research Centre, Department of Social Sciences, Health and Society Group, P.O. Box 8130, EW, Wageningen, The Netherlands
| | - Gerard R M Molleman
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Maria A Koelen
- Wageningen University & Research Centre, Department of Social Sciences, Health and Society Group, P.O. Box 8130, EW, Wageningen, The Netherlands
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24
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Hobden B, Bryant J, Sanson-Fisher R, Oldmeadow C, Carey M. Co-occurring depression and alcohol misuse is under-identified in general practice: A cross-sectional study. J Health Psychol 2016; 23:1085-1095. [DOI: 10.1177/1359105316643855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Depression and alcohol misuse are common co-occurring conditions. This study aimed to determine the accuracy of general practitioner identification of depression and alcohol misuse. Participants from 12 Australian general practices reported demographic and health risk behaviour data. General practitioners were asked to indicate the presence or absence of six health risk factors for individual patients. Accuracy of general practitioner identification was low at 21 per cent. Those with severe alcohol misuse, no chronic diseases and lower education levels were more likely to be identified. Routine screening prior to patient appointments may be a simple and efficient way to increase identification rates.
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25
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Gude WT, van Engen-Verheul MM, van der Veer SN, de Keizer NF, Peek N. How does audit and feedback influence intentions of health professionals to improve practice? A laboratory experiment and field study in cardiac rehabilitation. BMJ Qual Saf 2016; 26:279-287. [DOI: 10.1136/bmjqs-2015-004795] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 03/02/2016] [Accepted: 03/21/2016] [Indexed: 11/04/2022]
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26
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Zayapragassarazan Z, Kumar S. Awareness, Knowledge, Attitude and Skills of Telemedicine among Health Professional Faculty Working in Teaching Hospitals. J Clin Diagn Res 2016; 10:JC01-4. [PMID: 27134899 DOI: 10.7860/jcdr/2016/19080.7431] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/12/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Telemedicine is an emerging technology in health sector in India. The success of any new technology depends on many factors including the knowledge and understanding of the concept, skills acquired, attitude towards technology and working environment by the concerned professionals. AIM The main objective of this study was to assess the awareness, knowledge, attitude and skills of telemedicine among the health professionals working in the teaching hospitals of Puducherry Region of India. MATERIALS AND METHODS A cross-sectional survey was carried out among various healthcare professionals using a proper sampling frame obtained from a list of teaching hospitals located in Puducherry Union Territory, India. A total of 120 teaching faculties and practitioners from the preclinical, para-clinical and clinical departments were taken up for the study. A pre-validated self-administered questionnaire was used for the survey to assess the awareness, knowledge, attitude and skills of telemedicine. The questionnaires were mailed to the respondents and the completed questionnaires were analysed as per the study objectives using descriptive statistics for the quantitative data and content analysis for the qualitative data. RESULTS The knowledge level of the respondents was found to be good with 41% of the respondents, 35% possess fair knowledge and 24% don't have adequate knowledge of telemedicine. With regard to the attitude towards telemedicine 39% of the respondents possess high attitude, 31% possess moderate attitude and 30% possess low level of attitude. Investigations on the skills of the respondents on telemedicine showed that 19% respondents are highly skilled or experts, 25% are moderately skilled which includes learners or beginners, and 56% are unskilled in handling telemedicine and its related equipments. CONCLUSION The findings of the study suggest that although the respondents experience and knowledge are limited in telemedicine technology a fair number of them have positive attitude towards telemedicine. It is the need of the hour to educate and train the teaching faculty, practicing physicians, residents, medical students and other health professionals about telemedicine and issues related to its use.
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Affiliation(s)
- Zayabalaradjane Zayapragassarazan
- Associate Professor, Department of Medical Education, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Puducherry, India
| | - Santosh Kumar
- Senior Professor, Department of Urology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Puducherry, India
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Carraro N, Gaudreau P. Predicting Physical Activity Outcomes During Episodes of Academic Goal Conflict. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2015; 41:1291-305. [DOI: 10.1177/0146167215594121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/08/2015] [Indexed: 11/15/2022]
Abstract
The moderating role of academic goal conflict in the relations between action planning (AP) and coping planning (CP) with physical activity was tested using samples of university students concurrently pursuing an academic and a physical activity goal. In Study 1 ( N = 317), AP was found to positively relate to physical activity goal progress at low, but not at high, levels of goal conflict. CP trended toward being positively related to goal progress at high, but not at low levels of goal conflict. Study 2 ( N = 97), using a 1-week daily diary design and measures of self-reported physical activity behavior and goal progress, showed that daily AP positively related to daily physical activity outcomes on days when students experienced lower, but not higher, levels of goal conflict relative to their average. Conversely, CP positively related to daily physical activity outcomes on days when students experienced higher, but not lower, levels of goal conflict.
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Presseau J, Hawthorne G, Sniehotta FF, Steen N, Francis JJ, Johnston M, Mackintosh J, Grimshaw JM, Kaner E, Elovainio M, Deverill M, Coulthard T, Brown H, Hunter M, Eccles MP. Improving Diabetes care through Examining, Advising, and prescribing (IDEA): protocol for a theory-based cluster randomised controlled trial of a multiple behaviour change intervention aimed at primary healthcare professionals. Implement Sci 2014; 9:61. [PMID: 24886606 PMCID: PMC4049486 DOI: 10.1186/1748-5908-9-61] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/15/2014] [Indexed: 11/27/2022] Open
Abstract
Background New clinical research findings may require clinicians to change their behaviour to provide high-quality care to people with type 2 diabetes, likely requiring them to change multiple different clinical behaviours. The present study builds on findings from a UK-wide study of theory-based behavioural and organisational factors associated with prescribing, advising, and examining consistent with high-quality diabetes care. Aim To develop and evaluate the effectiveness and cost of an intervention to improve multiple behaviours in clinicians involved in delivering high-quality care for type 2 diabetes. Design/methods We will conduct a two-armed cluster randomised controlled trial in 44 general practices in the North East of England to evaluate a theory-based behaviour change intervention. We will target improvement in six underperformed clinical behaviours highlighted in quality standards for type 2 diabetes: prescribing for hypertension; prescribing for glycaemic control; providing physical activity advice; providing nutrition advice; providing on-going education; and ensuring that feet have been examined. The primary outcome will be the proportion of patients appropriately prescribed and examined (using anonymised computer records), and advised (using anonymous patient surveys) at 12 months. We will use behaviour change techniques targeting motivational, volitional, and impulsive factors that we have previously demonstrated to be predictive of multiple health professional behaviours involved in high-quality type 2 diabetes care. We will also investigate whether the intervention was delivered as designed (fidelity) by coding audiotaped workshops and interventionist delivery reports, and operated as hypothesised (process evaluation) by analysing responses to theory-based postal questionnaires. In addition, we will conduct post-trial qualitative interviews with practice teams to further inform the process evaluation, and a post-trial economic analysis to estimate the costs of the intervention and cost of service use. Discussion Consistent with UK Medical Research Council guidance and building on previous development research, this pragmatic cluster randomised trial will evaluate the effectiveness of a theory-based complex intervention focusing on changing multiple clinical behaviours to improve quality of diabetes care. Trial registration ISRCTN66498413.
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Affiliation(s)
- Justin Presseau
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, England.
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Presseau J, Boyd E, Francis JJ, Sniehotta FF. Goal conflict and goal facilitation in community-based cardiac rehabilitation: A theory-based interview study. PSYCHOL HEALTH MED 2014; 20:227-38. [DOI: 10.1080/13548506.2014.914235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Braithwaite J, Marks D, Taylor N. Harnessing implementation science to improve care quality and patient safety: a systematic review of targeted literature. Int J Qual Health Care 2014; 26:321-9. [DOI: 10.1093/intqhc/mzu047] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Ivers N, Barnsley J, Upshur R, Tu K, Shah B, Grimshaw J, Zwarenstein M. "My approach to this job is...one person at a time": Perceived discordance between population-level quality targets and patient-centred care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:258-266. [PMID: 24627384 PMCID: PMC3952764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To understand the usefulness of audit and feedback among family physicians and examine the barriers to using it to improve quality of care. DESIGN Qualitative study using in-depth interviews. SETTING Family physicians across Ontario participating in audit and feedback initiatives describing the proportion of patients meeting quality targets for chronic disease. PARTICIPANTS Purposive sampling was conducted to ensure variation in sex, years of experience, and baseline performance for quality metrics. All participants used electronic medical records and worked in multidisciplinary primary care practices. METHODS Semistructured interviews were conducted with family physicians. The interview guide and initial coding framework were adjusted iteratively in keeping with the constant comparative method. Sampling continued until saturation was reached. Interviews were analyzed using the framework approach. MAIN FINDINGS Participants reported that the feedback increased their awareness of gaps between ideal and actual performance. This resulted mainly in efforts to "try harder" patient by patient. Key barriers to acting upon feedback in a systematic manner included a perceived discordance between population-level quality targets and patient-centred care, as well as competing priorities at both the patient and organizational levels. Although all participants had electronic medical records, participants reported a lack of quality improvement infrastructure in their practices. CONCLUSION Family physicians were not highly motivated to achieve evidence-based population-level quality targets for diabetes; many competing organizational and clinical goals took priority. Additional human resources might be needed to translate data in feedback reports into systematic changes that could lead to sustained improvements in quality of care.
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Affiliation(s)
- Noah Ivers
- Women's College Hospital, Department of Family and Community Medicine, 77 Grenville St, 4th Floor, Toronto, ON M5S 1B3.
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Ivers NM, Sales A, Colquhoun H, Michie S, Foy R, Francis JJ, Grimshaw JM. No more 'business as usual' with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implement Sci 2014; 9:14. [PMID: 24438584 PMCID: PMC3896824 DOI: 10.1186/1748-5908-9-14] [Citation(s) in RCA: 254] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/14/2014] [Indexed: 11/11/2022] Open
Abstract
Background Audit and feedback interventions in healthcare have been found to be effective, but there has been little progress with respect to understanding their mechanisms of action or identifying their key ‘active ingredients.’ Discussion Given the increasing use of audit and feedback to improve quality of care, it is imperative to focus further research on understanding how and when it works best. In this paper, we argue that continuing the ‘business as usual’ approach to evaluating two-arm trials of audit and feedback interventions against usual care for common problems and settings is unlikely to contribute new generalizable findings. Future audit and feedback trials should incorporate evidence- and theory-based best practices, and address known gaps in the literature. Summary We offer an agenda for high-priority research topics for implementation researchers that focuses on reviewing best practices for designing audit and feedback interventions to optimize effectiveness.
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Affiliation(s)
- Noah M Ivers
- Department of Family and Community Medicine, Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, University of Toronto, 77 Grenville Street, Toronto, ON M5S 1B3, Canada.
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Halperin IJ, Ivers NM, Wong R. Re: Leiter LA, Berard L, Bowering CK, et al. Type 2 Diabetes mellitus management in Canada: is it improving? Can J Diabetes 37;2:82-9. Can J Diabetes 2013; 37:213. [PMID: 24070882 DOI: 10.1016/j.jcjd.2013.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ilana J Halperin
- Sunnybrook Health Science Center, University of Toronto, Toronto, Ontario, Canada
| | - Noah M Ivers
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rene Wong
- University Health Network, University of Toronto, Toronto, Ontario, Canada
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Abstract
When frontline staff do not adhere to policies, protocols, or checklists, managers often regard these violations as indicating poor practice or even negligence. More often than not, however, these policy and protocol violations reflect the efforts of well intentioned professionals to carry out their work efficiently in the face of systems poorly designed to meet the diverse demands of patient care. Thus, non-compliance with institutional policies and protocols often signals a systems problem, rather than a people problem, and can be influenced among other things by training, competing goals, context, process, location, case complexity, individual beliefs, the direct or indirect influence of others, job pressure, flexibility, rule definition, and clinician-centred design. Three candidates are considered for developing a model of safety behaviour and decision making. The dynamic safety model helps to understand the relationship between systems designs and human performance. The theory of planned behaviour suggests that intention is a function of attitudes, social norms and perceived behavioural control. The naturalistic decision making paradigm posits that decisions are based on a wider view of multiple patients, expertise, systems complexity, behavioural intention, individual beliefs and current understanding of the system. Understanding and predicting behavioural safety decisions could help us to encourage compliance to current processes and to design better interventions.
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Affiliation(s)
- Ken Catchpole
- Department of Surgery, Cedars-Sinai Medical Centre, Los Angeles, CA 90048, USA.
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Finch TL, Rapley T, Girling M, Mair FS, Murray E, Treweek S, McColl E, Steen IN, May CR. Improving the normalization of complex interventions: measure development based on normalization process theory (NoMAD): study protocol. Implement Sci 2013; 8:43. [PMID: 23578304 PMCID: PMC3637119 DOI: 10.1186/1748-5908-8-43] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding implementation processes is key to ensuring that complex interventions in healthcare are taken up in practice and thus maximize intended benefits for service provision and (ultimately) care to patients. Normalization Process Theory (NPT) provides a framework for understanding how a new intervention becomes part of normal practice. This study aims to develop and validate simple generic tools derived from NPT, to be used to improve the implementation of complex healthcare interventions. OBJECTIVES The objectives of this study are to: develop a set of NPT-based measures and formatively evaluate their use for identifying implementation problems and monitoring progress; conduct preliminary evaluation of these measures across a range of interventions and contexts, and identify factors that affect this process; explore the utility of these measures for predicting outcomes; and develop an online users' manual for the measures. METHODS A combination of qualitative (workshops, item development, user feedback, cognitive interviews) and quantitative (survey) methods will be used to develop NPT measures, and test the utility of the measures in six healthcare intervention settings. DISCUSSION The measures developed in the study will be available for use by those involved in planning, implementing, and evaluating complex interventions in healthcare and have the potential to enhance the chances of their implementation, leading to sustained changes in working practices.
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Affiliation(s)
- Tracy L Finch
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne NE2 4AX, UK.
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Robinson N, Lorenc A, Falinski A, Banarsee R. The challenges of facilitating primary healthcare discussions on traditional, complementary and alternative medicine for childhood eczema: piloting a computerized template. PATIENT EDUCATION AND COUNSELING 2012; 89:517-524. [PMID: 22465483 DOI: 10.1016/j.pec.2012.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 03/01/2012] [Accepted: 03/02/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Healthcare practitioners (HCPs) experience barriers to changing routine consultation practice. Communication and recording of traditional, complementary and alternative medicines (TCAM) is inadequate. This pilot study explored the challenges of implementing a computerized template in primary care to facilitate communication on TCAM for paediatric eczema. METHODS A computerized template to record TCAM use, with links to evidence-based TCAM databases, was designed, based on qualitative research with patients and HCPs. Four London general practices implemented the template integrated with usual practice. Twelve focus groups during the 6 month study period explored HCPs' knowledge, communication and information sources regarding TCAM and perceived barriers to template implementation. RESULTS HCPs were initially enthusiastic about discussing TCAM, for improving communication and understanding patient's choices, but the template was used in under a third of consultations. HCPs were surprised at low TCAM use (10%) and lack of correlation with eczema or ethnicity. Reported barriers were time and remembering, due to busy, target-driven practice. CONCLUSION HCPs recognize the importance of discussing TCAM use for childhood eczema, and potential benefits for HCP-patient communication. PRACTICE IMPLICATIONS Future tools to facilitate TCAM discussion should prioritise use of existing IT systems and address barriers to use, especially lack of time.
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Finch TL, Mair FS, O’Donnell C, Murray E, May CR. From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument. BMC Med Res Methodol 2012; 12:69. [PMID: 22594537 PMCID: PMC3473304 DOI: 10.1186/1471-2288-12-69] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 04/16/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field. METHODS A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals. RESULTS The developed instrument was pre-tested in two professional samples (N=46; N=231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts. CONCLUSIONS To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study.
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Affiliation(s)
- Tracy L Finch
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX, England
| | - Frances S Mair
- Institute of Health and WellBeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, Scotland
| | - Catherine O’Donnell
- Institute of Health and WellBeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, Scotland
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, Upper Floor 3, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, England
| | - Carl R May
- Faculty of Health Sciences, Building 67, University of Southampton, Highfield, Southampton, SO17 1BJ, England
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MacFarlane A, Clerkin P, Murray E, Heaney DJ, Wakeling M, Pesola UM, Waterworth EL, Larsen F, Makiniemi M, Winblad I. The e-Health Implementation Toolkit: qualitative evaluation across four European countries. Implement Sci 2011; 6:122. [PMID: 22098945 PMCID: PMC3283514 DOI: 10.1186/1748-5908-6-122] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 11/19/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation researchers have attempted to overcome the research-practice gap in e-health by developing tools that summarize and synthesize research evidence of factors that impede or facilitate implementation of innovation in healthcare settings. The e-Health Implementation Toolkit (e-HIT) is an example of such a tool that was designed within the context of the United Kingdom National Health Service to promote implementation of e-health services. Its utility in international settings is unknown. METHODS We conducted a qualitative evaluation of the e-HIT in use across four countries--Finland, Norway, Scotland, and Sweden. Data were generated using a combination of interview approaches (n = 22) to document e-HIT users' experiences of the tool to guide decision making about the selection of e-health pilot services and to monitor their progress over time. RESULTS e-HIT users evaluated the tool positively in terms of its scope to organize and enhance their critical thinking about their implementation work and, importantly, to facilitate discussion between those involved in that work. It was easy to use in either its paper- or web-based format, and its visual elements were positively received. There were some minor criticisms of the e-HIT with some suggestions for content changes and comments about its design as a generic tool (rather than specific to sites and e-health services). However, overall, e-HIT users considered it to be a highly workable tool that they found useful, which they would use again, and which they would recommend to other e-health implementers. CONCLUSION The use of the e-HIT is feasible and acceptable in a range of international contexts by a range of professionals for a range of different e-health systems.
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Affiliation(s)
- Anne MacFarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Pauline Clerkin
- Discipline of General Practice, National University of Ireland, Galway, Galway, Ireland
| | - Elizabeth Murray
- e-Health Unit, Department of Primary Care & Population Health, University College London, Upper Floor 3, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - David J Heaney
- Centre for Rural Health, University of Aberdeen, Inverness, UK
| | - Mary Wakeling
- Centre for Rural Health, University of Aberdeen, Inverness, UK
| | | | | | - Frank Larsen
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Minna Makiniemi
- Oulu University Hospital, Northern Ostrobothnia Hospital District, Oulu, Finland
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Presseau J, Francis JJ, Campbell NC, Sniehotta FF. Goal conflict, goal facilitation, and health professionals' provision of physical activity advice in primary care: an exploratory prospective study. Implement Sci 2011; 6:73. [PMID: 21762486 PMCID: PMC3224555 DOI: 10.1186/1748-5908-6-73] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 07/15/2011] [Indexed: 11/17/2022] Open
Abstract
Background The theory of planned behaviour has well-evidenced utility in predicting health professional behaviour, but focuses on a single behaviour isolated from the numerous potentially conflicting and facilitating goal-directed behaviours performed alongside. Goal conflict and goal facilitation may influence whether health professionals engage in guideline-recommended behaviours, and may supplement the predictive power of the theory of planned behaviour. We hypothesised that goal facilitation and goal conflict contribute to predicting primary care health professionals' provision of physical activity advice to patients with hypertension, over and above predictors of behaviour from the theory of planned behaviour. Methods Using a prospective predictive design, at baseline we invited a random sample of 606 primary care health professionals from all primary care practices in NHS Grampian and NHS Tayside (Scotland) to complete postal questionnaires. Goal facilitation and goal conflict were measured alongside theory of planned behaviour constructs at baseline. At follow-up six months later, participants self-reported the number of patients, out of those seen in the preceding two weeks, to whom they provided physical activity advice. Results Forty-four primary care physicians and nurses completed measures at both time points (7.3% response rate). Goal facilitation and goal conflict improved the prediction of behaviour, accounting for substantial additional variance (5.8% and 8.4%, respectively) in behaviour over and above intention and perceived behavioural control. Conclusions Health professionals' provision of physical activity advice in primary care can be predicted by perceptions about how their conflicting and facilitating goal-directed behaviours help and hinder giving advice, over and above theory of planned behaviour constructs. Incorporating features of multiple goal pursuit into the theory of planned behaviour may help to better understand health professional behaviour.
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Affiliation(s)
- Justin Presseau
- Institute of Health and Society, Baddiley-Clark Building, Richardson Road, Newcastle University, Newcastle Upon Tyne, NE2 4AX, UK.
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Bailis DS, Thacher TM, Aird NCA, Lipschitz LJ. Affective and Behavioral Traces of Goal Conflict With Physical Activity. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2011. [DOI: 10.1080/01973533.2011.568836] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Presseau J, Sniehotta FF, Francis JJ, Gebhardt WA. With a little help from my goals: Integrating intergoal facilitation with the theory of planned behaviour to predict physical activity. Br J Health Psychol 2010; 15:905-19. [DOI: 10.1348/135910710x494105] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, Finch T, Kennedy A, Mair F, O'Donnell C, Ong BN, Rapley T, Rogers A, May C. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med 2010; 8:63. [PMID: 20961442 PMCID: PMC2978112 DOI: 10.1186/1741-7015-8-63] [Citation(s) in RCA: 714] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 10/20/2010] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The past decade has seen considerable interest in the development and evaluation of complex interventions to improve health. Such interventions can only have a significant impact on health and health care if they are shown to be effective when tested, are capable of being widely implemented and can be normalised into routine practice. To date, there is still a problematic gap between research and implementation. The Normalisation Process Theory (NPT) addresses the factors needed for successful implementation and integration of interventions into routine work (normalisation). DISCUSSION In this paper, we suggest that the NPT can act as a sensitising tool, enabling researchers to think through issues of implementation while designing a complex intervention and its evaluation. The need to ensure trial procedures that are feasible and compatible with clinical practice is not limited to trials of complex interventions, and NPT may improve trial design by highlighting potential problems with recruitment or data collection, as well as ensuring the intervention has good implementation potential. SUMMARY The NPT is a new theory which offers trialists a consistent framework that can be used to describe, assess and enhance implementation potential. We encourage trialists to consider using it in their next trial.
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Affiliation(s)
- Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, Upper Floor 3, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Shaun Treweek
- Division of Clinical & Population Science and Education, Mackenzie Building, University of Dundee, Kirsty Semple Way, Dundee, DD2 4AD, UK
| | - Catherine Pope
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Anne MacFarlane
- Department of General Practice, 1 Distillery Road, National University of Ireland, Galway, Ireland
| | | | - Christopher Dowrick
- School of Population, Community and Behavioural Sciences, B121 Waterhouse Buildings, University of Liverpool, Liverpool L69 3GL, UK
| | - Tracy Finch
- Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne NE2 4AA, UK
| | - Anne Kennedy
- National Primary Care Research and Development Centre, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK
| | - Frances Mair
- General Practice & Primary Care, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, UK
| | - Catherine O'Donnell
- General Practice & Primary Care, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, UK
| | - Bie Nio Ong
- Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne NE2 4AA, UK
| | - Anne Rogers
- National Primary Care Research and Development Centre, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK
| | - Carl May
- Faculty of Health Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
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