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Dwyer T, Flenady T, Signal T, Boyle CM, Connor J, Le Lagadec D, Goodwin B, Browne M. A theoretical framework for identifying sociocultural factors that influence nurses' compliance with early warning systems for acute clinical deterioration: A cross-sectional survey. Int J Nurs Stud 2024; 158:104846. [PMID: 39043112 DOI: 10.1016/j.ijnurstu.2024.104846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 06/06/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Systematic adoption of early warning systems in healthcare settings is dependent on the optimal and reliable application by the user. Psychosocial issues and hospital culture influence clinicians' patient safety behaviours. OBJECTIVE (i) To examine the sociocultural factors that influence nurses' EWS compliance behaviours, using a theory driven behavioural model and (ii) to propose a conceptual model of sociocultural factors for EWS compliance behaviour. DESIGN A cross-sectional survey. SETTING Nurses employed in public hospitals across Queensland, Australia. PARTICIPANTS Using convenience and snowball sampling techniques eligible nurses accessed a dedicated web site and survey containing closed and open-ended questions. 291 nurses from 60 hospitals completed the survey. METHODS Quantitative data were analysed using ANOVA or t-tests to test differences in means. A series of path models based on the theory were conducted to develop a new model. Directed or theory driven content analysis informed qualitative data analysis. RESULTS Nurses report high levels of previous compliance behaviour and strong intentions to continue complying in the future (M=4.7; SD 0.48). Individual compliance attitudes (β 0.29, p<.05), perceived value of escalation (β 0.24, p<.05) and perceived ease or difficulty complying with documentation (β -0.31, p<.05) were statistically significant, predicting 24% of variation in compliance behaviour. Positive personal charting beliefs (β 0.14, p<.05) and subjective norms both explain higher behavioural intent indirectly through personal attitudes. High ratings of peer charting beliefs indirectly explain attitudes through subjective norms (β 0.20, p<.05). Perceptions of control over one's clinical actions (β -0.24, p<.05) and early warning system training (β -0.17, p<.05) directly contributed to fewer difficulties complying with documentation requirements. Prior difficulties when escalating care (β -0.31, p<.05) directly influenced the perceived value of escalating. CONCLUSIONS The developed theory-based conceptual model identified sociocultural variables that inform compliance behaviour (documenting and escalation protocols). The model highlights areas of clinical judgement, education, interprofessional trust, workplace norms and cultural factors that directly or indirectly influence nurses' intention to comply with EWS protocols. Extending our understanding of the sociocultural and system wide factors that hamper nurses' use of EWSs and professional accountability has the potential to improve the compliance behaviour of staff and subsequently enhance the safety climate attitudes of hospitals. TWEETABLE ABSTRACT A newly developed model reports nurse's personal attitudes, peer influence, perceived difficulties encountered documenting and escalation beliefs all predict early warning system compliance behaviour.
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Affiliation(s)
- Trudy Dwyer
- Appleton Institute, CQUniversity Australia, Australia; School of Nursing, Midwifery & Social Studies, CQUniversity Australia, Australia.
| | - Tracy Flenady
- School of Nursing, Midwifery & Social Studies, CQUniversity Australia, Australia.
| | - Tania Signal
- Appleton Institute, CQUniversity Australia, Australia; School of Health, Medical & Applied Sciences, CQUniversity Australia, Australia.
| | | | - Justine Connor
- School of Nursing, Midwifery & Social Studies, CQUniversity Australia, Australia
| | - Danielle Le Lagadec
- School of Nursing, Midwifery & Social Studies, CQUniversity Australia, Australia
| | - Belinda Goodwin
- Centre for Health Research, University of Southern Queensland, Australia
| | - Matthew Browne
- School of Health, Medical & Applied Sciences, CQUniversity Australia, Australia
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Zakaria WMZ, Mansor Z. Intention to receive Latent Tuberculosis Infection (LTBI) treatment and its associated factors among healthcare workers in a Malaysian teaching university hospital. PLoS One 2024; 19:e0307199. [PMID: 39024265 PMCID: PMC11257325 DOI: 10.1371/journal.pone.0307199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024] Open
Abstract
The acceptability of latent tuberculosis infection (LTBI) therapy remains low among healthcare workers (HCWs). Up to 10% of LTBI cases can reactivate into active tuberculosis, posing risks to HCWs and patients. Understanding HCWs' intention to undergo LTBI treatment is crucial for designing effective management policies, especially where no LTBI policy exists. This cross-sectional study investigated the intention to receive LTBI therapy and its associated factors among HCWs in a Malaysian teaching hospital. The study was conducted from 5th to 30th May 2023, in a hospital without an LTBI screening program. Stratified random sampling was used to select HCWs, excluding those undergoing TB or LTBI therapy. Respondents completed a questionnaire measuring intention to receive LTBI treatment, LTBI knowledge, attitude, perceived norm, and perceived behavioral control. Of the 256 respondents, the majority were female (63.7%), under 35 years old (64.45%), had no comorbidities (82.0%), and worked in clinical settings (70.3%). However, 60.5% of respondents had low LTBI knowledge and 60.5% held unfavorable attitudes toward LTBI treatment. Despite this, 53.5% of respondents intended to undergo LTBI therapy if diagnosed. Factors positively associated with this intention included being female [aOR: 2.033, 95% CI: 1.080-3.823], having high LTBI knowledge [aOR 1.926, 95% CI: 1.093-3.397], had favorable attitude [aOR 3.771, 95% CI: 1.759-8.084], and strongly perceiving social norms supportive of LTBI treatment [aOR 4.593, 95% CI: 2.104-10.023]. These findings emphasize the need for an LTBI management policy in the teaching hospital. To boost HCWs' intention and acceptance of LTBI treatment, a focused program improving knowledge, attitude, and perception of social norms could be introduced.
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Affiliation(s)
- Wan Muhammad Zainol Zakaria
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Zawiah Mansor
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
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Bogers S, Boyd A, Schim van der Loeff M, Geerlings S, Davidovich U. Opportunities for improved indicator-based HIV testing in the hospital setting: a structural equation model analysis. AIDS Care 2024; 36:840-848. [PMID: 37683267 DOI: 10.1080/09540121.2023.2254548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
Indicator condition (IC)-guided HIV testing, i.e., testing when diagnosing a condition associated with HIV, is a feasible and cost-effective testing strategy to identify undiagnosed individuals. Assessing determinants for IC-guided testing may identify opportunities for improvement. A survey study based on the Theory of Planned Behaviour (TPB) was conducted among 163 hospital physicians from five specialties in Amsterdam, the Netherlands. Structural equation models were used to determine the association between the TPB domains (i.e., attitude, belief, norms, self-efficacy and behavioural control) and (1) the intention to test as a mediator for HIV testing behaviour (intentional model) and (2) actual HIV testing behaviour (direct model). Both models accounted for the effect of guideline recommendations. Behaviour scored lower than intention on a five-point scale (mean score of 2.8, SD = 1.6 versus 3.8, SD = 1.1; p<0.0001). The direct model had a better fit than the intentional model based on fit statistics. Discrepancies between the determinants most important for intention versus those for behaviour led to the following recommendations: interventions to improve IC-guided testing in hospitals should primarily focus on implementation of guideline recommendations, followed by improving physicians' attitude towards IC-guided HIV testing and self-efficacy, as these were the most important correlates of actual HIV testing behaviour.
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Affiliation(s)
- Saskia Bogers
- Internal Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Infectious diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anders Boyd
- Infectious diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Maarten Schim van der Loeff
- Internal Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Infectious diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Geerlings
- Internal Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Infectious diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Lyon AR, Cook CR, Larson M, Hugh ML, Dopp A, Hamlin C, Reinke P, Bose M, Law A, Goosey R, Goerdt A, Morrell N, Wackerle-Hollman A, Pullmann MD. Protocol for a hybrid type 3 effectiveness-implementation trial of a pragmatic individual-level implementation strategy for supporting school-based prevention programming. Implement Sci 2024; 19:2. [PMID: 38167046 PMCID: PMC10763475 DOI: 10.1186/s13012-023-01330-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND For approximately one in five children who have social, emotional, and behavioral (SEB) challenges, accessible evidence-based prevention practices (EBPPs) are critical. In the USA, schools are the primary setting for children's SEB service delivery. Still, EBPPs are rarely adopted and implemented by front-line educators (e.g., teachers) with sufficient fidelity to see effects. Given that individual behavior change is ultimately required for successful implementation, focusing on individual-level processes holds promise as a parsimonious approach to enhance impact. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a pragmatic, multifaceted pre-implementation strategy targeting volitional and motivational mechanisms of educators' behavior change to enhance implementation and student SEB outcomes. This study protocol describes a hybrid type 3 effectiveness-implementation trial designed to evaluate the main effects, mediators, and moderators of the BASIS-T implementation strategy as applied to Positive Greetings at the Door, a universal school-based EBPP previously demonstrated to reduce student disruptive behavior and increase academic engagement. METHODS This project uses a blocked randomized cohort design with an active comparison control (ACC) condition. We will recruit and include approximately 276 teachers from 46 schools randomly assigned to BASIS-T or ACC conditions. Aim 1 will evaluate the main effects of BASIS-T on proximal implementation mechanisms (attitudes, subjective norms, self-efficacy, intentions to implement, and maintenance self-efficacy), implementation outcomes (adoption, reach, fidelity, and sustainment), and child outcomes (SEB, attendance, discipline, achievement). Aim 2 will examine how, for whom, under what conditions, and how efficiently BASIS-T works, specifically by testing whether the effects of BASIS-T on child outcomes are (a) mediated via its putative mechanisms of behavior change, (b) moderated by teacher factors or school contextual factors, and (c) cost-effective. DISCUSSION This study will provide a rigorous test of BASIS-T-a pragmatic, theory-driven, and generalizable implementation strategy designed to target theoretically-derived motivational mechanisms-to increase the yield of standard EBPP training and support strategies. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05989568. Registered on May 30, 2023.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Clayton R Cook
- Character Strong, 4227 S Meridian, Puyallup, WA, 98373, USA
| | | | - Maria L Hugh
- University of Kansas, 1122 W Campus Rd, Lawrence, KS, 66045, USA
| | - Alex Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 91604, USA
| | - Corinne Hamlin
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Peter Reinke
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Mahasweta Bose
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Amy Law
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
| | - Roger Goosey
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
| | - Annie Goerdt
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Nicole Morrell
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | | | - Michael D Pullmann
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
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Johnson E, Ghosh M, Daniels VJ, Wild TC, Campbell-Scherer D, Mellinger J, Winder GS, Fernandez AC, Kirkwood J, Tandon P. The development and evaluation of a provider-focused educational intervention about alcohol use disorder in patients with cirrhosis. CANADIAN LIVER JOURNAL 2023; 6:295-304. [PMID: 38020191 PMCID: PMC10652990 DOI: 10.3138/canlivj-2022-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 12/01/2023]
Abstract
Background Alcohol use disorder (AUD) is a leading cause of cirrhosis. Insufficient clinician knowledge and comfort managing AUD impacts access to treatment. Using Kern's Framework for Curriculum Development, we aimed to (i) develop and evaluate the effect of an "AUD in cirrhosis" educational intervention on clinicians' knowledge, attitudes, comfort, preparedness, and intention (practice habits) to integrate AUD management into their practice, and (ii) assess clinicians' motivation using Self Determination Theory. Methods Kern's approach was used for curriculum development. Pilot session feedback informed a three-part flipped-classroom series conducted by interdisciplinary clinicians in hepatology, psychiatry, primary care, and addiction psychology. Participants watched a video followed by a live session focused on (a) withdrawal, (b) screening and brief intervention, and (c) prescribing pharmacotherapy. Questionnaires assessing knowledge and practice habits were adapted from the literature. Attitudes were evaluated using the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Self Determination Theory informed motivation questions. Results Paired sample t-tests on pre-post questionnaires (n = 229 clinicians; 95 completed questionnaires) revealed significant improvements in preparedness and comfort screening, providing a brief intervention, prescribing pharmacotherapy, and SAAPPQ domains. No significant changes were observed in the intention to prescribe pharmacotherapy. Effect size analysis showed medium to large effects across most topic areas. Conclusions The developed sessions improved knowledge, attitudes, and practice habits of clinicians caring for this patient population. Given the rise in AUD and significant consequences in cirrhosis, this data offers promise that interactive education may improve practice habits of clinicians interfacing with this patient population.
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Affiliation(s)
- Emily Johnson
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Monty Ghosh
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Vijay John Daniels
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Denise Campbell-Scherer
- Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jessica Mellinger
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbour, Michigan, United States
| | - Gerald S Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States
| | - Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States
| | - Jessica Kirkwood
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
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Lin CY, Hou WL, Tseng YH, Lin ML, Griffiths MD. Validity, reliability, and cross-validation of a new questionnaire developed using the Theory of Planned Behavior: The Dating Violence Bystander Help-giving Intention Questionnaire (DVBHIQ). Heliyon 2023; 9:e19706. [PMID: 37809557 PMCID: PMC10558956 DOI: 10.1016/j.heliyon.2023.e19706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
The present study aimed to develop and psychometrically test a scale by using the Theory of Planned Behavior (TPB) comprising two types of measurement (direct and belief-based [indirect]) to assess bystander help-giving intention to victims of dating violence among youth. A two-phase, mixed-method design was adopted. The primary source of the samples was five universities, each in the northern, central, southern, eastern, and outer islands regions of Taiwan. Phase I involved developing an instrument based on the TPB (n = 10) and pilot testing (n = 220). Phase II conducted the psychometric evaluation (n = 622). The study used item analysis, explanatory factor analysis, confirmatory factor analysis, internal consistency, and cross-validation to examine the psychometric properties of the Dating Violence Bystander Help-giving Intention Questionnaire (DVBHIQ) with two types of measure (direct and belief-based). Explanatory factor analysis resulted in a four-factor solution (attitude/behavioral beliefs, subjective norms/normative beliefs, perceived behavioral control/control belief, and intention) of the direct and belief-based measures of the DVBHIQ, accounting for 72.67% and 76.62% of total variance respectively. Confirmatory factor analysis and cross-validation confirmed the proposed four-factor model and demonstrated good internal consistency reliability. The two types of DVBHIQ had good validity, reliability, and measurement invariance which may help address the core cognitive determinants for bystander help-giving intention. Healthcare providers (e.g., school nurses) could use the DVBHIQ to evaluate how bystander education programs affect youth and conduct related research in the future.
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Affiliation(s)
- Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Wen-Li Hou
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Ying-Hua Tseng
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Mei-Ling Lin
- Department of Nursing, College of Nursing, Hungkuang University, Taichung, 43304, Taiwan
| | - Mark D. Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
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Wemrell M, Tegel E, Öberg J, Ivert AK. Assessing the use of clinical guidelines against domestic violence in southern Sweden: A mixed-methods study. Scand J Caring Sci 2023; 37:828-841. [PMID: 37002636 DOI: 10.1111/scs.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/09/2023] [Accepted: 03/18/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND AND AIM Domestic violence is a prevalent public health issue. While clinical guidelines and care programs for its identification and handling have been formulated in all administrative regions of Sweden, their degree of implementation is largely unknown. This study aims to assess the implementation of one administrative region's care program, including how it is seen to align with and function in clinical practice, and any perceived barriers to or facilitators of its use. METHODS A survey was distributed to first-line managers for healthcare units with patient contact in the region (n = 807). The responses were analysed using descriptive statistics. Open responses were analysed thematically. Group interviews (n = 5) were held with caregivers (n = 15) working primarily with young patients and analysed thematically. RESULTS 73% of the survey respondents reported previous awareness of the care program, and 27% reported knowledge of its content. The extent to which their staff knew about and followed the care program was assessed to be relatively low. The survey response rate was 19%. Among interview participants, knowledge of the care program was generally quite low. Survey responses and interview discussions pointed to the importance of developing routines, of collegial and managerial support and of training on domestic violence and the care program. CONCLUSION This study indicates that the knowledge and use of the regional care program is limited among healthcare staff, including among those working with young patients. This underscores the importance of information and training for furthering the implementation of clinical guidelines on domestic violence.
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Affiliation(s)
- Maria Wemrell
- Department of Gender Studies, Faculty of Social Sciences, Lund University, Lund, Sweden
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Emma Tegel
- Department of Criminology, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Johan Öberg
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Health and Medical Care Management, Region Skåne, Malmö, Sweden
| | - Anna-Karin Ivert
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Criminology, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Hyzak KA, Bunger AC, Bogner J, Davis AK, Corrigan JD. Implementing traumatic brain injury screening in behavioral health treatment settings: results of an explanatory sequential mixed-methods investigation. Implement Sci 2023; 18:35. [PMID: 37587532 PMCID: PMC10428542 DOI: 10.1186/s13012-023-01289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a complex condition common among individuals treated in behavioral healthcare, but TBI screening has not been adopted in these settings which can affect optimal clinical decision-making. Integrating evidence-based practices that address complex health comorbidities into behavioral healthcare settings remains understudied in implementation science, limited by few studies using theory-driven hypotheses to disentangle relationships between proximal and medial indicators on distal implementation outcomes. Grounded in the Theory of Planned Behavior, we examined providers' attitudes, perceived behavioral control (PBC), subjective norms, and intentions to adopt The Ohio State University TBI Identification Method (OSU TBI-ID) in behavioral healthcare settings. METHODS We used an explanatory sequential mixed-methods design. In Phase I, 215 providers from 25 organizations in the USA completed training introducing the OSU TBI-ID, followed by a survey assessing attitudes, PBC, norms, and intentions to screen for TBI. After 1 month, providers completed another survey assessing the number of TBI screens conducted. Data were analyzed using structural equation modeling (SEM) with logistic regressions. In Phase II, 20 providers were purposively selected for semi-structured interviews to expand on SEM results. Qualitative data were analyzed using thematic analysis, integrated with quantitative results, and combined into joint displays. RESULTS Only 25% (55/215) of providers adopted TBI screening, which was driven by motivations to trial the intervention. Providers who reported more favorable attitudes (OR: 0.67, p < .001) and greater subjective norms (OR: 0.12, p < .001) toward TBI screening demonstrated increased odds of intention to screen, which resulted in greater TBI screening adoption (OR: 0.30; p < .01). PBC did not affect intentions or adoption. Providers explained that although TBI screening can improve diagnostic and clinical decision-making, they discussed that additional training, leadership engagement, and state-level mandates are needed to increase the widespread, systematic uptake of TBI screening. CONCLUSIONS This study advances implementation science by using theory-driven hypothesis testing to disentangle proximal and medial indicators at the provider level on TBI screening adoption. Our mixed-methods approach added in-depth contextualization and illuminated additional multilevel determinants affecting intervention adoption, which guides a more precise selection of implementation strategies.
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Affiliation(s)
- Kathryn A Hyzak
- Department of Physical Medicine and Rehabilitation, The Ohio State University College of Medicine, Columbus, OH, 43210-1234, USA.
| | - Alicia C Bunger
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University College of Medicine, Columbus, OH, 43210-1234, USA
| | - Alan K Davis
- College of Social Work, The Ohio State University, Columbus, OH, USA
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University Baltimore, Baltimore, MD, USA
- Department of Psychiatry, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University College of Medicine, Columbus, OH, 43210-1234, USA
- Ohio Valley Center for Brain Injury Prevention and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Rammou A, Berry C, Fowler D, Hayward M. "Attitudes to voices": a survey exploring the factors influencing clinicians' intention to assess distressing voices and attitudes towards working with young people who hear voices. Front Psychol 2023; 14:1167869. [PMID: 37287782 PMCID: PMC10242135 DOI: 10.3389/fpsyg.2023.1167869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/28/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Due to the general psychopathological vulnerability of young people who hear distressing voices, research has stressed the importance for clinicians to assess this experience in youth. Nonetheless, the limited literature on the topic comes from studies with clinicians in adult health services and it primarily reports that clinicians do not feel confident in systematically assessing voice-hearing and doubt the appropriateness of doing so. We applied the Theory of Planned Behavior and identified clinicians' job attitudes, perceived behavioral control, and perceived subjective norms as putative predictors of their intent to assess voice-hearing in youth. Method Nine hundred and ninety-six clinicians from adult mental health services, 467 from Child and Adolescent Mental Health (CAMHS) and Early Intervention in Psychosis (EIP) services and 318 primary care clinicians across the UK completed an online survey. The survey gathered data on attitudes toward working with people who hear voices, stigmatizing beliefs, and self-perceived confidence in voice-related practices (screening for, discussing and providing psychoeducation material about voice-hearing). Responses from youth mental health clinicians were compared with professionals working in adult mental health and primary care settings. This study also aimed to identify what youth mental health clinicians believe about assessing distressing voices in adolescents and how beliefs predict assessment intention. Results Compared to other clinicians, EIP clinicians reported the most positive job attitudes toward working with young voice-hearers, the highest self-efficacy in voice-hearing practices, and similar levels of stigma. Job attitudes, perceived behavioral control and subjective norms explained a large part of the influences on clinician's intention to assess voice-hearing across all service groups. In both CAMHS and EIP services, specific beliefs relating to the usefulness of assessing voice-hearing, and perceived social pressure from specialist mental health professionals regarding assessment practices predicted clinician intention. Discussion Clinicians' intention to assess distressing voices in young people was moderately high, with attitudes, subjective norms and perceived behavioral control explaining a large part of its variance. Specifically in youth mental health services, promoting a working culture that encourages opening and engaging in discussions about voice-hearing between clinicians, and with young people, and introducing supportive assessment and psychoeducation material about voice-hearing could encourage conversations about voices.
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Affiliation(s)
- Aikaterini Rammou
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, United Kingdom
| | - Clio Berry
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, United Kingdom
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, United Kingdom
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, United Kingdom
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Cormican A, Hirani SP, McKeown E. Healthcare professionals' perceived barriers and facilitators of implementing clinical practice guidelines for stroke rehabilitation: A systematic review. Clin Rehabil 2023; 37:701-712. [PMID: 36475911 PMCID: PMC10041573 DOI: 10.1177/02692155221141036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify healthcare professionals' perceived barriers and facilitators to clinical practice guideline implementation within stroke rehabilitation. DATA SOURCES CINAHL, MEDLINE, EMBASE, AMED, Cochrane library, Academic Search Complete and Scopus. Additional papers were identified through hand searching. REVIEW METHODS The review followed the Preferred Reporting Item for Systematic Reviews and Meta-Analysis Protocols systematic review approach. Any empirical research that provided qualitative data on healthcare professionals' perceived factors influencing clinical guideline implementation in stroke rehabilitation was included. One reviewer screened all titles and abstract reviews (n = 669). Another two reviewers independently screened 30% of title and abstract reviews, followed by full-text reviews (n = 61). Study quality was assessed using the mixed-method appraisal tool. RESULTS Data from 10 qualitative, six quantitative and six mixed-method studies published between 2000 and 2022, involving 1576 participants in total, were analysed and synthesised using modified thematic synthesis approach. The majority of participants were therapists n = 1297 (occupational therapists, physiotherapists, speech and language therapists). Organisational factors (time constraints, resources) alongside healthcare professionals' lack of knowledge and skills were the most cited barriers to guideline implementation. Contradictory attitudes and beliefs towards stroke guidelines applicability to real-life clinical practice and their evidence base were reported. Organisational support in the form of training, local protocols, performance monitoring and leadership were reported as perceived facilitators. CONCLUSION Barriers and facilitators are multifactorial and were identified at guideline, individual, team and organisational levels. There is a need to translate perceived barriers and facilitators into implementation interventions especially addressing organisational-level barriers.
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Affiliation(s)
| | | | - Eamonn McKeown
- Health Services Research & Management Division, School of Health Sciences City, University of London, London, UK
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11
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Zhang Y, Cook CR, Azad GF, Larson M, Merle JL, Thayer J, Pauls A, Lyon AR. A Pre-Implementation Enhancement Strategy to Increase the Yield of Training and Consultation for School-Based Behavioral Preventive Practices: a Triple-Blind Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:552-566. [PMID: 36367633 PMCID: PMC10258873 DOI: 10.1007/s11121-022-01464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/13/2022]
Abstract
As the most common setting where youth access behavioral healthcare, the education sector frequently employs training and follow-up consultation as cornerstone implementation strategies to promote the implementation of evidence-based practices (EBPs). However, these strategies alone are not sufficient to promote desirable implementation (e.g., intervention fidelity) and youth behavioral outcomes (e.g., mitigated externalizing behaviors). Theory-informed pragmatic pre-implementation enhancement strategies (PIES) are needed to prevent the lackluster outcomes of training and consultation. Specifically, social cognitive theory explicates principles that inform the design of PIES content and specify mechanisms of behavior change (e.g., "intentions to implement" (ITI)) to target increasing providers' responsiveness to training and consultation. This triple-blind parallel randomized controlled trial preliminarily examined the efficacy of a pragmatic PIES based on social cognitive theories (SC-PIES) to improve implementation and youth behavioral outcomes from universal preventive EBPs in the education sector. Teachers from a diverse urban district were recruited and randomly assigned to the treatment (SC-PIES; ntreatment = 22) or active control condition (administrative meeting; ncontrol = 21). Based on the condition assigned, teachers received the SC-PIES or met with administrators before their EBP training. We assessed teachers' ITI, intervention fidelity, and youth behavioral outcome (academic engagement as an incompatible behavior to externalizing disorders) at baseline, immediately after training, and 6 weeks afterward. A series of ANCOVAs detected sizeable effects of SC-PIES, where teachers who received SC-PIES demonstrated significantly larger improvement in their ITI, intervention fidelity, and youth behaviors as compared to the control. Conditional analyses indicated that teachers' ITI partially mediated the effect of SC-PIES on intervention fidelity, which in turn led to improved youth behaviors. Findings suggest that theory-informed pragmatic PIES targeting providers' ITI can boost their responsiveness to implementation strategies, as reflected in improved implementation behaviors and youth behavioral outcomes. The results have implications for targeting motivational mechanisms of behavior change and situating preventive implementation strategies at the intersection between the preparation and active implementation stages of an implementation process. Limitations and implications for research and practice are discussed. Clinicaltrials.gov: NCT05240222. Registered on: 2/14/2022. Retrospectively registered. https://clinicaltrials.gov/show/NCT05240222.
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Affiliation(s)
- Yanchen Zhang
- Department of Psychological & Quantitative Foundations, University of Iowa, 361 Lindquist Center, Iowa City, IA, 52242, USA.
| | - Clayton R Cook
- Department of Educational Psychology, University of Minnesota, 341 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Gazi F Azad
- Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Madeline Larson
- Center for Applied Research and Educational Improvement, University of Minnesota, 1954 Buford Ave, Suite 425, St. Paul, MN, 55108, USA
| | - James L Merle
- Department of Population Health Sciences, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Jordan Thayer
- Department of Educational Psychology, University of Minnesota, 341 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Alex Pauls
- Department of Psychological & Quantitative Foundations, University of Iowa, 361 Lindquist Center, Iowa City, IA, 52242, USA
| | - Aaron R Lyon
- Department of Psychiatry & Behavioral Sciences, University of Washington, Box 354920, 6200 NE 74Th Street, Suite 110, Seattle, WA, 98115, USA
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12
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Roudbarani F, Tablon Modica P, Maddox BB, Bohr Y, Weiss JA. Clinician factors related to the delivery of psychotherapy for autistic youth and youth with attention-deficit hyperactivity disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:415-427. [PMID: 35786029 DOI: 10.1177/13623613221106400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT Autistic children and youth often experience mental health problems, such as anxiety, depression and behavioural challenges. Although there are therapy programmes that have been found helpful in reducing these issues, such as cognitive behaviour therapy, autistic children often struggle to receive adequate mental health care. Clinicians' knowledge, attitudes, confidence and beliefs about treating mental health problems in autistic people may be related to their choices in providing psychotherapy. Across Ontario, Canada, 611 mental health clinicians, working in publicly funded agencies, completed an online survey about their experiences and opinions on delivering therapy for autistic clients compared to those with attention-deficit hyperactivity disorder. Clinician knowledge was associated with their intention to treat autistic clients or clients with attention-deficit hyperactivity disorder, partly because of their attitudes and the social pressures or values they felt. Clinicians reported feeling less intent on providing therapy to autistic youth compared to youth with attention-deficit hyperactivity disorder because of differences in their attitudes, social pressures and knowledge. This research can inform the training and educational initiatives for mental health practitioners.
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13
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Rad D, Redeș A, Roman A, Egerău A, Lile R, Demeter E, Dughi T, Ignat S, Balaș E, Maier R, Kiss C, Mărineanu V, Bocoș M, Bâtcă-Dumitru GC, Cuc LD, Vancu G, Rad G, Chiș R. The use of theory of planned behavior to systemically study the integrative-qualitative intentional behavior in Romanian preschool education with network analysis. Front Psychol 2023; 13:1017011. [PMID: 36698596 PMCID: PMC9869162 DOI: 10.3389/fpsyg.2022.1017011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
Predicting preschool teachers' intention to adopt qualitative and inclusive early childhood intentional behaviors represents an important research field. The objective of this research is first to develop and validate a scale to assess the integrative-qualitative intentional behavior (IQIB-ECEC) of preschool teachers in order to achieve SDG4.2's objective of ensuring that all children have access to high-quality pre-primary education and then to systemically analyze the relationship between variables with Network Analysis. The theory of planned behavior (TPB) describes key individual beliefs (attitudes, subjective norms, and perceived behavior control) that affect people's intentions to engage in a certain conduct and has previously been used with success in evaluating people's intentions to adopt a certain behavior. This research represents one of the first Romanian attempts to use the theory of planned behavior to study the Integrative-Qualitative Intentional Behavior in Romanian Preschool Education and systemically analyze results with Network Analysis approach. This study used a randomized 300 Romanian preschool teachers enrolled in a National Training Program entitled Qualitative and Inclusive Early Childhood Education managed by the Romanian Educational Ministry. Data were collected via an online questionnaire. The scale validation followed a confirmatory factor analysis (CFA). The fitting of the IQIB-ECEC 19-item scale showed that all coefficients CFI (0.942), TLI (0.920), SRMR (0.0452), and RMSEA (0.0451) bring strong evidence in the favor of the statistical validity of the scale. The final IQIB-ECEC 19 items and 8 factors scale obtained a Cronbach's alpha of 0.77. The systemic Network Analysis approach was used in interpreting data. The centrality of the network model was further investigated and the clustering coefficients index were calculated. According to the results, perceived power/control beliefs and behavioral intention were detected as the most important dimensions, whereas behavioral beliefs were less important. These findings were discussed in terms of their theoretical and practical significance.
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Affiliation(s)
- Dana Rad
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania,Academia Oamenilor de Știință din Romania, Bucharest, Romania,*Correspondence: Dana Rad,
| | - Adela Redeș
- Academia Oamenilor de Știință din Romania, Bucharest, Romania,Adela Redeș,
| | - Alina Roman
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania,Academia Oamenilor de Știință din Romania, Bucharest, Romania,Alina Roman,
| | - Anca Egerău
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania,Academia Oamenilor de Știință din Romania, Bucharest, Romania
| | - Raul Lile
- Academia Oamenilor de Știință din Romania, Bucharest, Romania
| | - Edgar Demeter
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania,Academia Oamenilor de Știință din Romania, Bucharest, Romania
| | - Tiberiu Dughi
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania,Academia Oamenilor de Știință din Romania, Bucharest, Romania
| | - Sonia Ignat
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania,Academia Oamenilor de Știință din Romania, Bucharest, Romania
| | - Evelina Balaș
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania,Academia Oamenilor de Știință din Romania, Bucharest, Romania
| | - Roxana Maier
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania,Academia Oamenilor de Știință din Romania, Bucharest, Romania
| | - Csaba Kiss
- Academia Oamenilor de Știință din Romania, Bucharest, Romania,Faculty of Psychology and Educational Sciences, Hyperion University of Bucharest, Bucharest, Romania
| | - Vasile Mărineanu
- Academia Oamenilor de Știință din Romania, Bucharest, Romania,Department of Psychology, University of Bucharest, Bucharest, Romania
| | - Mușata Bocoș
- Faculty of Psychology and Educational Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania,Mușata Bocoș,
| | - Graziella Corina Bâtcă-Dumitru
- Faculty of Accounting and Management Informatics, Department of Accounting and Audit, Bucharest University of Economic Studies, Bucharest, Romania
| | | | - Gabriela Vancu
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania
| | - Gavril Rad
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania,Academia Oamenilor de Știință din Romania, Bucharest, Romania
| | - Roxana Chiș
- Faculty of Educational Sciences, Psychology and Social Sciences, Center of Research Development and Innovation in Psychology, Aurel Vlaicu University of Arad, Arad, Romania,Academia Oamenilor de Știință din Romania, Bucharest, Romania
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Implementing an Evidence-Based Feeding Protocol: Impact on Nurses' Knowledge, Perceptions, and Feeding Culture in the NICU. Adv Neonatal Care 2022; 22:493-502. [PMID: 34596085 DOI: 10.1097/anc.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Evidence-based feeding practices are often variable among neonatal providers due to lack of knowledge and neonatal intensive care unit (NICU) feeding culture norms. PURPOSE To evaluate changes in NICU nurses' knowledge, perceptions, feeding practices and culture following education about, and implementation of, an evidence-based Infant-Driven Feeding (IDF) protocol. METHODS A pre-/postprospective comparative design was used to survey 120 registered nurses employed in a level 3 NICU about feeding practices, knowledge, and culture prior to IDF education and 1 to 2 months after IDF implementation. RESULTS The preeducation survey yielded 59 respondents; of these, 30 responded to the same survey after IDF implementation. Postimplementation responses were significant for fewer nurses making decisions to begin oral feedings ( P = .035), greater use of gestational age to increase frequency of oral feeding attempts ( P = .03), less reliance on weight loss to decrease oral feeding attempts ( P = .018), an increase in use of combination interventions to prepare infants for oral feeding ( P = .001), and greater willingness to allow a rest period or stop the feeding if an infant falls asleep after completing 70% of the feeding ( P = .03). IMPLICATIONS FOR PRACTICE AND RESEARCH Trends in several survey categories following the education program and implementation of IDF support the use of evidence-based practices (EBPs) such as IDF. Future research focused on nurses' perceptions of how education influences integration of specific EBPs into practice is needed. Evaluating EBP mentorship combined with education about EBPs can provide insights on how best to integrate EBPs into practice.
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Zhang X, Wang L. Factors Contributing to Citizens' Participation in COVID-19 Prevention and Control in China: An Integrated Model Based on Theory of Planned Behavior, Norm Activation Model, and Political Opportunity Structure Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15794. [PMID: 36497869 PMCID: PMC9739160 DOI: 10.3390/ijerph192315794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Chinese citizens' participation in COVID-19 prevention and control has made great contributions to the successful fight against the pandemic. The factors that have impacted citizens' participation have rarely been reported based on both social-psychological and political environmental theories. This paper presented a study to explore the determinants of Chinese citizens' participation in COVID-19 prevention and control based on a combined model of the theory of planned behavior, the norm activation model, and political opportunity structure theory. A dataset involving 463 respondents from Harbin in northeast China was acquired and analyzed. The results showed that the comprehensive model explained 62.9% of the total variance in citizens' participation behavior. The openness to public participation not only significantly directly influenced citizens' participation but also indirectly affected participation behaviors through attitude and perceived behavioral control, both of which were important mediators and had the greatest overall impacts. The awareness of consequences and subjective norms were crucial antecedents to the activation of other influencing factors. Personal norms indirectly affected participation behavior through the mediation of attitude. The empirical results showed the comprehensiveness, effectiveness, and high explanatory power of the postulated model. The study also provides both new theoretical perspectives for explaining public participation and useful practical implications for future policy development in promoting citizens' participation in public health emergency management.
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Affiliation(s)
- Xiaojie Zhang
- Department of Public Administration, School of Humanities & Law, Northeastern University, Shenyang 110169, China
| | - Lili Wang
- Party School of Weihai Municipal Committee of Communist Party of China, Weihai 264213, China
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16
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Idris AM, Crutzen R, Van Den Borne HW. Psychosocial beliefs of health providers' intention and behavior of offering HIV testing and counseling services: Estimating their relevance for intervention. Front Public Health 2022; 10:796035. [PMID: 36339151 PMCID: PMC9626800 DOI: 10.3389/fpubh.2022.796035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/21/2022] [Indexed: 01/21/2023] Open
Abstract
Background Diagnosis of people with HIV is vital in achieving the 95-95-95 global targets. The proportion of people with HIV who know they have HIV in Sudan is low. Promoting engagement of healthcare providers (HCPs) in offering HIV Testing and Counseling (HTC) services would improve the percentage of diagnosed people with HIV in the country. This study aims to assess the psychosocial beliefs associated with HCPs' intention and behavior to offer HTC services and their relevance for intervention. Methods This institutional cross-sectional study was conducted in Kassala State, from July 2019 to February 2020, among 438 healthcare providers from public health facilities. A self-administered questionnaire was used to assess behavior and intention to offer HTC services and related behavioral, normative, and control beliefs. Data were analyzed using R software. Confidence Interval Based Estimation of Relevance (CIBER) was used to estimate the relevance of the beliefs to interventions. Results The CIBER analysis showed that the belief "It causes many worries for patients if I offer or counsel them about HIV test" was negatively associated with HCPs' intention and behavior to offer HTC services and a highly relevant belief for intervention. The belief "My manager thinks I should offer or counsel patients about HIV test" was positively associated with the behavior and intention to offer HTC services and was a relatively highly relevant belief. The control belief "Patients are at low risk of HIV and do not need offering or counseling about HIV test" was negatively associated with HCPs' intention and behavior and was relevant for intervention. The control belief "If I offered or counseled patients about HIV test, I would spend more time with them" was negatively associated with the intention and behavior of HCPs toward HTC services, with high relevance to target with intervention. The belief "My colleagues think I should offer or counsel patients about HIV test" was weakly associated with behavior and intention, and it is a low relevant belief for intervention. Conclusion Different psychosocial beliefs among healthcare providers can influence their intention and behavior to offer HTC services to patients. More relevant beliefs are required to be targeted with interventions to promote the intention and behavior of providing HTC services among health care providers.
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Affiliation(s)
- Almutaz Mohammed Idris
- College of Applied Medical Sciences, Buraydah Colleges, Buraydah, Saudi Arabia,Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, Netherlands,*Correspondence: Almutaz Mohammed Idris
| | - Rik Crutzen
- College of Applied Medical Sciences, Buraydah Colleges, Buraydah, Saudi Arabia
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Coach Education Improves Adherence to Anterior Cruciate Ligament Injury Prevention Programs: A Cluster-Randomized Controlled Trial. Clin J Sport Med 2022; 32:348-354. [PMID: 34009795 DOI: 10.1097/jsm.0000000000000936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of an educational workshop on adherence to neuromuscular training (NMT) among high-school coaches. DESIGN Cluster-randomized controlled trial. SETTING High school. PARTICIPANTS A total of 21 teams in 8 high schools (unit of randomization) were randomized to the intervention or control group. Twelve boys' and 9 girls' teams in a variety of sports were enrolled. INTERVENTION Coaches in the intervention group participated in a 60-minute education workshop to teach effective implementation of a NMT program and also received print materials. Coaches in the control group received the same print materials. MAIN OUTCOME MEASURES Eight data collectors were trained to observe each team's practice/game 2 to 3 times a week. They completed a study questionnaire to identify the NMT exercise and whether the coach (1) delivered exercise instructions and (2) provided alignment cues (both yes/no). RESULTS A total of 399 practices/games were observed over 2 seasons. A greater proportion of coaches in the intervention group provided alignment cues to correct improper technique compared with the control group {difference = 0.04 [95% confidence interval (CI), 0.01-0.07], P = 0.006}. There was a similar proportion of coaches in the intervention and control groups who provided exercise instructions [difference = 0.01 (95% CI, -0.02 to 0.04), P = 0.44]. More coaches in the intervention group completed a full NMT program [OR = 4.62 (1.22, 17.50), P = 0.02]. CONCLUSIONS Coach education can improve adherence to a NMT program and delivery of alignment cues. Coaches should receive in-person training on NMT and how to deliver alignment cues to their athletes while performing the exercises.
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Lu Y, Liu C, Fawkes S, Wang Z, Yu D. Perceived extrinsic barriers hinder community detection and management of mild cognitive impairment: a cross-sectional study of general practitioners in Shanghai, China. BMC Geriatr 2022; 22:497. [PMID: 35681136 PMCID: PMC9185915 DOI: 10.1186/s12877-022-03175-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background General practitioners (GPs) play a critical role in community detection and management of mild cognitive impairment (MCI). Although adequate knowledge is essential, healthcare practice is shaped by intrinsic and extrinsic factors. This study aimed to test the mediating effect of perceived extrinsic barriers on the associations between knowledge, attitudes, and intended practice of GPs in community detection and management of MCI. Methods A cross-sectional study was conducted through an online survey of 1253 GPs sampled from 56 community health centres (CHCs) in Shanghai in 2021. Perceived extrinsic barriers were rated on a five-point Likert scale for patient engagement, working environment, and system context, respectively. A summed score was generated subsequently for each domain ranging from 0 to 100, with a higher score indicating higher barriers. The mediating effect of perceived extrinsic barriers (second-order) and the moderation effect of training on the association between MCI knowledge and practice scores, as well as the moderation effect of past experience on the association between MCI knowledge and extrinsic barriers, were tested through structural equation modelling (SEM) with a partial least square (PLS) approach. Results The study participants reported an average barrier score of 65.23 (SD = 13.98), 58.34 (SD = 16.95), and 60.37 (SD = 16.99) for patient engagement, working environment, and system context, respectively. Although knowledge had both direct and indirect (through attitudes) effects on intended practice, perceived extrinsic barriers negatively mediated (β = − 0.012, p = 0.025) the association between knowledge and practice. Training moderated the effect of knowledge on practice (β = − 0.066, p = 0.014). Conclusions Perceived extrinsic barriers have a detrimental effect on the translation of knowledge into practice for community detection and management of MCI. The effect of training on practice declines when knowledge scores become higher. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03175-4.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China.,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.,Tongji University School of Medicine, Shanghai, 200092, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Sally Fawkes
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China. .,Tongji University School of Medicine, Shanghai, 200092, China. .,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.
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Wright-Hughes A, Willis TA, Wilson S, Weller A, Lorencatto F, Althaf M, Seymour V, Farrin AJ, Francis J, Brehaut J, Ivers N, Alderson SL, Brown BC, Feltbower RG, Gale CP, Stanworth SJ, Hartley S, Colquhoun H, Presseau J, Walwyn R, Foy R. A randomised fractional factorial screening experiment to predict effective features of audit and feedback. Implement Sci 2022; 17:34. [PMID: 35619097 PMCID: PMC9137082 DOI: 10.1186/s13012-022-01208-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/29/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Audit and feedback aims to improve patient care by comparing healthcare performance against explicit standards. It is used to monitor and improve patient care, including through National Clinical Audit (NCA) programmes in the UK. Variability in effectiveness of audit and feedback is attributed to intervention design; separate randomised trials to address multiple questions about how to optimise effectiveness would be inefficient. We evaluated different feedback modifications to identify leading candidates for further "real-world" evaluation. METHODS Using an online fractional factorial screening experiment, we randomised recipients of feedback from five UK NCAs to different combinations of six feedback modifications applied within an audit report excerpt: use effective comparators, provide multimodal feedback, recommend specific actions, provide optional detail, incorporate the patient voice, and minimise cognitive load. Outcomes, assessed immediately after exposure to the online modifications, included intention to enact audit standards (primary outcome, ranked on a scale of -3 to +3, tailored to the NCA), comprehension, user experience, and engagement. RESULTS We randomised 1241 participants (clinicians, managers, and audit staff) between April and October 2019. Inappropriate repeated participant completion occurred; we conservatively excluded participant entries during the relevant period, leaving a primary analysis population of 638 (51.4%) participants. None of the six feedback modifications had an independent effect on intention across the five NCAs. We observed both synergistic and antagonistic effects across outcomes when modifications were combined; the specific NCA and whether recipients had a clinical role had dominant influences on outcome, and there was an antagonistic interaction between multimodal feedback and optional detail. Among clinical participants, predicted intention ranged from 1.22 (95% confidence interval 0.72, 1.72) for the least effective combination in which multimodal feedback, optional detail, and reduced cognitive load were applied within the audit report, up to 2.40 (95% CI 1.88, 2.93) for the most effective combination including multimodal feedback, specific actions, patient voice, and reduced cognitive load. CONCLUSION Potentially important synergistic and antagonistic effects were identified across combinations of feedback modifications, audit programmes, and recipients, suggesting that feedback designers must explicitly consider how different features of feedback may interact to achieve (or undermine) the desired effects. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number: ISRCTN41584028.
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Affiliation(s)
| | - Thomas A Willis
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stephanie Wilson
- Centre for Human-Computer Interaction Design, City, University of London, London, UK
| | - Ana Weller
- Centre for Human-Computer Interaction Design, City, University of London, London, UK
| | | | - Mohamed Althaf
- Centre for Human-Computer Interaction Design, City, University of London, London, UK
| | - Valentine Seymour
- Centre for Human-Computer Interaction Design, City, University of London, London, UK
| | - Amanda J Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jillian Francis
- School of Health Sciences, University of Melbourne, Melbourne, Australia
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jamie Brehaut
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Womens College Hospital, University of Toronto, Toronto, Canada
| | - Sarah L Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Benjamin C Brown
- Centre for Health Informatics, University of Manchester, Manchester, UK
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Chris P Gale
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Simon J Stanworth
- Transfusion Medicine, NHS Blood and Transplant (NHSBT), Oxford, UK
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Suzanne Hartley
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Rebecca Walwyn
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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20
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Hu Z, Sun Y, Ma Y, Chen K, Lv L, Wang L, He Y. Examining Primary Care Physicians' Intention to Perform Cervical Cancer Screening Services Using a Theory of Planned Behavior: A Structural Equation Modeling Approach. Front Public Health 2022; 10:893673. [PMID: 35685761 PMCID: PMC9171050 DOI: 10.3389/fpubh.2022.893673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPromoting cervical cancer screening (CCS) is undoubtedly effective in combating severe public health problems in developing countries, but there are challenges to its implementation. Understanding the factors influencing primary care physicians' intentions to provide CCSs to rural women is crucial for the future implementation of screening programs. The aim of this study was to assess the intentions of primary care physicians to provide cervical cancer screening services (CCSSs) to rural women and their determinants.MethodsThis cross-sectional study included 1,308 primary care physicians in rural primary health care, and the data collection tool was developed based on the theory of planned behavior (TPB), which included demographic characteristics, the basic constructs of TPB, and the degree of knowledge of CCSSs as an extended variable of the TPB model. Structural equation modeling was used to analyze the relationships between each factor.ResultsPathway analysis found that TPB is an appropriate theoretical basis for predicting primary care physicians' intent to provide CCSSs (χ2/df = 2.234 < 3, RMSEA = 0.035, and SRMR = 0.034). Meanwhile, the structural equation model showed that attitude (β = 0.251, p < 0.001), subjective norm (β = 0.311, p < 0.001), perceived behavioral control (β = 0.162, p < 0.001), and knowledge level (β = 0.152, p < 0.01) positively predicted primary care physicians' intention to provide CCSSs.ConclusionsTPB model, with the addition of knowledge, was useful in predicting primary care physicians' intention to provide CCSSs for rural Chinese women. The findings of this study provide a reference for the government and hospitals to develop strategies to improve the intent of primary care physicians to provide CCSSs.
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Affiliation(s)
- Zhiqing Hu
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
| | - Yanjun Sun
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
| | - Yuhao Ma
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
| | - Kejin Chen
- Department of Women's Healthcare, Changzhou Maternal and Child Health Care Centre, Changzhou, China
| | - Ling Lv
- Department of Women's Healthcare, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Lingling Wang
- Department of Psychology, Kangning Hospital, Rushan, China
| | - Yuan He
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
- Research Center for Social Risk Management of Major Public Health Events (Key Research Base of Philosophy and Social Sciences of Universities in Jiangsu), Nanjing Medical University, Nanjing, China
- *Correspondence: Yuan He
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21
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do Prado T, Parsons J, Ripat J. Evidence-Based Practice for Non-Specific Low Back Pain: Canadian Physiotherapists' Adherence, Beliefs, and Perspectives. Physiother Can 2022; 74:44-53. [PMID: 35185247 PMCID: PMC8816363 DOI: 10.3138/ptc-2020-0038] [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: 04/20/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 01/03/2023]
Abstract
Purpose: Physiotherapists are key providers of care for patients with low back pain (LBP); however, information on Canadian physiotherapists' use of evidence-based clinical practice guidelines (EBCPGs) for LBP is lacking. We aimed to (1) describe Canadian physiotherapists' adherence to EBCPGs for LBP; (2) compare beliefs and attitudes of physiotherapists with higher and lower adherence; (3) identify predictors of adherence; and (4) gather physiotherapists' perceptions about the care provided to patients with LBP. Method: This mixed methods study involved two phases: (1) a survey containing a LBP clinical scenario and (2) qualitative semi-structured interviews with physiotherapists. Results: A total of 406 (77%) of the 525 survey respondents demonstrated higher adherence (score of 3 or 4) to EBCPGs; however, only 29.5% chose interventions to address psychosocial issues. Postgraduate training was the strongest predictor of higher adherence. Interviewed physiotherapists reported being highly satisfied with the care provided to patients with LBP even when psychosocial issues are present, despite low confidence in addressing those issues. Conclusions: Although overall adherence was high, Canadian physiotherapists do not frequently address psychosocial issues with LBP patients, and often do not feel confident or competent in that aspect of practice. This suggests an opportunity for developing additional training for addressing psychosocial issues in LBP patients.
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Affiliation(s)
- Tamires do Prado
- College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joanne Parsons
- Department of Physical Therapy, University of Manitoba, Winnipeg, Manitoba, Canada, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacquie Ripat
- Department of Occupational Therapy, University of Manitoba, Winnipeg, Manitoba, Canada, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, Centre on Aging, University of Manitoba, Winnipeg, Manitoba, Canada, Manitoba Centre for Nursing and Health Research, University of Manitoba, Winnipeg, Manitoba, Canada
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22
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Theuns-Boumans L, Mathijssen J, Rots-de Vries C, van de Goor I. Survey of intention among public health nurses in providing solution-focused parenting support. Public Health Nurs 2021; 39:643-651. [PMID: 34897767 PMCID: PMC9300147 DOI: 10.1111/phn.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 12/03/2022]
Abstract
Objective Parenting support has shifted from a problem‐focused to a strengths‐based solution‐focused approach. This study surveyed public health nurses to explain their intention to provide solution‐focused parenting support in their practice. Design The design of this study was cross‐sectional. Sample The initial sample included 781 public health nurses who were employed with various youth healthcare organizations in the Netherlands. Measurements Based on the Theory of Planned Behavior, a questionnaire was developed and administered to measure (a) behavioral, normative, and control beliefs, (b) attitudes, subjective norm, and perceived behavioral control, and (c) intention. The data were subjected to structural equation modeling. Results A total of 449 (57.5%) public health nurses completed questionnaires. Associations as indicated by the Theory of Planned Behavior were confirmed with the exception of that between perceived behavioral control and intention. Statistically significant paths and correlations were added. The final model accounted for 53% of the variance in the intention to perform solution‐focused parenting support. Conclusions In this study, public health nurses strongly intended to provide solution‐focused parenting support, thus indicating their acceptance of the approach. Their intention was predominantly associated with subjective norm.
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Affiliation(s)
- Liesbeth Theuns-Boumans
- Department Tranzo, Academic Collaborative Centre Youth, Tilburg University, Tilburg, The Netherlands.,Avans University of Applied Sciences, Bachelor of Nursing, Breda, The Netherlands
| | - Jolanda Mathijssen
- Department Tranzo, Academic Collaborative Centre Youth, Tilburg University, Tilburg, The Netherlands
| | - Carin Rots-de Vries
- Department Tranzo, Tilburg University, Academic Collaborative Centre Public Health, Tilburg, The Netherlands
| | - Ien van de Goor
- Department Tranzo, Tilburg University, Academic Collaborative Centre Public Health, Tilburg, The Netherlands
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23
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Munk K, Rosenblum R, Blackburn S, Donahue E. The Impact of Education and Implementation Tools on Pre-Service Teachers' Attitudes About Classroom-Based Mindfulness. J Sch Nurs 2021; 38:547-557. [PMID: 34792417 DOI: 10.1177/10598405211059189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A growing body of research suggests that incorporating classroom-based mindfulness interventions in elementary schools can lead to improvements in student behavior, self-regulation, and measures of mental health and wellness. This quality improvement project explored the impact of an educational intervention on pre-service teachers' perceptions, attitudes, and intentions to implement mindfulness interventions in their classrooms. A brief educational intervention and website resource were provided to multidisciplinary teaching credential students. Participants completed a pre- and post-intervention survey to evaluate their intentions to implement mindfulness practices, as well as their perceptions about the acceptability, reasonableness, and effectiveness of incorporating mindfulness interventions in the classroom. Significant differences in pre- to post-intervention survey scores indicate that exposure to mindfulness concepts, practices, and resources may increase the willingness of pre-service teachers to adopt these practices in their classrooms.
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Affiliation(s)
- Kirsten Munk
- Department of Nursing, 300424California State University, Northern California Consortium, Fresno and San Jose, CA, USA.,School of Nursing, 300424California State University, Sacramento, CA, USA
| | - Ruth Rosenblum
- Department of Nursing, 300424California State University, Northern California Consortium, Fresno and San Jose, CA, USA.,The Valley Foundation School of Nursing, San Jose State University, 7161San Jose, CA, USA
| | - Samantha Blackburn
- School of Nursing, 300424California State University, Sacramento, CA, USA
| | - Eden Donahue
- School of Nursing, 300424California State University, Sacramento, CA, USA
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Abstract
The Theory of Planned Behavior was developed to explain human behaviors. The theory has been broadly applied to health-related behaviors in nursing science but has not been examined in depth based on a critical nursing framework. This article systematically analyzes and evaluates the theory based on Fawcett and DeSanto-Madeya's 2013 framework. The theory reflects nursing metaparadigm concepts and has both social and theoretical significance as well as pragmatic adequacy, and its testability is supported by abundant empirical evidence. However, the theory's internal consistency and clarity could be improved with use of consistent terms for its concepts and relationships.
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Affiliation(s)
- Sueyeon Lee
- Departments of Biobehavioral Nursing Science (Ms Lee) and Human Development Nursing Science (Dr Vincent), College of Nursing, University of Illinois at Chicago
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25
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Wykes TL, Worth AS, Richardson KA, Woods T, Longstreth M, McKibbin CL. Examining community mental health providers' delivery of structured weight loss intervention to youth with serious emotional disturbance: An application of the theory of planned behaviour. Health Expect 2021; 25:2056-2064. [PMID: 34585483 PMCID: PMC9615073 DOI: 10.1111/hex.13357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background Rates of overweight and obesity are disproportionately high among youth with serious emotional disturbance (SED). Little is known about community mental health providers' delivery of weight loss interventions to this vulnerable population. Objective This study examined attitudinal predictors of their providers' intentions to deliver weight loss interventions to youth with SED using the theory of planned behaviour. Design This study used a cross‐sectional, single‐time‐point design to examine the relationship of the theory of planned behaviour constructs with behavioural intention. Setting and Participants Community mental health providers (n = 101) serving youth with SED in the United States completed online clinical practice and theory of planned behaviour surveys. Main Variables Studied We examined the relationship of direct attitude constructs (i.e., attitude towards the behaviour, social norms and perceived behavioural control), role beliefs and moral norms with behavioural intention. Analyses included a confirmatory factor analysis and two‐step linear regression. Results The structure of the model and the reliability of the questionnaire were supported. Direct attitude constructs, role beliefs and moral norms predicted behavioural intention to deliver weight loss interventions. Discussion While there is debate about the usefulness of the theory of planned behaviour, our results showed that traditional and newer attitudinal constructs appear to influence provider intentions to deliver weight loss interventions to youth with SED. Findings suggest preliminary strategies to increase provider intentions. Public Contribution This study was designed and the results were interpreted as part of a larger, community‐based participatory research effort that included input from youth, families, providers, administrators and researchers. Collaborative discussions with community mental health providers and administrators particularly contributed to the study question asked as well as interpretation of results.
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Affiliation(s)
- Thomas L Wykes
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Andrea S Worth
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | | | - Tonja Woods
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
| | - Morgan Longstreth
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA
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26
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Medisauskaite A, Potts H, Gishen F, Alexander K, Sarker SJ, Griffin A. Cross-sectional exploration of the impact of the Dr Bawa-Garba case on doctors' professional behaviours and attitudes towards the regulator. BMJ Open 2021; 11:e045395. [PMID: 34408029 PMCID: PMC8375764 DOI: 10.1136/bmjopen-2020-045395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
OBJECTIVE This paper examines the impact on doctors' attitudes towards the General Medical Council (GMC) and on professional behaviours (reflective practice and raising concerns) following the Dr Bawa-Garba case. DESIGN A cross-sectional survey designed using the theoretical lens of the theory of planned behaviour (TPB) was administered from September 2017 to February 2019. By chance, this coincided with critical events in the Dr Bawa-Garba case. SETTING Primary and secondary care settings across a broad geographical spread in England. PARTICIPANTS 474 doctors. OUTCOME MEASURES Attitudes towards the GMC and two professional behaviours in TPB dimensions. RESULTS Attitudes towards the GMC became more negative during the period that the Medical Practitioners Tribunal Service and GMC suspended and subsequently erased Dr Bawa-Garba from the medical register. Specifically, confidence that doctors are well regulated by the GMC and that the GMC's disciplinary procedures produce fair outcomes was rated more negatively. After this period, overall attitudes start to recover and soon returned close to baseline; however, confidence in how the GMC regulates doctors and their disciplinary procedures improved but still remained below baseline. There was no change in doctors' attitudes or intention to reflect or raise concerns. CONCLUSIONS The lack of change in doctors' attitudes towards the GMC's guidance, the approachability of the regulator, defensive practice and professional behaviours as a response to the Dr Bawa-Garba case demonstrates the resilient and indelible nature of medical professionalism. At the time, professional bodies reported that repairing doctors' trust and confidence would take time and a significant effort to restore. However, this study suggests that attitudes are more fluid. Despite the high-profile nature of this case and concerns articulated by medical bodies regarding its impact on trust, the actual decline in doctors' overall attitudes towards the GMC was relatively short lived and had no measurable impact on professionalism.
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Affiliation(s)
- Asta Medisauskaite
- Research Department of Medical Education, University College London, London, UK
| | - Henry Potts
- UCL Institute of Health Informatics, University College London, London, UK
| | - Faye Gishen
- UCL Medical School, University College London, London, UK
| | - Kirsty Alexander
- Research Department of Medical Education, University College London, London, UK
| | - Shah-Jalal Sarker
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ann Griffin
- Research Department of Medical Education, University College London, London, UK
- UCL Medical School, University College London, London, UK
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A National Survey Identifying the Factors Associated With Cardiovascular Care Nurses' Perceived Knowledge of International Practice Guidelines: The First Step in the Development of an Implementation Strategy. J Cardiovasc Nurs 2021; 36:E1-E10. [PMID: 33833191 DOI: 10.1097/jcn.0000000000000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The implementation of international guidelines within everyday practice remains problematic, which can have a detrimental impact on quality of care delivered. This study aimed to ascertain the factors associated with clinical nurses' perceived knowledge of international guidelines. METHODS In this cross-sectional survey, nurses from 45 hospitals across Ireland were recruited. A previously validated anonymous questionnaire that assessed guideline knowledge, use, and barriers to implementation was used. Data were analyzed using SPSS 23 and logistic regression. RESULTS Of the 542 responses, 54% had used international guidelines relevant to their practice and 50% had consulted within the last year. Most nurses perceived that poor patient follow-up, lack of time and resources, poor clinical leadership, workload, long guidelines, and not understanding guideline detail were barriers to guideline use and implementation. Forty-five percent rated their perceived knowledge of guidelines as "low." Logistic regression identified that "high" knowledge levels were significantly associated with having read guidelines in the last year and their use with practice. In contrast, low knowledge of the guidelines was associated with perceptions that they were lengthy and not easy to use, lack of confidence to challenge colleagues when guidelines are not implemented, or not being able to influence current practice. CONCLUSIONS This study identified the specific knowledge needs in this cohort of mainly basic grade registered nurses, with low perceived guideline knowledge. A whole unit or team approach led by nurse champions is needed to develop and establish practice and educational strategies that would increase the availability, application, and knowledge of guidelines within everyday practice.
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28
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Suppan M, Abbas M, Catho G, Stuby L, Regard S, Achab S, Harbarth S, Suppan L. Impact of a Serious Game (Escape COVID-19) on the Intention to Change COVID-19 Control Practices Among Employees of Long-term Care Facilities: Web-Based Randomized Controlled Trial. J Med Internet Res 2021; 23:e27443. [PMID: 33685854 PMCID: PMC7996198 DOI: 10.2196/27443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/07/2021] [Accepted: 03/07/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Most residents of long-term care facilities (LTCFs) are at high risk of complications and death following SARS-CoV-2 infection. In these facilities, viral transmission can be facilitated by shortages of human and material resources, which can lead to suboptimal application of infection prevention and control (IPC) procedures. To improve the dissemination of COVID-19 IPC guidelines, we developed a serious game called "Escape COVID-19" using Nicholson's RECIPE for meaningful gamification, as engaging serious games have the potential to induce behavioral change. OBJECTIVE As the probability of executing an action is strongly linked to the intention of performing it, the objective of this study was to determine whether LTCF employees were willing to change their IPC practices after playing "Escape COVID-19." METHODS This was a web-based, triple-blind, randomized controlled trial, which took place between November 5 and December 4, 2020. The health authorities of Geneva, Switzerland, asked the managers of all LTCFs under their jurisdiction to forward information regarding the study to all their employees, regardless of professional status. Participants were unaware that they would be randomly allocated to one of two different study paths upon registration. In the control group, participants filled in a first questionnaire designed to gather demographic data and assess baseline knowledge before accessing regular online IPC guidelines. They then answered a second questionnaire, which assessed their willingness to change their IPC practices and identified the reasons underlying their decision. They were then granted access to the serious game. Conversely, the serious game group played "Escape COVID-19" after answering the first questionnaire but before answering the second one. This group accessed the control material after answering the second set of questions. There was no time limit. The primary outcome was the proportion of LTCF employees willing to change their IPC practices. Secondary outcomes included the factors underlying participants' decisions, the domains these changes would affect, changes in the use of protective equipment items, and attrition at each stage of the study. RESULTS A total of 295 answer sets were analyzed. Willingness to change behavior was higher in the serious game group (82% [119/145] versus 56% [84/150]; P<.001), with an odds ratio of 3.86 (95% CI 2.18-6.81; P<.001) after adjusting for professional category and baseline knowledge, using a mixed effects logistic regression model with LTCF as a random effect. For more than two-thirds (142/203) of the participants, the feeling of playing an important role against the epidemic was the most important factor explaining their willingness to change behavior. Most of the participants unwilling to change their behavior answered that they were already applying all the guidelines. CONCLUSIONS The serious game "Escape COVID-19" was more successful than standard IPC material in convincing LTCF employees to adopt COVID-19-safe IPC behavior. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/25595.
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Affiliation(s)
- Mélanie Suppan
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mohamed Abbas
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gaud Catho
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Simon Regard
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of the Surgeon General, Geneva Directorate of Health, Geneva, Switzerland
| | - Sophia Achab
- Specialized Facility in Behavioral Addictions ReConnecte, University of Geneva Hospitals, Geneva, Switzerland
- WHO Collaborating Center in Training and Research in Mental Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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29
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Babaier RS, Basudan SO. Do dentists practice what they know? A cross-sectional study on the agreement between dentists' knowledge and practice in restoring endodontically treated teeth. BMC Oral Health 2021; 21:110. [PMID: 33691705 PMCID: PMC7945671 DOI: 10.1186/s12903-021-01479-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/03/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There are very few studies comparing dentists' knowledge in relation to their clinical approach despite the existence of a possible gap between what they know and what they do. AIM To measure the agreement between knowledge and practice methods related to a selected clinical scenario involving the placement of an indirect post in endodontically treated teeth (ETT) among different types of practitioners. METHODS An electronic questionnaire was emailed to members of the Saudi Dental Society. The questionnaire presented a clinical scenario of restoring a posterior ETT with an indirect post, core unit, and crown, followed by specific questions regarding knowledge and practice related to ten different treatment aspects such as who prepares the post space, technique, isolation, time, gap between gutta-percha, and time to cementation of the crown. Each question was presented twice for each aspect, once asking about their practice method and then what they thought was the correct practice (knowledge). The relationship between the participants' responses and their specialty and the agreement between the responses of knowledge and practice for each participant were analyzed by Pearson's chi-square test and Kappa. RESULTS 203 completed questionnaires were analyzed. Most participants were 30 years old or younger (62.6%), and general dental practitioners (59%). When comparing the knowledge to the practice methods of each participant, nine out of ten aspects were of a "weak" level agreement or below (kappa < 0.59, p < 0.001). Only one aspect demonstrated a "strong" level of agreement (Kappa = 0.804), which was related to the duration of time between obturation and post space preparation in the presence of a periapical lesion. However, this strong agreement in the responses was not aligned with current evidence. There was also a significant difference among the responses of endodontists, restorative dentists and general practitioners in most of the aspects. CONCLUSION Overall, there was a weak agreement between what practitioners know and do in most aspects of a selected clinical scenario involving the placement of an indirect post in posterior ETT. Moreover, the participant's specialty influenced their responses regarding both knowledge and clinical practice.
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Affiliation(s)
- Rua S Babaier
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, 12372, Saudi Arabia. .,Division of Dentistry, Faculty of Biology, Medicine, and Health, School of Medical Sciences, University of Manchester, Manchester, UK.
| | - Sumaya O Basudan
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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30
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Hussein R, Lin ECJ, Grindrod K. Effects of computer-based education on health professionals' knowledge, skills, and behavior: A scoping review. J Am Pharm Assoc (2003) 2021; 61:e44-e68. [PMID: 33648894 DOI: 10.1016/j.japh.2021.01.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Computer-based platforms are rapidly growing as a promising way to deliver education to health professionals (HPs). However, evidence to support the use of computer-based education to change professional behavior and clinical practice and to guide the selection of design features of computer-based educational platforms is lacking in the existing literature. OBJECTIVES To address the current gaps in knowledge, a scoping review approach was used to explore the effects of computer-based education on HP knowledge, skills, and behavior as the primary objective. A secondary aim was to determine the design features of computer-based educational platforms that enhanced user satisfaction. METHODS The scoping review was conducted using the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Relevant studies were first identified through searches in 7 scientific databases. Studies were then selected through independent screening by 2 reviewers. Finally, the data of selected studies were extracted and charted using Excel (Microsoft Corporation). RESULTS Seventeen studies were selected for inclusion. The included studies were conducted on a wide range of HPs and used computer-based educational platforms with varying features, duration, clinical content, and offerings of accreditation. All studies reported at least 1 of the following outcomes: HPs' acceptance, attitude, and satisfaction; knowledge and skills; and behavior; however, none of the studies evaluated the degrees of change in patient outcomes. Only 2 studies used theoretical frameworks to develop their platform, with mixed impact on effectiveness and consistent effect on satisfaction. In addition, the platforms employed newer features such as tailored feedback and instant messaging. CONCLUSION Computer-based education can enhance HP knowledge, skills, and behavior. Future studies should explicitly outline the features that further improve learning outcomes and construct their interventions around well-grounded theory to improve the effectiveness of computer-based education on changing HP behavior.
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Wang J, Liu W, Zhao Q, Xiao M, Peng D. An Application of the Theory of Planned Behavior to Predict the Intention and Practice of Nursing Staff Toward Physical Restraint Use in Long-Term Care Facilities: Structural Equation Modeling. Psychol Res Behav Manag 2021; 14:275-287. [PMID: 33688280 PMCID: PMC7936668 DOI: 10.2147/prbm.s293759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/11/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Understanding the factors that affect nursing staffs' intention and practice of physical restraint (PR) on older adults help develop restraint-reduction programs. This study aimed to identify the relationship between the Theory of Planned Behavior (TPB) constructs and nursing staffs' practice to use PR in long-term care (LTC) facilities. PATIENTS AND METHODS A cross-sectional survey was conducted via convenience sampling among 316 nursing staff in six Chinese LTC facilities. PR-TPB questionnaire and the practice subscale of the Chinese version of the Staff Knowledge, Attitudes and Practices Questionnaire regarding PR were used to collect the data. Structural equation modeling (SEM) was used to examine the relationship between variables. RESULTS The SEM fit well with the data (χ2/df =1.639, RMSEA = 0.045, CFI= 0.955, GFI=0.945). Attitude (β=0.536, P<0.001) and perceived behavioral control (PBC) (β=0.139, P<0.05) predicted intention (R2 =0.359). PBC was a significant predictor of practice, with R2 accounting for 0.151. CONCLUSION TPB provided useful insight into better understanding nursing staffs' PR practices, although it did not support all the TPB principles significantly. Prospective studies may be conducted to design and implement multi-component interventions based on TPB and explore the effectiveness of PR reduction in LTC facilities in-depth.
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Affiliation(s)
- Jun Wang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Weichu Liu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Daomei Peng
- The First Social Welfare Home of Chongqing, Chongqing, People’s Republic of China
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Torlak NG, Kuzey C, Sait Dinç M, Budur T. Links connecting nurses’ planned behavior, burnout, job satisfaction, and organizational citizenship behavior. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2021. [DOI: 10.1080/15555240.2020.1862675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- N. Gökhan Torlak
- Department of Business Administration, Doğuş University, Üsküdar, Istanbul, Turkey
| | - Cemil Kuzey
- Department of Computer Science and Information Systems, Arthur J. Bauernfeind College of Business, Murray State University, Murray, Kentucky, USA
| | - Muhammet Sait Dinç
- Department of Human Resource Management, American University of the Middle East, Kuwait City, Kuwait
| | - Taylan Budur
- Department of Business and Management, Tishk International University, Sulaimania, Iraq
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Lyon AR, Pullmann MD, Dorsey S, Levin C, Gaias LM, Brewer SK, Larson M, Corbin CM, Davis C, Muse I, Joshi M, Reyes R, Jungbluth NJ, Barrett R, Hong D, Gomez MD, Cook CR. Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy. Implement Sci 2021; 16:3. [PMID: 33413511 PMCID: PMC7788537 DOI: 10.1186/s13012-020-01064-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services-schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes. METHODS Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4-6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness. DISCUSSION This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS-a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation-to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT04451161 . Registered on June 30, 2020.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Michael D Pullmann
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Shannon Dorsey
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Carol Levin
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Larissa M Gaias
- Department of Psychology, University of Massachusetts, Lowell, 850 Broadway St, Lowell, MA, 01854, USA
| | - Stephanie K Brewer
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Madeline Larson
- University of Minnesota, 250 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Catherine M Corbin
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Chayna Davis
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Ian Muse
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Mahima Joshi
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Rosemary Reyes
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | | | - Rachel Barrett
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - David Hong
- Washburn Training Institute, 1100 Glenwood Ave, Minneapolis, MN, 55405, USA
| | - Michael D Gomez
- Psychological Sciences, Texas Tech University, 2700 18th Street, Lubbock, TX, 79410, USA
| | - Clayton R Cook
- University of Minnesota, 250 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
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Suppan L, Abbas M, Catho G, Stuby L, Regard S, Harbarth S, Achab S, Suppan M. Impact of a Serious Game on the Intention to Change Infection Prevention and Control Practices in Nursing Homes During the COVID-19 Pandemic: Protocol for a Web-Based Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e25595. [PMID: 33296329 PMCID: PMC7744143 DOI: 10.2196/25595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nursing home residents are at high risk of complications and death due to COVID-19. Lack of resources, both human and material, amplifies the likelihood of contamination in these facilities where a single employee can contaminate dozens of residents and colleagues. Improving the dissemination of and adhesion to infection prevention and control (IPC) guidelines is therefore essential. Serious games have been shown to be effective in developing knowledge and in increasing engagement, and could motivate nursing home employees to change their IPC practices. OBJECTIVE Our aim is to assess the impact of "Escape COVID-19," a serious game designed to enhance knowledge and application of IPC procedures, on the intention of nursing home employees to change their IPC practices. METHODS We will carry out a web-based randomized controlled trial following the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines and incorporating relevant elements of CHERRIES (Checklist for Reporting Results of Internet E-Surveys). Participants will be randomized to either the control or the serious game (intervention) group. First, both groups will be asked to answer a questionnaire designed to gather demographic data and assess baseline knowledge. The control group will then receive a quick reminder of the current national guidelines and links to IPC guidelines for health care professionals, while the other group will play the game. Both groups will then have to answer a second questionnaire designed to assess their willingness to change their IPC practices after having followed their respective material. After completing this questionnaire, they will be granted access to the material presented to the group they were not assigned to and receive a course completion certificate. The primary outcome will be the proportion of participants willing to change their IPC practices according to group. Secondary outcomes will include the analysis of specific questions detailing the exact changes considered by the participants. Factors associated with participant willingness or reluctance to change behavior will also be assessed. Attrition will also be assessed at each stage of the study. RESULTS The study protocol has been presented to our regional ethics committee (Req-2020-01262), which issued a declaration of no objection as such projects do not fall within the scope of the Swiss federal law on human research. Data collection began on November 5, 2020, and should be completed by December 4, 2020. CONCLUSIONS This study should determine whether "Escape COVID-19," a serious game designed to improve compliance with COVID-19 safe practices, modifies the intention to follow IPC guidelines among nursing home employees. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25595.
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Affiliation(s)
- Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mohamed Abbas
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gaud Catho
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Simon Regard
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.,Division of General Surgeon, Geneva Directorate of Health, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Sophia Achab
- Specialized Facility in Behavioral Addictions ReConnecte, Geneva University Hospitals, Geneva, Switzerland.,WHO Collaborating Center in Training and Research in Mental Health, University of Geneva, Geneva, Switzerland
| | - Mélanie Suppan
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Greene L, Sathe N, House JA, Schott LL, Safo S. Evaluation of a Clinical Platform to Promote Chronic Disease Management. Popul Health Manag 2020; 24:470-477. [PMID: 33290149 DOI: 10.1089/pop.2020.0205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Self-reported data suggest American adults with multiple chronic conditions account for 25.7% to 60% of the population. Despite emphasis on information technology to improve quality in health care, data addressing outcomes of clinically focused, provider-oriented dashboards are limited. To explore integrating performance platforms into clinical care, the authors designed a platform-based intervention to address 2 prevalent chronic conditions with significant long-term burden. This study used a performance platform to enhance clinicians' management of patients with diabetes and osteoporosis. Descriptive statistics were used to summarize patients' surveys and quality metrics, and to analyze clinicians' knowledge, attitudes, and beliefs in the pre and post time frames. The frequency of screening for osteoporosis in women improved post intervention (40% vs. 44%, P < 0.0001), whereas other quality metrics did not. Clinician respondents were primarily physicians (82%), white (73%), internal medicine specialists (58%), with an average of 18 years' experience, and nearly equally male and female. Their percent of correctly answered knowledge questions increased slightly in the postintervention phase for osteoporosis and hypoglycemia (0.53 and 1.74, respectively); however, results were not statistically significant (P > 0.4). Post intervention, clinicians reported that their attitudes and beliefs regarding disease management had changed in the past 6 months in a positive direction. Although few outcomes studied changed over time, results suggest that performance platforms may have a role to play in managing chronic conditions. However, their efficacy must continue to be evaluated in order to improve understanding of optimal approaches to integrating technology into patient care.
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Affiliation(s)
- Laura Greene
- Premier Applied Sciences, Premier, Inc., Charlotte, North Carolina, USA
| | - Nila Sathe
- Premier Applied Sciences, Premier, Inc., Charlotte, North Carolina, USA
| | - John A House
- Premier Applied Sciences, Premier, Inc., Charlotte, North Carolina, USA
| | - Laura L Schott
- Premier Applied Sciences, Premier, Inc., Charlotte, North Carolina, USA
| | - Stella Safo
- Premier Applied Sciences, Premier, Inc., Charlotte, North Carolina, USA
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Andarge E, Fikadu T, Temesgen R, Shegaze M, Feleke T, Haile F, Endashaw G, Boti N, Bekele A, Glagn M. Intention and Practice on Personal Preventive Measures Against the COVID-19 Pandemic Among Adults with Chronic Conditions in Southern Ethiopia: A Survey Using the Theory of Planned Behavior. J Multidiscip Healthc 2020; 13:1863-1877. [PMID: 33299323 PMCID: PMC7721310 DOI: 10.2147/jmdh.s284707] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/11/2020] [Indexed: 01/30/2023] Open
Abstract
PURPOSE With prevention being the only and best available intervention, COVID-19 has recently become a global threat, having had and continuing to have enormous health, economic, and societal impacts. Evidence so far has documented a heightened risk of mortality to people with chronic conditions. There is a dearth of evidence regarding chronic disease patients' intention and practice on the preventive measures. This study tried to fill this gap by assessing the intention to practice and practice on personal preventive measures (PPMs) among adults with chronic conditions. MATERIALS AND METHODS A facility-based cross-sectional study was conducted in Southern Ethiopia among 806 adults with chronic conditions by employing a multistage sampling technique. Data were collected using a pre-tested and structured questionnaire. Statistical analysis was done using IBM SPSS software version 25. Binary logistic regression analysis was done to identify factors associated with intention and practice. Level of statistical significance was declared at a P-value of less than 0.05. RESULTS The study showed that 52% (95% CI=47.61-54.80) and 76.3% (95% CI=73.36-79.24) of adults with chronic conditions were intending to practice and had ever practiced the personal preventive measures. Participants' subjective norm (SN) (AOR=4.94; 95% CI=3.49-6.96) and perceived behavioral control (PBC) (AOR=4.13; 95% CI=2.69-6.34) were the factors associated with their intention. Good knowledge and a positive attitude were found to be significant factors associated with the participants' actual practice of the PPMs among other independent factors. CONCLUSION Around half of the participants were intending to practice PPMs, and three-quarters had good practice on the PPMs against COVID-19. Interventions targeted to improve intention and practice on the PPMs need to take into account improving knowledge and attitude, and build positive subjective norms and heighten the confidence to control the preventive behaviors.
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Affiliation(s)
- Eshetu Andarge
- School of Public Health, Arba Minch University, Arba Minch, Southern Nations Nationalities and Peoples Regional State, Ethiopia
| | - Teshale Fikadu
- School of Public Health, Arba Minch University, Arba Minch, Southern Nations Nationalities and Peoples Regional State, Ethiopia
| | - Rodas Temesgen
- Department of Internal Medicine, School of Medicine, Arba Minch University, Arba Minch, Southern Nations Nationalities and Peoples Regional State, Ethiopia
| | - Mulugeta Shegaze
- School of Public Health, Arba Minch University, Arba Minch, Southern Nations Nationalities and Peoples Regional State, Ethiopia
| | - Tesfaye Feleke
- School of Public Health, Arba Minch University, Arba Minch, Southern Nations Nationalities and Peoples Regional State, Ethiopia
| | - Firehiwot Haile
- School of Public Health, Arba Minch University, Arba Minch, Southern Nations Nationalities and Peoples Regional State, Ethiopia
| | - Gisila Endashaw
- School of Nursing, Arba Minch University, Arba Minch, Southern Nations Nationalities and Peoples Regional State, Ethiopia
| | - Negussie Boti
- School of Public Health, Arba Minch University, Arba Minch, Southern Nations Nationalities and Peoples Regional State, Ethiopia
| | - Alemayehu Bekele
- Center for Neglected Tropical Diseases, Arba Minch University, Arba Minch, Southern Nations Nationalities and Peoples Regional State, Ethiopia
| | - Mustefa Glagn
- School of Public Health, Arba Minch University, Arba Minch, Southern Nations Nationalities and Peoples Regional State, Ethiopia
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Psychometric Properties of the Health Professionals Communication Skills Scale in University Students of Health Sciences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207565. [PMID: 33080943 PMCID: PMC7589042 DOI: 10.3390/ijerph17207565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022]
Abstract
Communication is one of the determining factors of healthcare quality; however, a health model that prioritizes clinical over non-technical skills remains prevalent. The aims of this article were: (a) to validate a communication skills scale in a sample of fourth-year nursing degree students from two Spanish universities and (b) determine their perception of communication skills. The study included 289 fourth-year nursing undergraduate students with a mean age of 22.7 (SD = 4.87) years; 81.7% were female. The Health Professionals Communication Skills Scale (HP-CSS) questionnaire was adapted for use among nursing students. We analysed the psychometric properties and relationships with the variable attitudes toward communication skills. The HP-CSS showed a high internal consistency (0.88) and good fit of data to the model (TLI = 0.98; CFI = 0.97; RMSEA = 0.05 [95% CI = 0.04–0.06]). The total score and subscale scores correlated with the variable attitude towards communication skills. High scores were obtained for the students’ perception of communication skills. The HP-CSS is a valid and reliable tool to assess the communication skills in nursing students. This scale provides university teachers with a rapid and easily applied instrument to assess the level of communication skills and relationship with patients.
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de Jonge LPJWM, Mesters I, Govaerts MJB, Timmerman AA, Muris JWM, Kramer AWM, van der Vleuten CPM. Supervisors' intention to observe clinical task performance: an exploratory study using the theory of planned behaviour during postgraduate medical training. BMC MEDICAL EDUCATION 2020; 20:134. [PMID: 32354331 PMCID: PMC7193388 DOI: 10.1186/s12909-020-02047-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/21/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND Direct observation of clinical task performance plays a pivotal role in competency-based medical education. Although formal guidelines require supervisors to engage in direct observations, research demonstrates that trainees are infrequently observed. Supervisors may not only experience practical and socio-cultural barriers to direct observations in healthcare settings, they may also question usefulness or have low perceived self-efficacy in performing direct observations. A better understanding of how these multiple factors interact to influence supervisors' intention to perform direct observations may help us to more effectively implement the aforementioned guidelines and increase the frequency of direct observations. METHODS We conducted an exploratory quantitative study, using the Theory of Planned Behaviour (TPB) as our theoretical framework. In applying the TPB, we transfer a psychological theory to medical education to get insight in the influence of cognitive and emotional processes on intentions to use direct observations in workplace based learning and assessment. We developed an instrument to investigate supervisors intention to perform direct observations. The relationships between the TPB measures of our questionnaire were explored by computing bivariate correlations using Pearson's R tests. Hierarchical regression analysis was performed in order to assess the impact of the respective TPB measures as predictors on the intention to perform direct observations. RESULTS In our study 82 GP supervisors completed our TPB questionnaire. We found that supervisors had a positive attitude towards direct observations. Our TPB model explained 45% of the variance in supervisors' intentions to perform them. Normative beliefs and past behaviour were significant determinants of this intention. CONCLUSION Our study suggests that supervisors use their past experiences to form intentions to perform direct observations in a careful, thoughtful manner and, in doing so, also take the preferences of the learner and other stakeholders potentially engaged in direct observations into consideration. These findings have potential implications for research into work-based assessments and the development of training interventions to foster a shared mental model on the use of direct observations.
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Affiliation(s)
- Laury P J W M de Jonge
- Department of General Practice, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Ilse Mesters
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Marjan J B Govaerts
- Department of Educational Research and Development, Maastricht University, Maastricht, The Netherlands
| | - Angelique A Timmerman
- Department of General Practice, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Jean W M Muris
- Department of General Practice, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Anneke W M Kramer
- Department of Family Medicine, Leiden University, Leiden, The Netherlands
| | - Cees P M van der Vleuten
- Department of Educational Research and Development, Maastricht University, Maastricht, The Netherlands
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Assessment of healthcare workers' behavior in implementing a newborn screening program for congenital hypothyroidism in Perak, Malaysia. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-08-2019-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThe aim of this study is to assess healthcare workers' behavior on the congenital hypothyroidism screening program implementation based on a framework protocol and its associated factors.Design/methodology/approachA cross-sectional study was conducted using the multistage random sampling method in recruiting health clinic workers and purposive sampling techniques for hospital workers. The demographics, providers' characteristic, occupational profile, attitude, perceived behavior control (PBC), knowledge, behavioral intention and adherence to protocol were gathered using validated and reliable self-administered questionnaires.FindingsPartial intention to adhere to protocol was 25.7%. Weak attitude (adjusted odds ratio [AOR]: 5.48, 95% confidence interval [CI]: 3.32–9.06), low PBC score (AOR: 0.91, 95% CI: 0.86–0.95) and low knowledge score (AOR: 0.85, 95% CI: 0.75–0.96) were associated with partial intention to adhere to protocol. In the self-rated adherence assessment, 92.6% of participants from health clinics, 79.1% from pediatric and 61.1% from pathology were found not adhering to protocol. There was a significant association between intention and adherence to protocol.Research limitations/implicationsDocumentations and observations in assessing program implementation were limited to perform in the present study. Using self-rated instruments and focusing on healthcare workers alone did not provide a comprehensive assessment.Practical implicationsAvailability of a training module at site and regular refreshing course training should be made available to harness knowledge, attitude and behavioral perception in implementing the program activities.Originality/valueIntegrating the Logical Framework Approach in assessing program implementation and application of the Theory of Planned Behavior and Attitude, Subjective Norms, Self-Efficacy Model in this study were beneficial.
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Rich A, Medisauskaite A, Potts HWW, Griffin A. A theory-based study of doctors' intentions to engage in professional behaviours. BMC MEDICAL EDUCATION 2020; 20:44. [PMID: 32041599 PMCID: PMC7011214 DOI: 10.1186/s12909-020-1961-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/05/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND The Theory of Planned Behaviour (TPB) has been proposed as an appropriate model for creating a theory-driven approach to teaching medical professionalism. However, there is a lack of empirical evidence into its efficacy. This study explores if the TPB can assess UK medical doctors' professional behaviours and explores if there are differences in the TPB's efficacy depending on doctors' primary medical qualification (UK or outside). METHODS Three hundred fourteen doctors in England at 21 NHS Trusts completed a questionnaire about reflective practice, using the General Medical Council's confidentiality guidance, and raising a patient safety concern. The majority of participants were male (52%), white (68%), consultants (62%), and UK medical graduates (UKGs) (71%). RESULTS The TPB variables of attitudes, subjective norms, and perceived behavioural control were predictive of intention to engage in raising concerns (R2 = 35%), reflection (R2 = 52%), and use of confidentiality guidance (R2 = 45%). Perceived behavioural control was the strongest predictor of intentions to raise a concern (β = 0.44), while attitude was the strongest predictor of intentions to engage in reflective practice (β = 0.61) and using confidentiality guidance (β = 0.38). The TBP constructs predicted intention for raising concerns and reflecting for both UKGs and non-UKGs (Fs ≥ 2.3; ps ≤ .023, βs ≥ 0.12). However, only perceived behaviour control was predictive of intentions to use guidance for both UKGs and non-UKGs (β = 0.24) while attitudes and norms were just predictive for UKGs (βs ≥ 0.26). CONCLUSIONS This study demonstrates the efficacy of the TPB for three professional behaviours. The implications for medical educators are to use the variables of the TPB (attitudes, subjective norms, and perceived behavioural control) in the education of professionalism, and for medical education researchers to further our understanding by employing the TPB in more empirical studies of non-clinical behaviours.
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Affiliation(s)
- Antonia Rich
- Research Department of Medical Education, UCL Medical School, Room GF/664, Royal Free Hospital, London, NW3 2PF, UK
| | - Asta Medisauskaite
- Research Department of Medical Education, UCL Medical School, Room GF/664, Royal Free Hospital, London, NW3 2PF, UK.
| | - Henry W W Potts
- UCL Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, UK
| | - Ann Griffin
- Research Department of Medical Education, UCL Medical School, 74 Huntley Street, London, WC1E 6AU, UK
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Gillespie DC, Cadden AP, West RM, Broomfield NM. Non-pharmacological interventions for post-stroke emotionalism (PSE) within inpatient stroke settings: a theory of planned behavior survey. Top Stroke Rehabil 2019; 27:15-24. [DOI: 10.1080/10749357.2019.1654241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- David C Gillespie
- Clinical Neuropsychology Service, Department of Clinical Neurosciences (DCN), Western General Hospital, Edinburgh, UK
| | - Amy P Cadden
- Neuropsychology Service, Great Ormond Street Hospital for Children, London, UK
| | - Robert M West
- Institute of Health Sciences, University of Leeds, Leeds, UK
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Jones KE, Berry TR, Merali AS, Bello-Haas VD. Intentions of Canadian health professionals towards recommending exercise for people living with ALS. BMC Neurol 2019; 19:204. [PMID: 31438881 PMCID: PMC6706893 DOI: 10.1186/s12883-019-1426-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/07/2019] [Indexed: 12/11/2022] Open
Abstract
Background To provide a nationwide overview of the attitudes, social pressure, perceived ability and intentions of health professionals toward exercise prescription for people living with ALS (pALS). Methods An online survey of physician and non-physician health professionals (HPs) working in academic ALS clinics across Canada. Results The response rate was 48% (84/176) with 30% of respondents identifying as physicians, 63% as other HPs and the remainder as administrative or research personnel. Respondents were sharply divided in their intentions to provide exercise counsel: 24% unlikely and 45% likely. Respondents with low intentions were HPs that considered this activity outside their scope of practice. Measures of intention and attitude were more positive for flexibility compared to strength and aerobic exercise. Perceptions of social pressure and ability to provide exercise counsel were significantly correlated with intention across the three exercise modes in all respondents. Qualitative themes identified as barriers to exercise prescription were lack of confidence or competence (31% physicians, 32% HP), patient tolerance (30% HP), lack of evidence (22% physicians) and lack of infrastructure (22% physicians). Conclusions While “lack of evidence” for the benefit of exercise was a deterrent for physicians, the larger issue for all respondents was building competence and confidence in exercise prescription for pALS. Electronic supplementary material The online version of this article (10.1186/s12883-019-1426-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kelvin E Jones
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada. .,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada.
| | - Tanya R Berry
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Aaliya S Merali
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
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El Tantawi M, AlJameel AH, Fita S, AlSahan B, Alsuwaiyan F, El Meligy O. Dentists' intentions to manage drug users: Role of theory of planned behaviour and continuing education. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:364-372. [PMID: 31025512 DOI: 10.1111/eje.12438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess dentists' intention to manage drug users (DUs) and to evaluate the role of the theory of planned behavior (TPB) and continuing education (CE) in explaining this intention. MATERIALS AND METHODS A cross-sectional study was conducted in 2017, including dentists from three major Saudi cities. A questionnaire assessed personal and professional background and components of TPB: attitude, perceived social norms, perceived control and intention to manage DUs. Respondents expressed their agreement on a scale from 1 (disagree) to 7 (agree). Receiving CE to manage DUs was also assessed. Adjusted linear regression was used to assess the impact of the TPB constructs and receiving CE on dentists' intention. RESULTS Response rate = 72% (255/354), mean (SD) age = 35.2 (11.9). The mean (SD) for positive intention to manage DUs = 5.34 (1.37), negative attitude = 4.03 (1.10), positively perceived norms = 5.78 (1.06) and perception of no control = 4.45 (1.08). Only 9% received CE to manage DUs. Positive intention was associated with perception of positive norms (B = 0.73, 95% CI = 0.59, 0.87) and perception of no control (B = -0.47, 95% CI = -0.63, -0.32) but not with receiving CE (P = 0.58). CONCLUSION In major Saudi cities, dentists' intention to manage DUs was positive and was explained by TPB components: perception of norms and perception of control. Modified and targeted CE is needed to address this problem.
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Affiliation(s)
- Maha El Tantawi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Sarah Fita
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Basma AlSahan
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah Alsuwaiyan
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Omar El Meligy
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Bastani P, Alipoori S, Imani-Nasab MH, Jamalabadi S, Kavosi Z. Evidence-based decision making among healthcare managers: Evidence from a developing Country. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1632002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Peivand Bastani
- Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somayeh Alipoori
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad-Hasan Imani-Nasab
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Sara Jamalabadi
- Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kavosi
- Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
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Lyon AR, Cook CR, Duong MT, Nicodimos S, Pullmann MD, Brewer SK, Gaias LM, Cox S. The influence of a blended, theoretically-informed pre-implementation strategy on school-based clinician implementation of an evidence-based trauma intervention. Implement Sci 2019; 14:54. [PMID: 31146788 PMCID: PMC6543642 DOI: 10.1186/s13012-019-0905-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/16/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Individual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector. METHODS As part of a pilot trial, 25 school mental health clinicians were randomized to BASIS (n = 12) or an attention control placebo (n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked. RESULTS A series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls. CONCLUSION Findings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018-Retrospectively registered.
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Affiliation(s)
- Aaron R. Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Clayton R. Cook
- University of Minnesota, 250 Education Sciences Bldg, 56 East River Road, Minneapolis, MN 55455 USA
| | - Mylien T. Duong
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
- Committee for Children, 2815 2nd Ave #400, Seattle, WA 98121 USA
| | - Semret Nicodimos
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Michael D. Pullmann
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Stephanie K. Brewer
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Larissa M. Gaias
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Shanon Cox
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
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Developing Sustainable Healthcare Systems in Developing Countries: Examining the Role of Barriers, Enablers and Drivers on Knowledge Management Adoption. SUSTAINABILITY 2019. [DOI: 10.3390/su11040954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Knowledge management (KM) adoption is crucial to integrating sustainable development within the healthcare sector. Different barriers, enablers, and drivers affect KM adoption. Identifying these barriers, enablers, and drivers and their role in KM adoption is the core of successful KM adoption. However, there is scarcity of studies applying quantitative models and combing barriers, enablers and drivers to check their effect on KM adoption, especially form a developing country’s perspective such as Pakistan. Therefore, this study explores the role of barriers, enablers and drivers on KM adoption in Pakistan. Healthcare professionals participated in the data collection process, and results were analyzed using structural equation modeling. The findings described that: (1) organizational and strategic barriers have significant negative association with KM adoption; (2) government related enablers have significant positive association with KM adoption; (3) healthcare related drivers, and performance-based drivers have significant positive association with KM adoption. This study concludes that government intervention to promote KM adoption is necessary especially in developing countries. These findings will be helpful for the healthcare professionals and policy makers to promote KM adoption in healthcare sector. Current study contributes to the healthcare literature and body of knowledge by providing the empirical evidence of checking the quantitative effect of barriers, enablers and drivers on KM adoption.
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Potthoff S, Rasul O, Sniehotta FF, Marques M, Beyer F, Thomson R, Avery L, Presseau J. The relationship between habit and healthcare professional behaviour in clinical practice: a systematic review and meta-analysis. Health Psychol Rev 2019; 13:73-90. [DOI: 10.1080/17437199.2018.1547119] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sebastian Potthoff
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Othman Rasul
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F. Sniehotta
- NIHR Policy Research Unit Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
| | - Marta Marques
- Trinity Centre for Practice and Healthcare Innovation & ADAPT Centre, Trinity College Dublin, Dublin, Ireland
| | - Fiona Beyer
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Thomson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Leah Avery
- School of Health & Social Care, Teesside University, Middlesbrough, UK
| | - 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
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Abstract
Knowledge management (KM) is the source for creating a sustainable competitive advantage, and it helps the organizations to retain, develop, organize and utilize their knowledge. Due to globalization, the organizations must maintain their knowledge assets to survive. Many organizations have realized the potential of KM and are applying it. Since the healthcare industry is growing significantly, it is continuously generating a wealth of knowledge. This knowledge can be recorded, communicated and used by many health care professionals with the help of KM. There is a wealth of research on KM in healthcare of developed countries, but very few studies regarding KM implementation can be found in developing countries i.e., Pakistan. Pakistan is now looking towards the implementation of KM; it is in its initial stages. The implementation of KM in the healthcare of Pakistan is affected by different barriers. In this study, the barriers will be identified and analyzed. An interrelationship between the barriers will be determined, and how the different barriers support each other (driving power), and how they influence each other (dependence power). The results of interpretive structural modeling (ISM) and MICMAC (Matrice d’Impacts croises-multipication appliqué an classment i.e., cross-impact matrix multiplication applied to classification) approach show that lack of support from top management, insufficient strategic planning and lack of support from organizational structure are the main barriers to KM adoption in the healthcare of Pakistan. This study provides a solution in determining the main barriers that need to be solved first, and to ensure effective implementation of KM in the healthcare of Pakistan.
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Mas S, Bernard P, Gourlan M. Determinants of physical activity promotion by smoking cessation advisors. PATIENT EDUCATION AND COUNSELING 2018; 101:1942-1946. [PMID: 29793785 DOI: 10.1016/j.pec.2018.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the cross-sectional association between personal physical activity (PA) level, Theory of Planned Behavior (TPB) constructs toward PA promotion, and PA promotion behavior among smoking cessation advisors. METHOD 149 smoking cessation advisors were invited to complete online questionnaires. Hypotheses were tested using Bayesian path analysis. RESULTS Attitudes and perceived behavioral control (PBC) of smoking cessation advisors were related to PA promotion intentions; intentions were in turn related to PA promotion behaviors. Advisors' personal PA level was indirectly associated with PA promotion behaviors through PBC and PA promotion intentions. CONCLUSION The TPB is a relevant theoretical framework with which to explore determinants of PA promotion behavior among smoking cessation advisors. The PA level of health care professionals may be linked to PA promotion behavior through some TPB constructs. PRACTICE IMPLICATIONS Smoking cessation advisor training should include education on attitude development (e.g., PA benefits on smoking cessation), PBC (e.g., modality of PA prescription) and PA promotion intentions (e.g., goal setting). Smoking cessation advisors should also be encouraged to regularly practice PA in order to improve their PA promotion behaviors.
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Affiliation(s)
- Sébastien Mas
- Epsylon Laboratory EA 4556, Paul-Valéry University of Montpellier, Montpellier, France; Epidaure Prevention Department of the Montpellier Cancer Institute, Montpellier, France.
| | - Paquito Bernard
- Université du Québec à Montréal, Montréal, Quebec, Canada; Research Center, University Institute of Mental Health at Montreal, Montréal, Quebec, Canada.
| | - Mathieu Gourlan
- Epsylon Laboratory EA 4556, Paul-Valéry University of Montpellier, Montpellier, France; Epidaure Prevention Department of the Montpellier Cancer Institute, Montpellier, France.
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Orava T, Provvidenza C, Townley A, Kingsnorth S. Screening and assessment of chronic pain among children with cerebral palsy: a process evaluation of a pain toolbox. Disabil Rehabil 2018; 41:2695-2703. [DOI: 10.1080/09638288.2018.1471524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Taryn Orava
- Holland Bloorview Kids Rehabilitation Hospital, Teaching and Learning Institute, Toronto, Canada
| | - Christine Provvidenza
- Holland Bloorview Kids Rehabilitation Hospital, Teaching and Learning Institute, Toronto, Canada
| | - Ashleigh Townley
- Holland Bloorview Kids Rehabilitation Hospital, Teaching and Learning Institute, Toronto, Canada
| | - Shauna Kingsnorth
- Holland Bloorview Kids Rehabilitation Hospital, Teaching and Learning Institute, Toronto, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute University of Toronto, Toronto, Canada
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