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Girard A, Doucet A, Lambert M, Ouadfel S, Caron G, Hudon C. What is known about the role of external facilitators during the implementation of complex interventions in healthcare settings? A scoping review. BMJ Open 2024; 14:e084883. [PMID: 38951001 DOI: 10.1136/bmjopen-2024-084883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVE To synthesise current knowledge about the role of external facilitators as an individual role during the implementation of complex interventions in healthcare settings. DESIGN A scoping review was conducted. We reviewed original studies (between 2000 and 2023) about implementing an evidence-based complex intervention in a healthcare setting using external facilitators to support the implementation process. An information specialist used the following databases for the search strategy: MEDLINE, CINAHL, APA PsycINFO, Academic Search Complete, EMBASE (Scopus), Business Source Complete and SocINDEX. RESULTS 36 reports were included for analysis, including 34 different complex interventions. We performed a mixed thematic analysis to synthesise the data. We identified two primary external facilitator roles: lead facilitator and process expert facilitator. Process expert external facilitators have specific responsibilities according to their role and expertise in supporting three main processes: clinical, change management and knowledge/research management. CONCLUSIONS Future research should study processes supported by external facilitators and their relationship with facilitation strategies and implementation outcomes. Future systematic or realist reviews may also focus on outcomes and the effectiveness of external facilitation.
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Affiliation(s)
- Ariane Girard
- School of Nursing, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Amélie Doucet
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Mireille Lambert
- Department of Family Medicine and Emergency, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sarah Ouadfel
- Department of Family Medicine and Emergency, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Genève Caron
- Departement of Psychology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Lizcano‐Álvarez A, Esteban‐Hernández J, Alameda‐Cuesta A, Cid‐Expósito G, Palacios‐Ceña D. Chronic cardiovascular nursing care in Spanish primary care: A qualitative study. Int J Nurs Pract 2022:e13117. [DOI: 10.1111/ijn.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 07/25/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Angel Lizcano‐Álvarez
- Department of Nursing, Faculty of Health Sciences Universidad Rey Juan Carlos Madrid Spain
| | - Jesús Esteban‐Hernández
- Department of Medical Specialties and Public Health, Faculty of Health Sciences Universidad Rey Juan Carlos Madrid Spain
| | | | - Gema Cid‐Expósito
- Department of Nursing, Faculty of Health Sciences Universidad Rey Juan Carlos Madrid Spain
| | - Domingo Palacios‐Ceña
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS) Universidad Rey Juan Carlos Madrid Spain
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Wolker Manta S, Fabrício Sandreschi P, Christofoletti Dos Santos M, Maria Konrad L, Miranda Tassitano R, Rosane Bertoldo Benedetti T. Barriers and facilitators on the implementation of physical activity in Primary Health Care: A systematic review. Prev Med Rep 2022; 28:101875. [PMID: 35813399 PMCID: PMC9260606 DOI: 10.1016/j.pmedr.2022.101875] [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: 10/17/2021] [Revised: 05/05/2022] [Accepted: 06/24/2022] [Indexed: 11/26/2022] Open
Abstract
Barriers and facilitators influence the implementation of physical activity (PA) in Primary Health Care (PHC). This study aimed to analyze the scientific evidence on barriers and facilitators perceived by stakeholders on the implementation of PA in PHC.The search databases consisted of Web of Science, Medline, Scopus, and Lilacs. Two independent researchers reviewed the eligibility criteria and extracted and coded the information according to the Theoretical Domains Framework (TDF). The Consolidated Criteria for Reporting Qualitative Research was used to report the quality of the included studies. We analyzed 8.471 studies but included only 16. The studies identified 54 different reports on barriers and 48 on facilitators. Reports were often identified in the "environmental context and resources" domain, with 27 reports on barriers and 27 on facilitators. We found 25 reports of barriers and 16 of facilitators in the TDF domains that demonstrate professional profile characteristics. The low expectations in the professional profile for the implementation can influence the context and the organizational climate to identify more barriers than facilitators.
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Philbrick G, Sheridan NF, McCauley K. An exploration of New Zealand mental health nurses' personal physical activities. Int J Ment Health Nurs 2022; 31:625-638. [PMID: 35166003 PMCID: PMC9305261 DOI: 10.1111/inm.12981] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/25/2021] [Accepted: 01/23/2022] [Indexed: 12/26/2022]
Abstract
This study assessed the physical activities of Mental Health Nurses (MHN) in New Zealand against the 2018 World Health Organization recommended minimum levels of moderate-to-vigorous physical activity. The research design was exploratory and descriptive as there were no previous studies about physical activity levels of MHNs in New Zealand. Quantitative and qualitative data were collected using the International Physical Activity Questionnaire (IPAQ, Long Version) which included options for free-text responses. Data were analysed using descriptive and inferential statistics. A total of 266 participants returned the survey, a response rate of 4%, and a limitation of the study. More than 50% of MHNs reported <150 min of moderate-to-vigorous exercise per week for each of the four physical activity domains. When individual physical activity domains were combined, only 10% spent <150 min on moderate-to-vigorous physical activity. Work-related physical activities were higher for those working in the inpatient area than in community settings. Transport-related physical activities were higher for those working in community settings. Participants registered from 6 to 20 years had more time sitting than other groups. Nurses aged 55 years and above showed the highest total physical activity levels. Moreover, healthcare organizations and nurse leaders need to promote physical activity and provide wellness intervention for their staff. Nurses who are physically active may be more effective in supporting their patients to increase their physical activity.
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Affiliation(s)
- Glen Philbrick
- School of Nursing, Massey University, Wellington, New Zealand
| | | | - Kay McCauley
- School of Nursing, Massey University, Wellington, New Zealand
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Speake H, Copeland R, Breckon J, Till S. Challenges and opportunities for promoting physical activity in health care: a qualitative enquiry of stakeholder perspectives. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1663926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Helen Speake
- Sheffield Hallam University, Centre for Sport and Exercise Science, Collegiate Crescent, Sheffield, UK
- National Centre for Sport and Exercise Medicine, Sheffield, UK
| | - Robert Copeland
- Sheffield Hallam University, Advanced Wellbeing Research Centre, Collegiate Crescent, Sheffield, UK
- National Centre for Sport and Exercise Medicine, Sheffield, UK
| | - Jeff Breckon
- Sheffield Hallam University, Advanced Wellbeing Research Centre, Collegiate Crescent, Sheffield, UK
| | - Simon Till
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- National Centre for Sport and Exercise Medicine, Sheffield, UK
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Harris T, Kerry S, Victor C, Iliffe S, Ussher M, Fox-Rushby J, Whincup P, Ekelund U, Furness C, Limb E, Anokye N, Ibison J, DeWilde S, David L, Howard E, Dale R, Smith J, Normansell R, Beighton C, Morgan K, Wahlich C, Sanghera S, Cook D. A pedometer-based walking intervention in 45- to 75-year-olds, with and without practice nurse support: the PACE-UP three-arm cluster RCT. Health Technol Assess 2019; 22:1-274. [PMID: 29961442 DOI: 10.3310/hta22370] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Guidelines recommend walking to increase moderate to vigorous physical activity (MVPA) for health benefits. OBJECTIVES To assess the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention in inactive adults, delivered postally or through dedicated practice nurse physical activity (PA) consultations. DESIGN Parallel three-arm trial, cluster randomised by household. SETTING Seven London-based general practices. PARTICIPANTS A total of 11,015 people without PA contraindications, aged 45-75 years, randomly selected from practices, were invited. A total of 6399 people were non-responders, and 548 people self-reporting achieving PA guidelines were excluded. A total of 1023 people from 922 households were randomised to usual care (n = 338), postal intervention (n = 339) or nurse support (n = 346). The recruitment rate was 10% (1023/10,467). A total of 956 participants (93%) provided outcome data. INTERVENTIONS Intervention groups received pedometers, 12-week walking programmes advising participants to gradually add '3000 steps in 30 minutes' most days weekly and PA diaries. The nurse group was offered three dedicated PA consultations. MAIN OUTCOME MEASURES The primary and main secondary outcomes were changes from baseline to 12 months in average daily step counts and time in MVPA (in ≥ 10-minute bouts), respectively, from 7-day accelerometry. Individual resource-use data informed the within-trial economic evaluation and the Markov model for simulating long-term cost-effectiveness. Qualitative evaluations assessed nurse and participant views. A 3-year follow-up was conducted. RESULTS Baseline average daily step count was 7479 [standard deviation (SD) 2671], average minutes per week in MVPA bouts was 94 minutes (SD 102 minutes) for those randomised. PA increased significantly at 12 months in both intervention groups compared with the control group, with no difference between interventions; additional steps per day were 642 steps [95% confidence interval (CI) 329 to 955 steps] for the postal group and 677 steps (95% CI 365 to 989 steps) for nurse support, and additional MVPA in bouts (minutes per week) was 33 minutes per week (95% CI 17 to 49 minutes per week) for the postal group and 35 minutes per week (95% CI 19 to 51 minutes per week) for nurse support. Intervention groups showed no increase in adverse events. Incremental cost per step was 19p and £3.61 per minute in a ≥ 10-minute MVPA bout for nurse support, whereas the postal group took more steps and cost less than the control group. The postal group had a 50% chance of being cost-effective at a £20,000 per quality-adjusted life-year (QALY) threshold within 1 year and had both lower costs [-£11M (95% CI -£12M to -£10M) per 100,000 population] and more QALYs [759 QALYs gained (95% CI 400 to 1247 QALYs)] than the nurse support and control groups in the long term. Participants and nurses found the interventions acceptable and enjoyable. Three-year follow-up data showed persistent intervention effects (nurse support plus postal vs. control) on steps per day [648 steps (95% CI 272 to 1024 steps)] and MVPA bouts [26 minutes per week (95% CI 8 to 44 minutes per week)]. LIMITATIONS The 10% recruitment level, with lower levels in Asian and socioeconomically deprived participants, limits the generalisability of the findings. Assessors were unmasked to the group. CONCLUSIONS A primary care pedometer-based walking intervention in 45- to 75-year-olds increased 12-month step counts by around one-tenth, and time in MVPA bouts by around one-third, with similar effects for the nurse support and postal groups, and persistent 3-year effects. The postal intervention provides cost-effective, long-term quality-of-life benefits. A primary care pedometer intervention delivered by post could help address the public health physical inactivity challenge. FUTURE WORK Exploring different recruitment strategies to increase uptake. Integrating the Pedometer And Consultation Evaluation-UP (PACE-UP) trial with evolving PA monitoring technologies. TRIAL REGISTRATION Current Controlled Trials ISRCTN98538934. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tess Harris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Christina Victor
- Gerontology and Health Services Research Unit, Brunel University London, London, UK
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, London, UK
| | - Julia Fox-Rushby
- Health Economics Research Group, Brunel University London, London, UK
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Cheryl Furness
- Population Health Research Institute, St George's, University of London, London, UK
| | - Elizabeth Limb
- Population Health Research Institute, St George's, University of London, London, UK
| | - Nana Anokye
- Health Economics Research Group, Brunel University London, London, UK
| | - Judith Ibison
- Population Health Research Institute, St George's, University of London, London, UK
| | - Stephen DeWilde
- Population Health Research Institute, St George's, University of London, London, UK
| | - Lee David
- 10 Minute CBT, Devonshire Business Centre, Letchworth Garden City, UK
| | - Emma Howard
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Dale
- Population Health Research Institute, St George's, University of London, London, UK
| | - Jaime Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Normansell
- Population Health Research Institute, St George's, University of London, London, UK
| | - Carole Beighton
- Population Health Research Institute, St George's, University of London, London, UK
| | - Katy Morgan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Charlotte Wahlich
- Population Health Research Institute, St George's, University of London, London, UK
| | - Sabina Sanghera
- Health Economics Research Group, Brunel University London, London, UK
| | - Derek Cook
- Population Health Research Institute, St George's, University of London, London, UK
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Westland H, Koop Y, Schröder CD, Schuurmans MJ, Slabbers P, Trappenburg JCA, Vervoort SCJM. Nurses' perceptions towards the delivery and feasibility of a behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: a qualitative study. BMC FAMILY PRACTICE 2018; 19:194. [PMID: 30541460 PMCID: PMC6292042 DOI: 10.1186/s12875-018-0888-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/05/2018] [Indexed: 11/24/2022]
Abstract
Background Self-management support is widely accepted for the management of chronic conditions. Self-management often requires behaviour change in patients, in which primary care nurses play a pivotal role. To support patients in changing their behaviour, the structured behaviour change Activate intervention was developed. This intervention aims to enhance physical activity in patients at risk for cardiovascular disease in primary care as well as to enhance nurses’ role in supporting these patients. This study aimed to evaluate nurses’ perceptions towards the delivery and feasibility of the Activate intervention. Methods A qualitative study nested within a cluster-randomised controlled trial using semistructured interviews was conducted and thematically analysed. Fourteen nurses who delivered the Activate intervention participated. Results Three key themes emerged concerning nurses’ perceptions of delivering the intervention: nurses’ engagement towards delivering the intervention; acquiring knowledge and skills; and dealing with adherence to the consultation structure. Three key themes were identified concerning the feasibility of the intervention: expectations towards the use of the intervention in routine practice; perceptions towards the feasibility of the training programme; and enabling personal development. Conclusions Delivering a behaviour change intervention is challenged by the complexity of changing nurses’ consultation style, including acquiring corresponding knowledge and skills. The findings have increased the understanding of the effectiveness of the Activate trial and will guide the development and evaluation of future behaviour change interventions delivered by nurses in primary care. Trial registration ClinicalTrials.gov NCT02725203. Electronic supplementary material The online version of this article (10.1186/s12875-018-0888-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, HP Str. 6.131, PO 85500, 3508, GA, Utrecht, The Netherlands.
| | - Yvonne Koop
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carin D Schröder
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Marieke J Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P Slabbers
- Department of Acute Psychiatry, Psychiatric Center GGZ Central, Amersfoort, The Netherlands
| | - Jaap C A Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, HP Str. 6.131, PO 85500, 3508, GA, Utrecht, The Netherlands
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Mansfield L, Kay T, Anokye N, Fox-Rushby J. A qualitative investigation of the role of sport coaches in designing and delivering a complex community sport intervention for increasing physical activity and improving health. BMC Public Health 2018; 18:1196. [PMID: 30348131 PMCID: PMC6198428 DOI: 10.1186/s12889-018-6089-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/04/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Community sport can potentially help to increase levels of physical activity and improve public health. Sport coaches have a role to play in designing and implementing community sport for health. To equip the community sport workforce with the knowledge and skills to design and deliver sport and empower inactive participants to take part, this study delivered a bespoke training package on public health and recruiting inactive people to community sport for sport coaches. We examined the views of sport coach participants about the training and their role in designing and delivering a complex community sport intervention for increasing physical activity and improving health. METHODS Semi-structured interviews were conducted with paid full-time sport coaches (n = 15) and community sport managers and commissioners (n = 15) with expertise in sport coaching. Interviews were conducted by a skilled interviewer with in-depth understanding of community sport and sport coach training, transcribed verbatim and analysed using thematic analysis. RESULTS Three key themes were identified showing how the role of sport coaches can be maximised in designing and delivering community sport for physical activity and health outcomes, and in empowering participants to take part. The themes were: (1) training sport coaches in understanding public health, (2) public involvement in community sport for health, and (3) building collaborations between community sport and public health sectors. CONCLUSION Training for sport coaches is required to develop understandings of public health and skills in targeting, recruiting and retaining inactive people to community sport. Public involvement in designing community sport is significant in empowering inactive people to take part. Ongoing knowledge exchange activities between the community sport and public health sector are also required in ensuring community sport can increase physical activity and improve public health.
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Affiliation(s)
- Louise Mansfield
- Department of Life Sciences, Brunel University London, Kingston Lane, Uxbridge, Middlesex, UB8 3PH UK
| | - Tess Kay
- Department of Life Sciences, Brunel University London, Kingston Lane, Uxbridge, Middlesex, UB8 3PH UK
| | - Nana Anokye
- Department of Clinical Sciences, Brunel University London, Kingston Lane, Uxbridge, Middlesex, UB8 3PH UK
| | - Julia Fox-Rushby
- Department of Primary Care and Public Health Sciences, King’s College London, Addison House, Guy’s, London, SE1 1UL UK
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Cooke AB, Pace R, Chan D, Rosenberg E, Dasgupta K, Daskalopoulou SS. A qualitative evaluation of a physician-delivered pedometer-based step count prescription strategy with insight from participants and treating physicians. Diabetes Res Clin Pract 2018. [PMID: 29530385 DOI: 10.1016/j.diabres.2018.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIMS The integration of pedometers into clinical practice has the potential to enhance physical activity levels in patients with chronic disease. Our SMARTER randomized controlled trial demonstrated that a physician-delivered step count prescription strategy has measurable effects on daily steps, glycemic control, and insulin resistance in patients with type 2 diabetes and/or hypertension. In this study, we aimed to understand perceived barriers and facilitators influencing successful uptake and sustainability of the strategy, from patient and physician perspectives. METHODS Qualitative in-depth interviews were conducted in a purposive sample of physicians (n = 10) and participants (n = 20), including successful and less successful cases in terms of pedometer-assessed step count improvements. Themes that achieved saturation in either group through thematic analysis are presented. RESULTS All participants appreciated the pedometer-based monitoring combined with step count prescriptions. Accountability to physicians and support offered by the trial coordinator influenced participant motivation. Those who increased step counts adopted strategies to integrate more steps into their routines and were able to overcome weather-related barriers by finding indoor alternative options to outdoor steps. Those who decreased step counts reported difficulty in overcoming weather-related challenges, health limitations and work constraints. Physicians indicated the strategy provided a framework for discussing physical activity and motivating patients, but emphasized the need for support from allied professionals to help deliver the strategy in busy clinical settings. CONCLUSION A physician-delivered step count prescription strategy was feasibly integrated into clinical practice and successful in engaging most patients; however, continual support is needed for maximal engagement and sustained use.
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Affiliation(s)
- Alexandra B Cooke
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Romina Pace
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Deborah Chan
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ellen Rosenberg
- Department of Family Medicine, St. Mary's Hospital, McGill University, Montreal, Quebec, Canada
| | - Kaberi Dasgupta
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Stella S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Physiotherapist-Led Physical Activity Interventions Are Efficacious at Increasing Physical Activity Levels: A Systematic Review and Meta-analysis. Clin J Sport Med 2018; 28:304-315. [PMID: 29064864 DOI: 10.1097/jsm.0000000000000447] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Physical activity (PA) interventions to address noncommunicable disease (NCD) risk are commonly delivered in private practice and outpatient physiotherapy settings. This study reviewed the efficacy of physiotherapist-led physical activity (PLPA) interventions at improving PA levels. DATA SOURCES Twelve databases were searched using terms related to both physiotherapy and PA. English-language studies of all designs in adults were included. Meta-analyses were conducted separately for interventions measuring the following: (1) participants meeting recommended PA levels; (2) total PA at short- and long-term follow-up; and (3) total PA achieved after short and long PLPA interventions. Pooled effects were calculated using a fixed-effects model as standardized mean differences (SMDs). Nonstatistical analysis was used to identify the effect of PLPA interventions on the volume of PA performed at different intensities. MAIN RESULTS From an initial 4140 studies, 8 were retained, and risk of bias ranged from low to high. Meta-analysis showed the odds of adults meeting minimum recommended PA levels were doubled in groups provided a PLPA intervention [OR = 2.15, 95% confidence interval (CI) = 1.35-3.43]. Total PA levels were increased in the short term (SMD = 0.15, 95% CI = 0.03-0.27) but not in the long term. Longer term interventions did not improve outcomes. Nonstatistical analysis identified that PLPA interventions were efficacious at increasing the amount of PA adults performed at all intensities. CONCLUSIONS Clinic-based PLPA interventions delivered in private practice, primary care, and outpatient settings were efficacious at increasing PA in adults at risk of NCDs. Improvements did not last long term and were not enhanced with longer interventions.
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Candy B, Vickerstaff V, Jones L, King M. Description of complex interventions: analysis of changes in reporting in randomised trials since 2002. Trials 2018; 19:110. [PMID: 29467013 PMCID: PMC5822627 DOI: 10.1186/s13063-018-2503-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/15/2018] [Indexed: 11/22/2022] Open
Abstract
Background Inadequate description of non-pharmacological complex interventions in trial publications means that they cannot be replicated or assessed for generalisability. There are published guidelines on how to describe an intervention, such as those from the CONSORT Group. However, there have been few evaluations of whether intervention reporting is improving. Methods We aimed to assess whether descriptions of multicomponent, non-pharmacological interventions evaluated in randomised trials are improving. To do so, we chose trials of educational and psychotherapeutic interventions to promote adherence to therapy, and compared those published between 2002 and 2007 (Time-1) with those between 2010 and 2015 (Time-2). These time periods were chosen to concord with the publication in 2008 of the CONSORT extension statement of reporting guidelines for non-pharmacological treatment which included items on intervention description. We assessed 19 items, based on the CONSORT Statement and the more recent Template for Intervention Description and Replication Checklist (TIDieR). Two reviewers independently extracted data. We created a quality score of the eight items we considered key information for replication and assessment of generalisability (setting, provider, recipient, comparator, intervention intensity, how it was conducted, existence of a manual or protocol, and detail of whether there was an assessment of fidelity). Score per item was ‘1’ if reported adequately and ‘0’ if not. Results Of the eligible trials, 42 were published in Time-1 and 134 published in Time-2. The trials included were published in 112 peer-reviewed journals, 52 of these journals currently require authors to follow the CONSORT Statements, while only one recommended adherence to the TIDieR. Most items of CONSORT and TIDieR were reported by more than half of the trials at both time points. Few trials reported fidelity. A large proportion of the trials did not report the existence of a manual or protocol, or what the comparator group received. We found no statistically significant improvement in the eight-item quality score (Time-1: mean 5.71 (standard deviation (SD) 1.09), Time-2: 5.87 (SD 1.28), p = 0.49). Conclusions We found no overall evidence that reporting the specifics of multicomponent, non-pharmacological interventions is improving. Details to replicate interventions remain lacking, impairing best implementation or meaningful further research. Editorial endorsement of reporting checklists needs to be more extensive.
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Affiliation(s)
- Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Michael King
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Relating process evaluation measures to complex intervention outcomes: findings from the PACE-UP primary care pedometer-based walking trial. Trials 2018; 19:58. [PMID: 29357921 PMCID: PMC5778651 DOI: 10.1186/s13063-017-2428-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The PACE-UP trial demonstrated positive effects of a pedometer-based walking intervention on objective physical activity (PA) outcomes at three and 12 months in 45-75-year-old primary care patients, in postal and nurse-supported trial arms compared with controls. We explored associations between process evaluation measures and change in PA outcomes. METHODS The MRC framework guided process evaluation. Three quantitative measures (nurse session attendance [dose delivered], PA diary completion [fidelity] and pedometer use [fidelity]) were selected as independent variables in multi-level models estimating intervention effectiveness on PA outcomes (changes in step-counts and time in moderate-to-vigorous PA [MVPA] levels in ≥ 10-min bouts). RESULTS Dose: attending all three nurse sessions compared with 0-2 sessions was associated with an increase in steps/day at three and 12 months of 1197 (95% confidence interval [CI] = 627-1766) and 605 (95% CI = 74-1137), respectively; and MVPA in bouts (min/week) at three and 12 months by 74 (95% CI = 45-103) and 30 (95% CI = 3-57), respectively. Fidelity: postal and nurse groups showed strong positive associations of diary return with steps/day at three months: postal 1458 (95% CI = 854-2061), nurse 873 (95% CI = 190-1555). MVPA in bouts (min/week): postal 64 (95% CI = 33-94), nurse 50 (95% CI = 15-85). At 12 months, only the postal group effects remained statistically significant: steps/day 1114 (95% CI = 538-1689), MVPA 47 (95% CI = 18-75). Regular pedometer use in the postal group only was associated with higher three-month and 12-month steps/day: 1029 (95% CI = 383-1675) and 606 (95% CI = 22-1190), respectively, and with MVPA in bouts at three months: 40 (95% CI = 6-73). CONCLUSION Process evaluation measures demonstrated significant associations with PA outcomes at three and 12 months. We cannot infer causality, but the associations between the process measures and PA outcomes suggest that they were important in enabling the trial changes observed and should be considered core components of the PACE-UP nurse and postal interventions. We have shown the MRC framework to be a useful tool for process evaluation of intervention implementation. TRIAL REGISTRATION ISRCTN Registry, ISRCTN98538934 . Registered on 2 March 2012.
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Stephen C, McInnes S, Halcomb E. The feasibility and acceptability of nurse-led chronic disease management interventions in primary care: An integrative review. J Adv Nurs 2017; 74:279-288. [DOI: 10.1111/jan.13450] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Catherine Stephen
- School of Nursing; University of Wollongong; Wollongong NSW Australia
| | - Susan McInnes
- School of Nursing; University of Wollongong; Wollongong NSW Australia
| | - Elizabeth Halcomb
- School of Nursing; University of Wollongong; Wollongong NSW Australia
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Westland H, Bos-Touwen ID, Trappenburg JCA, Schröder CD, de Wit NJ, Schuurmans MJ. Unravelling effectiveness of a nurse-led behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: study protocol for a cluster randomised controlled trial. Trials 2017; 18:79. [PMID: 28228151 PMCID: PMC5322635 DOI: 10.1186/s13063-017-1823-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/06/2017] [Indexed: 11/24/2022] Open
Abstract
Background Self-management interventions are considered effective in patients with chronic disease, but trials have shown inconsistent results, and it is unknown which patients benefit most. Adequate self-management requires behaviour change in both patients and health care providers. Therefore, the Activate intervention was developed with a focus on behaviour change in both patients and nurses. The intervention aims for change in a single self-management behaviour, namely physical activity, in primary care patients at risk for cardiovascular disease. The aim of this study is to evaluate the effectiveness of the Activate intervention. Methods/design A two-arm cluster randomised controlled trial will be conducted to compare the Activate intervention with care as usual at 31 general practices in the Netherlands. Approximately 279 patients at risk for cardiovascular disease will participate. The Activate intervention is developed using the Behaviour Change Wheel and consists of 4 nurse-led consultations in a 3-month period, integrating 17 behaviour change techniques. The Behaviour Change Wheel was also applied to analyse what behaviour change is needed in nurses to deliver the intervention adequately. This resulted in 1-day training and coaching sessions (including 21 behaviour change techniques). The primary outcome is physical activity, measured as the number of minutes of moderate to vigorous physical activity using an accelerometer. Potential effect modifiers are age, body mass index, level of education, social support, depression, patient-provider relationship and baseline number of minutes of physical activity. Data will be collected at baseline and at 3 months and 6 months of follow-up. A process evaluation will be conducted to evaluate the training of nurses, treatment fidelity, and to identify barriers to and facilitators of implementation as well as to assess participants’ satisfaction. Discussion To increase physical activity in patients and to support nurses in delivering the intervention, behaviour change techniques are applied to change behaviours of the patients and nurses. Evaluation of the effectiveness of the intervention, exploration of which patients benefit most, and evaluation of our theory-based training for primary care nurses will enhance understanding of what works and for whom, which is essential for further implementation of self-management in clinical practice. Trial registration ClinicalTrials.gov identifier: NCT02725203. Registered on 25 March 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1823-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost STR 6.131, PO Box 85500, Utrecht, GA, 3508, The Netherlands.
| | - Irene D Bos-Touwen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost STR 6.131, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| | - Jaap C A Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost STR 6.131, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| | - Carin D Schröder
- Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost STR 6.131, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| | - Marieke J Schuurmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost STR 6.131, PO Box 85500, Utrecht, GA, 3508, The Netherlands
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Harris T, Kerry SM, Limb ES, Victor CR, Iliffe S, Ussher M, Whincup PH, Ekelund U, Fox-Rushby J, Furness C, Anokye N, Ibison J, DeWilde S, David L, Howard E, Dale R, Smith J, Cook DG. Effect of a Primary Care Walking Intervention with and without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial. PLoS Med 2017; 14:e1002210. [PMID: 28045890 PMCID: PMC5207642 DOI: 10.1371/journal.pmed.1002210] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/23/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Pedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations. METHODS AND FINDINGS A parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45-75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012-2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in ≥10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329-955) and 677 for nurse support (95% CI 365-989); additional MVPA in bouts (min/wk) were 33 for postal (95% CI 17-49) and 35 for nurse support (95% CI 19-51). There were no significant differences between the two interventions at 12 mo. The 10% (1,023/10,467) recruitment rate was a study limitation. CONCLUSIONS A primary care pedometer-based walking intervention in predominantly inactive 45- to 75-y-olds increased step-counts by about one-tenth and time in MVPA in bouts by about one-third. Nurse and postal delivery achieved similar 12-mo PA outcomes. A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge. CLINICAL TRIAL REGISTRATION isrctn.com ISRCTN98538934.
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Affiliation(s)
- Tess Harris
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Sally M. Kerry
- Pragmatic Clinical Trials Unit, Queen Mary’s University of London, London, United Kingdom
| | - Elizabeth S. Limb
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Christina R. Victor
- Gerontology and Health Services Research Unit, Brunel University, London, United Kingdom
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College, London, United Kingdom
| | - Michael Ussher
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Peter H. Whincup
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Julia Fox-Rushby
- Health Economics Research Group, Brunel, University of London, London, United Kingdom
| | - Cheryl Furness
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Nana Anokye
- Health Economics Research Group, Brunel, University of London, London, United Kingdom
| | - Judith Ibison
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Steve DeWilde
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Lee David
- 10 Minute CBT, Devonshire Business Centre, Letchworth Garden City, United Kingdom
| | - Emma Howard
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Rebecca Dale
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Jaime Smith
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Derek G. Cook
- Population Health Research Institute, St George’s University of London, London, United Kingdom
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Victor CR, Rogers A, Woodcock A, Beighton C, Cook DG, Kerry SM, Iliffe S, Whincup P, Ussher M, Harris TJ. What factors support older people to increase their physical activity levels? An exploratory analysis of the experiences of PACE-Lift trial participants. Arch Gerontol Geriatr 2016; 67:1-6. [PMID: 27394028 PMCID: PMC5019110 DOI: 10.1016/j.archger.2016.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 12/02/2022]
Abstract
A nurse led primary care walking based physical activity (PA) intervention showed increased step counts at 3 and 12 months. We explored the factors that promoted this long-term behaviour change. We selected intervention group participants who increased PA and those who had not to explore facilitators and barriers to behaviour change. We expected the two groups to give contrasting narratives but these did not emerge. The groups differed in the identification of the same factor, eg social support,as either a facilitator or barrier. Participants who sustained increased walking participated in the trial as couple and had a companion to walk with. Those who did not improve lacked these, had higher levels of chronic illness and were more sceptical of the goal setting element of the intervention.
Background Physical Activity (PA) has significant health benefits for older adults, but nearly all UK over 60′s are not achieving recommended levels. The PACE-Lift primary care-based walking intervention for 60–75 year-olds used a structured, theoretically grounded intervention with pedometers, accelerometers, handbooks and support from practice nurses trained in behaviour change techniques. It demonstrated an objective increase in walking at 3 and 12 months. We investigated the experiences of intervention participants who did (and did not) increase their walking, in order to explore facilitators to increased walking. Methods Semi-structured telephone interviews used an interview schedule with a purposive sample of 30 intervention participants, 19 who had objectively increased their walking over the previous year and 11 who had not. Interviews were audio-recorded, transcribed and coded independently by researchers to generate a thematic coding framework. Results Both groups confirmed that walking was an appropriate PA for people of ‘their age’. The majority of those with increased walking participated in the trial as a couple, were positive about individualised goal-setting, developed strategies for maintaining their walking, and had someone to walk with. Non-improvers reported their attempts to increase walking were difficult because of lack of social support and were less positive about the intervention’s behaviour change components. Discussion Walking is an acceptable and appropriate PA intervention for older people. The intervention’s goal-setting components were important for those who increased their walking. Mutual support between partners participating as a couple and having someone to walk with also facilitated increased walking.
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Affiliation(s)
- Christina R Victor
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Middlesex, UB8 3PH, UK.
| | - Annabelle Rogers
- Population Health Research Institute, St George's University of London, SW17 ORE, UK.
| | - Alison Woodcock
- Independent Psychology Research Consultant, Southampton, UK.
| | - Carole Beighton
- Faculty of Health, Social Care & Education, Kingston & St George's, University of London, SW17 ORE, UK.
| | - Derek G Cook
- Population Health Research Institute, St George's University of London, SW17 ORE, UK.
| | - Sally M Kerry
- Pragmatic Clinical Trials Unit, Queen Mary's University of London, E1 2AT, UK.
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College, London NW3 2PF, UK.
| | - Peter Whincup
- Population Health Research Institute, St George's University of London, SW17 ORE, UK.
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, SW17 ORE, UK.
| | - Tess J Harris
- Population Health Research Institute, St George's University of London, SW17 ORE, UK.
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