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Nabuuma D, Ekesa B, Faber M, Mbhenyane X. Designing a Contextualized Food-Based Strategy to Improve the Dietary Diversity of Children in Rural Farming Households in Central Uganda. Food Nutr Bull 2024; 45:24-37. [PMID: 38661354 PMCID: PMC11047017 DOI: 10.1177/03795721241240854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Food-based strategies have a high potential of improving the diet quality and reducing the prevalence of nutrient deficiencies in agriculture-dependent communities. Their design is however complex with trade-offs that are rarely systematically presented to allow replication and efficient contextualization. OBJECTIVE The systematic design of a food-based strategy to improve the dietary diversity of children in rural farming communities in Uganda. METHODS The intervention mapping protocol was used to provide a systematic approach to developing theory-based and evidence-based intervention methods and strategy. RESULTS The priority behavioral and environmental determinants identified were related to food production, consumption, and efficacy while the personal determinants focused on knowledge, skills, self-efficacy, attitude, and outcome expectations. The aim of the resulting strategy was set to improve the availability, accessibility, and consumption of diverse foods, with a particular focus on production diversity, production practices, market access, and market diversity. Behaviour change methods were selected to enhance ability and self-efficacy, strategic goal setting, and provision of feedback. The strategy focused on household groups for learning, demonstration, practice, and social support. The validation showed that the determinants and actors incorporated in the strategy were important and relevant for improving the productivity, food availability, dietary diversity, livelihoods, and health of rural farming households and communities. CONCLUSION Application of the protocol yielded a contextualized food-based strategy that can be adjusted for use in other smallholder contexts in developing countries by piloting implementation plans based on the strategy; reassessing the key determinants and implementing the revised strategy; or replicating the whole design process.
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Affiliation(s)
- Deborah Nabuuma
- Stellenbosch University, Cape Town, South Africa
- Alliance of Bioversity International and CIAT, Penang, Malaysia
| | - Beatrice Ekesa
- Alliance of Bioversity International and CIAT, Kampala, Uganda
| | - Mieke Faber
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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Channon S, Coulman E, Cannings-John R, Henley J, Lau M, Lugg-Widger F, Strange H, Davies F, Sanders J, Scherf C, Couzens Z, Morantz L. Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study. Health Technol Assess 2023; 27:1-224. [PMID: 36688498 PMCID: PMC9885302 DOI: 10.3310/nkix8285] [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: 01/24/2023] Open
Abstract
BACKGROUND Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention. OBJECTIVES The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention. DESIGN This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data. PARTICIPANTS The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception. SETTING UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media. DATA SOURCES Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders. RESULTS The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined. LIMITATIONS There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative. CONCLUSIONS An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners. FUTURE WORK Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority. TRIAL REGISTRATION This trial is registered as ISRCTN14733020. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.
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Affiliation(s)
- Susan Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Josie Henley
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Freya Davies
- The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Caroline Scherf
- Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
| | - Zoë Couzens
- Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
| | - Leah Morantz
- 1Centre for Trials Research, Cardiff University, Cardiff, UK
- 2The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
- 3School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- 4Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
- 5Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
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Blewitt C, Savaglio M, Madden SK, Meechan D, O’Connor A, Skouteris H, Hill B. Using Intervention Mapping to Develop a Workplace Digital Health Intervention for Preconception, Pregnant, and Postpartum Women: The Health in Planning, Pregnancy and Postpartum (HiPPP) Portal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15078. [PMID: 36429795 PMCID: PMC9690929 DOI: 10.3390/ijerph192215078] [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: 10/09/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Digital health interventions that specifically target working women across the preconception, pregnancy and postpartum (PPP) life stages may address the unique barriers to engaging in healthy lifestyle behaviours and self-care during this life phase. This paper describes the development of a workplace digital health intervention to promote healthy lifestyles and wellbeing for PPP women working at a community service organization in Australia. Intervention Mapping is a framework that guides program development, implementation, and evaluation. Steps 1 to 5 of Intervention Mapping methodology (needs assessment through to program implementation) were used, including identification of determinants and change objectives across socioecological levels (i.e., individual, interpersonal, and organisational) and iterative co-design and stakeholder engagement processes. The workplace digital health intervention was successfully developed and implemented as an online portal. Content included key strategies, information, and supports to promote health and wellbeing across PPP, including supporting the return to work in the postpartum period. Examples of resource pages included a parental leave checklist, process flows, Pride resources, and Aboriginal and Torres Strait Islander resources. Findings from a pilot feasibility study indicate the portal was accessible and beneficial for women in PPP life stages. The Intervention Mapping protocol may offer a valuable roadmap for collaborative design of interventions targeting PPP women's behaviour and organisational work culture. Future work is needed to evaluate whether such interventions lead to improvements in women's health and wellbeing.
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Affiliation(s)
- Claire Blewitt
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Melissa Savaglio
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Seonad K. Madden
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia
| | - Donna Meechan
- MacKillop Family Services, South Melbourne, VIC 3205, Australia
| | - Amanda O’Connor
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Hanafiah AN, Aagaard-Hansen J, Ch Cheah J, Norris SA, Karim ZB, Skau JK, Ali ZM, Biesma R, Matzen P, Sulaiman LH, Hanson M. Effectiveness of a complex, pre-conception intervention to reduce the risk of diabetes by reducing adiposity in young adults in Malaysia: The Jom Mama project - A randomised controlled trial. J Glob Health 2022; 12:04053. [PMID: 35972832 PMCID: PMC9380849 DOI: 10.7189/jogh.12.04053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Pre-conception interventions have the potential to lower non-communicable disease risk in prospective parents and reduce transmission of risk factors such as obesity to the next generation. The Jom Mama project in Malaysia investigated the effectiveness of a combined behaviour change communication and e-health intervention in young married couples prior to first pregnancy. This paper reports the evaluation of the effectiveness of this trial. Methods Jom Mama was a non-blinded, randomised controlled trial (RCT) conducted in Seremban, Malaysia, over a period of 33 weeks, covering six contact points between trained community health workers and newly married couples before the conception of a first child. Out of 2075 eligible nulliparous women, 549 participated and 305 completed the intervention, with 145 women in the intervention and 160 in the control group. The intervention group received a complex behavioural change intervention, combining behaviour change communication provided by community health promoters and access to a habit formation mobile application, while the control group received the standard care provided by public health clinics in Malaysia. The primary outcome was a change in the woman’s waist circumference. Secondary outcomes were anthropometric and metabolic measures, dietary intake (Food Frequency Questionnaire, FFQ), physical activity (International Physical Activity Questionnaire, IPAQ) and mental health (Depression Anxiety Stress Scale, DASS 21). An extensive process evaluation was conducted alongside the trial in order to aid the interpretation of the main findings. Results There were no significant differences of change in the woman’s waist circumference between intervention and control groups at the start and end of the intervention. While the weight, waist circumference and Body Mass Index (BMI) of women in both groups increased, there was a significantly lower increase in the intervention vs the control group over the period of the trial among women who are obese (0.1 kg vs 1.7 kg; P = 0.023, in the intervention and control group respectively). In terms of BMI, the obese intervention subgroup showed a slight reduction (0.01) compared to the obese control subgroup whose BMI increased by 0.7 (P = 0.015). There were no changes in the other secondary outcomes. Conclusions The Jom Mama pre-conception intervention did not lead to a reduction in waist circumference or significant changes in other secondary outcomes over the eight months prior to conception. However, there was a significantly smaller weight gain in the intervention vs the control group, predominantly in women with pre-existing obesity.
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Affiliation(s)
- Ainul Nm Hanafiah
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Jens Aagaard-Hansen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.,SA MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Julius Ch Cheah
- School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Shane A Norris
- SA MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zulkarnain Ba Karim
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Jutta Kh Skau
- SA MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zainudin M Ali
- Negeri Sembilan State Health Department, Seremban, Negeri Sembilan, Malaysia.,Universiti Teknologi Malaysia Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, Faculty of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Priya Matzen
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lokman H Sulaiman
- Office of the Deputy Director General of Health (Public Health), Ministry of Health, Putrajaya, Malaysia.,Institute for Research, Development and Innovation, International Medical University Malaysia, Kuala Lumpur, Malaysia
| | - Mark Hanson
- Institute of Developmental Sciences, British Heart Foundation Professor of Cardiovascular Sciences, Faculty of Medicine and NIHR Biomedical Research Centre, University of Southampton, Southampton, UK
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"Is the health system ready?" A qualitative exploration of stakeholders' opinions about the feasibility of preconception care services in the Nigerian health system. Reprod Health 2022; 19:153. [PMID: 35768811 PMCID: PMC9245213 DOI: 10.1186/s12978-022-01454-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Preconception care (PCC) services aim to improve reproductive health outcomes through the provision of biomedical, behavioural and social health interventions to women and couples before conception occurs. Countries that have deployed PCC services have policies that guide the services provided. In Nigeria, PCC is poorly developed and is often provided in an opportunistic manner with no guidelines in place to direct the provision. This study explored the opinions of policymakers and health workers about the feasibility of deploying PCC services in the country. Methods This study was a qualitative exploration of opinions about PCC service deployment within the Nigerian health system in which 39 in-depth interviews were conducted with policymakers at the federal and state tiers of government as well as health workers at the tertiary, secondary and primary levels of health care. The transcripts were analysed thematically using a hybrid of deductive and inductive coding on MAXQDA 2018 qualitative data analysis software. Results Four main themes emerged from the data—issues around policy for PCC, service integration and collaboration, health system readiness and challenges to PCC service deployment. While noting that the country has no PCC policy, participants identified existing policies into which PCC can be integrated. The participants also described the importance of policy to PCC provision and provided information on existing collaborations that can help the policy development and implementation process. Although many of the participants believed the health system is prepared for PCC deployment, they identified challenges related to policy formulation and implementation, including financial challenges that could hinder the process. Conclusion Deployment of PCC services in the Nigerian health system is achievable as there are existing health-related policies into which the guidelines can be integrated. However, there is a need to consider the possible implementation challenges and address them as part of the planning process. Optimising the health of women and men in preparation for childbearing can influence pregnancy outcomes positively. This optimisation can be achieved through the provision of preconception care. In many low- and middle-income countries including Nigeria, preconception care is provided in a haphazard manner with no guidelines to structure the service. In this article, the findings from discussions with health care providers and policymakers in Nigeria are presented. These findings show that preconception care can be deployed in a structured manner through collaboration between health care providers and integration with the existing maternal and child health services. Guiding policies can be provided by inclusion of preconception care in the existing health-related policies in the country.
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Sharif SM, Hanson M, Chong DW, Hanafiah ANM, Zulkepli MZ, Zulbahari SF, Skau J, Ho JCC, Matzen P, Biesma R, Norris SA, Aagaard-Hansen J. Learning from the process evaluation of a complex, pre-conception randomised controlled trial in Malaysia: the Jom Mama project. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.34228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Seen from a life-course perspective, pre-conception interventions are essential to reduce transmission to the next generation of obesity as a risk factor for later non-communicable diseases. The Malaysian Jom Mama project investigated the effectiveness of a combined behaviour change communication and e-health intervention in young married couples prior to first pregnancy. This paper reports on the extensive process evaluation (PE) that accompanied the Jom Mama trial. Methods In accordance with the realistic evaluation approach, a programme theory was developed for the Jom Mama project, based on key functions selected for six PE sub-studies, namely: recruitment; attrition; behaviour change communication (BCC); e-health (the Jom app); peer-support for community health promoters (CHPs); and contextual factors. The results of the first four sub-studies are reported here. Three cycles of data collection were conducted based on triangulation and a mixed-methods approach. Results The findings permitted distinguishing between theory and implementation challenges in interpreting the outcome of the Jom Mama trial.1 Recruitment and attrition proved to be challenges, and although the PE allowed Jom Mama investigators to improve procedures in order to achieve a sufficient sample size, it also has implications for engaging this age group in future pre-conception interventions. PE sub-studies showed that there were challenges in applying the BCC, and that the uptake of the Jom app varied. In one way this can be seen as an indication of limited fidelity, but it also leads to questions about how best to change the communication culture within the Malaysian health care system. Conclusions The Jom Mama PE highlighted the challenges of recruiting newly-wed couples for a pre-conception intervention. Despite thorough intervention development preparations, the PE revealed the difficulty of lifestyle behaviour change through Malaysian community health wokers who were trained on new communication strategies combined with e-health solutions, and that six intervention sessions of eight months do not constitute a sufficient dose to affect change. <div style=“page-break-after: always;”></div>
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Affiliation(s)
- Shakirah Md. Sharif
- National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Mark Hanson
- British Heart Foundation Professor of Cardiovascular Sciences, Faculty of Medicine and NIHR Biomedical Research Centre, University of Southampton, UK
| | - Diane W. Chong
- National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | | | - Mohamad Z. Zulkepli
- National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | | | - Jutta Skau
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | | | - Priya Matzen
- Faculty of Medicine, University of Southampton, UK
| | - Regien Biesma
- Faculty of Medical Sciences, University Medical Center, Groningen, the Netherlands
| | - Shane A. Norris
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Jens Aagaard-Hansen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark; SA MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ojifinni OO, Ibisomi L. Preconception care practices in Nigeria: a descriptive qualitative study. Reprod Health 2020; 17:172. [PMID: 33148313 PMCID: PMC7640668 DOI: 10.1186/s12978-020-01030-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Preconception care is a specialized care targeted at women of reproductive age before pregnancy to detect, treat or counsel them about pre-existing medical and social conditions that may militate against safe motherhood and positive pregnancy outcome. In spite of the known need for preconception care in Nigeria, routine preconception care services are not available in the country. This study explores existing preconception care practices in the country in order to encourage building on it and formalising it for inclusion in routine maternal and child health services in the country. Methods Forty-one in-depth interviews and 10 focus group discussions were conducted in this descriptive qualitative study to explore the existing preconception care services from the perspectives of community members (women and men in the reproductive age group), community and religious leaders, health care professionals as well as policy makers. Thematic analysis was carried out using MAXQDA 2018. Results Participants stated that there are no defined preconception care services in the health care system nor are there any structures or guidelines for preconception care in the country. Preconception care services are however provided when health workers perceive a need or when clients demand for it. The services provided include health information, education and counselling, treatment modification, medical check-up and screening. Outside of the health system, there are some traditional, religious and other practices with similar bearing to preconception care which the participants believed could be included as preconception care services. These include premarital counselling services by religious bodies, family life and HIV education within the secondary school system and some screening and outreach services provided by non-governmental and some governmental agencies. Conclusion There is a need to provide structure and guidelines for preconception care services in the country so that the services can be properly streamlined. This structure can also involve practices that are currently not within the health system.
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Affiliation(s)
| | - Latifat Ibisomi
- Division of Epidemiology and Biostatistics, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Nigerian Institute of Medical Research, Lagos, Nigeria
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Chen Y, Wu F, Wu Y, Li J, Yue P, Deng Y, Lamb KV, Fong S, Liu Y, Zhang Y. Development of interventions for an intelligent and individualized mobile health care system to promote healthy diet and physical activity: using an intervention mapping framework. BMC Public Health 2019; 19:1311. [PMID: 31623589 PMCID: PMC6798431 DOI: 10.1186/s12889-019-7639-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/16/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The mortality of coronary heart disease can be largely reduced by modifying unhealthy lifestyles. However, the long-term effectiveness of interventions for modifying unhealthy diet and physical inactivity of patients with coronary heart disease remain unsatisfactory worldwide. This study aims to systematically design a set of theory-based and evidence-based, individualized, and intelligent interventions for promoting the adoption and maintenance of a healthy diet and physical activity level in patients with coronary heart disease. METHODS The interventions will be delivered by a mobile health care system called Individualized, Intelligent and Integrated Cardiovascular Application for Risk Elimination. Three steps of the intervention mapping framework were used to systematically develop the interventions. Step 1: needs assessment, which was carried out by a literature review, in-depth interviews and focus group discussions. Step 2: development of objective matrix for diet and physical activity changes, based on the intersection of objectives and determinants from the Contemplation-Action-Maintenance behavior change model. Step 3: formulation of evidence-based methods and strategies, and practical applications, through a systematic review of existing literature, research team discussions, and consultation with multidisciplinary expert panels. RESULTS Three needs relevant to content of the intervention, one need relevant to presentation modes of the intervention, and four needs relevant to functional features of the application were identified. The objective matrix includes three performance objectives, and 24 proximal performance objectives. The evidence-based and theory-based interventions include 31 strategies, 61 evidence-based methods, and 393 practical applications. CONCLUSIONS This article describes the development of theory-based and evidence-based interventions of the mobile health care system for promoting the adoption and maintenance of a healthy diet and physical activity level in a structured format. The results will provide a theoretical and methodological basis to explore the application of intervention mapping in developing effective behavioral mobile health interventions for patients with coronary heart disease. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR-INR-16010242. Registered 24 December 2016. http://www.chictr.org.cn/index.aspx.
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Affiliation(s)
- Yuling Chen
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069 China
| | - Fangqin Wu
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069 China
| | - Ying Wu
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069 China
| | - Jia Li
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069 China
| | - Peng Yue
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069 China
| | - Ying Deng
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069 China
| | - Karen V. Lamb
- Department of Adult Health Gerontological Nursing Rush University IL, Chicago, CA 60613 USA
| | - Simon Fong
- Department of Computer and Information Science, University of Macau, Macau, China
| | - Yisi Liu
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069 China
| | - Yan Zhang
- School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069 China
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Mirghafourvand M, Babapour J, Mohammad-Alizadeh-Charandabi S, Ghasemi Yngyknd S. The effect of preconception counselling on health locus of control and stress in Iranian women: a randomized control trial. Women Health 2019; 60:314-329. [PMID: 31216955 DOI: 10.1080/03630242.2019.1626790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Preconception counseling can improve women's health and pregnancy outcomes. Internal health locus of control and belief in the benefits of health-promoting behaviors improve people's engagement in health-promoting behaviors. This study examined whether preconception counseling was related to stress and health locus of control. This randomized controlled trial was conducted from March to November 2016 on 152 healthy 18-35-year-old women intending to become pregnant within the next year in Iran. The intervention group received six sessions of group counseling, and the control group received only usual care. The Perceived Stress Scale, Multidimensional Health Locus of Control Scales and checklist for preconception control were completed before and after the intervention. Repeated measures ANOVA showed a significant post-intervention increase in the mean internal health locus of control (P < .001) and preconception control scores (P = .034) in the intervention group and the mean perceived stress score (P = .001), and chance health locus of control (P = .013) decreased significantly. Preconception counseling was associated with increased internal locus of control and reduced perceived stress. Preconception counselors should consider reinforcing women's internal beliefs with an emphasis on the effect of the couple's own behaviors and exposures on pregnancy and fetal outcomes.
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Affiliation(s)
- Mojgan Mirghafourvand
- Social Determinants of Health Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Sakineh Ghasemi Yngyknd
- Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Majid U, Kim C, Cako A, Gagliardi AR. Engaging stakeholders in the co-development of programs or interventions using Intervention Mapping: A scoping review. PLoS One 2018; 13:e0209826. [PMID: 30586425 PMCID: PMC6306258 DOI: 10.1371/journal.pone.0209826] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/12/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Health care innovations tailored to stakeholder context are more readily adopted. This study aimed to describe how Intervention Mapping (IM) was used to design health care innovations and how stakeholders were involved. METHODS A scoping review was conducted. MEDLINE, EMBASE, Cochrane Library, Scopus and Science Citation Index were searched from 2008 to November 2017. English language studies that used or cited Intervention Mapping were eligible. Screening and data extraction were done in triplicate. Summary statistics were used to describe study characteristics, IM steps employed, and stakeholder involvement. RESULTS A total of 852 studies were identified, 449 were unique, and 333 were excluded based on title and abstracts, 116 full-text articles were considered and 61 articles representing 60 studies from 13 countries for a variety of clinical issues were included. The number of studies published per year increased since 2008 and doubled in 2016 and 2017. The majority of studies employed multiple research methods (76.7%) and all 6 IM steps (73.3%). Resulting programs/interventions were single (55.4%) or multifaceted (46.4%), and 60.7% were pilot-tested. Programs or interventions were largely educational material or meetings, and were targeted to patients (70.2%), clinicians (14.0%) or both (15.8%). Studies provided few details about current or planned evaluation. Of the 4 (9.3%) studies that reported impact or outcomes, 3 achieved positive improvements in patient or professional behaviour or patient outcomes. Many studies (28.3%) did not involve stakeholders. Those that did (71.7%) often involved a combination of patients, clinicians, and community organizations. However, less than half (48.8%) described how they were engaged. Most often stakeholders were committee members and provide feedback on program or intervention content or format. CONCLUSIONS It is unclear if use of IM or stakeholder engagement in IM consistently results in effective programs or interventions. Those employing IM should report how stakeholders were involved in each IM step and how involvement influenced program or intervention design. They should also report the details or absence of planned evaluation. Future research should investigate how to optimize stakeholder engagement in IM, and whether use of IM itself or stakeholder engagement in IM are positively associated with effective programs or interventions.
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Affiliation(s)
- Umair Majid
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Claire Kim
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Albina Cako
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anna R. Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Cheong SM, Mohamad Nor NS, Ahmad MH, Manickam M, Ambak R, Shahrir SN, Aris T. Improvement of health literacy and intervention measurements among low socio-economic status women: findings from the MyBFF@home study. BMC WOMENS HEALTH 2018; 18:99. [PMID: 30066659 PMCID: PMC6069691 DOI: 10.1186/s12905-018-0596-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Health literacy (HL) consists of different components and associates with several health outcomes, including obesity. It is linked to an individual’s knowledge, motivation, competencies, behavior, and application to everyday life. The present study aimed to determine the change of HL scores and to investigate the difference of intervention outcomes at the weight loss (WL) intervention and WL maintenance phase between the HL groups. Methods A total of 322 participants from the MyBFF@home study completed the Newest Vital Sign (NVS) test at baseline. However, only data from 209 participants who completed the NVS test from baseline to WL intervention were used to determine the HL groups. Change of the NVS scores from baseline to WL intervention phase was categorized into two groups: those with HL improvement (increased 0.1 score and above) and those without HL improvement (no change or decreased 0.1 score and more). Independent variables in this study were change of energy intake, nutrient intake, physical activity, anthropometry measurements, and body composition measurements between baseline and WL intervention as well as between WL intervention and WL maintenance. An Independent sample t-test was used in the statistical analysis. Results In general, both intervention and control participants have low HL. The study revealed that the intervention group increased the NVS mean score from baseline (1.19 scores) to the end of the WL maintenance phase (1.51 scores) compared to the control group. There was no significant difference in sociodemographic characteristics between the group with HL improvement and the group without HL improvement at baseline. Most of the dietary intake measurements at WL intervention were significantly different between the two HL groups among intervention participants. Physical activity and body composition did not differ significantly between the two HL groups among both intervention and control groups. Conclusion There was an improvement of HL during the WL intervention and WL maintenance phase in intervention participants compared to control participants. HL shows positive impacts on dietary intake behavior among intervention participants. New research is suggested to explore the relationship between HL and weight loss behaviors in future obesity intervention studies.
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Affiliation(s)
- Siew Man Cheong
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Centre for Nutrition Epidemiology Research, Jalan Bangsar, 50590, Kuala Lumpur, Malaysia.
| | - Noor Safiza Mohamad Nor
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Centre for Nutrition Epidemiology Research, Jalan Bangsar, 50590, Kuala Lumpur, Malaysia
| | - Mohamad Hasnan Ahmad
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Centre for Nutrition Epidemiology Research, Jalan Bangsar, 50590, Kuala Lumpur, Malaysia
| | - Mala Manickam
- Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kem Sungai Besi, Kuala Lumpur, Malaysia
| | - Rashidah Ambak
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Centre for Nutrition Epidemiology Research, Jalan Bangsar, 50590, Kuala Lumpur, Malaysia
| | - Siti Nurbaya Shahrir
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Tahir Aris
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Centre for Nutrition Epidemiology Research, Jalan Bangsar, 50590, Kuala Lumpur, Malaysia
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12
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Barker M, Dombrowski SU, Colbourn T, Fall CHD, Kriznik NM, Lawrence WT, Norris SA, Ngaiza G, Patel D, Skordis-Worrall J, Sniehotta FF, Steegers-Theunissen R, Vogel C, Woods-Townsend K, Stephenson J. Intervention strategies to improve nutrition and health behaviours before conception. Lancet 2018; 391:1853-1864. [PMID: 29673875 PMCID: PMC6075694 DOI: 10.1016/s0140-6736(18)30313-1] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/03/2017] [Accepted: 01/31/2018] [Indexed: 12/11/2022]
Abstract
The nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions. On the basis of these strategies, we suggest a model specifying pathways to effect. Pathways are incorporated into a life-course framework using individual motivation and receptiveness at different preconception action phases, to guide design and targeting of preconception interventions. Interventions for individuals not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women's nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population. We propose a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Modern marketing techniques could be used to promote a social movement based on an emotional and symbolic connection between improved preconception maternal health and nutrition, and offspring health. We suggest that speedy and scalable benefits to public health might be achieved through strategic engagement with the private sector. Political theory supports the development of an advocacy coalition of groups interested in preconception health, to harness the political will and leadership necessary to turn high-level policy into effective coordinated action.
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Affiliation(s)
- Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Stephan U Dombrowski
- Faculty of Natural Sciences, Division of Psychology, University of Stirling, Stirling, UK
| | - Tim Colbourn
- UCL Institute for Global Health, University College London, London, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Natasha M Kriznik
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Wendy T Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Shane A Norris
- MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gloria Ngaiza
- UCL Institute for Global Health, University College London, London, UK
| | - Dilisha Patel
- UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | | | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University and Fuse, the UK Clinical Research Collaboration Centre of Excellence for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Régine Steegers-Theunissen
- Department of Obstetrics and Gynaecology, and Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK; Southampton Education School, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Judith Stephenson
- UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.
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