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Novak J, Jurkova K, Lojkaskova A, Jaklova A, Kuhnova J, Pfeiferova M, Kral N, Janek M, Omcirk D, Malisova K, Maes I, Dyck DV, Wahlich C, Ussher M, Elavsky S, Cimler R, Pelclova J, Tufano JJ, Steffl M, Seifert B, Yates T, Harris T, Vetrovsky T. Participatory development of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED). BMC Public Health 2024; 24:927. [PMID: 38556892 PMCID: PMC10983629 DOI: 10.1186/s12889-024-18384-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The escalating global prevalence of type 2 diabetes and prediabetes presents a major public health challenge. Physical activity plays a critical role in managing (pre)diabetes; however, adherence to physical activity recommendations remains low. The ENERGISED trial was designed to address these challenges by integrating mHealth tools into the routine practice of general practitioners, aiming for a significant, scalable impact in (pre)diabetes patient care through increased physical activity and reduced sedentary behaviour. METHODS The mHealth intervention for the ENERGISED trial was developed according to the mHealth development and evaluation framework, which includes the active participation of (pre)diabetes patients. This iterative process encompasses four sequential phases: (a) conceptualisation to identify key aspects of the intervention; (b) formative research including two focus groups with (pre)diabetes patients (n = 14) to tailor the intervention to the needs and preferences of the target population; (c) pre-testing using think-aloud patient interviews (n = 7) to optimise the intervention components; and (d) piloting (n = 10) to refine the intervention to its final form. RESULTS The final intervention comprises six types of text messages, each embodying different behaviour change techniques. Some of the messages, such as those providing interim reviews of the patients' weekly step goal or feedback on their weekly performance, are delivered at fixed times of the week. Others are triggered just in time by specific physical behaviour events as detected by the Fitbit activity tracker: for example, prompts to increase walking pace are triggered after 5 min of continuous walking; and prompts to interrupt sitting following 30 min of uninterrupted sitting. For patients without a smartphone or reliable internet connection, the intervention is adapted to ensure inclusivity. Patients receive on average three to six messages per week for 12 months. During the first six months, the text messaging is supplemented with monthly phone counselling to enable personalisation of the intervention, assistance with technical issues, and enhancement of adherence. CONCLUSIONS The participatory development of the ENERGISED mHealth intervention, incorporating just-in-time prompts, has the potential to significantly enhance the capacity of general practitioners for personalised behavioural counselling on physical activity in (pre)diabetes patients, with implications for broader applications in primary care.
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Grants
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
- NU21-09-00007 Czech Health Research Council, Ministry of Health of the Czech Republic
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Affiliation(s)
- Jan Novak
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Katerina Jurkova
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Anna Lojkaskova
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Andrea Jaklova
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Jitka Kuhnova
- Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Marketa Pfeiferova
- Institute of General Practice, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Norbert Kral
- Institute of General Practice, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael Janek
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Dan Omcirk
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Katerina Malisova
- Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Iris Maes
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Delfien Van Dyck
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Charlotte Wahlich
- Population Health Research Institute, St George's University of London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Steriani Elavsky
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Richard Cimler
- Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jana Pelclova
- Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - James J Tufano
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Michal Steffl
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Bohumil Seifert
- Institute of General Practice, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Tess Harris
- Population Health Research Institute, St George's University of London, London, UK
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic.
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Silva CS, Godinho C, Encantado J, Rodrigues B, Carraça EV, Teixeira PJ, Silva MN. Implementation determinants of physical activity interventions in primary health care settings using the TICD framework: a systematic review. BMC Health Serv Res 2023; 23:1082. [PMID: 37821932 PMCID: PMC10568782 DOI: 10.1186/s12913-023-09881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/07/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Translation into practice of effective physical activity interventions in primary care is difficult, due to a complex interaction of implementation determinants. We aimed to identify implementation barriers and facilitators of four primary care interventions: physical activity assessment, counselling, prescription, and referral. METHODS A systematic review of qualitative, quantitative and mixed-methods studies published since 2016 was conducted. The "Tailored Implementation for Chronic Diseases" (TICD) framework was adapted to extract and synthesize barriers and facilitators. RESULTS Sixty-two studies met the inclusion criteria. Barriers (n = 56) and facilitators (n = 55) were identified across seven domains, related to characteristics of the intervention, individual factors of the implementers and receivers, organizational factors, and political and social determinants. The five most frequently reported determinants were: professionals' knowledge and skills; intervention feasibility/compatibility with primary health care routine; interventions' cost and financial incentives; tools and materials; and professionals' cognitions and attitudes. "Social, political and legal factors" domain was the least reported. Physical activity counselling, prescription, and referral were influenced by determinants belonging to all the seven domains. CONCLUSION The implementation of physical activity interventions in primary care is influenced by a broader range of determinants. Barriers and facilitators related with health professionals, intervention characteristics, and available resources were the most frequently reported. A deep understanding of the local context, with particularly emphasis on these determinants, should be considered when preparing an intervention implementation, in order to contribute for designing tailored implementation strategies and optimize the interventions' effectiveness.
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Affiliation(s)
- Catarina Santos Silva
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal.
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal.
| | - Cristina Godinho
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisboa, Portugal
| | - Jorge Encantado
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Bruno Rodrigues
- CIAFEL, Faculdade de Desporto da Universidade Do Porto, Porto, Portugal
| | - Eliana V Carraça
- CIDEFES, Centro de Investigação em Desporto, Educação Física, Exercício e Saúde, Universidade Lusófona, Lisboa, Portugal
| | - Pedro J Teixeira
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Marlene Nunes Silva
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal
- CIDEFES, Centro de Investigação em Desporto, Educação Física, Exercício e Saúde, Universidade Lusófona, Lisboa, Portugal
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Patel T, Umeh K, Poole H, Vaja I, Ramtoola S, Newson L. Health professionals interface with cultural conflict in the delivery of type 2 diabetes care. Psychol Health 2023; 38:230-248. [PMID: 34351821 DOI: 10.1080/08870446.2021.1960346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D). DESIGN Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings. MAIN OUTCOME MEASURES Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients. RESULTS A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience. CONCLUSIONS The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients.
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Affiliation(s)
- Tasneem Patel
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Kanayo Umeh
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Helen Poole
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Ishfaq Vaja
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Shenaz Ramtoola
- Endocrinology and Metabolic Medicine, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
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Aldridge WA, Roppolo RH, Brown J, Bumbarger BK, Boothroyd RI. Mechanisms of change in external implementation support: A conceptual model and case examples to guide research and practice. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231179761. [PMID: 37790181 PMCID: PMC10291867 DOI: 10.1177/26334895231179761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background External implementation support (EIS) is a well-recognized feature of implementation science and practice, often under related terms such as technical assistance and implementation facilitation. Existing models of EIS have gaps related to addressing practice outcomes at both individual and organizational levels, connecting practice activities to intended outcomes, or grounding in well-established theories of behavior and organization change. Moreover, there have been calls to clarify the mechanisms of change through which EIS influences related outcomes. Method In this article, we theorize about mechanisms of change within EIS. Our theorizing process aligns with the approach advocated by Kislov et al. We aim to consolidate prior EIS literature, combining related constructs from previous empirical and conceptual work while drawing on our extensive EIS experience to develop a higher-order, midrange theory of change. Results Our theory of change is empirically and practically informed, conceptually situated within an established grand theory of change, and guided by eight practice principles and social cognitive theory. The theory of change proposes 10 core practice components as mechanisms of change within EIS. When used according to underlying theory and principles, they are believed to contribute to favorable practice outcomes at individual, team, organizational, and system levels. The model offers flexibility by recognizing the need for sequential support processes and the demand to practice in dynamic and responsive ways. Case examples are presented to illustrate major themes and patterns of the model in action. Conclusions The proposed model is intended to support prospective EIS studies by conceptualizing discernable practice components with hypothesized relationships to proximal and distal practice outcomes. The model can be behaviorally operationalized to compliment and extend competency-based approaches to implementation support practitioner (ISP) training and coaching. Over time, the model should be refined based on new empirical findings and contributions from ISPs across the field.
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Affiliation(s)
- William A. Aldridge
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca H. Roppolo
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Brian K. Bumbarger
- Griffith Criminology Institute, Griffith University, Mount Gravatt, Queensland, Australia
| | - Renée I. Boothroyd
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Applying the PDSA cycle to a group activity promoting lifestyle change for the active ageing of older Thai adults - a focused ethnography. BMC Geriatr 2022; 22:117. [PMID: 35148688 PMCID: PMC8840556 DOI: 10.1186/s12877-022-02775-4] [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: 05/28/2021] [Accepted: 01/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background The proportion of the older Thai population is increasing rapidly. Lifestyle may impact active ageing in later life. Interventions that empower older Thai adults to initiate and carry out lifestyle changes are needed. This study applied the Plan-Do-Study-Act (PDSA) cycle, a tool for improving lifestyle changes, with the aim of exploring interactions among older Thai adults when participating in group activities. Method Focused ethnography was used based on participant observations, field notes and video recordings of 15 older Thai adults aged 62–78 years. Results Older Thai adults faced difficulties at the beginning since they were unfamiliar with initiating and carrying out lifestyle changes according to the PDSA concept. This provided a learning opportunity enabling older Thai adults to reach their individual goals of lifestyle change. Conclusions The PDSA cycle has the potential to empower older adults in group contexts to promote lifestyle changes related to active ageing.
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Law RJ, Langley J, Hall B, Burton C, Hiscock J, Williams L, Morrison V, Lemmey AB, Lovell-Smith C, Gallanders J, Cooney J, Williams NH. Promoting physical activity and physical function in people with long-term conditions in primary care: the Function First realist synthesis with co-design. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain.
Objectives
To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention.
Data sources
Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews.
Design
Realist evidence synthesis and co-design for primary care service innovation.
Setting
Primary care in Wales and England.
Participants
Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers.
Methods
The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation.
Results
Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change.
Limitations
Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts.
Conclusions
We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention.
Future work
A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial.
Study registration
This study is registered as PROSPERO CRD42018103027.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Julia Hiscock
- School of Health Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Health Sciences, Bangor University, Bangor, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew B Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | - Jennifer Cooney
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Nefyn H Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Law RJ, Langley J, Hall B, Burton C, Hiscock J, Williams L, Morrison V, Lemmey A, Lovell-Smith C, Gallanders J, Cooney JK, Williams N. 'Function First': how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods. BMJ Open 2021; 11:e046751. [PMID: 34315792 PMCID: PMC8317101 DOI: 10.1136/bmjopen-2020-046751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory. DESIGN Realist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation. RESULTS A taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions. ABRIDGED REALIST PROGRAMME THEORY Routinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy. CO-DESIGN The programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff; describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active; and provide materials to support behaviour change. CONCLUSIONS Previous physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including implications relevant to COVID-19), and testing in a future study. The integration of realist and co-design methods strengthened this study.
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Affiliation(s)
- Rebecca-Jane Law
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | | | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Julia Hiscock
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | | | - Nefyn Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Knittle K, Charman SJ, O'Connell S, Avery L, Catt M, Sniehotta FF, Trenell MI. Movement as medicine for cardiovascular disease prevention: A pilot feasibility study of a physical activity promotion intervention for at-risk patients in primary care (Preprint). JMIR Cardio 2021; 6:e29035. [PMID: 35767316 PMCID: PMC9280491 DOI: 10.2196/29035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/08/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions Trial Registration
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Affiliation(s)
- Keegan Knittle
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah J Charman
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sophie O'Connell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - Leah Avery
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- School of Health & Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Michael Catt
- National Innovation Centre for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Falko F Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael I Trenell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Al-Ghafri TS, Al-Harthi S, Al-Farsi Y, Craigie AM, Bannerman E, Anderson AS. Changes in Self-Efficacy and Social Support after an Intervention to Increase Physical Activity Among Adults with Type 2 Diabetes in Oman: A 12-month follow-up of the MOVEdiabetes trial. Sultan Qaboos Univ Med J 2021; 21:e42-e49. [PMID: 33777422 PMCID: PMC7968896 DOI: 10.18295/squmj.2021.21.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/21/2020] [Accepted: 06/10/2020] [Indexed: 12/05/2022] Open
Abstract
Objectives This study aimed to describe changes in self-efficacy (SE) and social support (SS) 12 months after the MOVEdiabetes trial, an intervention designed to increase physical activity (PA) among adults with type 2 diabetes mellitus in Oman. Methods The original MOVEdiabetes trial was conducted between April 2016 and June 2017 in Muscat, Oman. The intervention group (IG) received personalised PA consultations, pedometers and monthly messages using a web-based application, while the comparison group received usual care. Self-reported SE and SS from family and friends were assessed using validated psychosocial scales. Results Of the 232 original participants in the trial, a total of 174 completed the 12 months follow-up study period (response rate: 75%). However, based on intention-to-treat analysis with several imputation procedures for missing data at 3 and/or 12 months, there was a significant increase in SE scores in the IG (+10.3, 95% confidence interval [CI]: 7.1–13.5; P <0.001); however, the correlation with PA levels was weak (+4.2, 95% CI: 2.7–5.7; P <0.001). Higher SE scores were noted in those without comorbidities (+12.2, 95% CI: 6.8–17.6; P <0.001) and with high income levels (+9.7, 95% CI: 5.2–14.2; P <0.001). Additionally, SS scores increased significantly among those in the IG who received support from friends (+2.3, 95% CI: 1.1–3.7; P <0.001), but not family (+1.2, 95% CI: −0.4–2.8; P = 0.110). The reliability of the scales was acceptable for SE and SS from family, but poor for SS from friends (Cronbach’s alpha coefficients = 0.82, 0.82 and 0.40, respectively). Conclusion The PA intervention was associated with positive changes in SE and SS from friends. However, further tools for assessing psychosocial influences on PA are needed in Arab countries.
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Affiliation(s)
- Thamra S Al-Ghafri
- Department of Planning, Directorate General of Planning & Studies, Ministry of Health, Muscat, Oman
| | - Saud Al-Harthi
- Department of Medicine, Al Nahdha Hospital, Muscat, Oman
| | - Yahya Al-Farsi
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Angela M Craigie
- Centre for Public Health Nutrition Research, University of Dundee, Dundee, UK
| | - Elaine Bannerman
- Global Academy of Agriculture & Food Security, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Dundee, UK
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10
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Hawkes RE, Cameron E, Miles LM, French DP. The Fidelity of Training in Behaviour Change Techniques to Intervention Design in a National Diabetes Prevention Programme. Int J Behav Med 2021; 28:671-682. [PMID: 33559009 PMCID: PMC8551141 DOI: 10.1007/s12529-021-09961-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Abstract
Background The National Health Service Diabetes Prevention Programme (NHS-DPP) is a behavioural intervention for people identified as high risk for developing type 2 diabetes that has been rolled out across England. The present study evaluates whether the four commercial providers of the NHS-DPP train staff to deliver behaviour change technique (BCT) content with fidelity to intervention plans. Method One set of mandatory training courses across the four NHS-DPP providers (seven courses across 13 days) was audio-recorded, and all additional training materials used were collected. Recordings and training materials were coded for BCT content using the BCT Taxonomy v1. BCTs and depth of training (e.g. instruction, demonstration, practice) of BCT content was checked against providers’ intervention plans. Results Ten trainers and 78 trainees were observed, and 12 documents examined. The number of unique BCTs in audio recordings and associated training materials ranged from 19 to 44 across providers, and staff were trained in 53 unique BCTs across the whole NHS-DPP. Staff were trained in 66% of BCTs that were in intervention plans, though two providers trained staff in approximately half of BCTs to be delivered. The most common way that staff were trained in BCT delivery was through instruction. Training delivery style (e.g. experiential versus educational) varied between providers. Conclusion Observed training evidences dilution from providers’ intervention plans. NHS-DPP providers should review their training to ensure staff are trained in all key intervention components, ensuring thorough training of BCTs (e.g. demonstrating and practicing how to deliver) to enhance BCT delivery.
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Affiliation(s)
- Rhiannon E Hawkes
- Division of Psychology and Mental Health, Manchester Centre of Health Psychology, University of Manchester, Coupland 1 Building, Manchester, M13 9PL, UK
| | - Elaine Cameron
- Division of Psychology and Mental Health, Manchester Centre of Health Psychology, University of Manchester, Coupland 1 Building, Manchester, M13 9PL, UK.,Division of Psychology, University of Stirling, Stirling, Scotland, UK
| | - Lisa M Miles
- Division of Psychology and Mental Health, Manchester Centre of Health Psychology, University of Manchester, Coupland 1 Building, Manchester, M13 9PL, UK
| | - David P French
- Division of Psychology and Mental Health, Manchester Centre of Health Psychology, University of Manchester, Coupland 1 Building, Manchester, M13 9PL, UK.
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11
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Paxton B, Mills K, Usher-Smith JA. Fidelity of the delivery of NHS Health Checks in general practice: an observational study. BJGP Open 2020; 4:bjgpopen20X101077. [PMID: 32967842 PMCID: PMC7606139 DOI: 10.3399/bjgpopen20x101077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 02/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The NHS Health Check programme aims to reduce the risk of common preventable diseases by providing risk information and behaviour change advice. Failure to deliver the consultation appropriately could undermine its efficacy. To date, to the authors' knowledge, there are no published data on the fidelity of delivery of NHS Health Checks. AIM To assess the fidelity of delivery of NHS Health Checks in general practice. DESIGN & SETTING Fidelity assessment of video and audio recordings of NHS Health Check consultations conducted in four GP practices across the East of England. METHOD A secondary analysis of 38 NHS Health Check consultations, which were video or audio recorded as part of a pilot study of introducing discussions of cancer risk into NHS Health Checks. Using a checklist based on the NHS Health Check Best Practice Guidance, fidelity of delivery was assessed as the proportion of key elements completed during the consultations. RESULTS The mean number of elements of the NHS Health Check completed across all consultations was 14.5/18 (80.6%), with a range of 10 to 17 (55.6% to 94.4%). The mean fidelity for risk assessment, risk communication, and risk management sections was 8.7/10 (87.0%), 4.1/5 (82.0%), and 1.7/3 (56.7%), respectively. Clinically appropriate lifestyle advice was given in 34/38 consultations. Elements with the lowest fidelity were ethnicity assessment (n = 12/38; 31.6%), family history of cardiovascular disease (CVD) assessment (n = 25/38; 65.8%), AUDIT-C communication (n = 13/38; 34.2%), and dementia risk management (n = 6/38; 15.8%). CONCLUSION Although fidelity of delivery was high overall, important elements of the NHS Health Check were being regularly omitted. Opportunities for behaviour change, particularly relating to alcohol consumption and dementia risk management, may be being missed.
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Affiliation(s)
- Ben Paxton
- University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Katie Mills
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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12
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Okwose NC, O'Brien N, Charman S, Cassidy S, Brodie D, Bailey K, MacGowan GA, Jakovljevic DG, Avery L. Overcoming barriers to engagement and adherence to a home-based physical activity intervention for patients with heart failure: a qualitative focus group study. BMJ Open 2020; 10:e036382. [PMID: 32958484 PMCID: PMC7507843 DOI: 10.1136/bmjopen-2019-036382] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Clinical guidelines recommend regular physical activity for patients with heart failure to improve functional capacity and symptoms and to reduce hospitalisation. Cardiac rehabilitation programmes have demonstrated success in this regard; however, uptake and adherence are suboptimal. Home-based physical activity programmes have gained popularity to address these issues, although it is acknowledged that their ability to provide personalised support will impact on their effectiveness. This study aimed to identify barriers and facilitators to engagement and adherence to a home-based physical activity programme, and to identify ways in which it could be integrated into the care pathway for patients with heart failure. DESIGN A qualitative focus group study was conducted. Data were analysed using thematic analysis. PARTICIPANTS A purposive sample of 16 patients, 82% male, aged 68±7 years, with heart failure duration of 10±9 years were recruited. INTERVENTION A 12-week behavioural intervention targeting physical activity was delivered once per week by telephone. RESULTS Ten main themes were generated that provided a comprehensive overview of the active ingredients of the intervention in terms of engagement and adherence. Fear of undertaking physical activity was reported to be a significant barrier to engagement. Influences of family members were both barriers and facilitators to engagement and adherence. Facilitators included endorsement of the intervention by clinicians knowledgeable about physical activity in the context of heart failure; ongoing support and personalised feedback from team members, including tailoring to meet individual needs, overcome barriers and increase confidence. CONCLUSIONS Endorsement of interventions by clinicians to reduce patients' fear of undertaking physical activity and individual tailoring to overcome barriers are necessary for long-term adherence. Encouraging family members to attend consultations to address misconceptions and fear about the contraindications of physical activity in the context of heart failure should be considered for adherence, and peer-support for long-term maintenance. TRIAL REGISTRATION NUMBER NCT03677271.
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Affiliation(s)
- Nduka C Okwose
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
| | - Nicola O'Brien
- Department of Psychology, Northumbria University - City Campus, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Sarah Charman
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
| | - Sophie Cassidy
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
| | - David Brodie
- School of Health and Social Sciences, Buckinghamshire New University, High Wycombe, Buckinghamshire, United Kingdom
| | - Kristian Bailey
- Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Guy A MacGowan
- Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Djordje G Jakovljevic
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
- Faculty of Health and Life Scienes, Coventry University, Coventry, United Kingdom
| | - Leah Avery
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom
- School of Health & Life Sciences, Teesside University, Middlesbrough, United Kingdom
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13
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Fynn JF, Hardeman W, Milton K, Murphy J, Jones A. A systematic review of the use and reporting of evaluation frameworks within evaluations of physical activity interventions. Int J Behav Nutr Phys Act 2020; 17:107. [PMID: 32831111 PMCID: PMC7444034 DOI: 10.1186/s12966-020-01013-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/12/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Evaluation of physical activity interventions is vital to inform, and justify, evidence-based policy and practice to support population-wide changes in physical activity. Several evaluation frameworks and guidance documents have been developed to facilitate the evaluation and reporting of evaluation studies in public health. However, there is a lack of evidence about whether frameworks are being used to guide evaluation. There continues to be claims of poor and inconsistent reporting in evaluation studies. The aim of this review was to assess the use of evaluation frameworks and the quality of reporting of how they were applied within evaluation studies of physical activity interventions. OBJECTIVES 1. To identify whether evaluation frameworks are reported to have been used within evaluation studies of physical activity interventions, and which frameworks have been used. 2. To appraise the quality of reporting with regards to how evaluation frameworks have been used. METHOD We developed a checklist of indicators to enable a critical appraisal of the use and reporting of different evaluation frameworks in evaluation studies. We conducted a systematic search and review of evaluation studies published between 2015 and the date of the search to appraise the use and reporting of evaluation frameworks. A narrative synthesis is provided. RESULTS The review identified 292 evaluation studies of physical activity interventions, only 69 (23%) of these mentioned using an evaluation framework, and only 16 different frameworks were referred to. There was variation in the quality of reporting of framework use. 51 (74%) studies were identified as being explicitly based on the stated framework, however only 26 (38%) provided detailed descriptions consistently across all the checklist indicators. Details of adaptations and limitations in how frameworks were applied were less frequently reported. The review also highlighted variability in the reporting of intervention components. More consistent and precise reporting of framework and intervention components is needed. CONCLUSION Evaluation frameworks can facilitate a more systematic evaluation report and we argue their limited use suggests missed opportunities to apply frameworks to guide evaluation and reporting in evaluation studies. Variability in the quality of reporting of framework use limits the comparability and transferability of evidence. Where a framework has been used, the checklist of indicators can be employed to facilitate the reporting of an evaluation study and to review the quality of an evaluation report.
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Affiliation(s)
- Judith F Fynn
- UKCRC Centre for Diet and Activity Research (CEDAR) and Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Joseph Murphy
- Physical Activity for Health Research Cluster, Physical Education and Sport Sciences Department, University of Limerick, Limerick, Ireland
| | - Andy Jones
- UKCRC Centre for Diet and Activity Research (CEDAR) and Norwich Medical School, University of East Anglia, Norwich, UK
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14
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Czosnek L, Rankin N, Zopf E, Richards J, Rosenbaum S, Cormie P. Implementing Exercise in Healthcare Settings: The Potential of Implementation Science. Sports Med 2020; 50:1-14. [PMID: 31749112 DOI: 10.1007/s40279-019-01228-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Exercise is an efficacious therapy for many chronic diseases. Integrating efficacious evidence-based interventions (EBIs), such as exercise, into daily healthcare practice is a slow and complex pursuit. Implementation science seeks to understand and address this phenomenon by conducting studies about the methods used to promote the routine uptake of EBIs. The purpose of this article is to explore implementation science and a common conceptual framework in the discipline, the Consolidated Framework for Implementation Research (CFIR), as it applies to exercise EBI. We conclude by offering recommendations for future research that leverage implementation science priorities to highlight the potential of this research field for advancing the implementation of exercise EBI.
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Affiliation(s)
- Louise Czosnek
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.
| | - Nicole Rankin
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Eva Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Justin Richards
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.,School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Prue Cormie
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
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Alghafri TS, Al Harthi SM, Al-Ajmi F, Al-Farsi Y, Craigie AM, Bannerman E, Anderson AS. Acceptability of the "MOVEdiabetes" physical activity intervention in diabetes primary care settings in Oman: findings from participants and practitioners. BMC Public Health 2020; 20:887. [PMID: 32513161 PMCID: PMC7281938 DOI: 10.1186/s12889-020-09029-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 06/01/2020] [Indexed: 02/03/2023] Open
Abstract
Background Adequate physical activity (PA) is considered essential in diabetes management. However, evidence on the best method of promoting PA within diabetes care is inconclusive. The current work identifies perceptions on the acceptability of Intervention Group Participants (IGP) and Project Officers (POs) about the “MOVEdiabetes” intervention programme aimed at increasing PA in adults with type 2 diabetes in Oman (a retrospectively registered trial). Methods The “MOVEdiabetes” programme (PA consultations, pedometers and WhatsApp messages) was delivered by the POs (primary health care practitioners) in four primary care centres within a one-year cluster randomised control trial. Recruitment and retention were measured from trial attendance records. Programme satisfaction, appropriateness, and content suitability were assessed using exit surveys for both the IGP (interview based) and POs (self-administered). Open text questions on perceptions to the study programme were also included. Results Participants were randomised to an intervention group (IG, n = 122) or comparison group (CG, n = 110). The overall retention rate at three and 12 months was 92.7% [110(90.2%) IG vs 105(95.5%) CG] and 75% [82(67.2%) IG vs 92(83.6%) CG] respectively. Most (n = 14, 87.5%) POs and more than half (n = 49, 59.8%) IGP perceived the programme as very appropriate and many reported that they were “quite/ very satisfied” with the programme (n = 16, 100% PO’s and n = 71, 86.6% IGP). Two thirds (n = 55, 66.0%) of IGP were very/quite likely to recommend the programme to others. PA consultations, use of pedometers and Whatsapp messages were well perceived by all. Participants recommended the inclusion of dietary advice and PA promotion for the general public. Exploring PA facilities within the community was suggested by POs. Conclusions The “MOVEdiabetes” programme achieved a high retention rate and was perceived as satisfactory and appropriate. Results from this study suggest that it is worthwhile exploring the use of the “MOVEdiabetes” programme in clinical practice and further community links. Trial registration International Standard Randomised Controlled Trials No: ISRCTN14425284. Registered retrospectively on 12th April 2016.
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Affiliation(s)
- Thamra S Alghafri
- Directorate General of Health Services, Ministry of Health, Muscat, Oman & University of Dundee, PO Box 2723, Postal Code 112, Muscat, Oman.
| | - Saud M Al Harthi
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Fatma Al-Ajmi
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Angela M Craigie
- Centre for Public Health Nutrition Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Elaine Bannerman
- Global Academy of Agriculture & Food Security, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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16
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Cassidy S, Okwose N, Scragg J, Houghton D, Ashley K, Trenell MI, Jakovljevic DG, Hallsworth K, Avery L. Assessing the feasibility and acceptability of Changing Health for the management of prediabetes: protocol for a pilot study of a digital behavioural intervention. Pilot Feasibility Stud 2019; 5:139. [PMID: 31788325 PMCID: PMC6878649 DOI: 10.1186/s40814-019-0519-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/15/2019] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence of prediabetes is rapidly rising in the UK, largely associated with an increase in obesity. Lifestyle programmes that provide support to make and sustain dietary and physical activity behavioural changes are necessary to initiate and maintain weight loss. However, these programmes are often intensive and time consuming. Given the magnitude of the problem, there is a need for behavioural interventions that can be delivered at scale. Digital interventions can address some of the aforementioned issues. The primary aim of the present study is to assess the feasibility and acceptability of a digital intervention called Changing Health that provides structured education and lifestyle behaviour change support to adults with prediabetes. Methods A single-group pilot study will be undertaken. We aim to recruit 40 participants with prediabetes defined by HbA1c or fasting plasma glucose (FPG), aged between 18 and 75 years with a BMI ≥ 25. Participants will receive the digital intervention (a mobile phone app incorporating structured education and behavioural tools to support lifestyle behaviour change) with the aim of losing and maintaining 5–6% of their baseline body weight. Each participant will receive 100 min of lifestyle coaching over the 9-month intervention period and will have continued access to the digital intervention. Clinical outcome measures will be collected during four visits to our clinical research facility: two visits at baseline, one visit at month 3, and one visit at month 9. These secondary outcome measures will include diet, physical activity, sleep, metabolic control, body composition, cardiorespiratory fitness, and cardiovascular function. To measure primary outcomes, an embedded qualitative study will be conducted to obtain data on feasibility and acceptability of the intervention. Discussion This pilot study will establish whether Changing Health is feasible and acceptable to adults with prediabetes. Clinical outcome measures will provide estimates of variability to inform sample size calculations, and qualitative data generated will inform any necessary refinements to the intervention. This will provide a platform for a larger evaluation to assess the effectiveness of Changing Health for changing diet and physical activity to initiate and maintain weight loss in adults with prediabetes. Trial registration ISRCTN Registry: ISRCTN69270299.
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Affiliation(s)
- Sophie Cassidy
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Nduka Okwose
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Jadine Scragg
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - David Houghton
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Kirsten Ashley
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Michael I Trenell
- 2NIHR Innovation Observatory, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Kate Hallsworth
- 1Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.,3The Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Leah Avery
- 4Centre for Rehabilitation, Exercise and Sports Sciences, School of Health & Social Care, Teesside University, Tees Valley, UK
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17
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Geerling R, Browne JL, Holmes-Truscott E, Furler J, Speight J, Mosely K. Positive reinforcement by general practitioners is associated with greater physical activity in adults with type 2 diabetes. BMJ Open Diabetes Res Care 2019; 7:e000701. [PMID: 31803479 PMCID: PMC6887508 DOI: 10.1136/bmjdrc-2019-000701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/25/2019] [Accepted: 10/07/2019] [Indexed: 11/03/2022] Open
Abstract
Objective In a sample of adults with type 2 diabetes mellitus (T2DM), the aim of this study was to examine whether self-reported physical activity level is associated with recall of specific physical activity-related interactions used by general practitioners (GP). Research design and methods Adults with T2DM completed an online survey reporting physical activity behaviors and recall of 14 GP-patient interactions about physical activity, mapped onto discrete behavior change techniques (BCT). Stepped logistical regression examined associations between recommended physical activity (≥600 MET-min/week) and GP-patient interactions, controlling for body mass index, diabetes-related comorbidities, depressive symptoms and self-efficacy. Results In total, 381 respondents (55% men, mean±SD age: 62±10 years and T2DM duration 8±8 years) provided complete data. Most (73%) reported receiving 'general advice', while interactions related to goal setting, monitoring, and relapse prevention were least commonly reported (all <20%). Self-reported achievement of the recommended physical activity level was significantly associated with recall of GP interactions involving praise for 'efforts to be active' (OR 2.1; 95% CI 1.24 to 3.53), 'lost weight' (OR 1.81; 95% CI 1.05 to 3.12) or lowering 'glucose levels as a result of being active' (OR 1.75; 95% CI 1.03 to 2.96). Conclusions Findings suggest GPs can be somewhat effective in promoting physical activity with simple, positive, reinforcing messages/interactions. Future research to develop and evaluate very brief primary care BCT-based physical activity interventions is needed.
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Affiliation(s)
- Ralph Geerling
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - Jessica L Browne
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Centre for Evidence and Implementation, Melbourne, Victoria, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - John Furler
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - Kylie Mosely
- BodyMatters Australasia, Sydney, New South Wales, Australia
- University of Technology Sydney, Sydney, New South Wales, Australia
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Booth V, Hood-Moore V, Hancox JE, Logan P, Robinson KR. Systematic scoping review of frameworks used to develop rehabilitation interventions for older adults. BMJ Open 2019; 9:e024185. [PMID: 30798309 PMCID: PMC6398678 DOI: 10.1136/bmjopen-2018-024185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Rehabilitation interventions for older adults are complex as they involve a number of interacting components, have multiple outcomes of interest and are influenced by a number of contextual factors. The importance of rigorous intervention development prior to formal evaluation has been acknowledged and a number of frameworks have been developed. This review explored which frameworks have been used to guide the development of rehabilitation interventions for older adults. DESIGN Systematic scoping review. SETTING Studies were not limited for inclusion based on setting. PARTICIPANTS Studies were included that featured older adults (>65 years of age). INTERVENTIONS Studies were included that reported the development of a rehabilitation intervention. PRIMARY AND SECONDARY OUTCOME MEASURES Data were extracted on study population, setting, type of intervention developed and frameworks used. The primary outcome of interest was the type of intervention development framework. RESULTS Thirty-five studies were included. There was a range of underlying medical conditions including mild cognitive impairment and dementia (n=5), cardiac (n=4), stroke (n=3), falls (n=3), hip fracture (n=2), diabetes (n=2), breast cancer (n=1), Parkinson's disease (n=1), depression (n=1), chronic health problems (n=1), osteoarthritis (n=1), leg ulcer (n=1), neck pain (n=1) and foot problems (n=1). The intervention types being developed included multicomponent, support based, cognitive, physical activities, nursing led, falls prevention and occupational therapy led. Twelve studies (34%) did not report using a framework. Five frameworks were reported with the Medical Research Council (MRC) framework for developing and evaluating complex interventions being the most frequently cited (77%, n=17). CONCLUSION At present, the MRC framework is the most popular for developing rehabilitation interventions for older adults. Many studies do not report using a framework. Further, specific guidance to assist this complex field of rehabilitation research is required.
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Affiliation(s)
- Vicky Booth
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
| | - Victoria Hood-Moore
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
| | - Jennie E Hancox
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
| | - Phillipa Logan
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
| | - Katie R Robinson
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
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19
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Alghafri TS, Alharthi SM, Al-Farsi Y, Alrawahi AH, Bannerman E, Craigie AM, Anderson AS. 'MOVEdiabetes': a cluster randomized controlled trial to increase physical activity in adults with type 2 diabetes in primary health in Oman. BMJ Open Diabetes Res Care 2018; 6:e000605. [PMID: 30487976 PMCID: PMC6235057 DOI: 10.1136/bmjdrc-2018-000605] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/27/2018] [Accepted: 10/16/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study examined the impact of a multicomponent intervention to increase physical activity (PA) in adults with type 2 diabetes (T2D) in Oman. RESEARCH DESIGN AND METHODS This is a cluster randomized controlled trial in eight primary health centers. Participants were physically inactive, aged ≥18 years, and with no contraindication to PA. Patients attending intervention health centers (n=4) received the 'MOVEdiabetes' intervention, which consisted of personalized, individual face-to-face consultations by dietitians. Pedometers and monthly telephone WhatsApp messages were also used. Patients attending comparison health centers received usual care. The primary outcome was change in PA [Metabolic Equivalent(MET).min/week] after 12 months assessed by the Global Physical Activity Questionnaire. The secondary outcomes were changes in daily step counts, sitting time, weight, body mass index, glycated hemoglobin, blood pressure and lipids. RESULTS Of the 232 participants (59.1% female, mean (SD) age 44.2 (8.1) years), 75% completed the study. At 12 months, the mean change in MET.min/week was +631.3 (95% CI 369.4 to 893.2) in the intervention group (IG) vs +183.2 (95% CI 83.3 to 283.0) in the comparison group, with a significant between-group difference of +447.4 (95% CI 150.7 to 744.1). The odds of meeting PA recommendations were 1.9 times higher in the IG (95% CI 1.2 to 3.3). Significant between-group differences in favor of IG were detected for mean steps/day (+757, 95% CI 18 to 1531) and sitting time hours/ per day (-1.5, 95% CI -2.4 to -0.7). Clinical measures of systolic and diastolic blood pressure and triglycerides also showed significant intervention effects. CONCLUSIONS 'MOVEdiabetes' was effective in increasing PA, the likelihood of meeting PA recommendations, and providing cardioprotective benefits in adults with T2D attending primary care.
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Affiliation(s)
| | | | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Abdul Hakeem Alrawahi
- Department of Planning and Studies, Research Section, Oman Medical Specialty Board, Muscat, Oman
| | - Elaine Bannerman
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Angela M Craigie
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Lambert JD, Greaves CJ, Farrand P, Cross R, Haase AM, Taylor AH. Assessment of fidelity in individual level behaviour change interventions promoting physical activity among adults: a systematic review. BMC Public Health 2017; 17:765. [PMID: 28969669 PMCID: PMC5625828 DOI: 10.1186/s12889-017-4778-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/20/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Behaviour change interventions that promote physical activity have major implications for health and well-being. Measuring intervention fidelity is crucial in determining the extent to which an intervention is delivered as intended, therefore increasing scientific confidence about effectiveness. However, we lack a clear overview of how well intervention fidelity is typically assessed in physical activity trials. METHODS A systematic literature search was conducted to identify peer - reviewed physical activity promotion trials that explicitly measured intervention fidelity. Methods used to assess intervention fidelity were categorised, narratively synthesised and critiqued using assessment criteria from NIH Behaviour Change Consortium (BCC) Treatment Fidelity Framework (design, training, delivery, receipt and enactment). RESULTS Twenty eight articles reporting of twenty one studies used a wide variety of approaches to measure intervention fidelity. Delivery was the most common domain of intervention fidelity measured. Approaches used to measure fidelity across all domains varied from researcher coding of observational data (using checklists or scales) to participant self-report measures. There was considerable heterogeneity of methodological approaches to data collection with respect to instruments used, attention to psychometric properties, rater-selection, observational method and sampling strategies. CONCLUSIONS In the field of physical activity interventions, fidelity measurement is highly heterogeneous both conceptually and methodologically. Clearer articulation of the core domains of intervention fidelity, along with appropriate measurement approaches for each domain are needed to improve the methodological quality of fidelity assessment in physical activity interventions. Recommendations are provided on how this situation can be improved.
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Affiliation(s)
- Jeffrey D. Lambert
- University of Exeter Medical School, St Luke’s Campus, Magdalen Road, Exeter, EX1 2LU UK
| | - Colin J. Greaves
- University of Exeter Medical School, St Luke’s Campus, Magdalen Road, Exeter, EX1 2LU UK
| | - Paul Farrand
- Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Exeter, EX4 4QG UK
| | - Rosina Cross
- Department for Health, University of Bath, Wessex House 6.9, Claverton, Bath, BA2 7AY UK
| | - Anne M. Haase
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Adrian H. Taylor
- Plymouth University, N6, ITTC, Tamar Science Park, Plymouth, Devon PL6 8BX UK
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