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Ali AZ, Wright B, Curran JA, Fawcett-Arsenault J, Newton AS. Co-designing discharge communication interventions for mental health visits to the pediatric emergency department: a mixed-methods study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:64. [PMID: 38907328 PMCID: PMC11191193 DOI: 10.1186/s40900-024-00594-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/31/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Discharge communication is essential to convey information regarding the care provided and follow-up plans after a visit to a hospital emergency department (ED), but it can be lacking for visits for pediatric mental health crises. Our objective was to co-design and conduct usability testing of new discharge communication interventions to improve pediatric mental health discharge communication. METHODS The study was conducted in two phases using experience-based co-design (EBCD). In phase 1 (Sep 2021 to Jan 2022), five meetings were conducted with a team of six parents and two clinicians to co-design new ED discharge communication interventions for pediatric mental health care. Thematic analysis was used to identify patterns in team discussions and participant feedback related to discharge communication improvement and the Capability, Opportunity, Motivation, Behavior (COM-B) model was used to identify strategies to support the delivery of the new interventions. After meeting five, team members completed the Public and Patient Engagement Evaluation Tool (PPEET) to evaluate the co-design experience. In phase 2 (Apr to Jul 2022), intervention usability and satisfaction were evaluated by a new group of parents, youth aged 16-24 years, ED physicians, and nurses (n = 2 of each). Thematic analysis was used to identify usability issues and a validated 5-point Likert survey was used to evaluate user satisfaction. Evaluation results were used by the co-design team to finalize the interventions and delivery strategies. RESULTS Two discharge communication interventions were created: a brochure for families and clinicians to use during the ED visit, and a text-messaging system for families after the visit. There was high satisfaction with engagement in phase 1 (overall mean PPEET score, 4.5/5). In phase 2, user satisfaction was high (mean clinician score, 4.4/5; mean caregiver/youth score, 4.1/5) with both interventions. Usability feedback included in the final intervention versions included instructions on intervention use and ensuring the text-messaging system activates within 12-24 h of discharge. CONCLUSIONS The interventions produced by this co-design initiative have the potential to address gaps in current discharge practices. Future testing is required to evaluate the impact on patients, caregivers, and health care system use after the ED visit.
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Affiliation(s)
- Amber Z Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Bruce Wright
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
- Women and Children's Health Research Institute, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | | | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
- Women and Children's Health Research Institute, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Baker S, Gallegos D, Rebuli MA, Taylor AJ, Mahoney R. Food Insecurity Screening in High-Income Countries, Tool Validity, and Implementation: A Scoping Review. Nutrients 2024; 16:1684. [PMID: 38892619 PMCID: PMC11174716 DOI: 10.3390/nu16111684] [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: 04/18/2024] [Revised: 05/17/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Household food insecurity has significant negative implications across the lifespan. While routine screening is recommended, particularly in healthcare, guidelines are lacking on selection of screening tools and best-practice implementation across different contexts in non-stigmatizing ways. The objective of this scoping review was to synthesize evidence on household food insecurity screening tools, including psychometrics, implementation in a range of settings, and experiences of carrying out screening or being screened. Four electronic databases were searched for studies in English published from 1990 until June 2023. A total of 58 papers were included, 21 of which focused on tool development and validation, and 37 papers described implementation and perceptions of screening. Most papers were from the USA and described screening in healthcare settings. There was a lack of evidence regarding screening in settings utilized by Indigenous people. The two-item Hunger Vital Sign emerged as the most used and most valid tool across settings. While there is minimal discomfort associated with screening, screening rates in practice are still low. Barriers and facilitators of screening were identified at the setting, system, provider, and recipient level and were mapped onto the COM-B model of behavior change. This review identifies practical strategies to optimize screening and disclosure.
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Affiliation(s)
- Sabine Baker
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Danielle Gallegos
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | | | - Amanda J. Taylor
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Ray Mahoney
- Australian e-Health Research Centre, CSIRO Health and Biosecurity, Herston, QLD 4029, Australia;
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Iturralde E, Rubinsky AD, Nguyen KH, Anderson C, Lyles CR, Mangurian C. Serious Mental Illness, Glycemic Control, and Neighborhood Factors within an Urban Diabetes Cohort. Schizophr Bull 2024; 50:653-662. [PMID: 37597839 PMCID: PMC11059791 DOI: 10.1093/schbul/sbad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Abstract
BACKGROUND AND HYPOTHESIS Serious mental illness (SMI) may compromise diabetes self-management. This study assessed the association between SMI and glycemic control, and explored sociodemographic predictors and geographic clustering of this outcome among patients with and without SMI. STUDY DESIGN We used electronic health record data for adult primary care patients with diabetes from 2 San Francisco health care delivery systems. The primary outcome was poor glycemic control (hemoglobin A1c >9.0%), which was modeled on SMI diagnosis status and sociodemographics. Geospatial analyses examined hotspots of poor glycemic control and neighborhood characteristics. STUDY RESULTS The study included 11 694 participants with diabetes, 21% with comorbid SMI, of whom 22% had a schizophrenia spectrum or bipolar disorder. Median age was 62 years; 52% were female and 79% were Asian, Black, or Hispanic. In adjusted models, having schizophrenia spectrum disorder or bipolar disorder was associated with greater risk for poor glycemic control (vs participants without SMI, adjusted relative risk [aRR] = 1.24; 95% confidence interval, 1.02, 1.49), but having broadly defined SMI was not. People with and without SMI had similar sociodemographic correlates of poor glycemic control including younger versus older age, Hispanic versus non-Hispanic White race/ethnicity, and English versus Chinese language preference. Hotspots for poor glycemic control were found in neighborhoods with more lower-income, Hispanic, and Black residents. CONCLUSIONS Poor diabetes control was significantly related to having a schizophrenia spectrum or bipolar disorder, and to sociodemographic factors and neighborhood. Community-based mental health clinics in hotspots could be targets for implementation of diabetes management services.
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Affiliation(s)
- Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Anna D Rubinsky
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Academic Research Services, Information Technology, University of California San Francisco, San Francisco, CA, United States
| | - Kim H Nguyen
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
| | - Chelsie Anderson
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Courtney R Lyles
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
| | - Christina Mangurian
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
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Henderson K, Reihm J, Koshal K, Wijangco J, Sara N, Miller N, Doyle M, Mallory A, Sheridan J, Guo CY, Oommen L, Rankin KP, Sanders S, Feinstein A, Mangurian C, Bove R. A Closed-Loop Digital Health Tool to Improve Depression Care in Multiple Sclerosis: Iterative Design and Cross-Sectional Pilot Randomized Controlled Trial and its Impact on Depression Care. JMIR Form Res 2024; 8:e52809. [PMID: 38488827 PMCID: PMC10980989 DOI: 10.2196/52809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND People living with multiple sclerosis (MS) face a higher likelihood of being diagnosed with a depressive disorder than the general population. Although many low-cost screening tools and evidence-based interventions exist, depression in people living with MS is underreported, underascertained by clinicians, and undertreated. OBJECTIVE This study aims to design a closed-loop tool to improve depression care for these patients. It would support regular depression screening, tie into the point of care, and support shared decision-making and comprehensive follow-up. After an initial development phase, this study involved a proof-of-concept pilot randomized controlled trial (RCT) validation phase and a detailed human-centered design (HCD) phase. METHODS During the initial development phase, the technological infrastructure of a clinician-facing point-of-care clinical dashboard for MS management (BRIDGE) was leveraged to incorporate features that would support depression screening and comprehensive care (Care Technology to Ascertain, Treat, and Engage the Community to Heal Depression in people living with MS [MS CATCH]). This linked a patient survey, in-basket messages, and a clinician dashboard. During the pilot RCT phase, a convenience sample of 50 adults with MS was recruited from a single MS center with 9-item Patient Health Questionnaire scores of 5-19 (mild to moderately severe depression). During the routine MS visit, their clinicians were either asked or not to use MS CATCH to review their scores and care outcomes were collected. During the HCD phase, the MS CATCH components were iteratively modified based on feedback from stakeholders: people living with MS, MS clinicians, and interprofessional experts. RESULTS MS CATCH links 3 features designed to support mood reporting and ascertainment, comprehensive evidence-based management, and clinician and patient self-management behaviors likely to lead to sustained depression relief. In the pilot RCT (n=50 visits), visits in which the clinician was randomized to use MS CATCH had more notes documenting a discussion of depressive symptoms than those in which MS CATCH was not used (75% vs 34.6%; χ21=8.2; P=.004). During the HCD phase, 45 people living with MS, clinicians, and other experts participated in the design and refinement. The final testing round included 20 people living with MS and 10 clinicians including 5 not affiliated with our health system. Most scoring targets for likeability and usability, including perceived ease of use and perceived effectiveness, were met. Net Promoter Scale was 50 for patients and 40 for clinicians. CONCLUSIONS Created with extensive stakeholder feedback, MS CATCH is a closed-loop system aimed to increase communication about depression between people living with MS and their clinicians, and ultimately improve depression care. The pilot findings showed evidence of enhanced communication. Stakeholders also advised on trial design features of a full year long Department of Defense-funded feasibility and efficacy trial, which is now underway. TRIAL REGISTRATION ClinicalTrials.gov NCT05865405; http://tinyurl.com/4zkvru9x.
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Affiliation(s)
- Kyra Henderson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Reihm
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kanishka Koshal
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jaeleene Wijangco
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Narender Sara
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Nicolette Miller
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Marianne Doyle
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Alicia Mallory
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Judith Sheridan
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Chu-Yueh Guo
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Lauren Oommen
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine P Rankin
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Stephan Sanders
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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Sheshadri A, Elia JR, Garcia G, Abrams G, Adey DB, Lai JC, Sudore RL. Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners. Kidney Med 2024; 6:100779. [PMID: 38419789 PMCID: PMC10900112 DOI: 10.1016/j.xkme.2023.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Rationale & Objective Despite guidelines calling to improve physical activity in older adults, and evidence suggesting that prekidney transplant physical function is highly associated with posttransplant outcomes, only a small percentage of older patients treated with dialysis are engaged in structured exercise. We sought to elucidate barriers and facilitators of exercise among older adults treated with dialysis awaiting transplant and their care partners. Study Design Individual, in-depth, cognitive interviews were conducted separately for patients and care partners through secure web-conferencing. Setting & Participants Twenty-three patients (≥50 years of age, treated with dialysis from the University of San Francisco kidney transplantation clinic, with a short physical performance battery of ≤10) and their care partners. Analytical Approach All audio interviews were transcribed verbatim. Three investigators independently coded data and performed qualitative thematic content. The interview guide was updated iteratively based on the Capability Opportunity Motivation Behavior model. Results Patients' median age was 60 years (57 ± 63.5) and care partners' median ages was 57 years (49.5 ± 65.5). Thirty-nine percent of patients and 78% of care partners were female, 39% of patients and 30% of care partners self-identified as African American, and 47% of dyads were spouse or partner relationships. Major themes for barriers to pretransplant exercise included lack of understanding of an appropriate regimen, physical impairments, dialysis schedules, and safety concerns. Major facilitators included having individualized or structured exercise programs, increasing social support for patients and care partners, and motivation to regain independence or functionality or to promote successful transplantation. Limitations Participants geographically limited to Northern California. Conclusions Although patients and care partners report numerous barriers to pretransplant exercise and activity, they also reported many facilitators. An individualized, structured, home-based exercise program could circumvent many of the reported barriers and allow older patients to improve pretransplant physical function.
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Affiliation(s)
- Anoop Sheshadri
- Division of Nephrology, Department of Medicine, University of California, San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Jessica R. Elia
- Division of Nephrology, Department of Medicine, University of California, San Francisco
| | - Gabriel Garcia
- Division of Nephrology, Department of Medicine, University of California, San Francisco
| | - Gary Abrams
- University of California Weill Institute for Neurosciences, San Francisco, California
| | - Deborah B. Adey
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Jennifer C. Lai
- Division of Gastroenterology/Hepatology, Department of Medicine, University of California, San Francisco
| | - Rebecca L. Sudore
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California
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Nouri S, Li L, Huang C, Chung A, Stokes SC, Pan S, Wong EC, Newman J, Woo JW, Cheng J, Tan CH, Wertz M, Wood-Hughes E, Quinn M, Pantilat SZ, Lyles CR, Ritchie CS, Sudore RL. "At the End I Have a Say": Engaging the Chinese Community in Advance Care Planning. J Pain Symptom Manage 2023; 66:551-560.e1. [PMID: 37536524 PMCID: PMC10593504 DOI: 10.1016/j.jpainsymman.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/22/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
CONTEXT Despite the association of advance care planning (ACP) with improved patient and caregiver outcomes, Chinese American elders have low rates of ACP. OBJECTIVES Assess ACP facilitators/barriers in the San Francisco (SF) Chinese community and codesign, implement, and test community-based ACP-promoting pilot events. METHODS A Chinese Community Committee (N = 19 community-based organization leaders, health system representatives, community members) conducted focus groups in Cantonese and English with Chinese older adults (age ≥55), caregivers, and community leaders. The Committee designed and implemented pilot events in-person and online. We analyzed focus group data using thematic analysis; assessed pre-to-post-event readiness to engage in ACP (validated survey; 14 scale, 4 = most ready); and assessed event acceptability. RESULTS A total of 34 people participated in six focus groups. Themes described Chinese community-specific importance of ACP (e.g., reduces family burden), barriers (e.g., younger generations lack tools to discuss ACP with elders and vice versa), and facilitators (e.g., intergenerational events, culturally/linguistically appropriate materials). Based on focus groups findings, the Committee developed a novel ACP tool and designed intergenerational events. A total of 195 participants attended 10 events; 95% were Chinese, 90% spoke Chinese languages, 80% were women. ACP readiness increased significantly (1.66 [SD 0.84] vs. 2.03 [SD 0.85]; P < 0.001); 94% of participants were comfortable attending and 96% would recommend events. CONCLUSION Community-developed intergenerational events that highlight the value of ACP and address barriers are acceptable and increase ACP engagement in the Chinese community.
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Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine, Department of Medicine (S.N., M.Q., S.Z.P.), University of California San Francisco, San Francisco, California, USA.
| | - Lingsheng Li
- Division of Geriatrics, Department of Medicine (L.L.), University of California San Francisco, San Francisco, California, USA
| | - Carrie Huang
- Thriving in Place (C.H.), San Francisco, California, USA
| | - Anni Chung
- Self-Help for the Elderly (A.C.), San Francisco, California, USA
| | - Sandy Chen Stokes
- Chinese American Coalition for Compassionate Care (S.C.S., S.P.), Cupertino, California, USA
| | - Shirley Pan
- Chinese American Coalition for Compassionate Care (S.C.S., S.P.), Cupertino, California, USA
| | - Elizabeth C Wong
- Independent community advocate (E.C.W.), San Francisco, California, USA
| | - Jeffrey Newman
- Institute for Health & Aging, University of California San Francisco (J.N.), San Francisco, California, USA
| | - Joseph W Woo
- Chinese Community Healthcare Association (J.W.W.), San Francisco, California, USA
| | - Joyce Cheng
- Chinese Community Health Resource Center (J.C.), San Francisco, California, USA
| | - Charissa H Tan
- John A. Burns School of Medicine, University of Hawai'i at Mānoa (C.H.T.), Honolulu, Hawaii, USA
| | - Molly Wertz
- Molly Wertz Consulting (M.W.), San Francisco, California, USA
| | - Elyse Wood-Hughes
- Richmond Senior Center, Golden Gate Senior Services (E.W.H.), San Francisco, California, USA
| | - Mara Quinn
- Division of Palliative Medicine, Department of Medicine (S.N., M.Q., S.Z.P.), University of California San Francisco, San Francisco, California, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine (S.N., M.Q., S.Z.P.), University of California San Francisco, San Francisco, California, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine (C.R.L.), Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine (C.S.R.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine (R.L.S.), University of California San Francisco, San Francisco, California, USA
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Wright L, Bennett S, Meredith P, Doig E. Planning for Change: Co-Designing Implementation Strategies to Improve the Use of Sensory Approaches in an Acute Psychiatric Unit. Issues Ment Health Nurs 2023; 44:960-973. [PMID: 37643312 DOI: 10.1080/01612840.2023.2236712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Implementing sensory approaches in psychiatric units has proven challenging. This multi-staged study involved qualitative interviews (n = 7) with mental health care staff in an acute psychiatric ward to identify the local factors influencing use of sensory approaches, and co-design implementation strategies with key stakeholders to improve their use. Using framework analysis, results revealed that the use of sensory approaches were hindered by: inadequate access to sensory resources/equipment; lack of time; lack of staff knowledge; and belief that sensory approaches are not effective or part of staff's role. To address identified barriers a systematic theory-informed method was used to co-design implementation strategies to improve the use of sensory approaches.
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Affiliation(s)
- Lisa Wright
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Metro North Mental Health - The Prince Charles Hospital, Metro North Health, Brisbane, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Pamela Meredith
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- School of Health and Behavioural Sciences, University of Sunshine Coast, Sunshine Coast, Australia
| | - Emmah Doig
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Metro North Health, Brisbane, Australia
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Kronish IM, Phillips E, Alcántara C, Carter E, Schwartz JE, Shimbo D, Serafini M, Boyd R, Chang M, Wang X, Razon D, Patel A, Moise N. A Multifaceted Implementation Strategy to Increase Out-of-Office Blood Pressure Monitoring: The EMBRACE Cluster Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2334646. [PMID: 37747734 PMCID: PMC10520739 DOI: 10.1001/jamanetworkopen.2023.34646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/13/2023] [Indexed: 09/26/2023] Open
Abstract
Importance Few primary care patients complete guideline-recommended out-of-office blood pressure (BP) monitoring prior to having hypertension diagnosed. Objective To evaluate the effectiveness of a behavioral theory-informed, multifaceted implementation strategy on out-of-office BP monitoring (ambulatory BP monitoring [ABPM] or home BP monitoring [HBPM]) among patients with new hypertension. Design, Setting, and Participants This 2-group, pre-post cluster randomized trial was conducted within a primary care network of 8 practices (4 intervention practices with 99 clinicians; 4 control practices with 55 clinicians) and 1186 patients (857 intervention; 329 control) with at least 1 visit with elevated office BP and no prior hypertension diagnosis between October 2016 and September 2017 (preimplementation period) or between April 2018 and March 2019 (postimplementation period). Data were analyzed from February to July 2023. Interventions Usual care (control group) or a multifaceted implementation strategy consisting of an accessible ABPM service; electronic health record (EHR) tools to facilitate test ordering; clinician education, reminders, and feedback relevant to out-of-office BP monitoring; nurse training on HBPM; and patient information handouts. Main Outcomes and Measures The primary outcome was patient completion of out-of-office BP monitoring within 6 months of an eligible visit. Secondary outcomes included clinician ordering of out-of-office BP monitoring. Blinded assessors extracted outcomes from the EHR. Results A total of 1186 patients (857 intervention; 329 control) were included, with a mean (SD) age of 54 (16) years; 808 (68%) were female, and 549 (48%) were Spanish speaking; among those with race and ethnicity documented, 123 (10%) were Black or African American, and 368 (31%) were Hispanic. Among intervention practices, the percentage of visits resulting in completed out-of-office BP monitoring increased from 0.6% (0% ABPM; 0.6% HBPM) to 5.7% (3.7% ABPM; 2.0% HBPM) between the preimplementation and postimplementation periods (P = .009). Among control practices, the percentage of visits resulting in completed out-of-office BP monitoring changed from 5.4% (0% ABPM; 5.4% HBPM) to 4.3% (0% ABPM; 4.3% HBPM) during the corresponding period (P = .94). The ratio of relative risks (RRs) of out-of-office BP monitoring in the postimplementation vs preimplementation periods for intervention vs control practices was 10.5 (95% CI, 1.9-58.0; P = .01). The ratio of RRs of out-of-office BP monitoring being ordered was 2.2 (95% CI, 0.8-6.3; P = .12). Conclusions and Relevance This study found that a theory-informed implementation strategy that included access to ABPM modestly increased out-of-office BP monitoring among patients with elevated office BP but no hypertension diagnosis. Trial Registration ClinicalTrials.gov Identifier: NCT03480217.
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Affiliation(s)
- Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Erica Phillips
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | | | - Eileen Carter
- School of Nursing, University of Connecticut, Storrs
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Daichi Shimbo
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Maria Serafini
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Rebekah Boyd
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Melinda Chang
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Xiaohui Wang
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Dominic Razon
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Akash Patel
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
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Pajka SE, Kushel M, Handley MA, Olsen P, Li B, Enriquez C, Kaplan L, Sudore RL. Using behavioral theory to adapt advance care planning for homeless-experienced older adults in permanent supportive housing. J Am Geriatr Soc 2023; 71:2615-2626. [PMID: 36928791 PMCID: PMC10440262 DOI: 10.1111/jgs.18314] [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: 09/01/2022] [Revised: 01/31/2023] [Accepted: 02/18/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Older adults experiencing chronic homelessness (i.e., prolonged homelessness and a disabling condition) have low rates of advance care planning (ACP) despite high rates of morbidity and mortality. Rehousing of homeless-experienced individuals into permanent supportive housing (PSH) may present an opportunity to introduce ACP; but this is unknown. Therefore, we explored staff and resident perceptions of conducting ACP in PSH. METHODS We conducted semi-structured interviews with PSH staff (n = 13) and tenants (PSH residents) (n = 26) in San Francisco. We used the capability (C), opportunity (O), motivation (M), behavior (COM-B) framework within the Behavior Change Wheel model and the Theoretical Domains Framework (TDF) to inform interviews, categorize themes, and guide qualitative thematic analysis. RESULTS The mean age of PSH residents was 67 (SD = 6.1) years and 52% were women. Of staff, 69% were women. Important COM-B barriers included ACP complexity (C), complicated relationship dynamics (O), resource limitations (O), pessimism (M), variable staff confidence (M), and competing priorities (M). Facilitators included easy-to-use documents/videos, including the PREPARE for Your Care program (C), stability with housing (O), exposure to health crises (O), potential for strong relationships (O), and belief that ACP is impactful (M). Recommendations included adapting materials to the PSH setting, providing staff trainings/scripts, and using optional one-on-one or group sessions. CONCLUSIONS We identified behavioral determinants related to ACP for formerly chronically homeless older adults in PSH. Future interventions should include using easy-to-use ACP materials and developing resources to educate PSH residents, train staff, and model ACP in groups or one-on-one sessions.
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Affiliation(s)
- Sarah E Pajka
- Medical Student, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Margot Kushel
- Department of Medicine, The University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, The University of California San Francisco, San Francisco, California, USA
| | - Margaret A Handley
- Department of Medicine, The University of California San Francisco, San Francisco, California, USA
| | - Pamela Olsen
- Department of Medicine, The University of California San Francisco, San Francisco, California, USA
| | - Brookelle Li
- Department of Medicine, The University of California San Francisco, San Francisco, California, USA
| | - Celeste Enriquez
- Department of Medicine, The University of California San Francisco, San Francisco, California, USA
| | - Lauren Kaplan
- Department of Medicine, The University of California San Francisco, San Francisco, California, USA
| | - Rebecca L Sudore
- Department of Medicine, The University of California San Francisco, San Francisco, California, USA
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Bennett RJ, Bucks RS, Saulsman L, Pachana NA, Eikelboom RH, Meyer CJ. Use of the Behaviour Change Wheel to design an intervention to improve the provision of mental wellbeing support within the audiology setting. Implement Sci Commun 2023; 4:46. [PMID: 37131257 PMCID: PMC10153035 DOI: 10.1186/s43058-023-00427-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 04/05/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE This study describes the development of an intervention to increase the frequency of audiologists' asking about and providing information regarding mental wellbeing within adult audiology services. DESIGN The Behaviour Change Wheel (BCW), an eight-step systematic process, was followed to develop the intervention. Reports describing the first four steps are published elsewhere. This report describes the final four steps and details the intervention developed. RESULTS A multifaceted intervention was developed to change audiologists' behaviours relating to providing mental wellbeing support to adults with hearing loss. Specifically, three behaviours were targeted: (1) asking clients about their mental wellbeing, (2) providing general information on the mental wellbeing impacts of hearing loss, and (3) providing personalised information on managing the mental wellbeing impacts of hearing loss. A variety of intervention functions and behaviour change techniques were incorporated into the intervention, including instruction and demonstration, information about others approval, adding objects to the environment, use of prompts/cues, and endorsement from credible sources. CONCLUSION This study is the first to use the Behaviour Change Wheel to develop an intervention targeting mental wellbeing support behaviours in audiologists and confirms the usability and usefulness of the approach in a complex area of clinical care. The systematic development of the Ask, Inform, Manage, Encourage, Refer (AIMER) intervention will facilitate a thorough evaluation of its effectiveness in the next phase of this work.
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Affiliation(s)
- Rebecca J Bennett
- Ear Science Institute Australia, 1 Salvado Road, Subiaco, WA, Australia.
- Centre for Ear Sciences, The University of Western Australia, Perth, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
- Medical School, Curtin University, Bentley, Australia.
| | - Romola S Bucks
- The Raine Study, School of Population and Global Health, The University of Western Australia, Perth, Australia
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Lisa Saulsman
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Robert H Eikelboom
- Ear Science Institute Australia, 1 Salvado Road, Subiaco, WA, Australia
- Centre for Ear Sciences, The University of Western Australia, Perth, Australia
- Medical School, Curtin University, Bentley, Australia
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Carly J Meyer
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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11
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Murphy KA, Daumit GL. Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness. Curr Cardiol Rep 2023; 25:193-202. [PMID: 36847991 PMCID: PMC10042919 DOI: 10.1007/s11886-023-01848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Addressing cardiometabolic risk factors in persons with serious mental illness requires early screening and proactive medical management in both medical and mental health settings. RECENT FINDINGS Cardiovascular disease remains the leading cause of death for persons with serious mental illness (SMI), such as schizophrenia or bipolar disorder, much of which is driven by a high prevalence of metabolic syndrome, diabetes, and tobacco use. We summarize barriers and recent approaches to screening and treatment for metabolic cardiovascular risk factors within physical health and specialty mental health settings. Incorporating system-based and provider-level support within physical health and psychiatric clinical settings should contribute to improvement for screening, diagnosis, and treatment for cardiometabolic conditions for patients with SMI. Targeted education for clinicians and leveraging multi-disciplinary teams are important first steps to recognize and treat populations with SMI at risk of CVD.
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Affiliation(s)
- Karly A Murphy
- Division of General Internal Medicine, University of California San Francisco School of Medicine, 1701 Divisidero Street, Suite 500, 94117, San Francisco, CA, USA.
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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12
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O'Brien K, Burke R, Karlawish J. A Roadmap for Modifying Clinician Behavior to Improve the Detection of Cognitive Impairment. J Gen Intern Med 2023; 38:508-512. [PMID: 36163531 PMCID: PMC9905516 DOI: 10.1007/s11606-022-07824-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
Abstract
A staggering number of individuals live with cognitive decline. Primary care providers are ideally situated to detect the first signs of cognitive decline, but many persons remain undiagnosed. This limits their access to appropriate care. Unfortunately, the timely diagnosis of mild cognitive impairment or dementia in primary care is difficult to achieve. There is a great need for interventions to address this problem. This article applies an implementation science framework, the Behavioral Change Wheel, to evaluate the factors that influence detection of cognitive impairment in primary care and proposes candidate interventions for future study.
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Affiliation(s)
- Kyra O'Brien
- Department of Neurology, Perelman School of Medicine, Penn Memory Center, University of Pennsylvania, Philadelphia, PA, USA. kyra.o'
| | - Robert Burke
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Jason Karlawish
- Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Perelman School of Medicine, Penn Memory Center, University of Pennsylvania, Philadelphia, USA
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13
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Moise N, Paniagua-Avila A, Barbecho JM, Blanco L, Dauber-Decker K, Simantiris S, McElhiney M, Serafini M, Straussman D, Patel SR, Ye S, Duran AT. A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (The Transform DepCare Study). Implement Sci Commun 2023; 4:10. [PMID: 36698220 PMCID: PMC9875183 DOI: 10.1186/s43058-022-00383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/04/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Few real-world examples exist of how best to select and adapt implementation strategies that promote sustainability. We used a collaborative care (CC) use case to describe a novel, theory-informed, stakeholder engaged process for operationalizing strategies for sustainability using a behavioral lens. METHODS Informed by the Dynamic Sustainability Framework, we applied the Behaviour Change Wheel to our prior mixed methods to identify key sustainability behaviors and determinants of sustainability before specifying corresponding intervention functions, behavior change techniques, and implementation strategies that would be acceptable, equitable and promote key tenets of sustainability (i.e., continued improvement, education). Drawing on user-centered design principles, we enlisted 22 national and local stakeholders to operationalize and adapt (e.g., content, functionality, workflow) a multi-level, multi-component implementation strategy to maximally target behavioral and contextual determinants of sustainability. RESULTS After reviewing the long-term impact of early implementation strategies (i.e., external technical support, quality monitoring, and reimbursement), we identified ongoing care manager CC delivery, provider treatment optimization, and patient enrollment as key sustainability behaviors. The most acceptable, equitable, and feasible intervention functions that would facilitate ongoing improvement included environmental restructuring, education, training, modeling, persuasion, and enablement. We determined that a waiting room delivered shared decision-making and psychoeducation patient tool (DepCare), the results of which are delivered to providers, as well as ongoing problem-solving meetings/local technical assistance with care managers would be the most acceptable and equitable multi-level strategy in diverse settings seeking to sustain CC programs. Key adaptations in response to dynamic contextual factors included expanding the DepCare tool to incorporate anxiety/suicide screening, triage support, multi-modal delivery, and patient activation (vs. shared decision making) (patient); pairing summary reports with decisional support and yearly onboarding/motivational educational videos (provider); incorporating behavioral health providers into problem-solving meetings and shifting from billing support to quality improvement and triage (system). CONCLUSION We provide a roadmap for designing behavioral theory-informed, implementation strategies that promote sustainability and employing user-centered design principles to adapt strategies to changing mental health landscapes.
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Affiliation(s)
- Nathalie Moise
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Alejandra Paniagua-Avila
- grid.21729.3f0000000419368729Mailman School of Public Health, Columbia University, New York, NY USA
| | - Jennifer Mizhquiri Barbecho
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Luis Blanco
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | | | - Samantha Simantiris
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Martin McElhiney
- grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY USA
| | - Maria Serafini
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Darlene Straussman
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Sapana R. Patel
- grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY USA ,grid.21729.3f0000000419368729Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Siqin Ye
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
| | - Andrea T. Duran
- grid.239585.00000 0001 2285 2675Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY USA
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14
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Odes R, Alway J, Kushel M, Max W, Vijayaraghavan M. The smoke-free home study: study protocol for a cluster randomized controlled trial of a smoke-free home intervention in permanent supportive housing. BMC Public Health 2022; 22:2076. [PMCID: PMC9664594 DOI: 10.1186/s12889-022-14423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/23/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Formerly chronically homeless adults who live in permanent supportive housing (PSH) have high prevalence of smoking. It is uncommon to find smoke-free policies in PSH because of the concern that such policies contradict PSH’s harm reduction framework and could increase homelessness should residents lose their housing because of the policy. However, in the absence of such policies, non-smoking PSH residents face the harmful effects of secondhand smoke exposure while residents who smoke see increased risks from high rates of smoking throughout their residence. Our pilot work highlighted the feasibility and acceptability of an intervention designed to promote voluntary adoption of a smoke-free home. Here we report a protocol for a cluster randomized controlled trial of the smoke-free home intervention for formerly chronically homeless residents in PSH.
Methods
The smoke-free home intervention provides face-to-face counseling and instruction to PSH residents on how to adopt a smoke-free home and offers training for PSH staff on how to refer residents to tobacco cessation services. We will randomize 20 PSH sites in the San Francisco Bay Area to either the intervention or wait-list control arms. We will enroll 400 PSH residents who smoke cigarettes in their housing unit and 120 PSH staff who work at the sites. At baseline, three- and six-months follow-up, we will ask residents to report their tobacco use and cessation behaviors and adoption of smoke-free homes. We will ask staff to answer questions on their knowledge, attitudes, practices, and barriers related to supporting residents’ smoking cessation. The primary outcome for PSH residents is adoption of smoke-free homes for 90 days or more at six-months follow-up, and the secondary outcome is point prevalence tobacco abstinence. The primary outcome for PSH staff is change in Smoking Knowledge Attitudes Practices survey score.
Discussion
Voluntary adoption of smoke-free homes is a promising approach for reducing exposure to secondhand smoke and reducing tobacco use among a population facing high rates of tobacco-related disease, and is aligned with PSH’s harm reduction framework. Findings from this study have the potential to inform adoption of tobacco control policies among vulnerable populations most at risk for smoking-related harms.
Trial registration
This study was registered with the U.S. National Institute of Health Clinical Trials register on April 22, 2021: NCT04855357.
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15
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Hwong AR, Chagwedera DN, Thomas M, Niu G, Quan J, Vittinghoff E, Schillinger D, Newcomer JW, Gonzalez A, Essock S, Mangurian C. CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care. BMC Psychiatry 2022; 22:687. [PMID: 36348280 PMCID: PMC9644536 DOI: 10.1186/s12888-022-04293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with serious mental illness often do not receive guideline-concordant metabolic screening and human immunodeficiency virus (HIV) testing, contributing to increased morbidity and premature mortality. This study evaluates the effectiveness of CRANIUM (Cardiometabolic Risk Assessment and treatment through a Novel Integration model for Underserved populations with Mental illness), an intervention to increase metabolic screening and HIV testing among patients with serious mental illness in a community mental health clinic compared to usual care. METHODS The study used a quasi-experimental design, prospectively comparing a preventive care screening intervention at one community mental health clinic (n = 536 patients) to usual care at the remaining clinics within an urban behavioural health system (n = 4,847 patients). Psychiatrists at the intervention site received training in preventive health screening and had access to a primary care consultant, screening and treatment algorithms, patient registries, and a peer support specialist. Outcomes were the change in screening rates of A1c, lipid, and HIV testing post-intervention at the intervention site compared to usual care sites. RESULTS Rates of lipid screening and HIV testing increased significantly at the intervention site compared to usual care, with and without multivariable adjustment [Lipid: aOR 1.90, 95% CI 1.32-2.75, P = .001; HIV: aOR 23.42, 95% CI 5.94-92.41, P < .001]. While we observed a significant increase in A1c screening rates at the intervention site, this increase did not persist after multivariable adjustment (aOR 1.37, 95% CI .95-1.99, P = .09). CONCLUSIONS This low-cost, reverse integrated care model targeting community psychiatrist practices had modest effects on increasing preventive care screenings, with the biggest effect seen for HIV testing rates. Additional incentives and structural supports may be needed to further promote screening practices for individuals with serious mental illness.
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Affiliation(s)
- Alison R Hwong
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA. .,UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | | | - Marilyn Thomas
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Grace Niu
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Judy Quan
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Dean Schillinger
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - John W Newcomer
- Thriving Mind South Florida, Miami, FL, USA.,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ana Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Essock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychiatry, Columbia University, New York, NY, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,UCSF Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA
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16
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Furtado T, Perkins E, Pinchbeck G, McGowan C, Watkins F, Christley R. Exploring human behavior change in equine welfare: Insights from a COM-B analysis of the UK's equine obesity epidemic. Front Vet Sci 2022; 9:961537. [DOI: 10.3389/fvets.2022.961537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
While equine obesity is understood by equine professionals to be a serious and widespread welfare problem, thus far approaches to reducing the prevalence of obesity in the UK's leisure horses have mainly been limited to educating owners about the dangers of obesity in their horses. In human health, approaches to behavior change encourage holistic thinking around human behavior, recognizing the importance of the connection between the individuals' knowledge, attitudes, habits, and the social and physical environments. This study used qualitative data from interviews with horse owners and professionals, open-access discussion fora and focus groups in order to collate extensive information about the factors shaping the UK's equine obesity crisis. The data were initially analyzed using a grounded theory method to determine the common themes, and were then analyzed using the COM-B model of behavior change, in order to identify areas where human behavior change might be better supported. The analysis highlighted the importance of a holistic approach to behavior change, since all areas of the COM-B were important in limiting owners' recognition of, and response to, equine obesity. For example, environments and social norms limited the likelihood of owners proactively managing horse weight, and owners also found it difficult to identify overweight horses, and evaluate the risks of long-term health issues as a result of weight, with short-term negative impacts of weight management. While interventions often aim to educate owners into changing their behavior, this analysis highlights the importance of creative and holistic approaches which work alongside the owners' motivations, while shaping the social and physical environments.
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17
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Reuter K, Genao K, Callanan EM, Cannone DE, Giardina EG, Rollman BL, Singer J, Slutzky AR, Ye S, Duran AT, Moise N. Increasing Uptake of Depression Screening and Treatment Guidelines in Cardiac Patients: A Behavioral and Implementation Science Approach to Developing a Theory-Informed, Multilevel Implementation Strategy. Circ Cardiovasc Qual Outcomes 2022; 15:e009338. [PMID: 36378766 PMCID: PMC9909565 DOI: 10.1161/circoutcomes.122.009338] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression leads to poor health outcomes in patients with coronary heart disease (CHD). Despite guidelines recommending screening and treatment of depressed patients with CHD, few patients receive optimal care. We applied behavioral and implementation science methods to (1) identify generalizable, multilevel barriers to depression screening and treatment in patients with CHD and (2) develop a theory-informed, multilevel implementation strategy for promoting guideline adoption. METHODS We conducted a narrative review of barriers to depression screening and treatment in patients with CHD (ie, medications, exercise, cardiac rehabilitation, or therapy) comprising data from 748 study participants. Informed by the behavior change wheel framework and Expert Recommendations for Implementing Change, we defined multilevel target behaviors, characterized determinants (capability, opportunity, motivation), and mapped barriers to feasible, acceptable, and equitable intervention functions and behavior change techniques to develop a multilevel implementation strategy, targeting health care systems/providers and patients. RESULTS We identified implementation barriers at the system/provider level (eg, Capability: knowledge; Opportunity: workflow integration; Motivation: ownership) and patient level (eg, Capability: knowledge; Opportunity: mobility; Motivation: symptom denial). Acceptable, feasible, and equitable intervention functions included education, persuasion, environmental restructuring, and enablement. Expert Recommendations for Implementing Change strategies included learning collaborative, audit, feedback, and educational materials. The final multicomponent strategy (iHeart DepCare) for promoting depression screening/treatment included problem-solving meetings with clinic staff (system); educational/motivational videos, electronic health record reminders/decisional support (provider); and a shared decision-making (electronic shared decision-making) tool with several functions for patients, for example, patient activation, patient treatment selection support. CONCLUSIONS We applied implementation and behavioral science methods to identify implementation barriers and to develop a multilevel implementation strategy for increasing uptake of depression screening and treatment in patients with CHD as a use case. The multilevel implementation strategy will be evaluated in a future hybrid II effectiveness-implementation trial.
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Affiliation(s)
- Katja Reuter
- Department of Medicine, SUNY Upstate Medical University, New York, USA
| | - Kirali Genao
- Columbia University Irving Medical Center, New York, USA
| | | | | | - Elsa-Grace Giardina
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Bruce L. Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jessica Singer
- Columbia University Irving Medical Center, New York, USA
| | - Amy R. Slutzky
- Health Sciences Library, SUNY Upstate Medical University, New York, USA
| | - Siqin Ye
- Columbia University Irving Medical Center, New York, USA
| | | | - Nathalie Moise
- Columbia University Irving Medical Center, New York, USA
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Chiu M, Moist L, Al-Jaishi A, Jain AK. Recognition of Obesity and Perceptions of Weight Loss Management in Patients With Chronic Kidney Disease: A Retrospective Cross-Sectional Study. Can J Kidney Health Dis 2022; 9:20543581221129465. [PMID: 36246343 PMCID: PMC9561641 DOI: 10.1177/20543581221129465] [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: 05/19/2022] [Accepted: 08/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Obesity is, directly and indirectly, linked to the progression of chronic
kidney disease (CKD). However, nephrologists’ recognition of obesity and
willingness to address and manage obesity are unknown. Objectives: The aim of this article is to investigate if obesity is recognized and
documented in the clinical encounter and to examine nephrologists’
perceptions of obesity and comfort with weight loss management. Design: We conducted a 2-part study. Part I used a retrospective chart review and
part II used an anonymous online survey of practicing nephrologists (n = 14)
in our center. Setting: The study took place in the Multi-care Kidney Clinic (MCKC) at London Health
Sciences Centre in London, Ontario, Canada. Patients: In part I, we conducted a retrospective chart review of 10 random patients
with advanced CKD and obesity (body mass index [BMI] > 30
kg/m2) from each of the nephrologists between January and
December 2019. Methods: In part I, charts were assessed for documentation of obesity and/or a
treatment plan (lifestyle counseling, pharmacologic intervention, and
specialist referral). In part II, a survey completed by the nephrologists
explored their current experience and perceptions of obesity and comfort
with weight loss management. Responses were ranked on a 5-point Likert
scale. Results: In all, 140 patient charts were reviewed. The median age was 69
(interquartile range [IQR] = 60-77) years, estimated glomerular filtration
rate (eGFR) was 17 (IQR = 12-20) ml/min/1.73 m2, weight was 99
(IQR = 90-116) kg, and BMI was 36 (IQR = 33-40) kg/m2. Obesity
with a BMI was documented in 36 (26%) charts, and only 2 (1%) documented a
weight loss plan, which only included non-pharmacologic strategies. There
were 13 survey responses (93% response rate). All nephrologists agreed that
obesity negatively affects the health of patients with CKD. Twelve (92%)
reported discussing obesity with patients, but none felt that they had time
to treat it. All reported discussions of obesity would evoke a negative
patient response, while 5 (38%) thought patients actually want to discuss
obesity. Regarding treatment, 8 (62%) nephrologists felt comfortable with
non-pharmacologic treatment, but only 1 respondent was comfortable with
pharmacologic treatments. Twelve (92%) nephrologists thought patients should
be referred to a specialist. Limitations: There was limited generalizability as this was a single center study. The BMI
may reflect hypervolemia rather than body mass. Conclusion: In our study, nephrologists rarely document and manage obesity in patients
with advanced CKD, despite their perception of treatment benefits. Improved
outcomes of obesity management for patients with CKD will require increased
knowledge and clinical tools to efficiently address obesity with
patients.
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Affiliation(s)
- Michael Chiu
- Division of Nephrology, Department of
Medicine, Western University and London Health Sciences Centre, ON, Canada,Kidney Clinical Research Unit, London
Health Sciences Centre, ON, Canada,Michael Chiu, Division of Nephrology,
Department of Medicine, Western University and London Health Sciences Centre,
London, ON N6A 5W9, Canada.
| | - Louise Moist
- Division of Nephrology, Department of
Medicine, Western University and London Health Sciences Centre, ON, Canada,Kidney Clinical Research Unit, London
Health Sciences Centre, ON, Canada
| | - Ahmed Al-Jaishi
- Kidney Clinical Research Unit, London
Health Sciences Centre, ON, Canada,Clinical Epidemiology Program, The
Ottawa Hospital Research Institute, ON, Canada
| | - Arsh K. Jain
- Division of Nephrology, Department of
Medicine, Western University and London Health Sciences Centre, ON, Canada,Kidney Clinical Research Unit, London
Health Sciences Centre, ON, Canada
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Mangurian C, Thomas MD, Mitsuishi F, Goldman LE, Niu G, Handley MA, Riano NS, Hwong A, Essock S, Dilley J, Newcomer JW, Schillinger D. Lessons Learned From a New Reverse-Integration Model to Improve Primary Care Screening in Community Mental Health Settings. Psychiatr Serv 2022; 73:942-945. [PMID: 35138129 PMCID: PMC9357142 DOI: 10.1176/appi.ps.202100177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors sought to describe a reverse-integration intervention aimed at improving preventive health screening in a community mental health clinic. The intervention, CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness), integrated primary care services into a large urban community mental health setting. It was implemented in 2015 and included a patient-centered team, population-based care, emphasis on screening, and evidence-based treatment. CRANIUM's strengths included provider acceptability, a patient-centered approach, sustained patient engagement, and economic feasibility. Challenges included underutilized staff, registry maintenance, and unanticipated screening barriers. The CRANIUM reverse-integration model can be feasibly implemented and was acceptable to providers.
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Affiliation(s)
- Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Marilyn D Thomas
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Fumi Mitsuishi
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - L Elizabeth Goldman
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Grace Niu
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Margaret A Handley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Nicholas S Riano
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Alison Hwong
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Susan Essock
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - James Dilley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - John W Newcomer
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Dean Schillinger
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
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Desse TA, Namara KM, Yifter H, Manias E. Development of a Complex Intervention for Effective Management of Type 2 Diabetes in a Developing Country. J Clin Med 2022; 11:1149. [PMID: 35268240 PMCID: PMC8911192 DOI: 10.3390/jcm11051149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/07/2023] Open
Abstract
There has been little focus on designing tailored diabetes management strategies in developing countries. The aim of this study is to develop a theory-driven, tailored and context-specific complex intervention for the effective management of type 2 diabetes at a tertiary care setting of a developing country. We conducted interviews and focus groups with patients, health professionals, and policymakers and undertook thematic analysis to identify gaps in diabetes management. The results of our previously completed systematic review informed data collection. We used the United Kingdom Medical Research Council framework to guide the development of the intervention. Results comprised 48 interviews, two focus groups with 11 participants and three co-design panels with 24 participants. We identified a lack of structured type 2 diabetes education, counselling, and collaborative care of type 2 diabetes. Through triangulation of the evidence obtained from data collection, we developed an intervention called VICKY (patient-centred collaborative care and structured diabetes education and counselling) for effective management of type 2 diabetes. VICKY comprised five components: (1) patient-centred collaborative care; (2) referral system for patients across transitions of care between different health professionals of the diabetes care team; (3) tools for the provision of collaborative care and documentation of care; (4) diabetes education and counselling by trained diabetes educators; and (5) contextualised diabetes education curriculum, educational materials, and documentation tools for diabetes education and counselling. Implementation of the intervention may help to promote evidence-based, patient-centred, and contextualised diabetes care for improved patient outcomes in a developing country.
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Affiliation(s)
- Tigestu Alemu Desse
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC 3217, Australia;
| | - Kevin Mc Namara
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, VIC 3217, Australia;
- Deakin Health Economics, Institute for Healthcare Transformation, Deakin University, Geelong, VIC 3217, Australia
| | - Helen Yifter
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia;
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC 3217, Australia;
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#LetsUnlitterUK: A demonstration and evaluation of the Behavior Change Wheel methodology. PLoS One 2021; 16:e0259747. [PMID: 34784385 PMCID: PMC8594830 DOI: 10.1371/journal.pone.0259747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022] Open
Abstract
The Behavior Change Wheel is the most comprehensive and practically useful methodology available for developing behavior change interventions. The current article demonstrates how it can be applied to optimize pro-environmental behaviors and, in so doing, give interventionists access to a rigorous set of theories and techniques for systematically developing pro-environmental interventions. Section 1 describes the development of an intervention to increase people's intentions to post anti-littering messages on social media. Study 2 describes the development and evaluation of an intervention to increase people's actual anti-littering posts. Both evaluations are randomized controlled trials that compare the effectiveness of the developed intervention with interventions less informed by the Wheel. We found interventions completely informed by the Wheel to be more effective than interventions less (or not at all) informed by the Wheel. The discussion explores how the Behavior Change Wheel methodology can be used to design future pro-environment interventions.
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Replacement of Meat with Non-Meat Protein Sources: A Review of the Drivers and Inhibitors in Developed Countries. Nutrients 2021; 13:nu13103602. [PMID: 34684603 PMCID: PMC8537109 DOI: 10.3390/nu13103602] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
The overconsumption of meat has been charged with contributing to poor health and environmental degradation. Replacing meat with non-meat protein sources is one strategy advocated to reduce meat intake. This narrative review aims to identify the drivers and inhibitors underlying replacing meat with non-meat protein sources in omnivores and flexitarians in developed countries. A systematic search was conducted in Scopus and Web of Science until April 2021. In total, twenty-three studies were included in this review examining personal, socio-cultural, and external factors. Factors including female gender, information on health and the environment, and lower price may act as drivers to replacing meat with non-meat protein sources. Factors including male gender, meat attachment, food neophobia, and lower situational appropriateness of consuming non-meat protein sources may act as inhibitors. Research is needed to establish the relevance of socioeconomic status, race, ethnicity, religion, health status, food environment, and cooking skills. Future studies should prioritize standardizing the definitions of meat and non-meat protein replacements and examining factors across different consumer segments and types of non-meat protein sources. Thereby, the factors determining the replacement of meat with non-meat protein sources can be better elucidated, thus, facilitating the transition to a healthier and more sustainable diet.
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Watt M, Spence JC, Tandon P. Development of a Theoretically Informed Web-Based Mind-Body Wellness Intervention for Patients With Primary Biliary Cholangitis: Formative Study. JMIR Form Res 2021; 5:e29064. [PMID: 34623317 PMCID: PMC8538029 DOI: 10.2196/29064] [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: 03/24/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background Mind-body interventions have the potential to positively impact the symptom burden associated with primary biliary cholangitis (PBC). Interventions are more likely to be effective if they are informed by a theoretical framework. The Behaviour Change Wheel (BCW) and the behaviour change technique taxonomy version 1 (BCTv1) provide frameworks for intervention development. Objective This study describes how theory has guided the development of a 12-week multicomponent mind-body wellness intervention for PBC. Methods The steps involved in developing the BCW intervention included specifying the target behavior; explaining barriers and facilitators using the Capability, Opportunity, Motivation, and Behaviour and the theoretical domains framework; identifying intervention functions to target explanatory domains; and selecting relevant behavior change techniques to address intervention functions. Qualitative data from patients with inflammatory bowel disease using an earlier version of the program and feedback from a PBC patient advisory team were used to guide intervention development. Results Barriers and facilitators to intervention participation associated with capability, opportunity, and motivation were identified. Intervention functions and behavior change techniques were identified to target each barrier and facilitator. Conclusions The Peace Power Pack PBC intervention was developed to help individuals with PBC manage their symptom burden. The theoretical frameworks employed in this intervention provide direction on targeting antecedents of behavior and allow standardized reporting of intervention components. Trial Registration ClinicalTrials.gov NCT04791527; https://clinicaltrials.gov/ct2/show/NCT04791527
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24
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Dyson J, Cowdell F. How is the Theoretical Domains Framework applied in designing interventions to support healthcare practitioner behaviour change? A systematic review. Int J Qual Health Care 2021; 33:6324052. [PMID: 34279637 DOI: 10.1093/intqhc/mzab106] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/21/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The use of theory is recommended to support interventions to promote implementation of evidence-based practices. However, there are multiple models of behaviour change which can be complex and lack comprehensiveness and are therefore difficult to understand and operationalize. The Theoretical Domains Framework sought to address these problems by synthesizing 33 models of behaviour or behaviour change. Given that it is 15 years since the first publication of the Theoretical Domains Framework (TDF), it is timely to reflect on how the framework has been applied in practice. OBJECTIVE The objective of this review is to identify and narratively synthesize papers in which the TDF, (including frameworks that incorporate the TDF) have been used have been used to develop implementation interventions. METHODS We searched MEDLINE, PsychINFO, CINAHL and the Cochrane databases using the terms: 'theoretical domains framework*' or TDF or Capability, Opportunity, Motivation to Behaviour (COM-B) or 'behav* change wheel' or 'BCW' AND implement* or improv* or quality or guideline* or intervention* or practice* or EBP or 'evidence based practice' and conducted citation and key author searches. The included papers were those that used any version of the TDF published from 2005 onwards. The included papers were subject to narrative synthesis. RESULTS A total of 3540 papers were identified and 60 were included. Thirty-two papers reported intervention design only and 28 reported intervention design and testing. Despite over 3000 citations there has been limited application to the point of designing interventions to support the best practice. In particular use of the framework has not been tried or tested in non-western countries and barely used in non-primary or acute care settings. Authors have applied the framework to assess barriers and facilitators successfully but reporting of the process of selection of behaviour change techniques and intervention design thereafter was variable. CONCLUSION Despite over three thousand citations of the framework there has been limited application to the point of designing interventions to support best practice. The framework is barely used in non-western countries or beyond primary or acute care settings. A stated purpose of the framework was to make psychological theory accessible to researchers and practitioners alike; if this is to be fully achieved, further guidance is needed on the application of the framework beyond the point of assessment of barriers and facilitators.
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Affiliation(s)
- Judith Dyson
- Healthcare Research and Implementation Science, Faculty of Health, Education and Life Sciences, Birmingham City University, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK
| | - Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Nursing and Healthcare Research, Birmingham City University, Westbourne Road, Birmingham B15 3TN, UK
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Garcia ME, Goldman EL, Thomas M, Chan S, Mitsuishi F, Schillinger D, Mangurian C. Accuracy of Primary Care Medical Home Designation in a Specialty Mental Health Clinic. Psychiatr Q 2021; 92:601-607. [PMID: 32829448 PMCID: PMC8774075 DOI: 10.1007/s11126-020-09829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To assess whether primary care medical homes (PCMHs) are accurately identified for patients receiving care in a specialty mental health clinic within an integrated public delivery system. This study reviewed the electronic records of patients in a large urban mental health clinic. The study defined 'matching PCMH' if the same primary care clinic was listed in both the mental health and medical electronic records. This study designated all others as 'PCMH unknown.' This study assessed whether demographic factors predicted PCMH status using chi-square tests. Among 229 patients (66% male; mean age 49; 36% White, 30% Black, and 17% Asian), 72% had a matching PCMH. Sex, age, race, psychiatric diagnosis, and psychotropic medication use were not associated with matching PCMH. To improve care coordination and health outcomes for people with severe mental illness, greater efforts are needed to ensure the accurate designation of PCMHs in all mental health patient electronic records.
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Affiliation(s)
- Maria E Garcia
- Center for Aging in Diverse Communities, Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, USA.
| | - Elizabeth L Goldman
- Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Marilyn Thomas
- Department of Epidemiology, University of California, Berkeley, CA, USA
| | - Stephen Chan
- Department of Medicine, University of California, Davis, CA, USA
| | - Fumi Mitsuishi
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Dean Schillinger
- Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Christina Mangurian
- Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, CA, USA
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Vasquez T, Fernandez A, Haya-Fisher J, Kim S, Beck AL. A Qualitative Exploration of Barriers and Facilitators to Physical Activity Among Low-Income Latino Adolescents. HISPANIC HEALTH CARE INTERNATIONAL 2021; 19:86-94. [PMID: 32911975 PMCID: PMC8496995 DOI: 10.1177/1540415320956933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Latino adolescents experience high rates of obesity and physical activity can protect against obesity and obesity comorbidities. Health interventions to promote physical activity are more likely to be successful if they take into account the experiences and perspectives of their target population. Our study objective was to explore barriers and facilitators to physical activity among Latino adolescents with the goal of informing future interventions for this population. METHOD Semistructured interviews were conducted with (n = 30) low-income, Latino adolescents. The interviews were analyzed using inductive methods and the Capability-Opportunity-Motivation model of behavior. RESULTS Adolescents described capability gaps including lacking skills for preferred activities. School physical education and parks provided opportunities for adolescents to be physically active. Adolescents also described opportunity challenges, including age limits, not being able to afford preferred classes, and safety concerns. Families provided role modeling but rarely engaged in activities with adolescents. Adolescents were motivated to engage in physical activity but often lacked the necessary resources. CONCLUSIONS Interventions to increase physical activity among urban Latino adolescents should offer tailored programming, incorporate families, enhance physical education, and improve the safety and appeal of recreational facilities.
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Affiliation(s)
| | | | | | - Sarah Kim
- 8785University of California, San Francisco, CA, USA
| | - Amy L Beck
- 8785University of California, San Francisco, CA, USA
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Improving the way healthcare professionals deliver different news to families during pregnancy or at birth: a qualitative study. Prim Health Care Res Dev 2021; 22:e10. [PMID: 33775272 PMCID: PMC8101073 DOI: 10.1017/s1463423620000651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM To explore the lived experience of delivering or receiving news about an unborn or newborn child having a condition associated with a learning disability in order to inform the development of a training intervention for healthcare professionals. We refer to this news as different news. BACKGROUND How healthcare professionals deliver different news to parents affects the way they adjust to the situation, the wellbeing of their child and their ongoing engagement with services. This is the first study that examined the lived experience of delivering and receiving different news, in order to inform the development of training for healthcare professionals using the Theoretical Domains Framework version 2. METHOD We conducted qualitative interviews with a purposive sample of 9 different parents with the lived experience of receiving different news and 12 healthcare professionals who delivered different news. It was through these descriptions of the lived experience that barriers and facilitators to effectively delivering different news were identified to inform the training programme. Data analysis was guided by Theoretical Domains Framework version 2 to identify these barriers and facilitators as well as the content of a training intervention. FINDINGS Receiving different news had a significant impact on parents' emotional and mental wellbeing. They remembered how professionals described their child, the quality of care and emotional support they received. The process had a significant impact on the parent-child relationship and the relationship between the family and healthcare professionals.Delivering different news was challenging for some healthcare professionals due to lack of training. Future training informed by parents' experiences should equip professionals to demonstrate empathy, compassion, provide a balanced description of conditions and make referrals for further care and support. This can minimise the negative psychological impact of the news, maximise psychological wellbeing of families and reduce the burden on primary care services.
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28
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Iturralde E, Slama N, Kline-Simon AH, Young-Wolff KC, Mordecai D, Sterling SA. Premature mortality associated with severe mental illness or substance use disorder in an integrated health care system. Gen Hosp Psychiatry 2021; 68:1-6. [PMID: 33227668 DOI: 10.1016/j.genhosppsych.2020.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/20/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Research has reported shortened lifespans (by 15-30 years) for those with severe mental illness (SMI) or substance use disorder (SUD), particularly among public mental health treatment consumers. We assessed SMI- and SUD-associated mortality in the understudied setting of a large, nonprofit integrated health care system. METHOD This retrospective cohort study examined 2010-2017 health system and death records for 564,592 adult patients. Half had SMI/SUD diagnosis; half were a demographically matched comparison group without SMI, other mental health, or SUD diagnoses. We estimated mortality risks, adjusting for demographic and physical health factors. RESULTS Having SMI or SUD was associated with higher odds of death (adjusted odds ratio = 1.87) and an average 6.3 years of earlier death relative to comparison individuals. Co-occurring SMI and SUD conferred higher mortality risk from major natural and unnatural causes than did SMI with no SUD. CONCLUSIONS Some indicators of premature mortality were lower than those reported for U.S. public mental health consumers, but risk level varied widely by diagnosis. While patients' having insurance and broad access to care may lower risk, access to care may be insufficient to overcome the many patient-, provider-, and system-level factors contributing to poor physical health in SMI and SUD.
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Affiliation(s)
- Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Natalie Slama
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Don Mordecai
- The Permanente Medical Group, Kaiser Permanente Northern California, 1950 Franklin Street, Oakland, CA 94612, United States of America
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States of America
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Prevention and treatment of pressure injuries: A meta-synthesis of Cochrane Reviews. J Tissue Viability 2020; 29:227-243. [DOI: 10.1016/j.jtv.2020.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/13/2020] [Accepted: 05/29/2020] [Indexed: 12/21/2022]
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Moise N, Phillips E, Carter E, Alcantara C, Julian J, Thanataveerat A, Schwartz JE, Ye S, Duran A, Shimbo D, Kronish IM. Design and study protocol for a cluster randomized trial of a multi-faceted implementation strategy to increase the uptake of the USPSTF hypertension screening recommendations: the EMBRACE study. Implement Sci 2020; 15:63. [PMID: 32771002 PMCID: PMC7414682 DOI: 10.1186/s13012-020-01017-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background The US Preventive Services Task Force (USPSTF) recommends out-of-office blood pressure (BP) testing to exclude white coat hypertension prior to hypertension diagnosis. Despite improved availability and coverage of home and 24-h ambulatory BP monitoring (HBPM, ABPM), both are infrequently used to confirm diagnoses. We used the Behavior Change Wheel (BCW) framework, a multi-step process for mapping barriers to theory-informed behavior change techniques, to develop a multi-component implementation strategy for increasing out-of-office BP testing for hypertension diagnosis. Informed by geographically diverse provider focus groups (n = 63) exploring barriers to out-of-office testing and key informant interviews (n = 12), a multi-disciplinary team (medicine, psychology, nursing) used rigorous mixed methods to develop, refine, locally adapt, and finalize intervention components. The purpose of this report is to describe the protocol of the Effects of a Multi-faceted intervention on Blood pRessure Actions in the primary Care Environment (EMBRACE) trial, a cluster randomized control trial evaluating whether a theory-informed multi-component strategy increased out-of-office testing for hypertension diagnosis. Methods/design The EMBRACE Trial patient sample will include all adults ≥ 18 years of age with a newly elevated office BP (≥ 140/90 mmHg) at a scheduled visit with a primary care provider from a study clinic. All providers with scheduled visits with adult primary care patients at enrolled ACN primary care clinics were included. We determined that the most feasible, effective implementation strategy would include delivering education about out-of-office testing, demonstration/instruction on how to perform out-of-office HBPM and ABPM testing, feedback on completion rates of out-of-office testing, environmental prompts/cues via computerized clinical decision support (CDS) tool, and a culturally tailored, locally accessible ABPM testing service. We are currently comparing the effect of this locally adapted multi-component strategy with usual care on the change in the proportion of eligible patients who complete out-of-office BP testing in a 1:1 cluster randomized trial across 8 socioeconomically diverse clinics. Conclusions The EMBRACE trial is the first trial to test an implementation strategy for improving out-of-office testing for hypertension diagnosis. It will elucidate the degree to which targeting provider behavior via education, reminders, and decision support in addition to providing an ABPM testing service will improve referral to and completion of ABPM and HBPMs. Trial registration Clinicaltrials.gov, NCT03480217, Registered on 29 March 2018
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Affiliation(s)
- Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA.
| | - Erica Phillips
- Division of General Internal Medicine, Weill Cornell Medicine, 1320 York Avenue, New York, NY, 10021, USA
| | - Eileen Carter
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 West 168th Street, New York, NY, 10032, USA
| | - Carmela Alcantara
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Jacob Julian
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Anusorn Thanataveerat
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA.,Department of Psychiatry and Behavioral Science, Stony Brook University School of Medicine, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Andrea Duran
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 10032, USA
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Jakobs KM, Posthuma A, de Grauw WJC, Schalk BWM, Akkermans RP, Lucassen P, Schermer T, Assendelft WJJ, Biermans MJC. Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice. BMC FAMILY PRACTICE 2020; 21:153. [PMID: 32727372 PMCID: PMC7391510 DOI: 10.1186/s12875-020-01225-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/19/2020] [Indexed: 12/02/2022]
Abstract
Background Patients with serious mental illness (SMI) and patients on antipsychotics (AP) have an elevated risk for cardiovascular diseases. In the Netherlands, the mental healthcare for these patients is increasingly taken care of by family practitioners (FP) as a result of a shift from secondary to primary care. Therefore, it is essential to increase our knowledge regarding the characteristics of this patient group and the (somatic) care provided by their FPs. The aim was to examine the rate of cardiovascular risk screening in patients with SMI or the use of AP in family practice. Methods We performed a retrospective cohort study of 151.238 patients listed in 24 family practices in the Netherlands. From electronic medical records we extracted data concerning diagnoses, measurement values of CVR factors, medication and frequency of visits over a 2 year period. Primary outcome was the rate of patients who were screened for CVR factors. We compared three groups: patients with SMI/AP without diabetes or CVD (SMI/AP-only), patients with SMI/AP and diabetes mellitus (SMI/AP + DM), patients with SMI/AP and a history of cardiovascular disease (SMI/AP + CVD). We explored factors associated with adequate screening using multilevel logistic regression. Results We identified 1705 patients with SMI/AP, 834 with a SMI diagnosis, 1150 using AP. The screening rate for CVR in the SMI/AP-only group (n = 1383) was adequate in 8.5%. Screening was higher in the SMI/AP − +DM (n = 206, 68.4% adequate, OR 24.6 (95%CI, 17.3–35.1) and SMI/AP + CVD (n = 116, 26.7% adequate, OR 4.2 (95%CI, 2.7–6.6). A high frequency of visits, age, the use of AP and a diagnosis of COPD were associated with a higher screening rate. In addition we also examined differences between patients with SMI and patients using AP without SMI. Conclusion CVR screening in patients with SMI/AP is performed poorly in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as comorbidity. The finding of a large group of AP users without a SMI diagnosis may indicate that FPs often prescribe AP off-label, lack information about the diagnosis, or use the wrong code.
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Affiliation(s)
- Kirsti M Jakobs
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Anne Posthuma
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Wim J C de Grauw
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Bianca W M Schalk
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Reinier P Akkermans
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Tjard Schermer
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Marion J C Biermans
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
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Hwong A, Wang K, Bent S, Mangurian C. Breast Cancer Screening in Women With Schizophrenia: A Systematic Review and Meta-Analysis. Psychiatr Serv 2020; 71:263-268. [PMID: 31722645 PMCID: PMC7323869 DOI: 10.1176/appi.ps.201900318] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Women with schizophrenia appear to receive breast cancer diagnoses at later stages of the disease compared with the general population. To study this disparity, this report reviewed and quantified the differences in rates of mammography screening for women with schizophrenia and other psychotic disorders compared with the general population. METHODS A systematic literature search was conducted in PubMed, Embase, Web of Science, and PsycINFO databases. Each database was searched from inception to September 14, 2018. The search strategy included search terms for breast cancer, mammography, schizophrenia, and psychosis. Two reviewers independently screened and evaluated eligible studies. The main outcome measure was the rate of mammography screening among women with schizophrenia and psychotic disorders versus a comparable population of women without these diagnoses. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for abstracting data, and the Newcastle-Ottawa Scale was used for assessing data quality. A meta-analysis with a random-effects model was performed. RESULTS From a total of 304 abstracts reviewed, 11 studies met the inclusion criteria, representing 25,447 women with diagnoses of schizophrenia or psychosis across four countries. The meta-analysis showed that women with schizophrenia were less likely than women without schizophrenia to receive mammography screening (pooled OR=0.50, 95% confidence interval=0.38-0.64, p<0.001). In subgroup analysis, this association was not significantly affected by quality of the study. CONCLUSIONS Women with schizophrenia and other psychotic disorders were about half as likely as the general population to receive mammography screening. Further research is needed to determine causes of this disparity.
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Affiliation(s)
- Alison Hwong
- Department of Psychiatry, University of California, San Francisco (UCSF), and UCSF Weill Institute for Neurosciences, San Francisco (Hwong, Mangurian); UCSF School of Medicine, San Francisco (Wang); Department of Medicine, UCSF (Bent)
| | - Kara Wang
- Department of Psychiatry, University of California, San Francisco (UCSF), and UCSF Weill Institute for Neurosciences, San Francisco (Hwong, Mangurian); UCSF School of Medicine, San Francisco (Wang); Department of Medicine, UCSF (Bent)
| | - Stephen Bent
- Department of Psychiatry, University of California, San Francisco (UCSF), and UCSF Weill Institute for Neurosciences, San Francisco (Hwong, Mangurian); UCSF School of Medicine, San Francisco (Wang); Department of Medicine, UCSF (Bent)
| | - Christina Mangurian
- Department of Psychiatry, University of California, San Francisco (UCSF), and UCSF Weill Institute for Neurosciences, San Francisco (Hwong, Mangurian); UCSF School of Medicine, San Francisco (Wang); Department of Medicine, UCSF (Bent)
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33
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Screening for Diabetes and Self-Care in Patients With Severe Mental Illness. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2019.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Melamed OC, Wong EN, LaChance LR, Kanji S, Taylor VH. Interventions to Improve Metabolic Risk Screening Among Adult Patients Taking Antipsychotic Medication: A Systematic Review. Psychiatr Serv 2019; 70:1138-1156. [PMID: 31522630 DOI: 10.1176/appi.ps.201900108] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Antipsychotic use is associated with elevated cardiometabolic risk. Guidelines for metabolic risk screening of individuals taking antipsychotics have been issued, but with little uptake into clinical practice. This review systematically assessed interventions that address this guideline-to-practice gap and described their quality, improvement strategies, and effect on screening rates. METHODS Studies of interventions that addressed metabolic risk screening of adult patients taking antipsychotics, published from inception to July 2018, were selected from MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Reviews databases. Information was extracted on study characteristics; improvement strategies at the provider, patient, and system levels; and screening rates in the intervention and comparison groups. RESULTS The review included 30 complex interventions that used between one and nine unique improvement strategies. Social influence to shift provider and health organization culture to encourage metabolic risk screening was a common strategy, as were clinical prompts and monitoring tools to capture provider attention. Most studies were deemed at high risk of bias. Relative to comparison groups, the interventions were associated with an increase in median screening rates for glucose (28% to 65%), lipids (22% to 61%), weight (19% to 67%), and blood pressure (22% to 80%). CONCLUSIONS This knowledge synthesis points to shortcomings of current interventions to improve antipsychotic metabolic risk screening, both in quality and in outcomes. Findings may be used to inform the design of future programs. Additional interventions are needed to address the current guideline-to-practice gap, in which approximately one-third of patients are unscreened for metabolic risk.
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Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Erin N Wong
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Laura R LaChance
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Sarah Kanji
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
| | - Valerie H Taylor
- Centre for Addiction and Mental Health, Toronto (Melamed, LaChance); Department of Psychiatry, University of Toronto, Toronto (Melamed, Wong, Kanji, Taylor); Department of Psychiatry, McGill University, Montreal (LaChance); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Taylor)
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Bernstein A, Rogers KM, Possin KL, Steele NZR, Ritchie CS, Kramer JH, Geschwind M, Higgins JJ, Wohlgemuth J, Pesano R, Miller BL, Rankin KP. Dementia assessment and management in primary care settings: a survey of current provider practices in the United States. BMC Health Serv Res 2019; 19:919. [PMID: 31783848 PMCID: PMC6884754 DOI: 10.1186/s12913-019-4603-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 10/03/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Primary care providers (PCPs) are typically the first to screen and evaluate patients for neurocognitive disorders (NCDs), including mild cognitive impairment and dementia. However, data on PCP attitudes and evaluation and management practices are sparse. Our objective was to quantify perspectives and behaviors of PCPs and neurologists with respect to NCD evaluation and management. METHODS A cross-sectional survey with 150 PCPs and 50 neurologists in the United States who evaluated more than 10 patients over age 55 per month. The 51-item survey assessed clinical practice characteristics, and confidence, perceived barriers, and typical practices when diagnosing and managing patients with NCDs. RESULTS PCPs and neurologists reported similar confidence and approaches to general medical care and laboratory testing. Though over half of PCPs performed cognitive screening or referred patients for cognitive testing in over 50% of their patients, only 20% reported high confidence in interpreting results of cognitive tests. PCPs were more likely to order CT scans than MRIs, and only 14% of PCPs reported high confidence interpreting brain imaging findings, compared to 70% of specialists. Only 21% of PCPs were highly confident that they correctly recognized when a patient had an NCD, and only 13% were highly confident in making a specific NCD diagnosis (compared to 72 and 44% for neurologists, both p < 0.001). A quarter of all providers identified lack of familiarity with diagnostic criteria for NCD syndromes as a barrier to clinical practice. CONCLUSIONS This study demonstrates how PCPs approach diagnosis and management of patients with NCDs, and identified areas for improvement in regards to cognitive testing and neuroimaging. This study also identified all providers' lack of familiarity with published diagnostic criteria for NCD syndromes. These findings may inform the development of new policies and interventions to help providers improve the efficacy of their decision processes and deliver better quality care to patients with NCDs.
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Affiliation(s)
- Alissa Bernstein
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA. .,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.
| | - Kirsten M Rogers
- Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Katherine L Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California San Francisco, San Francisco, USA
| | | | - Christine S Ritchie
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joel H Kramer
- Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Michael Geschwind
- Department of Neurology, University of California San Francisco, San Francisco, USA
| | | | | | | | - Bruce L Miller
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Katherine P Rankin
- Department of Neurology, University of California San Francisco, San Francisco, USA
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van Leeuwen LM, Pronk M, Merkus P, Goverts ST, Anema JR, Kramer SE. Developing an intervention to implement an ICF-based e-intake tool in clinical otology and audiology practice. Int J Audiol 2019; 59:282-300. [DOI: 10.1080/14992027.2019.1691746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Lisette M. van Leeuwen
- Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marieke Pronk
- Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul Merkus
- Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S. Theo Goverts
- Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes R. Anema
- Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sophia E. Kramer
- Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Graça J, Godinho CA, Truninger M. Reducing meat consumption and following plant-based diets: Current evidence and future directions to inform integrated transitions. Trends Food Sci Technol 2019. [DOI: 10.1016/j.tifs.2019.07.046] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Beck AL, Iturralde E, Haya-Fisher J, Kim S, Keeton V, Fernandez A. Barriers and facilitators to healthy eating among low-income Latino adolescents. Appetite 2019; 138:215-222. [PMID: 30954634 PMCID: PMC6628719 DOI: 10.1016/j.appet.2019.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of this study was to explore barriers and facilitators to healthy eating among low-income Latino adolescents using an intervention development framework. METHODS Semi-structured interviews (n = 30) were conducted with Latino youth ages 13-17 who had overweight or obesity at a safety-net clinic in San Francisco, CA. Adolescent beliefs and attitudes regarding healthy eating and individual, family, and community level barriers and facilitators were elicited. Interviews were analyzed using an inductive approach and the Capability-Opportunity-Motivation (COM-B) model. RESULTS Participants had capability gaps; while they demonstrated basic nutrition knowledge, they also held significant misconceptions about healthy eating, equating "organic" with healthy and failing to recognize sugar in a number of beverages and foods. Families were a source of support through role modeling and purchasing fresh produce, yet in many cases also undermined adolescents' healthy eating goals through purchases of high calorie low nutrient food, an opportunity facilitator and challenge. By contrast, peers were mostly a negative influence due to frequent consumption of high calorie low nutrient food. The school environment posed opportunity challenges as participants found school lunch unpalatable and had ready access to unhealthy options nearby. Participants were motivated to improve their eating habits but often not resilient in the face of obstacles. CONCLUSIONS Interventions to promote healthy eating among low-income Latino adolescents should address common nutritional misconceptions, target families as well as teens, consider peer influences, and advocate for policy approaches that improve the school food environment.
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Affiliation(s)
- Amy L Beck
- Department of Pediatrics, School of Medicine, University of California San Francisco, USA.
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, USA.
| | - Julissa Haya-Fisher
- Department of Pediatrics, School of Medicine, University of California San Francisco, USA.
| | - Sarah Kim
- Department of Medicine, School of Medicine, University of California, San Francisco, USA.
| | - Victoria Keeton
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, USA.
| | - Alicia Fernandez
- Department of Medicine, School of Medicine, University of California, San Francisco, USA.
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Moving Cancer Care Ontario's Exercise for People with Cancer guidelines into oncology practice: using the Theoretical Domains Framework to validate a questionnaire. Support Care Cancer 2019; 27:1965-1968. [PMID: 30762143 DOI: 10.1007/s00520-019-04689-1] [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] [Received: 10/24/2018] [Accepted: 02/05/2019] [Indexed: 12/20/2022]
Abstract
Evidence supporting the benefits of exercise surrounding cancer treatment has led to internationally published guidelines, with minimal uptake by oncology care providers (OCPs). There is a need to understand how to implement research evidence into practice. Our team developed a questionnaire to assess OCPs' knowledge of exercise guidelines and barriers/facilitators to exercise counseling and program referral. We validated the questionnaire using the Theoretical Domains Framework, a knowledge translation (KT) framework used to implement evidence-based guidelines into practice. In this commentary, we describe this process and the rationale for integrating a KT framework into intervention development and implementation in oncology practice. The revised questionnaire, entitled Clinicians Perspectives on Exercise in Patients with Cancer (CliPEC), is shared to facilitate the implementation process and allow for comparison across oncology practices.
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