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Hodgson W, Kirk A, Lennon M, Janssen X, Russell E, Wani C, Eskandarani D. RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Evaluation of the Use of Activity Trackers in the Clinical Care of Adults Diagnosed With a Chronic Disease: Integrative Systematic Review. J Med Internet Res 2023; 25:e44919. [PMID: 37955960 PMCID: PMC10682916 DOI: 10.2196/44919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 07/20/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Chronic diseases are a leading cause of adult mortality, accounting for 41 million deaths globally each year. Low levels of physical activity and sedentary behavior are major risk factors for adults to develop a chronic disease. Physical activity interventions can help support patients in clinical care to be more active. Commercial activity trackers that can measure daily steps, physical activity intensity, sedentary behavior, and distance moved are being more frequently used within health-related interventions. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a planning and evaluation approach to explore the reach, effectiveness, adoption, implementation, and maintenance of interventions. OBJECTIVE The objective of this study is to conduct an integrative systematic review and report the 5 main RE-AIM dimensions in interventions that used activity trackers in clinical care to improve physical activity or reduce sedentary behavior in adults diagnosed with chronic diseases. METHODS A search strategy and study protocol were developed and registered on the PROSPERO platform. Inclusion criteria included adults (18 years and older) diagnosed with a chronic disease and have used an activity tracker within their clinical care. Searches of 10 databases and gray literature were conducted, and qualitative, quantitative, and mixed methods studies were included. Screening was undertaken by more than 1 researcher to reduce the risk of bias. After screening, the final studies were analyzed using a RE-AIM framework data extraction evaluation tool. This tool assisted in identifying the 28 RE-AIM indicators within the studies and linked them to the 5 main RE-AIM dimensions. RESULTS The initial search identified 4585 potential studies. After a title and abstract review followed by full-text screening, 15 studies were identified for data extraction. The analysis of the extracted data found that the RE-AIM dimensions of adoption (n=1, 7% of studies) and maintenance (n=2, 13% of studies) were underreported. The use of qualitative thematic analysis to understand the individual RE-AIM dimensions was also underreported and only used in 3 of the studies. Two studies used qualitative analysis to explore the effectiveness of the project, while 1 study used thematic analysis to understand the implementation of an intervention. CONCLUSIONS Further research is required in the use of activity trackers to support patients to lead a more active lifestyle. Such studies should consider using the RE-AIM framework at the planning stage with a greater focus on the dimensions of adoption and maintenance and using qualitative methods to understand the main RE-AIM dimensions within their design. These results should form the basis for establishing long-term interventions in clinical care. TRIAL REGISTRATION PROSPERO CRD42022319635; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319635.
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Affiliation(s)
- William Hodgson
- School of Psychological Sciences and Health, Department of Physical Activity for Health, University of Strathclyde, Glasgow, United Kingdom
| | - Alison Kirk
- School of Psychological Sciences and Health, Department of Physical Activity for Health, University of Strathclyde, Glasgow, United Kingdom
| | - Marilyn Lennon
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Xanne Janssen
- School of Psychological Sciences and Health, Department of Physical Activity for Health, University of Strathclyde, Glasgow, United Kingdom
| | - Eilidh Russell
- School of Psychological Sciences and Health, Department of Physical Activity for Health, University of Strathclyde, Glasgow, United Kingdom
| | - Carolina Wani
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Dina Eskandarani
- School of Psychological Sciences and Health, Department of Physical Activity for Health, University of Strathclyde, Glasgow, United Kingdom
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Yap B, Rajaram N, Ho WK, Khor GL, Teo SH. Perceptions, attitudes and beliefs towards soya among healthy Asian women participating in a soya randomised controlled trial. J Nutr Sci 2023; 12:e69. [PMID: 37457681 PMCID: PMC10345781 DOI: 10.1017/jns.2023.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 07/18/2023] Open
Abstract
The soya-breast cancer risk relationship remains controversial in Asia due to limited and inconsistent research findings and is exacerbated by difficulties in recruiting and retaining participants in intervention trials. Understanding public perceptions towards soya is important for designing effective intervention trials. Here, we administered a close-ended, quantitative survey to healthy, peri- and post-menopausal Asian women in the Malaysian Soy and Mammographic Density (MiSo) Study to assess perception towards soya and explore motivators and barriers that affect study adherence using the Capability, Opportunity, Motivation and Belief (COM-B) Model and Theoretical Domains Framework (TDF). Of 118 participants, the majority reported the belief that soya promotes good health (Supplement = 85⋅7 %, Diet = 90⋅0 %, Control = 87⋅9 %). Most participants reported obtaining information about soya from the internet (Supplement = 61⋅0 %, Diet = 55⋅3 %, Control = 35⋅9 %), while health professionals were least reported (Supplement = 9⋅8 %, Diet = 7⋅9 %, Control = 5⋅1 %). Stratified analyses by study completion and adherence status yielded comparable findings. By the end of the study, dietary arm participants reported a strong belief that soya has no impact on their health (Supplement = 7⋅1 % v. Diet = 20⋅0 % v. Control = 0⋅0 %, P = 0⋅012). Motivation and opportunity strongly facilitated soya consumption, while psychological capability was the most common barrier to consumption though less evident among dietary arm participants. While most Asian women have a positive perception towards soya, theory-based intervention trials are warranted to understand the perception-study adherence relationship and to accurately inform the public of the health effects of soya.
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Affiliation(s)
- Beverley Yap
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
| | - Nadia Rajaram
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor 43500, Malaysia
| | - Weang Kee Ho
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor 43500, Malaysia
| | - Geok Lin Khor
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Soo Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur 50603, Malaysia
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Freeley S, Broughan J, McCombe G, Casey M, Fitzpatrick P, Frawley T, Morrisey J, Treanor JT, Collins T, Cullen W. Promoting nurse-led behaviour change interventions to prevent cardiovascular disease in disadvantaged communities: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2071-2095. [PMID: 35695081 PMCID: PMC10084375 DOI: 10.1111/hsc.13867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/07/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Cardiovascular diseases (CVD) are the leading cause of death worldwide and they disproportionally affect people living in disadvantaged communities. Nurse-led behaviour change interventions have shown great promise in preventing CVD. However, knowledge regarding the impact and nature of such interventions in disadvantaged communities is limited. This review aimed to address this knowledge gap. A six-stage scoping review framework developed by Arksey and O'Malley, with revisions by Levac et al., was used. The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR). Three electronic databases were searched (PUBMED/MEDLINE, CINAHL Plus, and Cochrane CENTRAL), and included studies were analysed using Braun and Clarke's 'Thematic Analysis' approach. Initial searches yielded 952 papers and 30 studies were included in the review following duplicate, title/abstract, and full-text screening. The included studies indicate that nurse-led behaviour change primary prevention interventions in disadvantaged areas are largely effective; albeit the considerable variety of intervention approaches, study populations and outcome measures used to date make it difficult to ascertain this. Other identified key areas in the promotion of nurse-led behaviour change included tailoring interventions to specific populations, providing adequate training for nurses, overcoming patient access difficulties and encouraging patient engagement. Overall, the findings indicate that nurse-led behaviour change interventions for high-risk CVD patients in disadvantaged areas show much promise, although there is considerable variety in the interventions employed and studied to date. Further research is needed to examine the unique barriers and facilitators of interventions for specific disadvantaged groups.
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Affiliation(s)
- Sarah Freeley
- School of MedicineHealth Sciences Centre, University College DublinDublinIreland
| | - John Broughan
- School of MedicineHealth Sciences Centre, University College DublinDublinIreland
| | - Geoff McCombe
- School of MedicineHealth Sciences Centre, University College DublinDublinIreland
| | - Mary Casey
- School of Nursing, Midwifery, and Health SystemsHealth Sciences Centre, University College DublinDublinIreland
| | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College DublinHealth Sciences CentreDublinIreland
- St. Vincent's University HospitalDublinIreland
| | - Timothy Frawley
- School of Nursing, Midwifery, and Health SystemsHealth Sciences Centre, University College DublinDublinIreland
- Ireland East Hospital GroupDublinIreland
| | | | | | | | - Walter Cullen
- School of MedicineHealth Sciences Centre, University College DublinDublinIreland
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Mixed Methods Process Evaluation of a National Peer-Led Training Program to Increase Brief Advice on Physical Activity Given By Health Care Professionals. J Phys Act Health 2021; 18:1372-1382. [PMID: 34627128 DOI: 10.1123/jpah.2021-0188] [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: 03/18/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Health care professionals are well-positioned to encourage physical activity. The Clinical Champions Physical Activity Training Program (CCTP) aimed to increase population-level physical activity across England. This study aimed to (1) evaluate CCTP uptake and utilization; (2) explore CCTP fidelity, barriers, facilitators, and satisfaction; and (3) provide recommendations for program improvement. METHODS Physical Activity Clinical Champions were recruited and trained to deliver training to other health care professionals about physical activity. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to conduct a process evaluation using data collected from CCTP training sessions delivered (often at hospitals and General Practitioner surgeries) between February and December 2018. RESULTS About 509 training sessions were delivered, with 89% of sessions delivered by doctor/physician and nurse Clinical Champions; 8917 health care professionals attended a training session. Sessions lasted on average 1 hour 28 minutes and core slide sets were used in 65% of sessions. Barriers related to arranging the sessions and time available to deliver sessions. CONCLUSION The process evaluation demonstrated a national peer-led training program can reach all geographical regions of England; however, barriers need to be addressed. Recommendations include providing more administrative support to the Clinical Champions, improving communication and advertising to raise awareness of the CCTP, and standardizing training session duration and content.
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Hanson P, Summers C, Panesar A, Oduro-Donkor D, Lange M, Menon V, Barber TM. Low Carb Program Health App Within a Hospital-Based Obesity Setting: Observational Service Evaluation. JMIR Form Res 2021; 5:e29110. [PMID: 34449405 PMCID: PMC8462489 DOI: 10.2196/29110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/14/2021] [Accepted: 08/01/2021] [Indexed: 12/18/2022] Open
Abstract
Background Obesity underlies much chronic disease. Digitalization of obesity management provides an opportunity to innovate our traditional model of health care delivery within this setting, and to transform its scalability potentially to the population level. Objective The objective was to assess the feasibility and effectiveness of the Low Carb Program app for weight loss, applied within our hospital-based (tier 3) obesity service. Due to the disrupting effects of the COVID-19 pandemic on our obesity service, we compared the clinical outcomes from the Low Carb Program app applied in the context of remote patient appointments over the telephone with the prepandemic traditional standard of care. Methods We invited patients who attended our hospital-based obesity service to engage with the Low Carb Program smartphone app. We combined this approach with remote delivery (over the telephone) of obesity management from medical and psychology members of our obesity team during the COVID-19 pandemic. Outcome variables included changes in body weight and changes in HbA1c as a marker of glycemic control. We compared data from the Low Carb Program group with a retrospective control group (n=126) that had received traditional face-to-face obesity management from our team without concomitant use of the Low Carb Program app in the pre–COVID-19 era. T test comparisons were employed, with P<.05 considered significant. Results The mean weight of participants (n=105) was 130.2 kg, with 59% (n=62) females and a mean age of 48.8 years. Most participants (90/105, 86%) completed the Low Carb Program app registration process and engaged with the Low Carb Program app program; at follow-up, most participants (88/105, 84%) had actively engaged with the Low Carb Program app within the prior 30 days. The majority of participants (58/105, 55%) self-reported outcomes within the app. Mean duration of clinical follow-up for recruited participants who received the app was 7.4 months. Paired data were available for 48 participants for body weight and 41 participants for HbA1c. Paired sample t test analysis revealed a statistically significant mean loss of body weight of 2.7 kg (P=.001) and improvement in HbA1c of 3.3 mmol/mol (P=.01). The mean weight of control group patients (n=126) was 137.1 kg, with 74% (93/126) females and a mean age of 44.4 years. The mean follow-up for this group was 6 months. Data comparisons between the app user group and the pre–COVID-19 retrospective control group revealed equivalence for loss of body weight and change in HbA1c between the two groups. Conclusions We provide evidence to support the feasibility of implementing the Low Carb Program app combined with remote management; this is the first proof of concept for digitalized management within a hospital-based (tier 3) obesity service. We demonstrate the potential clinical efficacy of the approach in terms of improvements in body weight and glycemic control.
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Affiliation(s)
- Petra Hanson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | | | | | - Dominic Oduro-Donkor
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Maria Lange
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Vinod Menon
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Thomas M Barber
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
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Westland H, Trappenburg JCA, Schuurmans MJ, Zonneveld MH, Schröder CD. Fidelity of primary care nurses' delivery of a behavioural change intervention enhancing physical activity in patients at risk of cardiovascular disease: an observational study. BMJ Open 2021; 11:e046551. [PMID: 33757957 PMCID: PMC7993355 DOI: 10.1136/bmjopen-2020-046551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate the fidelity of delivery of a nurse-led intervention to enhance physical activity in patients at risk for cardiovascular diseases, the Activate intervention, by assessing: (1) self-reported fidelity of delivery; (2) observed fidelity of delivery; (3) quality of delivery of the Activate intervention and (4) nurses' beliefs about their capability, motivation, confidence and effectiveness towards delivering the Activate intervention, including behavioural change techniques. DESIGN An observational study. SETTING General practices in the Netherlands. PARTICIPANTS Primary care nurses (n=20) from 16 general practices. PRIMARY AND SECONDARY OUTCOME MEASURES Nurses' self-reported fidelity was evaluated using checklists (n=282), and the observed fidelity and quality of delivery were examined using audiorecordings of consultations of the delivery of the Activate intervention (n=42). Nurses' beliefs towards delivering the intervention were assessed using questionnaires (n=72). RESULTS The self-reported fidelity was 88.1% and observed fidelity was 85.4%, representing high fidelity. The observed fidelity of applied behavioural change techniques was moderate (75.0%). The observed quality of delivery was sufficient and varied among nurses (mean 2.9; SD 4.4; range 0-4). Nurses' beliefs about their capability, motivation, confidence and effectiveness towards delivering the intervention increased over time. CONCLUSIONS Nurses delivered most intervention components as intended with sufficient quality. Nurses believed they were capable, motivated and confident to deliver the intervention. They believed the intervention was effective to increase patients' physical activity level. Despite the high fidelity and moderate fidelity of applied behavioural change techniques, the varying quality of delivery within and across nurses might have diluted the effectiveness of the Activate intervention. TRIAL REGISTRATION NUMBER NCT02725203.
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Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Jaap C A Trappenburg
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | | | - Michelle H Zonneveld
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Carin D Schröder
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht, Utrecht, The Netherlands
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Chen XS, Changolkar S, Navathe AS, Linn KA, Reh G, Szwartz G, Steier D, Godby S, Balachandran M, Harrison JD, Rareshide CAL, Patel MS. Association between behavioral phenotypes and response to a physical activity intervention using gamification and social incentives: Secondary analysis of the STEP UP randomized clinical trial. PLoS One 2020; 15:e0239288. [PMID: 33052906 PMCID: PMC7556484 DOI: 10.1371/journal.pone.0239288] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/01/2020] [Indexed: 01/18/2023] Open
Abstract
Participants often vary in their response to behavioral interventions, but methods to identify groups of participants that are more likely to respond are lacking. In this secondary analysis of a randomized clinical trial, we used baseline characteristics to group participants into distinct behavioral phenotypes and evaluated differential responses to a physical activity intervention. Latent class analysis was used to segment participants based on baseline participant data including demographics, validated measures of psychosocial variables, and physical activity behavior. The trial included 602 adults from 40 U.S. states with body mass index ≥25 who were randomized to control or one of three gamification interventions (supportive, collaborative, or competitive) to increase physical activity. Daily step counts were monitored using a wearable device for a 24-week intervention with 12 weeks of follow-up. The model segmented participants into three classes named for key defining traits: Class 1, extroverted and motivated; Class 2, less active and less social; Class 3, less motivated and at-risk. Adjusted regression models were used to test for differences in intervention response relative to control within each behavioral phenotype. In Class 1, only participants in the competitive arm increased their mean daily steps during the intervention (adjusted difference, 945; 95% CI, 352-1537; P = .002), but it was not sustained during follow-up. In Class 2, participants in all three gamification arms significantly increased their mean daily steps compared to control during the intervention (supportive arm adjusted difference 1172; 95% CI, 363-1980; P = .005; collaborative arm adjusted difference 1119; 95% CI, 319-1919; P = .006; competitive arm adjusted difference 1179; 95% CI, 400-1957; P = .003) and all three had sustained impact during follow-up. In Class 3, none of the interventions had a significant effect on physical activity. Three behavioral phenotypes were identified, each with a different response to the interventions. This approach could be used to better target behavioral interventions to participants that are more likely to respond to them.
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Affiliation(s)
- Xisui Shirley Chen
- Department of Medicine, University of Pennyslvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Sujatha Changolkar
- Penn Medicine Nudge Unit, University of Pennyslvania, Philadelphia, Pennsylvania, United States of America
| | - Amol S. Navathe
- Department of Medicine, University of Pennyslvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, United States of America
| | - Kristin A. Linn
- Department of Biostatistics, Epidemiology and Informatics, University of Pennyslvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Gregory Reh
- Deloitte Consulting, Philadelphia, Pennsylvania, United States of America
| | - Gregory Szwartz
- Deloitte Consulting, Philadelphia, Pennsylvania, United States of America
| | - David Steier
- Deloitte Consulting, Philadelphia, Pennsylvania, United States of America
| | - Sarah Godby
- Deloitte Consulting, Philadelphia, Pennsylvania, United States of America
| | - Mohan Balachandran
- Penn Medicine Nudge Unit, University of Pennyslvania, Philadelphia, Pennsylvania, United States of America
| | - Joseph D. Harrison
- Penn Medicine Nudge Unit, University of Pennyslvania, Philadelphia, Pennsylvania, United States of America
| | - Charles A. L. Rareshide
- Penn Medicine Nudge Unit, University of Pennyslvania, Philadelphia, Pennsylvania, United States of America
| | - Mitesh S. Patel
- Department of Medicine, University of Pennyslvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Penn Medicine Nudge Unit, University of Pennyslvania, Philadelphia, Pennsylvania, United States of America
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, United States of America
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Perceptions of receiving behaviour change interventions from GPs during routine consultations: A qualitative study. PLoS One 2020; 15:e0233399. [PMID: 32437462 PMCID: PMC7241720 DOI: 10.1371/journal.pone.0233399] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/04/2020] [Indexed: 01/19/2023] Open
Abstract
General Practitioners (GPs) are expected to provide patients with health behaviour change interventions, yet little is known about the views of patients themselves. We aimed to understand recent patients': (1) general expectations about GPs delivering health behaviour change interventions during routine consultations (including perceptions of appropriateness and helpfulness for receiving interventions), (2) perceptions of responsibility for GPs to talk about health behaviours, and (3) experiences of receiving behaviour change interventions. Twenty-four semi-structured interviews were conducted with people who had recently attended a routine GP consultation. Data were analysed thematically. Three major themes were identified: (1) acceptability of discussions about behaviour change, (2) establishing clinician-patient rapport, and (3) healthcare professionals as a credible source and well placed to offer behaviour change interventions. Most patients were positive about, and were willing to accept behaviour change interventions from their GP during a routine consultation. Although behaviour change was perceived as a sensitive topic for patients, the doctor-patient relationship was perceived to provide an effective platform to discuss behaviour change, with the GP perceived as an appropriate and important healthcare professional from whom to receive advice. Contrary to the views of GPs, behaviour change interventions were perceived by patients as appropriate and helpful during routine medical consultations, particularly where behaviour change could have a positive effect on long-term condition management. Behaviour change interventions delivered by GPs during routine consultations could be used effectively in time-restricted consultations.
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Affiliation(s)
- Chris Keyworth
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Tracy Epton
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Joanna Goldthorpe
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Rachel Calam
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Christopher J. Armitage
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Westland H, Schuurmans MJ, Bos-Touwen ID, de Bruin-van Leersum MA, Monninkhof EM, Schröder CD, de Vette DA, Trappenburg JC. Effectiveness of the nurse-led Activate intervention in patients at risk of cardiovascular disease in primary care: a cluster-randomised controlled trial. Eur J Cardiovasc Nurs 2020; 19:721-731. [PMID: 32375491 PMCID: PMC7817988 DOI: 10.1177/1474515120919547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background To understand better the success of self-management interventions and to
enable tailoring of such interventions at specific subgroups of patients,
the nurse-led Activate intervention is developed targeting one component of
self-management (physical activity) in a heterogeneous subgroup (patients at
risk of cardiovascular disease) in Dutch primary care. Aim The aim of this study was to evaluate the effectiveness of the Activate
intervention and identifying which patient-related characteristics modify
the effect. Methods A two-armed cluster-randomised controlled trial was conducted comparing the
intervention with care as usual. The intervention consisted of four
nurse-led behaviour change consultations within a 3-month period. Data were
collected at baseline, 3 months and 6 months. Primary outcome was the daily
amount of moderate to vigorous physical activity at 6 months. Secondary
outcomes included sedentary behaviour, self-efficacy for physical activity,
patient activation for self-management and health status. Prespecified
effect modifiers were age, body mass index, level of education, social
support, depression, patient provider relationship and baseline physical
activity. Results Thirty-one general practices (n = 195 patients) were
included (intervention group n = 93; control group
n = 102). No significant between-group difference was
found for physical activity (mean difference 2.49 minutes; 95% confidence
interval -2.1; 7.1; P = 0.28) and secondary outcomes.
Patients with low perceived social support (P = 0.01) and
patients with a low baseline activity level (P = 0.02)
benefitted more from the intervention. Conclusion The Activate intervention did not improve patients’ physical activity and
secondary outcomes in primary care patients at risk of cardiovascular
disease. To understand the results, the intervention fidelity and active
components for effective self-management require further investigation. Trial registration: ClinicalTrials.gov NCT02725203.
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Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | | | - Irene D Bos-Touwen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | | | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Carin D Schröder
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, The Netherlands
| | - Daphne A de Vette
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Jaap Ca Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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Improving Physical Activity and Body Composition in a Medical Workplace Using Brief Goal Setting. Mayo Clin Proc Innov Qual Outcomes 2019; 3:495-505. [PMID: 31993569 PMCID: PMC6978599 DOI: 10.1016/j.mayocpiqo.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the use of a wearable activity tracker and brief feedback in the workplace to motivate employees to improve activity. Patients and Methods A total of 135 adult participants were randomized to 1 of 3 groups: control group (blinded to their step activity), intervention group (received counseling based on their step count), or no step-tracking device group. Participants were recruited from June 27, 2016, through February 21, 2018. Results Most of the 135 participants were women (84%), with a mean ± SD age of 42.6±10.1 years. Most participants (96%) completed 11 of the 12 weeks of step counts. Comparing treatment groups at week 12 (end of treatment), the intervention group (vs the control group) had significantly more steps (644.8; P<.01), had an 11.1% increase in step count from baseline (P<.01), was more likely to achieve goal (odds ratio=1.73; P=.02), increased distance traveled per week (0.46 miles; P<.01) and calories burned (90.6; P<.01), and had a decrease in some bioelectrical impedance measurements over time, including a greater loss in body fat mass (–0.90 kg; P=.01), percentage fat (–0.96; P<.01), and visceral fat level (–0.60; P<.01). Finally, the intervention group indicated significantly greater satisfaction with their assigned randomization (89% vs 77%; P=.01) and greater confidence in the effectiveness of their activity tracker (P<.01). Conclusion Brief counseling accompanied by use of a step-counting device can improve workplace activity, which, in turn, can increase steps and decrease body fat, including visceral fat. Trial Registration clinicaltrials.gov Identifier: NCT02794727
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