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Zhou Y, Huang Y, Wang Y, Xu X, Yu Z, Gu Y. Theoretical Domains Framework: A Bibliometric and Visualization Analysis from 2005-2023. J Multidiscip Healthc 2024; 17:4055-4069. [PMID: 39188813 PMCID: PMC11345462 DOI: 10.2147/jmdh.s470223] [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: 04/17/2024] [Accepted: 07/18/2024] [Indexed: 08/28/2024] Open
Abstract
Background The Theoretical Domains Framework (TDF) is among the most extensively utilised foundational frameworks in implementation science. It was developed from 33 psychological theories, with the latest version identifying 14 domains encompassing 84 theoretical constructs. These domains and constructs capture the complexity of factors that affect behaviours, making the framework a valuable tool for designing and implementing interventions within health and social care settings. Objective To summarise the development, hot topics, and future trends in TDF-related research and provide implementation practitioners with more information on the application of TDF. Methods We used TDF as the topic and searched the ISI Web of Science Core Collection, identifying 1382 relevant publications. We used analytical tools such as Excel, Tableau, VOSviewer, and Citespace to conduct a bibliometric analysis of the relevant publication. Results We identified the United Kingdom as the primary contributor, with University College London as the key institution. Susan Michie ranked highest in total citations. The analysis highlighted cancer and stroke as primary clinic medicine-related topics using TDF. Emerging themes encompass abuse, violence, maternal health, antenatal care, patient involvement, and trauma-informed care et al. "Nurse" and "qualitative research" emerged as recent and enduring hotspots, possibly indicating future research trends. Conclusion This article represents the first attempt to summarise the TDF using bibliometric analysis. We suggest this method can be used to analyse other theoretical frameworks in scientific implementation of its objectivity and quantifiability. Overall, the application scope of TDF is shifting from public health towards more specialised clinical directions, although its application in the field of public health is continuously expanding. In the future, the number of users of TDF is also expected to expand from implementation scientists to professional technical personnel.
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Affiliation(s)
- Yiwen Zhou
- Department of Gastroenterology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, 201102, People’s Republic of China
| | - Yuyan Huang
- Department of Gastroenterology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, 201102, People’s Republic of China
| | - Yingwen Wang
- Centre for Clinical Practice Guideline Production and Evaluation, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, 201102, People’s Republic of China
| | - Xiaofeng Xu
- Department of Gastroenterology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, 201102, People’s Republic of China
| | - Zhuowen Yu
- Department of Gastroenterology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, 201102, People’s Republic of China
| | - Ying Gu
- Nursing Department, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, 201102, People’s Republic of China
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Bijker R, Merkouris SS, Dowling NA, Rodda SN. ChatGPT for Automated Qualitative Research: Content Analysis. J Med Internet Res 2024; 26:e59050. [PMID: 39052327 PMCID: PMC11310599 DOI: 10.2196/59050] [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: 03/31/2024] [Revised: 05/08/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Data analysis approaches such as qualitative content analysis are notoriously time and labor intensive because of the time to detect, assess, and code a large amount of data. Tools such as ChatGPT may have tremendous potential in automating at least some of the analysis. OBJECTIVE The aim of this study was to explore the utility of ChatGPT in conducting qualitative content analysis through the analysis of forum posts from people sharing their experiences on reducing their sugar consumption. METHODS Inductive and deductive content analysis were performed on 537 forum posts to detect mechanisms of behavior change. Thorough prompt engineering provided appropriate instructions for ChatGPT to execute data analysis tasks. Data identification involved extracting change mechanisms from a subset of forum posts. The precision of the extracted data was assessed through comparison with human coding. On the basis of the identified change mechanisms, coding schemes were developed with ChatGPT using data-driven (inductive) and theory-driven (deductive) content analysis approaches. The deductive approach was informed by the Theoretical Domains Framework using both an unconstrained coding scheme and a structured coding matrix. In total, 10 coding schemes were created from a subset of data and then applied to the full data set in 10 new conversations, resulting in 100 conversations each for inductive and unconstrained deductive analysis. A total of 10 further conversations coded the full data set into the structured coding matrix. Intercoder agreement was evaluated across and within coding schemes. ChatGPT output was also evaluated by the researchers to assess whether it reflected prompt instructions. RESULTS The precision of detecting change mechanisms in the data subset ranged from 66% to 88%. Overall κ scores for intercoder agreement ranged from 0.72 to 0.82 across inductive coding schemes and from 0.58 to 0.73 across unconstrained coding schemes and structured coding matrix. Coding into the best-performing coding scheme resulted in category-specific κ scores ranging from 0.67 to 0.95 for the inductive approach and from 0.13 to 0.87 for the deductive approaches. ChatGPT largely followed prompt instructions in producing a description of each coding scheme, although the wording for the inductively developed coding schemes was lengthier than specified. CONCLUSIONS ChatGPT appears fairly reliable in assisting with qualitative analysis. ChatGPT performed better in developing an inductive coding scheme that emerged from the data than adapting an existing framework into an unconstrained coding scheme or coding directly into a structured matrix. The potential for ChatGPT to act as a second coder also appears promising, with almost perfect agreement in at least 1 coding scheme. The findings suggest that ChatGPT could prove useful as a tool to assist in each phase of qualitative content analysis, but multiple iterations are required to determine the reliability of each stage of analysis.
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Affiliation(s)
- Rimke Bijker
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Simone N Rodda
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
- School of Psychology, Deakin University, Burwood, Australia
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Cui J. Measuring the adoption of internet and communication technologies among practitioners in routine disability services: a stepped inclusive approach. Disabil Rehabil Assist Technol 2024:1-9. [PMID: 38949182 DOI: 10.1080/17483107.2024.2367080] [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: 10/04/2023] [Accepted: 06/06/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE Existing measurements of the use of information and communication technologies (ICTs) among practitioners in disability services often treat ICT adoption as a monolithic concept, overlooking its multifaceted nature within the disability field. This study introduces a stepped, inclusive approach to capturing this complexity, elucidating disparities in the utilization of various ICT dimensions, the present vs. anticipated use, and variations among different clinical-demographic groups. MATERIALS AND METHODS A cross-sectional survey was conducted in Hong Kong, gathering valid data from 324 practitioners spanning diverse disciplines and disability services. RESULTS Data analysis produced a three-factor model categorizing ICT tools into (1) information and communication tools, (2) screening and monitoring tools, and (3) treatment and rehabilitation tools. The first category was identified as the predominant ICT utilized currently, with significant projected growth in the latter two categories' usage. Variances in current ICT adoption were influenced by practitioners' roles, clientele, positions, affiliating agencies, and educational attainments. CONCLUSIONS This research provides a deeper understanding of the key dimensions of ICT adoption within disability services. It underscores the importance of devising specific and customized strategies for the effective integration of ICTs, ensuring a more tailored approach to meeting the unique demands of the disability field.
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Affiliation(s)
- Jialiang Cui
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
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Bullock L, Manning F, Hawarden A, Fleming J, Leyland S, Clark EM, Thomas S, Gidlow C, Iglesias-Urrutia CP, Protheroe J, Lefroy J, Ryan S, O'Neill TW, Mallen C, Jinks C, Paskins Z. Exploring practice and perspectives on shared decision-making about osteoporosis medicines in Fracture Liaison Services: the iFraP development qualitative study. Arch Osteoporos 2024; 19:50. [PMID: 38898212 PMCID: PMC11186902 DOI: 10.1007/s11657-024-01410-6] [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: 01/05/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
Interviews and focus groups with patients, FLS clinicians, and GPs identified challenges relating to clinical and shared decision-making about bone health and osteoporosis medicines. Findings will inform the development of the multicomponent iFraP intervention to address identified training needs and barriers to implementation to facilitate SDM about osteoporosis medicines. PURPOSE The iFraP (improving uptake of Fracture Prevention treatments) study aimed to develop a multicomponent intervention, including an osteoporosis decision support tool (DST), to support shared decision-making (SDM) about osteoporosis medicines. To inform iFraP intervention development, this qualitative study explored current practice in relation to communication about bone health and osteoporosis medicines, anticipated barriers to, and facilitators of, an osteoporosis DST, and perceived training needs. METHODS Patients attending an FLS consultation (n = 8), FLS clinicians (n = 9), and general practitioners (GPs; n = 7) were purposively sampled to participate in a focus group and/or telephone interview. Data were transcribed, inductively coded, and then mapped to the Theoretical Domains Framework (TDF) as a deductive framework to systematically identify possible barriers to, and facilitators of, implementing a DST. RESULTS Inductive codes were deductively mapped to 12 TDF domains. FLS clinicians were perceived to have specialist expertise (knowledge). However, clinicians described aspects of clinical decision-making and risk communication as difficult (cognitive skills). Patients reflected on decisional uncertainty about medicines (decision processes). Discussions about current practice and the proposed DST indicated opportunities to facilitate SDM, if identified training needs are met. Potential individual and system-level barriers to implementation were identified, such as differences in FLS configuration and a move to remote consulting (environmental context and resources). CONCLUSIONS Understanding of current practice revealed unmet training needs, indicating that using a DST in isolation would be unlikely to produce a sustained shift to SDM. Findings will shape iFraP intervention development to address unmet needs.
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Affiliation(s)
- Laurna Bullock
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Staffordshire, UK.
| | - Fay Manning
- University of Exeter Medical School, Devon, UK
| | - Ashley Hawarden
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Stoke-On-Trent, Staffordshire, UK
| | - Jane Fleming
- Cambridge Public Health, University of Cambridge, Cambridge, UK
- Addenbrooke's Hospital Fracture Liaison Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Emma M Clark
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Simon Thomas
- Prescribing Decision Support Ltd and School of Pharmacy and Bioengineering, Keele University, Staffordshire, UK
| | - Christopher Gidlow
- Centre for Health and Development, Staffordshire University, Stoke-On-Trent, Staffordshire, UK
| | - Cynthia P Iglesias-Urrutia
- Department of Health Sciences, University of York, York, UK
- Danish Centre for Healthcare Improvement (CHI), Aalborg University, Aalborg, Denmark
| | - Joanne Protheroe
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Staffordshire, UK
| | - Janet Lefroy
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Staffordshire, UK
| | - Sarah Ryan
- Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Stoke-On-Trent, Staffordshire, UK
- School of Nursing and Midwifery, Keele University, Staffordshire, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Christian Mallen
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Staffordshire, UK
| | - Clare Jinks
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Staffordshire, UK
| | - Zoe Paskins
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Stoke-On-Trent, Staffordshire, UK
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Eggiman-Ketter J, Derrough B, Wolfe DL, Unger J. Enablers and barriers to implementing an interdisciplinary experiential learning program for university students in a Canadian rehabilitation centre. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1336559. [PMID: 38887696 PMCID: PMC11180755 DOI: 10.3389/fresc.2024.1336559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/01/2024] [Indexed: 06/20/2024]
Abstract
Objective This qualitative study aims to identify a comprehensive set of enablers and barriers to implementing an interdisciplinary experiential learning program for university students at a Canadian rehabilitation centre. Methods A researcher conducted one-on-one semi-structured interviews with individuals from four key stakeholder groups (i.e., rehabilitation centre leadership, clinicians, university clinical coordinators, and health and rehabilitation students). Interviews and data analysis followed the Theoretical Domains Framework (TDF), which is designed to identify possible cognitive, affective, social, and environmental influences on program implementation. Interviews were transcribed verbatim, and two researchers coded data independently to identify the major themes of enablers and barriers to implementing an interdisciplinary experiential learning approach to rehabilitation care. Results From a total of 12 interviews, domains of the TDF were identified to represent overarching themes, which were (1) enablers (i.e., reinforcement, beliefs and consequences, optimism, professional identity, knowledge, and skills), (2) barriers (i.e., environment/resources and beliefs and capabilities), and (3) program development (i.e., goals and evaluation that was not previously a TDF domain). A list of recommendations for implementing an interdisciplinary experiential learning program was created that represented qualitative data from each stakeholder group. Conclusion This study provides insight into the potential enablers and barriers to developing an interdisciplinary experiential learning program for university students within rehabilitation centres. This type of program could enhance educational curriculums, student and clinical experiences, and patient outcomes. In this study, the findings inform recommendations for developing an interdisciplinary program in teaching hospitals and explore their potential impact. Future research and pilot studies must be conducted to fully understand the effects of implementing an interdisciplinary experiential learning approach within rehabilitation centres.
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Affiliation(s)
- Jordan Eggiman-Ketter
- Gray Centre for Mobility and Activity, Parkwood Institute, St. Joseph’s Health Care, London, ON, Canada
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Benjamin Derrough
- Gray Centre for Mobility and Activity, Parkwood Institute, St. Joseph’s Health Care, London, ON, Canada
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Dalton L. Wolfe
- Gray Centre for Mobility and Activity, Parkwood Institute, St. Joseph’s Health Care, London, ON, Canada
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Janelle Unger
- Gray Centre for Mobility and Activity, Parkwood Institute, St. Joseph’s Health Care, London, ON, Canada
- Faculty of Health Sciences, Western University, London, ON, Canada
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Ayeno HD, Kassie GM, Atee M, Nguyen T. PROTOCOL: Factors influencing the implementation of non-pharmacological interventions for behaviours and psychological symptoms of dementia in residential aged care homes: A systematic review and qualitative evidence synthesis. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1393. [PMID: 38524867 PMCID: PMC10958098 DOI: 10.1002/cl2.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/18/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Abstract
This is a protocol for a Cochrane Review. The objectives are as follows. This paper aims to describe a protocol for a systematic review that will synthesise the qualitative evidence regarding factors influencing the implementation of non-pharmacological interventions (NPIs) for behavioural and psychological symptoms of dementia (BPSD) management in residential aged care homes (RACHs). The planned systematic review aims to answer the research question: 'What are the factors influencing the implementation of NPIs in the management of BPSD at RACHs?'. Additionally, the planned systematic review also aims to generate recommendations to guide stakeholders (e.g., clinicians and aged care staff) and policymakers in the implementation of NPIs for managing BPSD at RACHs.
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Affiliation(s)
- Hunduma Dinsa Ayeno
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Department of PharmacyAmbo UniversityAmboEthiopia
| | - Gizat M. Kassie
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Mustafa Atee
- The Dementia Centre, HammondCareOsborne ParkWestern AustraliaAustralia
- Sydney Pharmacy School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- School of Nursing and Midwifery, Centre for Research in Aged CareEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Curtin Medical School, Faculty of Health SciencesCurtin UniversityBentleyWestern AustraliaAustralia
| | - Tuan Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- School of Health SciencesSwinburne University of TechnologyMelbourneVictoriaAustralia
- National Ageing Research InstituteMelbourneVictoriaAustralia
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Atkins E, Birmpili P, Kellar I, Johal AS, Li Q, Waton S, Boyle JR, Pherwani AD, Chetter I, Cromwell DA. Understanding delays in chronic limb-threatening ischaemia care: Application of the theoretical domains framework to identify factors affecting primary care clinicians' referral behaviours. J Foot Ankle Res 2024; 17:e12015. [PMID: 38703396 PMCID: PMC11296715 DOI: 10.1002/jfa2.12015] [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: 10/12/2023] [Accepted: 04/15/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Patients in the community with suspected Chronic limb-threatening ischaemia (CLTI) should be urgently referred to vascular services for investigation and management. The Theoretical Domains Framework (TDF) allows identification of influences on health professional behaviour in order to inform future interventions. Here, the TDF is used to explore primary care clinicians' behaviours with regards to recognition and referral of CLTI. METHODS Semi-structured interviews were conducted with 20 podiatrists, nurses and general practitioners in primary care. Directed content analysis was performed according to the framework method. Utterances were coded to TDF domains, and belief statements were defined by grouping similar utterances. Relevance of domains was confirmed according to belief frequency, presence of conflicting beliefs and the content of the beliefs indicating relevance. RESULTS Nine TDF domains were identified as relevant to primary care clinicians: Knowledge, Environmental context and resources, Memory, Decision and attention processes, Beliefs about capabilities, Skills, Emotions, Reinforcement and Behavioural regulation. Relationships across domains were identified, including how primary care clinician confidence and working in a highly pressurized environment can affect behaviour. CONCLUSION We have identified key barriers and enablers to timely recognition and referral behaviour. These beliefs identify targets for theory-driven behaviour change interventions to reduce delays in CLTI pathways.
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Affiliation(s)
- Eleanor Atkins
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Hull York Medical SchoolHullUK
| | - Panagiota Birmpili
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Hull York Medical SchoolHullUK
| | | | - Amundeep S. Johal
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
| | - Qiuju Li
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sam Waton
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
| | - Jonathan R. Boyle
- Department of Vascular SurgeryCambridge University Hospitals NHS Trust & Department of SurgeryUniversity of CambridgeCambridgeUK
| | - Arun D. Pherwani
- Staffordshire & South Cheshire Vascular NetworkRoyal Stoke University HospitalStoke‐on‐TrentUK
| | | | - David A. Cromwell
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
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Lai J, Pilla B, Stephenson M, Brettle A, Zhou C, Li W, Li C, Fu J, Deng S, Zhang Y, Guo Z, Wu Y. Pre-treatment assessment of chemotherapy for cancer patients: a multi-site evidence implementation project of 74 hospitals in China. BMC Nurs 2024; 23:320. [PMID: 38734605 PMCID: PMC11088226 DOI: 10.1186/s12912-024-01997-8] [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: 08/31/2023] [Accepted: 05/07/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Chemotherapy, whilst treating tumours, can also lead to numerous adverse reactions such as nausea and vomiting, fatigue and kidney toxicity, threatening the physical and mental health of patients. Simultaneously, misuse of chemotherapeutic drugs can seriously endanger patients' lives. Therefore, to maintain the safety of chemotherapy for cancer patients and to reduce the incidence of adverse reactions to chemotherapy, many guidelines state that a comprehensive assessment of the cancer patient should be conducted and documented before chemotherapy. This recommended procedure, however, has yet to be extensively embraced in Chinese hospitals. As such, this study aimed to standardise the content of pre-chemotherapy assessment for cancer patients in hospitals and to improve nurses' adherence to pre-chemotherapy assessment of cancer patients by conducting a national multi-site evidence implementation in China, hence protecting the safety of cancer patients undergoing chemotherapy and reducing the incidence of adverse reactions to chemotherapy in patients. METHODS The national multi-site evidence implementation project was launched by a JBI Centre of Excellence in China and conducted using the JBI approach to evidence implementation. A pre- and post-audit approach was used to evaluate the effectiveness of the project. This project had seven phases: training, planning, baseline audit, evidence implementation, two rounds of follow-up audits (3 and 9 months after evidence implementation, respectively) and sustainability assessment. A live online broadcast allowed all participating hospitals to come together to provide a summary and feedback on the implementation of the project. RESULTS Seventy-four hospitals from 32 cities in China participated in the project, four withdrew during the project's implementation, and 70 hospitals completed the project. The pre-and post-audit showed a significant improvement in the compliance rate of nurses performing pre-chemotherapy assessments for cancer patients. Patient satisfaction and chemotherapy safety were also improved through the project's implementation, and the participating nurses' enthusiasm and belief in implementing evidence into practice was increased. CONCLUSION The study demonstrated the feasibility of academic centres working with hospitals to promote the dissemination of evidence in clinical practice to accelerate knowledge translation. Further research is needed on the effectiveness of cross-regional and cross-organisational collaborations to facilitate evidence dissemination.
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Affiliation(s)
- Jie Lai
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Bianca Pilla
- JBI, School of Public Health, University of Adelaide, Adelaide, Australia
| | - Matthew Stephenson
- JBI, School of Public Health, University of Adelaide, Adelaide, Australia
| | - Alison Brettle
- School of Health & Society, University of Salford, Manchester, UK
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Wenji Li
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Chaixiu Li
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Jiaqi Fu
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Shisi Deng
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Yujie Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Zihan Guo
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
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Tigerstrand Grevnerts H, Delisle Nyström C, Migueles JH, Löf M. Longitudinal associations of meeting the WHO physical activity guidelines and physical fitness, from preschool to childhood. Scand J Med Sci Sports 2024; 34:e14624. [PMID: 38572847 DOI: 10.1111/sms.14624] [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: 11/07/2023] [Revised: 02/16/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
There is a well-established relationship between physical activity (PA) and physical fitness in children, being the latter an important marker for present and future health; however, there is still insufficient knowledge for the transition from the preschool age to early childhood. Therefore, this study in Swedish children aimed to investigate the estimated effect of meeting the aerobic component of the PA guidelines at 4 and/or 9 years of age on physical fitness measured at 9 years of age. PA was assessed using a wrist-worn ActiGraph accelerometer and identical data processing in 217 healthy children in Sweden (114 boys and 103 girls). Physical fitness test included cardiorespiratory (20 m shuttle run test), motor (4 × 10 m shuttle run), and muscular fitness (hand grip strength and long jump). A linear mixed model was run, investigating the interaction between meeting the PA guidelines and time (either 4 or 9 years of age) and each fitness component (at 4 and 9). Interactions by sex were also checked. Meeting the PA guidelines consistently (at 4 and 9 years) was significantly associated to better performance in physical fitness parameters for motor fitness (-0.76 s, p < 0.001) and lower body muscular fitness (+4.6 cm; p < 0.001) at 9 years. There was an interaction between meeting the PA guidelines and time point, for cardiorespiratory fitness (+4.58 laps; p < 0.001). This study shows that meeting the PA guidelines at 4 and 9 years of age is associated to higher physical fitness at 9 years of age.
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Affiliation(s)
| | | | | | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
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Haro E, Butcher EA, Alves ML, El Khoury C, Vinson A, Harper DM. Barriers to Cervical Cancer Screening and Satisfaction with Self-Sampling among Black Women in Michigan: a Mixed Methods Study. MEDICAL RESEARCH ARCHIVES 2024; 12:10.18103/mra.v12i4.5209. [PMID: 38818307 PMCID: PMC11138408 DOI: 10.18103/mra.v12i4.5209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Background In recent years, cervical cancer screening among Black women in the United States has declined, followed by increased incidence and mortality. We aim to evaluate the individual, sociocultural, and structural barriers to cervical cancer screening in relationship to the exam technique barriers. Methods Participants received cervical cancer self-screening kits in the mail. They returned their samples and a quantitative survey developed from the Health Information National Trends Survey (HINTS) modules designed to address the known individual, sociocultural, and structural barriers to screening. We established the fourteen attributes of cervical cancer screening techniques from prior work. Participants then shared their experiences in a semi-structured qualitative interview informed by the Theoretical Domains Framework (TDF) to explore the answers to the survey questions. We coded themes from the interviews. Women were grouped as younger (30-45 years) and older (46-65 years). Results Of the 41 women completing the study, 21 were in the younger age group (mean 37.3, SD 4.7), and 20 were in the older age group (56.5 (5.5)). All participants self-identified as African American/Black and were due for cervical cancer screening. Women indicated that individual, sociocultural, and structural barriers influenced their cervical cancer screening, but the most significant barrier was the speculum-based technique itself. Three positive attributes and eight negative attributes significantly differed by screening technique, favoring the self-screening technique. Conclusions The self-screening technique for screening for cervical cancer is feasible and acceptable to this group of Black women.
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Affiliation(s)
- Elizabeth Haro
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Emma A. Butcher
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Martha L Alves
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | | | - Alexandra Vinson
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
| | - Diane M Harper
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI
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Mantzourani E, James D, Akthar M, Brown S, Yemm R, Lehnbom E, Hanrahan J, Seage C. Can a mock medication-taking learning activity enable pharmacy students to experience the range of barriers and facilitators to medication adherence? An analysis informed by the Theoretical Domains Framework and COM-B model. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100393. [PMID: 38192385 PMCID: PMC10772815 DOI: 10.1016/j.rcsop.2023.100393] [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: 07/26/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Background Pharmacy professionals are well-placed to provide medication adherence support to patients. The Capability, Opportunity, Motivation-Behaviour (COM-B) and Theoretical Domains Framework (TDF) are two complementary models previously applied to medication-taking behaviour. Understanding the patient-specific barriers and facilitators to adherence using psychological frameworks from the early stages of pharmacy education enables the design and delivery of effective interventions. Objectives To examine whether a novel 'mock medicine' learning activity enabled students to experience the range of barriers and facilitators to medication adherence using the COM-B and TDF. Methods A mock medicine activity was conducted with students at pharmacy schools in three universities in the UK, Norway, and Australia over one week. Percentage adherence was calculated for five dosing regimens; theoretical framework analysis was applied to map reflective statements from student logs to COM-B and TDF. Results A total of 349 students (52.6%) returned completed logs, with high overall mean adherence (83.5%, range 0-100%). Analysis of the 277 (79.4%) students who provided reflective statements included barriers and facilitators that mapped onto one (9%), two (29%) or all three (62%) of the COM-B components and all fourteen TDF domains (overall mean = 4.04; Uni 1 = 3.72; Uni 2 = 4.50; Uni 3 = 4.38; range 1-8). Most frequently mapped domains were 'Environmental context and resources' (n = 199; 72%), 'Skills' (n = 186; 67%), 'Memory, attention and decision-making' (184; 66%) and 'Beliefs about capabilities' (n = 175; 63%). Conclusions This is the first study to utilise both COM-B and TDF to analyse a proxy measure of medication adherence in pharmacy education. Data mapping demonstrated that students experienced similar issues to patients when prescribed a short course of medication. Importantly, all the factors influencing medication-taking reported by students were captured by these two psychological frameworks. Future educational strategies will involve students in the mapping exercise to gain hands-on experience of using these psychological constructs in practice.
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Affiliation(s)
- E. Mantzourani
- Cardiff School of Pharmacy & Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - D.H. James
- Department of Applied Psychology, Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Llandaff Campus, 200 Western Avenue, Cardiff, Wales, UK
- Department of Applied Psychology, School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - M.A. Akthar
- Department of Applied Psychology, School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - S.L. Brown
- Department of Applied Psychology, Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Llandaff Campus, 200 Western Avenue, Cardiff, Wales, UK
| | - R. Yemm
- Cardiff School of Pharmacy & Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - E.C. Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - J.R. Hanrahan
- School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - C.H. Seage
- Department of Applied Psychology, School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
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12
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Mbuagbaw L, Fernando S, Lee C, Owino M, Youssef C, Snow ME. Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study. BMC Health Serv Res 2024; 24:48. [PMID: 38200516 PMCID: PMC10782539 DOI: 10.1186/s12913-023-10481-z] [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: 05/15/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Engagement in care is important for people living with HIV (PLH) to achieve optimal outcomes. Several strategies have been developed to improve client flow through the HIV care cascade, specifically targeting initiation of treatment, adherence to antiretroviral therapy (ART), retention in care, and engagement in care. We have previously identified effective care cascade strategies in a systematic review. Initiation of ART could be improved by mobile health interventions, and changes in healthcare delivery. Adherence to ART could be improved by mobile health interventions, incentives, counselling, and psychotherapy. Retention in care could be improved by mobile health interventions, incentives, education, and electronic interventions. The aim of this study was to investigate barriers and facilitators to implementing these effective interventions in HIV clinics in Ontario, Canada. METHODS We conducted a sequential explanatory mixed methods study. In the quantitative strand, we administered a survey to health workers who provide care to PLH to identify barriers and facilitators. In the qualitative strand, we conducted in-depth interviews informed by the theoretical domains framework (TDF) with health workers and with PLH to explain our quantitative findings. Qualitative and quantitative data were merged to create meta-inferences. RESULTS Twenty health workers from 8 clinics in 9 cities in Ontario took the survey. Nine PLH and 10 health workers participated in the qualitative interviews. Clinics in Ontario implemented all the effective interventions identified from the literature for initiation of treatment, adherence to ART, and retention in care despite concerns about resources. Barriers to physical and financial access to care, the workload for tailored care, and expertise were identified by both health workers and PLH. Key facilitators were virtual care and client preparedness through education and peer support. CONCLUSION Clinics in Ontario appear to implement several evidence-based strategies to improve PLH engagement. There is a need for more health workers with skills to address unique PLH needs. Virtual care is beneficial to both health workers and PLH.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada.
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Josep's Healthcare, Hamilton, ON, Canada.
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon.
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
| | - Saranee Fernando
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Chloe Lee
- McMaster University, Bachelors of Health Sciences Program, Hamilton, ON, Canada
| | - Maureen Owino
- The Canadian HIV Trials Network (CTN), Vancouver, BC, Canada
- Committee for Accessible AIDS Treatment, Toronto, ON, Canada
- York University, Toronto, ON, Canada
| | - Cynthia Youssef
- McMaster University, Bachelors of Health Sciences Program, Hamilton, ON, Canada
| | - M Elizabeth Snow
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
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13
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Al Hail M, Abdulrouf P, Stewart D, Elkassem W, Singh R, Al Enany R, Mohammed Azad A, Tarannum A, Thomas B. Behaviour and associated determinants of COVID-19 vaccine acceptance and advocacy: a nationwide survey of pharmacy professionals in Qatar. J Pharm Policy Pract 2023; 16:160. [PMID: 38017533 PMCID: PMC10683145 DOI: 10.1186/s40545-023-00668-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Vaccine hesitancy poses a global challenge and is acknowledged to be a complex, multifactorial phenomenon. Of particular concern is hesitancy among health professionals, as this may also impact their advocacy roles. There is a lack of theory-based investigations of pharmacy professionals. AIM The study aims to determine the behaviour and associated determinants influencing pharmacy professionals' attitude towards vaccine acceptance and advocacy. METHODS A cross-sectional survey of 2400 pharmacists and pharmacy technicians at government, semi-government, and private community pharmacies in Qatar. Questionnaire items captured perspectives on COVID vaccine acceptance, advocacy and associated determinants based on the domains and constructs of the Theoretical Domains Framework (TDF). Data were analysed by descriptive and inferential statistics, with TDF items subjected to principal components analysis (PCA). FINDINGS The response rate was 38.6% (927/2400). Almost all (n = 825, 89.0%) were willing to receive the vaccine, which was higher for males (p < 0.001) and those in polyclinics (p < 0.05). PCA of acceptance items gave five components, with response to 'emotions' being most negative, associated with acceptance (p < 0.001) and more negative in females (p < 0.001). The majority (n = 799, 86.2%) agreed that it was their professional duty to advocate vaccines. PCA for advocacy items gave two components, with the most negative responses for 'professional role and identity', which were more negative for those working in hospitals (p < 0.05). CONCLUSION Respondents were least positive regarding emotion-related behavioral determinants for acceptance and professional role and identity for advocacy. Behavior change technique interventions that target these issues have the potential to influence the vaccine hesitancy of pharmacy professionals and other individuals.
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Affiliation(s)
- Moza Al Hail
- Pharmacy Executive Directors Office, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Wessam Elkassem
- Pharmacy Executive Directors Office, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Pharmacy Executive Directors Office, Hamad Medical Corporation, Doha, Qatar
- Cardiology Research, Adult Cardiology Dept, Heart Hospital, Doha, Qatar
| | | | - Aftab Mohammed Azad
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Asma Tarannum
- St John of God, Midland Public and Private Hospitals, Perth, Australia
| | - Binny Thomas
- Pharmacy Executive Directors Office, Hamad Medical Corporation, Doha, Qatar.
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Gyawali R, Toomey M, Stapleton F, Keay L, Jalbert I. Enhancing the appropriateness of eyecare delivery: the iCaretrack approach. Clin Exp Optom 2023; 106:825-835. [PMID: 36813262 DOI: 10.1080/08164622.2023.2178286] [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: 07/27/2022] [Accepted: 02/04/2023] [Indexed: 02/24/2023] Open
Abstract
Optometrists play an integral role in primary eyecare services, including prevention, diagnosis, and management of acute and chronic eye conditions. Therefore, it remains essential that the care they provide be timely and appropriate to ensure the best patient outcomes and optimal utilisation of resources. However, optometrists continuously face many challenges that can affect their ability to provide appropriate care (i.e., the care in line with evidence-based clinical practice guidelines). To address any resulting evidence-to-practice gaps, programs are needed that support and enable optometrists to adopt and utilise the best evidence in clinical practice. Implementation science is a field of research that can be applied to improving the adoption and maintenance of evidence-based practices in routine care, through systematic development and application of strategies or interventions to address barriers to evidence-based practice. This paper demonstrates an approach using implementation science to enhance optometric eyecare delivery. A brief overview of the methods used to identify existing gaps in appropriate eyecare delivery is presented. An outline of the process used to understand the behavioural barriers responsible for such gaps follows, involving theoretical models and frameworks. The resulting development of an online program for optometrists to enhance their capability, motivation, and opportunity to provide evidence-based eyecare is described, using the Behaviour Change Model and co-design methods. The importance of and methods used in evaluating such programs are also discussed. Finally, reflections on the experience and key learnings from the project are shared. While the paper focuses on experiences in improving glaucoma and diabetic eyecare in the Australian optometry context, this approach can be adapted to other conditions and contexts.
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Affiliation(s)
| | - Melinda Toomey
- School of Optometry and Vision Science, UNSW, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW, Sydney, Australia
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Kgasi M, Chimbo B, Motsi L. mHealth Self-Monitoring Model for Medicine Adherence of Patients With Diabetes in Resource-Limited Countries: Structural Equation Modeling Approach. JMIR Form Res 2023; 7:e49407. [PMID: 37870902 PMCID: PMC10628689 DOI: 10.2196/49407] [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: 06/02/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to serious challenges and emphasized the importance of using technology for health care operational transformation. Consequently, the need for technological innovations has increased, thus empowering patients with chronic conditions to tighten their adherence to medical prescriptions. OBJECTIVE This study aimed to develop a model for a mobile health (mHealth) self-monitoring system for patients with diabetes in rural communities within resource-limited countries. The developed model could be based on the implementation of a system for the self-monitoring of patients with diabetes to increase medical adherence. METHODS This study followed a quantitative approach, in which data were collected from health care providers using a questionnaire with close-ended questions. Data were collected from district hospitals in 3 South African provinces that were selected based on the prevalence rates of diabetes and the number of patients with diabetes treated. The collected data were analyzed using smart partial least squares to validate the model and test the suggested hypotheses. RESULTS Using variance-based structural equation modeling that leverages smart partial least squares, the analysis indicated that environmental factors significantly influence all the independent constructs that inform patients' change of behavior toward the use of mHealth for self-monitoring of medication adherence. Technology characteristics such as effort expectancy, self-efficacy, and performance expectancy were equally significant; hence, their hypotheses were accepted. In contrast, the contributions of culture and social aspects were found to be insignificant, and their hypotheses were rejected. In addition, an analysis was conducted to determine the interaction effects of the moderating variables on the independent constructs. The results indicated that with the exception of cultural and social influences, there were significant interacting effects on other independent constructs influencing mHealth use for self-monitoring. CONCLUSIONS On the basis of the findings of this study, we conclude that behavioral changes are essential for the self-monitoring of chronic diseases. Therefore, it is important to enhance those effects that stimulate the behavior to change toward the use of mHealth for self-monitoring. Motivational aspects were also found to be highly significant as they triggered changes in behavior. The developed model can be used to extend the research on the self-monitoring of patients with chronic conditions. Moreover, the model will be used as a basic architecture for the implementation of fully fledged systems for self-monitoring of patients with diabetes.
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Affiliation(s)
- Mmamolefe Kgasi
- Faculty of ICT, Tshwane University of Technology, Pretoria, South Africa
- School of Computing, University of South Africa, Johannesburg, South Africa
| | - Bester Chimbo
- School of Computing, University of South Africa, Johannesburg, South Africa
| | - Lovemore Motsi
- School of Computing, University of South Africa, Johannesburg, South Africa
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O'Donovan B, Kirke C, Pate M, McHugh S, Bennett K, Cahir C. Mapping the Theoretical Domain Framework to the Consolidated Framework for Implementation Research: do multiple frameworks add value? Implement Sci Commun 2023; 4:100. [PMID: 37620981 PMCID: PMC10464139 DOI: 10.1186/s43058-023-00466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Implementation researchers often combine the Theoretical Domain Framework (TDF) and Consolidated Framework for Implementation Research (CFIR) in their studies. However there is some debate on the merits of using multiple frameworks-whether they contribute to results or provide superfluous analysis. Our recent research combined the TDF and CFIR to identify determinants to widespread incorporation of patient held medication lists (PHML) in healthcare practice. The aim of this report is to provide guidance on the use of the TDF and CFIR; by assessing the degree of overlap between the two frameworks in their application to interviews about PHML. METHODS Semi-structured telephone interviews were conducted with healthcare professionals (HCPs) and non HCPs (people taking multiple medicines and caregivers).Interview data were transcribed and analysed using the TDF and CFIR. Within paired domains substantial intersection/overlap across constructs and domains within the two frameworks was classified as > 75% of coding references, consistent intersection/overlap was defined as > 50% and ≤ 75%, average intersection/overlap was defined as ≤ 50% and > 25% and non-substantial intersection/overlap was classified as ≤ 25% of coding references. RESULTS Interview data were collected from 39 participants - 21 HCPs and 18 non HCPs. Mapping of TDF domains to CFIR domains/constructs identified key determinants in six TDF domains: Environmental context & resources, Beliefs about capabilities, Beliefs about consequences, Social influences, Behavioural regulation and Social/professional role & identity; and five CFIR domains: Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individual and Process. A pattern of substantial intersection/overlap in coding emerged with broad TDF domains such as Environmental context & resources often linked to well-defined CFIR domains and constructs (e.g. design quality & packaging within Intervention Characteristics). Broad CFIR constructs such as knowledge & beliefs about intervention within Characteristics of Individuals also linked to more descriptive TDF domains like Beliefs about capabilities. In addition there was some unexpected non-substantial intersection/overlap in coding with the TDF domain Social influences less frequently linked to the CFIR Inner Setting domain and constructs such as networks and communications. CONCLUSIONS Identifying intersections/overlaps in coding between CFIR and TDF can assist interpretation of findings in implementation research. The strengths of each framework were exploited in a reciprocal process which provided more information to broad/poorly defined domains and enabled identification of implementation determinants and innovation determinants.
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Affiliation(s)
- B O'Donovan
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - C Kirke
- Quality Improvement Division, Health Service Executive (HSE), Medication Safety, Dublin, Ireland
| | - M Pate
- Quality Improvement Division, Health Service Executive (HSE), Medication Safety, Dublin, Ireland
| | - S McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - K Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - C Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Taylor N, McKay S, Long JC, Gaff C, North K, Braithwaite J, Francis JJ, Best S. Aligning intuition and theory: a novel approach to identifying the determinants of behaviours necessary to support implementation of evidence into practice. Implement Sci 2023; 18:29. [PMID: 37475088 PMCID: PMC10360252 DOI: 10.1186/s13012-023-01284-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Disentangling the interplay between experience-based intuition and theory-informed implementation is crucial for identifying the direct contribution theory can make for generating behaviour changes needed for successful evidence translation. In the context of 'clinicogenomics', a complex and rapidly evolving field demanding swift practice change, we aimed to (a) describe a combined clinician intuition- and theory-driven method for identifying determinants of and strategies for implementing clinicogenomics, and (b) articulate a structured approach to standardise hypothesised behavioural pathways and make potential underlying theory explicit. METHODS Interview data from 16 non-genetic medical specialists using genomics in practice identified three target behaviour areas across the testing process: (1) identifying patients, (2) test ordering and reporting, (3) communicating results. The Theoretical Domains Framework (TDF) was used to group barriers and facilitators to performing these actions. Barriers were grouped by distinct TDF domains, with 'overarching' TDF themes identified for overlapping barriers. Clinician intuitively-derived implementation strategies were matched with corresponding barriers, and retrospectively coded against behaviour change techniques (BCTs). Where no intuitive strategies were provided, theory-driven strategies were generated. An algorithm was developed and applied to articulate how implementation strategies address barriers to influence behaviour change. RESULTS Across all target behaviour areas, 32 identified barriers were coded across seven distinct TDF domains and eight overarching TDF themes. Within the 29 intuitive strategies, 21 BCTs were represented and used on 49 occasions to address 23 barriers. On 10 (20%) of these occasions, existing empirical links were found between BCTs and corresponding distinct TDF-coded barriers. Twenty additional theory-driven implementation strategies (using 19 BCTs on 31 occasions) were developed to address nine remaining barriers. CONCLUSION Clinicians naturally generate their own solutions when implementing clinical interventions, and in this clinicogenomics example these intuitive strategies aligned with theoretical recommendations 20% of the time. We have matched intuitive strategies with theory-driven BCTs to make potential underlying theory explicit through proposed structured hypothesised causal pathways. Transparency and efficiency are enhanced, providing a novel method to identify determinants of implementation. Operationalising this approach to support the design of implementation strategies may optimise practice change in response to rapidly evolving scientific advances requiring swift translation into healthcare.
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Affiliation(s)
- Natalie Taylor
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, High Street Kensington, Sydney, NSW, 2052, Australia.
| | - Skye McKay
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, High Street Kensington, Sydney, NSW, 2052, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Clara Gaff
- Melbourne Genomics Health Alliance, University of Melbourne, Melbourne, Australia
| | - Kathryn North
- Australian Genomics, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jill J Francis
- School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Australian Genomics, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
- Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, Australia
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Ellis SD, Brooks JV, Birken SA, Morrow E, Hilbig ZS, Wulff-Burchfield E, Kinney AY, Ellerbeck EF. Determinants of targeted cancer therapy use in community oncology practice: a qualitative study using the Theoretical Domains Framework and Rummler-Brache process mapping. Implement Sci Commun 2023; 4:66. [PMID: 37308981 PMCID: PMC10259814 DOI: 10.1186/s43058-023-00441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Precision medicine holds enormous potential to improve outcomes for cancer patients, offering improved rates of cancer control and quality of life. Not all patients who could benefit from targeted cancer therapy receive it, and some who may not benefit do receive targeted therapy. We sought to comprehensively identify determinants of targeted therapy use among community oncology programs, where most cancer patients receive their care. METHODS Guided by the Theoretical Domains Framework, we conducted semi-structured interviews with 24 community cancer care providers and mapped targeted therapy delivery across 11 cancer care delivery teams using a Rummler-Brache diagram. Transcripts were coded to the framework using template analysis, and inductive coding was used to identify key behaviors. Coding was revised until a consensus was reached. RESULTS Intention to deliver precision medicine was high across all participants interviewed, who also reported untenable knowledge demands. We identified distinctly different teams, processes, and determinants for (1) genomic test ordering and (2) delivery of targeted therapies. A key determinant of molecular testing was role alignment. The dominant expectation for oncologists to order and interpret genomic tests is at odds with their role as treatment decision-makers' and pathologists' typical role to stage tumors. Programs in which pathologists considered genomic test ordering as part of their staging responsibilities reported high and timely testing rates. Determinants of treatment delivery were contingent on resources and ability to offset delivery costs, which low- volume programs could not do. Rural programs faced additional treatment delivery challenges. CONCLUSIONS We identified novel determinants of targeted therapy delivery that potentially could be addressed through role re-alignment. Standardized, pathology-initiated genomic testing may prove fruitful in ensuring patients eligible for targeted therapy are identified, even if the care they need cannot be delivered at small and rural sites which may have distinct challenges in treatment delivery. Incorporating behavior specification and Rummler-Brache process mapping with determinant analysis may extend its usefulness beyond the identification of the need for contextual adaptation.
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Affiliation(s)
- Shellie D. Ellis
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | - Joanna Veazey Brooks
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | - Sarah A. Birken
- Wake Forest University School of Medicine, 525 Vine Street, Winston-Salem, NC 27101 USA
| | - Emily Morrow
- Kansas City Kansas Community College, 7250 State Ave., Kansas City, KS 66112 USA
| | - Zachary S. Hilbig
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | | | - Anita Y. Kinney
- Rutgers Cancer Institute of New Jersey, Rutgers University, 195 Little Albany St., New Brunswick, NJ 08901 USA
| | - Edward F. Ellerbeck
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
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Hawarden A, Bullock L, Chew-Graham CA, Herron D, Hider S, Jinks C, Erandie Ediriweera De Silva R, Machin A, Paskins Z. Incorporating FRAX into a nurse-delivered integrated care review: a multi-method qualitative study. BJGP Open 2023; 7:BJGPO.2022.0146. [PMID: 36746471 PMCID: PMC10354387 DOI: 10.3399/bjgpo.2022.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND People with inflammatory rheumatological conditions (IRCs) are at increased risk of common comorbidities including osteoporosis. AIM To explore the barriers to and facilitators of implementing nurse-delivered fracture risk assessments in primary care, in the context of multimorbidity reviews for people with IRCs. DESIGN & SETTING A multi-method qualitative study in primary care. METHOD As part of a process evaluation in a pilot trial, semi-structured interviews were conducted with 20 patients, two nurses, and three GPs. Twenty-four patient-nurse INCLUDE review consultations were audiorecorded and transcribed. A framework analysis was conducted using the Theoretical Domains Framework (TDF). RESULTS Nurses reported positive views about the value of the Fracture Risk Assessment Tool (FRAX) and they felt confident to deliver the assessments following training. Barriers to implementation, as identified by TDF, particularly related to the domains of knowledge, skills, professional roles, and environmental context. GPs reported difficulty keeping up to date with osteoporosis guidelines and voiced differing opinions about whether fracture risk assessment was the role of primary or secondary care. Lack of integration of FRAX into IT systems was a barrier to use. GPs and nurses had differing views about the nurse role in communicating risk and acting on FRAX findings; for example, explanations of the FRAX result and action needed were limited. Patients reported limited understanding of FRAX outcomes. CONCLUSION The findings suggest that, with appropriate training including risk communication, practice nurses are likely to be confident to play a key role in conducting fracture risk assessments, but further work is needed to address the barriers identified.
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Affiliation(s)
| | | | | | - Daniel Herron
- Department of Psychology, School of Health, Science and Wellbeing, Staffordshire University, Staffordshire, UK
| | - Samantha Hider
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
| | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Risni Erandie Ediriweera De Silva
- School of Medicine, Keele University, Keele, UK
- Department of Family Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
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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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Lion KC, Zhou C, Fishman P, Senturia K, Cole A, Sherr K, Opel DJ, Stout J, Hazim CE, Warren L, Rains BH, Lewis CC. A sequential, multiple assignment randomized trial comparing web-based education to mobile video interpreter access for improving provider interpreter use in primary care clinics: the mVOCAL hybrid type 3 study protocol. Implement Sci 2023; 18:8. [PMID: 36915138 PMCID: PMC10012737 DOI: 10.1186/s13012-023-01263-6] [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: 10/26/2022] [Accepted: 02/12/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Individuals who use a language other than English for medical care are at risk for disparities related to healthcare safety, patient-centered care, and quality. Professional interpreter use decreases these disparities but remains underutilized, despite widespread access and legal mandates. In this study, we compare two discrete implementation strategies for improving interpreter use: (1) enhanced education targeting intrapersonal barriers to use delivered in a scalable format (interactive web-based educational modules) and (2) a strategy targeting system barriers to use in which mobile video interpreting is enabled on providers' own mobile devices. METHODS We will conduct a type 3 hybrid implementation-effectiveness study in 3-5 primary care organizations, using a sequential multiple assignment randomized trial (SMART) design. Our primary implementation outcome is interpreter use, calculated by matching clinic visits to interpreter invoices. Our secondary effectiveness outcome is patient comprehension, determined by comparing patient-reported to provider-documented visit diagnosis. Enrolled providers (n = 55) will be randomized to mobile video interpreting or educational modules, plus standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative strategy. After another 9 months, both strategies will be available to enrolled providers for 9 more months. Providers will complete 2 surveys (beginning and end) and 3 in-depth interviews (beginning, middle, and end) to understand barriers to interpreter use, based on the Theoretical Domains Framework. Patients who use a language other than English will be surveyed (n = 648) and interviewed (n = 75) following visits with enrolled providers to understand their experiences with communication. Visits will be video recorded (n = 100) to assess fidelity to assigned strategies. We will explore strategy mechanism activation to refine causal pathway models using a quantitative plus qualitative approach. We will also determine the incremental cost-effectiveness of each implementation strategy from a healthcare organization perspective, using administrative and provider survey data. DISCUSSION Determining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, the mechanisms by which they do so, and at what cost, will provide critical insights for addressing a persistent cause of healthcare disparities. TRIAL REGISTRATION NCT05591586.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA.
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA
| | - Paul Fishman
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Kirsten Senturia
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Allison Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - James Stout
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Carmen E Hazim
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
| | - Louise Warren
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Bonnie H Rains
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Cara C Lewis
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Willems I, Verbestel V, Calders P, Lapauw B, De Craemer M. Test-Retest Reliability and Internal Consistency of a Newly Developed Questionnaire to Assess Explanatory Variables of 24-h Movement Behaviors in Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4407. [PMID: 36901416 PMCID: PMC10001532 DOI: 10.3390/ijerph20054407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/25/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
A questionnaire on explanatory variables for each behavior of the 24-h movement behaviors (i.e., physical activity, sedentary behavior, sleep) was developed based on three levels of the socio-ecological model, i.e., the intrapersonal level, interpersonal level and the physical environmental level. Within these levels, different constructs were questioned, i.e., autonomous motivation, attitude, facilitators, internal behavioral control, self-efficacy, barriers, subjective norm, social modeling, social support, home environment, neighborhood, and work environment. The questionnaire was tested for test-retest reliability (i.e., intraclass correlation (ICC)) for each item and internal consistency for each construct (i.e., Cronbach's Alpha Coefficient) among a group of 35 healthy adults with a mean age of 42.9 (±16.1) years. The total questionnaire contained 266 items, consisting of 14 items on general information, 70 items on physical activity, 102 items on sedentary behavior, 45 items on sleep and 35 items on the physical environment. Seventy-one percent of the explanatory items showed moderate to excellent reliability (ICC between 0.50 and 0.90) and a majority of constructs had a good homogeneity among items (Cronbach's Alpha Coefficient ≥ 0.70). This newly developed and comprehensive questionnaire might be used as a tool to understand adults' 24-h movement behaviors.
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Affiliation(s)
- Iris Willems
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Research Foundation Flanders, 1000 Brussels, Belgium
| | - Vera Verbestel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Bruno Lapauw
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Marieke De Craemer
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
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Shrubsole K, Power E, Hallé MC. Communication partner training with familiar partners of people with aphasia: A systematic review and synthesis of barriers and facilitators to implementation. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:601-628. [PMID: 36417196 DOI: 10.1111/1460-6984.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Factors influencing the implementation of communication partner training (CPT) with familiar partners of people with aphasia (PWA) have previously been documented using disparate approaches. To date there has been no synthesis of these factors using a common theoretical framework. Investigating CPT implementation factors using a common theoretical framework may further our understanding of universal barriers and guide future development of tailored, theoretically informed implementation strategies. AIMS (1) To determine the perceived and/or observed barriers and facilitators to implementing CPT with familiar partners of adults with aphasia; (2) to map extracted barriers and facilitators to a common theoretical framework; (3) to synthesize extracted barriers and facilitators; and (4) to identify potential implementation strategies to address the most frequently identified barriers and facilitators. METHODS & PROCEDURES A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, CINAHL, Web of Science) were systematically searched in April 2021. Empirical qualitative and/or quantitative research studies reporting barriers/facilitators to speech-language therapists (SLTs) implementing CPT with familiar partners of adults with aphasia were included. The search was limited to English or French articles with no date limit applied. Methodological quality of included studies was assessed using the Mixed-Methods Appraisal Tool (MMAT). A framework and content analysis was then conducted to extract and synthesize the implementation factors in alignment with the Theoretical Domains Framework (TDF), followed by a theoretically informed mapping exercise to identify potential implementation strategies. RESULTS & MAIN CONTRIBUTION The database searches yielded 2115 studies. Following screening, 17 studies were included in the review. Overall, the included studies had good methodological quality. Extracted implementation factors were classified as barriers, facilitators or mixed (i.e., both) and aligned with 13 of the 14 TDF domains, plus two additional domains: 'carer perspectives on the CPT intervention' and 'patient/carer characteristics'. Synthesized data revealed eight key theoretical domains: Environmental context and resources; Social influences; Beliefs about consequences; Skills; Memory, attention and decision-making; Knowledge; Beliefs about capabilities; and Reinforcement. Within each domain, the research team identified common categories and developed illustrative examples of theoretically informed implementation strategies. CONCLUSIONS & IMPLICATIONS This systematic review and theory-informed synthesis of previously reported CPT implementation factors enabled the identification of key barriers to SLTs delivering this best practice. This led to proposed implementation strategies that should be validated, refined and evaluated in future research involving stakeholders who have contextual understanding of implementing CPT. WHAT THIS PAPER ADDS What is already known on the subject CPT of familiar partners of PWA is an effective intervention that is inconsistently used in clinical settings. Factors influencing CPT implementation have previously been identified, but using disparate approaches and frameworks. A synthesis of these factors articulated around a common framework is currently not available. What this paper adds to existing knowledge This paper provides a theory-informed synthesis of previously reported barriers and facilitators to SLTs implementing CPT with familiar partners of PWA. It highlights key factors influencing the uptake of this best practice and includes suggestion of implementation strategies to address them. What are the potential or actual clinical implications of this work? The key influencing factors and proposed implementation strategies reported in this paper may support stakeholders in the future design of tailored and theoretically informed implementation strategies aiming to improve the delivery of familiar CPT in their setting.
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Affiliation(s)
- Kirstine Shrubsole
- The Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
- Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Victoria, Australia
| | - Emma Power
- Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Victoria, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Marie-Christine Hallé
- Speech and Language Pathology Department, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
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Carter BJ, Siddiqi AD, Chen TA, Britton M, Martinez Leal I, Correa-Fernández V, Rogova A, Kyburz B, Williams T, Casey K, Reitzel LR. Educating Substance Use Treatment Center Providers on Tobacco Use Treatments Is Associated with Increased Provision of Counseling and Medication to Patients Who Use Tobacco. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4013. [PMID: 36901024 PMCID: PMC10001967 DOI: 10.3390/ijerph20054013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Tobacco use is the leading preventable cause of death in America and is elevated among patients with non-tobacco substance use disorders. Substance use treatment centers (SUTCs) do not commonly address their patients' tobacco use. Lack of knowledge on treating tobacco use with counseling and medication may be a barrier that underlies this inaction. A multi-component tobacco-free workplace program implemented in Texas SUTCs educated providers on treating tobacco use with evidence-based medication (or referral) and counseling. This study examined how center-level changes in knowledge from pre- to post-implementation (i.e., over time) affected center-level behavioral changes in providers' provision of tobacco use treatment over time. Providers from 15 SUTCs completed pre- and post-implementation surveys (pre N = 259; post N = 194) assessing (1) perceived barriers to treating tobacco use, specifically, a lack of knowledge on treating tobacco use with counseling or medication; (2) receipt of past-year education on treating tobacco use with counseling or medication; and (3) their intervention practices, specifically, the self-reported regular use of (a) counseling or (b) medication intervention or referral with patients who use tobacco. Generalized linear mixed models explored associations between provider-reported knowledge barriers, education receipt, and intervention practices over time. Overall, recent counseling education receipt was endorsed by 32.00% versus 70.21% of providers from pre- to post-implementation; the regular use of counseling to treat tobacco use was endorsed by 19.31% versus 28.87% from pre- to post-implementation. Recent medication education receipt was endorsed by 20.46% versus 71.88% of providers from pre- to post-implementation; the regular use of medication to treat tobacco use was endorsed by 31.66% versus 55.15% from pre- to post-implementation. All changes were statistically significant (ps < 0.05). High versus low reductions in the provider-reported barrier of "lack of knowledge on pharmacotherapy treatment" over time were a significant moderator of effects, such that SUTCs with high reductions in this barrier were more likely to report greater increases in both medication education receipt and medication treatment/referral for patients who use tobacco over time. In conclusion, a tobacco-free workplace program implementation strategy that included SUTC provider education improved knowledge and resulted in increased delivery of evidence-based treatment of tobacco use at SUTCs; however, treatment provision rates-in particular, offering tobacco cessation counseling-remained less than desirable, suggesting that barriers beyond lack of knowledge may be important to address to improve tobacco use care in SUTCs. Moderation results suggest (1) differences in the mechanisms underlying uptake of counseling education versus medication education and (2) that the relative difficulty of providing counseling versus providing medication persists regardless of knowledge gains.
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Affiliation(s)
- Brian J. Carter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Ammar D. Siddiqi
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Maggie Britton
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | | | - Lorraine R. Reitzel
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, Houston, TX 77204, USA
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Schilling S, Powell BJ, Stewart PW, Wood JN. Child Adult Relationship Enhancement in Primary Care (PriCARE): study design/protocol for a randomized trial of a primary care-based group parenting intervention to prevent child maltreatment. Trials 2023; 24:138. [PMID: 36823526 PMCID: PMC9947901 DOI: 10.1186/s13063-022-07024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/15/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Child maltreatment (CM) is a pervasive public health problem and there is a critical need for brief, effective, scalable prevention programs. Problematic parent-child relationships lie at the heart of CM. Parents who maltreat their children are more likely to have punitive parenting styles characterized by high rates of negative interaction and ineffective discipline strategies with over-reliance on punishment. Thus, parenting interventions that strengthen parent-child relationships, teach positive discipline techniques, decrease harsh parenting, and decrease child behavioral problems hold promise as CM prevention strategies. Challenges in engaging parents, particularly low-income and minority parents, and a lack of knowledge regarding effective implementation strategies, however, have greatly limited the reach and impact of parenting interventions. Child Adult Relationship Enhancement in Primary Care (PriCARE)/Criando Niños con CARIÑO is a 6-session group parenting intervention that holds promise in addressing these challenges because PriCARE/CARIÑO was (1) developed and iteratively adapted with input from racially and ethnically diverse families, including low-income families and (2) designed specifically for implementation in primary care with inclusion of strategies to align with usual care workflow to increase uptake and retention. METHODS This study is a multicenter randomized controlled trial with two parallel arms. Children, 2-6 years old with Medicaid/CHIP/no insurance, and their English- and Spanish-speaking caregivers recruited from pediatric primary care clinics in Philadelphia and North Carolina will be enrolled. Caregivers assigned to the intervention regimen will attend PriCARE/CARIÑO and receive usual care. Caregivers assigned to the control regimen will receive usual care only. The primary outcome is occurrence of an investigation for CM by child protective services during the 48 months following completion of the intervention. In addition, scores for CM risk, child behavior problems, harsh and neglectful parenting behaviors, caregiver stress, and caregiver-child interactions will be assessed as secondary outcome measures and for investigation of possible mechanisms of intervention-induced change. We will also identify PriCARE/CARIÑO implementation factors that may be barriers and facilitators to intervention referrals, enrollment, and attendance. DISCUSSION By evaluating proximal outcomes in addition to the distal outcome of CM, this study, the largest CM prevention trial with individual randomization, will help elucidate mechanisms of change and advance the science of CM prevention. This study will also gather critical information on factors influencing successful implementation and how to optimize intervention referrals, enrollment, and attendance to inform future dissemination and practical applications. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov (NCT05233150) on February 1, 2022, prior to enrolling subjects.
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Affiliation(s)
- Samantha Schilling
- Department of Pediatrics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Paul W Stewart
- Department of Biostatistics, Gilling School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Joanne N Wood
- Safe Place: The Center for Child Protection and Health, PolicyLab, Center for Pediatric Effectiveness and Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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Shapiro LM, Đình MP, Fox PM, Richard MJ, Eppler SL, Kamal RN. Barriers and Facilitators of Outcome Collection During Hand Surgery Outreach: A Quality Improvement Study. Hand (N Y) 2022; 17:1219-1227. [PMID: 33789491 PMCID: PMC9608306 DOI: 10.1177/15589447211003183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical outreach trips to low- and middle-income countries have been increasing. Outcome collection on these trips, however, has been inconsistent and often incomplete. We conducted a qualitative study of surgeons, administrators, and patients to identify the barriers and facilitators to outcome collection on hand surgery outreach trips to Hospital 175 in Ho Chi Minh City, Vietnam. METHODS A purposive sample of surgeons, administrators, and patients from Hospital 175 were interviewed about their beliefs regarding outcome collection. We used a semi-structured interview guide based on the Theoretical Domains Framework to systematically explore barriers and facilitators. Interviews were recorded, transcribed, and analyzed using content analysis. Beliefs underlying similar responses were identified and aggregated to describe barriers and facilitators of outcome measurement. RESULTS Twelve surgeons and administrative staff (3 visiting and 9 local) and 5 patients were interviewed before saturation was achieved. All stakeholders believed outcome collection on hand surgery outreach trips is important. Barriers identified were primarily related to environmental context and resources (eg, cost of returning) and memory, attention, and decision process (eg, difficulty in remembering patient follow-up intervals). The most commonly identified barriers address the distance patients live from the hospital/clinic, the resources required for them to return, and the lack of an organized system to assist in follow-up. CONCLUSIONS Multiple barriers to outcome collection exist at Hospital 175 in Vietnam. Understanding these barriers informs context-specific implementation approaches to collect outcomes on hand surgery outreach trips, which may improve the safety and quality of care provided.
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Affiliation(s)
- Lauren M. Shapiro
- Sustainable Global Surgery, Palo Alto, CA, USA
- Stanford University, Redwood City, CA, USA
| | - Mừng Phan Đình
- Orthopedic and Trauma Institute, Ho Chi Minh City, Vietnam
| | | | | | | | - Robin N. Kamal
- Sustainable Global Surgery, Palo Alto, CA, USA
- Stanford University, Redwood City, CA, USA
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Bursey K, Hall A, Pike A, Etchegary H, Aubrey-Bassler K, Patey AM, Romme K. Physician-reported barriers to using evidence-based antibiotic prescription guidelines in primary care: protocol for a systematic review and synthesis of qualitative studies using the Theoretical Domains Framework. BMJ Open 2022; 12:e066681. [PMID: 36319054 PMCID: PMC9628688 DOI: 10.1136/bmjopen-2022-066681] [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] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Overprescription of antibiotics poses a significant threat to healthcare globally as it contributes to the issue of antibiotic resistance. While antibiotics should be predominately prescribed for bacterial infections, they are often inappropriately given for uncomplicated upper respiratory tract infections (URTIs) and related conditions, such as the common cold. This study will involve a qualitative systematic review of physician-reported barriers to using evidence-based antibiotic prescription guidelines in primary care settings and synthesise the findings using a theoretical basis. METHODS AND ANALYSIS We will conduct a systematic review of qualitative studies that assess physicians' reported barriers to following evidence-based antibiotic prescription guidelines in primary care settings for URTIs. We plan to search the following databases with no date or language restrictions: MEDLINE, Web of Science, CINAHL, Embase, the Cochrane Library and PsycInfo. Qualitative studies that explore the barriers and enablers to following antibiotic prescription guidelines for URTIs for primary care physicians will be included. We will analyse our findings using the Theoretical Domains Framework (TDF), which is a theoretically designed resource based on numerous behaviour change theories grouped into 14 domains. Using the TDF approach, we will be able to identify the determinants of our behaviour of interest (ie, following antibiotic prescription guidelines for URTIs) and categorise them into the 14 TDF domains. This will provide the necessary information to develop future evidence-based interventions that will target the identified issues and apply the most effective behaviour change techniques to affect change. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. ETHICS AND DISSEMINATION Ethical approval is not required. Findings will be published in a peer-reviewed journal and presented at conferences.
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Affiliation(s)
- Krystal Bursey
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Holly Etchegary
- Clinical Epidemiology, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Andrea M Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kristen Romme
- Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
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van Grondelle SE, van Bruggen S, Meijer J, van Duin E, Bots ML, Rutten G, Vos HMM, Numans ME, Vos RC. Opinions on hypertension care and therapy adherence at the healthcare provider and healthcare system level: a qualitative study in the Hague, Netherlands. BMJ Open 2022; 12:e062128. [PMID: 35803634 PMCID: PMC9272114 DOI: 10.1136/bmjopen-2022-062128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Hypertension is a common cause of cardiovascular morbidity and mortality. Although hypertension can be effectively controlled by blood pressure-lowering drugs, uncontrolled blood pressure is common despite use of these medications. One explanation is therapy non-adherence. Therapy non-adherence can be addressed at the individual level, the level of the healthcare provider and at the healthcare system level. Since the latter two levels are often overlooked, we wished to explore facilitators and barriers on each of these levels in relation to hypertension care for people with hypertension, with a specific focus on therapy adherence. DESIGN Qualitative study using focus groups of healthcare providers. Data were analysed using the theoretical domains framework (TDF) and the behaviour change wheel. SETTING AND PARTICIPANTS Participants were from a highly urbanised city environment (the Hague, Netherlands), and included nine primary care physicians, six practice nurses and five secondary care physicians involved in hypertension care. RESULTS Nine domains on the TDF were found to be relevant at the healthcare provider level ('knowledge', 'physical, cognitive and interpersonal skills', 'memory, attention and decision processes', 'professional, social role and identity', 'optimism', 'beliefs about consequences', 'intention', 'emotion' and 'social influences') and two domains ('resources' and 'goals') were found to be relevant at the system level. Facilitators for these domains were good interpersonal skills, paying attention to behavioural factors such as medication use, and the belief that treatment improves health outcomes. Barriers were related to time, interdisciplinary collaboration, technical and financial issues, availability of blood pressure devices and education of people with hypertension. CONCLUSIONS This study highlighted a need for better collaboration between primary and secondary care, for more team-based care including pharmacists and social workers, tools to improve interpersonal skills and more time for patient-healthcare provider communication.
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Affiliation(s)
- Saskia E van Grondelle
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Sytske van Bruggen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Hadoks Chronische zorg BV, Den Haag, The Netherlands
| | - Judith Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik van Duin
- Hadoks Chronische zorg BV, Den Haag, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, UMC, Utrecht, The Netherlands
| | - Guy Rutten
- Julius Center for Health Sciences and Primary Care, UMC, Utrecht, The Netherlands
| | - Hedwig M M Vos
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Rimke C Vos
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Wong CH, Zhong CC, Chung VC, Nilsen P, Wong EL, Yeoh EK. Barriers and Facilitators to Receiving the COVID-19 Vaccination and Development of Theoretically-Informed Implementation Strategies for the Public: Qualitative Study in Hong Kong. Vaccines (Basel) 2022; 10:vaccines10050764. [PMID: 35632520 PMCID: PMC9143598 DOI: 10.3390/vaccines10050764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
Objectives: enhancing uptake of COVID-19 vaccines is an important tool for managing the pandemic. However, in Hong Kong, the COVID-19 vaccination rate in the general population was unsatisfactory during the early phase of the vaccination program. This two-part study aimed to (i) identify barriers and facilitators to receiving vaccinations, and (ii) develop theoretically-informed implementation strategies for promoting uptake. Methods: in part 1, 45 Hong Kong residents who differed in their willingness to vaccinate (willing (n = 15), were unwilling (n = 15), and were hesitant (n = 15)), were interviewed individually in February 2021. They were invited to express their perceptions of receiving the COVID-19 vaccination. The theoretical domains framework (TDF) was applied to guide the interviews and analyses. Behavioral diagnoses from these findings were then used to develop theoretically-informed implementation strategies in part 2, composed of behavior change techniques (BCTs) informed by the established BCT taxonomy. Results: in part 1, the five main barriers were (i) concerns on severe and long-term side effects; (ii) low confidence in the safety and effectiveness due to concerns of their accelerated development; (iii) unclear information on logistical arrangements of the vaccination program; (iv) insufficient data on safety and effectiveness; and (v) perceived low protection ability conferred by the vaccines. The five main facilitators included (i) healthcare professionals’ recommendations; (ii) news from TV, radio, and newspapers as main sources of trustworthy information; (iii) vaccine-related health education delivered by healthcare professionals; (iv) expectations of resuming to a normal social life; and (v) perceived benefits outweighing risks of mild and short-term side effects. Conclusions: seven implementation strategies were developed in part 2 based on the results above, namely (i) providing trustworthy vaccine-related information and scaling up the promotion; (ii) encouraging healthcare professionals to recommend vaccinations; (iii) giving incentives; (iv) using social influence approaches; (v) allowing a selection of COVID-19 vaccine brands; (vi) increasing accessibility for vaccinations; and (vii) emphasizing social responsibility.
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Affiliation(s)
- Charlene Hl Wong
- Faculty of Medicine, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong; (C.H.W.); (C.C.Z.)
| | - Claire Cw Zhong
- Faculty of Medicine, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong; (C.H.W.); (C.C.Z.)
| | - Vincent Ch Chung
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong; (E.L.W.); (E.-k.Y.)
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
- Correspondence: ; Tel.: +852-22528453; Fax: +852-26453098
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden;
| | - Eliza Ly Wong
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong; (E.L.W.); (E.-k.Y.)
| | - Eng-kiong Yeoh
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong; (E.L.W.); (E.-k.Y.)
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Bravington A, Chen H, Dyson J, Jones L, Dalgliesh C, Bryan A, Patnick J, Macleod U. Translating qualitative data into intervention content using the Theoretical Domains Framework and stakeholder co-design: a worked example from a study of cervical screening attendance in older women. BMC Health Serv Res 2022; 22:610. [PMID: 35524217 PMCID: PMC9074234 DOI: 10.1186/s12913-022-07926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous screening interventions have demonstrated a series of features related to social determinants which have increased uptake in targeted populations, including the assessment of health beliefs and barriers to screening attendance as part of intervention development. Many studies cite the use of theory to identify methods of behaviour change, but fail to describe in detail how theoretical constructs are transformed into intervention content. The aim of this study was to use data from a qualitative exploration of cervical screening in women over 50 in the UK as the basis of intervention co-design with stakeholders using behavioural change frameworks. We describe the identification of behavioural mechanisms from qualitative data, and how these were used to develop content for a service-user leaflet and a video animation for practitioner training. The interventions aimed to encourage sustained commitment to cervical screening among women over 50, and to increase sensitivity to age-related problems in screening among primary care practitioners. METHODS Secondary coding of a qualitative data set to extract barriers and facilitators of cervical screening attendance. Barrier and facilitator statements were categorised using the Theoretical Domains Framework (TDF) to identify relevant behaviour change techniques (BCTs). Key TDF domains and associated BCTs were presented in stakeholder focus groups to guide the design of intervention content and mode of delivery. RESULTS Behavioural determinants relating to attendance clustered under three domains: beliefs about consequences, emotion and social influences, which mapped to three BCTs respectively: (1) persuasive communication/information provision; (2) stress management; (3) role modelling and encouragement. Service-user stakeholders translated these into three pragmatic intervention components: (i) addressing unanswered questions, (ii) problem-solving practitioner challenges and (iii) peer group communication. Based on (ii), practitioner stakeholders developed a call to action in three areas - clinical networking, history-taking, and flexibility in screening processes. APEASE informed modes of delivery (a service-user leaflet and a cartoon animation for practitioners). CONCLUSION The application of the TDF to qualitative data can provide an auditable protocol for the translation of qualitative data into intervention content.
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Affiliation(s)
- Alison Bravington
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK.
| | - Hong Chen
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Judith Dyson
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
| | - Lesley Jones
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | | | | | - Julietta Patnick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
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Alenezi A, Yahyouche A, Paudyal V. Patient Perspectives on the Appropriate Use of Prescribed Opioids in Chronic Non-Malignant Pain: Analysis of Online Forums Using Theoretical Domains Framework. J Pain Res 2022; 15:1567-1583. [PMID: 35668956 PMCID: PMC9166377 DOI: 10.2147/jpr.s357354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/10/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Aziza Alenezi
- University of Birmingham, School of Pharmacy, Institute of Clinical Sciences, Birmingham, B15 2TT, UK
| | - Asma Yahyouche
- University of Birmingham, School of Pharmacy, Institute of Clinical Sciences, Birmingham, B15 2TT, UK
- Correspondence: Asma Yahyouche, School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK, Tel/Fax + 44121 415 8798, Email
| | - Vibhu Paudyal
- University of Birmingham, School of Pharmacy, Institute of Clinical Sciences, Birmingham, B15 2TT, UK
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Baumann A, Vázquez A, Macchione A, Lima A, Coelho A, Juras M, Ribeiro M, Kohlsdorf M, Carothers B. Translation and validation of the evidence-based practice attitude scale (EBPAS-15) to Brazilian Portuguese: Examining providers' perspective about evidence-based parent intervention. CHILDREN AND YOUTH SERVICES REVIEW 2022; 136:106421. [PMID: 35431379 PMCID: PMC9012479 DOI: 10.1016/j.childyouth.2022.106421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Few existing evidence-based parent interventions (EBPIs) for prevention and treatment of child and youth mental health disorders are implemented in low-middle-income countries. This study aimed to translate and confirm the factor structure of the Evidence-Based Practice Attitude Scale (EBPAS-15) survey in Brazilian Portuguese with the goal of examining providers' perspective about EBPIs. Methods We translated and back translated the EBPAS-15 from English to Brazilian Portuguese. Participants were recruited via snowball sampling and data were collected using an online survey from July of 2018 through January of 2020. A confirmatory factor analysis was conducted to determine if the scale retained its original structure. Open-ended questions about providers' perspectives of their own clinical practice were coded using the Theoretical Domains Framework (TDF). Analyses included data from 362 clinicians (318 women, 41 men) from 20 of the 27 states of Brazil. Participants on average were 26.7 years old, held specialist degrees in the field of psychology, actively worked as therapists, and practiced in private clinics. Results The translation of the EBPAS to Brazilian Portuguese retained the same four-factor structure as the English version except for dropping one item from the Divergence domain. When asked about the challenges in their practices, providers generally referred to parents as clients with little skills to discipline their children and lacking knowledge about child development. Discussion The Brazilian version of the EBPAS-15 is promising, but future research should consider using quantitative data alongside qualitative information to better understand providers' attitudes about evidence-based interventions to inform implementation efforts. Trial registration N/A.
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Affiliation(s)
- A.A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, MO, USA
| | | | - A.C. Macchione
- Centro Paradigma de Ciências do Comportamento, São Paulo, Brazil
| | - A. Lima
- Sam Houston State University, TX, USA
| | - A.F. Coelho
- Universidade de Brasilia, Brasília-DF, Brazil
| | - M. Juras
- Florida Gulf Coast University, USA
| | - M. Ribeiro
- Aiutare Instituto de Psicologia, Brasília-DF, Brazil
| | - M. Kohlsdorf
- Centro Universitario UniCEUB, Brasília-DF, Brazil
| | - B.J. Carothers
- Brown School, Washington University in St. Louis, Missouri, United States
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Overwijk A, Hilgenkamp TIM, van der Schans CP, van der Putten AAJ, Waninge A. Development of a Dutch Training/Education Program for a Healthy Lifestyle of People With Intellectual Disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:163-177. [PMID: 35297990 DOI: 10.1352/1934-9556-60.2.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/18/2021] [Indexed: 06/14/2023]
Abstract
Individuals with intellectual disability (ID) need support from direct support professionals (DSPs) to engage in a healthy lifestyle. However, literature shows DSPs feel insufficiently equipped to support a healthy lifestyle. Therefore, the aim of this study is to develop a theory-based program for DSPs to support physical activity and healthy nutrition for people with moderate to profound levels of ID, and to design its evaluation. The Intervention Mapping Protocol (IM) was followed to develop a theory-based program for DSPs. The program evaluation consists of process and feasibility evaluations. This study provided a theory-based program consisting of a training and education section with online and face-to-face components to support DSPs in promoting health for people with ID.
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Affiliation(s)
- Annelies Overwijk
- Annelies Overwijk, Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences and University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands
| | - Thessa I M Hilgenkamp
- Thessa I.M. Hilgenkamp, Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands, and Department of Physical Therapy, University of Nevada
| | - Cees P van der Schans
- Cees P. van der Schans, Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine and Department of Health Psychology
| | - Annette A J van der Putten
- Annette A.J. van der Putten, Department of Inclusive and Special Needs Education, University of Groningen, The Netherlands
| | - Aly Waninge
- Aly Waninge, Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, and University of Groningen, University Medical Center Groningen, Department of Health Psychology, The Netherlands
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Quinn LM, Shukla D, Greenfield SM, Barrett T, Garstang J, Boardman F, Litchfield I, Dayan C, Gardner C, Connop C, Lepley A, Narendran P. EarLy Surveillance for Autoimmune diabetes: protocol for a qualitative study of general population and stakeholder perspectives on screening for type 1 diabetes in the UK (ELSA 1). BMJ Open Diabetes Res Care 2022; 10:10/2/e002750. [PMID: 35450871 PMCID: PMC9024254 DOI: 10.1136/bmjdrc-2021-002750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/19/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Type 1 diabetes (T1D) is the most common form of diabetes in children, accounting for 96% of cases, with 29 000 children affected in the UK. Studies have recently identified immunotherapies that safely delay the development of T1D for at least 3 years, and further therapies are in development. General population screening programs in other countries can now accurately identify children with presymptomatic T1D who can be entered into prevention studies. The UK does not have such a system in place. We aim to explore whether parents and children in the UK would want to be part of such a program of testing for T1D in the general population, how they would want to be informed and participate in such a program, and how any barriers to recruitment and participation can be addressed. Additionally, the views of stakeholders who would be involved in the testing program will be collected and analyzed. RESEARCH DESIGN AND METHODS We will interview parents/guardians and children aged 3-13 years about their views on screening for T1D. We will recruit purposefully to ensure representation across ethnicities and socioeconomic groups. Interviews will be transcribed, analyzed and used to inform iterative co-design work with additional families to address any issues raised. Similar qualitative work will be undertaken with professional stakeholders who would be involved in implementing any future screening program. Where possible, all aspects of this study will be performed remotely by phone or online to minimize infection risk. CONCLUSIONS This qualitative study will provide the first insights into acceptability of testing and monitoring for T1D in the general population from the perspective of families and stakeholders in the UK. Co-design work will help establish the barriers and identify strategies to mitigate and overcome these issues, as an important step towards consideration of national testing for T1D.
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Affiliation(s)
- Lauren Marie Quinn
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - David Shukla
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Tim Barrett
- Institute of Child Health, University of Birmingham, Birmingham, UK
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
- School of Nursing, University of Birmingham, Birmingham, UK
| | | | - Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Colin Dayan
- School of Medicine, University of Cardiff, Cardiff, UK
| | | | | | | | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Diabetes, University Hospitals of Birmingham, Birmingham, UK
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Martinez-Cajas JL, Torres J, Mueses HF, Plazas PC, Arrivillaga M, Gomez SA, Galindo X, Buitrago EM, Llano BEA. Applying implementation science frameworks to identify factors that influence the intention of healthcare providers to offer PrEP care and advocate for PrEP in HIV clinics in Colombia: a cross-sectional study. Implement Sci Commun 2022; 3:31. [PMID: 35296369 PMCID: PMC8925047 DOI: 10.1186/s43058-022-00278-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Few studies have used implementation science frameworks to identify determinants of PrEP prescription by healthcare providers. In this work, we developed and psychometrically examined a questionnaire using the theoretical domains framework (TDF) and the consolidated framework for implementation research (CFIR). We used this questionnaire to investigate what factors influence the intention of healthcare providers to offer PrEP care and advocate for PrEP. Methods We conducted a cross-sectional study in 16 HIV healthcare organizations in Colombia. A 98-item questionnaire was administered online to 129 healthcare professionals. One hundred had complete data for this analysis. We used exploratory factor analysis to assess the psychometric properties of both frameworks, and multinomial regression analysis to evaluate the associations of the frameworks’ domains with two outcomes: (1) intention to offer PrEP care and (2) intention to advocate for PrEP impmentation. Results We found support for nine indices with good internal consistency, reflecting PrEP characteristics, attitudes towards population needs, concerns about the use of PrEP, concerns about the role of the healthcare systems, knowledge, beliefs about capabilities, professional role, social influence, and beliefs about consequences. Notably, only 57% of the participants were likely to have a plan to care for people in PrEP and 66.7% were likely to advocate for PrEP. The perception of the need for PrEP in populations, the value of PrEP as a practice, the influence of colleagues, and seeing PrEP care as a priority was related to being less likely to be unwilling to provide or advocate for PrEP care. Conclusion Our findings suggested the importance of multilevel strategies to increase the provision of PrEP care by healthcare providers including adquisition of new skills, training of PrEP champions, and strength the capacity of the health system. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00278-2.
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Affiliation(s)
- Jorge Luis Martinez-Cajas
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, ON, K7L 3 N6, Canada
| | - Julian Torres
- Montefiore Medical Center, Moses Division, Albert Einstein College of Medicine, The Oval Center at Montefiore, 3230 Bainbridge Ave, Bronx, NY, 10467, USA
| | | | | | - Marcela Arrivillaga
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali, Colombia, Calle, 18 118-250, Cali, Colombia
| | - Sheila Andrea Gomez
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali, Colombia, Calle, 18 118-250, Cali, Colombia
| | - Ximena Galindo
- Corporación de Lucha Contra el Sida, Carrera 56 2- 120, Cali, Colombia
| | - Ernesto Martinez Buitrago
- Departamento de Medicina Interna, Universidad del Valle, Calle 5 36-08 Hospital Universitario del Valle, Cali, Colombia
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Watson JS, Jordan RE, Adab P, Vlaev I, Enocson A, Greenfield S. Investigating primary healthcare practitioners' barriers and enablers to referral of patients with COPD to pulmonary rehabilitation: a mixed-methods study using the Theoretical Domains Framework. BMJ Open 2022; 12:e046875. [PMID: 35045995 PMCID: PMC8772414 DOI: 10.1136/bmjopen-2020-046875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Pulmonary rehabilitation (PR) is a highly effective, recommended intervention for patients with chronic obstructive pulmonary disease (COPD). Using behavioural theory within mixed-methods research to understand why referral remains low enables the development of targeted interventions in order to improve future PR referral. DESIGN A multiphase sequential mixed-methods study. SETTING United Kingdom (UK). PARTICIPANTS 252 multiprofessional primary healthcare practitioners (PHCPs). MEASURES Phase 1: semistructured interviews. Phase 2: a 54-item paper and online questionnaire, based on the Theoretical Domains Framework (TDF). Content and descriptive analysis utilised. Data mixed at two points: instrument design and interpretation. RESULTS 19 PHCPs took part in interviews and 233 responded to the survey. Integrated results revealed that PHCPs with a post qualifying respiratory qualification (154/241; 63.9%) referred more frequently (91/154; 59.1%) than those without (28/87; 32.2%). There were more barriers than enablers for referral in all 13 TDF domains. Key barriers included: infrequent engagement from PR provider to referrer, concern around patient's physical ability and access to PR (particularly for those in work), assumed poor patient motivation, no clear practice referrer and few referral opportunities. These mapped to domains: belief about capabilities, social influences, environment, optimism, skills and social and professional role. Enablers to referral were observed in knowledge, social influences memory and environment domains. Many PHCPs believed in the physical and psychological value of PR. Helpful enablers were out-of-practice support from respiratory interested colleagues, dedicated referral time (annual review) and on-screen referral prompts. CONCLUSIONS Referral to PR is complex. Barriers outweighed enablers. Aligning these findings to behaviour change techniques will identify interventions to overcome barriers and strengthen enablers, thereby increasing referral of patients with COPD to PR.
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Affiliation(s)
- Jane Suzanne Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, UK
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle P. Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel. Implement Sci Commun 2021; 2:139. [PMID: 34922624 PMCID: PMC8684208 DOI: 10.1186/s43058-021-00242-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. METHODS We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. RESULTS Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians' perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. CONCLUSIONS Improving primary care physicians' knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
- CRUK Convergence Science Center, Institute for Cancer Research & Imperial College London, Roderic Hill Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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Lohiniva AL, Elwali E, Abuobaida D, Abdulrahim A, Bukuluki P, Talaat M. A theory-based exploration of antibiotic use in primary healthcare in Gezira state, Sudan. Implement Sci Commun 2021; 2:132. [PMID: 34863311 PMCID: PMC8642910 DOI: 10.1186/s43058-021-00229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Inappropriate use of antibiotics is a major contributing factor to the emergence of antimicrobial resistance globally, including in Sudan. OBJECTIVES The project aimed to develop a theory-driven behaviour change strategy addressing both prescribers and patients based on factors that are driving antibiotic use in primary healthcare settings in Gezira state in Sudan. METHODS The strategy was designed based on the Theoretical Domains Framework (TDF) to identify behavioural domains and the Behaviour Change Wheel (BCW) to select appropriate intervention functions. The process included (1) a formative qualitative research study and (2) a knowledge co-production workshop that utilized the results of the qualitative study to design a salient, appropriate, and credible behaviour change strategy. RESULTS The TDF domains related to prescribers that emerged from the study included knowledge, skills, and intention. The selected BCW intervention functions included education, training, modelling, and persuasion. The main TDF domains related to patients included social influences and intention. The selected BCW intervention functions included enablement and education. CONCLUSION Using the TDF and BCW intervention functions, the study identified behavioural domains that influence antibiotic prescription and consumption in rural primary healthcare settings in Gezira state in Sudan and appropriate intervention functions to modify these behaviours. Knowledge co-production ensured that the evidence-based strategy was acceptable and practical in the local context.
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Affiliation(s)
| | | | | | | | | | - Maha Talaat
- WHO Eastern Mediterranean Regional Office, Cairo, Egypt
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Roles, barriers and behavioral determinants related to community pharmacists' involvement in optimizing opioid therapy for chronic pain: a qualitative study. Int J Clin Pharm 2021; 44:180-191. [PMID: 34599720 PMCID: PMC8486957 DOI: 10.1007/s11096-021-01331-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
Background Opioid are currently widely used to manage chronic non-malignant pain (CNMP), but there is a growing concern about harm resulting from opioid misuse and the need for medicine optimization, in which pharmacists could potentially play a key role. Objective This study explored pharmacists' roles, barriers and determinants related to their involvement in optimizing prescribed opioids for patients with chronic pain. Setting Community pharmacies in the United Kingdom. Method Semi-structured interviews based on the Theoretical Domains Framework were conducted between January and May 2020 with 20 community pharmacists recruited through professional networks. Data were analysed thematically. Main outcome measure: Pharmacists’ perceived roles, barriers and behavioural determinants in relation to opioid therapy optimization. Result Pharmacists demonstrated desire to contribute to opioid therapy optimization. However, they described that they were often challenged by the lack of relevant knowledge, skills and training, inadequate time and resources, systemic constraints (such as lack of access to medical records and information about diagnosis), and other barriers including relationships with doctors and patients. Conclusion The contribution of community pharmacists to optimize opioid therapy in CNMP is unclear and impeded by lack of appropriate training and systemic constraints. There is a need to develop innovative practice models by addressing the barriers identified in this study to enhance the contribution of community pharmacists in optimization of opioid therapy for chronic pain.
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Armstrong CC, Aguilera A, Hwang J, Harvey AG. Barriers and Facilitators to Behavior Change for Individuals with Severe Mental Illness who Received the Transdiagnostic Intervention for Sleep and Circadian Dysfunction in a Community Mental Health Setting. J Behav Health Serv Res 2021; 49:204-220. [PMID: 34561774 DOI: 10.1007/s11414-021-09770-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) was implemented in a community mental health center (CMHC) setting. The goal of TranS-C is to improve sleep and circadian dysfunction among people with severe mental illness. The present study uses the Theoretical Domains Framework (TDF) to uncover barriers and facilitators to changing behaviors learned in TranS-C. Adults with severe mental illness who completed TranS-C (n = 14) were given a semi-structured interview based on the TDF. Interview transcripts were independently coded using inductive and deductive coding. The most commonly coded TDF domains were Behavior Regulation, Beliefs about Consequences, Knowledge and Beliefs about Capabilities. Action planning was the most discussed facilitator and compromising sleep health in favor of time spent with loved ones was the most discussed barrier. These findings suggest that TranS-C has promising strengths and raise important barriers that can be addressed in TranS-C to improve its fit within CMHCs.
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Affiliation(s)
- Courtney C Armstrong
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA
| | - Adrian Aguilera
- Department of Social Welfare, University of California, Berkeley, 120 Haviland Hall, Berkeley, CA, 94720-1650, USA
| | - Janet Hwang
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA.
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Corcuff M, Routhier F, Paquette-Raynard E, Gagnon M, Battalova A, Mwaka C, Lamontagne ME. Organizations strategies to improve implementation of universal accessibility principles: protocol of a scoping review (Preprint). JMIR Res Protoc 2021; 11:e33641. [PMID: 35816367 PMCID: PMC9315903 DOI: 10.2196/33641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/02/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
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Affiliation(s)
- Maëlle Corcuff
- Département de réadaptation, Université Laval, Québec, QC, Canada
| | | | | | | | | | - Claudel Mwaka
- Département de réadaptation, Université Laval, Québec, QC, Canada
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Morrow A, Chan P, Tucker KM, Taylor N. The design, implementation, and effectiveness of intervention strategies aimed at improving genetic referral practices: a systematic review of the literature. Genet Med 2021; 23:2239-2249. [PMID: 34426665 PMCID: PMC8629749 DOI: 10.1038/s41436-021-01272-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Despite rapid advancements in genetics and genomics, referral practices remain suboptimal. This systematic review assesses the extent to which approaches from implementation science have been applied to address suboptimal genetic referral practices. Methods A search of MEDLINE, EMBASE, and PsycINFO generated 7,794 articles, of which 28 were included. Lay barriers were mapped to the Theoretical Domains Framework (TDF) and interventions mapped to behavior change techniques. Use of implementation and behavior change frameworks was assessed, and the Theory and Techniques Tool used to determine theoretical alignment. Results Knowledge was the most frequent retrospectively TDF-coded barrier, followed by environmental context and resources, and skills. Significant referral improvements occurred in 56% of studies. Among these, the most frequent interventions were clinical data review systems, family history collection and referral tools, and embedding genetics staff into nongenetic specialties. Few studies used implementation frameworks or reported implementation outcomes, though some deployed intuitive strategies that aligned with theory. Conclusion Genetic referral interventions are rarely informed by implementation and/or behavior change theories, limiting opportunities for learning across contexts. Retrospective coding has provided a suite of theoretically linked strategies, which may be useful for informing future efforts. Incorporating these strategies into clinical guidelines may facilitate operationalization within the system.
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Affiliation(s)
- April Morrow
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia. .,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
| | - Priscilla Chan
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia.,UNSW Prince of Wales Clinical School, Randwick, NSW, Australia
| | - Natalie Taylor
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Gondi S, Ellis S, Gupta M, Ellerbeck E, Richter K, Burns J, Gupta A. Physician perceived barriers and facilitators for self-measured blood pressure monitoring- a qualitative study. PLoS One 2021; 16:e0255578. [PMID: 34415946 PMCID: PMC8378703 DOI: 10.1371/journal.pone.0255578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Improving hypertension management is a national priority that can decrease morbidity and mortality. Evidence-based hypertension management guidelines advocate self-measured BP (SMBP), but widespread implementation of SMBP is lacking. The purpose of this study was to describe the perspective of primary care physicians (PCPs) on SMBP to identify the barriers and facilitators for implementing SMBP. METHODS We collected data from PCPs from a large health system using semi-structured interviews based on the Theoretical Domains Framework (TDF). Responses were recorded, transcribed, and qualitatively analyzed into three overarching TDF domains based on the Behavior Change Wheel (BCW): 1) Motivation 2) Opportunity and 3) Capabilities. The sample size was based on theme saturation. RESULTS All 17 participating PCPs believed that SMBP is a useful, but underutilized tool. Although individual practices varied, most physicians felt that the increased data points from SMBP allowed for better hypertension management. Most felt that overcoming existing barriers would be difficult, but identified several facilitators: physician support of SMBP, the possibility of having other trained health professionals to assist with SMBP and patient education; improving patient engagement and empowerment with SMBP, and the interest of the health system in using technology to improve hypertension management. CONCLUSION PCPs believe that SMBP can improve hypertension management. There are numerous barriers and facilitators for implementing SMBP. Successful implementation in clinical practice will require implementation strategies targeted at increasing patient acceptability and reducing physician workload. This may need a radical change in the current methods of managing hypertension.
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Affiliation(s)
- Saahith Gondi
- Department of Biology, Wake Forest University, Winston-Salem, NC, United States of America
| | - Shellie Ellis
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Mallika Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Edward Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Kimber Richter
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Jeffrey Burns
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Aditi Gupta
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
- * E-mail:
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Brown MK, Shahar S, You YX, Michael V, Majid HA, Manaf ZA, Haron H, Sukiman NS, Chia YC, He FJ, MacGregor GA. Developing a policy to reduce the salt content of food consumed outside the home in Malaysia: protocol of a qualitative study. BMJ Open 2021; 11:e044628. [PMID: 34301647 PMCID: PMC8311303 DOI: 10.1136/bmjopen-2020-044628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Current salt intake in Malaysia is high. The existing national salt reduction policy has faced slow progress and does not yet include measures to address the out of home sector. Dishes consumed in the out of home sector are a known leading contributor to daily salt intake. This study aims to develop a salt reduction strategy, tailored to the out of home sector in Malaysia. METHODS AND ANALYSIS This study is a qualitative analysis of stakeholder views towards salt reduction. Participants will be recruited from five zones of Malaysia (Western, Northern, Eastern and Southern regions and East Malaysia), including policy-makers, non-governmental organisations, food industries, school canteen operators, street food vendors and consumers, to participate in focus group discussions or in-depth interviews. Interviews will be transcribed and analysed using thematic analysis. Barriers will be identified and used to develop a tailored salt reduction strategy. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Universiti Kebangsaan Malaysia Medical Research Ethics Committee (UKM PPI/1118/JEP-2020-524), the Malaysian National Medical Research Ethics Committee (NMRR-20-1387-55481 (IIR)) and Queen Mary University of London Research Ethics Committee (QMERC2020/37) . Results will be presented orally and in report form and made available to the relevant ministries for example, Ministry of Health, Ministry of Education and Ministry of Trade to encourage adoption of strategy as policy. The findings of this study will be disseminated through conference presentations, peer-reviewed publications and webinars.
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Affiliation(s)
- Mhairi Karen Brown
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Suzana Shahar
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yee Xing You
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Viola Michael
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health (CePH) and Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hasnah Haron
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noor Shahida Sukiman
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yook Chin Chia
- Department of Medical Science, Sunway University, Bandar Sunway, Malaysia
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Weller CD, Richards C, Turnour L, Team V. Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study. Front Pharmacol 2021; 12:663570. [PMID: 34149416 PMCID: PMC8209379 DOI: 10.3389/fphar.2021.663570] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/19/2021] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to understand which factors influence patients’ adherence to venous leg ulcer treatment recommendations in primary care. We adopted a qualitative study design, conducting phone interviews with 31 people with venous leg ulcers in Melbourne, Australia. We conducted 31 semi-structured phone interviews between October and December 2019 with patients with clinically diagnosed venous leg ulcers. Participants recruited to the Aspirin in Venous Leg Ulcer Randomized Control Trial and Cohort study were invited to participate in a qualitative study, which was nested under this trial. We applied the Theoretical Domains Framework to guide the data analysis. The following factors influenced patients’ adherence to venous leg ulcer treatment: understanding the management plan and rationale behind treatment (Knowledge Domain); compression-related body image issues (Social Influences); understanding consequences of not wearing compression (Beliefs about Consequences); feeling overwhelmed because it’s not getting better (Emotions); hot weather and discomfort when wearing compression (Environmental Context and Resources); cost of compression (Environmental Context and Resources); ability to wear compression (Beliefs about Capabilities); patience and persistence (Behavioral Regulation); and remembering self-care instructions (Memory, Attention and Decision Making). The Theoretical Domains Framework was useful for identifying factors that influence patients’ adherence to treatment recommendations for venous leg ulcers management. These factors may inform development of novel interventions to optimize shared decision making and self-care to improve healing outcomes. The findings from this article will be relevant to clinicians involved in management of patients with venous leg ulcers, as their support is crucial to patients’ treatment adherence. Consultation with patients about VLU treatment adherence is an opportunity for clinical practice to be targeted and collaborative. This process may inform guideline development.
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Affiliation(s)
- Carolina D Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VI, Australia
| | - Catelyn Richards
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VI, Australia
| | - Louise Turnour
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VI, Australia
| | - Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VI, Australia
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Castillo G, Lalu M, Asad S, Foster M, Kekre N, Fergusson D, Hawrysh T, Atkins H, Thavorn K, Montroy J, Schwartz S, Holt R, Broady R, Presseau J. Hematologists' barriers and enablers to screening and recruiting patients to a chimeric antigen receptor (CAR) T cell therapy trial: a theory-informed interview study. Trials 2021; 22:230. [PMID: 33766105 PMCID: PMC7995587 DOI: 10.1186/s13063-021-05121-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 02/11/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Novel therapies often fail to reach the bedside due to low trial recruitment rates. Prior to conducting one of the first chimeric antigen receptor (CAR) T cell therapy trials in Canada, we used the Theoretical Domains Framework, a novel tool for identifying barriers and enablers to behavior change, to identify physician-related barriers and enablers to screening and recruiting patients for an early phase immunotherapy trial. METHODS We conducted interviews with hematologists across Canada and used a directed content analysis to identify relevant domains reflecting the key factors that may affect screening and recruitment. RESULTS In total, we interviewed 15 hematologists. Physicians expressed "cautious hope"; while expressing safety, feasibility, and screening criteria concerns, 14 out of 15 hematologists intended to screen for the trial (domains: knowledge, goals, beliefs about consequences, intentions). Physicians underscored the "challenging contexts," identifying resources, workload, forgetting, and patient wait times to receive CAR T cells as key practical barriers to screening (domains: environmental context and resources, memory, attention and decision-making, behavioral regulation). They also highlighted "variability in roles and procedures" that may lead to missed trial candidates (domain: social and professional role). Left unaddressed, these barriers may undermine trial recruitment. CONCLUSIONS This study is among the first to use the Theoretical Domains Framework from the physician perspective to identify recruitment challenges to early phase trials and demonstrates the value of this approach for identifying barriers to screening and recruitment that may not otherwise have been elicited. This approach can optimize trial procedures and may serve to inform future promising early phase cancer therapy trials. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03765177 . Registered on December 5, 2018.
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Affiliation(s)
- Gisell Castillo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Manoj Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
- Department of Anaesthesiology and Pain Medicine, University of Ottawa at the Ottawa Hospital General Campus, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Sarah Asad
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Madison Foster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Natasha Kekre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
- Blood and Marrow Transplant Program, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | | | - Harold Atkins
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
- Blood and Marrow Transplant Program, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
- Institute for Clinical and Evaluative Sciences (ICES), University of Ottawa, 1053 Carling Ave., Ottawa, Ontario, K1Y 4E9, Canada
| | - Joshua Montroy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | | | - Robert Holt
- BC Cancer Genome Sciences Centre, 100-570 West 7th Avenue, Vancouver, British Columbia, V5Z 4S6, Canada
| | - Raewyn Broady
- Leukemia/BMT Program, Vancouver General Hospital, 2775 Laurel St - 10th floor, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
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Castillo G, Lalu MM, Asad S, Foster M, Kekre N, Fergusson DA, Hawrysh T, Atkins H, Thavorn K, Montroy J, Schwartz S, Holt RA, Broady R, Presseau J. Navigating choice in the face of uncertainty: using a theory informed qualitative approach to identifying potential patient barriers and enablers to participating in an early phase chimeric antigen receptor T (CAR-T) cell therapy trial. BMJ Open 2021; 11:e043929. [PMID: 33741670 PMCID: PMC7986876 DOI: 10.1136/bmjopen-2020-043929] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Bench to bedside translation of groundbreaking treatments like chimeric antigen receptor T (CAR-T) cell therapy depends on patient participation in early phase trials. Unfortunately, many novel therapies fail to be adequately evaluated due to low recruitment rates, which slows patient access to emerging treatments. Using the Theoretical Domains Framework (TDF), we sought to identify potential patient barriers and enablers to participating in an early phase CAR-T cell therapy trial. DESIGN We used qualitative semistructured interviews to identify potential barriers and enablers to patients' hypothetical participation in an early phase CAR-T cell therapy trial. We used the TDF and directed content analysis to identify relevant domains based on frequency, relevance and the presence of conflicting beliefs. PARTICIPANTS Canadian adult patients diagnosed with haematological malignancies. RESULTS In total, we interviewed 13 participants (8 women, 5 men). Participants ranged in age from 18 to 73 (median=56) and had been living with haematological cancer from a few months to several years. We found participants were unfamiliar with CAR-T cell therapy but wished to know more about treatment safety, efficacy and trial logistics (domains: knowledge, beliefs about consequences). They were motivated by altruistic considerations, though many prioritised personal health benefits despite recognising the goals (ie, establishing safety) of early phase clinical trials (domains: goals, intentions). Every participant valued receiving medical advice from their haematologists and oncologists, though some preferred impartial medical experts to inform their decision making (domain: social influences). Finally, participants indicated that improving access to financial and social supports would improve their trial participation experience (domain: environmental context and resources). CONCLUSION Using the TDF allowed us to identify factors that might undermine participation to a CAR-T cell therapy trial and to optimise recruitment processes by considering patient perspectives to taking part in early phase trials.Trial regestration: NCT03765177; Pre-results.
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Affiliation(s)
- Gisell Castillo
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Manoj M Lalu
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Anaesthesiology and Pain Medicine, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Sarah Asad
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Madison Foster
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Natasha Kekre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Blood and Marrow Transplant Program, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Harold Atkins
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Blood and Marrow Transplant Program, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- ICES University of Ottawa, Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Joshua Montroy
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Robert A Holt
- Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada
| | - Raewyn Broady
- Leukemia/BMT Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Justin Presseau
- Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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48
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Wshah A, Selzler AM, Ellerton L, Hill K, Brooks D, Goldstein R. Reducing sedentary behavior in individuals with COPD: healthcare professionals' perspectives. Physiother Theory Pract 2021; 38:1693-1704. [PMID: 33586622 DOI: 10.1080/09593985.2021.1885088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Reducing sedentary behavior (SB) in individuals with chronic obstructive pulmonary disease (COPD) is being increasingly recognized as a novel health target. Understanding healthcare professionals (HCPs) behavior that influences a reduction in SB in this population could facilitate achieving this target. Objective: To explore the determinants of behavior related to HCPs targeting a reduction in SB in people with COPD. Methods: We used a qualitative semi-structured interview approach informed by the Theoretical Domains Framework (TDF). Sixteen HCPs were interviewed. Interview transcripts were mapped against the relevant TDF domain(s) and then higher order themes were generated. Results: Directed content analysis resulted in mapping 949 quotes to the TDF domains with environmental context and resources being the most coded domain. Three higher order themes were identified: 1) HCPs need more knowledge on reducing SB; 2) Strategies suggested to include in pulmonary rehabilitation (PR) to reduce SB; and 3) Barriers to adding SB to PR. Domains of environmental context and resources, knowledge, social/professional role and identity, reinforcement, social influences, skills and beliefs about capabilities were relevant to the study population to reduce SB in people with COPD. Conclusion: Knowledge of SB varied across participants. This study provided information on potential behavioral targets for future interventions that involve HCPs and aim to reduce SB among people with COPD.
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Affiliation(s)
- Adnan Wshah
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Anne-Marie Selzler
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Lauren Ellerton
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Dina Brooks
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Roger Goldstein
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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49
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Schexnayder J, Longenecker CT, Muiruri C, Bosworth HB, Gebhardt D, Gonzales SE, Hanson JE, Hileman CO, Okeke NL, Sico IP, Vedanthan R, Webel AR. Understanding constraints on integrated care for people with HIV and multimorbid cardiovascular conditions: an application of the Theoretical Domains Framework. Implement Sci Commun 2021; 2:17. [PMID: 33579396 PMCID: PMC7881687 DOI: 10.1186/s43058-021-00114-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People with HIV (PWH) experience increased cardiovascular disease (CVD) risk. Many PWH in the USA receive their primary medical care from infectious disease specialists in HIV clinics. HIV care teams may not be fully prepared to provide evidence-based CVD care. We sought to describe local context for HIV clinics participating in an NIH-funded implementation trial and to identify facilitators and barriers to integrated CVD preventive care for PWH. METHODS Data were collected in semi-structured interviews and focus groups with PWH and multidisciplinary healthcare providers at three academic medical centers. We used template analysis to identify barriers and facilitators of CVD preventive care in three HIV specialty clinics using the Theoretical Domains Framework (TDF). RESULTS Six focus groups were conducted with 37 PWH. Individual interviews were conducted with 34 healthcare providers and 14 PWH. Major themes were captured in seven TDF domains. Within those themes, we identified nine facilitators and 11 barriers to CVD preventive care. Knowledge gaps contributed to inaccurate CVD risk perceptions and ineffective self-management practices in PWH. Exclusive prioritization of HIV over CVD-related conditions was common in PWH and their providers. HIV care providers assumed inconsistent roles in CVD prevention, including for PWH with primary care providers. HIV providers were knowledgeable of HIV-related CVD risks and co-located health resources were consistently available to support PWH with limited resources in health behavior change. However, infrequent medical visits, perceptions of CVD prevention as a primary care service, and multiple co-location of support programs introduced local challenges to engaging in CVD preventive care. CONCLUSIONS Barriers to screening and treatment of cardiovascular conditions are common in HIV care settings and highlight a need for greater primary care integration. Improving long-term cardiovascular outcomes of PWH will likely require multi-level interventions supporting HIV providers to expand their scope of practice, addressing patient preferences for co-located CVD preventive care, changing clinic cultures that focus only on HIV to the exclusion of non-AIDS multimorbidity, and managing constraints associated with multiple services co-location. TRIAL REGISTRATION ClinicalTrials.gov , NCT03643705.
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Affiliation(s)
- Julie Schexnayder
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106-7343, USA
| | - Chris T Longenecker
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH, USA
| | | | | | | | | | - Jan E Hanson
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106-7343, USA
| | | | | | | | - Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, NY, USA
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106-7343, USA.
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50
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Verot E, Bouleftour W, Macron C, Rivoirard R, Chauvin F. Effect of PARACT (PARAmedical Interventions on Patient ACTivation) on the Cancer Care Pathway: Protocol for Implementation of the Patient Activation Measure-13 Item (PAM-13) Version. JMIR Res Protoc 2020; 9:e17485. [PMID: 33289495 PMCID: PMC7755534 DOI: 10.2196/17485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The increase in the number of cancer cases and the evolution of cancer care management have become a significant problem for the French health care system, thereby making patient empowerment as a long sought-after goal in chronic pathologies. The implementation of an activation measure via the Patient Activation Measure-13 item (PAM-13) in the course of cancer care can potentially highlight the patient's needs, with nursing care adapting accordingly. OBJECTIVE The objectives of this PARACT (PARAmedical Interventions on Patient ACTivation) multicentric study were as follows: (1) evaluate the implementation of PAM-13 in oncology nursing practices in 5 comprehensive cancer centers, (2) identify the obstacles and facilitators to the implementation of PAM-13, and (3) produce recommendations for the dissemination of such interventions in other comprehensive cancer centers. METHODS This study will follow the "Reach, Effectiveness, Adoption, Implementation, and Maintenance" framework and will consist of 3 stages. First, a robust preimplementation analysis will be conducted using the Theoretical Domains Framework (TDF) linked to the "Capability, Opportunity, Motivation, and Behavior" model to identify the obstacles and facilitators to implementing new nursing practices in each context. Then, using the Behavior Change Wheel, we will personalize a strategy for implementing the PAM-13, depending on the specificities of each context, to encourage acceptability by the nursing staff involved in the project. This analysis will be performed via a qualitative study through semistructured interviews. Second, the patient will be included in the study for 12 months, during which the patient care pathway will be studied, particularly to collect all relevant contacts of oncology nurses and other health professionals involved in the pathway. The axes of nursing care will also be collected. The primary goal is to implement PAM-13. Secondary factors to be measured are the patient's anxiety level, quality of life, and health literacy level. The oncology nurses will be responsible for completing the questionnaires when the patient is at the hospital for his/her intravenous chemotherapy/immunotherapy treatment. The questionnaires will be completed thrice in a year: (1) at the time of the patient's enrollment, (2) at 6 months, and (3) at 12 months. Third, a postimplementation analysis will be performed through semistructured interviews using the TDF to investigate the implementation problems at each site. RESULTS This study was supported by a grant from the French Ministry of Health (PHRIP PARACT 2016-0405) and the Lucien Neuwirth Institute of Cancerology of Saint-Etienne, France. Data collection for this study is ongoing. CONCLUSIONS This study would improve the implemented targeted nursing interventions in cancer centers so that a patient is offered a personalized cancer care pathway. Furthermore, measuring the level of activation and the implementation of measures intended to increase such activation could constitute a significant advantage in reducing social health inequalities. TRIAL REGISTRATION ClinicalTrials.gov NCT03240341; https://clinicaltrials.gov/ct2/show/NCT03240341. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17485.
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Affiliation(s)
- Elise Verot
- Centre Hygée, University of Saint-Etienne, University of Lyon, Saint-Priest-en-Jarez, France
| | - Wafa Bouleftour
- Medical Oncology Department, Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez, France
| | - Corinne Macron
- Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez, France
| | - Romain Rivoirard
- Medical Oncology Department, Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez, France
| | - Franck Chauvin
- Centre Hygée, University of Saint-Etienne, University of Lyon, Saint-Priest-en-Jarez, France
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