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Crocker TF, Lam N, Ensor J, Jordão M, Bajpai R, Bond M, Forster A, Riley RD, Andre D, Brundle C, Ellwood A, Green J, Hale M, Morgan J, Patetsini E, Prescott M, Ramiz R, Todd O, Walford R, Gladman J, Clegg A. Community-based complex interventions to sustain independence in older people, stratified by frailty: a systematic review and network meta-analysis. Health Technol Assess 2024; 28:1-194. [PMID: 39252602 PMCID: PMC11403382 DOI: 10.3310/hnrp2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Background Sustaining independence is important for older people, but there is insufficient guidance about which community health and care services to implement. Objectives To synthesise evidence of the effectiveness of community services to sustain independence for older people grouped according to their intervention components, and to examine if frailty moderates the effect. Review design Systematic review and network meta-analysis. Eligibility criteria Studies: Randomised controlled trials or cluster-randomised controlled trials. Participants: Older people (mean age 65+) living at home. Interventions: community-based complex interventions for sustaining independence. Comparators: usual care, placebo or another complex intervention. Main outcomes Living at home, instrumental activities of daily living, personal activities of daily living, care-home placement and service/economic outcomes at 1 year. Data sources We searched MEDLINE (1946-), Embase (1947-), CINAHL (1972-), PsycINFO (1806-), CENTRAL and trial registries from inception to August 2021, without restrictions, and scanned reference lists. Review methods Interventions were coded, summarised and grouped. Study populations were classified by frailty. A random-effects network meta-analysis was used. We assessed trial-result risk of bias (Cochrane RoB 2), network meta-analysis inconsistency and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation for network meta-analysis). Results We included 129 studies (74,946 participants). Nineteen intervention components, including 'multifactorial-action' (multidomain assessment and management/individualised care planning), were identified in 63 combinations. The following results were of low certainty unless otherwise stated. For living at home, compared to no intervention/placebo, evidence favoured: multifactorial-action and review with medication-review (odds ratio 1.22, 95% confidence interval 0.93 to 1.59; moderate certainty) multifactorial-action with medication-review (odds ratio 2.55, 95% confidence interval 0.61 to 10.60) cognitive training, medication-review, nutrition and exercise (odds ratio 1.93, 95% confidence interval 0.79 to 4.77) and activities of daily living training, nutrition and exercise (odds ratio 1.79, 95% confidence interval 0.67 to 4.76). Four intervention combinations may reduce living at home. For instrumental activities of daily living, evidence favoured multifactorial-action and review with medication-review (standardised mean difference 0.11, 95% confidence interval 0.00 to 0.21; moderate certainty). Two interventions may reduce instrumental activities of daily living. For personal activities of daily living, evidence favoured exercise, multifactorial-action and review with medication-review and self-management (standardised mean difference 0.16, 95% confidence interval -0.51 to 0.82). For homecare recipients, evidence favoured the addition of multifactorial-action and review with medication-review (standardised mean difference 0.60, 95% confidence interval 0.32 to 0.88). Care-home placement and service/economic findings were inconclusive. Limitations High risk of bias in most results and imprecise estimates meant that most evidence was low or very low certainty. Few studies contributed to each comparison, impeding evaluation of inconsistency and frailty. Studies were diverse; findings may not apply to all contexts. Conclusions Findings for the many intervention combinations evaluated were largely small and uncertain. However, the combinations most likely to sustain independence include multifactorial-action, medication-review and ongoing review of patients. Some combinations may reduce independence. Future work Further research is required to explore mechanisms of action and interaction with context. Different methods for evidence synthesis may illuminate further. Study registration This study is registered as PROSPERO CRD42019162195. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128862) and is published in full in Health Technology Assessment; Vol. 28, No. 48. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Thomas Frederick Crocker
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Natalie Lam
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Joie Ensor
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Magda Jordão
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ram Bajpai
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Matthew Bond
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Richard D Riley
- Centre for Prognosis Research, Keele School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Deirdre Andre
- Research Support Team, Leeds University Library, University of Leeds, Leeds, West Yorkshire, UK
| | - Caroline Brundle
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Alison Ellwood
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Green
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Matthew Hale
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jessica Morgan
- Geriatric Medicine, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Eleftheria Patetsini
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Matthew Prescott
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ridha Ramiz
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Oliver Todd
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rebecca Walford
- Geriatric Medicine, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Gladman
- Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Inflammation and Recovery Sciences, University of Nottingham and Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Arulselvan G, Chidambaram S, George N, Rizvana S, Narayan P, Annamalai P, Vadakaraiyan PHR, Rajagopal N, Dharmaraj RB, M T. Preventive Health Checkup: Utilization, Motivators, and Barriers Among the General Population in a Rural District in Tamil Nadu, India. Cureus 2024; 16:e52529. [PMID: 38371042 PMCID: PMC10874466 DOI: 10.7759/cureus.52529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The main goals of preventive health care include the early detection of disease by screening, identifying and reducing disease risk factors, and improving the current disease processes. Moreover, early disease discovery in the latent stage facilitates prompt intervention, reducing morbidity and death. OBJECTIVE To estimate the proportion of people who have availed preventive health check-ups in Perambalur and to determine the motivators and barriers to health check-ups among adults (age group: 18 years and above). MATERIALS AND METHODS We conducted a cross-sectional study among the general population from September 2021 to November 2021. A total of 436 participants were included in the study. A structured questionnaire was used to collect the socio-demographic characteristics and preventive health check-up details, along with the motivators and barriers. The data were entered in Microsoft Excel (Microsoft, Redmond, WA), and analysis was done using SPSS version 26 (IBM Corp., Armonk, NY). RESULT The mean ± SD of the age of the general population was 52.27 ± 21.09. Out of 436 participants, only 130 (29.82%) had undergone preventive health check-ups in the past. The subjects with young age (p = 0.006), those who obtained COVID-19 vaccination (p = 0.001), subjects with stable occupation (p = 0.002), and those with higher education (p < 0.001) (chi-square test) had preventive health check-ups. A significant association was found between motivators and barriers for age, gender, education, occupation, marital status, the presence of comorbidities, and vaccination status against COVID-19. CONCLUSION Preventive health check-up is still not up the ladder of health care for the general population. The health programmes should orient the public towards the concept of individual responsibility in health.
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Affiliation(s)
| | | | - Neethu George
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
| | - Shagirunisha Rizvana
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
| | - Pooja Narayan
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
| | - Pooja Annamalai
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
| | | | - Nirmala Rajagopal
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
| | - Rock B Dharmaraj
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
| | - Tamilarasan M
- Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
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Mendes C, Carvalho M, Oliveira L, Rodrigues LM, Gregório J. Nurse-led intervention for the management of bariatric surgery patients: A systematic review. Obes Rev 2023; 24:e13614. [PMID: 37607837 DOI: 10.1111/obr.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/16/2023] [Accepted: 06/24/2023] [Indexed: 08/24/2023]
Abstract
The prevalence of obesity has become a global health concern, and severe obesity is associated with various chronic diseases and decreased quality of life. Bariatric surgery has shown success in treating obesity. Nevertheless, some patients experience weight regain and unsatisfactory outcomes. Multidisciplinary interventions have been shown to improve postoperative outcomes. Case managers, often specialized nurses, play a crucial role in patient support and coordination of care. However, the diverse design of case-managing interventions hinders the assessment of their success. Thus, the aim of this review is to identify the most successful structural characteristics of case-managing interventions, with or without the support of e-Health, in the process of perioperative management of bariatric surgery patients. A systematic literature review was conducted following the PRISMA guidelines. PubMed, MEDLINE, EBSCOhost, and CINAHL databases were searched for relevant studies published in the last 10 years. Eligible studies included randomized controlled trials, controlled clinical studies, case studies, or observational studies that evaluated perioperative care in bariatric surgery. The PICO framework was used to frame the search strategy. The initial search yielded 225 articles, of which 10 studies met the inclusion criteria. Nurse-led case-managing interventions with a multidisciplinary approach showed positive results in weight loss, physical activity, and quality of life. Patient-centered care models were found to promote adherence to treatment and patient satisfaction. E-Health technologies improved quality of life but not weight loss. The duration of behavioral interventions and the long-term outcomes after surgery remained unclear. Nurse-led case-management interventions, with a focus on behavioral change and multidisciplinary approaches, show promise in improving outcomes in bariatric surgery patients. Patient-centered care models and longer term interventions may contribute to sustained weight loss and better postoperative outcomes. Further research is needed to determine the optimal duration of interventions and the long-term effects on weight maintenance.
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Affiliation(s)
- Cláudia Mendes
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal
- CRI.COM-Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
- Escuela de Doctorado, Programa de Ciencias de la Salud, Universidade de Alcalá, Madrid, Spain
| | - Manuel Carvalho
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal
- CRI.COM-Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
| | - Leandro Oliveira
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - Luís Monteiro Rodrigues
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - João Gregório
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
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Zhang J, Eggink E, Zhang X, Li X, Jiang B, Liu H, Ge S, Zhang W, Lyu J, Niu Y, Yu Y, Hou H, Xu X, Ye X, Wang W, Terlou R, Richard E, Wang W, Wang Y, Moll van Charante EP, Song M. Needs and views on healthy lifestyles for the prevention of dementia and the potential role for mobile health (mHealth) interventions in China: a qualitative study. BMJ Open 2022; 12:e061111. [PMID: 36414280 PMCID: PMC9684993 DOI: 10.1136/bmjopen-2022-061111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Over the coming decades, China is expected to face the largest worldwide increase in dementia incidence. Mobile health (mHealth) may improve the accessibility of dementia prevention strategies, targeting lifestyle-related risk factors. Our aim is to explore the needs and views of Chinese older adults regarding healthy lifestyles to prevent cardiovascular disease (CVD) and dementia through mHealth, supporting the Prevention of Dementia using Mobile Phone Applications (PRODEMOS) study. DESIGN Qualitative semi-structured interview study, using thematic analysis. SETTING Primary and secondary care in Beijing and Tai'an, China. PARTICIPANTS Older adults aged 55 and over without dementia with an increased dementia risk, possessing a smartphone. Participants were recruited through seven hospitals participating in the PRODEMOS study, purposively sampled on age, sex, living area and history of CVD and diabetes. RESULTS We performed 26 interviews with participants aged 55-86 years. Three main themes were identified: valuing a healthy lifestyle, sociocultural expectations and need for guidance. First, following a healthy lifestyle was generally deemed important. In addition to generic healthy behaviours, participants regarded certain specific Chinese lifestyle practices as important to prevent disease. Second, the sociocultural context played a crucial role, as an important motive to avoid disease was to limit the care burden put on family members. However, time-consuming family obligations and other social values could also impede healthy behaviours such as regular physical activity. Finally, there seemed to be a need for reliable and personalised lifestyle advice and for guidance from a health professional. CONCLUSIONS The Chinese older adults included in this study highly value a healthy lifestyle. They express a need for personalised lifestyle support in order to adopt healthy behaviours. Potentially, the PRODEMOS mHealth intervention can meet these needs through blended lifestyle support to improve risk factors for dementia and CVD. TRIAL REGISTRATION NUMBER ISRCTN15986016; Pre-results.
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Affiliation(s)
- Jinxia Zhang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Esmé Eggink
- Department of General Practice, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Xiaoyu Zhang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Xingming Li
- Department of Health Administration and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Bin Jiang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Hongmei Liu
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Siqi Ge
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Wei Zhang
- Centre for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital,Capital Medical University, Beijing, China
| | - Jihui Lyu
- Centre for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Yixuan Niu
- Department of Geriatrics, The Second Medical Centre & National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yueyi Yu
- Innovation Centre for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haifeng Hou
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Science, Tai'an, Shandong, China
| | - Xizhu Xu
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Science, Tai'an, Shandong, China
| | - Xiaoyan Ye
- Comvee Research Institute, Fuzhou Comvee Network & Technology Co., Ltd, Fuzhou, China
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | | | - Edo Richard
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Radboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Science, Tai'an, Shandong, China
- Centre for Precision Health, Edith Cowan University, Perth, Western Australia, Australia
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Perth, Western Australia, Australia
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Manshu Song
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
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Lavoie A, Dubé V. Web-Based Interventions to Promote Healthy Lifestyles for Older Adults: Scoping Review. Interact J Med Res 2022; 11:e37315. [PMID: 35998024 PMCID: PMC9449830 DOI: 10.2196/37315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/14/2022] [Accepted: 08/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background With the aging of the population and rising rates of chronic diseases, web-based interventions could be considered to support older adults in adopting healthy lifestyles. To date, published knowledge syntheses have focused on quantitative studies among older adults aged ≥50 years. However, those aged ≥65 years may have different needs to be met by these interventions because of the biological and physiological changes associated with aging, and qualitative studies could help advance knowledge in this field. Objective The objective of this scoping review is to explore the extent of the literature on web-based interventions aimed at promoting healthy lifestyles among people aged ≥65 years. Methods A scoping review was conducted based on the framework proposed by Levac et al. Six databases (ie, MEDLINE, CINAHL, PsycINFO, Web of Science, the Cochrane Database of Systematic Reviews, and the Joanna Briggs Library) and gray literature (ie, Google Scholar and OpenGrey) were searched. The final search was conducted on June 23, 2021. The studies were selected by 2 persons (AL and ML) independently. The included studies were systematic reviews and qualitative and quantitative studies focusing on web-based interventions to promote healthy lifestyles in people aged ≥65 years that were published in French or English between 1990 and 2021. Data were extracted in a table and synthesized based on the conceptualization of web-based interventions (ie, according to the use parameters, behavior change techniques, delivery modes, and theories). A thematic analysis was performed. Results In total, 20 articles were included in this review, which represents studies focused on 11 distinct interventions. All of the interventions (11/11, 100%) aimed to promote physical activity among older adults. The number of intervention sessions varied from 5 to 16, with a frequency from daily to once every 2 weeks. Diverse delivery modes such as electronic diary, video, and phone call were found. The most used behavior change techniques were instruction, feedback, and self-monitoring. Few interventions (6/11, 55%) were based on a theory. A favorable trend was observed in increasing physical activity, and 5 themes emerged that appeared to be central to behavior change among older adults: motivation, support, tailoring, barriers, and perceptions. Conclusions This scoping review provides a better understanding of the components of web-based interventions and their outcomes on the healthy lifestyles of people aged ≥65 years. These findings could provide important guidance for the design and development of future web-based interventions in this field. Further research is needed to continue the development and evaluation of innovative and accessible interventions to promote healthy lifestyles among older adults. International Registered Report Identifier (IRRID) RR2-10.2196/23207
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Affiliation(s)
- Audrey Lavoie
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Université de Montréal Marguerite-d'Youville Research Chair on Humanistic Nursing Interventions, Montreal, QC, Canada.,Research center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Véronique Dubé
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Université de Montréal Marguerite-d'Youville Research Chair on Humanistic Nursing Interventions, Montreal, QC, Canada.,Research center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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Patient-Centered Care for Patients with Cardiometabolic Diseases: An Integrative Review. J Pers Med 2021; 11:jpm11121289. [PMID: 34945763 PMCID: PMC8703261 DOI: 10.3390/jpm11121289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/28/2021] [Accepted: 11/19/2021] [Indexed: 12/31/2022] Open
Abstract
Patient-centered care is essential in high-quality health care, as it leads to beneficial outcomes for patients. The objective of this review is to systematize indicators for the care of patients with cardiometabolic diseases based on patient-centered care, extending from the stages of diagnostic evaluation and care planning to intervention. An integrative literature review was conducted by searching seven scientific databases, and a narrative analysis was performed. A total of 15 articles were included, and indicators related to diagnosis and care planning/intervention were extracted. In the planning of care centered on the person with cardiometabolic diseases, the individuality, dynamics of the processes, flexibility and the participation of all stakeholders should be taken into account. The needs of the person must be addressed through the identification of problems; establishment of individual goals; shared decision making; information and education; systematic feedback; case management; meeting the patient’s preferences and satisfaction with care; engagement of the family; and therapeutic management. The indicators for intervention planning extracted were behavioral interventions, therapeutic management programs, lifestyle promotion, shared decision making, education patient and information, interventions with the use of technology, promotion of self-management, program using technology, therapeutic relationship, therapeutic adherence programs and specialized intervention.
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Curran E, Chong TWH, Godbee K, Abraham C, Lautenschlager NT, Palmer VJ. General population perspectives of dementia risk reduction and the implications for intervention: A systematic review and thematic synthesis of qualitative evidence. PLoS One 2021; 16:e0257540. [PMID: 34534250 PMCID: PMC8448319 DOI: 10.1371/journal.pone.0257540] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/06/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Evidence for the potential prevention of dementia through lifestyle risk factor modification is growing and has prompted examination of implementation approaches. Understanding the general population's perspectives regarding dementia risk reduction is key to implementation. This may provide useful insights into more effective and efficient ways to help people change relevant beliefs, motivations and behaviour patterns. We conducted a systematic review and thematic synthesis of qualitative evidence to develop an integrated model of general population dementia risk reduction perspectives and the implications for intervention in research and implementation contexts. METHODS AND FINDINGS We searched electronic databases, supplemented by lateral search techniques, to identify studies published since 1995 reporting qualitative dementia risk reduction perspectives of the non-expert general population who do not have dementia. Thematic synthesis, incorporating an expert panel discussion, was used to identify overarching themes and develop an integrated model to guide intervention to support individuals to adopt and maintain dementia risk reduction behaviour patterns. Quality of included studies and confidence in review findings were systematically appraised. We included 50 papers, reflecting the views of more than 4,500 individuals. Main themes were: 1) The need for effective education about a complex topic to prevent confusion and facilitate understanding and empowerment; 2) Personally relevant short- and long-term benefits of dementia risk reduction behaviour patterns can generate value and facilitate action; 3) Individuals benefit from trusted, reliable and sensitive support to convert understanding to personal commitment to relevant behaviour change; 4) Choice, control and relevant self-regulatory supports help individuals take-action and direct their own progress; 5) Collaborative and empowering social opportunities can facilitate and propagate dementia risk reduction behaviour change; 6) Individual behaviour patterns occur in social contexts that influence beliefs through heuristic processes and need to be understood. Findings indicate that, for intervention: 1) education is key, but both content and delivery need to be tailored; 2) complementary interventions to support self-regulation mechanisms and social processes will increase education effectiveness; 3) co-design principles should guide intervention design and delivery processes; 4) all interventions need to be supported by context-specific data. CONCLUSIONS This systematic review and thematic synthesis provides a comprehensive, integrated model of the dementia risk reduction perspectives of the general population and intervention approaches to support behaviour change that can be applied in clinical trial and real-world implementation settings. Findings extend existing knowledge and may assist more effective intervention design and delivery.
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Affiliation(s)
- Eleanor Curran
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- St Vincent’s Hospital Melbourne, Kew, Victoria, Australia
| | - Terence W. H. Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- St Vincent’s Hospital Melbourne, Kew, Victoria, Australia
| | - Kali Godbee
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Charles Abraham
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Nicola T. Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Victoria J. Palmer
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- The Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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Munshi MN, Meneilly GS, Rodríguez-Mañas L, Close KL, Conlin PR, Cukierman-Yaffe T, Forbes A, Ganda OP, Kahn CR, Huang E, Laffel LM, Lee CG, Lee S, Nathan DM, Pandya N, Pratley R, Gabbay R, Sinclair AJ. Diabetes in ageing: pathways for developing the evidence base for clinical guidance. Lancet Diabetes Endocrinol 2020; 8:855-867. [PMID: 32946822 PMCID: PMC8223534 DOI: 10.1016/s2213-8587(20)30230-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
Older adults with diabetes are heterogeneous in their medical, functional, and cognitive status, and require careful individualisation of their treatment regimens. However, in the absence of detailed information from clinical trials involving older people with varying characteristics, there is little evidence-based guidance, which is a notable limitation of current approaches to care. It is important to recognise that older people with diabetes might vary in their profiles according to age category, functional health, presence of frailty, and comorbidity profiles. In addition, all older adults with diabetes require an individualised approach to care, ranging from robust individuals to those residing in care homes with a short life expectancy, those requiring palliative care, or those requiring end-of-life management. In this Review, our multidisciplinary team of experts describes the current evidence in several important areas in geriatric diabetes, and outlines key research gaps and research questions in each of these areas with the aim to develop evidence-based recommendations to improve the outcomes of interest in older adults.
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Affiliation(s)
- Medha N Munshi
- Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | | | | | - Kelly L Close
- The diaTribe Foundation San Francisco, CA, USA; Close Concerns, San Francisco, CA, USA
| | - Paul R Conlin
- Harvard Medical School, Boston, MA, USA; Veteran Affairs Boston Healthcare System, Boston, MA, USA
| | - Tali Cukierman-Yaffe
- Division of Endocrinology, Diabetes and Metabolism, Gertner Institute, Ramat Gan, Israel; Sheba Medical Centre, Ramat Gan, Israel; Epidemiology Department, Sackler School of Medicine, Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | | | - Om P Ganda
- Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA
| | - C Ronald Kahn
- Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA
| | - Elbert Huang
- Center for Chronic Disease Research and Policy, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Lori M Laffel
- Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA
| | - Christine G Lee
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sei Lee
- University of California San Francisco, San Francisco, CA, USA; Geriatrics and Extended Care, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - David M Nathan
- Harvard Medical School, Boston, MA, USA; Diabetes Research Center and Clinical Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Naushira Pandya
- Department of Geriatrics, Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Aventura Hospital, Aventura, FL, USA
| | - Richard Pratley
- AdventHealth, AdventHealth Diabetes Institute, AdventHealth Translational Research Institute, Orlando, FL, USA
| | - Robert Gabbay
- Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA
| | - Alan J Sinclair
- King's College London, London, UK; Diabetes Frail, London, UK
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9
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Akenine U, Barbera M, Beishuizen CR, Fallah Pour M, Guillemont J, Rosenberg A, Coley N, Mangialasche F, Salo L, Savy S, Pols AJ, Andrieu S, Richard E, Soininen H, Moll van Charante E, Kivipelto M. Attitudes of at-risk older adults about prevention of cardiovascular disease and dementia using eHealth: a qualitative study in a European context. BMJ Open 2020; 10:e037050. [PMID: 32764085 PMCID: PMC7412614 DOI: 10.1136/bmjopen-2020-037050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/27/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Prevention of cardiovascular disease (CVD) and dementia is a key health priority among older adults. Understanding individuals' attitudes to, the prevention of these conditions, particularly when delivered through novel eHealth tools, could help in designing effective prevention programmes. The aim of the study was to explore the attitudes of older adults at increased risk of CVD and dementia regarding engagement in eHealth self-management prevention programmes, and to describe the facilitators and barriers. DESIGN A qualitative research approach was used. Data were collected through eight focus groups in Finland, France and the Netherlands. Data were analysed following the principles of grounded theory. SETTING AND PARTICIPANTS Forty-four community-dwellers aged 65+ at risk of CVD were recruited from a previous trial cohort in Finland, and through general practices in France and the Netherlands. RESULTS The study identified three categories: access to reliable information, trust in the healthcare providers and burden and stigma of dementia. A core category was also identified: the interactive process of the three categories influencing engagement in self-management prevention programme. The categories were interconnected through an interactive process and influenced by the local healthcare culture and context which shaped them differently, becoming either facilitators or barriers to engage in eHealth self-management prevention programmes. CONCLUSIONS The study emphasises the importance of considering the interactions between the identified categories in this study, grounded in the local healthcare culture and context in further developments of eHealth self-management interventions that aim to prevent CVD and dementia. TRIAL REGISTRATION NUMBER ISRCTN48151589.
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Affiliation(s)
- Ulrika Akenine
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mariagnese Barbera
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Cathrien Rl Beishuizen
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Mandana Fallah Pour
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Anna Rosenberg
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Nicola Coley
- INSERM, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lotta Salo
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | | | - A Jeannette Pols
- Section of Medical Ethics, Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Sandrine Andrieu
- INSERM, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Edo Richard
- Department of Neurology, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
- Neurocenter Finland, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Eric Moll van Charante
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
- R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, United Kingdom
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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10
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Sr PAA, DeFeis B, De Wit L, O'Shea D, Mejia A, Chandler M, Locke DEC, Fields J, Phatak V, Dean PM, Crook J, Smith G. Functional ability is associated with higher adherence to behavioral interventions in mild cognitive impairment. Clin Neuropsychol 2019; 34:937-955. [PMID: 31608773 DOI: 10.1080/13854046.2019.1672792] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Behavioral interventions during early memory decline hold promise in delaying the development of dementia. In the present study, participants in a multimodal behavioral intervention study were assessed for post-intervention adherence and predictors of adherence.Methods: Participants (N = 272, mean age = 75.04 ± 7.54) diagnosed with amnestic Mild Cognitive Impairment (aMCI) were assigned to intervention groups receiving four out of five behavioral intervention components, including yoga, memory compensation training, computerized cognitive training, support groups, and/or wellness education. Length of the intervention was 10 days, 4 h per day, with post-intervention follow-up at 6, 12, and 18 months.Results: Two-hundred and thirty-seven participants completed the 6-month post-intervention follow-up measures, 228 participants completed the 12-month measures, and 218 participants completed the 18-month measures. Participants fully adhered to a mean of 2 out of the 4 taught intervention components. Eighty-nine percent of participants were at least partially adherent to one or more taught intervention components at 6-, 12-, and 18-month post-intervention follow-up. Physical activity was the most adhered to intervention while group support was the least adhered to intervention across all three follow-up time-points. Higher educational level, higher baseline depressive symptoms, higher baseline global cognitive functioning, and better baseline and concurrent functional abilities were associated post-intervention adherence.Conclusion: Changes in functional abilities are associated with disease progression among persons with aMCI. In the present study, individuals with aMCI who have higher education, higher depressive symptoms, and better baseline functioning abilities are more likely to adhere to behavioral intervention components over time. Post-intervention adherence also associates with concurrent daily function.
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Affiliation(s)
- Priscilla A Amofa Sr
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Brittany DeFeis
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Liselotte De Wit
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Deirdre O'Shea
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Andrea Mejia
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Melanie Chandler
- Department of Psychiatry and Psychology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Dona E C Locke
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Julie Fields
- Department of Psychiatry and Psychology, Mayo Clinic Minnesota, Rochester, MN, USA
| | - Vaishali Phatak
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Pamela M Dean
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Julia Crook
- Division of Biomedical Statistics and Informatics, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Glenn Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.,Department of Psychiatry and Psychology, Mayo Clinic Minnesota, Rochester, MN, USA
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11
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Beishuizen CR, Akenine U, Barbera M, Rosenberg A, Fallah Pour M, Richard E, Soininen H, Mangialasche F, Kivipelto M, Pols AJ, Moll van Charante E. Integrating nurses' experiences with supporting behaviour change for cardiovascular prevention into a self-management internet platform in Finland and the Netherlands: a qualitative study. BMJ Open 2019; 9:e023480. [PMID: 31175194 PMCID: PMC6577411 DOI: 10.1136/bmjopen-2018-023480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 03/13/2019] [Accepted: 03/28/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Global ageing is linked to an increased burden of cardiovascular disease and dementia, which calls for better prevention strategies. Self-management and eHealth applications are regarded as promising strategies to support prevention. The aim of this study was to explore nurses' best practices concerning behaviour change guidance for cardiovascular (CV) prevention in order to learn how to optimally integrate them into a coach-supported internet platform for CV self-management. DESIGN Qualitative focus group study in Finland and the Netherlands. Discussions were audiotaped and transcribed. Data were thematically analysed following principles of grounded theory. SETTING Dutch and Finnish primary care settings. PARTICIPANTS Six Finnish and seven Dutch primary care nurses with experience in CV prevention. RESULTS Similar best practices were found in both countries and comprised of (1) establishing a relationship of trust, (2) managing awareness and expectations and (3) appropriate timing and monitoring of the process of behaviour change. However, the Finnish and Dutch nurses used different approaches for accomplishment of these practices, which was reflected in their recommendations for online support. Both groups emphasised that online support should be combined with human support and integrated into regular care. Finnish nurses had more confidence in patient self-management and remote communication than Dutch nurses, who emphasised the importance of face-to-face contact and preferred to keep control of medical aspects of prevention. CONCLUSIONS Differences in Dutch and Finnish's nurses' practices for supporting CV prevention appear to reflect their local healthcare practices, which should be taken into account when designing internet platforms for health self-management. Including cognitive health as a goal of CV prevention might stimulate motivation for health behaviour change. TRIAL REGISTRATION NUMBER ISRCTN48151589; Pre-results.
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Affiliation(s)
- Cathrien Rl Beishuizen
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Ulrika Akenine
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mariagnese Barbera
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
| | - Anna Rosenberg
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
| | - Mandana Fallah Pour
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Edo Richard
- Department of Neurology, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilkka Soininen
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
| | | | - Miia Kivipelto
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
- Division of Geriatric Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - A Jeannette Pols
- Department of General Practice, Section of Medical Ethics, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Moll van Charante
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
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12
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Older Adults' Reasons for Participating in an eHealth Prevention Trial: A Cross-Country, Mixed-Methods Comparison. J Am Med Dir Assoc 2018; 20:843-849.e5. [PMID: 30541689 DOI: 10.1016/j.jamda.2018.10.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To explore older adults' reasons for participating in a multinational eHealth prevention trial, and compare motivations between countries. DESIGN Cross-sectional mixed methods research using quantitative and qualitative approaches (the ACCEPT-HATICE study). SETTING AND PARTICIPANTS Substudy conducted during the recruitment phase of an 18-month RCT testing the efficacy of an eHealth intervention for self-management of risk factors for cardiovascular disease (CVD) and cognitive decline in older adults in Finland, France, and the Netherlands. Participants were 343 dementia-free community dwellers aged 65+ with basic computer literacy and either ≥2 cardiovascular risk factors or a history of CVD/diabetes. MEASURES Online questionnaire (quantitative data) and semistructured interviews (qualitative data). RESULTS Contributing to scientific progress, wanting to improve one's lifestyle, and benefiting from additional medical monitoring were the predominant reasons for participating. Altruistic reasons were particularly relevant among the French, whereas Finnish and Dutch participants mainly emphasized the benefits of lifestyle changes and regular medical checkups. During interviews, preventing functional dependency emerged as a key underlying motivation. Although some trial design features influenced the decision to participate, the use of an eHealth intervention was not an important motivator in this population. CONCLUSIONS/IMPLICATIONS Altruism and personal benefits motivated older adults to participate in the trial; emphasizing such aspects could facilitate recruitment in future RCTs. Additional medical monitoring may be particularly appealing when access to public health care is considered limited. Furthermore, maintaining autonomy and preventing functional dependency emerged as a key concern in this population of young older adults.
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13
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de Waard AKM, Wändell PE, Holzmann MJ, Korevaar JC, Hollander M, Gornitzki C, de Wit NJ, Schellevis FG, Lionis C, Søndergaard J, Seifert B, Carlsson AC. Barriers and facilitators to participation in a health check for cardiometabolic diseases in primary care: A systematic review. Eur J Prev Cardiol 2018; 25:1326-1340. [PMID: 29916723 PMCID: PMC6097107 DOI: 10.1177/2047487318780751] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Health checks for cardiometabolic diseases could play a role in the identification of persons at high risk for disease. To improve the uptake of these health checks in primary care, we need to know what barriers and facilitators determine participation. Methods We used an iterative search strategy consisting of three steps: (a) identification of key-articles; (b) systematic literature search in PubMed, Medline and Embase based on keywords; (c) screening of titles and abstracts and subsequently full-text screening. We summarised the results into four categories: characteristics, attitudes, practical reasons and healthcare provider-related factors. Results Thirty-nine studies were included. Attitudes such as wanting to know of cardiometabolic disease risk, feeling responsible for, and concerns about one’s own health were facilitators for participation. Younger age, smoking, low education and attitudes such as not wanting to be, or being, worried about the outcome, low perceived severity or susceptibility, and negative attitude towards health checks or prevention in general were barriers. Furthermore, practical issues such as information and the ease of access to appointments could influence participation. Conclusion Barriers and facilitators to participation in health checks for cardiometabolic diseases were heterogeneous. Hence, it is not possible to develop a ‘one size fits all’ approach to maximise the uptake. For optimal implementation we suggest a multifactorial approach adapted to the national context with special attention to people who might be more difficult to reach. Increasing the uptake of health checks could contribute to identifying the people at risk to be able to start preventive interventions.
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Affiliation(s)
- Anne-Karien M de Waard
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | - Per E Wändell
- 2 Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden
| | - Martin J Holzmann
- 3 Functional Area of Emergency Medicine, Karolinska University Hospital, Sweden.,4 Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joke C Korevaar
- 5 NIVEL (Netherlands Institute for Health Services Research), the Netherlands
| | - Monika Hollander
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | | | - Niek J de Wit
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | - François G Schellevis
- 5 NIVEL (Netherlands Institute for Health Services Research), the Netherlands.,7 Department of General Practice and Elderly Care Medicine, VU University Medical Center, the Netherlands
| | - Christos Lionis
- 8 Clinic of Social and Family Medicine, University of Crete, Greece
| | - Jens Søndergaard
- 9 Research Unit for General Practice, University of Southern Denmark, Denmark
| | - Bohumil Seifert
- 10 Department of General Practice, Charles University, Czech Republic
| | - Axel C Carlsson
- 2 Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden.,11 Department of Medical Sciences, Uppsala University, Sweden
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14
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Lobchuk M, Hoplock L, Halas G, West C, Dika C, Schroeder W, Ashcroft T, Clouston KC, Lemoine J. Heart health whispering: A randomized, controlled pilot study to promote nursing student perspective-taking on carers' health risk behaviors. BMC Nurs 2018; 17:21. [PMID: 29849504 PMCID: PMC5968556 DOI: 10.1186/s12912-018-0291-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lifestyle counseling is described as a "major breakthrough" in the control of chronic diseases. Counseling can be challenging to nurses due their lack of motivation to counsel, hesitancy to appear non-judgmental, lack of empathy, and lack of time. Nurses voice their need for more training in counseling communication skills. Our main objective was to engage in ongoing development and testing of a promising Heart Health Whispering perspective-taking intervention on nursing students' clinical empathy, perceptual understanding, and client readiness to alter health risk behaviors. METHODS In this randomized controlled pilot study, the full intervention (perspective-taking instructions, practice, and video-feedback) and partial intervention (video-feedback only) comprised 24 and 18 nursing students, respectively. Quantitative data were collected with a 10-item pre- and post-intervention clinical empathy tool, a one-item 'readiness to change' health risk behavior tool plus similarity ratings on students' empathic accuracy were calculated. Data were analyzed using Independent Samples t Tests and mixed model ANCOVA models. Students' and actors' evaluative responses toward the intervention phases were collected by handwritten notes, and analyzed using content analysis and constant comparison techniques. RESULTS The main finding was that students in the full intervention group reported greater clinical empathy in the post versus baseline condition. Students underestimated their clinical empathy in comparison to carers' reports in the post-condition. In both intervention groups, carers reported more readiness to change in the post-condition. Carers identified favorable and unfavorable perceptions and outcomes of approaches taken by students. Students desired immediate and direct feedback after the video-dialogue and -tagging exercise. CONCLUSIONS Heart Health Whispering is a promising intervention to help educators in basic and continuing education to bolster nurse confidence in empathic conversations on health risk behaviors. This intervention incorporates commonly used strategies to teach empathic communication along with a novel video-analysis application of a perspective-taking task. Student and carer actor comments highlighted the value in opportunities for students to engage in self-evaluation and practicing the empathic process of taking the client's perspective on health risk behaviors.
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Affiliation(s)
- Michelle Lobchuk
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Lisa Hoplock
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Gayle Halas
- Max Rady Faculty of Health Sciences, College of Medicine, University of Manitoba, P228-770, Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Christina West
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Cheryl Dika
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Wilma Schroeder
- Red River College, Nursing, 2055 Notre Dame Avenue, Winnipeg, MB R3H 0J9 Canada
| | - Terri Ashcroft
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Kathleen Chambers Clouston
- Department of Surgery, Section of General Surgery, University of Manitoba, 770 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Jocelyne Lemoine
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Room 315 – 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
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15
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van Middelaar T, Beishuizen CRL, Guillemont J, Barbera M, Richard E, Moll van Charante EP. Engaging older people in an internet platform for cardiovascular risk self-management: a qualitative study among Dutch HATICE participants. BMJ Open 2018; 8:e019683. [PMID: 29358447 PMCID: PMC5781010 DOI: 10.1136/bmjopen-2017-019683] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To study older peoples' experiences with an interactive internet platform for cardiovascular self-management, to assess which factors influence initial and sustained engagement. To assess their views on future use within primary care. DESIGN Qualitative semistructured interview study, with thematic analysis. SETTING Primary care in the Netherlands. PARTICIPANTS People ≥65 years with an increased risk of cardiovascular disease who used the 'Healthy Ageing Through Internet Counselling in the Elderly' internet platform with remote support of a coach. Participants were selected using a purposive sampling method based on gender, age, level of education, cardiovascular history, diabetes, duration of participation and login frequency. RESULTS We performed 17 interviews with 20 participants, including three couples. In the initial phase, platform engagement was influenced by perceived computer literacy of the participants, user-friendliness, acceptability and appropriateness of the intervention and the initial interaction with the coach. Sustained platform use was mainly facilitated by a relationship of trust with the coach. Other facilitating factors were regular automatic and personal reminders, clear expectations of the platform, incorporation into daily routine, social support and a loyal and persistent attitude. Perceived lack of change in content of the platform could work both stimulating and discouraging. Participants supported the idea of embedding the platform into the primary care setting. CONCLUSIONS Human support is crucial to initial and sustained engagement of older people in using an interactive internet platform for cardiovascular self-management. Regular reminders further facilitate sustained use, and increased tailoring to personal preference is recommended. Embedding the platform in primary healthcare may enhance future adoption. TRIAL REGISTRATION NUMBER ISRCTN48151589; Pre-results.
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Affiliation(s)
- Tessa van Middelaar
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Mariagnese Barbera
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Edo Richard
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands
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16
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Lionis C, Midlöv P. Prevention in the elderly: A necessary priority for general practitioners. Eur J Gen Pract 2017; 23:202-207. [PMID: 28762840 PMCID: PMC5806089 DOI: 10.1080/13814788.2017.1350646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 11/17/2022] Open
Abstract
Prevention is viewed as a key issue for general practice, yet there is a lack of evidence regarding general practitioners' interventions in both middle-aged and elderly people. This is despite the fact that recommendations and key indicators for monitoring the use of clinical preventive strategies aimed at these groups are available and that both the World Health Organization and European Commission endorse the importance of interventions for healthy and active ageing. This paper draws on two keynote presentations given at the 2015 autumn meeting of the European General Practice Research Network (EGPRN) in Edirne, Turkey (17-20 October 2015). According to the EU2020 strategy, general practitioners should design and implement prevention services and programmes to promote healthy and active ageing. Their primary focus should be on interventions on multimorbid patients, either by improving prescribing and adherence to medical plans or by targeting to fall and frailty prevention and vaccination uptake.
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Affiliation(s)
- Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of CreteCreteGreece
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University HospitalMalmöSweden
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17
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Beishuizen CRL, Coley N, Moll van Charante EP, van Gool WA, Richard E, Andrieu S. Determinants of Dropout and Nonadherence in a Dementia Prevention Randomized Controlled Trial: The Prevention of Dementia by Intensive Vascular Care Trial. J Am Geriatr Soc 2017; 65:1505-1513. [PMID: 28263374 DOI: 10.1111/jgs.14834] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore and compare sociodemographic, clinical, and neuropsychiatric determinants of dropout and nonadherence in older people participating in an open-label cluster-randomized controlled trial-the Prevention of Dementia by Intensive Vascular care (preDIVA) trial-over 6 years. DESIGN Secondary analysis. SETTING One hundred sixteen general practices in the Netherlands. PARTICIPANTS Community-dwelling individuals aged 70 to 78 (N = 2,994). INTERVENTION Nurse-led multidomain intervention targeting cardiovascular risk factors to prevent dementia. MEASUREMENTS The associations between participant baseline sociodemographic (age, sex, education), clinical (medical history, disability, cardiovascular risk), neuropsychiatric (depressive symptoms (Geriatric Depression Scale-15), and cognitive (Mini-Mental State Examination)) characteristics and dropout from the trial and nonadherence to the trial intervention were explored using multilevel logistic regression models. RESULTS Older age, poorer cognitive function, more symptoms of depression, and greater disability were the most important determinants of dropout of older people. The presence of cardiovascular risk factors was not associated with dropout but was associated with nonadherence. Being overweight was a risk factor for nonadherence, whereas people with high blood pressure or a low level of physical exercise adhered better to the intervention. The association between poorer cognitive function and symptoms of depression and dropout was stronger in the control group than in the intervention group, and vice versa for increased disability. CONCLUSION In a large dementia prevention trial with 6-year follow-up, dropout was associated with older age, poorer cognitive function, symptoms of depression, and disability at baseline. These findings can help to guide the design of future dementia prevention trials in older adults. The associations found between cardiovascular risk factors and nonadherence need to be confirmed in other older populations receiving cardiovascular prevention interventions.
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Affiliation(s)
- Cathrien R L Beishuizen
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicola Coley
- Department of Epidemiology and Public Health, UMR1027, Université de Toulouse, Université Paul Sabatier, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Eric P Moll van Charante
- Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem A van Gool
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Edo Richard
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Donders Centre for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Sandrine Andrieu
- Department of Epidemiology and Public Health, UMR1027, Université de Toulouse, Université Paul Sabatier, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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GPs' perspectives on secondary cardiovascular prevention in older age: a focus group study in the Netherlands. Br J Gen Pract 2016; 65:e739-47. [PMID: 26500321 DOI: 10.3399/bjgp15x687373] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Although guidelines recommend secondary cardiovascular prevention irrespective of age, in older age the uptake of treatment is lower than in younger age groups. AIM To explore the dilemmas GPs in the Netherlands encounter when implementing guidelines for secondary cardiovascular prevention in older age. DESIGN AND SETTING Qualitative study in four focus groups consisting of GPs (n = 23, from the northern part of the province South Holland) and a fifth focus group consisting of GP trainees (n = 4, from the Leiden University Medical Center). METHOD Focus group discussions were organised to elicit perspectives on the implementation of secondary cardiovascular prevention for older people. The 14 theoretical domains of the refined Theoretical Domains Framework (TDF) were used for (deductive) coding of the focus group discussions. The coded texts were analysed, content was discussed, and barriers and facilitators were identified for each domain of the TDF. RESULTS The main theme that emerged was 'uncertainty'. Identified barriers were guideline-related, patient-related, and organisation-related. Identified facilitators were doctor-related, patient-related, and organisation-related. The main aim of secondary preventive treatment was improvement in quality of life. CONCLUSION GPs in the Netherlands are uncertain about many aspects of secondary cardiovascular prevention in older age; the guidelines themselves, their own role, patient factors, and the organisation of care. In view of this uncertainty, GPs consciously weigh all aspects of the situation in close dialogue with the individual patient, with the ultimate aim of improving quality of life. This highly-individualised care may largely explain the reduced prescription rates.
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