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Lee H, Mtengezo JT, Makin MS, Shi L, Malata A, Fitzpatrick J, Ngoma J, Zhang L, Larkey L, Stuart-Shor E, Mlombe Y, Kim D. Mobile health-delivered narrative intervention to increase cervical cancer screening among Malawian women living with HIV: A pilot randomized controlled trial. Asia Pac J Oncol Nurs 2024; 11:100448. [PMID: 38784066 PMCID: PMC11111816 DOI: 10.1016/j.apjon.2024.100448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/18/2024] [Indexed: 05/25/2024] Open
Abstract
Objective This study aimed to develop and evaluate a mobile health (mHealth)-delivered, theory-guided, culturally tailored storytelling narrative (STN) intervention to increase cervical cancer screening among Malawian women living with human immunodeficiency virus (HIV). Methods This study involved two phases: Phase 1: development of a theory-guided and culturally adapted STN intervention and Phase 2: a pilot randomized controlled trial was conducted. Participants were randomly assigned to one of three arms: Arm 1: tablet-based video (mHealth) with STN (n = 60); Arm 2: mHealth with a video of nonnarrative educational materials (n = 59); and Arm 3: control group with only reading nonnarrative educational materials in person (n = 60). Cervical cancer screening was measured using visual inspection with acetic acid (VIA) uptakes by self-report and health passport record review at 2 and 6 months after intervention. Results Both arms 1 and 2 had nearly twice the rate of VIA uptakes than those in Arm 3 (51.0% and 50.0%, respectively, vs. 35.0%, P = 0.01) at 2 months follow-up, but there were no differences among groups from 2- to 6-month follow-ups. All groups demonstrated significant improvement of knowledge about risk factors, intention, and VIA uptakes. Conclusions The findings demonstrate the preliminary effectiveness of the intervention on cervical cancer screening behavior and the feasibility of the study regarding recruitment, retention, treatment fidelity, and acceptability of the single 30-min session. The feasibility and the preliminary results of the effectiveness of the proposed study indicate scaling up the STN intervention to a larger population of women to increase cervical cancer screening uptake to prevent deaths due to cervical cancer in Malawi.
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Affiliation(s)
- Haeok Lee
- Rory Meyers College of Nursing, New York University, New York City, NY, USA
| | | | | | - Ling Shi
- Manning Colleges of Nursing and Health Sciences, University of Massachusetts Boston, Boston, USA
| | - Address Malata
- Malawi University of Science and Technology, Thylolo, Malawi
| | | | | | - Lingling Zhang
- Manning Colleges of Nursing and Health Sciences, University of Massachusetts Boston, Boston, USA
| | - Linda Larkey
- College of Nursing and Health Innovation, Arizona State University, Phoenix, USA
| | - Eileen Stuart-Shor
- Manning Colleges of Nursing and Health Sciences, University of Massachusetts Boston, Boston, USA
| | - Yohannie Mlombe
- Hematology Unit, Pathology Department, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Deogwoon Kim
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, USA
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Alimoradi Z, Rajabalipour S, Rahmani K, Pakpour AH. The effect of a social network-based cognitive behavioral therapy intervention on the severity of premenstrual syndrome symptoms: a protocol of a randomized clinical trial study. Trials 2022; 23:346. [PMID: 35461297 PMCID: PMC9034079 DOI: 10.1186/s13063-022-06290-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Premenstrual syndrome (PMS) is one of the most widespread menstrual disorders in women of reproductive age. This recurrent syndrome is a combination of physically, mentally, or behaviorally disturbing changes occurring during the secretory phase of the menstrual cycle. The aim of this study is to determine the effect of a cognitive-behavioral therapy-based educational intervention using social networks on PMS in female health center employees in Rudbar, Iran. Methods/design A randomized superiority controlled trial will be conducted involving 140 female employees of health centers affiliated with the Guilan University of Medical Sciences, Rudbar. The study involves a block size of 4 and 6 in a randomly varied order, 140 women who meet all the inclusion criteria will be randomly and equally divided into 2 groups: the intervention and the control groups. Those in the former group will receive a cognitive-behavioral therapy-based treatment for eight consecutive weeks on the social network platform WhatsApp; however, those in the control group will not be offered any treatment except usual care practices (unprotocolized usual care). The study’s primary outcome is the severity of PMS symptoms, and the secondary outcomes include general self-efficacy, work-related quality of life, the impact of PMS on daily life, coping with the symptoms, and experiencing anxiety and depression at the beginning of the study to identify people with PMS. A daily record of the symptoms will be completed for two consecutive months by all female employees aged 20–45 years who wish to participate in the study. According to the initial screening, those with moderate to severe PMS will be included. We will use the MLwin software for the analyses. All questionnaires will be completed by both groups immediately and 8 weeks after the termination of the treatment. The data will be analyzed using linear mixed-effects modeling with random intercepts and slopes. Discussion It is anticipated that the findings of the present study may demonstrate the effectiveness of the cognitive behavioral therapy intervention on the severity of PMS symptoms that could guide healthcare providers in opting for suitable treatment alternatives for the syndrome. Ethics and dissemination The research proposal is approved by the Human Ethics Committee of Qazvin University of Medical Sciences (IR.QUMS.REC.1399.252). The results of this intervention trial will be submitted for publication in a peer-reviewed research journal. Trial registration Iranian Registry of Clinical Trials IRCT20180218038789N4. Registered prospectively on October 28, 2020
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Affiliation(s)
- Zainab Alimoradi
- Social Determinants of Health Research Center,Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, 34197-59811, Iran
| | | | - Khaled Rahmani
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Amir H Pakpour
- Social Determinants of Health Research Center,Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, 34197-59811, Iran. .,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
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Barrows J, Fleury J. Pilot randomized controlled trial of the Yoga for HEART intervention in community-dwelling older adults. Geriatr Nurs 2022; 44:184-191. [PMID: 35217325 DOI: 10.1016/j.gerinurse.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/04/2022]
Abstract
Physical activity reduces cardiovascular risk; however, many older adults do not engage in recommended levels. Theory-based interventions supporting motivation for physical activity are limited. This pilot study evaluated the feasibility of Yoga for Health Empowerment and Realizing Transformation (HEART), a theory-based intervention combining motivation and yoga-based physical activity. Feasibility was addressed as acceptability, demand, implementation fidelity, and limited efficacy in promoting physical activity, cardiovascular health, and mechanisms of action. Sedentary older adults (m = 65 years old, sd = 8.5) were randomized to Yoga for HEART (n=8) or Active Control (n=7) conditions. Yoga for HEART was: (a) acceptable, (b) retention 73%, (c) implemented as planned. A significant main effect for body mass index (BMI) was found in Yoga for HEART participants (p = .02). No significant effects were found for physical activity, other cardiovascular outcomes, or mechanisms of action. Yoga for HEART is feasible and recommended for further testing.
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Affiliation(s)
- Jennifer Barrows
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3(rd) St., Phoenix, AZ 85004, United States; Present address: Children's Hospital of Orange County, 1201 W. La Veta Ave., Orange, CA 92868, United States.
| | - Julie Fleury
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3(rd) St., Phoenix, AZ 85004, United States.
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Sclar GD, Bauza V, Mosler HJ, Bisoyi A, Chang HH, Clasen TF. Study design and rationale for a cluster randomized trial of a safe child feces management intervention in rural Odisha, India. BMC Public Health 2022; 22:106. [PMID: 35033048 PMCID: PMC8760865 DOI: 10.1186/s12889-021-12405-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor child feces management (CFM) is believed to be an important source of exposure to enteric pathogens that contribute to a large disease burden in low-income settings. While access to sanitation facilities is improving, national surveys indicate that even households with latrines often do not safely dispose of their child's feces. Working with caregivers in rural Odisha, India, we co-developed an intervention aimed at improving safe disposal of child feces and encouraging child latrine use at an earlier age. We describe the rationale for the intervention and summarize the protocol for a cluster randomized trial (CRT) to evaluate its effectiveness at changing CFM practices. METHODS The intervention consists of six behavior change strategies together with hardware provision: wash basin and bucket with lid to aid safe management of soiled nappies and a novel latrine training mat to aid safe disposal and latrine training. The intervention will be offered at the village level to interested caregivers of children < 5 years of age by a community-based organization. Following a baseline survey, 74 villages were randomly allocated to either intervention or control arm. The primary outcome is caregiver reported safe disposal of child feces after last defecation, either by the caregiver disposing of the child's feces into the latrine or the child using the latrine, measured approximately four to six months following intervention delivery. Secondary outcomes include fecal contamination of household drinking water and the childs' hands. A process evaluation will also be conducted to assess intervention fidelity and reach, and explore implementer and participant feedback. DISCUSSION This study addresses a crucial knowledge gap in sanitation by developing a scalable intervention to improve safe management of child feces. The behavior change strategies were designed following the Risks, Attitudes, Norms, Abilities and Self-Regulation (RANAS) approach, which has shown to be effective for other environmental behavior change interventions in low-income settings. The latrine training mat hardware is a novel design developed cooperatively and manufactured locally. The evaluation follows a rigorous CRT study design assessing the impact of the intervention on CFM behavior change, as well as fecal contamination of two sources of potential exposure. TRIAL REGISTRATION This trial is registered at ISRCTN: ISRCTN15831099.
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Affiliation(s)
- Gloria D Sclar
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Psychology, University of Zürich, Zürich, Switzerland.
| | - Valerie Bauza
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Howard H Chang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas F Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fontaine G, Cossette S. A theory-based adaptive E-learning program aimed at increasing intentions to provide brief behavior change counseling: Randomized controlled trial. Nurse Educ Today 2021; 107:105112. [PMID: 34455287 DOI: 10.1016/j.nedt.2021.105112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Unhealthy behaviors are significant contributors to non-communicable diseases. Nurses can support patient health behavior change by providing brief behavior change counseling. However, training programs in brief counseling are generally not personalized, or adapted, to the barriers and theoretical determinants of its provision in clinical practice. OBJECTIVE This study aimed to evaluate the effectiveness of the E_MOTIVA theory-based adaptive e-learning program on nurses' and nursing students' intentions to provide brief counseling for smoking, unhealthy eating habits and medication nonadherence. DESIGN AND METHODS A randomized controlled trial was conducted with nurses and nursing students in Canada. Experimental group participants were allocated to the E_MOTIVA theory-based adaptive e-learning program. Control group participants were allocated to the E_MOTIVB knowledge-based standardized e-learning program. E_MOTIVA was designed to influence the constructs of the Theory of Planned Behavior (e.g., attitude, subjective norms) in relation to brief counseling. Outcomes were improvement in intention to provide brief counseling, improvement in other Theory of Planned Behavior variables, as well as cognitive load and engagement related to e-learning. RESULTS A total of 102 participants were randomized to the experimental (n = 51) and control (n = 51) groups. End of study questionnaires were completed by 27 experimental group and 38 control group participants. Analyses indicated no significant differences between groups in the change of scores for intention to provide brief counseling. However, while not significant, the change of score was greater in the experimental group (10.22 ± 3.34 versus 9.04 ± 2.80; p = 0.787). Scores in both groups improved significantly for attitude, subjective norms, perceived behavioral control, behavioral beliefs, and control beliefs. However, there were no statistically significant differences between groups for these variables as well as for cognitive load and engagement. CONCLUSIONS Both e-learning programs had a similar positive effect on nurses' and nursing students' intentions to provide brief counseling and on Theory of Planned Behavior variables. TRIAL REGISTRATION ISRCTN Registry ISRCTN32603572; http://www.isrctn.com/ISRCTN32603572. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/18894; https://doi.org/10.2196/18894.
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Affiliation(s)
- Guillaume Fontaine
- Faculty of Nursing, Université de Montréal, 2375 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1A8, Canada; Montreal Heart Institute Research Center, 5000 Bélanger, Montréal, QC H1T 1C8, Canada.
| | - Sylvie Cossette
- Faculty of Nursing, Université de Montréal, 2375 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1A8, Canada; Montreal Heart Institute Research Center, 5000 Bélanger, Montréal, QC H1T 1C8, Canada.
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Renko E, Knittle K, Palsola M, Lintunen T, Hankonen N. Acceptability, reach and implementation of a training to enhance teachers' skills in physical activity promotion. BMC Public Health 2020; 20:1568. [PMID: 33076881 DOI: 10.1186/s12889-020-09653-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/07/2020] [Indexed: 01/13/2023] Open
Abstract
Background To achieve real-world impacts, behavior change interventions need to be scaled up and broadly implemented. Implementation is challenging however, and the factors influencing successful implementation are not fully understood. This study describes the nationwide implementation of a complex theory-based program targeting physical activity and sedentary behavior in vocational schools (Lets’s Move It; LMI). The implementation primarily involved a systematic and theory-based training and user manual for school staff. We explore how the perceived acceptability of this training (in line with the Theoretical Framework of Acceptability) relates to (un) successful implementation. The study evaluates (1) the experienced acceptability of the training and anticipated acceptability of later delivering the program; (2) reach and implementation, including adaptations and barriers; (3) whether acceptability ratings predict teachers’ intentions for implementation. Methods Upper secondary school staff from vocational and high schools (n = 194) enrolled in a two-part training, covering implementation of the LMI program and training in motivational interaction styles. One hundred fifty-one participants attended both parts of the training. Participants reported their perceived acceptability of the training and their implementation efforts in online questionnaires at baseline, after training sessions and at long-term follow-up. Qualitative data (open-ended questions) were analysed with content analysis to collate responses. Quantitative data analyses involved correlations and logistic regression. Results Participants rated the training as highly acceptable on all dimensions (average ratings exceeded 4.0 on a 5-point scale). The implementation reached at least 6100 students and 341 school classes. Most teachers intended to continue program implementation. Acceptability ratings explained 51.7% of teachers’ intentions to implement the student program (훘2 = 30.08; df = 8; p < .001), with affective attitude, perceived effectiveness and self-efficacy the most influential. Teachers commonly reported condensing program content, and reported deficits of time and collegial support as common barriers to implementation. Conclusion High acceptability and reach of the training indicate strong potential for implementation success. Multiple facets of acceptability seem important to successful implementation. Future research should explore ways to improve acceptability, thereby promoting successful implementation in real-world settings.
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Eilayyan O, Thomas A, Hallé MC, Ahmed S, Tibbles AC, Jacobs C, Mior S, Davis C, Evans R, Schneider MJ, Owens H, Zoubi FA, Barnsley J, Long CR, Bussières A. Promoting the use of self-management in patients with spine pain managed by chiropractors and chiropractic interns: barriers and design of a theory-based knowledge translation intervention. Chiropr Man Therap 2019; 27:44. [PMID: 31636895 PMCID: PMC6794734 DOI: 10.1186/s12998-019-0267-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/05/2019] [Indexed: 12/29/2022] Open
Abstract
Background The literature supports the effectiveness of self-management support (SMS) to improve health outcomes of patients with chronic spine pain. However, patient engagement in SMS programs is suboptimal. The objectives of this study were to: 1) assess participation in self-care (i.e. activation) among patients with spine pain, 2) identify patients’ barriers and enablers to using SMS, and 3) map behaviour change techniques (BCTs) to key barriers to inform the design of a knowledge translation (KT) intervention aimed to increase the use of SMS. Methods In summer 2016, we invited 250 patients with spine pain seeking care at the Canadian Memorial Chiropractic College in Ontario, Canada to complete the Patient Activation Measure (PAM) survey to assess the level of participation in self-care. We subsequently conducted individual interviews, in summer 2017, based on the Theoretical Domains Framework (TDF) in a subset of patients to identify potential challenges to using SMS. The interview guide included 20 open-ended questions and accompanying probes. Findings were deductively analysed guided by the TDF. A panel of 7 experts mapped key barriers to BCTs, designed a KT intervention, and selected the modes of delivery. Results Two hundred and twenty-three patients completed the PAM. Approximately 24% of respondents were not actively involved in their care. Interview findings from 13 spine pain patients suggested that the potential barriers to using SMS corresponded to four TDF domains: Environmental Context and Resources; Emotion; Memory, Attention & Decision-Making; and Behavioural Regulation. The proposed theory-based KT intervention includes paper-based educational materials, webinars and videos, summarising and demonstrating the therapeutic recommendations including exercises and other lifestyle changes. In addition, the KT intervention includes Brief Action Planning, a SMS strategy based on motivational interviewing, along with a SMART plan and reminders. Conclusions Almost one quarter of study participants were not actively engaged in their spine care. Key barriers likely to influence uptake of SMS among patients were identified and used to inform the design of a theory-based KT intervention to increase their participation level. The proposed multi-component KT intervention may be an effective strategy to optimize the quality of spine pain care and improve patients’ health-outcomes. Electronic supplementary material The online version of this article (10.1186/s12998-019-0267-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Owis Eilayyan
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
| | - Aliki Thomas
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
| | - Marie-Christine Hallé
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
| | - Sara Ahmed
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
| | - Anthony C Tibbles
- 3Canadian Memorial Chiropractic College, 6100 Leslie St, North York, ON M2H 3J1 Canada
| | - Craig Jacobs
- 3Canadian Memorial Chiropractic College, 6100 Leslie St, North York, ON M2H 3J1 Canada
| | - Silvano Mior
- 3Canadian Memorial Chiropractic College, 6100 Leslie St, North York, ON M2H 3J1 Canada
| | - Connie Davis
- 4University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4 Canada.,Centre for Collaboration, Motivation and Innovation, PO Box 1343, Vernon, BC V1T 6N6 Canada
| | - Roni Evans
- 6University of Minnesota, Minneapolis, MN 55455 USA
| | | | - Heather Owens
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada
| | - Fadi Al Zoubi
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
| | - Jan Barnsley
- 8University of Toronto, 27 King's College Cir, Toronto, ON M5S Canada
| | - Cynthia R Long
- 9Palmer College, Davenport, 1000 Brady St, Davenport, IA 52803 USA
| | - Andre Bussières
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
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Ramis MA, Chang A, Conway A, Lim D, Munday J, Nissen L. Theory-based strategies for teaching evidence-based practice to undergraduate health students: a systematic review. BMC Med Educ 2019; 19:267. [PMID: 31319892 PMCID: PMC6637485 DOI: 10.1186/s12909-019-1698-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/08/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Undergraduate students across health professions are required to be capable users of evidence in their clinical practice after graduation. Gaining the essential knowledge and clinical behaviors for evidence-based practice can be enhanced by theory-based strategies. Limited evidence exists on the effect of underpinning undergraduate EBP curricula with a theoretical framework to support EBP competence. A systematic review was conducted to determine the effectiveness of EBP teaching strategies for undergraduate students, with specific focus on efficacy of theory-based strategies. METHODS This review critically appraised and synthesized evidence on the effectiveness of EBP theory-based teaching strategies specifically for undergraduate health students on long or short-term change in multiple outcomes, including but not limited to, EBP knowledge and attitudes. PubMed, CINAHL, Scopus, ProQuest Health, ERIC, The Campbell Collaboration, PsycINFO were searched for published studies and The New York Academy of Medicine, ProQuest Dissertations and Mednar were searched for unpublished studies. Two independent reviewers assessed studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. RESULTS Twenty-eight studies reporting EBP teaching strategies were initially selected for review with methodological quality ranging from low to high. Studies varied in course duration, timing of delivery, population and course content. Only five included papers reported alignment with, and detail of, one or more theoretical frameworks. Theories reported included Social Cognitive Theory (one study), Roger's Diffusion of Innovation Theory (two studies) and Cognitive Apprenticeship Theory (one study). Cognitive Flexibility Theory and Cognitive Load Theory were discussed in two separate papers by the same authors. All but one study measured EBP knowledge. Mixed results were reported on EBP knowledge, attitudes and skills across the five studies. CONCLUSIONS EBP programs for undergraduate health students require consideration of multiple domains, including clinical behaviors, attitudes and cognitive learning processes; Interventions grounded in theory were found to have a small but positive effect on EBP attitudes. The most effective theory for developing and supporting EBP capability is not able to be determined by this review therefore additional rigorous research is required.
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Affiliation(s)
- Mary-Anne Ramis
- Mater Health, Evidence in Practice Unit & Queensland Centre for Evidence Based Nursing and Midwifery, A Joanna Briggs Institute Centre of Excellence, South Brisbane, QLD 4101 Australia
- Queensland University of Technology, School of Nursing, Victoria Park Road, Kelvin Grove, Brisbane, Queensland 4059 Australia
| | - Anne Chang
- Queensland University of Technology, School of Nursing, Kelvin Grove Campus, Victoria Park Road, Brisbane, 4059 Australia
| | - Aaron Conway
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5G 2N2 Canada
| | - David Lim
- School of Science and Health, Western Sydney University, Sydney, 2751 Australia
| | - Judy Munday
- Queensland University of Technology, School of Nursing, Kelvin Grove Campus, Victoria Park Road, Brisbane, 4059 Australia
- Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | - Lisa Nissen
- Queensland University of Technology, School of Clinical Sciences, Gardens Point Campus, QLD, Brisbane, 4000 Australia
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Caruso BA, Sclar GD, Routray P, Majorin F, Nagel C, Clasen T. A cluster-randomized multi-level intervention to increase latrine use and safe disposal of child feces in rural Odisha, India: the Sundara Grama research protocol. BMC Public Health 2019; 19:322. [PMID: 30885158 PMCID: PMC6423860 DOI: 10.1186/s12889-019-6601-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/27/2019] [Indexed: 11/11/2022] Open
Abstract
Background Despite health benefits of sanitation, an estimated 12% of the global population practices open defecation, including an estimated 50% of the population of India. Current estimates, however, do not include households that own toilets but do not use them, suggesting that the actual number of people defecating in the open is underestimated. This protocol describes a cluster randomized controlled trial to evaluate an intervention specifically designed to increase latrine use, including the safe disposal of child feces, in rural Odisha, India. Methods The trial engages 66 villages in Puri district, 33 randomly allocated to receive the intervention and 33 to serve as controls. The primary outcome is latrine use and is recorded at baseline and endline for all members of all households that own latrines in all trial vilalges. Additional data on determinants of latrine use and safe child feces disposal are also collected to assess change based on the intervetntion. A process evaluation assesses the delivery of the intervention and qualiative research takes place in non-trial villages as well as post-endline in trial villages to help explain trial findings. Discussion This is one of four trials taking place simultaneously in rural India with latrine use as the primary outcome. All four studies use the same outcome to gerenate comparable data across sites that can serve the government of India. The trial in Odisha is unique in that it collects latrine use data from all potential users in all households that own latrines, enabling a thorough view of the sanitation situation and factors that influence use at the community level. That latrine use is collected via self-report is a limitation, however any bias in reporting should be the same across villages and not impact the overall assessment of intervention impact. Trial registration This trial is registered at clinicaltrials.gov: NCT03274245.
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Affiliation(s)
- Bethany A Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Gloria D Sclar
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Fiona Majorin
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Corey Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Rantanen T, Pynnönen K, Saajanaho M, Siltanen S, Karavirta L, Kokko K, Karvonen A, Kauppinen M, Rantalainen T, Rantakokko M, Portegijs E, Hassandra M. Individualized counselling for active aging: protocol of a single-blinded, randomized controlled trial among older people (the AGNES intervention study). BMC Geriatr 2019; 19:5. [PMID: 30616537 PMCID: PMC6323746 DOI: 10.1186/s12877-018-1012-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/11/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Active aging has been established as a policy goal for aging societies. We define active aging at the individual level as striving for elements of well-being through activities in relation to a person's goals, functional capacities and opportunities. Increasing evidence suggests that any meaningful activity is beneficial for different aspects of well-being in older people. The aim of the present randomized controlled trial is to test the feasibility and effectiveness of a one-year community-based intervention on active aging. The AGNES intervention aims at increasing older peoples' participation in self-selected valued activities. METHODS The proposed study is a two-arm single-blinded randomized controlled trial. The intervention group receives individually tailored counselling for an active life (one face-to-face session, four phone calls and supportive written material) and the control group written general health information only. Two hundred older adults aged 75- and 80- year old, with intermediate mobility function and without cognitive impairment, living independently in the municipality of Jyväskylä, Finland, are recruited and randomized with a 1:1 allocation to the intervention and control group. Randomization is computer-generated stratified by sex and age. The primary outcome is active aging and secondary outcomes are well-being, depressive symptoms, quality of life, personal goals, mobility and physical activity. Measures are administered at pre-trial, mid-trial (at 6 months) and post-trial (12 months after baseline). DISCUSSION The AGNES intervention study will provide new knowledge on the effects of individualized counselling on active aging and the potential of older people to promote their own well-being. TRIAL REGISTRATION The trial is registered at ISRCTN - ISRCTN16172390 : Promoting well-being through active aging.
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Affiliation(s)
- Taina Rantanen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Katja Pynnönen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Milla Saajanaho
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Sini Siltanen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Laura Karavirta
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Katja Kokko
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Anu Karvonen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Markku Kauppinen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Timo Rantalainen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Merja Rantakokko
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Erja Portegijs
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Mary Hassandra
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
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Eilayyan O, Thomas A, Hallé MC, Ahmed S, Tibbles AC, Jacobs C, Mior S, Davis C, Evans R, Schneider MJ, Alzoubi F, Barnsley J, Long CR, Bussières A. Promoting the use of self-management in novice chiropractors treating individuals with spine pain: the design of a theory-based knowledge translation intervention. BMC Musculoskelet Disord 2018; 19:328. [PMID: 30205825 PMCID: PMC6134709 DOI: 10.1186/s12891-018-2241-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/24/2018] [Indexed: 12/19/2022] Open
Abstract
Background Clinical practice guidelines generally recommend clinicians use self-management support (SMS) when managing patients with spine pain. However, even within the educational setting, the implementation of SMS remains suboptimal. The objectives of this study were to 1) estimate the organizational readiness for change toward using SMS at the Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario from the perspective of directors and deans, 2) estimate the attitudes and self-reported behaviours towards using evidence-based practice (EBP), and beliefs about pain management among supervisory clinicians and chiropractic interns, 3) identify potential barriers and enablers to using SMS, and 4) design a theory-based tailored Knowledge Translation (KT) intervention to increase the use of SMS. Methods Mixed method design. We administered three self-administered questionnaires to assess clinicians’ and interns’ attitudes and behaviours toward EBP, beliefs about pain management, and practice style. In addition, we conducted 3 focus groups with clinicians and interns based on the Theoretical Domain Framework (TDF) to explore their beliefs about using SMS for patients with spine pain. Data were analysed using deductive thematic analysis by 2 independent assessors. A panel of 7 experts mapped behaviour change techniques to key barriers identified informing the design of a KT intervention. Results Participants showed high level of EBP knowledge, positive attitude of EBP, and moderate frequency of EBP use. A number of barrier factors were identified from clinicians (N = 6) and interns (N = 16) corresponding to 7 TDF domains: Knowledge; Skills; Environmental context and resources; Emotion; Beliefs about Capabilities; Memory, attention & decision making; and Social Influence. To address these barriers, the expert panel proposed a multifaceted KT intervention composed of a webinar and online educational module on a SMS guided by the Brief Action Planning, clinical vignettes, training workshop, and opinion leader support. Conclusion SMS strategies can help maximizing the health care services for patients with spine pain. This may in turn optimize patients’ health. The proposed theory-based KT intervention may facilitate the implementation of SMS among clinicians and interns. Electronic supplementary material The online version of this article (10.1186/s12891-018-2241-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Owis Eilayyan
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada. .,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada.
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Marie-Christine Hallé
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Sara Ahmed
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | | | - Craig Jacobs
- Canadian Memorial Chiropractic College, North York, Canada
| | - Silvano Mior
- Canadian Memorial Chiropractic College, North York, Canada
| | - Connie Davis
- University of British Columbia, Vancouver, Canada.,Centre for Collaboration, Motivation and Innovation, Vancouver, Canada
| | - Roni Evans
- University of Minnesota, Minneapolis, USA
| | | | - Fadi Alzoubi
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | | | | | - Andre Bussières
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
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Darabi F, Kaveh MH, Majlessi F, Farahani FKA, Yaseri M, Shojaeizadeh D. Effect of theory-based intervention to promote physical activity among adolescent girls: a randomized control trial. Electron Physician 2017; 9:4238-4247. [PMID: 28607661 PMCID: PMC5459298 DOI: 10.19082/4238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/10/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Physical activity (PA) rates decline among most high school female students, and due to cultural restrictions, the reduction of physical activity might be exacerbated in female Iranian adolescents. OBJECTIVE To determine the effects of the physical activity education theory-based intervention to promote activity among adolescent girls. METHODS This randomized clinical trial was conducted at public high schools in Tehran, Iran, from September 2015 to July 2016 on 578 girls. The subjects were assigned randomly to two groups of experiment and control (n=289 per group). All participants in the experimental group received an educational program based on a modified TPB. Measures were assessed before and 6 months after the experiment. The data were analyzed using SPSS version 23. We used descriptive statistics, multilevel analysis, Likelihood Ratio (LR) test, P-value less than 0.05 were considered statistically significant. RESULTS Five hundred and seventy-eight participants with a mean age of 14.26±0.96 years were studied in two groups of experiment (n=289) and control (n=289). Moreover, adjusted for the baseline values, the mean of the scores of the knowledge (84.1±13.6), attitude (31.2±13.6), subjective norm (40.4±11.1), behavioral intention (34.3±14.7), perceived behavioral control (38.4±11.6), perceived parental control (42.9±14.2), behavioral (42.6±17.1) was significantly higher in the experiment group compared with the control group (p<0.001). CONCLUSIONS The results of this study implicate that theory based educational intervention is considered to be more effective in improving physical activity in adolescents. This result can be used to increase adolescent's health promotion. TRIAL REGISTRATION The trial was registered at the Iranian Registry of Clinical Trials (IRST) with the identification number: IRCT2015070623089N2. FUNDING The authors received no financial support for the research from Kermanshah University of Medical Sciences.
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Affiliation(s)
- Fatemeh Darabi
- Ph.D. Student of Health Education and Health Promotion, Department of Health Education and Health Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Public Health, Asadabad Sciences Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Hossein Kaveh
- Ph.D. of Health Education and Health Promotion, Associate Professor, Department of Health Education and Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Majlessi
- Professor, Department of Health Education and Health Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Khalaj Abadi Farahani
- Ph.D. of Population Studies/Reproductive Health, Associate Professor, Department of Population, Health and Family Planning, National Institute for Population Research, Tehran, Iran
| | - Mehdi Yaseri
- Ph.D. of Biostatistics, Assistant Professor, Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Davoud Shojaeizadeh
- Professor of Health Education and Health Promotion, Department of Education Health and Promotion Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Jacob R, Lamarche B, Provencher V, Laramée C, Valois P, Goulet C, Drapeau V. Evaluation of a Theory-Based Intervention Aimed at Improving Coaches' Recommendations on Sports Nutrition to Their Athletes. J Acad Nutr Diet 2016; 116:1308-15. [PMID: 27234619 DOI: 10.1016/j.jand.2016.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Coaches are a major source of nutrition information and influence for young athletes. Yet, most coaches do not have training in nutrition to properly guide their athletes. OBJECTIVE The aim of this study was to evaluate the effectiveness of an intervention aimed at improving the accuracy of coaches' recommendations on sports nutrition. DESIGN This was a quasi-experimental study with a comparison group and an intervention group. Measurements were made at baseline, post-intervention, and after a 2-month follow-up period. Coaches' recommendations on sports nutrition during the follow-up period were recorded in a diary. PARTICIPANTS/SETTING High school coaches from various sports (n=41) were randomly assigned to a comparison group or an intervention group. INTERVENTION Both groups attended two 90-minute sessions of a theory-based intervention targeting determinants of coaches' intention to provide recommendations on sports nutrition. The intervention group further received an algorithm that summarizes sports nutrition guidelines to help promote decision making on sports nutrition recommendations. MAIN OUTCOME MEASURES Nutrition knowledge and accuracy of coaches' recommendations on sports nutrition. STATISTICAL ANALYSIS PERFORMED χ(2) analyses and t-tests were used to compare baseline characteristics; mixed and general linear model analyses were used to assess the change in response to the intervention and differences in behaviors, respectively. RESULTS Coaches in the intervention vs comparison group provided more nutrition recommendations during the 2-month post-intervention period (mean number of recommendations per coach 25.7±22.0 vs 9.4±6.5, respectively; P=0.004) and recommendations had a greater accuracy (mean number of accurate recommendations per coach 22.4±19.9 [87.1%] vs 4.3±3.2 [46.1%], respectively; P<0.001). Knowledge was significantly increased post-intervention in both groups, but was maintained only in the intervention group during the 2-month follow-up (Pgroup*time=0.04). CONCLUSIONS A theory-based intervention combined with a decision-making algorithm maintained coaches' sports nutrition knowledge level over time and helped them to provide more accurate recommendations on sports nutrition.
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