201
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Easthall C, Song F, Bhattacharya D. A meta-analysis of cognitive-based behaviour change techniques as interventions to improve medication adherence. BMJ Open 2013; 3:e002749. [PMID: 23935093 PMCID: PMC3740257 DOI: 10.1136/bmjopen-2013-002749] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To describe and evaluate the use of cognitive-based behaviour change techniques as interventions to improve medication adherence. DESIGN Systematic review and meta-analysis of interventions to improve medication adherence. DATA SOURCES Search of the MEDLINE, EMBASE, PsycINFO, CINAHL and The Cochrane Library databases from the earliest year to April 2013 without language restriction. References of included studies were also screened to identify further relevant articles. REVIEW METHODS We used predefined criteria to select randomised controlled trials describing a medication adherence intervention that used Motivational Interviewing (MI) or other cognitive-based techniques. Data were extracted and risk of bias was assessed by two independent reviewers. We conducted the meta-analysis using a random effects model and Hedges' g as the measure of effect size. RESULTS We included 26 studies (5216 participants) in the meta-analysis. Interventions most commonly used MI, but many used techniques such as aiming to increase the patient's confidence and sense of self-efficacy, encouraging support-seeking behaviours and challenging negative thoughts, which were not specifically categorised. Interventions were most commonly delivered from community-based settings by routine healthcare providers such as general practitioners and nurses. An effect size (95% CI) of 0.34 (0.23 to 0.46) was calculated and was statistically significant (p < 0.001). Heterogeneity was high with an I(2) value of 68%. Adjustment for publication bias generated a more conservative estimate of summary effect size of 0.21 (0.08 to 0.33). The majority of subgroup analyses produced statistically non-significant results. CONCLUSIONS Cognitive-based behaviour change techniques are effective interventions eliciting improvements in medication adherence that are likely to be greater than the behavioural and educational interventions largely used in current practice. Subgroup analyses suggest that these interventions are amenable to use across different populations and in differing manners without loss of efficacy. These factors may facilitate incorporation of these techniques into routine care.
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Affiliation(s)
- Claire Easthall
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Debi Bhattacharya
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
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202
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Wu SFV, Tung HH, Liang SY, Lee MC, Yu NC. Differences in the perceptions of self-care, health education barriers and educational needs between diabetes patients and nurses. Contemp Nurse 2013:2767-2796. [PMID: 23909458 DOI: 10.5172/conu.2013.2767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Abstract This study examined the differing perceptions of diabetic patients and their nurses regarding the completion of self-care activities, barriers to participation in diabetes health education, and diabetic patients' educational needs to promote better health care for patients with diabetes in Taiwan. This study employed a cross-sectional survey. The data were collected during 2009. Questionnaires were developed to collect data on a convenience sample of 312 patients with type 2 diabetes and 202 nurses recruited from diabetes clinics in Taiwan. Perceptions of self-care behavior were statistically significantly different between patients and nurses (t=-5.05, P<0.000). The patients perceived themselves to be more successful at completing self-care tasks whereas nurses perceived patients to be less successful at completing self-care tasks. Nurses perceived patients to experience greater difficulties in diabetes health education (t=18.36, P<0.000). Nurses perceived there to be a greater need for health education as compared with patients (t=9.03, P<0.000).
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Affiliation(s)
- Shu-Fang Vivienne Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan E-mail:
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203
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Blakely TJ, Bruggink S, Dziadosz GM, Rose M. Combining evidence-based practices for improved behavioral outcomes: a demonstration project. Community Ment Health J 2013; 49:396-400. [PMID: 23054153 DOI: 10.1007/s10597-012-9550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 09/18/2012] [Indexed: 11/24/2022]
Abstract
This article describes a demonstration project carried out by a special team at a mental health agency serving adults with a serious psychiatric condition. The project consisted of combining the evidence-based practices of cognitive therapy, Motivational Interviewing and Stages of Change with Social Role Theory and the Chronic Care Model that were the organizing concepts of the agency's assessment and treatment program. Measures of the results of clients' improved mental health and social functioning indicated the successful use of this combination.
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Affiliation(s)
- Thomas J Blakely
- Cherry Street Health Services, 100 Cherry St. S.E., Grand Rapids, MI 49503, USA.
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204
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Verbrugge R, de Boer F, Georges JJ. Strategies used by respiratory nurses to stimulate self-management in patients with COPD. J Clin Nurs 2013; 22:2787-99. [PMID: 23834504 DOI: 10.1111/jocn.12048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To gain an insight into strategies, adopted by Dutch respiratory nurses during clinic sessions, to improve self-management of patients with chronic obstructive pulmonary disease. BACKGROUND Chronic obstructive pulmonary disease is highly prevalent and a significant cause of morbidity and mortality, impacting on quality of life and healthcare expenditure. Health promotion is therefore an important consideration. By applying specific strategies, respiratory nurses can play a major role in the promotion of self-management. Research has shown that respiratory nurses, who run clinics, have insufficient knowledge of evidence-based strategies that can be adopted to promote self-management among chronic obstructive pulmonary disease patients. It appears that respiratory nurses adopt their own strategies during clinic sessions. DESIGN A qualitative research study was carried out using Grounded Theory method. METHODS Data were collected during open interviews conducted by an external researcher with a nursing background. The interviews were analysed through coding after which categories were developed. RESULTS Fourteen respiratory nurses were interviewed. The results show that respiratory nurses emphasise quitting smoking during the consult. Attention is also paid to inhalation medication and techniques. Other self-management strategies that respiratory nurses use are: application of specific interviewing techniques, referring to other healthcare professionals and providing tools for coping with the illness in everyday life. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE The main emphasis during the clinic session is directed at quitting smoking. Other self-management strategies such as providing information regarding nutrition and exercise, instilling confidence and becoming an equal discussion partner, gain less attention. During the clinic session, respiratory nurses should also focus on these self-management strategies in addition to quitting smoking. Further research should be directed at self-management strategies used by respiratory nurses in relation to different characteristics of patients. In this way, a more patient-oriented form of consultation could be developed for chronic obstructive pulmonary disease patients.
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Affiliation(s)
- Remco Verbrugge
- St. Antonius Hospital Nieuwegein, Utrecht and Graduate Student, Faculty of Medicine, Department of Nursing Science, Utrecht, The Netherlands
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205
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Abstract
Alcohol use disorders are related to many negative health, emotional, societal, and economic consequences. These disorders are often difficult to treat because individuals suffering from them tend to be ambivalent about and resistant to change. Motivational interviewing provides health care providers with the appropriate tools to treat individuals who are resistant to change and can help with long-term lifestyle and behavioral changes. Motivational interviewing has also been shown to be helpful when a lifestyle approach to treatment is used.
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Affiliation(s)
- Craig A. Johnston
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics–Nutrition, Baylor College of Medicine, Houston, Texas (CAJ, BES) and Department of Medicine, Baylor College of Medicine, Houston, Texas (CAJ)
| | - Brian E. Stevens
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics–Nutrition, Baylor College of Medicine, Houston, Texas (CAJ, BES) and Department of Medicine, Baylor College of Medicine, Houston, Texas (CAJ)
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206
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Clarke PB, Giordano AL. The Motivational Supervisor: Motivational Interviewing as a Clinical Supervision Approach. CLINICAL SUPERVISOR 2013. [DOI: 10.1080/07325223.2013.851633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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207
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Murphy M, Porter J, Yusuf H, Ntouva A, Newton T, Kolliakou A, Crawley H, Tsakos G, Pikhart H, Watt RG. Considerations and lessons learned from designing a motivational interviewing obesity intervention for young people attending dental practices: a study protocol paper. Contemp Clin Trials 2013; 36:126-34. [PMID: 23816488 DOI: 10.1016/j.cct.2013.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/20/2013] [Accepted: 06/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND With the prevalence of child obesity increasing worldwide, and the consumption of sugar-sweetened beverages identified as a major contributor to obesity in adolescents, there is a need for effective interventions aimed at dietary behaviour change in this group. Primary dental care settings are in an ideal position to influence adolescents' dietary behaviours, yet have been under-utilised for this purpose. Motivational Interviewing (MI) has shown promise in influencing other health behaviours. However, there is lack of published methodologies on which to base the design of such interventions, and limited evidence on its effectiveness in influencing dietary change. We undertook a study to test the feasibility of a MI intervention aimed at reducing soft drink consumption in adolescents attending dental surgeries. We present the study design for the development and evaluation of the intervention. METHOD Ten dental practices in north London were randomised into control or intervention. Adolescent participants in control settings received routine advice and intervention participants received a brief MI intervention. The intervention was designed using comprehensive stakeholder engagement and consisted of 3-4 short MI sessions and a maintenance phase delivered by trained researchers through the use of age-specific resources. Process evaluation was carried out using qualitative and quantitative methods to assess intervention feasibility in a primary dental care setting. DISCUSSION By focussing on the development and evaluation of the intervention, this paper contributes to the limited available knowledge and identifies methodological considerations for undertaking a MI intervention for dietary change in adolescents in primary dental care settings.
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Affiliation(s)
- Marie Murphy
- UCL Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
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208
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Jansink R, Braspenning J, Keizer E, van der Weijden T, Elwyn G, Grol R. No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interviewing: a cluster randomised trial. Scand J Prim Health Care 2013; 31:119-27. [PMID: 23659710 PMCID: PMC3656395 DOI: 10.3109/02813432.2013.797178] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To study the effectiveness of a comprehensive diabetes programme in general practice that integrates patient-centred lifestyle counselling into structured diabetes care. Design and setting. Cluster randomised trial in general practices. INTERVENTION Nurse-led structured diabetes care with a protocol, record keeping, reminders, and feedback, plus training in motivational interviewing and agenda setting. SUBJECTS Primary care nurses in 58 general practices and their 940 type 2 diabetes patients with an HbA1c concentration above 7%, and a body mass index (BMI) above 25 kg/m². Main outcome measures. HbA1c, diet, and physical activity (medical records and patient questionnaires). RESULTS Multilevel linear and logistic regression analyses adjusted for baseline outcomes showed that despite active nurse participation in the intervention, the comprehensive programme was no more effective than usual care after 14 months, as shown by HbA1c levels (difference between groups = 0.13; CI 20.8-0.35) and diet (fat (difference between groups = 0.19; CI 20.82-1.21); vegetables (difference between groups = 0.10; CI-0.21-0.41); fruit (difference between groups = 20.02; CI 20.26-0.22)), and physical activity (difference between groups = 21.15; CI 212.26-9.97), or any of the other measures of clinical parameters, patient's readiness to change, or quality of life. CONCLUSION A comprehensive programme that integrated lifestyle counselling based on motivational interviewing principles integrated into structured diabetes care did not alter HbA1c or the lifestyle related to diet and physical activity. We thus question the impact of motivational interviewing in terms of its ability to improve routine diabetes care in general practice.
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Affiliation(s)
- Renate Jansink
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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209
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Cassoff J, Knäuper B, Michaelsen S, Gruber R. School-based sleep promotion programs: Effectiveness, feasibility and insights for future research. Sleep Med Rev 2013; 17:207-14. [DOI: 10.1016/j.smrv.2012.07.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 07/16/2012] [Accepted: 07/17/2012] [Indexed: 11/12/2022]
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210
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van Grieken A, Veldhuis L, Renders CM, Borsboom GJ, van der Wouden JC, Hirasing RA, Raat H. Population-based childhood overweight prevention: outcomes of the 'Be active, eat right' study. PLoS One 2013; 8:e65376. [PMID: 23741491 PMCID: PMC3669240 DOI: 10.1371/journal.pone.0065376] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/22/2013] [Indexed: 11/18/2022] Open
Abstract
Objective An overweight prevention protocol was used in the ‘Be active, eat right’ study; parents of overweight children (5 years) were offered healthy lifestyle counseling by youth health care professionals. Effects of the protocol on child BMI and waist circumference at age 7 years were evaluated. Methods A cluster RCT was conducted among nine youth health care centers in the Netherlands. Parents of overweight, not obese, children received lifestyle counseling and motivational interviewing according to the overweight prevention protocol in the intervention condition (n = 349) and usual care in the control condition (n = 288). Measurements were made of child height, weight and waist circumference at baseline and at a two-year follow-up; parents completed questionnaires regarding demographic characteristics. Linear mixed models were applied; interaction terms were explored. Results The analyzed population consisted of 38.1% boys; mean age 5.7 [sd: 0.4] years; mean BMI 18.1 [sd: 0.6], the median number of counseling sessions in the intervention condition was 2. The regression model showed no significant difference in BMI increase between the research conditions at follow-up (beta −0.16; 95% CI:−0.60 to 0.27; p = 0.463). There was a significant interaction between baseline BMI and research condition; children with a baseline BMI of 17.25 and 17.50 had a smaller increase in BMI at follow-up when allocated to the intervention condition compared to control condition (estimated adjusted mean difference −0.67 [se: 0.30] and −0.52 [se: 0.36]). Conclusion Mildly overweight children (baseline BMI 17.25 and 17.50) in the intervention condition showed a significantly smaller increase in BMI at follow-up compared to the control condition; there was no overall difference between intervention and control condition. Future research may explore and evaluate improvements of the prevention protocol. Trial Registration Current Controlled Trials ISRCTN04965410
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Affiliation(s)
- Amy van Grieken
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lydian Veldhuis
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carry M. Renders
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Gerard J. Borsboom
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johannes C. van der Wouden
- EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Remy A. Hirasing
- EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
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211
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Hardcastle SJ, Taylor AH, Bailey MP, Harley RA, Hagger MS. Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up. Int J Behav Nutr Phys Act 2013; 10:40. [PMID: 23537492 PMCID: PMC3639183 DOI: 10.1186/1479-5868-10-40] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 03/18/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intensive diet and physical activity interventions have been found to reduce cardiovascular disease (CVD) risk, but are resource intensive. The American Heart Association recently recommended motivational interviewing (MI) as an effective approach for low-intensity interventions to promote health-related outcomes such as weight loss. However, there is limited research evaluating the long-term effectiveness of MI-based interventions on health-related outcomes associated with CVD risk. The current research evaluated the effectiveness of a six-month low-intensity MI intervention in a UK primary-care setting in maintaining reductions in CVD risk factors at12 months post-intervention. METHODS Primary-care patients were randomised to an intervention group that received standard exercise and nutrition information plus up to five face-to-face MI sessions, delivered by a physical activity specialist and registered dietician over a 6-month period, or to a minimal intervention comparison group that received the standard information only. Follow-up measures of behavioural (vigorous and moderate physical activity, walking, physical activity stage-of-change, fruit and vegetable intake, and dietary fat intake) and biomedical (weight, body mass index [BMI], blood pressure, cholesterol) outcomes were taken immediately post-intervention and at a 12-month follow-up occasion. RESULTS Intent-to-treat analyses revealed significant differences between groups for walking and cholesterol. Obese and hypercholesterolemic patients at baseline exhibited significant improvements in BMI and cholesterol respectively among those allocated to the intervention group compared to the comparison group. Post-intervention improvements in other health-related outcomes including blood pressure, weight, and BMI were not maintained. CONCLUSIONS The present study suggests that a low-intensity MI counselling intervention is effective in bringing about long-term changes in some, but not all, health-related outcomes (walking, cholesterol levels) associated with CVD risk. The intervention was particularly effective for patients with elevated levels of CVD risk factors at baseline. Based on these findings future interventions should be conducted in a primary care setting and target patients with high risk of CVD. Future research should investigate how the long-term gains in health-related outcomes brought about by the MI-counselling intervention in the current study could be extended to a wider range of health outcomes.
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Affiliation(s)
- Sarah J Hardcastle
- School of Sport and Service Management, University of Brighton, Denton Road, Eastbourne, ES BN20 7SP, UK
| | - Adrian H Taylor
- Sport, Exercise and Health Sciences, University of Exeter, St. Luke’s Campus, Exeter, Exeter EX1 2LU, UK
| | - Martin P Bailey
- School of Sport and Service Management, University of Brighton, Denton Road, Eastbourne, ES BN20 7SP, UK
| | - Robert A Harley
- School of Sport and Service Management, University of Brighton, Denton Road, Eastbourne, ES BN20 7SP, UK
| | - Martin S Hagger
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth WA6845, Australia
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212
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Jansink R, Braspenning J, Laurant M, Keizer E, Elwyn G, Weijden TVD, Grol R. Minimal improvement of nurses' motivational interviewing skills in routine diabetes care one year after training: a cluster randomized trial. BMC FAMILY PRACTICE 2013; 14:44. [PMID: 23537327 PMCID: PMC3637576 DOI: 10.1186/1471-2296-14-44] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 03/21/2013] [Indexed: 05/06/2024]
Abstract
BACKGROUND The effectiveness of nurse-led motivational interviewing (MI) in routine diabetes care in general practice is inconclusive. Knowledge about the extent to which nurses apply MI skills and the factors that affect the usage can help to understand the black box of this intervention. The current study compared MI skills of trained versus non-trained general practice nurses in diabetes consultations. The nurses participated in a cluster randomized trial in which a comprehensive program (including MI training) was tested on improving clinical parameters, lifestyle, patients' readiness to change lifestyle, and quality of life. METHODS Fifty-eight general practices were randomly assigned to usual care (35 nurses) or the intervention (30 nurses). The ratings of applying 24 MI skills (primary outcome) were based on five consultation recordings per nurse at baseline and 14 months later. Two judges evaluated independently the MI skills and the consultation characteristics time, amount of nurse communication, amount of lifestyle discussion and patients' readiness to change. The effect of the training on the MI skills was analysed with a multilevel linear regression by comparing baseline and the one-year follow-up between the interventions with usual care group. The overall effect of the consultation characteristics on the MI skills was studied in a multilevel regression analyses. RESULTS At one year follow up, it was demonstrated that the nurses improved on 2 of the 24 MI skills, namely, "inviting the patient to talk about behaviour change" (mean difference=0.39, p=0.009), and "assessing patient's confidence in changing their lifestyle" (mean difference=0.28, p=0.037). Consultation time and the amount of lifestyle discussion as well as the patients' readiness to change health behaviour was associated positively with applying MI skills. CONCLUSIONS The maintenance of the MI skills one year after the training program was minimal. The question is whether the success of MI to change unhealthy behaviour must be doubted, whether the technique is less suitable for patients with a complex chronic disease, such as diabetes mellitus, or that nurses have problems with the acquisition and maintenance of MI skills in daily practice. Overall, performing MI skills during consultation increases, if there is more time, more lifestyle discussion, and the patients show more readiness to change. TRIAL REGISTRATION Current Controlled Trials ISRCTN68707773.
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Affiliation(s)
- Renate Jansink
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - Jozé Braspenning
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - Miranda Laurant
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - Ellen Keizer
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - Glyn Elwyn
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park CF14 4XN, Wales, UK
| | - Trudy van der Weijden
- Department of General Practice, Caphri School for Primary Care and Public Health, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Richard Grol
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
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213
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Noordman J, de Vet E, van der Weijden T, van Dulmen S. Motivational interviewing within the different stages of change: an analysis of practice nurse-patient consultations aimed at promoting a healthier lifestyle. Soc Sci Med 2013; 87:60-7. [PMID: 23631779 DOI: 10.1016/j.socscimed.2013.03.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 11/07/2012] [Accepted: 03/15/2013] [Indexed: 11/16/2022]
Abstract
Combining the Stages of Change (SOC) model with Motivational Interviewing (MI) is seen as a helpful strategy for health care providers to guide patients in changing unhealthy lifestyle behaviour. SOC suggests that people are at different stages of motivational readiness for engaging in health behaviours and that intervention methods are most useful when tailored to a person's stage of change. However, it is unknown whether practice nurses (PNs) actually adapt their MI and more generic communication skills to a particular stage during real-life face-to-face consultations with their patients. The aim of this study was to explore whether and how PNs apply MI and general communication skills to the different SOC of patients, targeting behaviour change about smoking, alcohol use, dietary habits and/or physical activity. Real-life consultations between nineteen Dutch PNs and 103 patients were recorded on video between June 2010 and March 2011. All consultations focused on a discussion of patients' lifestyle behaviour. The Behaviour Change Counselling Index (BECCI) was used to code PNs' MI skills. Generic communication skills were rated with the MAAS-global. Patients' SOC was assessed for each consultation by observing the communication between patient and PN regarding the patient's current lifestyle behaviour. Multilevel analyses revealed that PNs adapt their MI skills to a patient's SOC to some extent. On average PNs apply MI skills more to patients in the preparation stage (P < 0.05) than during the other stages of change. PNs adjusted three MI skills and one generic communication skill to patients' SOC. This explorative study suggests that, at least to some extent, PNs intuitively assess the stage of patients' readiness to change and tailor their communication accordingly. However, differences between the stages were small. By teaching PNs to explicitly identify patients' SOC they could further enhance and adapt their MI and general communication skills to the individual.
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Affiliation(s)
- Janneke Noordman
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, The Netherlands.
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214
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McGowan P. The challenge of integrating self-management support into clinical settings. Can J Diabetes 2013; 37:45-50. [PMID: 24070748 DOI: 10.1016/j.jcjd.2013.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/03/2013] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
Abstract
Best practice diabetes mellitus clinical treatment and education takes place in the medical clinic, however, patient outcomes are largely mediated through their own behaviour and lifestyle that occurs after they leave the clinical setting. Once they return home, people usually continue to engage in the social, cultural and lifestyle behaviours that had contributed to having diabetes in the first place. Although a host of factors (e.g. economic, health care team and system, condition and client-related) can impact a client's capacity to self-manage, there are client, organizational and community level strategies that may partially mitigate these difficulties. To address client behaviour, clinicians are increasingly becoming skilled to incorporate self-management support including behavioural counselling interventions into routine practice. At the organizational level, the operation and structure of the clinical setting may create difficulty for staff to provide self-management support. Sustaining benefits on a day-to-day basis presents an additional challenge. This article will review several common implementation barriers to self-management support and describe strategies and techniques used elsewhere to successfully integrate self-management support as a core care component for persons with diabetes.
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Affiliation(s)
- Patrick McGowan
- Professor, School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada.
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215
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Wong EMY, Cheng MMH. Effects of motivational interviewing to promote weight loss in obese children. J Clin Nurs 2013; 22:2519-30. [DOI: 10.1111/jocn.12098] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Emmy MY Wong
- Department of Health and Physical Education; The Hong Kong Institute of Education; Hong Kong SAR China
| | - May MH Cheng
- Department of Science and Environmental Studies; The Hong Kong Institute of Education; Tai Po New Territories Hong Kong China
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216
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van Beelen MEJ, Vogel I, Beirens TMJ, Kloek GC, den Hertog P, van der Veen MD, Raat H. Web-Based eHealth to Support Counseling in Routine Well-Child Care: Pilot Study of E-health4Uth Home Safety. JMIR Res Protoc 2013; 2:e9. [PMID: 23611794 PMCID: PMC3628163 DOI: 10.2196/resprot.1862] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 07/13/2012] [Accepted: 09/24/2012] [Indexed: 11/25/2022] Open
Abstract
Background Providing safety education to parents of young children is important in the prevention of unintentional injuries in or around the home. We developed a Web-based, tailored safety advice module to support face-to-face counseling in the setting of preventive youth health care (E-health4Uth home safety) in order to improve the provision of safety information for parents of young children. Objective This pilot study evaluated a Web-based, tailored safety advice module (E-health4Uth home safety) and evaluated the use of E-health4Uth home safety to support counseling in routine well-child care visits. Methods From a preventive youth health care center, 312 parents with a child aged 10-31 months were assigned to the E-health4Uth home safety condition or to the care-as-usual condition (provision of a generic safety information leaflet). All parents completed a questionnaire either via the Internet or paper-and-pencil, and parents in the E-health4Uth condition received tailored home safety advice either online or by a print that was mailed to their home. This tailored home safety advice was used to discuss the safety of their home during the next scheduled well-child visit. Parents in the care-as-usual condition received a generic safety information leaflet during the well-child visit. Results Mean age of the parents was 32.5 years (SD 5.4), 87.8% (274/312) of participants were mothers; mean age of the children was 16.9 months (SD 5.1). In the E-health4Uth condition, 38.4% (61/159) completed the online version of the questionnaire (allowing Web-based tailored safety advice), 61.6% (98/159) preferred to complete the questionnaire via paper (allowing only a hardcopy of the advice to be sent by regular mail). Parents in the E-health4Uth condition evaluated the Web-based, tailored safety advice (n=61) as easy to use (mean 4.5, SD 0.7), pleasant (mean 4.0, SD 0.9), reliable (mean 4.6, SD 0.6), understandable (mean 4.6, SD 0.5), relevant (mean 4.2, SD 0.9), and useful (mean 4.3, SD 0.8). After the well-child visit, no significant differences were found between the E-health4Uth condition and care-as-usual condition with regard to the satisfaction with the information received (n=61, P=.51). Health care professionals (n=43) rated the tailored safety advice as adequate (mean 4.0, SD 0.4) and useful (mean 3.9, SD 0.4). Conclusions Less than half of the parents accepted the invitation to complete a Web-based questionnaire to receive online tailored safety advice prior to a face-to-face consultation. Despite wide access to the Internet, most parents preferred to complete questionnaires using paper-and-pencil. In the subgroup that completed E-health4Uth home safety online, evaluations of E-health4Uth home safety were positive. However, satisfaction scores with regard to tailored safety advice were not different from those with regard to generic safety information leaflets.
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ter Huurne ED, Postel MG, de Haan HA, Drossaert CHC, DeJong CAJ. Web-based treatment program using intensive therapeutic contact for patients with eating disorders: before-after study. J Med Internet Res 2013; 15:e12. [PMID: 23380291 PMCID: PMC3636210 DOI: 10.2196/jmir.2211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/17/2012] [Accepted: 10/24/2012] [Indexed: 12/18/2022] Open
Abstract
Background Although eating disorders are common in the Netherlands, only a few patients are treated by mental health care professionals. To reach and treat more patients with eating disorders, Tactus Addiction Treatment developed a web-based treatment program with asynchronous and intensive personalized communication between the patient and the therapist. Objective This pilot study evaluated the web-based treatment program using intensive therapeutic contact in a population of 165 patients with an eating disorder. Methods In a pre-post design with 6-week and 6-month follow-ups, eating disorder psychopathology, body dissatisfaction, Body Mass Index, physical and mental health, and quality of life were measured. The participant’s satisfaction with the web-based treatment program was also studied. Attrition data were collected, and participants were classified as noncompleters if they did not complete all 10 assignments of the web-based treatment program. Differences in baseline characteristics between completers and noncompleters were studied, as well as reasons for noncompletion. Furthermore, differences in treatment effectiveness, treatment adherence, and baseline characteristics between participants of the three major eating disorder diagnostic groups EDNOS (n=115), BN purging (n=24), and BN nonpurging (n=24) were measured. Results Of the 165 participants who started the web-based treatment program, 89 participants (54%) completed all of the program assignments (completers) and 76 participants (46%) ended the program prematurely (noncompleters). Severe body dissatisfaction and physical and mental health problems seemed to have a negative impact on the completion of the web-based treatment program. Among the participants who completed the treatment program, significant improvements were found in eating disorder psychopathology (F=54.6, df = 68, P<.001, d=1.14). Body dissatisfaction, quality of life, and physical and mental health also significantly improved, and almost all of these positive effects were sustained up to 6 months after the participants had completed the web-based treatment program. Body Mass Index improved only within the group of participants suffering from obesity. The improvement in eating disorder psychopathology occurred in all three eating disorder diagnostic groups, and the percentage of completers did not differ significantly between these groups. Participants’ satisfaction with the treatment program, as well as with their therapist, was high, and participants indicated that they would recommend the program to other patients with eating disorders. Conclusions The results of this study suggest that the web-based treatment program has the potential to improve eating disorder psychopathology in patients with different types of eating disorders.
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Behaviour Change Counselling—How Do I Know If I Am Doing It Well? The Development of the Behaviour Change Counselling Scale (BCCS). Can J Diabetes 2013; 37:18-26. [DOI: 10.1016/j.jcjd.2013.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 01/08/2013] [Accepted: 01/08/2013] [Indexed: 11/23/2022]
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Wu SFV, Huang YC, Lee MC, Wang TJ, Tung HH, Wu MP. Self-efficacy, self-care behavior, anxiety, and depression in Taiwanese with type 2 diabetes: A cross-sectional survey. Nurs Health Sci 2013; 15:213-9. [PMID: 23301516 DOI: 10.1111/nhs.12022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 10/24/2012] [Accepted: 10/29/2012] [Indexed: 11/29/2022]
Abstract
The relationships between self-efficacy, self-care behavior, anxiety, and depression for Taiwanese individuals with type 2 diabetes were determined in this study. Depression and anxiety are common symptoms that can contribute toward adverse medical outcomes. A descriptive, cross-sectional, correlational design was used. The sample comprised 201 patients with type 2 diabetes from diabetes outpatient clinics at three teaching hospitals in Taiwan. The results of this study revealed that people with diabetes who had received diabetes health education, regularly made clinical visits, underwent treatment, and did not smoke demonstrated a high self-efficacy score (P < 0.05). Self-efficacy among people with diabetes positively correlated with illness duration (P < 0.05), treatment (P < 0.01), and self-care behavior (P < 0.01). Self-efficacy among people with diabetes negatively correlated with anxiety and depression (P < 0.01). Self-efficacy can be a predictor of anxiety and depression (P < 0.01). This study revealed that enhancing self-efficacy levels might reduce anxiety and depression. Self-efficacy-enhancing programs should be held regularly in clinical practices. Conducting psychological research on diabetes drives policy and healthcare system change.
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Affiliation(s)
- Shu-Fang Vivienne Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Yi-Ching Huang
- Department of Exercise and Health Science, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Mei-Chen Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Heng-Hsin Tung
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Meng-Ping Wu
- Department of Nursing, Taipei City Hospital, Taipei, Taiwan
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Wouda JC, van de Wiel HBM. Education in patient-physician communication: how to improve effectiveness? PATIENT EDUCATION AND COUNSELING 2013; 90:46-53. [PMID: 23068910 DOI: 10.1016/j.pec.2012.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 08/30/2012] [Accepted: 09/16/2012] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Despite educational efforts expertise in communication as required by the CanMEDS competency framework is not achieved by medical students and residents. Several factors complicate the learning of professional communication. METHODS We adapted the reflective-impulsive model of social behaviour to explain the complexities of learning professional communication behaviour. We formulated recommendations for the learning objectives and teaching methods of communication education. Our recommendations are based on the reflective-impulsive model and on the model of deliberate practice which complements the reflective-impulsive model. Our recommendations are substantiated by those we found in the literature. RESULTS The reflective-impulsive model explains why the results of communication education fall below expectations and how expertise in communication can be attained by deliberate practice. The model of deliberate practice specifies learning conditions which are insufficiently fulfilled in current communication programmes. CONCLUSION The implementation of our recommendations would require a great deal of effort. Therefore we doubt whether expertise in professional communication can be fully attained during medical training. PRACTICE IMPLICATIONS We propose that the CanMEDS communication competencies not be regarded as endpoints in medical education but as guidelines to improve communication competency through deliberate practice throughout a professional career.
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Affiliation(s)
- Jan C Wouda
- Wenckebach Institute, University of Groningen, University Medical Center, Groningen, The Netherlands.
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Broekhuizen K, van Poppel MNM, Koppes LL, Kindt I, Brug J, van Mechelen W. Can multiple lifestyle behaviours be improved in people with familial hypercholesterolemia? Results of a parallel randomised controlled trial. PLoS One 2012; 7:e50032. [PMID: 23251355 PMCID: PMC3520968 DOI: 10.1371/journal.pone.0050032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 10/15/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of an individualised tailored lifestyle intervention on physical activity, dietary intake, smoking and compliance to statin therapy in people with Familial Hypercholesterolemia (FH). METHODS Adults with FH (n = 340) were randomly assigned to a usual care control group or an intervention group. The intervention consisted of web-based tailored lifestyle advice and face-to-face counselling. Physical activity, fat, fruit and vegetable intake, smoking and compliance to statin therapy were self-reported at baseline and after 12 months. Regression analyses were conducted to examine between-group differences. Intervention reach, dose and fidelity were assessed. RESULTS In both groups, non-significant improvements in all lifestyle behaviours were found. Post-hoc analyses showed a significant decrease in saturated fat intake among women in the intervention group (β = -1.03; CI -1.98/-0.03). In the intervention group, 95% received a log on account, of which 49% logged on and completed one module. Nearly all participants received face-to-face counselling and on average, 4.2 telephone booster calls. Intervention fidelity was low. CONCLUSIONS Individually tailored feedback is not superior to no intervention regarding changes in multiple lifestyle behaviours in people with FH. A higher received dose of computer-tailored interventions should be achieved by uplifting the website and reducing the burden of screening questionnaires. Counsellor training should be more extensive. TRIAL REGISTRATION Dutch Trial Register NTR1899.
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Affiliation(s)
- Karen Broekhuizen
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mireille N. M. van Poppel
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Lando L. Koppes
- Division of Work and Employment, TNO, Hoofddorp, The Netherlands
| | - Iris Kindt
- Foundation for the Identification of Persons with Inherited Hypercholesterolemia, Amsterdam, The Netherlands
| | - Johannes Brug
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Willem van Mechelen
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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Rotheram-Borus MJ, Ingram BL, Swendeman D, Lee A. Adoption of self-management interventions for prevention and care. Prim Care 2012; 39:649-60. [PMID: 23148958 PMCID: PMC3990217 DOI: 10.1016/j.pop.2012.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Seventy-five percent of health care costs can be attributed to chronic diseases, making prevention and management imperative. Collaborative patient self-management in primary care is efficacious in reducing symptoms and increasing quality of life. In this article, the authors argue that self-management interventions span the continuum of prevention and disease management. Self-management interventions rest on a foundation of 5 core actions: (1) activate motivation to change, (2) apply domain-specific information from education and self-monitoring, (3) develop skills, (4) acquire environmental resources, and (5) build social support. Several delivery vehicles are described and evaluated in terms of diffusion and cost-containment goals.
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Affiliation(s)
- Mary Jane Rotheram-Borus
- Global Center for Children and Families, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA 90024-6521, USA.
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Cate H, Bhattacharya D, Clark A, Fordham R, Notley C, Broadway DC. Protocol for a randomised controlled trial to estimate the effects and costs of a patient centred educational intervention in glaucoma management. BMC Ophthalmol 2012; 12:57. [PMID: 23171166 PMCID: PMC3536708 DOI: 10.1186/1471-2415-12-57] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 11/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor glaucoma education is thought to be a causative factor of non-adherence to glaucoma therapy. However, the multi-factorial nature of non-adherent behaviour may explain the failure of purely educational interventions to achieve significant improvement in adherence. Behaviour Change Counselling (BCC) allows both the imparting of information and assessment of patient ambivalence to medication use and may elicit behaviour change in order to achieve better adherence. The chronic and complex nature of glaucoma means that patient non-adherence to glaucoma therapy does not easily correlate with measureable objective clinical endpoints. However, electronic medication monitoring offers an objective method of measuring adherence without reliance on clinical endpoints. METHODS/DESIGN The study is a randomised controlled trial (RCT) with glaucoma (open angle) or ocular hypertension patients attending a glaucoma clinic and prescribed travoprost. The study will determine whether additional glaucoma education using BCC is beneficial and cost effective in improving adherence with glaucoma therapy. An 8-month follow-up period, using an electronic adherence monitoring device (Travalert dosing aid, TDA), will indicate if the intervention is likely to be sustained in the longer term. Additionally, a cost-effectiveness framework will be used to estimate the cost benefit of improving adherence. The development of a novel intervention to deliver glaucoma education using BCC required practitioner training and fidelity testing. Five practitioners were successfully trained to become Glaucoma Support Assistants able to deliver the BCC intervention. The research group had prior clinical and investigative experience in this setting, and used multiple strategies to design a method to address the study objectives. DISCUSSION This RCT, using BCC to improve adherence to ocular hypotensive therapy, to our knowledge is the first within this disease area. Using a variety of adherence measures allows examination of the known inaccuracies of patient self-report with respect to glaucoma medication. The novel BCC component has undergone fidelity testing using BECCI and the BCC template will ensure conformity to a standardised intervention. TRIAL REGISTRATION Current Controlled Trials: ISRCTN89683704.
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Affiliation(s)
- Heidi Cate
- Ophthalmology, Norfolk & Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, UK.
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Noordman J, van der Weijden T, van Dulmen S. Communication-related behavior change techniques used in face-to-face lifestyle interventions in primary care: a systematic review of the literature. PATIENT EDUCATION AND COUNSELING 2012; 89:227-244. [PMID: 22878028 DOI: 10.1016/j.pec.2012.07.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/23/2012] [Accepted: 07/10/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To systematically review the literature on the relative effectiveness of face-to-face communication-related behavior change techniques (BCTs) provided in primary care by either physicians or nurses to intervene on patients' lifestyle behavior. METHODS PubMed, EMBASE, PsychINFO, CINAHL and The Cochrane Library were searched for studies published before October 2010. Fifty studies were included and assessed on methodological quality. RESULTS Twenty-eight studies reported significantly favorable health outcomes following communication-related BCTs. In these studies, 'behavioral counseling' was most frequently used (15 times), followed by motivational interviewing (eight times), education and advice (both seven times). Physicians and nurses seem equally capable of providing face-to-face communication-related BCTs in primary care. CONCLUSION Behavioral counseling, motivational interviewing, education and advice all seem effective communication-related BCTs. However, BCTs were also found in less successful studies. Furthermore, based on existing literature, one primary care profession does not seem better equipped than the other to provide face-to-face communication-related BCTs. PRACTICE IMPLICATIONS There is evidence that behavioral counseling, motivational interviewing, education and advice can be used as effective communication-related BCTs by physicians and nurses. However, further research is needed to examine the underlying working mechanisms of communication-related BCTs, and whether they meet the requirements of patients and primary care providers.
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Affiliation(s)
- Janneke Noordman
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
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DeBate RD, Cragun D, Gallentine AA, Severson HH, Shaw T, Cantwell C, Christiansen S, Koerber A, Hendricson W, Tomar SL, McCormack Brown K, Tedesco LA. Evaluate, assess, treat: development and evaluation of the EAT framework to increase effective communication regarding sensitive oral-systemic health issues. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2012; 16:232-8. [PMID: 23050505 PMCID: PMC3471784 DOI: 10.1111/j.1600-0579.2012.00747.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Oral healthcare providers are likely to encounter a number of sensitive oral/systemic health issues whilst interacting with patients. The purpose of the current study was to develop and evaluate a framework aimed at oral healthcare providers to engage in active secondary prevention of eating disorders (i.e. early detection of oral manifestations of disordered eating behaviours, patient approach and communication, patient-specific oral treatment, and referral to care) for patients presenting with signs of disordered eating behaviours. The EAT Framework was developed based on the Brief Motivational Interviewing (B-MI) conceptual framework and comprises three continuous steps: Evaluating, Assessing, and Treating. Using a group-randomized control design, 11 dental hygiene (DH) and seven dental (D) classes from eight institutions were randomized to either the intervention or control conditions. Both groups completed pre- and post-intervention assessments. Hierarchical linear models were conducted to measure the effects of the intervention whilst controlling for baseline levels. Statistically significant improvements from pre- to post-intervention were observed in the Intervention group compared with the Control group on knowledge of eating disorders and oral findings, skills-based knowledge, and self-efficacy (all P < 0.01). Effect sizes ranged from 0.57 to 0.95. No statistically significant differences in outcomes were observed by type of student. Although the EAT Framework was developed as part of a larger study on secondary prevention of eating disorders, the procedures and skills presented can be applied to other sensitive oral/systemic health issues. Because the EAT Framework was developed by translating B-MI principles and procedures, the framework can be easily adopted as a non-confrontational method for patient communication.
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Affiliation(s)
- R D DeBate
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL 33612, USA.
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Current knowledge and future directions about the disclosure of dementia: A systematic review of the first decade of the 21st century. Alzheimers Dement 2012; 9:e74-88. [PMID: 23098912 DOI: 10.1016/j.jalz.2012.02.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 02/16/2012] [Accepted: 02/29/2012] [Indexed: 11/22/2022]
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Zwikker H, van den Bemt B, van den Ende C, van Lankveld W, den Broeder A, van den Hoogen F, van de Mosselaar B, van Dulmen S. Development and content of a group-based intervention to improve medication adherence in non-adherent patients with rheumatoid arthritis. PATIENT EDUCATION AND COUNSELING 2012; 89:143-151. [PMID: 22878029 DOI: 10.1016/j.pec.2012.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To describe the systematic development and content of a short intervention to improve medication adherence to disease-modifying anti-rheumatic drugs in non-adherent patients with rheumatoid arthritis (RA). METHODS The intervention mapping (IM) framework was used to develop the intervention. The following IM steps were conducted: (1) a needs assessment; (2) formulation of specific intervention objectives; (3) inventory of methods and techniques needed to design the intervention and (4) production and piloting of the intervention. RESULTS The intervention (consisting of two group sessions led by a pharmacist, a homework assignment, and a follow-up call) aims to improve the balance between necessity and concern beliefs about medication, and to resolve practical barriers in medication taking. The central communication method used is motivational interviewing. CONCLUSION By applying the IM framework, we were able to create a feasible, time-efficient and promising intervention to improve medication adherence in non-adherent RA patients. Intervention effects are currently being assessed in a randomized controlled trial. PRACTICE IMPLICATIONS This paper could serve as a guideline for other health care professionals when developing similar interventions. If the RCT demonstrates sufficient effectiveness of this intervention in reducing medication non-adherence in RA patients, the intervention could be embedded in clinical practice.
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Affiliation(s)
- Hanneke Zwikker
- Department of Rheumatology and Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.
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Paavilainen E, Salminen-Tuomaala M, Leikkola P. Counselling for patients and family members: a follow-up study in the emergency department. ISRN NURSING 2012; 2012:303790. [PMID: 23008782 PMCID: PMC3447345 DOI: 10.5402/2012/303790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/18/2012] [Indexed: 11/24/2022]
Abstract
Although the research indicates that patients and family members are not fully satisfied with the counselling they receive, little is known about the quality of counselling in more detail. The purpose of the study was to describe patients' and their family members' experiences about counselling in emergency department, and follow how these experiences possibly change after the educational intervention for the whole nursing staff of the ED ward. The pre-test-post-test follow-up design was implemented including online continuing education for ED staff. The data were collected via questionnaires from patients and their family members in two phases and analyzed statistically. After online education of staff, experiences of patients and family members concerning counselling were better than before the education. Especially, family members' satisfaction had increased. However, our results also indicated that patients and family members desire more information for example, regarding medications. Care practices had developed towards family-centeredness, which patients and family members appreciate. Online education proved also in some degree its usefulness in educating ED staff, by offering the same education to a staff which works in shifts. Furthermore, family presence and participation practices should be developed by offering possibilities for families to stay with each other on ED ward.
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Affiliation(s)
- Eija Paavilainen
- Nursing Science, Research Collegium, School of Health Sciences, University of Tampere, Etelä-Pohjanmaa Hospital District, 33014 Tampere, Finland
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Bean MK, Biskobing D, Francis GL, Wickham E. Motivational interviewing in health care: results of a brief training in endocrinology. J Grad Med Educ 2012; 4:357-61. [PMID: 23997882 PMCID: PMC3444191 DOI: 10.4300/jgme-d-11-00166.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 02/03/2012] [Accepted: 02/06/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite the importance of lifestyle change in disease management and the growing evidence supporting motivational interviewing (MI) as an effective counseling method to promote behavioral change, to date there are few published reports about MI training in graduate medical education. OBJECTIVE The study aimed to pilot the feasibility and effectiveness of a brief MI training intervention for endocrinology fellows and other providers. METHODS We used a pretest/posttest design to evaluate a brief MI training for 5 endocrinology fellows and 9 other providers. All participants completed subjective assessments of perceived confidence and beliefs about behavioral counseling at pretest and posttest. Objective assessment of MI was conducted using fellows' audiotaped patient encounters, which were coded using a validated tool for adherence to MI before and after the training. Paired t tests examined changes in objective and subjective assessments. RESULTS The training intervention was well received and feasible in the endocrinology setting. At posttest, participants reported increased endorsement of the MI spirit and improved confidence in MI skills. Objective assessment revealed relative improvements in MI skills across several domains. However, most domains, as assessed by a validated tool, did not reach competency level after the training intervention. CONCLUSIONS Although more intensive training may be needed to develop MI competence, the results of our pilot study suggest that brief, targeted MI training has short-term efficacy and is well received by endocrinology fellows and other providers.
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Hjalmarson HV, Strandmark K. M. Forming a learning culture to promote fracture prevention activities. HEALTH EDUCATION 2012. [DOI: 10.1108/09654281211253434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chilton R, Pires-Yfantouda R, Wylie M. A systematic review of motivational interviewing within musculoskeletal health. PSYCHOL HEALTH MED 2012; 17:392-407. [DOI: 10.1080/13548506.2011.635661] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Broekhuizen K, van Poppel MNM, Koppes LL, Kindt I, Brug J, van Mechelen W. No significant improvement of cardiovascular disease risk indicators by a lifestyle intervention in people with familial hypercholesterolemia compared to usual care: results of a randomised controlled trial. BMC Res Notes 2012; 5:181. [PMID: 22490761 PMCID: PMC3392724 DOI: 10.1186/1756-0500-5-181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 04/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with Familial Hypercholesterolemia (FH) may benefit from lifestyle changes supporting their primary treatment of dyslipidaemia. This project evaluated the efficacy of an individualised tailored lifestyle intervention on lipids (low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and triglycerides), systolic blood pressure, glucose, body mass index (BMI) and waist circumference in people with FH. METHODS Adults with FH (n = 340), recruited from a Dutch cascade screening program, were randomly assigned to either a control group or an intervention group. The personalised intervention consisted of web-based tailored lifestyle advice and personal counselling. The control group received care as usual. Lipids, systolic blood pressure, glucose, BMI, and waist circumference were measured at baseline and after 12 months. Regression analyses were conducted to examine differences between both groups. RESULTS After 12 months, no significant between-group differences of cardiovascular disease (CVD) risk indicators were observed. LDL-C levels had decreased in both the intervention and control group. This difference between intervention and control group was not statistically significant. CONCLUSIONS This project suggests that an individually tailored lifestyle intervention did not have an additional effect in improving CVD risk indicators among people with FH. The cumulative effect of many small improvements in all indicators on long term CVD risk remains to be assessed in future studies. TRIAL REGISTRATION NTR1899 at ww.trialregister.nl.
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Affiliation(s)
- Karen Broekhuizen
- Department of Public and Occupational Health, EMGO+Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Pirlott AG, Kisbu-Sakarya Y, DeFrancesco CA, Elliot DL, MacKinnon DP. Mechanisms of motivational interviewing in health promotion: a Bayesian mediation analysis. Int J Behav Nutr Phys Act 2012; 9:69. [PMID: 22681874 PMCID: PMC3439244 DOI: 10.1186/1479-5868-9-69] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 03/26/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Counselor behaviors that mediate the efficacy of motivational interviewing (MI) are not well understood, especially when applied to health behavior promotion. We hypothesized that client change talk mediates the relationship between counselor variables and subsequent client behavior change. METHODS Purposeful sampling identified individuals from a prospective randomized worksite trial using an MI intervention to promote firefighters' healthy diet and regular exercise that increased dietary intake of fruits and vegetables (n = 21) or did not increase intake of fruits and vegetables (n = 22). MI interactions were coded using the Motivational Interviewing Skill Code (MISC 2.1) to categorize counselor and firefighter verbal utterances. Both Bayesian and frequentist mediation analyses were used to investigate whether client change talk mediated the relationship between counselor skills and behavior change. RESULTS Counselors' global spirit, empathy, and direction and MI-consistent behavioral counts (e.g., reflections, open questions, affirmations, emphasize control) significantly correlated with firefighters' total client change talk utterances (rs = 0.42, 0.40, 0.30, and 0.61, respectively), which correlated significantly with their fruit and vegetable intake increase (r = 0.33). Both Bayesian and frequentist mediation analyses demonstrated that findings were consistent with hypotheses, such that total client change talk mediated the relationship between counselor's skills--MI-consistent behaviors [Bayesian mediated effect: αβ = .06 (.03), 95% CI = .02, .12] and MI spirit [Bayesian mediated effect: αβ = .06 (.03), 95% CI = .01, .13]--and increased fruit and vegetable consumption. CONCLUSION Motivational interviewing is a resource- and time-intensive intervention, and is currently being applied in many arenas. Previous research has identified the importance of counselor behaviors and client change talk in the treatment of substance use disorders. Our results indicate that similar mechanisms may underlie the effects of MI for dietary change. These results inform MI training and application by identifying those processes critical for MI success in health promotion domains.
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Affiliation(s)
- Angela G Pirlott
- Department of Psychology, Arizona State University, Tempe, AZ, 85287-1104, USA
| | | | - Carol A DeFrancesco
- Division of Health Promotion and Sports Medicine; Department of Medicine, Oregon Health & Science University, Portland, OR, 97239-3098, USA
| | - Diane L Elliot
- Division of Health Promotion and Sports Medicine; Department of Medicine, Oregon Health & Science University, Portland, OR, 97239-3098, USA
| | - David P MacKinnon
- Department of Psychology, Arizona State University, Tempe, AZ, 85287-1104, USA
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Homan G, Litt J, Norman RJ. The FAST study: Fertility ASsessment and advice Targeting lifestyle choices and behaviours: a pilot study. Hum Reprod 2012; 27:2396-404. [DOI: 10.1093/humrep/des176] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Broekhuizen K, Jelsma JGM, van Poppel MNM, Koppes LLJ, Brug J, van Mechelen W. Is the process of delivery of an individually tailored lifestyle intervention associated with improvements in LDL cholesterol and multiple lifestyle behaviours in people with familial hypercholesterolemia? BMC Public Health 2012; 12:348. [PMID: 22583789 PMCID: PMC3487747 DOI: 10.1186/1471-2458-12-348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 05/04/2012] [Indexed: 11/26/2022] Open
Abstract
Background More insight in the association between reach, dose and fidelity of intervention components and effects is needed. In the current study, we aimed to evaluate reach, dose and fidelity of an individually tailored lifestyle intervention in people with Familial Hypercholesterolemia (FH) and the association between intervention dose and changes in LDL-Cholesterol (LDL-C), and multiple lifestyle behaviours at 12-months follow-up. Methods Participants (n = 181) randomly allocated to the intervention group received the PRO-FIT intervention consisting of computer-tailored lifestyle advice (PRO-FIT*advice) and counselling (face-to-face and telephone booster calls) using Motivational Interviewing (MI). According to a process evaluation plan, intervention reach, dose delivered and received, and MI fidelity were assessed using the recruitment database, website/counselling logs and the Motivational Interviewing Treatment Integrity (MITI 3.1.1.) code. Regression analyses were conducted to explore differences between participant and non-participant characteristics, and the association between intervention dose and change in LDL-C, and multiple lifestyle behaviours. Results A 34% (n = 181) representative proportion of the intended intervention group was reached during the recruitment phase; participants did not differ from non-participants (n = 623) on age, gender and LDL-C levels. Of the participants, 95% received a PRO-FIT*advice log on account, of which 49% actually logged on and completed at least one advice module. Nearly all participants received a face-to-face counselling session and on average, 4.2 telephone booster calls were delivered. None of the face-to-face sessions were implemented according to MI guidelines. Overall, weak non-significant positive associations were found between intervention dose and LDL-C and lifestyle behaviours. Conclusions Implementation of the PRO-FIT intervention in practice appears feasible, particularly PRO-FIT*advice, since it can be relative easily implemented with a high dose delivered. However, only less than half of the intervention group received the complete intervention-package as intended. Strategies to let participants optimally engage in using web-based computer-tailored interventions like PRO-FIT*advice are needed. Further, more emphasis should be put on more extensive MI training and monitoring/supervision. Trial registration NTR1899 at ww.trialregister.nl.
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Affiliation(s)
- Karen Broekhuizen
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
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Vriezekolk JE, Geenen R, van den Ende CHM, Slot H, van Lankveld WGJM, van Helmond T. Behavior change, acceptance, and coping flexibility in highly distressed patients with rheumatic diseases: feasibility of a cognitive-behavioral therapy in multimodal rehabilitation. PATIENT EDUCATION AND COUNSELING 2012; 87:171-177. [PMID: 21978928 DOI: 10.1016/j.pec.2011.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 08/30/2011] [Accepted: 09/01/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To describe the development and feasibility of the integration of a cognitive-behavioral therapy (CBT) within a multimodal rehabilitation program for highly distressed patients with rheumatic diseases. METHODS Development included the detailed specification of the theoretical and empirical-based underpinnings of the CBT and the comprehensive description of its design and content. Feasibility was assessed by percentage of eligible patients, attrition and attendance rates, and patient satisfaction. RESULTS The developed CBT component seeks to decrease psychological distress and improve activities and participation across multiple life domains by accomplishing behavior change, acceptance, and coping flexibility. Motivational interviewing was applied to endorse patients' own reasons to change. Forty percent (35/87) of the eligible patients were admitted to the program. Attendance rate (>95%) was high. Patient satisfaction ranged from 6.8 to 8.0 (10-point scale). CONCLUSION Integrating CBT within a multimodal rehabilitation program is feasible. An acceptable proportion of the intended patient sample is eligible and patient's attendance and satisfaction is high. PRACTICE IMPLICATIONS Patients with impaired physical and psychosocial functioning despite adequate medical treatment pose a great challenge. Their treatment outcome may be improved by screening and selecting highly distressed patients and offering them a CBT embedded in multimodal rehabilitation program.
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Finset A. Comprehensive and interdisciplinary patient education and counseling programs for highly distressed patients with rheumatic diseases - a need in rheumatology care and a challenge to outcome research. PATIENT EDUCATION AND COUNSELING 2012; 87:131-132. [PMID: 22546482 DOI: 10.1016/j.pec.2012.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2012] [Indexed: 05/31/2023]
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McPhail S, Schippers M. An evolving perspective on physical activity counselling by medical professionals. BMC FAMILY PRACTICE 2012; 13:31. [PMID: 22524484 PMCID: PMC3438055 DOI: 10.1186/1471-2296-13-31] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 02/23/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND Physical inactivity is a modifiable risk factor for many chronic conditions and a leading cause of premature mortality. An increasing proportion of adults worldwide are not engaging in a level of physical activity sufficient to prevent or alleviate these adverse effects. Medical professionals have been identified as potentially powerful sources of influence for those who do not meet minimum physical activity guidelines. Health professionals are respected and expected sources of advice and they reach a large and relevant proportion of the population. Despite this potential, health professionals are not routinely practicing physical activity promotion. DISCUSSION Medical professionals experience several known barriers to physical activity promotion including lack of time and lack of perceived efficacy in changing physical activity behaviour in patients. Furthermore, evidence for effective physical activity promotion by medical professionals is inconclusive. To address these problems, new approaches to physical activity promotion are being proposed. These include collaborating with community based physical activity behaviour change interventions, preparing patients for effective brief counselling during a consultation with the medical professional, and use of interactive behaviour change technology. SUMMARY It is important that we recognise the latent risk of physical inactivity among patients presenting in clinical settings. Preparation for improving patient physical activity behaviours should commence before the consultation and may include physical activity screening. Medical professionals should also identify suitable community interventions to which they can refer physically inactive patients. Outsourcing the majority of a comprehensive physical activity intervention to community based interventions will reduce the required clinical consultation time for addressing the issue with each patient. Priorities for future research include investigating ways to promote successful referrals and subsequent engagement in comprehensive community support programs to increase physical activity levels of inactive patients. Additionally, future clinical trials of physical activity interventions should be evaluated in the context of a broader framework of outcomes to inform a systematic consideration of broad strengths and weaknesses regarding not only efficacy but cost-effectiveness and likelihood of successful translation of interventions to clinical contexts.
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Affiliation(s)
- Steven McPhail
- School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Queensland, Australia
| | - Mandy Schippers
- School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Queensland, Australia
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Helmink JHM, Kremers SPJ, Van Boekel LC, Van Brussel-Visser FN, Preller L, De Vries NK. The BeweegKuur programme: a qualitative study of promoting and impeding factors for successful implementation of a primary health care lifestyle intervention for overweight and obese people. Fam Pract 2012; 29 Suppl 1:i68-i74. [PMID: 22399560 DOI: 10.1093/fampra/cmr056] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of the study was to identify promoting and impeding factors for successful implementation of a Dutch primary health care-based lifestyle programme called 'BeweegKuur'. BeweegKuur aims to increase the physical activity and change the diet of people at increased health risk due to overweight or obesity. OBJECTIVE To determine perceived promoting and impeding factors in the implementation of the BeweegKuur programme for overweight and obese people. METHODS This study consisted of 3 focus group meetings with intervention participants, 15 interviews with health care professionals (HCPs) and 1 focus group session with dieticians. The interviews and focus groups were recorded and transcribed verbatim. The data were analysed with the Nvivo qualitative research software package. RESULTS For some intervention participants, the invitation to participate in BeweegKuur came unexpectedly, as they had not been diagnosed with an illness. HCPs were aware of this and took time to explain to participants that the programme was appropriate and safe for them. Participants as well as professionals were generally positive about the feasibility of the programme for overweight and obese people. CONCLUSIONS HCPs as well as intervention participants were motivated to participate in the programme, and generally indicated that the intervention was in accordance with their needs. The multidisciplinary approach and the combination of physical activity and dietary behaviour change can make the BeweegKuur programme a success if potential impeding factors like those identified in the present study are overcome.
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Affiliation(s)
- J H M Helmink
- Department of Health Promotion, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
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Pringle JL, Kowalchuk A, Meyers JA, Seale JP. Equipping Residents to Address Alcohol and Drug Abuse: The National SBIRT Residency Training Project. J Grad Med Educ 2012; 4:58-63. [PMID: 23451308 PMCID: PMC3312535 DOI: 10.4300/jgme-d-11-00019.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 12/01/2011] [Accepted: 12/06/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Screening, Brief Intervention and Referral to Treatment (SBIRT) service for unhealthy alcohol use has been shown to be one of the most cost-effective medical preventive services and has been associated with long-term reductions in alcohol use and health care utilization. Recent studies also indicate that SBIRT reduces illicit drug use. In 2008 and 2009, the Substance Abuse Mental Health Service Administration funded 17 grantees to develop and implement medical residency training programs that teach residents how to provide SBIRT services for individuals with alcohol and drug misuse conditions. This paper presents the curricular activities associated with this initiative. METHODS We used an online survey delivery application (Qualtrics) to e-mail a survey instrument developed by the project directors of 4 SBIRT residency programs to each residency grantee's director. The survey included both quantitative and qualitative data. RESULTS All 17 (100%) grantees responded. Respondents encompassed residency programs in emergency medicine, family medicine, pediatrics, obstetrics-gynecology, psychiatry, surgery, and preventive medicine. Thirteen of 17 (76%) grantee programs used both online and in-person approaches to deliver the curriculum. All 17 grantees incorporated motivational interviewing and validated screening instruments in the curriculum. As of June 2011, 2867 residents had been trained, and project directors reported all residents were incorporating SBIRT into their practices. Consistently mentioned challenges in implementing an SBIRT curriculum included finding time in residents' schedules for the modules and the need for trained faculty to verify resident competence. CONCLUSIONS The SBIRT initiative has resulted in rapid development of educational programs and a cohort of residents who utilize SBIRT in practice. Skills verification, program dissemination, and sustainability after grant funding ends remain ongoing challenges.
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Oka RK, Conte MS, Owens CD, Rapp J, Fung G, Alley HF, Giacomini JC, Myers J, Mohler ER. Efficacy of optimal long-term management of multiple cardiovascular risk factors (CVD) on walking and quality of life in patients with peripheral artery disease (PAD): protocol for randomized controlled trial. Vasc Med 2012; 17:17-28. [PMID: 22363015 PMCID: PMC3405920 DOI: 10.1177/1358863x11430886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Peripheral artery disease (PAD) is an understudied chronic illness most prevalent in elderly individuals. PAD patients experience substantial walking impairment due to symptoms of limb ischemia that significantly diminishes quality of life (QOL). Cardiovascular disease (CVD) morbidity and mortality is increased in this population because of aggressive atherosclerosis resulting from untreated CVD risk factors. Despite current national guidelines recommending intensive CVD risk factor management for PAD patients, untreated CVD risk factors are common. Interventions that bridge this gap are imperative. The Vascular Insufficiency - Goals for Optimal Risk Reduction (VIGOR(2)) study is a randomized controlled trial (RCT) that examines the effectiveness of a long-term multifactor CVD risk reduction program on walking and quality of life in patients with PAD. The purpose of this article is to provide a detailed description of the design and methods of VIGOR(2). Clinical Trial Registration - URL: http://clinicaltrials.gov/ct2/show/NCT00537225.
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Affiliation(s)
- Roberta K Oka
- Department of Veteran's Affairs, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA.
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Exploring patient experiences with prescription medicines to identify unmet patient needs: implications for research and practice. Res Social Adm Pharm 2012; 8:321-32. [PMID: 22222341 DOI: 10.1016/j.sapharm.2011.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 08/18/2011] [Accepted: 08/18/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pharmacy services are offered to patients, and often, they decline participation. Research is needed to better understand patients' unmet needs when taking prescribed medications. OBJECTIVE To identify and characterize patients' unmet needs related to using prescribed medication for chronic conditions. METHODS Focus groups of patients using prescription medication for chronic conditions discussed their experiences with medications, starting from initial diagnosis to ongoing management. Sessions involved 40 patients from 1 Midwestern U.S. state. Major themes were identified using content analysis. RESULTS Three major themes emerged. First, patients seek information to understand their health condition and treatment rationale. Patients form an illness perception (its consequence, controllability, cause, and duration) that dictates their actions. Second, patients desire to be involved in treatment decisions, and they often feel that decisions are made for them without their understanding of the risk-to-benefit trade-off. Third, patients monitor the impact of treatment decisions to determine if anticipated outcomes are achieved. CONCLUSION The results were consistent with Dowell's therapeutic alliance model (TAM) and Leventhal's common sense model (CSM). The TAM can be used to model the consultative services between pharmacists and patients. The impact of the new services (or interventions) can be evaluated using the CSM. Patients expressed a strong desire to be involved in their treatment decisions. The effectiveness of medication therapy management services may be enhanced if pharmacists build on patients' desire to be involved in their treatment decisions and assist them to understand the role of medications and their risks and expected outcomes within the context of the patients' perceptions of illness and desired coping strategies.
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Hollis JL, Williams LT, Collins CE, Morgan PJ. Effectiveness of Interventions using Motivational Interviewing for dietary and physical activity modification in Adults: A Systematic Review. ACTA ACUST UNITED AC 2012; 10:1-12. [DOI: 10.11124/jbisrir-2012-171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Muscat AC. Ready, Set, Go: The Transtheoretical Model of Change and Motivational Interviewing for “Fringe” Clients. JOURNAL OF EMPLOYMENT COUNSELING 2011. [DOI: 10.1002/j.2161-1920.2005.tb01089.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Pollak KI, Coffman CJ, Alexander SC, Manusov JRE, Ostbye T, Tulsky JA, Lyna P, Esoimeme I, Brouwer RJN, Dolor RJ. Predictors of weight loss communication in primary care encounters. PATIENT EDUCATION AND COUNSELING 2011; 85:e175-e182. [PMID: 21474267 PMCID: PMC3154469 DOI: 10.1016/j.pec.2011.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 02/15/2011] [Accepted: 03/05/2011] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Evidence suggests that physicians' use of motivational interviewing (MI) techniques helps patients lose weight. We assessed patient, physician, relationship, and systems predictors of length of weight-loss discussions and whether physicians' used MI techniques. METHODS Forty primary care physicians and 461 of their overweight or obese patients were audio recorded and surveyed. RESULTS Weight-related topics were commonly discussed (nutrition 78%, physical activity 82%, and BMI/weight 72%). Use of MI techniques was low. A multivariable linear mixed model was fit to time spent discussing weight, adjusting for patient clustering within physician. More time was spent with obese patients (p=.0002), by African American physicians (p=.03), family physicians (p=.02), and physicians who believed patients were embarrassed to discuss weight (p=.05). Female physicians were more likely to use MI techniques (p=.02); African American physicians were more likely to use MI-inconsistent techniques (p<.001). CONCLUSION Primary care physicians routinely counsel about weight and are likely to spend more time with obese than with overweight patients. Internists spend less time on weight. Patient and systems factors do not seem to influence physicians' use MI techniques. PRACTICE IMPLICATIONS All physicians, particularly, male and African American physicians, could increase their use of MI techniques to promote more weight loss among patients.
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Martin MY, Kratt P, Kim Y, Schoenberger YM, Pisu M. 'Too much trouble for what I get out of it': acceptability of cancer screening tests among low-income rural men and women in the Deep South. Public Health 2011; 126:64-6. [PMID: 22123455 DOI: 10.1016/j.puhe.2011.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 07/22/2011] [Accepted: 09/22/2011] [Indexed: 10/14/2022]
Affiliation(s)
- M Y Martin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, MT 617, 1530 3rd Ave South, Birmingham, AL 35294-4410, United States.
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Bjerregaard L, Rubak S, Høst A, Wagner L. Alcohol consumption patterns among parents of hospitalized children: findings from a brief intervention study. Int Nurs Rev 2011. [DOI: 10.1111/j.1466-7657.2011.00930.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pengchit W, Walters ST, Simmons RG, Kohlmann W, Burt RW, Schwartz MD, Kinney AY. Motivation-based intervention to promote colonoscopy screening: an integration of a fear management model and motivational interviewing. J Health Psychol 2011; 16:1187-97. [PMID: 21464114 PMCID: PMC3162074 DOI: 10.1177/1359105311402408] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Colorectal cancer (CRC) screening rates have been low despite effectiveness of screening in reducing CRC mortality. This article outlines the theoretical background and development of an innovative, telephone-based risk communication designed to promote screening among individuals at increased risk for familial CRC. This ongoing intervention integrates the Extended Parallel Process Model of fear management and the motivational interviewing counselling style. Tailoring and implementation intentions are incorporated. The primary outcome is self-reported colonoscopy within nine months following intervention. If proven effective, the remote intervention could be broadly disseminated to individuals at increased familial CRC risk, especially those in geographically underserved areas.
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Wouda JC, Zandbelt LC, Smets EMA, van de Wiel HBM. Assessment of physician competency in patient education: reliability and validity of a model-based instrument. PATIENT EDUCATION AND COUNSELING 2011; 85:92-98. [PMID: 21075590 DOI: 10.1016/j.pec.2010.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 08/13/2010] [Accepted: 09/04/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Establish the inter-rater reliability and the concept, convergent and construct validity of an instrument for assessing the competency of physicians in patient education. METHODS Three raters assessed the quality of patient education in 30 outpatient consultations with the CELI instrument. This instrument is based on a goal-directed model of patient education and assesses distinctive skills for patient education categorized in four subcompetencies. The inter-rater reliability was calculated. The concept validity was explored by factor analysis. The convergent validity was established by a comparison with two measures of patient-centred behaviour. The construct validity was explored by relating the subcompetencies with physician gender and patient satisfaction. RESULTS The inter-rater reliability for the subcompetencies varied between 0.65 and 0.91. The factor analysis distinguished the four subcompetencies. All subcompetencies correlated with the measures of patient-centred behaviour. Female physicians performed better than male physicians on three subcompetencies. Positive correlations were found for three subcompetencies and patient satisfaction. CONCLUSION The CELI instrument appears to be a reliable and valid instrument. However, further research is needed to establish the generalizability and construct validity. PRACTICE IMPLICATION The CELI instrument is a useful tool for assessment and feedback in medical education since it assesses the performance of distinctive skills.
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Affiliation(s)
- Jan C Wouda
- Wenckebach Institute, University Medical Centre, Groningen, The Netherlands.
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Chair SY, Chan SWC, Thompson DR, Leung KP, Ng SKC, Choi KC. Short-term effect of motivational interviewing on clinical and psychological outcomes and health-related quality of life in cardiac rehabilitation patients with poor motivation in Hong Kong: a randomized controlled trial. Eur J Prev Cardiol 2011; 19:1383-92. [PMID: 21960653 DOI: 10.1177/1741826711425428] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Motivational interviewing (MI) is effective in promoting behavioural changes in patients with substance abuse and smoking. However, its effectiveness on health outcomes in cardiac rehabilitation patients is unclear. DESIGN A randomized controlled trial. METHOD A total of 146 patients assessed as having poor motivation attended a cardiac rehabilitation programme from February 2008 to June 2010. Patients (n = 73) in the control group received usual care while those in the experimental group (n = 73) received usual care plus four sessions of MI, each lasting 30-45 min. Clinical and psychological outcomes and health-related quality of life were measured at baseline and 3 months after entering the programme. Descriptive statistics, independent t-test, Pearson Chi-squared test, and generalized estimating equations models were used to analyse the data. RESULTS There was no significant difference between the two groups on clinical outcomes (all p-values >0.05). Patients in the experimental group had higher increases in health-related quality of life (SF-36) scores in the aspects of general health (4.74, 95% CI 0.04-9.44; p = 0.048) and role limitation due to emotional problems (8.80, 95% CI 1.16-16.43; p = 0.024). However, they reported significantly higher increases in anxiety levels (Hospital Anxiety and Depression Scale) than those in the control group (0.96, 95% CI 0.09-1.83; p = 0.030). CONCLUSION The short-term effectiveness of MI on clinical outcomes and health-related quality of life in poorly motivated cardiac rehabilitation patients is limited. MI, however, was shown to increase anxiety levels of patients during the study period (3 months). More evidence is needed to better understand this phenomenon in the future studies.
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