Physical activity counseling intervention at a federally qualified health center: improves autonomy-supportiveness, but not patients' perceived competence

Autonomy support in an exercise intervention with colorectal cancer patients during chemotherapy: a qualitative perspective

OBJECTIVE

Physical activity (PA) has emerged as an important element of supportive care for cancer patients, but few patients engage with exercise. Considering that autonomy support is associated with healthy lifestyles, it would be useful to know the specific autonomy-supportive techniques that can help to encourage PA in colorectal cancer (CRC) patients. This study aims to qualitatively explore autonomy support perceptions through a self-determination-theory-based exercise program (FIT-CANCER) with CRC patients during chemotherapy treatment.

METHODS AND MEASURES

A total of 27 participants were included, 16 CRC patients, six relatives, and five healthcare professionals. Qualitative data from semi-structured interviews and observational field notes were analyzed with thematic analysis.

RESULTS

Three main themes were identified: Healthcare professionals encouraging enrollment in the exercise program, Relatives supporting attendance to the exercise sessions, Exercise instructor favoring adherence to the exercise program. The different subthemes showed autonomy-supportive techniques from these social agents to promote CRC patients' participation in the exercise program.

CONCLUSION

The present research showed the importance of autonomy support from healthcare professionals, relatives and the exercise instructor to promote the initiation and maintenance of CRC patients' PA behavior and improve their quality of life, health and well-being.

Usability evaluation of emergency information systems in educational hospitals in Kerman, Iran

BACKGROUND

Smart and practical health information systems and applications with fewer errors are crucial for healthcare facilities. One method that ensures the proper design of health information systems (HIS) and applications is usability evaluation.

OBJECTIVE

This study aimed to evaluate the usability of the emergency information systems used at the emergency departments of four educational hospitals in Kerman, Iran.

METHOD

This study was conducted in two phases. In the first phase, the information systems' errors and shortages were identified using a semi-structured questionnaire by users (nurses and the IT staff). In the second phase, based on the results of the first phase, two questionnaires were designed for each group of users to their opinions about the usability of the emergency information systems.

RESULTS

The average score of "reducing and facilitating user's daily activities" was significantly different among hospitals (p = 0.03). Shahid Beheshti Hospital obtained the lowest usability score (17.5), and Afzalipour Hospital received the highest usability score (21.75). Moreover, the average score in "use of the HIS" for nurses and IT staff was 2.93 and 3.54 on a scale of 5, respectively.

CONCLUSION

Usability evaluation of health information systems is essential to ensure that these systems provide sufficient and accurate information and requirements for users and health care providers. Also, modifying health information systems based on the user views and expectations improves the quality of the system and user-system Interaction.

Factors influencing autonomy supportive consultation: A realist review

OBJECTIVE

Gaining insight into contextual factors and mechanisms supporting or hindering autonomy supportive consultation and into outcomes of such consultations.

METHODS

We conducted a systematic review using the realist synthesis procedure according to RAMESES guideline. A search was performed in PubMed, Embase, PsycINFO and Cinahl from inception to March 2019 using the search terms: 'autonomy' AND 'support' AND 'consultation' OR 'communication' AND 'intervention'. The review process including paper selection, quality assessment, full text reading for data-extraction was conducted by two researchers independently.

RESULTS

Of 2792 articles, 18 met our inclusion criteria. Contextual factors influencing an autonomy supportive consultation were: work organization and the attitude of professionals. An overarching supporting mechanism for AS was relationship building. In addition, each phase of the decision-making process seems to need supporting mechanisms fulfilling patients 'specific psychological needs in that phase. The outcome of AS is higher levels of patient well-being.

CONCLUSION

Autonomy supportive consultation works under various contexts coupled with mechanisms that give rise to favourable-outcomes, of which relationship building, taking time and exploring patients' needs seem the most important.

PRACTICE IMPLICATIONS

The results of our review facilitate professionals to reflect on their autonomy supportive consultation skills, which could improve their autonomy supportive behaviour.

Psychosocial dental impact in adult orthodontic patients: what about health competence?

Background

Several studies have assessed the psychological benefits of orthodontic treatment; however, the impact of competence on psychological benefits remains unknown.

Aims: To analyze the change of the perception of psychosocial dental impact in a sample of adults undergoing orthodontic treatment (mild/moderate dental malocclusions) and to assess the possible moderating effect of health competence level.

Methods

A longitudinal prospective design was used. Three time points were included: baseline (T0), 6 months after starting orthodontic treatment (T1) and once treatment had finished (T2). The pretreatment sample consisted of 78 patients recruited from the Rey Juan Carlos University Dental Clinic, all of whom had moderate malocclusions and were going to undergo orthodontic treatment for approximately 18 months with fixed metal multibrackets. All participants were instructed to complete the Spanish version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and the aesthetic component of the Index of Orthodontic Treatment Need (IOTN-AC) on the three points of the research. Statistical analysis involved the General Linear Model (GLM) repeated-measures ANOVA to test if the outcome measures of psychosocial dental impact significantly changed over time during orthodontic treatment (baseline, at 6-month evaluation and posttreatment). To assess the effect of the previous health competence levels (high/low) in the change from baseline to the 6-month assessment, for each PIDAQ dimension, a 2*2 (time*group) repeated measures ANOVA was performed.

Results

A significant increase was observed in dental self-confidence values (T0-T1 and T0-T2). Similar results were observed for the psychological impact variables and for the IOTN-AC scores, which showed significant decreases between T0 and T1 and between T0 and T2. Finally, significantly decreases were observed between T0 and T2 in aesthetic concern. Interaction effects were found regarding the health competence variable from T0-T1 for the psychological impact, social impact and aesthetic concern and the IOTN-AC index, with significant development results regarding the high competence group.

Conclusions

The first 6 months of orthodontic treatment seemed to be key to the development of psychosocial dental impact perception, during which the role of health competence was of great importance to developing a positive change. It is necessary to follow a biopsychosocial approach towards orthodontic treatment.

Discontinuing Treatment Against Medical Advice: The Role of Perceived Autonomy Support From Providers in Relapsing-Remitting Multiple Sclerosis

BACKGROUND

Long-term medication adherence is problematic among patients with chronic medical conditions. To our knowledge, this was the first study to examine factors associated with nonadherence among patients with relapsing-remitting multiple sclerosis who discontinue disease-modifying treatments against medical advice.

PURPOSE

To examine differences in perceived provider autonomy support between disease-modifying treatment-adherent relapsing-remitting multiple sclerosis patients and relapsing-remitting multiple sclerosis patients who discontinued disease-modifying treatments against medical advice.

METHODS

Self-report questionnaires and a neurologic exam were administered to demographically matched adherent (n = 50) and nonadherent (n = 79) relapsing- remitting multiple sclerosis patients from the Midwest and Northeast USA.

RESULTS

Adherent patients reported greater perceived autonomy support from their treatment providers, F(1, 124) = 28.170, p < .001, partial η2 = .185. This difference persisted after controlling for current multiple sclerosis healthcare provider, education, disease duration, Expanded Disability Status Scale, perceived barriers to adherence, and prevalence of side effects, F(1, 121) = 9.61, p = .002, partial η2 = .074. Neither depressive symptoms, F(1, 124) = 1.001, p > .05, partial η2 = .009, nor the occurrence of a major depressive episode, χ2(1, N = 129) = .288, p > .05, differed between adherent and nonadherent patients.

CONCLUSIONS

Greater perceived autonomy support from treatment providers may increase adherence to disease-modifying treatments among patients who discontinue treatment against medical advice. Results may inform interventions for patients who discontinue treatment against medical advice.

Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial

Young adults (18-39 year-olds) with hypertension have a higher lifetime risk for cardiovascular disease. However, less than 50% of young adults achieve hypertension control in the United States. Hypertension self-management programs are recommended to improve control, but have been targeted to middle-aged and older populations. Young adults need hypertension self-management programs (i.e., home blood pressure monitoring and lifestyle modifications) tailored to their unique needs to lower blood pressure and reduce the risks and medication burden they may face over a lifetime. To address the unmet need in hypertensive care for young adults, we developed MyHEART (My Hypertension Education And Reaching Target), a multi-component, theoretically-based intervention designed to achieve self-management among young adults with uncontrolled hypertension. MyHEART is a patient-centered program, based upon the Self-Determination Theory, that uses evidence-based health behavior approaches to lower blood pressure. Therefore, the objective of this study is to evaluate MyHEART's impact on changes in systolic and diastolic blood pressure compared to usual care after 6 and 12 months in 310 geographically and racially/ethnically diverse young adults with uncontrolled hypertension. Secondary outcomes include MyHEART's impact on behavioral outcomes at 6 and 12 months, compared to usual clinical care (increased physical activity, decreased sodium intake) and to examine whether MyHEART's effects on self-management behavior are mediated through variables of perceived competence, autonomy, motivation, and activation (mediation outcomes). MyHEART is one of the first multicenter, randomized controlled hypertension trials tailored to young adults with primary care. The design and methodology will maximize the generalizability of this study. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03158051.

Physical activity counseling in primary care and family medicine residency training: a systematic review

BACKGROUND

Physical inactivity is a global public health challenge. Physical activity (PA) promotion in healthcare delivery systems is effective to reduce physical inactivity. A primary care setting provides an appropriate environment for PA counseling since it is a primary contact with primary care or family physicians encounter the majority of the population. Lack of knowledge and inadequate training in PA counseling is one of the most important barriers to PA promotion. The purpose of this systematic review was to evaluate PA counseling training in primary care residency programs.

METHODS

The authors systematically searched PubMed, Web of Science, Scopus and The Cochrane Library for articles published in English from 2000 to 2017. Articles regarding PA counseling in primary care residency training were extracted and outcomes assessed for this systematic review.

RESULTS

Based on the initial review, 378 articles were excluded (362 articles excluded based on titles and abstracts and 16 articles excluded based on full texts). Four articles were included in this review, addressed PA counseling curricula in primary care residency training. All studies included PA counseling training as part of obesity and healthy lifestyle training. The training improved knowledge among primary care residents, but may not necessarily result in better attitudes or self-efficacy, which could be improved by elective rotations that focus on improved attitudes, self-efficacy, and professional norms for PA counseling. Brief training in counseling did not improve quality nor increase the rate of counseling.

CONCLUSIONS

This systematic review demonstrates a lack of evidence due to a small number of included studies. The heterogeneous outcomes from the minimal programs are needed to carefully interpret. However, this review sheds light on the importance of training in PA counseling in primary care residency programs. The development of training in PA counseling should focus on an approach that improves attitudes and the self-efficacy of primary care residents. Elective rotations, where residents voluntarily choose their subject, may provide the appropriate training period for PA counseling. Policymakers and academics should play an active role in the implementation of PA counseling as an essential competency for primary care physicians.

Effectiveness of a clinician intervention to improve physical activity discussions in underserved adults

BACKGROUND

Physical activity (PA) counselling is challenging in primary care. It is unknown whether clinician training on the 5As (Ask, Advise, Agree, Assist, Arrange) improves PA counselling skills.

OBJECTIVE

To evaluate the effect of a clinician training intervention on PA counselling for underserved adults using the 5As framework.

METHODS

Pragmatic pilot clinical trial was used in the study. Clinicians (n = 13) were randomly assigned to two groups. Each group received the intervention consisting of four 1-hour training sessions to teach the 5As for PA counselling. Patient-clinician visits (n = 325) were audio recorded at baseline, immediately post-intervention, and at 6 months. Outcomes were the frequency and quality of PA discussions using the 5As, assessed by blinded coders.

RESULTS

Patients' mean age was 44 years; 75% were African American. PA was discussed in 37% (n = 119) of visits overall and did not change from baseline to follow-up. When PA discussions occurred, the frequency of 5As increased from baseline to follow-up for Advise (51-54%), Agree (11-26%), and Assist (11-17%); however, none of the 5As had a statistically significant increase. For Agree, exploration of patient willingness to engage in PA increased from 23% at baseline to 50% at follow-up.

CONCLUSION

A clinician-directed intervention to improve PA counselling increased the frequency of Advise, Agree and Assist, and the quality of Ask and Agree statements, though the absolute numbers were small and only Agree reached statistical significance. Future research is needed to understand the factors that affect the optimal uptake and approach to 5As counselling.

Usability testing of a monitoring and feedback tool to stimulate physical activity

INTRODUCTION

A MONITORING AND FEEDBACK TOOL TO STIMULATE PHYSICAL ACTIVITY, CONSISTING OF AN ACTIVITY SENSOR, SMARTPHONE APPLICATION (APP), AND WEBSITE FOR PATIENTS AND THEIR PRACTICE NURSES, HAS BEEN DEVELOPED: the 'It's LiFe!' tool. In this study the usability of the tool was evaluated by technology experts and end users (people with chronic obstructive pulmonary disease or type 2 diabetes, with ages from 40-70 years), to improve the user interfaces and content of the tool.

PATIENTS AND METHODS

THE STUDY HAD FOUR PHASES: 1) a heuristic evaluation with six technology experts; 2) a usability test in a laboratory by five patients; 3) a pilot in real life wherein 20 patients used the tool for 3 months; and 4) a final lab test by five patients. In both lab tests (phases 2 and 4) qualitative data were collected through a thinking-aloud procedure and video recordings, and quantitative data through questions about task complexity, text comprehensiveness, and readability. In addition, the post-study system usability questionnaire (PSSUQ) was completed for the app and the website. In the pilot test (phase 3), all patients were interviewed three times and the Software Usability Measurement Inventory (SUMI) was completed.

RESULTS

After each phase, improvements were made, mainly to the layout and text. The main improvement was a refresh button for active data synchronization between activity sensor, app, and server, implemented after connectivity problems in the pilot test. The mean score on the PSSUQ for the website improved from 5.6 (standard deviation [SD] 1.3) to 6.5 (SD 0.5), and for the app from 5.4 (SD 1.5) to 6.2 (SD 1.1). Satisfaction in the pilot was not very high according to the SUMI.

DISCUSSION

The use of laboratory versus real-life tests and expert-based versus user-based tests revealed a wide range of usability issues. The usability of the It's LiFe! tool improved considerably during the study.