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De Dios Pérez B, das Nair R, Radford K. Development of a Job Retention Vocational Rehabilitation Intervention for People with Multiple Sclerosis Following the Person-Based Approach. Clin Rehabil 2024; 38:965-978. [PMID: 38418389 PMCID: PMC11118787 DOI: 10.1177/02692155241235956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To describe the process of developing a job retention vocational rehabilitation intervention for people with multiple sclerosis. DESIGN We used the person-based approach, to develop interventions through an iterative process incorporating stakeholders' views, resulting in an intervention that is likely to be more acceptable, contextually relevant, and implementable for end-users. Phase 1 combined the results of a systematic review and interview study to develop the guiding principles and intervention logic model. Phase 2 involved conceptual testing and refining the intervention with stakeholder feedback. We present the final intervention following the template for intervention description and replication. PARTICIPANTS We recruited 20 participants for Phase 1 (10 people with multiple sclerosis, four employers, six healthcare professionals), and 10 stakeholders (three people with multiple sclerosis, seven healthcare professionals) for Phase 2 to contribute to the intervention refinement process. RESULTS Stakeholders described the need for an individually tailored intervention to support people with multiple sclerosis to manage symptoms and workplace relationships. A stepped-care approach and remote support were deemed essential. The resulting intervention involves an initial assessment of employment needs, vocational goal setting, up to 10 h of tailored support (e.g., reasonable adjustments, employer engagement, legal rights), and a final review to discuss future steps. People with multiple sclerosis can include their employer for advice to optimise the management of the employee with multiple sclerosis at work. CONCLUSION The person-based approach provided a rigorous framework to systematically understand the vocational needs of people with multiple sclerosis and develop a vocational rehabilitation intervention.
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Affiliation(s)
- Blanca De Dios Pérez
- Centre for Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Roshan das Nair
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire NHS Foundation Trust, Nottingham, UK
- Health Research, SINTEF Digital, Trondheim, Norway
| | - Kathryn Radford
- Centre for Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, Nottingham, UK
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Mbanje C, Kuhn I, Musakwa N, Calvi M, Boccia D, Muhwa JC, Mvusi L, Jaramillo E, Evans D, Meghji J. A scoping review of interventions to address TB associated respiratory disability. EClinicalMedicine 2024; 73:102646. [PMID: 38846067 PMCID: PMC11154123 DOI: 10.1016/j.eclinm.2024.102646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024] Open
Abstract
There is a growing body of data describing a high burden of respiratory morbidity amongst pulmonary TB patients and survivors, with up to half thought to experience residual respiratory symptoms, abnormal spirometry, or structural pathology after TB treatment completion. Many patients experiencing marked impacts on their lives and livelihoods. However, there remain no guidelines or evidence-based frameworks for integrated TB-respiratory care during or post TB treatment completion. In this scoping review, completed in collaboration with the WHO Global Tuberculosis Programme, we have identified a lack of primary data on the clinical efficacy, cost effectiveness or feasibility of six potential interventions for the prevention and management of TB-associated respiratory impairment and disability, with a lack of studies in children and adolescents. There is a need for robust interventional trials to improve the long-term respiratory outcomes of people affected by pulmonary TB disease, and to explore how these might be implemented within resource-limited settings.
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Affiliation(s)
- Cassandra Mbanje
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Isla Kuhn
- Cambridge University Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nozipho Musakwa
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marzia Calvi
- Global Tuberculosis Programme, WHO, Geneva, Switzerland
| | - Delia Boccia
- Global Tuberculosis Programme, WHO, Geneva, Switzerland
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeremiah Chakaya Muhwa
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
| | - Lindiwe Mvusi
- National Department of Health, Johannesburg, South Africa
| | | | - Denise Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jamilah Meghji
- National Heart and Lung Institute, Imperial College London, London, UK
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Kavussanu M, Zhang S, Tang Q, Cumming J, Mackman T. Mental health in athletes: Does authentic leadership matter? PSYCHOLOGY OF SPORT AND EXERCISE 2024; 73:102617. [PMID: 38547636 DOI: 10.1016/j.psychsport.2024.102617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 06/01/2024]
Abstract
Recent research has attested to the prevalence of mental health issues in sport, and the need to identify factors that could promote athletes' mental health. In this study, we investigated: (a) whether authentic leadership is associated with athletes' mental health directly and indirectly via psychological capital and prosocial and antisocial behaviour experienced from one's teammates; and (b) whether the hypothesized model testing these relationships is the same in higher versus lower competitive level athletes. We examined two dimensions of mental health, namely positive mental health and mental illness. A total of 751 athletes (Mage = 22.92, SD = 8.53; 294 female) from a range of sports completed a multi-section questionnaire administered via an online survey. Path analysis showed that authentic leadership was positively related to positive mental health via psychological capital and prosocial behaviour and negatively linked to mental illness via psychological capital and antisocial behaviour. The effects of authentic leadership on positive mental health via prosocial teammate behaviour and subsequently psychological capital, and on mental illness via prosocial teammate behaviour, were stronger in higher compared to lower competitive level athletes. The findings suggest that by adopting an authentic leadership style coaches could strengthen athletes' positive mental health and protect them from mental illness. This may happen by increasing athletes' psychological capital and prosocial behaviour within the team and decreasing antisocial behaviour within the team.
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Affiliation(s)
| | - Shuge Zhang
- University of Derby, UK & Hunan University of Technology, China
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Clifford AM, Cheung PS, Malley NO, Byrne S, Whiston A, Kennelly B, Mphepo T, Eshghimanesh Z, Thabane L, Louw Q, Moss H, Gowran RJ, Neill DO, Glynn L, Woods CB, Maher C, Sheikhi A, Salsberg J, Bhriain ON. Findings from a pragmatic cluster randomised controlled feasibility trial of a music and dance programme for community dwelling older adults. Arch Gerontol Geriatr 2024; 122:105371. [PMID: 38471410 DOI: 10.1016/j.archger.2024.105371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Functional decline, chronic illness, reduced quality of life and increased healthcare utilisation are common in older adults. Evidence suggests music and dance can support healthy ageing in older adults. This study explored the feasibility, potential for effect and cost effectiveness of the Music and Movement for Health (MMH) programme among community-dwelling older adults using a pragmatic cluster-randomised, controlled feasibility trial design. METHODS Community-dwelling adults aged 65 years or older were recruited to seven clusters in the Mid-West region of Ireland. Clusters were block randomised to either the MMH intervention or control. Primary feasibility outcomes included recruitment, retention, adherence, fidelity, and safety. Secondary outcomes measured physical activity, physical and cognitive performance, and psychosocial well-being, along with healthcare utilisation were assessed at baseline and after 12 weeks. RESULTS The study successfully met feasibility targets, with recruitment (n = 100), retention (91 %), adherence (71 %), data completeness (92 %) and intervention fidelity (21 out of 24) all meeting predetermined criteria. Both groups exhibited an increase in self-reported physical activity and improved physical function. Participants in the intervention group scored consistently better in psychosocial measures compared to the control group at follow-up. The health economic analysis confirmed the feasibility of the methodology employed and points to the potential cost-effectiveness of the MMH relative to the control or no organised programme. DISCUSSION AND IMPLICATIONS The MMH intervention and study design were found to be feasible and acceptable with important findings to inform future evaluation of the clinical and cost-effectiveness of a definitive randomised controlled trial.
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Affiliation(s)
- Amanda M Clifford
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Pui-Sze Cheung
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Irish World Academy of Music and Dance, University of Limerick, Limerick, V94DK18, Ireland
| | - Nicola O' Malley
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Steven Byrne
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Department of Nursing & Midwifery, University of Limerick, Ireland
| | - Aoife Whiston
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland
| | - Brendan Kennelly
- Cairnes School of Business and Economics, University of Ireland Galway, Galway, Ireland
| | - Tumeliwa Mphepo
- Cairnes School of Business and Economics, University of Ireland Galway, Galway, Ireland
| | | | - Lehana Thabane
- Department of Health Research Methods, McMaster University, Hamilton ON, Canada; Research Institute of St Joe's Hamilton, St Joseph's Healthcare Hamilton, Hamilton ON, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hilary Moss
- Health Research Institute, University of Limerick, Limerick, Ireland; Irish World Academy of Music and Dance, University of Limerick, Limerick, V94DK18, Ireland
| | - Rosemary Joan Gowran
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Assisting Living and Learning (ALL) Institute, Maynooth University, Maynooth, Ireland
| | - Desmond O' Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Dublin, Ireland
| | - Liam Glynn
- Health Research Institute, University of Limerick, Limerick, Ireland; School of Medicine, University of Limerick, Limerick, Ireland
| | - Catherine B Woods
- Health Research Institute, University of Limerick, Limerick, Ireland; Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Catherine Maher
- Rehabilitation Unit, Community Hospital of the Assumption, HSE, Thurles, Tipperary, Ireland
| | - Ali Sheikhi
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jon Salsberg
- Health Research Institute, University of Limerick, Limerick, Ireland; School of Medicine, University of Limerick, Limerick, Ireland
| | - Orfhlaith Ni Bhriain
- Health Research Institute, University of Limerick, Limerick, Ireland; Irish World Academy of Music and Dance, University of Limerick, Limerick, V94DK18, Ireland
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Schroeder E, Yi H, Okech D, Bolton C, Aletraris L, Cody A. Do Social Service Interventions for Human Trafficking Survivors Work? A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:2012-2027. [PMID: 37897353 DOI: 10.1177/15248380231204885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
Human trafficking leaves victims with long-term social, psychological, and health effects. Research in this area is still nascent, and there are limited studies that show the effectiveness of existing services for survivors. This study fills the gaps in knowledge of the effectiveness of existing programs through a comprehensive systematic review and meta-analysis. Inclusion and exclusion criteria retained 15 studies using the preferred reporting items for systematic reviews and meta-analyses method, containing 16 populations. Included studies examined programs and/or interventions providing direct services to human trafficking survivors using quantitative pre- and post-intervention measurements published from January 2010 to June 2022. Outcomes among survivors were grouped into five categories: (a) mental health, (b) physical health, (c) social support or social behavior, (d) personal development, and (e) other. Roughly half (n = 31, 51.66%) of the outcomes across the 15 studies were statistically significant. Most measured constructs showed a moderate effect size (E.S.; n = 31, 51.67%). In all, 21 constructs (27.91%) met high E.S. levels, and eight (13.33%) met the criteria for a low-level effect. Analyzing different intervention types, physical-based interventions represented the smallest subset and the largest mean effect size (n = 5, g = 1.632, 95% CI [0.608, 2.655]) followed by standardized therapy (n = 23, g = 1.111, 95% CI [0.624, 1.599]), wrap-around services (n = 14, g = 0.594, 95% CI [0.241, 0.947]), and peer and support group modalities (n = 18, g = 0.440, 95% CI [0.310, 0.571]). A meta-regression showed that non-U.S.-based interventions were significantly more effective than U.S.-based interventions (z = -2.25, p = 0.025). While only 15 studies contributed to this analysis, the current study ushered in new avenues regarding future research, policies, and practice in services for survivors of human trafficking.
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Affiliation(s)
- Elyssa Schroeder
- School of Social Work, Center on Human Trafficking Research and Outreach, University of Georgia, Athens, USA
| | - Hui Yi
- School of Social Work, Center on Human Trafficking Research and Outreach, University of Georgia, Athens, USA
| | - David Okech
- School of Social Work, Center on Human Trafficking Research and Outreach, University of Georgia, Athens, USA
| | - Claire Bolton
- School of Social Work, Center on Human Trafficking Research and Outreach, University of Georgia, Athens, USA
| | - Lydia Aletraris
- School of Social Work, Center on Human Trafficking Research and Outreach, University of Georgia, Athens, USA
| | - Anna Cody
- School of Social Work, Center on Human Trafficking Research and Outreach, University of Georgia, Athens, USA
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Neill S, Bayes N, Thompson M, Croxson C, Roland D, Lakhanpaul M. Helping parents know when to seek help for an acutely ill child: Evidence based co-development of a mobile phone app using complex intervention methodology. Int J Med Inform 2024; 187:105459. [PMID: 38640593 DOI: 10.1016/j.ijmedinf.2024.105459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Acute illness accounts for the majority of episodes of illness in children under five years of age and is the age group with the highest consultation rate in general practice in the UK. The number of children presenting to emergency care is also steadily increasing, having risen beyond pre-pandemic numbers. Such high, and increasing, rates of consultation have prompted concerns about parents' level of knowledge and confidence in caring for their children when they are ill, and particularly when and how to seek help appropriately. AIM The ASK SNIFF collaboration research programme identified parents' need for accurate and accessible information to help them know when to seek help for a sick child in 2010. This paper presents the resulting programme of research which aimed to co-develop an evidence-based safety netting intervention (mobile app) to help parents know when to seek help for an acutely ill child under the age of five years in the UK. METHODS Our programme used a collaborative six step process with 147 parent and 324 health professional participants over a period of six years including: scoping existing interventions, systematic review, qualitative research, video capture, content identification and development, consensus methodology, parent and expert clinical review. RESULTS Our programme has produced evidence-based content for an app supported by video clips. Our collaborative approach has supported every stage of our work, ensuring that the end result reflects the experiences, perspectives and expressed needs of parents and the clinicians they consult. CONCLUSION We have not found any other resource which has used this type of approach, which may explain why there is no published evaluation data demonstrating the impact of existing UK resources. Future mobile apps should be designed and developed with the service users for whom they are intended.
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Affiliation(s)
- Sarah Neill
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.
| | - Natasha Bayes
- Faculty of Health, University of Northampton, Northampton, UK.
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, USA.
| | - Caroline Croxson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK; SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK.
| | - Monica Lakhanpaul
- UCL Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; Community Paediatrics, Whittington Health NHS, London N19 5NF, UK.
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Bugge SJ, Henriksen DP, Damkier P, Rahbek MT, Schousboe K, Rothmann MJ, Poulsen MK, Hansen C, Nagarajah S, Jensen PB, Johansson SL, Panou V, Schneider IR, Pedersen CG, Andersen JD, Hangaard J, Zwisler ADO. Network of doctors for multimorbidity and diabetes - the NOMAD intervention: protocol for feasibility trial of multidisciplinary team conferences for people with diabetes and multimorbidity. Pilot Feasibility Stud 2024; 10:91. [PMID: 38879561 PMCID: PMC11179232 DOI: 10.1186/s40814-024-01517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 06/06/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND The prevalence of diabetes and coexisting multimorbidity rises worldwide. Treatment of this patient group can be complex. Providing an evidence-based, coherent, and patient-centred treatment of patients with multimorbidity poses a challenge in healthcare systems, which are typically designed to deliver disease-specific care. We propose an intervention comprising multidisciplinary team conferences (MDTs) to address this issue. The MDT consists of medical specialists in five different specialities meeting to discuss multimorbid diabetes patients. This protocol describes a feasibility test of MDTs designed to coordinate care and improve quality of life for people with diabetes and multimorbidity. METHODS A mixed-methods one-arm feasibility test of the MDT. Feasibility will be assessed through prospectively collected data. We will explore patient perspectives through patient-reported outcomes (PROs) and assess the feasibility of electronic questionnaires. Feasibility outcomes are recruitment, PRO completion, technical difficulties, impact of MDT, and doctor preparation time. During 17 months, up to 112 participants will be recruited. We will report results narratively and by the use of descriptive statistics. The collected data will form the basis for a future large-scale randomised trial. DISCUSSION A multidisciplinary approach focusing on better management of diabetic patients suffering from multimorbidity may improve functional status, quality of life, and health outcomes. Multimorbidity and diabetes are highly prevalent in our healthcare system, but we lack a solid evidence-based approach to patient-centred care for these patients. This study represents the initial steps towards building such evidence. The concept can be efficiency tested in a randomised setting, if found feasible to intervention providers and receivers. If not, we will have gained experience on how to manage diabetes and multimorbidity as well as organisational aspects, which together may generate hypotheses for research on how to handle multimorbidity in the future. ADMINISTRATIVE INFORMATION Protocol version: 01 TRIAL REGISTRATION: NCT05913726 - registration date: 21 June 2023.
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Affiliation(s)
- Stine Jorstad Bugge
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark.
- Department of Pharmacology, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Daniel Pilsgaard Henriksen
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Damkier
- Department of Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Torp Rahbek
- Department of Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karoline Schousboe
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Kjær Poulsen
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Hansen
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
| | - Subagini Nagarajah
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Per Bruno Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Sofie Lock Johansson
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Vasiliki Panou
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Ida Ransby Schneider
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Charlotte Gjørup Pedersen
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jonas Dahl Andersen
- Steno Diabetes Centre Northern Jutland, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jørgen Hangaard
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Olsen Zwisler
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
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Milton S, Macrae F, McIntosh JG, Saya S, Alphonse P, Yogaparan T, Karnchanachari N, Novy K, Nguyen P, Lau P, Emery J. Designing a decision aid for cancer prevention: a qualitative study. Fam Pract 2024; 41:349-359. [PMID: 37058423 PMCID: PMC11167968 DOI: 10.1093/fampra/cmad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES Australian guidelines recommend people aged 50-70 years old consider taking low-dose aspirin to reduce their risk of colorectal cancer. The aim was to design sex-specific decision aids (DAs) with clinician and consumer input, including expected frequency trees (EFTs) to communicate the risks and benefits of taking aspirin. METHODS Semi-structured interviews were conducted with clinicians. Focus groups were conducted with consumers. The interview schedules covered ease of comprehension, design, potential effects on decision-making, and approaches to implementation of the DAs. Thematic analysis was employed; independent coding by 2 researchers was inductive. Themes were developed through consensus between authors. RESULTS Sixty-four clinicians were interviewed over 6 months in 2019. Twelve consumers aged 50-70 years participated in two focus groups in February and March 2020. The clinicians agreed that the EFTs would be helpful to facilitate a discussion with patients but suggested including an additional estimate of the effects of aspirin on all-cause mortality. The consumers felt favourable about the DAs and suggested changes to the design and wording to ease comprehension. CONCLUSION DAs were designed to communicate the risks and benefits of low-dose aspirin for disease prevention. The DAs are currently being trialled in general practice to determine their impact on informed decision-making and aspirin uptake.
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Affiliation(s)
- Shakira Milton
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Finlay Macrae
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia
| | - Jennifer G McIntosh
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Sibel Saya
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Pavithran Alphonse
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Thivagar Yogaparan
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Napin Karnchanachari
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Kitty Novy
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Peter Nguyen
- Health and Government Sector, Quantium, Melbourne, Australia
| | - Phyllis Lau
- Department of General Practice, University of Melbourne, Melbourne, Australia
- School of Medicine, University of Western Sydney, Sydney, Australia
| | - Jon Emery
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
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Evrard P, Henrard S, Spinewine A. Development of a Behavior-Change Intervention toward Benzodiazepine Deprescribing in Older Adults Living in Nursing Homes. J Am Med Dir Assoc 2024; 25:105053. [PMID: 38838741 DOI: 10.1016/j.jamda.2024.105053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE We aimed to develop a context-specific intervention toward benzodiazepine deprescribing in nursing homes (NHs), with insights from behavior-change theories and involvement of stakeholders. DESIGN Selection of behavior change techniques (BCTs), through online survey and group discussion, followed by operationalization of these BCTs into intervention components. SETTING AND PARTICIPANTS The intervention was developed for Belgian NHs, involving various stakeholders: health care professionals (HCPs), NH administrators, and policy makers. METHODS Using the Theory and Techniques Tool, we preselected the BCTs linked to one of the 9 Theoretical Domain Framework domains identified as being the main barriers for benzodiazepine deprescribing in Belgian NHs. These were then presented to stakeholders. Based on the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Ethics) criteria, participants ranked BCTs through an online survey, and then performed final selection during a group discussion. Selected BCTs were operationalized into intervention components, with specific contents and methods of delivery validated by stakeholders. RESULTS Thirty-seven potential BCTs were identified. Eighteen stakeholders participated in the survey, and 7 in the group discussion. This led to the final inclusion of 9 BCTs: instruction on how to perform the behavior, information about health consequences, pros and cons, problem solving, goal setting (behavior), social comparison, restructuring physical environment, restructuring social environment, and graded tasks. These BCTs were operationalized into a 6-component intervention: process and goal setting, HCP education, physical environment adaptations, audit and feedback, NH residents' and relatives' increased awareness, and multidisciplinary work. CONCLUSION AND IMPLICATIONS Use of a theory-based approach toward intervention development has the potential to improve the probability of its feasibility and effectiveness in tackling barriers to benzodiazepine deprescribing. By doing so, we have developed a multifaceted approach with actions taken at the patient, HCP, and NH levels. Our novel 6-component intervention will be evaluated in a pilot cluster-randomized controlled trial to assess its feasibility.
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Affiliation(s)
- Perrine Evrard
- Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium.
| | - Séverine Henrard
- Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium; Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
| | - Anne Spinewine
- Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium; Pharmacy Department, CHU UCL Namur, UCLouvain, Yvoir, Belgium
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van Houtert WFC, Strijbos DO, Bimmel R, Krijnen WP, Jager J, van Meeteren NLU, van der Sluis G. A stepwise transformation: description and outcome of perioperative procedures in patients receiving a total knee arthroplasty. Bone Joint J 2024; 106-B:573-581. [PMID: 38821499 DOI: 10.1302/0301-620x.106b6.bjj-2023-0819.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Aims To investigate the impact of consecutive perioperative care transitions on in-hospital recovery of patients who had primary total knee arthroplasty (TKA) over an 11-year period. Methods This observational cohort study used electronic health record data from all patients undergoing preoperative screening for primary TKA at a Northern Netherlands hospital between 2009 and 2020. In this timeframe, three perioperative care transitions were divided into four periods: Baseline care (Joint Care, n = 171; May 2009 to August 2010), Function-tailored (n = 404; September 2010 to October 2013), Fast-track (n = 721; November 2013 to May 2018), and Prehabilitation (n = 601; June 2018 to December 2020). In-hospital recovery was measured using inpatient recovery of activities (IROA), length of stay (LOS), and discharge to preoperative living situation (PLS). Multivariable regression models were used to analyze the impact of each perioperative care transition on in-hospital recovery. Results The four periods analyzed involved 1,853 patients (65.9% female (1,221/1,853); mean age 70.1 years (SD 9.0)). IROA improved significantly with each transition: Function-tailored (0.9 days; p < 0.001 (95% confidence interval (CI) -0.32 to -0.15)), Fast-track (0.6 days; p < 0.001 (95% CI -0.25 to -0.16)), and Prehabilitation (0.4 days; p < 0.001 (95% CI -0.18 to -0.10)). LOS decreased significantly in Function-tailored (1.1 days; p = 0.001 (95% CI -0.30 to -0.06)), Fast-track (0.6 days; p < 0.001 (95% CI -0.21 to -0.05)), and Prehabilitation (0.6 days; p < 0.001 (95%CI -0.27 to -0.11)). Discharge to PLS increased in Function-tailored (77%), Fast-track (91.6%), and Prehabilitation (92.6%). Post-hoc analysis indicated a significant increase after the transition to the Fast-track period (p < 0.001 (95% CI 3.19 to 8.00)). Conclusion This study highlights the positive impact of different perioperative care procedures on in-hospital recovery of patients undergoing primary TKA. Assessing functional recovery, LOS, and discharge towards PLS consistently, provides hospitals with valuable insights into postoperative recovery. This can potentially aid planning and identifying areas for targeted improvements to optimize patient outcomes.
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Affiliation(s)
| | - Daniël O Strijbos
- Department of Physiotherapy, Nij Smellinghe Hospital, Drachten, Netherlands
| | - Richard Bimmel
- Department of Orthopaedics, Nij Smellinghe Hospital, Drachten, Netherlands
| | - Wim P Krijnen
- Hanze University of Applied Sciences Groningen, Groningen, Netherlands
| | - Jelmer Jager
- Faculty of Health, University of Applied Sciences Leiden, Leiden, Netherlands
| | | | - Geert van der Sluis
- Department of Health Innovation, Nij Smellinghe Hospital, Drachten, Netherlands
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11
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Gibson R, Oliver N, McGowan B, Guess N, Lorencatto F. Developing an intervention to support dietary change for shift workers living with type 2 diabetes: A stakeholder consultation. Diabet Med 2024; 41:e15318. [PMID: 38551208 DOI: 10.1111/dme.15318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Shift workers, compared to day workers, are more likely to be diagnosed with type 2 diabetes (T2D). Currently, there is no tailored programme of dietary support available to either shift workers living with T2D or employers. METHODS An intervention development consultation workshop was convened in June 2023 with the aim of evaluating potential interventions to identify those with a potential to take forward for further development. Findings from prior formative research into factors influencing dietary behaviour in shift workers with T2D were mapped to potential interventions addressing the barriers and enablers to healthy eating reported by shift workers with T2D. The findings of the Shift-Diabetes Study were presented in the context of the COM-B (Capability, Opportunity, Motivation, Behaviour) theoretical framework of behaviour change. Three interventions in turn were presented to attendees: (1) Educational resources and structured education, (2) Increasing availability and accessibility of food on a night shift and (3) Biofeedback and tailored advice. Seven workshop attendees were invited to express their thoughts, using the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side-effects/Safety, Equity) to guide the discussion. The workshop was conducted online and recorded, and transcripts were thematically coded to the APEASE framework. RESULTS/CONCLUSIONS The workshop highlighted the importance of multilevel interventions to support dietary behaviour change in this occupational group. Priority actions identified include (i) understanding barriers to 24/7 food availability, (ii) including shift workers in clinical diabetes studies and (iii) research to understand the effectiveness of continuous glucose monitoring in shift workers with T2D.
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Affiliation(s)
- Rachel Gibson
- Department of Nutritional Sciences, King's College London, London, UK
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Barbara McGowan
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicola Guess
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Khan ZA, Kidholm K, Pedersen SA, Haga SM, Drozd F, Sundrehagen T, Olavesen E, Halsteinli V. Developing a Program Costs Checklist of Digital Health Interventions: A Scoping Review and Empirical Case Study. PHARMACOECONOMICS 2024; 42:663-678. [PMID: 38530596 PMCID: PMC11126496 DOI: 10.1007/s40273-024-01366-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The rate of development and complexity of digital health interventions (DHIs) in recent years has to some extent outpaced the methodological development in economic evaluation and costing. Particularly, the choice of cost components included in intervention or program costs of DHIs have received scant attention. The aim of this study was to build a literature-informed checklist of program cost components of DHIs. The checklist was next tested by applying it to an empirical case, Mamma Mia, a DHI developed to prevent perinatal depression. METHOD A scoping review with a structured literature search identified peer-reviewed literature from 2010 to 2022 that offers guidance on program costs of DHIs. Relevant guidance was summarized and extracted elements were organized into categories of main cost components and their associated activities following the standard three-step approach, that is, activities, resource use and unit costs. RESULTS Of the 3448 records reviewed, 12 studies met the criteria for data extraction. The main cost categories identified were development, research, maintenance, implementation and health personnel involvement (HPI). Costs are largely considered to be context-specific, may decrease as the DHI matures and vary with number of users. The five categories and their associated activities constitute the checklist. This was applied to estimate program costs per user for Mamma Mia Self-Guided and Blended, the latter including additional guidance from public health nurses during standard maternal check-ups. Excluding research, the program cost per mother was more than double for Blended compared with Self-Guided (€140.5 versus €56.6, 2022 Euros) due to increased implementation and HPI costs. Including research increased the program costs to €190.8 and €106.9, respectively. One-way sensitivity analyses showed sensitivity to changes in number of users, lifespan of the app, salaries and license fee. CONCLUSION The checklist can help increase transparency of cost calculation and improve future comparison across studies.
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Affiliation(s)
- Zareen Abbas Khan
- Center for Health Care Improvement, St. Olav Hospital, Trondheim University Hospital, 3250, Torgarden, 7006, Trondheim, Norway.
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Kristian Kidholm
- Center for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
| | - Sindre Andre Pedersen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Silje Marie Haga
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Filip Drozd
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Thea Sundrehagen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Ellen Olavesen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Vidar Halsteinli
- Center for Health Care Improvement, St. Olav Hospital, Trondheim University Hospital, 3250, Torgarden, 7006, Trondheim, Norway
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Werther L, Thorén E, Brännström J, Andersson G, Öberg M. Hearing impaired persons' experiences with the online Swedish Individualized Active Communication Education (I-ACE) program: A feasibility study. Internet Interv 2024; 36:100734. [PMID: 38524894 PMCID: PMC10958056 DOI: 10.1016/j.invent.2024.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Even with optimally fitted hearing aids, many individuals with hearing impairment struggle to hear in situations with difficult listening conditions. Active Communication Education (ACE) is an interactive group rehabilitation program aimed at helping people with hearing loss communicate more effectively using communication strategies to better cope with everyday life. To increase accessibility and allow more people to benefit from the ACE program, a modified individualized version was created. The purpose of this study was to examine the feasibility of providing the Swedish Individualized Active Communication Education (I-ACE) program via an online platform and to explore hearing impaired persons' experiences with the program. For five weeks, ten participants completed the Swedish I-ACE through an online platform. The participants were assigned a new chapter to complete each week and later received individual feedback on their work via the platform. The participants were asked to complete an evaluation form regarding the content and their experiences during and after completing the I-ACE. They were later interviewed to provide more detailed information on their experiences with the program. The program completion rate was 80 %. Participants found the I-ACE program to be informative and relevant but somewhat repetitive. However, only a few participants thought of the repetitiveness as negative. Few participants reported difficulties using the platform. This study indicated that it is feasible to provide the I-ACE program via an online platform and that the content of the program is informative, relevant, and comprehensible. Further research evaluating the effects of the I-ACE is warranted.
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Affiliation(s)
- Louise Werther
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Elisabet Thorén
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology Clinic, Skåne University Hospital, Lund, Sweden
- Department of Clinical Science, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Jonas Brännström
- Department of Clinical Science, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Gerhard Andersson
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Marie Öberg
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Anyiwe K, Erman A, Hassan M, Feld JJ, Pullenayegum E, Wong WWL, Sander B. Characterising the effectiveness of social determinants of health-focused hepatitis B interventions: a systematic review. THE LANCET. INFECTIOUS DISEASES 2024; 24:e366-e385. [PMID: 38184004 DOI: 10.1016/s1473-3099(23)00590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 01/08/2024]
Abstract
Social determinants of health are important in designing effective interventions for hepatitis B virus (HBV) infection. This systematic review characterises equity-oriented, social determinants of health-focused HBV interventions, and describes their effectiveness in terms of the prevention, care, or treatment of HBV in high-income countries. We searched electronic databases for central concepts of 'HBV', 'equity', 'social determinants of health', 'intervention', and 'Organization for Economic Co-operation and Development (OECD) countries'. Screening and data abstraction were conducted independently by two reviewers. Data were abstracted from 66 studies; articles with a comparative study design (n=36) were included in the narrative synthesis, highlighting social determinants of health domains of interventions, HBV-relevant health outcomes, and extra-health social determinants of health effects (ie, those effects that extend beyond health outcomes). Synthesis aligned with six emergent themes corresponding to HBV prevention and care: knowledge and education, diagnosis and screening, immunisation, care initiation, engagement with clinical care and treatment, and upstream prevention. Studies presented a heterogeneous array of HBV-relevant health outcomes. Most interventions were tailored for social determinants of health domains of race, ethnicity, culture, and language; drug use; and socioeconomic status. Across the themes, at least two-thirds of interventions showed comparative effectiveness for addressing HBV. Extra-health social determinants of health outcomes were observed for two studies. Considerable diversity in population-level approaches was observed regarding intervention goals and effectiveness; most interventions were effective at enhancing the prevention, care, or treatment of HBV.
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Affiliation(s)
- Kikanwa Anyiwe
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
| | - Aysegul Erman
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Marian Hassan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, Toronto, ON, Canada; London School of Hygiene & Tropical Medicine, London, UK
| | - Jordan J Feld
- Sandra Rotman Centre for Global Health, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - William W L Wong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, Toronto, ON, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada; ICES, Toronto, ON, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, University Health Network, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada
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Engler J, Engler F, Gerber M, Brosse F, Voigt K, Mergenthal K. Establishing a standing patient advisory board in family practice research: A qualitative evaluation from patients' and researchers' perspectives. Health Expect 2024; 27:e14094. [PMID: 38881096 PMCID: PMC11180710 DOI: 10.1111/hex.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/20/2024] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
INTRODUCTION Patient and public involvement is vital for high-quality research. Integrating patients' and providers' perspectives early in research enhances the feasibility and relevance of study results. Within our family practice-based research network ForN, we established a standing patient advisory board (PAB) to include patients with diverse conditions and experiences. In this paper, we aim to describe the establishment and functioning of a standing PAB in family medicine research from patients' and researchers' perspectives. METHODS After each PAB meeting, patients and researchers were asked to name anonymously positive and challenging moments in a feedback form with open questions. Researchers were also asked to reflect on how they implemented the discussion content in their research projects. The responses from both groups were transferred to MAXQDA 2018 and analyzed separately using thematic analysis. RESULTS We analyzed 40 feedback forms from patients and 14 feedback forms from researchers. The dominant theme in the patients' feedback was 'exchange': They positively emphasized the 'exciting and open discussions' and the exchange of perspectives with one another and researchers. The clarity of the researchers' presentations and the research topics were appreciated. Researchers also positively highlighted the open atmosphere of the discussions. Presenting their research to the PAB helped most researchers reflect on their research topics from patients' perspectives and implement changes. However, researchers also mentioned several barriers to the implementation of PAB members' feedback. CONCLUSION The establishment of a standing PAB in family practice research is feasible and productive both from patients' and researchers' perspectives. PATIENT OR PUBLIC CONTRIBUTION This study reports the evaluation of the establishment of a standing PAB in family practice research. Board members are involved in the design of studies, the co-production of interventions and information material, and the interpretation of data.
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Affiliation(s)
- Jennifer Engler
- Institute of General PracticeFaculty of Medicine at Goethe‐Universität Frankfurt am MainFrankfurtGermany
| | - Fabian Engler
- Institute of General PracticeFaculty of Medicine at Goethe‐Universität Frankfurt am MainFrankfurtGermany
| | - Meike Gerber
- Institute of General PracticeFaculty of Medicine at Goethe‐Universität Frankfurt am MainFrankfurtGermany
- Present address:
Researcher, Faculty of Medicine Carl Gustav CarusInstitute for the History of Medicine, Technische Universität DresdenFetscherstraße 74 01307DresdenGermany
| | - Franziska Brosse
- Department of General Practice, Faculty of Medicine Carl Gustav Carus, Medical Clinic IIITechnische Universität DresdenDresdenGermany
| | - Karen Voigt
- Department of General Practice, Faculty of Medicine Carl Gustav Carus, Medical Clinic IIITechnische Universität DresdenDresdenGermany
| | - Karola Mergenthal
- Institute of General PracticeFaculty of Medicine at Goethe‐Universität Frankfurt am MainFrankfurtGermany
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Høj K, Bekker HL, Bro F, Olesen AE, Kristensen JK, Christensen LD. Person-centred medicine in the care home setting: development of a complex intervention. BMC PRIMARY CARE 2024; 25:189. [PMID: 38802794 PMCID: PMC11131350 DOI: 10.1186/s12875-024-02437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Person-centred medicine is recommended in the care of older patients. Yet, involvement of care home residents and relatives in medication processes remains limited in routine care. Therefore, we aimed to develop a complex intervention focusing on resident and relative involvement and interprofessional communication to support person-centred medicine in the care home setting. METHODS The development took place from October 2021 to March 2022 in the Municipality of Aarhus, Denmark. The study followed the Medical Research Council guidance on complex intervention development using a combination of theoretical, evidence-based, and partnership approaches. The patient involvement tool, the PREparation of Patients for Active Involvement in medication Review (PREPAIR), was included in a preliminary intervention model. Study activities included developing programme theory, engaging stakeholders, and exploring key uncertainties through interviews, co-producing workshops, and testing with end-users to develop the intervention and an implementation strategy. The Consolidated Framework for Implementation Research and the Interprofessional Shared Decision Making Model were used. Data were analysed using a rapid analysis approach. RESULTS Before the workshops, six residents and four relatives were interviewed. Based on their feedback, PREPAIR was modified to the PREPAIR care home to fit the care home population. In total, ten persons participated in the co-producing workshops, including health care professionals and municipal managerial and quality improvement staff. The developed intervention prototype was tested for three residents and subsequently refined to the final intervention, including two fixed components (PREPAIR care home and an interprofessional medication communication template) delivered in a flexible three-stage workflow. Additionally, a multi-component implementation strategy was formed. In line with the developed programme theory, the intervention supported health care professionals´ awareness about resident and relative involvement. It provided a structure for involvement, empowered the residents to speak, and brought new insights through dialogue, thereby supporting involvement in medication-related decisions. The final intervention was perceived to be relevant, acceptable, and feasible in the care home setting. CONCLUSION Our results indicate that the final intervention may be a viable approach to facilitate person-centred medicine through resident and relative involvement. This will be further explored in a planned feasibility study.
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Affiliation(s)
- Kirsten Høj
- Research Unit for General Practice, Aarhus, Denmark.
- Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.
| | - Hilary Louise Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Research Centre of Patient Involvement, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anne Estrup Olesen
- Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Klamroth S, Mino E, Naber I, Weissenfels A, Geidl W, Gelius P, Abu-Omar K, Pfeifer K. Coproducing a physical activity referral scheme in Germany: a qualitative analysis of stakeholder experiences. BMJ Open 2024; 14:e082710. [PMID: 38777585 PMCID: PMC11116878 DOI: 10.1136/bmjopen-2023-082710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/03/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES This study evaluated stakeholders' experiences of participating in a coproduction process to develop a physical activity referral scheme (PARS) in the German healthcare system. The focus was on examining facilitators and challenges, along with gathering insights on potential modifications to the joint development process, all from the viewpoint of stakeholders. DESIGN This qualitative study employed one-to-one semi-structured interviews, and the findings were analysed using summarising qualitative content analysis. SETTING The study focused on the German healthcare system. PARTICIPANTS Seven stakeholders from the coproduction process were purposefully selected for interviews using maximum variation sampling. The interviewees represented different sectors (physician associations, physical activity professionals' associations, health insurance companies and patient organisations), various positions within their organisations, and different levels of attendance during the coproduction process. RESULTS In almost all interviews, the following factors were highlighted as facilitators of the development process: coproduction approach, process of coproduction, multi-sector stakeholder group, possibility of active participation, coordinating role of researchers, communication, atmosphere and interaction. In contrast, differences in roles and hierarchy, merging of different perspectives, clarification of intervention costs, and competition and conflicting interests were pointed out as challenges. Only a few suggestions regarding adaptations in terms of group composition and cooperation among stakeholders were mentioned. CONCLUSIONS Stakeholder experiences with the joint development process were predominantly positive, indicating that coproduction is a beneficial approach for the development of PARS intended for integration into healthcare systems. The effective management of power differences among stakeholders is intricately tied to the coproduction method; therefore, it should be selected carefully. The research team plays a pivotal role in coordinating and negotiating the process, and the team should be equipped with a diverse set of skills and knowledge, particularly to understand the intricacies of the healthcare system where the PARS is intended for implementation. TRIAL REGISTRATION NUMBER NCT04947787.
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Affiliation(s)
- Sarah Klamroth
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Eriselda Mino
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Inga Naber
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anja Weissenfels
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Geidl
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Gelius
- Insitute of Sport Sciences, Université de Lausanne, Lausanne, Switzerland
| | - Karim Abu-Omar
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Gagnon J, Chartrand J, Probst S, Lalonde M. Content of a wound care mobile application for newly graduated nurses: an e-Delphi study. BMC Nurs 2024; 23:331. [PMID: 38755617 PMCID: PMC11097557 DOI: 10.1186/s12912-024-02003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Wound care represents a considerable challenge, especially for newly graduated nurses. The development of a mobile application is envisioned to improve knowledge transfer and facilitate evidence-based practice. The aim of this study was to establish expert consensus on the initial content of the algorithm for a wound care mobile application for newly graduated nurses. METHODS Experts participated in online surveys conducted in three rounds. Twenty-nine expert wound care nurses participated in the first round, and 25 participated in the two subsequent rounds. The first round, which was qualitative, included a mandatory open-ended question solicitating suggestions for items to be included in the mobile application. The responses underwent content analysis. The subsequent two rounds were quantitative, with experts being asked to rate their level of agreement on a 5-point Likert scale. These rounds were carried out iteratively, allowing experts to review their responses and see anonymized results from the previous round. We calculated the weighted kappa to determine the individual stability of responses within-subjects between the quantitative rounds. A consensus threshold of 80% was predetermined. RESULTS In total, 80 items were divided into 6 categories based on the results of the first round. Of these, 75 (93.75%) achieved consensus during the two subsequent rounds. Notably, 5 items (6.25%) did not reach consensus. The items with the highest consensus related to the signs and symptoms of infection, pressure ulcers, and the essential elements for healing. Conversely, items such as toe pressure measurement, wounds around drains, and frostbite failed to achieve consensus. CONCLUSIONS The results of this study will inform the development of the initial content of the algorithm for a wound care mobile application. Expert participation and their insights on infection-related matters have the potential to support evidence-based wound care practice. Ongoing debates surround items without consensus. Finally, this study establishes expert wound care nurses' perspectives on the competencies anticipated from newly graduated nurses.
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Affiliation(s)
- Julie Gagnon
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
- Département des sciences de la santé, Université du Québec à Rimouski, Rimouski, Québec, G5L 3A1, Canada.
| | - Julie Chartrand
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Sebastian Probst
- HES-SO, University of Applied Sciences and Arts Western Switzerland, 47 Avenue de Champel, Geneva, 1206, Switzerland
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton VIC 3168, Melbourne, Australia
- College of Medicine, Nursing and Health Sciences, University of Galway, University Road, Galway, H91TK33, Ireland
- Care Directorate, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
| | - Michelle Lalonde
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Institut du Savoir Montfort, Montfort Hospital, 745A Montréal Road, Suite 202, Ottawa, ON, K1K 0T1, Canada
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Brown MC, Araújo-Soares V, Skinner R, Brown J, Glaser AW, Hanratty H, McCabe MG, Amariutei AE, Mauri S, Sharp L. Protocol for the 'Supporting Young Cancer Survivors who Smoke' study (PRISM): Informing the development of a smoking cessation intervention for childhood, adolescent and young adult cancer survivors in England. PLoS One 2024; 19:e0299321. [PMID: 38748708 PMCID: PMC11095735 DOI: 10.1371/journal.pone.0299321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Childhood, adolescent and young adult (CAYA) cancer survivors are vulnerable to adverse late-effects. For CAYA cancer survivors, tobacco smoking is the most important preventable cause of ill-health and early death. Yet, effective strategies to support smoking cessation in this group are lacking. The PRISM study aims to undertake multi-method formative research to explore the need for, and if appropriate, inform the future development of an evidence-based and theory-informed tobacco smoking cessation intervention for CAYA cancer survivors. MATERIALS AND METHODS PRISM involves three phases of: 1) an environmental scan using multiple strategies to identify and examine a) smoking cessation interventions for CAYA cancer survivors that are published in the international literature and b) current smoking cessation services in England that may be available to, or tailorable to, CAYA cancer survivors; 2) a qualitative study involving semi-structured interviews with CAYA cancer survivors (aged 16-29 years and who are current or recent ex-smokers and/or current vapers) to explore their views and experiences of smoking, smoking cessation and vaping; and 3) stakeholder workshops with survivors, healthcare professionals and other stakeholders to consider the potential for a smoking cessation intervention for CAYA cancer survivors and what such an intervention would need to target and change. Findings will be disseminated to patient groups, healthcare professionals and researchers, through conference presentations, journal papers, plain English summaries and social media. DISCUSSION PRISM will explore current delivery of, perceived need for, and barriers and facilitators to, smoking cessation advice and support to CAYA cancer survivors from the perspective of both survivors and healthcare professionals. A key strength of PRISM is the user involvement throughout the study and the additional exploration of survivors' views on vaping, a behaviour which often co-occurs with smoking. PRISM is the first step in the development of a person-centred, evidence- and theory-based smoking cessation intervention for CAYA cancer survivors who smoke, which if effective, will reduce morbidity and mortality in the CAYA cancer survivor population.
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Affiliation(s)
- Morven C. Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Vera Araújo-Soares
- Centre for Preventive Medicine and Digital Health (CPD), Division for Prevention of Cardiovascular and Metabolic Disease, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Roderick Skinner
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Adam W. Glaser
- Department of Paediatric Oncology, Leeds Children’s Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Helena Hanratty
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Martin G. McCabe
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Sabrina Mauri
- Patient and Public Representatives for the Study, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
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Salvador-Carulla L, Woods C, de Miquel C, Lukersmith S. Adaptation of the technology readiness levels for impact assessment in implementation sciences: The TRL-IS checklist. Heliyon 2024; 10:e29930. [PMID: 38726201 PMCID: PMC11078766 DOI: 10.1016/j.heliyon.2024.e29930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
Background Intervention development is a critical process in implementation research. There are key stages involved in the process to design, pilot, demonstrate and release a technology or an intervention. The Technology Readiness Level (TRL) is a globally accepted instrument for assessing the maturity of research development. However, the original levels do not fit all, and some adjustments are required for its applicability in implementation sciences. Aims This study aimed to gather the prior knowledge base on TRL in public and population health research; to develop a standard definition of readiness, and to adapt and validate the TRL to an implementation science context (TRL-IS). Materials and methods A Mixed methods approach has been followed in this study. A scoping review using the PRISMA extension (PRISMA-ScR) informed a nominal expert panel for developing a standard definition of readiness and to modify the TRL following an ontoterminology approach. Then the maturity of six practical case study examples were rated by ten researchers using the modified TRL to estimate inter-rater reliability, and a group of experts provided final content and face validity and feasibility.This mixed methods study included 1) a scoping review to examine the current literature and develop a knowledge base, identify knowledge gaps and to clarify concepts; 2) the development of a standard definition of 'Readiness' and related terms; and 3) adaptation of the TRL to implementation science and development of a checklist to rate the maturity of applications.A standard definition of readiness and related terms was produced by the core team, and an international nominal group (n = 30) was conducted to discuss and validate the definition and terms, and the location of 'Readiness' in the initiation and early development phases of implementation.Following feedback from the nominal group, the development of the TRL-IS was finalised and a TRL-IS rating checklist was developed to rate the maturity of applications. The TRL-IS checklist was tested using six cases based on real world studies on implementation research.The inter-rater reliability of the TRL-IS was evaluated by ten raters and finally six raters evaluated the content and face validity, and feasibility, of the TRL-IS checklist using the System Usability Scale (SUS). Results Few papers (n = 11) utilised the TRL to evaluate the readiness of readiness of health and social science implementation research. The main changes in the adaption of the TRL-IS included the removal of laboratory testing, limiting the use of "operational" environment and a clearer distinction between level 6 (pilot in a relevant environment) and 7 (demonstration in the real world prior to release). The adapted version was considered relevant by the expert panel. The TRL-IS checklist showed evidence of good inter-rater reliability (ICC = 0.90 with 95 % confident interval = 0.74-0.98, p < .001) and provides a consistent metric. Conclusions In spite of recommendations made by national and international research funding agencies, few health and social science implementation studies include the TRL as part of their evaluation protocol. The TRL-IS offers a high degree of conceptual clarity between scientific maturity phases or readiness levels, and good reliability among raters of varying experience. This study highlights that adoption of the TRL-IS framework in implementation sciences will bolster the scientific robustness and comparability of research maturity in this domain.
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Affiliation(s)
| | | | - Carlota de Miquel
- University of Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Spain
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Hebda-Boon A, Shortland AP, Birn-Jeffery A, Morrissey D. Can on-line gait training improve clinical practice? Study protocol for feasibility randomised controlled trial of an on-line educational intervention to improve clinician's gait-related decision-making in ambulant children and young people with cerebral palsy. Pilot Feasibility Stud 2024; 10:76. [PMID: 38745259 PMCID: PMC11091998 DOI: 10.1186/s40814-024-01477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Instrumented gait analysis (IGA) is an assessment and research tool with proven impacts on clinical decision-making for the management of ambulant children and young people with cerebral palsy (CYPwCP) but is underused and variably understood by relevant clinicians. Clinicians' difficulties in gaining expertise and confidence in using IGA are multifactorial and related to access for clinical decision-making, limited training opportunities and inability to translate this training into clinical practice. METHODS The primary aim of this study is to test the feasibility of an educational intervention to advance clinicians' application of gait analysis in CYPwCP, to inform a definitive trial. The secondary aim is to measure the effect that appropriate IGA training has on physiotherapists' knowledge, skills, confidence and behaviours. This will be a two-arm feasibility randomised controlled trial with an experimental and control group. The 6-week on-line intervention uses a multicomponent approach grounded in behavioural change techniques. A repeated measures design will be adopted, whereby participants will complete outcome measures at baseline, immediately after the intervention and at 4 months. The primary outcome measures (trial feasibility-related outcomes) are recruitment and engagement. The secondary outcome measures (trial research-related outcomes) are knowledge, skills, confidence and practice change. Outcome measures will be collected via online questionnaires and during observed skill assessments. Analysis of data will use descriptive statistics, two-way mixed ANOVA model and qualitative content analysis. DISCUSSION This study will determine feasibility of the definitive randomised control trial of educational intervention delivered to advance clinicians' application of gait analysis in CYPwCP. This study offers the shift in emphasis from regarding IGA as a tool to a focus on clinicians' requirements for access, training and a well-defined role to optimise utilisation of IGA. The impact of this should be better engagement with IGA and clinical practice change. This study will contribute to a body of educational research into clinical education of healthcare professionals and IGA training offering insight into high levels of evaluation evidence including clinical behaviour change. TRIAL REGISTRATION Protocol has been registered with the Open Science Framework (osf.io/nweq6) in June 2023.
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Affiliation(s)
- Anna Hebda-Boon
- Sport and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Adam P Shortland
- School of Biomedical Engineering and Imaging Science, King's College London, London, UK
| | | | - Dylan Morrissey
- Sport and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Physiotherapy Department, Barts Health NHS Trust, London, UK
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de Oliveira ESF, Presado MH, Baixinho CL. Qualitative methodology: considerations and singularities regarding the implementation of person-centered interventions. Rev Bras Enferm 2024; 77:e770301. [PMID: 38747844 PMCID: PMC11095907 DOI: 10.1590/0034-7167.2024770301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Affiliation(s)
| | - Maria Helena Presado
- Escola Superior de Enfermagem de Lisboa, Docente de Enfermagem. Lisboa, Portugal
- Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa. Lisboa, Portugal
| | - Cristina Lavareda Baixinho
- Escola Superior de Enfermagem de Lisboa, Docente de Enfermagem. Lisboa, Portugal
- Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa. Lisboa, Portugal
- Centro de Inovação em Tecnologias e Cuidados de Saúde. Leiria, Portugal
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Farmer N, McPherson A, Thomson J, Lowrie R. Perspectives of people experiencing homelessness with recent non-fatal street drug overdose on the Pharmacist and Homeless Outreach Engagement and Non-medical Independent prescribing Rx (PHOENIx) intervention. PLoS One 2024; 19:e0302988. [PMID: 38739649 PMCID: PMC11090330 DOI: 10.1371/journal.pone.0302988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION In Scotland, a third of all deaths of people experiencing homelessness (PExH) are street-drug-related, and less than half of their multiple physical- and mental health conditions are treated. New, holistic interventions are required to address these health inequalities. PHOENIx (Pharmacist Homeless Outreach Engagement and Non-medical Independent prescribing Rx) is delivered on outreach by National Health Service (NHS) pharmacist independent prescribers in partnership with third sector homelessness charity workers. We describe participant's perspectives of PHOENIx. METHODS This study aims to understand experiences of the PHOENIx intervention by participants recruited into the active arm of a pilot randomised controlled trial (RCT). Semi-structured in-person interviews explored participants' evaluation of the intervention. In this study, the four components (coherence, cognitive participation, collective action, reflexive monitoring) of the Normalisation Process Theory (NPT) framework underpinned data collection and analyses. RESULTS We identified four themes that were interpreted within the NPT framework that describe participant evaluation of the PHOENIx intervention: differentiating the intervention from usual care (coherence), embedding connection and consistency in practice (cognitive participation), implementation of practical and emotional operational work (collective action), and lack of power and a commitment to long-term support (reflexive monitoring). Participants successfully engaged with the intervention. Facilitators for participant motivation included the relationship-based work created by the PHOENIx team. This included operational work to fulfil both the practical and emotional needs of participants. Barriers included concern regarding power imbalances within the sector, a lack of long-term support and the impact of the intervention concluding. CONCLUSIONS Findings identify and describe participants' evaluations of the PHOENIx intervention. NPT is a theoretical framework facilitating understanding of experiences, highlighting both facilitators and barriers to sustained engagement and investment. Our findings inform future developments regarding a subsequent definitive RCT of PHOENIx, despite challenges brought about by challenging micro and macro-economic and political landscapes.
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Affiliation(s)
- Natalia Farmer
- School of Social Work, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Andrew McPherson
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | | | - Richard Lowrie
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
- Centre for Homelessness and Inclusion Health, University of Edinburgh, Edinburgh, United Kingdom
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Day J, Simmonds RL, Shaw L, Price CI, McClelland G, Ford GA, James M, White P, Stein K, Pope C. Healthcare professional views about a prehospital redirection pathway for stroke thrombectomy: a multiphase deductive qualitative study. Emerg Med J 2024:emermed-2023-213350. [PMID: 38729751 DOI: 10.1136/emermed-2023-213350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Mechanical thrombectomy for stroke is highly effective but time-critical. Delays are common because many patients require transfer between local hospitals and regional centres. A two-stage prehospital redirection pathway consisting of a simple ambulance screen followed by regional centre assessment to select patients for direct admission could optimise access. However, implementation might be challenged by the limited number of thrombectomy providers, a lack of prehospital diagnostic tests for selecting patients and whether finite resources can accommodate longer ambulance journeys plus greater central admissions. We undertook a three-phase, multiregional, qualitative study to obtain health professional views on the acceptability and feasibility of a new pathway. METHODS Online focus groups/semistructured interviews were undertaken designed to capture important contextual influences. We purposively sampled NHS staff in four regions of England. Anonymised interview transcripts underwent deductive thematic analysis guided by the NASSS (Non-adoption, Abandonment and Challenges to Scale-up, Spread and Sustainability, Implementation) Implementation Science framework. RESULTS Twenty-eight staff participated in 4 focus groups, 2 group interviews and 18 individual interviews across 4 Ambulance Trusts, 5 Hospital Trusts and 3 Integrated Stroke Delivery Networks (ISDNs). Five deductive themes were identified: (1) (suspected) stroke as a condition, (2) the pathway change, (3) the value participants placed on the proposed pathway, (4) the possible impact on NHS organisations/adopter systems and (5) the wider healthcare context. Participants perceived suspected stroke as a complex scenario. Most viewed the proposed new thrombectomy pathway as beneficial but potentially challenging to implement. Organisational concerns included staff shortages, increased workflow and bed capacity. Participants also reported wider socioeconomic issues impacting on their services contributing to concerns around the future implementation. CONCLUSIONS Positive views from health professionals were expressed about the concept of a proposed pathway while raising key content and implementation challenges and useful 'real-world' issues for consideration.
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Affiliation(s)
- Jo Day
- NIHR Applied Research Collaboration South West Peninsula, Health and Community Sciences, University of Exeter, Exeter, Devon, UK
| | | | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Graham McClelland
- North East Ambulance Service NHS Foundation Trust, Newcastle Upon Tyne, UK
- Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Gary A Ford
- Oxford University Hospitals NHS Foundation Trust and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Martin James
- Royal Devon University Healthcare NHS Foundation Trust and University of Exeter, University of Exeter, Exeter, Devon, UK
| | - Phil White
- Stroke Research Group, Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ken Stein
- NIHR Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, Devon, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Munce SEP, Wong E, Luong D, Rao J, Cunningham J, Bailey K, John T, Barber C, Batthish M, Chambers K, Cleverley K, Crabtree M, Diaz S, Dimitropoulos G, Gorter JW, Grahovac D, Grimes R, Guttman B, Hébert ML, Henze M, Higgins A, Khodyakov D, Li E, Lo L, Macgregor L, Mooney S, Severino SM, Mukerji G, Penner M, Pidduck J, Shulman R, Stromquist L, Trbovich P, Wan M, Williams L, Yates D, Toulany A. Patient, caregiver and other knowledge user engagement in consensus-building healthcare initiatives: a scoping review protocol. BMJ Open 2024; 14:e080822. [PMID: 38719333 PMCID: PMC11086512 DOI: 10.1136/bmjopen-2023-080822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Patient engagement and integrated knowledge translation (iKT) processes improve health outcomes and care experiences through meaningful partnerships in consensus-building initiatives and research. Consensus-building is essential for engaging a diverse group of experienced knowledge users in co-developing and supporting a solution where none readily exists or is less optimal. Patients and caregivers provide invaluable insights for building consensus in decision-making around healthcare, policy and research. However, despite emerging evidence, patient engagement remains sparse within consensus-building initiatives. Specifically, our research has identified a lack of opportunity for youth living with chronic health conditions and their caregivers to participate in developing consensus on indicators/benchmarks for transition into adult care. To bridge this gap and inform our consensus-building approach with youth/caregivers, this scoping review will synthesise the extent of the literature on patient and other knowledge user engagement in consensus-building healthcare initiatives. METHODS AND ANALYSIS Following the scoping review methodology from Joanna Briggs Institute, published literature will be searched in MEDLINE, EMBASE, CINAHL and PsycINFO databases from inception to July 2023. Grey literature will be hand-searched. Two independent reviewers will determine the eligibility of articles in a two-stage process, with disagreements resolved by a third reviewer. Included studies must be consensus-building studies within the healthcare context that involve patient engagement strategies. Data from eligible studies will be extracted and charted on a standardised form. Abstracted data will be analysed quantitatively and descriptively, according to specific consensus methodologies, and patient engagement models and/or strategies. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review protocol. The review process and findings will be shared with and informed by relevant knowledge users. Dissemination of findings will also include peer-reviewed publications and conference presentations. The results will offer new insights for supporting patient engagement in consensus-building healthcare initiatives. PROTOCOL REGISTRATION https://osf.io/beqjr.
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Affiliation(s)
- Sarah E P Munce
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Elliott Wong
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dorothy Luong
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Justin Rao
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Jessie Cunningham
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Katherine Bailey
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Tomisin John
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claire Barber
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Kyle Chambers
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health Queen Street Site, Toronto, Ontario, Canada
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Marilyn Crabtree
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Sanober Diaz
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Gina Dimitropoulos
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Southern Ontario, Canada
- Department of Rehabilitation, Physical Therapy Science & Sports, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Danijela Grahovac
- National Health Hub in Transition, Children's Healthcare Canada, Hamilton, Southern Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Southern Ontario, Canada
| | - Ruth Grimes
- Canadian Pediatric Society, Winnipeg, Manitoba, Canada
| | - Beverly Guttman
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Michèle L Hébert
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Henze
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Surrey Place Centre, Toronto, Ontario, Canada
| | - Amanda Higgins
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Elaine Li
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Lisha Lo
- University of Toronto Centre for Quality Improvement and Patient Safety, Toronto, Ontario, Canada
| | - Laura Macgregor
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Martin Luther University College, Waterloo, Ontario, Canada
| | - Sarah Mooney
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Samadhi Mora Severino
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Melanie Penner
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Jacklynn Pidduck
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Rayzel Shulman
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Endocrinology and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Stromquist
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- National Health Hub in Transition, Children's Healthcare Canada, Ottawa, Ontario, Canada
| | - Patricia Trbovich
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
- Patient Safety and Quality Improvement, North York General Hospital, Toronto, Ontario, Canada
| | - Michelle Wan
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Laura Williams
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Darryl Yates
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Alene Toulany
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Sim YJ, Townsend RF, Mills S, Stocker R, Stevenson E, McEvoy C, Fairley AM. Understanding engagement in diet and dementia prevention research among British South Asians: a short report of findings from a patient and public involvement group. J Hum Nutr Diet 2024. [PMID: 38713734 DOI: 10.1111/jhn.13316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/07/2024] [Accepted: 04/20/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Dementia is a global public health challenge. Evidence suggests that individuals from South Asian communities are an at-risk group for dementia, partly as a result of early and cumulative exposure to known dementia risk factors, such as obesity and type 2 diabetes. There needs to be more culturally appropriate community engagement to increase awareness of dementia and identify better strategies to encourage participation in dementia-related research. METHODS We aimed to better understand the barriers and facilitators towards engaging with, and participating in, diet and dementia related research among British South Asians. This was achieved using a public and patient involvement (PPI) approach. A community-based, engagement event involving information sharing from experts and roundtable discussions with South Asian communities (n = 26 contributors) was held in June 2023 in Newcastle-upon-Tyne, UK. Collaboration from preidentified PPI representatives (n = 3) informed the content and structure of PPI activities, as well as recruitment. Data were synthesised using template analysis, a form of codebook thematic analysis. This involved deductively analysing data using relevant a priori themes, which were expanded upon, or modified, via inductive analysis. RESULTS The findings highlighted the importance of trust, representation and appreciation of cultural barriers as facilitators to engagement in diet and dementia risk reduction research. Consideration of language barriers, time constraints, social influences and how to embed community outreach activities were reported as driving factors to maximise participation. CONCLUSIONS This PPI work will inform the design and co-creation of a culturally adapted dietary intervention for brain health in accordance with the Medical Research Council and National Institute for Health and Care Research guidance for developing complex interventions.
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Affiliation(s)
- Yi J Sim
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca F Townsend
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susanna Mills
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Stocker
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Stevenson
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire McEvoy
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Andrea M Fairley
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Perks J, McBride P, Mansoubi M, Clatworthy P, Hulme C, Taylor G, Warner M, Dawes H. EvolvRehab-MoveWell telerehabilitation for stroke survivors: study protocol for a feasibility with embedded initial proof-of-concept study. BMJ Open 2024; 14:e078104. [PMID: 38719328 PMCID: PMC11086497 DOI: 10.1136/bmjopen-2023-078104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/26/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Stroke is a leading cause of disability throughout the world. Unilateral upper limb impairment is common in people who have had a stroke. As a result of impaired upper limb function, people who have had a stroke often employ abnormal 'compensatory' movements. In the short term, these compensatory movements allow the individual to complete tasks, though long-term movement in this manner can lead to limitations. Telerehabilitation offers the provision of rehabilitation services to patients at a remote location using information and communication technologies. 'EvolvRehab' is one such telerehabilitation system, which uses activities to assess and correct compensatory upper body movements, although the feasibility of its use is yet to be determined in National Health Service services. Using EvolvRehab, we aim to assess the feasibility of 6 weeks telerehabilitation in people after a stroke. METHODS AND ANALYSIS A multisite feasibility study with embedded design phase. Normally distributed data will be analysed using paired samples t-tests; non-normally distributed data will be analysed using related samples Wilcoxon signed rank tests. Thematic content analysis of interview transcripts will be used to investigate the usability and perceived usefulness of the EvolvRehab kit. ETHICS AND DISSEMINATION This study has received ethical approval from Solihull Research Ethics Committee (REC reference: 23/WM/0054). Dissemination will be carried out according to the dissemination plan co-written with stroke survivors, including academic publications and presentations; written reports; articles in publications of stakeholder organisations; presentations to and publications for potential customers. TRIAL REGISTRATION NUMBER NCT05875792.
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Affiliation(s)
- Jemma Perks
- University of Exeter, Exeter, UK
- Medical School, University of Exeter, Exeter, UK
| | - Philip McBride
- University of Exeter, Exeter, UK
- Medical School, University of Exeter, Exeter, UK
| | | | | | - Claire Hulme
- Health Economics Group, University of Exeter, Exeter, UK
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Helen Dawes
- Medical School, University of Exeter, Exeter, UK
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Oliver H, Thomas O, Neil R, Copeland RJ, Moll T, Chadd K, Jukes MJ, Quartermaine A. A longitudinal study combining the Double Diamond framework and Behavior Change Wheel to co-create a sedentary behavior intervention in police control rooms. J Public Health (Oxf) 2024:fdae061. [PMID: 38702850 DOI: 10.1093/pubmed/fdae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/26/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Police work can be sedentary and stressful, negatively impacting health and wellbeing. In a novel co-creation approach, we used the Behavior Change Wheel (BCW) and Double Diamond (DD) design framework to guide the collaborative design and development of a sedentary behavior intervention in the control rooms of two British police forces. METHODS Multiple stakeholders participated in four phases of research. In Phase 1, a literature review, focus groups (n = 20) and interviews (n = 10) were conducted to 'discover' the relationship between physical activity and wellbeing in the police. In Phase 2, a steering group consolidated Phase 1 findings to 'define' a specific behavior for intervention. Phases 3 and 4 'developed' the intervention across six workshops with control room workers and six steering group workshops. RESULTS The co-creation process identified contextual sedentary behavior as the target behavior, driven by behavioral regulation, social influence and social norms. The sedentary behavior intervention targeted these drivers and aimed to engage control room workers in short bursts of physical activity throughout their shifts. Key intervention features targeted involvement of staff in decision-making and embedding physical activity into work practices. CONCLUSIONS The BCW and DD can be combined to co-create evidence-based and participant-informed interventions and translate science into action.
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Affiliation(s)
- Helen Oliver
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, CF23 6XD, Wales, UK
| | - Owen Thomas
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, CF23 6XD, Wales, UK
| | - Rich Neil
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, CF23 6XD, Wales, UK
| | - Robert J Copeland
- Sheffield Hallam University, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, S9 3TY, UK
| | - Tjerk Moll
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, CF23 6XD, Wales, UK
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McConnell K, McFeeters C, Marley J, Crawford A, Pedlow K. A co-designed mixed methods study on community-based gym exercise for non-ambulant adults with childhood onset disability. Disabil Rehabil 2024:1-9. [PMID: 38702917 DOI: 10.1080/09638288.2024.2346628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Explore community-based gym exercise for non-ambulant adults with childhood-onset disability. MATERIALS AND METHODS Non-ambulant adults with childhood-onset disability participated in four, weekly gym sessions co-facilitated by physiotherapists and exercise professionals. Practicalities of participating in the sessions were recorded via uptake and attrition, weekly surveys, and focus groups. Perspectives of those who designed/delivered the study were gathered via weekly debrief meetings. Quantitative data were analysed descriptively, qualitative data were analysed thematically. RESULTS Ten non-ambulant adults with childhood-onset disability participated; 70% completed all exercise sessions. Focus groups identified three themes. "I wouldn't be able to exercise…there's no option for a community-based setting" described the lack of opportunities for exercise in gyms. "You don't realise the benefit of coming here" highlighted benefits of exercise. "We can do better" had two sub-themes: problem solving and ingredients for community-based gym exercise. Weekly feedback and debrief meetings identified practicalities related to equipment, exercises, and collaborative working between facilitators. CONCLUSIONS Whilst there is an interest in community-based gym exercise for non-ambulant adults with childhood-onset disability, there remains a lack of inclusive gyms. Co-design of inclusive gym guidelines and condition-specific physical activity referral scheme may enhance opportunities for participation in gym exercise for adults with childhood-onset disability.
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Affiliation(s)
- Karen McConnell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Joanne Marley
- School of Health Sciences, Ulster University, Londonderry, UK
| | | | - Katy Pedlow
- School of Health Sciences, Ulster University, Londonderry, UK
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Al-Aqeel S. Nonadherence to antiseizure medications: what have we learned and what can be done next? Expert Rev Pharmacoecon Outcomes Res 2024:1-8. [PMID: 38676921 DOI: 10.1080/14737167.2024.2349191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Nonadherence to antiseizure medications (ASMs) is associated with increased mortality, morbidity, health care utilization, and costs. AREAS COVERED This article reviewed 18 randomized controlled trials published between Jan 2010 and Feb 2024 on Medication Adherence Enhancing Intervention (MAEI) for people with epilepsy. The adequacy of reporting intervention development process was assessed using the GUIDance for the rEporting of intervention Development (GUIDED). The adequacy of the intervention description was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. The interventions were categorized as educational (n = 7), behavioral (n = 5), or mixed (n = 6). The impact of MAEIs on adherence is mixed with majority of studies either reporting no difference between intervention and control groups (n = 6) or improvement in the intervention group (n = 7). The shortcomings in the reporting of MAEIs development, MAEIs description, and MAEIs impact measurement were discussed. EXPERT OPINION Future research needs to accomplish the following tasks: 1) develop and test valid epilepsy-specific self-report measures for assessing adherence; 2) optimize intervention design; and 3) increase transparency in reporting all stages of research.
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Affiliation(s)
- Sinaa Al-Aqeel
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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O'Donoghue M, Kennedy N, Forbes J, Murphy CA. Stakeholder Perceptions of the Acceptability of Peer-Mediated Intervention for Minimally Speaking Preschoolers on the Autism Spectrum. J Autism Dev Disord 2024; 54:1774-1791. [PMID: 36859610 PMCID: PMC9977098 DOI: 10.1007/s10803-023-05928-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/03/2023]
Abstract
Peer mediated intervention (PMI) is an evidence-based approach to supporting social and communication development for children on the autism spectrum. For PMI to be integrated into everyday practice, it needs to be acceptable to stakeholders. This article engaged with autistic individuals, early childhood educators, parents, and speech and language pathologists on the prospective acceptability of implementing PMI with minimally speaking preschoolers in inclusive preschool settings. Focus groups and semi-structured interviews were conducted. The transcriptions were analyzed qualitatively using reflexive thematic analysis. Stakeholders described PMI as an acceptable intervention approach for this population and provided valuable insights to inform the development and implementation of PMIs. Attention needs to be paid to how to support preschools to adopt a PMI-friendly philosophy.
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Affiliation(s)
- Michelle O'Donoghue
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Norelee Kennedy
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - John Forbes
- Graduate Entry Medical School, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Carol-Anne Murphy
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
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Danford CA, Mooney-Doyle K, Deatrick JA, Feetham S, Gross D, Knafl KA, Kobayashi K, Moriarty H, Østergaard B, Swallow V. Building Family Interventions for Scalability and Impact. JOURNAL OF FAMILY NURSING 2024; 30:94-113. [PMID: 38629802 DOI: 10.1177/10748407241231342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Family nursing researchers are charged with addressing the conceptual and methodological underpinnings of family research when developing family-focused interventions. Step-by-step guidance is needed that integrates current science of intervention development with family science and helps researchers progress from foundational work to experimental work with policy integration. The purpose of this manuscript is to provide pragmatic, evidence-based guidance for advancing family intervention research from foundational work through efficacy testing. Guidance regarding the development of family interventions is presented using the first three of Sidani's five-stage method: (a) foundational work to understand the problem targeted for change; (b) intervention development and assessment of acceptability and feasibility; and (c) efficacy testing. Each stage of family intervention development is described in terms of process, design considerations, and policy and practice implications. Examples are included to emphasize the family lens. This manuscript provides guidance to family scientists for intervention development and implementation to advance family nursing science and inform policy.
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Affiliation(s)
| | | | | | - Suzanne Feetham
- University of Illinois Chicago, Chicago, IL USA
- Children's National Hospital, Washington, DC, USA
| | | | - Kathleen A Knafl
- The University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Helene Moriarty
- Villanova University, PA, Villanova, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Azcárate-Cenoz N, Canga-Armayor A, Alfaro-Díaz C, Canga-Armayor N, Pueyo-Garrigues M, Esandi N. Family-Oriented Therapeutic Conversations: A Systematic Scoping Review. JOURNAL OF FAMILY NURSING 2024; 30:145-173. [PMID: 38529615 DOI: 10.1177/10748407241235141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
There is increasing evidence that highlights the benefits of Family-oriented Therapeutic Conversations (FAM-TC) for the patient and the family; however, studies show variability regarding the content and the way these interventions are offered. This may hamper its further development in clinical practice. This review systematically maps the available literature on nurse-led FAM-TC and offers a solid synthesis of the characteristic, effectiveness, and feasibility of these interventions. A systematic search in PubMed, CINAHL, Cochrane, Web of Science, PsycINFO, Trip (Turning Research Into Practice), BASE (Bielefeld Academic Search Engine), OATD (Open Access Theses and Dissertations), and ProQuest databases identified 37 studies. The interventions varied in interventionist nurses' profile, the intervention content, or the duration of the sessions offered. Most of the interventions showed beneficial effects on perceived family support and family functioning. This review offers suggestions for future studies, such as the inclusion of specific theoretical frameworks for intervention design, targeting both the patient and the family and offered by nurses with family nursing competency.
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Affiliation(s)
- Nerea Azcárate-Cenoz
- University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNa), Pamplona, Spain
| | - Ana Canga-Armayor
- University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNa), Pamplona, Spain
| | - Cristina Alfaro-Díaz
- University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNa), Pamplona, Spain
| | - Navidad Canga-Armayor
- University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNa), Pamplona, Spain
| | - María Pueyo-Garrigues
- University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNa), Pamplona, Spain
| | - Nuria Esandi
- University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNa), Pamplona, Spain
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Linkiewich D, Dib KC, Forgeron PA, Dick BD, McMurtry CM. Roadmap to the 'Chronic Pain GPS for Adolescents' Intervention: Content and Design Considerations for a Group Peer Support Intervention. Clin J Pain 2024; 40:288-298. [PMID: 38303597 DOI: 10.1097/ajp.0000000000001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES A biopsychosocial approach to understanding and treating pain is crucial; however, there are limited socially targeted interventions for adolescents with chronic pain (ACP). Peer support interventions implemented with other populations are associated with positive outcomes. ACPs perceive peer support to have high potential value. This study explored the preferences of ACP regarding the content and design of a group peer support intervention. METHODS Fourteen ACP (M age : 15.21 y; 9 females; 3 males, 1 nonbinary, and 1 gender questioning) completed a virtual interview and survey. Interviews were analyzed using inductive qualitative content analysis, and surveys were analyzed using descriptive statistics. RESULTS Adolescents described how they want to both talk and do activities together within a fun and casual environment with a facilitator present-ideally, someone with lived experience of chronic pain. Preferences were for a medium-sized group intervention that was in-person, at a consistent time on a weekday after school, and semi-structured. Barriers to attending and engaging in the potential group peer intervention were also discussed. DISCUSSION ACPs desire a facilitated socially focused intervention that provides them with the opportunity to spend time with other ACPs. A group peer support environment where ACPs can provide and receive peer support through sharing their experiences with others who understand them as well as engage in activities was described. The findings from this study provide insights for the development of a group peer support intervention.
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Affiliation(s)
| | | | | | - Bruce D Dick
- Department of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph
- Department of Anesthesia, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
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Granberg A, Lundqvist LO, Duberg A, Matérne M. The influence of contextual factors on an intervention for people with disabilities from support persons' and health personnel's perspectives: a focus group study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1294990. [PMID: 38751820 PMCID: PMC11094220 DOI: 10.3389/fresc.2024.1294990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Introduction Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons' and health personnel's experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons' and health personnel's experience of contextual factors during involvement in an intervention for people with PIMD. Methods This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach. Results Three themes emerged from the analysis of the informants' perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention's benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons' and health personnel's motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention. Discussion Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.
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Affiliation(s)
- Anette Granberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Lars-Olov Lundqvist
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Anna Duberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Marie Matérne
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
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Pryjmachuk S, Kirk S, Fraser C, Evans N, Lane R, Neill L, Camacho E, Bower P, Bee P, McDougall T. Service design for children and young people with common mental health problems: literature review, service mapping and collective case study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-181. [PMID: 38767587 DOI: 10.3310/dkrt6293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background The mental health of children/young people is a growing concern internationally. Numerous reports and reviews have consistently described United Kingdom children's mental health services as fragmented, variable, inaccessible and lacking an evidence base. Little is known about the effectiveness of, and implementation complexities associated with, service models for children/young people experiencing 'common' mental health problems like anxiety, depression, attention deficit hyperactivity disorder and self-harm. Aim To develop a model for high-quality service design for children/young people experiencing common mental health problems by identifying available services, barriers and enablers to access, and the effectiveness, cost effectiveness and acceptability of such services. Design Evidence syntheses with primary research, using a sequential, mixed-methods design. Inter-related scoping and integrative reviews were conducted alongside a map of relevant services across England and Wales, followed by a collective case study of English and Welsh services. Setting Global (systematic reviews); England and Wales (service map; case study). Data sources Literature reviews: relevant bibliographic databases and grey literature. Service map: online survey and offline desk research. Case study: 108 participants (41 children/young people, 26 parents, 41 staff) across nine case study sites. Methods A single literature search informed both reviews. The service map was obtained from an online survey and internet searches. Case study sites were sampled from the service map; because of coronavirus disease 2019, case study data were collected remotely. 'Young co-researchers' assisted with case study data collection. The integrative review and case study data were synthesised using the 'weaving' approach of 'integration through narrative'. Results A service model typology was derived from the scoping review. The integrative review found effectiveness evidence for collaborative care, outreach approaches, brief intervention services and the 'availability, responsiveness and continuity' framework. There was cost-effectiveness evidence only for collaborative care. No service model appeared to be more acceptable than others. The service map identified 154 English and Welsh services. Three themes emerged from the case study data: 'pathways to support'; 'service engagement'; and 'learning and understanding'. The integrative review and case study data were synthesised into a coproduced model of high-quality service provision for children/young people experiencing common mental health problems. Limitations Defining 'service model' was a challenge. Some service initiatives were too new to have filtered through into the literature or service map. Coronavirus disease 2019 brought about a surge in remote/digital services which were under-represented in the literature. A dearth of relevant studies meant few cost-effectiveness conclusions could be drawn. Conclusions There was no strong evidence to suggest any existing service model was better than another. Instead, we developed a coproduced, evidence-based model that incorporates the fundamental components necessary for high-quality children's mental health services and which has utility for policy, practice and research. Future work Future work should focus on: the potential of our model to assist in designing, delivering and auditing children's mental health services; reasons for non-engagement in services; the cost effectiveness of different approaches in children's mental health; the advantages/disadvantages of digital/remote platforms in delivering services; understanding how and what the statutory sector might learn from the non-statutory sector regarding choice, personalisation and flexibility. Study registration This study is registered as PROSPERO CRD42018106219. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/08) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Steven Pryjmachuk
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Susan Kirk
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Claire Fraser
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Nicola Evans
- School of Healthcare Studies, Cardiff University, Cardiff, UK
| | - Rhiannon Lane
- School of Healthcare Studies, Cardiff University, Cardiff, UK
| | | | - Elizabeth Camacho
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Peter Bower
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Penny Bee
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Tim McDougall
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
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DeVore K, Schneider K, Laures E, Harmon A, Van Heukelom P. Improving Outcomes in Patients Sent to the Emergency Department from Outpatient Providers: A Receiver-Driven Handoff Process Improvement. Jt Comm J Qual Patient Saf 2024; 50:363-370. [PMID: 38368190 DOI: 10.1016/j.jcjq.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Outpatient providers refer to emergency departments (EDs) due to findings requiring assessment beyond existing capabilities. However, poor communication surrounding these transitions may hinder safety and timeliness of emergency care. Receiver-driven handoff (RDH) is a process that helps ensure that all pertinent information is shared. This quality improvement project aimed to (1) improve knowledge of RDH, (2) increase satisfaction and perceptions surrounding RDH, (3) modify behaviors in relation to RDH, and (4) decrease referred patients leaving without being seen (LWBS). METHODS The Iowa Model and Implementation Framework guided this evidence-based quality improvement project. A multidisciplinary team developed and implemented a standardized RDH process consisting of screening to determine whether a patient was referred to the ED, review of electronic health record (EHR), and use of EHR documentation. Process measures were collected via questionnaire pre- and postimplementation and were analyzed quantitatively. Outcome measures were trended by a statistical process control p-chart, which was developed to demonstrate changes in the percentage of patients who were referred to the ED from the outpatient setting and LWBS. RESULTS The average response for the question "How satisfied are you with the handoff of patient information from referring clinic providers to the ED?" increased from 1.51 preintervention to 2.04 postintervention (p = 0.005). Respondents rated the information received during handoff higher postintervention (2.12 vs. 2.52, p = 0.04). Compliance with screening for referral to the ED was 84.0%. The proportion of patients LWBS after referral decreased by 6.2 percentage points (p < 0.001). CONCLUSION Using RDH in conjunction with a standardized triage screening may improve quality of information shared during this vulnerable transition and may assist in reduction of referred patients LWBS. The RDH process should be adapted into everyday workflow to ensure sustainability and effectiveness.
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O'Donoghue M, Kennedy N, Forbes J, Murphy CA. Feasible Peer-Mediated Intervention for Autistic Children Using Minimal Speech: A Qualitative Intervention Development Process. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1337-1355. [PMID: 38346137 DOI: 10.1044/2024_ajslp-23-00303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE Qualitative engagement with stakeholders in the development of interventions can provide insight into strategies to maximize feasibility in real-life settings. We engaged stakeholders (autistic adults, early childhood educators, early childhood sector leaders and policy influencers, parents of autistic children, and speech-language pathologists) to inform the development of an educator-led peer-mediated intervention (PMI) for autistic preschoolers who use minimal speech that is feasible to implement in inclusive early childhood education and care (ECEC) settings. METHOD A qualitative iterative intervention design process was utilized. Stakeholders (N = 15) attended an online workshop and completed a document review exploring the acceptability and feasibility of the proposed embedded PMI. A two-step analysis procedure using the Theoretical Domains Framework and template analysis was conducted to identify the barriers, enablers, and supports to the implementation of embedded PMI in early childhood settings. RESULTS While embedded PMI was unanimously acceptable to stakeholders, several participants expressed concerns regarding feasibility. Barriers to the successful integration and implementation of PMI in inclusive preschool contexts included access to skills, knowledge, and resources. Participants identified strategies to overcome modifiable barriers and to enhance the existing enablers. These strategies are reflected in the following themes: build on the familiar, build capacity in augmentative and alternative communication, adopt a whole center approach, adapt to meet the needs of the ECEC setting, and engage in proactive implementation. CONCLUSION To address barriers to the implementation of embedded PMI, action is needed at various levels: macro (national/policy), meso (organization/setting), and micro (individual). SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25155770.
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Affiliation(s)
- Michelle O'Donoghue
- Health Research Institute, School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - Norelee Kennedy
- Health Research Institute, School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - John Forbes
- Health Research Institute, Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - Carol-Anne Murphy
- Health Research Institute, School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Ireland
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Witharana P, Chang L, Maier R, Ogundimu E, Wilkinson C, Athanasiou T, Akowuah E. Feasibility study of rehabilitation for cardiac patients aided by an artificial intelligence web-based programme: a randomised controlled trial (RECAP trial)-a study protocol. BMJ Open 2024; 14:e079404. [PMID: 38688664 PMCID: PMC11086203 DOI: 10.1136/bmjopen-2023-079404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/20/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) delivered by rehabilitation specialists in a healthcare setting is effective in improving functional capacity and reducing readmission rates after cardiac surgery. It is also associated with a reduction in cardiac mortality and recurrent myocardial infarction. This trial assesses the feasibility of a home-based CR programme delivered using a mobile application (app). METHODS The Rehabilitation through Exercise prescription for Cardiac patients using an Artificial intelligence web-based Programme (RECAP) randomised controlled feasibility trial is a single-centre prospective study, in which patients will be allocated on a 1:1 ratio to a home-based CR programme delivered using a mobile app with accelerometers or standard hospital-based rehabilitation classes. The home-based CR programme will employ artificial intelligence to prescribe exercise goals to the participants on a weekly basis. The trial will recruit 70 patients in total. The primary objectives are to evaluate participant recruitment and dropout rates, assess the feasibility of randomisation, determine acceptability to participants and staff, assess the rates of potential outcome measures and determine hospital resource allocation to inform the design of a larger randomised controlled trial for clinical efficacy and health economic evaluation. Secondary objectives include evaluation of health-related quality of life and 6 minute walk distance. ETHICS AND DISSEMINATION RECAP trial received a favourable outcome from the Berkshire research ethics committee in September 2022 (IRAS 315483).Trial results will be made available through publication in peer-reviewed journals and presented at relevant scientific meetings. TRIAL REGISTRATION NUMBER ISRCTN97352737.
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Affiliation(s)
- Pasan Witharana
- Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lisa Chang
- Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Rebecca Maier
- Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | | | - Christopher Wilkinson
- Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Hull York Medical School, University of York, York, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Enoch Akowuah
- Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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Wall G, Pearce C, Gustafsson L, Isbel S. Designing an occupation-based group intervention for adult inpatient rehabilitation: Partnering with clinicians and patients using a nominal group technique design. Aust Occup Ther J 2024. [PMID: 38689435 DOI: 10.1111/1440-1630.12950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Occupation-based interventions use engagement in a person's daily activities to achieve change. There is growing research into the use of occupation-based group interventions in the inpatient rehabilitation setting. It remains unclear whether occupation-based groups offer comparable outcomes to occupation-based interventions delivered individually; this research will precede a clinical trial aimed at comparing these two approaches for improving occupational performance outcomes. This study details the process of co-designing the intervention. Partnering with clinicians and patients in the design of healthcare interventions can promote patient-centred care, enhance uptake, and improve applicability and sustainability of the intervention to that setting. METHODS A modified nominal group technique (NGT) design was applied to facilitate two meetings and an electronic survey with an expert panel of clinicians and patients. Twelve participants (n = 4 occupational therapists, n = 1 registered nurse, n = 1 physiotherapist, n = 1 occupational therapy assistant, n = 1 occupational therapy manager, and n = 4 patients) were purposively recruited. A modified approach to the technique's four stages was used: silent generation, round robin, clarification, and voting. Consensus was set at >50%. Qualitative data from group discussions were analysed thematically. FINDINGS All participants agreed the intervention should include patient-centred, goal-directed, practice of daily activities, including breakfast and lunch preparation, domestic tasks, and laundry. Other components that were agreed included where the groups could run, group size, eligibility criteria, and frequency. Key themes from clinicians included needing a goal-directed intervention, focused on progressing towards hospital discharge; time and resource requirements were also discussed. Patients emphasised the importance of building social connections, opportunity to engage in meaningful activity, and the importance of linking participation to patient goals. CONCLUSION Through collaboration with clinicians and patients, an occupation-based group intervention considering the available evidence, alongside clinical, experiential, and contextual sources of knowledge was developed; this resulted in an evidence-based, patient-centred, and contextually relevant intervention.
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Affiliation(s)
- Gemma Wall
- Discipline of Occupational Therapy, Faculty of Health, University of Canberra, Canberra, Australia
- Occupational Therapy Department, University of Canberra Hospital, Canberra, Australia
| | - Claire Pearce
- Discipline of Occupational Therapy, Faculty of Health, University of Canberra, Canberra, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Nathan, Queensland, Australia
| | - Stephen Isbel
- Discipline of Occupational Therapy, Faculty of Health, University of Canberra, Canberra, Australia
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Tol S, de Haan GA, Postuma EMJL, Jansen JL, Heutink J. Reading Difficulties in Individuals with Homonymous Visual Field Defects: A Systematic Review of Reported Interventions. Neuropsychol Rev 2024:10.1007/s11065-024-09636-4. [PMID: 38639880 DOI: 10.1007/s11065-024-09636-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/20/2024] [Indexed: 04/20/2024]
Abstract
Reading difficulties are amongst the most commonly reported problems in individuals with homonymous visual field defects (HVFDs). To be able to provide guidance for healthcare professionals considering offering reading training, researchers in this field and interested individuals with HVFDs, this systematic review aims to (1) provide an overview of the contextual and intervention characteristics of all published HVFD interventions and (2) generate insights into the different reading outcome measures that these studies adopted. A search on PsycINFO, MEDLINE and Web of Science was conducted up to February 2, 2023. All intervention studies for HVFD in which reading was measured were included. Data was collected about the intervention type, session duration, number of sessions, the intensity, duration, circumstance of the interventions, country in which the intervention was studied and reading measures. Sixty records are included, describing 70 interventions in total of which 21 are specifically reading interventions. Overall, adjusted saccadic behaviour interventions occur most in the literature. A wide range within all intervention characteristics was observed. Forty-nine records reported task-performance reading measures, and 33 records reported self-reported reading measures. The majority of task-performance measures are based on self-developed paragraph reading tasks with a time-based outcome measure (e.g. words per minute). Future research could benefit from making use of validated reading tests, approaching the measurement of reading mixed-methods and providing participants the possibility to supply outcomes relevant to them.
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Affiliation(s)
- S Tol
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - G A de Haan
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Amersfoortsestraatweg 180, 1272 RR, Huizen, The Netherlands
| | - E M J L Postuma
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - J L Jansen
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - J Heutink
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Amersfoortsestraatweg 180, 1272 RR, Huizen, The Netherlands
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Pijpers EJ, Bloemen B, Cup EHC, Groothuis JT, Oortwijn WJ, van Engelen BGM, van der Wilt GJ. The capability approach in rehabilitation: developing capability care. Disabil Rehabil 2024:1-13. [PMID: 38625146 DOI: 10.1080/09638288.2024.2342494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To develop a multidisciplinary outpatient rehabilitation intervention for people with neuromuscular diseases (NMD) based on the capability approach: capability care for persons with NMD. MATERIALS AND METHODS The development process is described using a framework of actions for intervention development. It has been an iterative process consisting of a design phase based on theoretical insights and project group discussions, and a refine phase involving input from relevant stakeholders. RESULTS Multidisciplinary efforts have resulted in the development of capability care for rehabilitation of persons with NMD. It can focus both on facilitating and achieving functionings (beings and doings), as well as looking for alternative functionings that fulfil the same underlying value, thereby contributing to the persons' well-being. To facilitate a conversation on broader aspects that impact on well-being, persons with NMD receive a preparation letter and healthcare professionals are provided with guiding questions and practical tools to use. CONCLUSIONS We have shown that it is possible to develop a healthcare intervention based on the capability approach. We hope that rehabilitation professionals will be encouraged to use capability care and that other medical professionals will be inspired to develop capability care in their respective fields. REGISTRATION Registered at trialregister.nl NL8946.
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Affiliation(s)
- Eirlys J Pijpers
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Bloemen
- Donders Institute for Brain, Cognition and Behaviour, Department of IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edith H C Cup
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wija J Oortwijn
- Research Institute for Medical Innovation, Science Department IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Donders Institute for Brain, Cognition and Behaviour, Department of IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands
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Melén E, Faner R, Allinson JP, Bui D, Bush A, Custovic A, Garcia-Aymerich J, Guerra S, Breyer-Kohansal R, Hallberg J, Lahousse L, Martinez FD, Merid SK, Powell P, Pinnock H, Stanojevic S, Vanfleteren LEGW, Wang G, Dharmage SC, Wedzicha J, Agusti A. Lung-function trajectories: relevance and implementation in clinical practice. Lancet 2024; 403:1494-1503. [PMID: 38490231 DOI: 10.1016/s0140-6736(24)00016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/30/2023] [Accepted: 01/04/2024] [Indexed: 03/17/2024]
Abstract
Lung development starts in utero and continues during childhood through to adolescence, reaching its peak in early adulthood. This growth is followed by gradual decline due to physiological lung ageing. Lung-function development can be altered by several host and environmental factors during the life course. As a result, a range of lung-function trajectories exist in the population. Below average trajectories are associated with respiratory, cardiovascular, metabolic, and mental health comorbidities, as well as with premature death. This Review presents progressive research into lung-function trajectories and assists the implementation of this knowledge in clinical practice as an innovative approach to detect poor lung health early, monitor respiratory disease progression, and promote lung health. Specifically, we propose that, similar to paediatric height and weight charts used globally to monitor children's growth, lung-function charts could be used for both children and adults to monitor lung health status across the life course. To achieve this proposal, we introduce our free online Lung Function Tracker tool. Finally, we discuss challenges and opportunities for effective implementation of the trajectory concept at population level and outline an agenda for crucial research needed to support such implementation.
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Affiliation(s)
- Erik Melén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet and Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
| | - Rosa Faner
- University of Barcelona, FCRB-IDIBAPS, CIBERES, Barcelona, Spain
| | - James P Allinson
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Dinh Bui
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Bush
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Robab Breyer-Kohansal
- Department of Respiratory and Pulmonary Diseases and Ludwig Boltzmann Institute for Lung Health, Clinic Hietzing, Vienna, Austria
| | - Jenny Hallberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet and Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | | | - Fernando D Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Simon Kebede Merid
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet and Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | | | | | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gang Wang
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet and Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden; Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jadwiga Wedzicha
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Alvar Agusti
- Respiratory Institute, Clinic Barcelona, Cathedra Salud Respiratoria-University of Barcelona, CIBERES, Barcelona, Spain
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Losciale JM, Truong LK, Zhang K, Silvester-Lee T, Miciak M, Pajkic A, Le CY, Xie H, Hoens AM, Mosewich AD, Hunt MA, Li LC, Roos EM, Whittaker JL. Assessing the efficacy of the Stop OsteoARthritis (SOAR) program: A randomized delayed-controlled trial in persons at increased risk of early onset post-traumatic knee osteoarthritis. Osteoarthritis Cartilage 2024:S1063-4584(24)01151-8. [PMID: 38615974 DOI: 10.1016/j.joca.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Assess the efficacy of an 8-week virtual, physiotherapist (PT)-guided knee health program (Stop OsteoARthritis (SOAR)) to improve knee extensor strength in individuals at risk of post-traumatic knee osteoarthritis (PTOA). METHOD In this superiority, randomized delayed-control trial, persons aged 16-35 years, 1-4 years after a self-reported knee joint injury were randomly assigned (1:1) to receive the SOAR program immediately (experimental group) or after a 9-week delay (control group). SOAR includes 1) one-time Knee Camp (virtual PT-guided group education, knee assessment, 1:1 exercise and physical activity (PA) goal-setting); 2) Weekly personalized home-based exercise and PA program with tracking; 3) Weekly 1:1 PT counseling (virtual). The primary outcome was a change in isokinetic knee extensor strength (baseline to 9-weeks). Additional outcomes included change in self-reported knee-related quality-of-life (QOL), self-efficacy, self-management and kinesiophobia, and PA (accelerometer) at 9 and 18-weeks. Linear regression models estimated the effect of the 8-week intervention at the primary endpoint (9-week). RESULTS 49 of 54 randomized participants completed the study (91%). Participants were a mean ± standard deviation age of 27 ± 5.0 years, and 2.4 ± 0.9 years post-injury. No mean between group differences for the primary (0.05; 95% confidence interval (CI): -0.10, 0.19) or other outcomes were seen at 9 weeks except for greater improvements in perceived self-management (Partner in Health Scale; 11.3/96, 95%CI: 5.5, 17.1) and kinesiophobia (Tampa Scale of Kinesiophobia; -4.4/33, 95%CI: -7.0, -1.8). CONCLUSION For active persons with elevated risk of PTOA, an 8-week SOAR program did not change knee-related strength, QOL, self-efficacy, or PA, on average, but may benefit the ability to self-manage knee health and kinesiophobia.
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Affiliation(s)
- Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Kexin Zhang
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Pajkic
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Christina Y Le
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alison M Hoens
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Amber D Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Ewa M Roos
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada.
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McNaught E, Reale S, Bourke L, Brown JE, Collinson M, Day F, Hewison J, Farrin AJ, Ibeggazene S, Innes AQ, Mason E, Meads D, Scope A, Taylor C, Taylor SJ, Turner RR, Rosario DJ. Supported exercise TrAining for Men wIth prostate caNcer on Androgen deprivation therapy (STAMINA): study protocol for a randomised controlled trial of the clinical and cost-effectiveness of the STAMINA lifestyle intervention compared with optimised usual care, including internal pilot and parallel process evaluation. Trials 2024; 25:257. [PMID: 38610058 PMCID: PMC11010375 DOI: 10.1186/s13063-024-07989-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND UK national clinical guidance recommends that men with prostate cancer on androgen deprivation therapy are offered twice weekly supervised aerobic and resistance exercise to address iatrogenic harm caused by treatment. Very few NHS trusts have established adequate provision of such services. Furthermore, interventions fail to demonstrate sustained behaviour change. The STAMINA lifestyle intervention offers a system-level change to clinical care delivery addressing barriers to long-term behaviour change and implementation of new prostate cancer care pathways. This trial aims to establish whether STAMINA is clinically and cost-effective in improving cancer-specific quality of life and/or reducing fatigue compared to optimised usual care. The process evaluation aims to inform the interpretation of results and, if the intervention is shown to benefit patients, to inform the implementation of the intervention into the NHS. METHODS Men with prostate cancer on androgen deprivation therapy (n = 697) will be identified from a minimum of 12 UK NHS trusts to participate in a multi-centre, two-arm, individually randomised controlled trial. Consenting men will have a 'safety to exercise' check and be randomly allocated (5:4) to the STAMINA lifestyle intervention (n = 384) or optimised usual care (n = 313). Outcomes will be collected at baseline, 3-, 6- and 12-month post-randomisation. The two primary outcomes are cancer-specific quality of life and fatigue. The parallel process evaluation will follow a mixed-methods approach to explore recruitment and aspects of the intervention including, reach, fidelity, acceptability, and implementation. An economic evaluation will estimate the cost-effectiveness of the STAMINA lifestyle intervention versus optimised usual care and a discrete choice experiment will explore patient preferences. DISCUSSION The STAMINA lifestyle intervention has the potential to improve quality of life and reduce fatigue in men on androgen deprivation therapy for prostate cancer. Embedding supervised exercise into prostate cancer care may also support long-term positive behaviour change and reduce adverse events caused by treatment. Findings will inform future clinical care and could provide a blueprint for the integration of supervised exercise and behavioural support into other cancer and/or clinical services. TRIAL REGISTRATION ISRCTN 46385239, registered on 30/07/2020. Cancer Research UK 17002, retrospectively registered on 24/08/2022.
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Affiliation(s)
- Emma McNaught
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Sophie Reale
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Liam Bourke
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Janet E Brown
- Division of Clinical Medicine, University of Sheffield, Sheffield, S10 2RX, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Florence Day
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jenny Hewison
- Division of Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Saïd Ibeggazene
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Aidan Q Innes
- Nuffield Health, 2 Ashley Avenue, Epsom, Surrey, KT18 5AL, UK
| | - Ellen Mason
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Alison Scope
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Chris Taylor
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Steph Jc Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Rebecca R Turner
- Division of Psychology and Mental Health in the School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Derek J Rosario
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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Van Stan JH, Roy N, Stemple J, Gartner-Schmidt J, Gillespie AI, Whyte J, Duffy J, Turkstra L. Rehabilitation Treatment Specification System: Content and Criterion Validity Across Evidence-Based Voice Therapies for Muscle Tension Dysphonia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-18. [PMID: 38597797 DOI: 10.1044/2024_ajslp-23-00362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE Systematically improving voice therapy outcomes is challenging as the clinician actions (i.e., active ingredients) responsible for improved patient functioning (i.e., targets) are relatively unknown. The theory-driven Rehabilitation Treatment Specification System (RTSS) and standard, voice-specific terminology based on the RTSS (RTSS-Voice) may help address this problem. This qualitative study evaluated if the RTSS and RTSS-Voice can describe four evidence-based voice therapies for muscle tension dysphonia without missing critical aspects (content validity) and identify commonalities and differences across them (criterion validity). METHOD Qualitative interviews were completed between the clinicians (protocol experts) who developed and/or popularized the vocal function exercises, laryngeal reposturing, circumlaryngeal massage, and conversation training therapies as well as RTSS experts to produce RTSS specifications that met two consensus criteria: (a) The protocol expert agreed that the specification represented their treatment theory, and (b) the RTSS experts agreed that the specifications correctly adhered to both the RTSS framework and the RTSS-Voice's standard terminology. RESULTS The RTSS and RTSS-Voice comprehensively described voice therapy variations across and within the four diverse treatment programs, needing only the addition of one new target: overall auditory-perceptual severity. CONCLUSIONS The RTSS and RTSS-Voice exhibited strong content validity. The standard RTSS-Voice terminology helped identify, for the first time, commonalities and differences in treatment ingredients, targets, and mechanisms of action across four treatments developed for the same patient population. In the long term, the RTSS and RTSS-Voice could provide the framework for an ever-growing collection of clinically meaningful and evidence-based therapy algorithms with potential to improve research, education, and clinical care. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25537624.
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Affiliation(s)
- Jarrad H Van Stan
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | | | | | | | | | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA
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Pfledderer CD, von Klinggraeff L, Burkart S, da Silva Bandeira A, Lubans DR, Jago R, Okely AD, van Sluijs EMF, Ioannidis JPA, Thrasher JF, Li X, Beets MW. Consolidated guidance for behavioral intervention pilot and feasibility studies. Pilot Feasibility Stud 2024; 10:57. [PMID: 38582840 PMCID: PMC10998328 DOI: 10.1186/s40814-024-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/26/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND In the behavioral sciences, conducting pilot and/or feasibility studies (PFS) is a key step that provides essential information used to inform the design, conduct, and implementation of a larger-scale trial. There are more than 160 published guidelines, reporting checklists, frameworks, and recommendations related to PFS. All of these publications offer some form of guidance on PFS, but many focus on one or a few topics. This makes it difficult for researchers wanting to gain a broader understanding of all the relevant and important aspects of PFS and requires them to seek out multiple sources of information, which increases the risk of missing key considerations to incorporate into their PFS. The purpose of this study was to develop a consolidated set of considerations for the design, conduct, implementation, and reporting of PFS for interventions conducted in the behavioral sciences. METHODS To develop this consolidation, we undertook a review of the published guidance on PFS in combination with expert consensus (via a Delphi study) from the authors who wrote such guidance to inform the identified considerations. A total of 161 PFS-related guidelines, checklists, frameworks, and recommendations were identified via a review of recently published behavioral intervention PFS and backward/forward citation tracking of a well-known PFS literature (e.g., CONSORT Ext. for PFS). Authors of all 161 PFS publications were invited to complete a three-round Delphi survey, which was used to guide the creation of a consolidated list of considerations to guide the design, conduct, and reporting of PFS conducted by researchers in the behavioral sciences. RESULTS A total of 496 authors were invited to take part in the three-round Delphi survey (round 1, N = 46; round 2, N = 24; round 3, N = 22). A set of twenty considerations, broadly categorized into six themes (intervention design, study design, conduct of trial, implementation of intervention, statistical analysis, and reporting) were generated from a review of the 161 PFS-related publications as well as a synthesis of feedback from the three-round Delphi process. These 20 considerations are presented alongside a supporting narrative for each consideration as well as a crosswalk of all 161 publications aligned with each consideration for further reading. CONCLUSION We leveraged expert opinion from researchers who have published PFS-related guidelines, checklists, frameworks, and recommendations on a wide range of topics and distilled this knowledge into a valuable and universal resource for researchers conducting PFS. Researchers may use these considerations alongside the previously published literature to guide decisions about all aspects of PFS, with the hope of creating and disseminating interventions with broad public health impact.
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Affiliation(s)
- Christopher D Pfledderer
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, 78701, USA.
- Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX, 78701, USA.
| | | | - Sarah Burkart
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | | | - David R Lubans
- College of Human and Social Futures, The University of Newcastle Australia, Callaghan, NSW, 2308, Australia
| | - Russell Jago
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 1QU, UK
| | - Anthony D Okely
- Faculty of Arts, Social Sciences and Humanities, School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
| | | | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
- Department of Statistics, Stanford University, Stanford, CA, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
| | - Michael W Beets
- Arnold School of Public Health, University of South Carolina, Columbia, SC, 29205, USA
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Broc G, Brunel L, Lareyre O. Dynamic Ecosystem Adaptation through Allostasis (DEA-A) Model: Conceptual Presentation of an Integrative Theoretical Framework for Global Health Change. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:432. [PMID: 38673343 PMCID: PMC11050241 DOI: 10.3390/ijerph21040432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/27/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024]
Abstract
Achieving ambitious goals in Global Health first requires an integrative understanding of how individuals and organizations adapt in a living ecosystem. The absence of a unified framework limits the consideration of the issues in their complexity, which further complicates the planning of Global Health programs aimed at articulating population-based prevention and individual-level (clinical) interventions. The aim of the conceptual contribution is to propose such a model. It introduces the Dynamic Ecosystem of Adaptation through Allostasis (DEA-A) theoretical framework, emphasizing the functional adaptation of individuals and organizations in symbiosis with their living ecosystem. The DEA-A framework articulates two central components to grasp the complexity of adaptation: the internal dynamics (intrasystem level) and the environmental dynamics (ecosystem level). It bridges diverse conceptual approaches, including stress and adaptation models, behavior-change models, and ecosystem-based perspectives. Epistemological considerations raised in the conceptual article prompt a reconsideration of methods and tools for the planning of intervention. Further contributions will present a suitable methodology for the application of the DEA-A framework along with practical recommendations.
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Affiliation(s)
- Guillaume Broc
- EPSYLON EA 4556, Paul Valéry Montpellier 3, University of Montpellier, 34090 Montpellier, France; (L.B.); (O.L.)
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Plys E, Grunberg VA, Vranceanu AM. Advancing Methodological Rigor for Psychosocial Aspects of Neuropalliative Care Interventions. J Palliat Care 2024; 39:92-96. [PMID: 38343071 PMCID: PMC10986462 DOI: 10.1177/08258597241232490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Background: Neurological disorders (NDs) have unique biopsychosocial-spiritual features that impact patients and their families. As a result, the subspeciality of neuropalliative care (NPC) emerged within the past decade and has grown exponentially in research and practice. Given the cognitive, emotional, and behavioral changes associated with NDs, psychosocial components (eg, coping skills) of NPC interventions are essential for improving the quality of life for patients and families. However, psychosocial components of NPC interventions warrant more rigorous testing to improve their evidence base and their likelihood of implementation and dissemination. Aim: In this commentary, we provide methodological recommendations with the goal of improving scientific knowledge and rigor for psychosocial components of multicomponent NPC interventions in clinical trials. Results: We emphasize the need for transparent reporting of psychosocial intervention components; using established models of intervention development to guide the development and testing of multicomponent NPC interventions; identifying mechanisms of action for psychosocial outcomes; and choosing psychometrically sound measures for mechanisms and outcomes. Conclusions: Given the importance of psychosocial care to the holistic NPC model, rigorous testing of psychosocial components of NPC interventions is a high priority for clinical investigators to advance the evidence base and practice of NPC.
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Affiliation(s)
- Evan Plys
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Victoria A. Grunberg
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Newborn Medicine, MassGeneral for Children, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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50
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Whittal A, Ehringfeld I, Steinhoff P, Herber OR. Determining Contextual Factors for a Heart Failure Self-Care Intervention: A Consensus Delphi Study (ACHIEVE). HEALTH EDUCATION & BEHAVIOR 2024; 51:311-320. [PMID: 34605710 PMCID: PMC10981183 DOI: 10.1177/10901981211043116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a rising recognition of the crucial role self-care plays in managing heart failure (HF). Yet patients often have difficulties implementing ongoing self-care recommendations into their daily lives. There is also recognition of the importance of theory for successful intervention design, and understanding of key factors for implementation so interventions fit a given context. Local key stakeholders can provide valuable insights to help understand relevant context-specific factors for intervention implementation. This study sought to engage stakeholders to explore and determine relevant contextual factors needed to design and facilitate successful implementation of an HF self-care intervention in the German health care system. A ranking-type Delphi approach was used to establish consensus from stakeholders (i.e., clinicians, patients, policymakers/potential funders) regarding eight factors (content, interventionist, target group, location, mode of delivery, intensity, duration, and format) to adequately define the components and implementation strategy of the intervention. Seventeen participants were invited to participate in the first Delphi round. A response rate of 94% (16/17) was achieved and maintained for all three Delphi rounds. Stakeholder consensus determined that nurses specializing in HF are the most appropriate interventionists, target groups should include patients and carers, and the intervention should occur in an outpatient HF clinic, be a mixture of group and individual training sessions, and last for 30 minutes. Sessions should take place more frequently in the beginning and less often over time. Local stakeholders can help determine contextual factors that must be taken into account for successful delivery of an intervention. This enables the intervention to be developed and applied based on these factors, to make it suitable for the target context and to enhance participation to achieve the desired outcomes.
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Affiliation(s)
- Amanda Whittal
- Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Witten/Herdecke University, Witten, Germany
| | | | | | - Oliver Rudolf Herber
- Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Witten/Herdecke University, Witten, Germany
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