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Oy S, Saing CH, Ung M, Zahari M, Nouhak I, Kim S, Nagashima-Hayashi M, Khuon D, Koy V, Mam S, Sayasone S, Saphonn V, Yi S. Developing an infection prevention and control intervention to reduce hospital-acquired infections in Cambodia and Lao People's Democratic Republic: the HAI-PC study protocol. Front Public Health 2023; 11:1239228. [PMID: 37799162 PMCID: PMC10548876 DOI: 10.3389/fpubh.2023.1239228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
Background Hospital-acquired infections (HAIs) are significant public health issues, especially in low-and middle-income countries (LMICs). Hand hygiene and low-level disinfection of equipment practices among healthcare workers are some of the essential measures to reduce HAIs. Various infection prevention and control (IPC) interventions to reduce HAI incidence have been developed. However, effective interventions have not been well developed in the LMICs context. Therefore, this protocol aims to develop, pilot, and assess the feasibility and acceptability of an IPC intervention in Cambodia and the Lao People's Democratic Republic. Methods This study will consist of four phases guided by the Medical Research Council (MRC) Framework. Three hospitals will be purposely selected - each from the district, provincial, and national levels - in each country. The gap analysis will be conducted in Phase 1 to explore IPC practices among healthcare workers at each hospital through desk reviews, direct observation of hand hygiene and low-level disinfection of equipment practices, in-depth interviews with healthcare workers, and key informant interviews with stakeholders. In Phase 2, an IPC intervention will be developed based on the results of Phase 1 and interventions selected from a systematic literature review of IPC interventions in LMICs. In Phase 3, the developed intervention will be piloted in the hospitals chosen in Phase 1. In Phase 4, the feasibility and acceptability of the developed intervention will be assessed among healthcare workers and representatives at the selected hospitals. National consultative workshops in both countries will be conducted to validate the developed intervention with the national technical working groups. Discussion The MRC Framework will be employed to develop and evaluate an intervention to reduce HAIs in two LMICs. This theoretical framework will be used to explore the factors influencing hand hygiene compliance among healthcare workers. The gap analysis results will allow us to develop a comprehensive IPC intervention to reduce HAI incidence in Cambodia and Lao People's Democratic Republic. Findings from this protocol will feed into promising IPC interventions to reduce HAI incidence in other resource-limited settings. Clinical trial registration ClinicalTrial.Gov, identifier NCT05547373.
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Affiliation(s)
- Sreymom Oy
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mengieng Ung
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Marina Zahari
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Inthavong Nouhak
- Department of International Program for Health in the Tropics, Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | - Sothea Kim
- University of Health Sciences, Phnom Penh, Cambodia
| | - Michiko Nagashima-Hayashi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Dyna Khuon
- University of Health Sciences, Phnom Penh, Cambodia
| | - Virya Koy
- Department of Hospital Services, Ministry of Health, Phnom Penh, Cambodia
| | - Sovatha Mam
- University of Health Sciences, Phnom Penh, Cambodia
| | - Somphou Sayasone
- Department of International Program for Health in the Tropics, Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | | | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, United States
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Kaur J, Kaur M, Chakrapani V, Kumar R. Theory-guided process evaluation of a multicomponent, technology-based 'SMART Eating' trial among Indian adults: an embedded mixed-methods study. HEALTH EDUCATION RESEARCH 2023; 38:469-489. [PMID: 37207678 DOI: 10.1093/her/cyad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/26/2023] [Accepted: 04/20/2023] [Indexed: 05/21/2023]
Abstract
We report process evaluation findings from the 'SMART Eating' intervention trial, which significantly improved fat, sugar and salt (FSS), and fruits and vegetables (FVs) intake among adults. Intervention used information technology [short message service (SMS), WhatsApp and website] and interpersonal communication (distribution of SMART Eating kit) and pamphlet for comparison group. Guided by UK Medical Research Council's framework, using embedded mixed-methods design, continuous process evaluation documented fidelity, dose, reach, acceptability and mechanisms. Intervention was implemented as intended, with high reach (91%) in both groups: 'comparison group' (n = 366): inadequate use of pamphlets (46%); 'intervention group' (n = 366): with timely remedial measures to remove implementation/usage barriers, dose of SMS (93%), WhatsApp (89%) and 'SMART Eating' kit (100%) was adequate, but website usage was low (50%); compliance was evident from participants' interactions with the implementor and observations on kit usage. All these might have improved attitude, social influence, self-efficacy and household behaviours, which, in turn, mediated intervention's effect on improving FSS and FV intake. Among poor performers, lack of effect on FV intake was perceived to be related to high cost/pesticides use and FSS intake was related to lack of family support. Low website usage, challenges with WhatsApp messaging and contextual factors (cost, pesticides abuse and family support) need to be considered while designing similar future interventions.
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Affiliation(s)
- Jasvir Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012 India
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012 India
| | | | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012 India
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3
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Dutta O, Tan-Ho G, Low XC, Tan THB, Ganapathy S, Car J, Ho RMH, Miao CY, Ho AHY. Acceptability and feasibility of a pilot randomized controlled trial of Narrative e-Writing Intervention (NeW-I) for parent-caregivers of children with chronic life-threatening illnesses in Singapore. Palliat Care 2022; 21:59. [PMID: 35488270 PMCID: PMC9052453 DOI: 10.1186/s12904-022-00945-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background Narrative e-Writing Intervention (NeW-I) is a novel psycho-socio-spiritual intervention which aims to bridge gaps in paediatric palliative care by providing anticipatory grief support to parent-caregivers who are looking after their child with a chronic life-threatening illness in Singapore. This is done via a therapist-facilitated smartphone app that focuses on strengths and meaning derived from parents’ caregiving journey. NeW-I is empirically informed by an international systematic review and a Singapore-based qualitative inquiry on the lived experience of parental bereavement and supported by anticipatory grief interventions literature for improving the holistic well-being for parent-caregivers of seriously ill children. NeW-I is implemented in Singapore as an open-label two-armed randomized controlled trial comprising an intervention and control group. Methods This study examined the acceptability (via analysis of participants’ post-intervention qualitative feedback and responses to a post-intervention evaluation survey) and feasibility (via records and memos of therapists’ experience of delivering the intervention) of NeW-I among 26 intervention participants drawn from the larger trial. Results Framework analysis of participants’ post-intervention feedback revealed four themes, namely: (i) Meaningful opportunity for reflection, (ii) Congruity with parent-caregivers’ needs, (iii) Compatibility of online narrative writing and (iv) Sustainability and enhancement recommendations. The post-intervention evaluation survey showed that participants were overall satisfied with their NeW-I experience with a large number of participants acknowledging that NeW-I had improved their spiritual well-being, hopefulness about the future and perception of social support that was available to them, as well as lessened their feelings of sadness and depression, caregiver burden and fear and anxiety about their child’s illness. The research team found it feasible to deliver the intervention in the current setting. Conclusion NeW-I is an innovative e-health tool that could immeasurably value-add to paediatric palliative care services for Asian families in Singapore and around the world. Trial registration ClinicalTrials.gov, ID: NCT03684382, Verified: September 2018.
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Affiliation(s)
- Oindrila Dutta
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Geraldine Tan-Ho
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Toh Hsiang Benny Tan
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Josip Car
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ringo Moon-Ho Ho
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chun Yan Miao
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Andy Hau Yan Ho
- School of Social Sciences; School of Computer Science and Engineering; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore.
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Shahsavari H, Ghiyasvandian S, Matourypour P, Golestannejad MR. Medical research council framework for designing and evaluating a re-integration into life care plan in patients following upper limb amputation in Iran: An interventional study. JOURNAL OF VASCULAR NURSING 2022; 40:86-91. [DOI: 10.1016/j.jvn.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/02/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022]
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Leon N, Namadingo H, Cooper S, Bobrow K, Mwantisi C, Nyasulu M, Sicwebu N, Crampin A, Levitt N, Farmer A. Process evaluation of a brief messaging intervention to improve diabetes treatment adherence in sub-Saharan Africa. BMC Public Health 2021; 21:1576. [PMID: 34418987 PMCID: PMC8379852 DOI: 10.1186/s12889-021-11552-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background The SMS text Adherence suppoRt for people with type 2 diabetes (StAR2D) intervention is a pragmatic randomised controlled trial, testing the effectiveness of brief text messaging for improving clinical outcomes and medication adherence. The intervention did not impact glycaemic control. We conducted a pre-and post-trial process evaluation alongside the StAR2D study in Malawi and South Africa, exploring the experiences and perceptions of patient participants, to better understand potential underlying reasons for the trial outcomes. Methods We employed a qualitative research design, including conducting semi structured in-depth interviews and focus groups at both trial sites. Purposive sampling was used to ensure representation of a wide range of patients with type 2 diabetes with regards to age, gender, ethnicity, language, and duration of diabetes. We interviewed the same participants at baseline and at the end of the trial. We used within-case and across-case thematic analysis to identify key themes. Results Brief messages delivered by text were acceptable and useful for addressing informational and support needs for participants. Some participants reported behaviour changes because of the text reminders and advice on a healthy lifestyle. Both participating in the trial and the messages were experienced as a source of support, caring, and motivation. Participants’ ability to act on the messages was limited. A common theme was frustration over the lack of ability to effectively control one’s blood glucose level. They reported a range of routinised, partial diabetes care adherence behaviours, shaped by complex and interacting individual, social, and health service factors. Participant responses and intervention impact were similar across sites, despite differences in health services. Conclusion This process evaluation provided context and insight into the factors influencing participants’ engagement with the text messaging intervention. The complex context in which patients take their diabetes medication, may explain in part, why brief text messaging may have been insufficient to bring about changes in health outcomes. The scale of need for self-management and health service support, suggests that health system strengthening, and other forms of self-management support should accompany digital communication interventions. (Current Controlled Trials ISRCTN70768808, registered 03/08/2015.) Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11552-8.
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Affiliation(s)
- N Leon
- South African Medical Research Council, Fransie van Zyl Drive, 7535, Tygerberg, Cape Town, South Africa. .,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| | - H Namadingo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - S Cooper
- South African Medical Research Council, Fransie van Zyl Drive, 7535, Tygerberg, Cape Town, South Africa
| | - K Bobrow
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - C Mwantisi
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - M Nyasulu
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - N Sicwebu
- Division of Social and Behavioural Science, School of Family Medicine and Public Health, University of Cape Town, Cape Town, South Africa
| | - A Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.,London School of Hygiene and Tropical Medicine, London, UK
| | - N Levitt
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - A Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Dreischor F, Laan ETM, Apers S, Repping S, van Lunsen RHW, Lambalk CB, D' Hooghe TM, Goddijn M, Custers IM, Dancet EAF. The stepwise development of an interactive web-based sex education programme for subfertile couples: the Pleasure & Pregnancy programme. Hum Reprod 2021; 35:1839-1854. [PMID: 32649754 DOI: 10.1093/humrep/deaa106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/27/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Can we develop a web-based sex education programme (programme running in a web browser) that addresses the needs of subfertile couples who are advised expectant management for at least 6 months? SUMMARY ANSWER The 'Pleasure & Pregnancy' programme addresses couples' needs, is likely to improve couples' sexual functioning, and is subsequently hypothesised to improve the chance of natural pregnancy. WHAT IS KNOWN ALREADY According to professional guidelines (e.g. the Netherlands and UK) couples with unexplained subfertility and a good chance of natural pregnancy, should be advised at least 6 months of expectant management. Adherence to expectant management is challenging as couples and gynaecologist prefer a more active approach. Targeting sexuality may be useful as subfertility is a risk factor for decreased sexual functioning. STUDY DESIGN, SIZE, DURATION A novel programme was developed according to the three steps of the Medical Research Councils' (MRC) framework. First, relevant literature was explored. Second, an interdisciplinary expert panel developed a theory (based on a systematic literature review and patient interviews) on how the chance of natural conception can be improved. Third, the expected process and outcomes were modelled. PARTICIPANTS/MATERIALS, SETTING, METHODS Two licenced clinical sexologists, two gynaecologists, a clinical embryologist and two midwife-researchers, all from Belgium and the Netherlands, proposed components for the sex education programme. PubMed was searched systematically for randomised controlled trials (RCTs) evaluating the proposed components in different patient populations. The needs of 12 heterosexual Dutch or Belgian couples who were advised expectant management were explored with in-depth interviews. The content and delivery characteristics of the novel programme were described in detail with the aid of 'Intervention Taxonomy'. To model the outcomes, a protocol for an RCT was designed, registered and submitted for publication. MAIN RESULTS AND THE ROLE OF CHANCE To help maintain or improve sexual functioning, mainly pleasure, and hence increase pregnancy rates, the web-based Pleasure & Pregnancy programme contains a combination of psychosexual education and couple communication, mindfulness and sensate focus exercises. Information on the biology of conception and interaction with fertility clinic staff and peers were added based on couples' needs to increase potential acceptability. LIMITATIONS AND REASON FOR CAUTION This paper outlines the development phase of a sex education programme according to the MRC-framework. Whether the Pleasure & Pregnancy programme actually is acceptable, improves sexual functioning, increases pregnancy rates and is cost-effective remains to be determined. WIDER IMPLICATIONS OF THE FINDINGS No previous interactive web-based sex education programme has aimed to increase the natural pregnancy rate of subfertile couples by targeting their sexual pleasure. The Pleasure & Pregnancy programme addresses couples' needs and its effect on sexual functioning and pregnancy rate is plausible but remains to be demonstrated by an RCT which is currently ongoing. STUDY FUNDING/COMPETING INTEREST(S) Funding was provided by The Netherlands Organisation for Health Research and Development (ZonMw), Flanders Research Foundation and the University of Amsterdam. C.B.L. is editor-in-chief of Human Reproductionbut was blinded to all parts of the peer review process. The remaining authors have no conflict of interest to report. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- F Dreischor
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - E T M Laan
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), 1105 AZ Amsterdam, The Netherlands
| | - S Apers
- Department of Development and Regeneration, University of Leuven (KU Leuven), 3000 Leuven, Belgium
| | - S Repping
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - R H W van Lunsen
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), 1105 AZ Amsterdam, The Netherlands
| | - C B Lambalk
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - T M D' Hooghe
- Department of Development and Regeneration, University of Leuven (KU Leuven), 3000 Leuven, Belgium
| | - M Goddijn
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.,Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - I M Custers
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - E A F Dancet
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.,Department of Development and Regeneration, University of Leuven (KU Leuven), 3000 Leuven, Belgium.,Research Foundation of Flanders, Belgium
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Leon N, Namadingo H, Bobrow K, Cooper S, Crampin A, Pauly B, Levitt N, Farmer A. Intervention development of a brief messaging intervention for a randomised controlled trial to improve diabetes treatment adherence in sub-Saharan Africa. BMC Public Health 2021; 21:147. [PMID: 33451308 PMCID: PMC7811237 DOI: 10.1186/s12889-020-10089-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/17/2020] [Indexed: 01/04/2023] Open
Abstract
Background Brief messaging interventions, including Short Message Service (SMS) text-messages, delivered via mobile device platforms, show promise to support and improve treatment adherence. To understand how these interventions work, and to facilitate transparency, we need clear descriptions of the intervention development process. Method We describe and reflect on the process of designing and pretesting an evidence- and theory-informed brief messaging intervention, to improve diabetes treatment adherence in sub-Saharan Africa. We followed the stepwise approach recommended by the Medical Research Council, United Kingdom (MRC UK) Framework for Development and Evaluation of Complex Health Interventions and guidance for mobile health intervention development. Results We used a four-phase, iterative approach that first generated primary and secondary evidence on the lived experience of diabetes, diabetes treatment services and mobile-phone use. Second, we designed a type 2 diabetes-specific, brief text-message library, building on our previous hypertension text-message library, as well as drawing on the primary and secondary data from phase one, and on expert opinion. We then mapped the brief text-messages onto behaviour change (COM-B) theoretical constructs. Third, we refined and finalised the newly developed brief text-message library through stakeholder consultation and translated it into three local languages. Finally, we piloted the intervention by pre-testing the automated delivery of the brief text-messages in the trial sites in Malawi and South Africa. The final SMS text Adherence suppoRt for people with type 2 diabetes (StAR2D) intervention was tested in a randomised controlled trial in Malawi and South Africa (trial registration: ISRCTN70768808). Conclusion The complexity of public health interventions requires that we give more attention to intervention development work. Our documentation and reflection on the StAR2D intervention development process promotes transparency, replicability, assessment of intervention quality, and comparison with other studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10089-6.
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Affiliation(s)
- Natalie Leon
- South African Medical Research Council, Cape Town, South Africa.
| | - Hazel Namadingo
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Kirsty Bobrow
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Sara Cooper
- South African Medical Research Council, Cape Town, South Africa
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bruno Pauly
- Department of Diabetes and Endocrinology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Rotevatn TA, Melendez-Torres GJ, Overgaard C, Peven K, Hyldgaard Nilsen J, Bøggild H, Høstgaard AMB. Understanding rapid infant weight gain prevention: a systematic review of quantitative and qualitative evidence. Eur J Public Health 2020; 30:703-712. [PMID: 31410463 PMCID: PMC7445039 DOI: 10.1093/eurpub/ckz140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Rapid infant weight gain (RIWG) is strongly related to childhood overweight and obesity, and prevention of RIWG is an approach to early years obesity prevention. This systematic review aimed to explore effectiveness, deliverers' and recipients' experiences of involvement, and key intervention components and processes of such prevention activities. METHODS Key databases and websites were searched systematically for quantitative and qualitative studies covering intervention effectiveness, experiences with intervention involvement or process outcomes. After duplicate screening and quality assessment, papers were analyzed through narrative synthesis, thematic synthesis and intervention component analysis. RESULTS Seven quantitative and seven qualitative studies were eligible for inclusion. Most intervention studies reported small, but significant results on infant weight gain. More significant results were measured on weight gain during the first compared with the second year of life. A weak evidence base made elaboration of the relationship between intervention effectiveness and content challenging. Home-delivered interventions may be more relevant for parents. Contextual factors, such as social norms, beliefs and professional identity should be considered during intervention development. Stakeholder involvement can be key to increase intervention acceptability and feasibility. CONCLUSIONS The field of RIWG prevention is new and evolving, but more research is needed before further conclusions about intervention effectiveness and intervention content can be drawn. Future interventions should take parents, health professionals and other contextual needs into account to improve chances of success. More research on long-term effects on overweight and obesity is needed.
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Affiliation(s)
- Torill A Rotevatn
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - G J Melendez-Torres
- DECIPHer, Cardiff School of Social Sciences, Cardiff University, Cardiff, Wales, UK
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Kimberly Peven
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Jane Hyldgaard Nilsen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Anna Marie Balling Høstgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Ho AHY, Dutta O, Tan-Ho G, Tan THB, Low XC, Ganapathy S, Car J, Ho RMH, Miao CY. A Novel Narrative E-Writing Intervention for Parents of Children With Chronic Life-Threatening Illnesses: Protocol for a Pilot, Open-Label Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17561. [PMID: 32623367 PMCID: PMC7380996 DOI: 10.2196/17561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 12/28/2022] Open
Abstract
Background A novel evidence-based Narrative e-Writing Intervention (NeW-I) has been developed and tested in Singapore to advance psychosociospiritual support for parents of children with chronic life-threatening illnesses. NeW-I is informed by an international systematic review and a Singapore-based qualitative inquiry on the lived experience of parental bereavement and supported by literature on anticipatory grief interventions for improving the holistic well-being of parent caregivers of seriously ill children. Objective This study's aim was to provide an accessible platform, NeW-I—which is a strengths- and meaning-focused and therapist-facilitated mobile app and web-based counseling platform—that aims to enhance quality of life, spiritual well-being, hope, and perceived social support and reduce depressive symptoms, caregiver burden, and risk of complicated grief among parents of children with chronic life-threatening illnesses. Methods The NeW-I therapist-facilitated web-based platform comprises a mobile app and a website (both of which have the same content
and functionality). NeW-I has been implemented in Singapore as a pilot open-label randomized controlled trial comprising intervention and control groups. Both primary and secondary outcomes will be self-reported by participants through questionnaires. In collaboration with leading pediatric palliative care providers in Singapore, the trial aims to enroll 36 participants in each group (N=72), so that when allowing for 30% attrition at follow-up, the sample size will be adequate to detect a small effect size of 0.2 in the primary outcome measure, with 90% power and two-sided significance level of at least .05. The potential effectiveness of NeW-I and the accessibility and feasibility of implementing and delivering the intervention will be assessed. Results Funding support and institutional review board approval for this study have been secured. Data collection started in January 2019 and is ongoing. Conclusions NeW-I aspires to enhance holistic pediatric palliative care services through a structured web-based counseling platform that is sensitive to the unique cultural needs of Asian family caregivers who are uncomfortable with expressing emotion even during times of loss and separation. The findings of this pilot study will inform the development of a full-scale NeW-I protocol and further research to evaluate the efficacy of NeW-I in Singapore and in other Asian communities around the world. Trial Registration ClinicalTrials.gov NCT03684382; https://clinicaltrials.gov/ct2/show/NCT03684382 International Registered Report Identifier (IRRID) DERR1-10.2196/17561
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Affiliation(s)
- Andy Hau Yan Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Oindrila Dutta
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Geraldine Tan-Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Toh Hsiang Benny Tan
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Xinyi Casuarine Low
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | | | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ringo Moon-Ho Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Chun Yan Miao
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
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Shahsavari H, Matourypour P, Ghiyasvandian S, Nejad MRG. Medical Research Council framework for development and evaluation of complex interventions: A comprehensive guidance. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:88. [PMID: 32509896 PMCID: PMC7271909 DOI: 10.4103/jehp.jehp_649_19] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/13/2019] [Indexed: 06/11/2023]
Affiliation(s)
- Hooman Shahsavari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Matourypour
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Ghiyasvandian
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Carvalho CAD, Fonseca PCDA, Nobre LN, Silva MA, Pessoa MC, Ribeiro AQ, Priore SE, Franceschini S. [Factors associated with dietary patterns in the second half of life]. CIENCIA & SAUDE COLETIVA 2020; 25:449-459. [PMID: 32022186 DOI: 10.1590/1413-81232020252.12982018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/12/2018] [Indexed: 11/21/2022] Open
Abstract
The aim of this paper is to identify eating patterns of children aged 6, 9 and 12 months and their association with socioeconomic, behavioral, birth and nutrition variables. Cross-sectional study with children from a cohort in Viçosa-MG, with 112 children at 6 months, 149 at 9 months and 117 at 12 months. Food intake was assessed by a 24-hour recall and patterns extracted by cluster analysis. Breast milk was identified in at least one dietary pattern every month. There was a low participation of ultra-processed foods in the identified dietary patterns. At month 6, children with lower family income were less likely to belong to the dietary pattern composed of milk formulas. Already overweight/obesity was 3.69 times higher in children who made up the pattern 2 (dairy formulas, vegetables, vegetables, beef and pear). At 12 months height deficit (PR = 3.28) and bottle use (PR = 4.51) were associated with the dietary pattern composed of milk formulas and cow's milk. The dietary patterns identified reflected the important participation of breast milk in children's diets. Dietary patterns with the presence of other types of milk were associated with nutritional deviations and bottle feeding.
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Affiliation(s)
- Carolina Abreu de Carvalho
- Instituto Federal de Educação Ciência e Tecnologia do Maranhão. Rodovia MA-225, Km 04, Povoado Santa Cruz. 65590-000, Barreirinhas, MA, Brasil.
| | | | - Luciana Neri Nobre
- Departamento de Nutrição e Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri. Diamantina, MG, Brasil
| | - Mariane Alves Silva
- Departamento de Nutrição, Universidade Federal do Piauí. Teresina, PI, Brasil
| | - Milene Cristine Pessoa
- Escola de Enfermagem, Departamento de Nutrição, Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Andréia Queiroz Ribeiro
- Centro de Ciências Biológicas e da Saúde, Universidade Federal de Viçosa. Viçosa, MG, Brasil
| | | | - Sylvia Franceschini
- Departamento de Nutrição, Universidade Federal do Piauí. Teresina, PI, Brasil
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Lakshman R, Sharp SJ, Whittle F, Schiff A, Hardeman W, Irvine L, Wilson E, Griffin SJ, Ong KK. Randomised controlled trial of a theory-based behavioural intervention to reduce formula milk intake. Arch Dis Child 2018; 103:1054-1060. [PMID: 29760009 PMCID: PMC6225804 DOI: 10.1136/archdischild-2018-314784] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/28/2018] [Accepted: 04/20/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the efficacy of a theory-based behavioural intervention to prevent rapid weight gain in formula milk-fed infants. DESIGN In this single (assessor) blind, randomised controlled trial, 669 healthy full-term infants receiving formula milk within 14 weeks of birth were individually randomised to intervention (n=340) or attention-matched control (n=329) groups. The intervention aimed to reduce formula milk intakes, and promote responsive feeding and growth monitoring to prevent rapid weight gain (≥+0.67 SD scores (SDS)). It was delivered to mothers by trained facilitators up to infant age 6 months through three face-to-face contacts, two telephone contacts and written materials. RESULTS Retention was 93% (622) at 6 months, 88% (586) at 12 months and 94% attended ≥4/5 sessions. The intervention strengthened maternal attitudes to following infant feeding recommendations, reduced reported milk intakes at ages 3 (-14%; intervention vs control infants), 4 (-12%), 5 (-9%) and 6 (-7%) months, slowed initial infant weight gain from baseline to 6 months (mean change 0.32 vs 0.42 SDS, baseline-adjusted difference (intervention vs control) -0.08 (95% CI -0.17 to -0.004) SDS), but had no effect on the primary outcome of weight gain to 12 months (baseline-adjusted difference -0.04 (-0.17, 0.10) SDS). By 12 months, 40.3% of infants in the intervention group and 45.9% in the control group showed rapid weight gain (OR 0.84, 95% CI 0.59 to 1.17). CONCLUSIONS Despite reducing milk intakes and initial weight gain, the intervention did not alter the high prevalence of rapid weight gain to age 12 months suggesting the need for sustained intervention. TRIAL REGISTRATION NUMBER ISRCTN20814693.
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Affiliation(s)
- Rajalakshmi Lakshman
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Fiona Whittle
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Annie Schiff
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Wendy Hardeman
- Health Promotion Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lisa Irvine
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ed Wilson
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- Primary Care Research Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ken K Ong
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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13
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McEvoy CT, Moore SE, Appleton KM, Cupples ME, Erwin C, Kee F, Prior L, Young IS, McKinley MC, Woodside JV. Development of a peer support intervention to encourage dietary behaviour change towards a Mediterranean diet in adults at high cardiovascular risk. BMC Public Health 2018; 18:1194. [PMID: 30348137 PMCID: PMC6198381 DOI: 10.1186/s12889-018-6108-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mediterranean diet (MD) interventions are demonstrated to significantly reduce cardiovascular disease (CVD) risk but are typically resource intensive and delivered by health professionals. There is considerable interest to develop interventions that target sustained dietary behaviour change and that are feasible to scale-up for wider public health benefit. The aim of this paper is to describe the process used to develop a peer support intervention to encourage dietary behaviour change towards a MD in non-Mediterranean adults at high CVD risk. METHODS The Medical Research Council (MRC) and Behaviour Change Wheel (BCW) frameworks and the COM-B (Capability, Opportunity, Motivation, Behaviour) theoretical model were used to guide the intervention development process. We used a combination of evidence synthesis and qualitative research with the target population, health professionals, and community health personnel to develop the intervention over three main stages: (1) we identified the evidence base and selected dietary behaviours that needed to change, (2) we developed a theoretical basis for how the intervention might encourage behaviour change towards a MD and selected intervention functions that could drive the desired MD behaviour change, and (3) we defined the intervention content and modelled outcomes. RESULTS A theory-based, culturally tailored, peer support intervention was developed to specifically target behaviour change towards a MD in the target population. The intervention was a group-based program delivered by trained peer volunteers over 12-months, and incorporated strategies to enhance social support, self-efficacy, problem-solving, knowledge, and attitudes to address identified barriers to adopting a MD from the COM-B analysis. CONCLUSIONS The MRC and BCW frameworks provided a systematic and complementary process for development of a theory-based peer support intervention to encourage dietary behaviour change towards a MD in non-Mediterranean adults at high CVD risk. The next step is to evaluate feasibility, acceptability, and diet behaviour change outcomes in response to the peer support intervention (change towards a MD and nutrient biomarkers) using a randomized controlled trial design.
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Affiliation(s)
- Claire T. McEvoy
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Sarah E. Moore
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Katherine M. Appleton
- Research Centre for Behaviour Change, Department of Psychology, Faculty of Science and Technology, Bournemouth University, Fern Barrow, Talbot Campus, Bournemouth, BH12 5BB UK
| | - Margaret E. Cupples
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Christina Erwin
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Lindsay Prior
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Ian S. Young
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Michelle C. McKinley
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Jayne V. Woodside
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
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14
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Carvalho CAD, Fonsêca PCDA, Nobre LN, Silva MA, Pessoa MC, Ribeiro AQ, Priore SE, Franceschini SDCC. Sociodemographic, perinatal and behavioral factors associated to types of milk consumed by children under in six months: birth coort. CIENCIA & SAUDE COLETIVA 2018; 22:3699-3710. [PMID: 29211175 DOI: 10.1590/1413-812320172211.28482015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 04/02/2016] [Indexed: 11/22/2022] Open
Abstract
This study evaluated factors associated with the consumption of breast milk (BM), infant formula (IF) and cow milk (CM) in children. This was a cohort study with 256 children followed-up at the 1st, 4th and 6th month of age in Viçosa (MG), Brazil. With respect to CM and IF, consumption was recorded regardless of BM intake. Regarding BM, only exclusive or predominant consumption was considered. From the 1st to the 6th month, an increase was recorded in the number of children who did not consume BM exclusively or predominantly (31.6%), as well as the consumption of CM (27.2%) and IF (9.3%). BM was associated with pacifier use at 1st month, and mother's employment status and pacifier use in the 4th and 6th month. Pacifier use was a risk factor for IF consumption in every month, while belonging to the lower income group was inversely associated in the 6th month. As for CM, the number of prenatal visits was a risk factor in every month, the mother's employment status and use of pacifier in the 4th month, family income, mother's employment status, low birth weight, number of prenatal visits and pacifier use in the 6th month. Since the 1st month, the introduction of other milk types is high, revealing that there is still much to go to ensure exclusive breastfeeding up to 6 months.
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Affiliation(s)
- Carolina Abreu de Carvalho
- Departamento de Desenvolvimento Educacional do Instituto Federal do Maranhão. Rodovia MA-225/Km 04, Povoado Santa Cruz. 65590-000 Barreirinhas MA Brasil.
| | | | - Luciana Neri Nobre
- Departamento de Nutrição, Universidade Federal dos Vales do Jequitinhonha e Mucuri. Diamantina MG Brasil
| | - Mariane Alves Silva
- Departamento de Nutrição, Universidade Federal dos Vales do Jequitinhonha e Mucuri. Diamantina MG Brasil
| | | | | | - Silvia Eloiza Priore
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa. Viçosa MG Brasil
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15
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Bobrow K, Farmer A, Cishe N, Nwagi N, Namane M, Brennan TP, Springer D, Tarassenko L, Levitt N. Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control. BMC Health Serv Res 2018; 18:33. [PMID: 29361934 PMCID: PMC5782371 DOI: 10.1186/s12913-017-2808-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/15/2017] [Indexed: 11/18/2022] Open
Abstract
Background Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description. Methods We used a non-sequential and flexible approach guided by the 2008 MRC Framework for the development and evaluation of complex interventions. Results We reviewed published literature and established a multi-disciplinary expert group to guide the development process. We selected health psychology theory and behaviour change techniques that have been shown to be important in adherence and persistence with chronic medications. Semi-structured interviews and focus groups with various stakeholders identified ways in which treatment adherence could be supported and also identified key features of well-regarded messages: polite tone, credible information, contextualised, and endorsed by identifiable member of primary care facility staff. Direct and indirect user testing enabled us to refine the intervention including refining use of language and testing of interactive components. Conclusions Our experience shows that using a formal intervention development process is feasible in a low-resource multi-lingual setting. The process enabled us to pre-test assumptions about the intervention and the evaluation process, allowing the improvement of both. Describing how a multi-component intervention was developed including standardised descriptions of content aimed to support behaviour change will enable comparison with other similar interventions and support development of new interventions. Even in low-resource settings, funders and policy-makers should provide researchers with time and resources for intervention development work and encourage evaluation of the entire design and testing process. Trial registration The trial of the intervention is registered with South African National Clinical Trials Register number (SANCTR DOH-27-1212-386; 28/12/2012); Pan Africa Trial Register (PACTR201411000724141; 14/12/2013); ClinicalTrials.gov (NCT02019823; 24/12/2013).
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Affiliation(s)
- Kirsten Bobrow
- Chronic Disease Initiative for Africa, Cape Town, South Africa. .,Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa. .,Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK.
| | - Andrew Farmer
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nomazizi Cishe
- Women's Health Research Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ntobeko Nwagi
- Women's Health Research Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mosedi Namane
- Western Cape Province Department of Health, Cape Town, South Africa
| | - Thomas P Brennan
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - David Springer
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Cape Town, South Africa.,Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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16
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Wylde V, Howells N, Bertram W, Moore AJ, Bruce J, McCabe C, Blom AW, Dennis J, Burston A, Gooberman-Hill R. Development of a complex intervention for people with chronic pain after knee replacement: the STAR care pathway. Trials 2018; 19:61. [PMID: 29361982 PMCID: PMC5781277 DOI: 10.1186/s13063-017-2391-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/07/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Approximately 20% of people who have total knee replacement experience chronic pain afterwards, but there is little evidence about effective interventions for managing this type of pain. This article describes the systematic development and refinement of a complex intervention for people with chronic pain after knee replacement. The intervention is a care pathway involving an assessment clinic and onward referral, with telephone follow-up as required. In the design of this multistage study, we chose to focus on ensuring that the intervention was deliverable, implementable and acceptable. METHODS In line with the UK Medical Research Council's recommendations for comprehensive development of complex interventions, multiple phases of work were undertaken. Following on from initial development work to design the intervention, the draft intervention content was refined through consensus questionnaires with 22 health professionals and discussion at meetings with 18 healthcare professionals. Testing of intervention delivery and acceptability to patients was undertaken by two health professionals delivering the assessment clinic to ten patients. Views about future implementation within the context of a randomised trial were evaluated through a questionnaire based on the Normalisation Measure Development (NoMAD) instrument with ten health professional stakeholders. RESULTS Consensus work with health professionals ensured the components of the intervention were appropriate and informed a number of substantive changes to improve the intervention. Testing of intervention delivery identified a number of logistical issues that were then addressed in the development of a comprehensive intervention training manual. Engagement with stakeholders indicated that the intervention could be successfully implemented in a clinical setting for evaluation in a randomised trial. CONCLUSIONS This work has informed the development and refinement of a complex intervention for people with chronic pain after knee replacement. The next stage is to evaluate the clinical and cost-effectiveness of the STAR care pathway in a multicentre randomised trial.
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Affiliation(s)
- Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK. .,National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.
| | - Nicholas Howells
- North Bristol NHS Trust, Brunel Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Wendy Bertram
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.,North Bristol NHS Trust, Brunel Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Andrew J Moore
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Candy McCabe
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Jane Dennis
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
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17
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Wilson PM, Boaden R, Harvey G. Plans to accelerate innovation in health systems are less than IDEAL. BMJ Qual Saf 2015; 25:572-6. [PMID: 26700544 PMCID: PMC4975842 DOI: 10.1136/bmjqs-2015-004605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Paul M Wilson
- Manchester Business School, University of Manchester, Manchester, UK
| | - Ruth Boaden
- Manchester Business School, University of Manchester, Manchester, UK
| | - Gillian Harvey
- Manchester Business School, University of Manchester, Manchester, UK School of Nursing, University of Adelaide, Adelaide, Australia
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18
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Lakshman R, Whittle F, Hardeman W, Suhrcke M, Wilson E, Griffin S, Ong KK. Effectiveness of a behavioural intervention to prevent excessive weight gain during infancy (The Baby Milk Trial): study protocol for a randomised controlled trial. Trials 2015; 16:442. [PMID: 26445092 PMCID: PMC4595312 DOI: 10.1186/s13063-015-0941-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Infancy is a period of rapid growth and habit formation and hence could be a critical period for obesity prevention. Excess weight gain during infancy is associated with later obesity and formula-fed babies are more likely to gain excess weight compared to breastfed babies. The primary trial outcome is a change in the weight standard deviation score from birth to 1 year. METHODS/DESIGN We will recruit 650 to 700 parents who introduce formula-milk feeds within 14 weeks of their baby's birth to a single (assessor) blind, parallel group, individually randomised controlled trial. The focus of the intervention is the caregiver (usually the mother), and the focus of the primary outcome is the infant. The intervention group will receive the behavioural intervention, which aims to reduce formula-milk intake, promote responsive feeding and healthy weaning, and prevent excessive weight gain during infancy. The intervention is based on Social Cognitive Theory and action planning ('implementation intentions'). It consists of three components: (1) a motivational component to strengthen parents' motivation to follow the Baby Milk feeding guidelines, (2) an action planning component to help translate motivation into action, and (3) a coping planning component to help parents deal with difficult situations. It will be delivered by trained facilitators (research nurses) over 6 months through three face-to-face contacts, two telephone contacts and written materials. The control group will have the same number of contacts with facilitators, and general issues about feeding will be discussed. Anthropometric outcomes will be measured by trained research staff, blind to group allocation, at baseline, 6 months and 12 months following standard operating procedures. Validated questionnaires will assess milk intake, temperament, appetite, sleep, maternal quality of life and maternal psychological factors. A 4-day food diary will be completed at 8 months. DISCUSSION The results of the trial will help to inform infant feeding guidelines and to understand the links between infant feeding, behaviour, appetite and growth. TRIAL REGISTRATION ISRTCN20814693 . Registration date 13 January 2011.
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Affiliation(s)
- Rajalakshmi Lakshman
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK.
| | - Fiona Whittle
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK.
| | - Wendy Hardeman
- Behavioural Science Group, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK.
| | - Ed Wilson
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Simon Griffin
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK.
| | - Ken K Ong
- MRC Epidemiology Unit and UKCRC Centre of Excellence in Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK.
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19
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Sinnott C, Mercer SW, Payne RA, Duerden M, Bradley CP, Byrne M. Improving medication management in multimorbidity: development of the MultimorbiditY COllaborative Medication Review And DEcision Making (MY COMRADE) intervention using the Behaviour Change Wheel. Implement Sci 2015; 10:132. [PMID: 26404642 PMCID: PMC4582886 DOI: 10.1186/s13012-015-0322-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/09/2015] [Indexed: 11/21/2022] Open
Abstract
Background Multimorbidity, the presence of two or more chronic conditions, affects over 60 % of patients in primary care. Due to its association with polypharmacy, the development of interventions to optimise medication management in patients with multimorbidity is a priority. The Behaviour Change Wheel is a new approach for applying behavioural theory to intervention development. Here, we describe how we have used results from a review of previous research, original research of our own and the Behaviour Change Wheel to develop an intervention to improve medication management in multimorbidity by general practitioners (GPs), within the overarching UK Medical Research Council guidance on complex interventions. Methods Following the steps of the Behaviour Change Wheel, we sought behaviours associated with medication management in multimorbidity by conducting a systematic review and qualitative study with GPs. From the modifiable GP behaviours identified, we selected one and conducted a focused behavioural analysis to explain why GPs were or were not engaging in this behaviour. We used the behavioural analysis to determine the intervention functions, behavioural change techniques and implementation plan most likely to effect behavioural change. Results We identified numerous modifiable GP behaviours in the systematic review and qualitative study, from which active medication review (rather than passive maintaining the status quo) was chosen as the target behaviour. Behavioural analysis revealed GPs’ capabilities, opportunities and motivations relating to active medication review. We combined the three intervention functions deemed most likely to effect behavioural change (enablement, environmental restructuring and incentivisation) to form the MultimorbiditY COllaborative Medication Review And DEcision Making (MY COMRADE) intervention. MY COMRADE primarily involves the technique of social support: two GPs review the medications prescribed to a complex multimorbid patient together. Four other behavioural change techniques are incorporated: restructuring the social environment, prompts/cues, action planning and self-incentives. Conclusions This study is the first to use the Behaviour Change Wheel to develop an intervention targeting multimorbidity and confirms the usability and usefulness of the approach in a complex area of clinical care. The systematic development of the MY COMRADE intervention will facilitate a thorough evaluation of its effectiveness in the next phase of this work. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0322-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carol Sinnott
- Department of General Practice, University College Cork, Cork, Ireland.
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Rupert A Payne
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Martin Duerden
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK.
| | - Colin P Bradley
- Department of General Practice, University College Cork, Cork, Ireland.
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland.
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Kumar A. Do parental coronary heart disease risk factors (non-modifiable) effect their young ones? Asian Pac J Trop Biomed 2015. [DOI: 10.1016/s2221-1691(15)30154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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