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Díaz-Del Cerro E, Félix J, De la Fuente M. [Touch, a crucial sense in social interactions to improve homeostasis in aging and promote healthy longevity]. Rev Esp Geriatr Gerontol 2023; 58:161-166. [PMID: 37085344 DOI: 10.1016/j.regg.2023.03.005] [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: 01/05/2023] [Revised: 03/11/2023] [Accepted: 03/24/2023] [Indexed: 04/23/2023]
Abstract
Aging is associated with the generalized deterioration of the organism, being of great relevance experienced by homeostatic systems such as the nervous, immune, and endocrine systems, which increases the risk of morbidity and mortality. Among the lifestyle strategies that have been researched to improve these systems and achieve greater healthy longevity, this review will focus on the social environment. In order to verify the effectiveness of these both in the improvement of homeostasis and in life expectancy, the research carried out with experimental animals that have allowed this to be done will be discussed. In addition, as it has been observed that physical contact is crucial for the positive outcomes of social interaction on homeostatic systems and longevity to occur, we will focus on that mechanism, as well as some of the possible molecular pathways underlying the effects found.
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Affiliation(s)
- Estefanía Díaz-Del Cerro
- Departamento de Genética, Fisiología y Microbiología (Unidad de Fisiología Animal). Facultad de Ciencias biológicas de la Universidad Complutense de Madrid, Madrid, España; Instituto de investigación del Hospital 12 de Octubre (i+12) de Madrid, Madrid, España
| | - Judith Félix
- Departamento de Genética, Fisiología y Microbiología (Unidad de Fisiología Animal). Facultad de Ciencias biológicas de la Universidad Complutense de Madrid, Madrid, España; Instituto de investigación del Hospital 12 de Octubre (i+12) de Madrid, Madrid, España
| | - Mónica De la Fuente
- Departamento de Genética, Fisiología y Microbiología (Unidad de Fisiología Animal). Facultad de Ciencias biológicas de la Universidad Complutense de Madrid, Madrid, España; Instituto de investigación del Hospital 12 de Octubre (i+12) de Madrid, Madrid, España.
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Social Environment as a Modulator of Immunosenescence. Expert Rev Mol Med 2022; 24:e29. [PMID: 35912691 DOI: 10.1017/erm.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fear of falling is as important as multiple previous falls in terms of limiting daily activities: a longitudinal study. BMC Geriatr 2021; 21:350. [PMID: 34098904 PMCID: PMC8185919 DOI: 10.1186/s12877-021-02305-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Fear of falling and previous falls are both risk factors that affect daily activities of older adults. However, it remains unclear whether they independently limit daily activities accounting for each other. Methods We used the data from Round 1 (Year 1) to Round 5 (Year 5) of the National Health and Aging Trends Study. We included a total of 864 community-dwelling participants who provided data on previous falls, fear of falling and limited activities from Year 1 to Year 5 and had no limited daily activities at Year 1 in this study. Previous falls and fear of falling were ascertained by asking participants how many falls they had in the past year and whether they had worried about falling in the last month. Limited daily activities included any difficulties with mobility (e.g., going outside), self-care (e.g., eating), and household activities (e.g., laundering). Generalized estimation equation models were used to examine whether previous falls and fear of falling independently predicted development of limited daily activities adjusting covariates. Results Participants were mainly between 65 and 79 years old (83 %), male (57 %), and non-Hispanic White (79 %). Among participants who had multiple falls in Year 1, 19.1-31 %, 21.4-52.4 %, and 11.9-35.7 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 5, respectively. Among those who had fear of falling in Year 1, 22.5-41.3 %, 30.0-55.0 %, and 18.8-36.3 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 4, respectively. Fear of falling independently predicted limitations in mobility (Incidence rate ratio [IRR]: 1.79, 95 % CI: 1.44, 2.24), self-care (IRR: 1.25, 95 % CI: 1.08, 1.44) and household activities (IRR: 1.39, 95 % CI: 1.08, 1.78) after adjusting for previous falls and covariates. Multiple previous falls independently predicted limitations in mobility (IRR: 1.72, 1.30, 2.27), self-care (IRR: 1.40, 95 % CI: 1.19, 1.66) and household activities (IRR: 1.36, 95 % CI: 1.01, 1.83) after adjusting fear of falling and covariates. Conclusions Fear of falling seems to be as important as multiple previous falls in terms of limiting older adults’ daily activities.
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Okoye EC, Akosile CO, Maruf FA, Onwuakagba IU, Mgbeojedo UG. Falls and fear of falling among older adults in an assisted-living facility: A qualitative and foundational study for intervention development in a developing country. Arch Gerontol Geriatr 2021; 94:104375. [PMID: 33571785 DOI: 10.1016/j.archger.2021.104375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Falls and fear of falling (FOF) have serious adverse effects for older adults. Culturally-specific and environmentally-tailored interventions may help address the problems of falls and FOF. No such interventions are however available for use in the African context. OBJECTIVE To explore falls and FOF among older adults in an assisted-living facility, as a foundation for developing interventions to address falls and FOF. METHODS This qualitative study involved purposefully recruiting nine older adults and four caregivers at an assisted-living facility in Southeast Nigeria. Focus group discussions were conducted separately for older adults and the caregivers. Data were analysed using an Inductive Approach. RESULTS Four themes emerged: incidence of falls and fear of falling; factors associated with falls and fear of falling; health implications of falls and fear of falling; and coping strategies to deal with falls and fear of falling. Older adults were experiencing a high prevalence of falls and FOF perceived to be caused by both cultural/environmental/institutional-related factors (poorly lit environment at night; poor ambulatory surfaces; unwillingness to accept age-related changes in physical capacity; poor disposition towards walking aids; poor treatment of injuries; misconceptions; poor physical activity participation; and external perturbation) and intrinsic factors (psychological/emotional, concentration/attention, socio-demographic and morbidity-related). CONCLUSION The older adults were experiencing a high prevalence of falls and FOF which has a multifactorial origin of common and cultural/societal/institutional/environmental-related factors. The need for a multicomponent and culturally and environmentally-specific interventions to address falls and FOF in this sample is thus highlighted.
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Affiliation(s)
- Emmanuel Chiebuka Okoye
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria.
| | - Christopher Olusanjo Akosile
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria.
| | - Fatai Adesina Maruf
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria.
| | - Ifeoma Uchenna Onwuakagba
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria.
| | - Ukamaka Gloria Mgbeojedo
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Nigeria.
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Duncan E, O'Cathain A, Rousseau N, Croot L, Sworn K, Turner KM, Yardley L, Hoddinott P. Guidance for reporting intervention development studies in health research (GUIDED): an evidence-based consensus study. BMJ Open 2020; 10:e033516. [PMID: 32273313 PMCID: PMC7245409 DOI: 10.1136/bmjopen-2019-033516] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/10/2020] [Accepted: 02/19/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To improve the quality and consistency of intervention development reporting in health research. DESIGN This was a consensus exercise consisting of two simultaneous and identical three-round e-Delphi studies (one with experts in intervention development and one with wider stakeholders including funders, journal editors and public involvement members), followed by a consensus workshop. Delphi items were systematically derived from two preceding systematic reviews and a qualitative interview study. PARTICIPANTS Intervention developers (n=26) and wider stakeholders (n=18) from the UK, North America and Europe participated in separate e-Delphi studies. Intervention developers (n=13) and wider stakeholders (n=13) participated in a 1-day consensus workshop. RESULTS e-Delphi participants achieved consensus on 15 reporting items. Following feedback from the consensus meeting, the final inclusion and wording of 14 items with description and explanations for each item were agreed. Items focus on context, purpose, target population, approaches, evidence, theory, guiding principles, stakeholder contribution, changes in content or format during the development process, required changes for subgroups, continuing uncertainties, and open access publication. They form the GUIDED (GUIDance for the rEporting of intervention Development) checklist, which contains a description and explanation of each item, alongside examples of good reporting. CONCLUSIONS Consensus-based reporting guidance for intervention development in health research is now available for publishers and researchers to use. GUIDED has the potential to lead to greater transparency, and enhance quality and improve learning about intervention development research and practice.
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Affiliation(s)
- Edward Duncan
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nikki Rousseau
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
- Leeds Institute of Clinical Trials, School of Medicine, University of Leeds, Leeds, UK
| | - Liz Croot
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katie Sworn
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Lucy Yardley
- Psychology, University of Southampton, Southampton, UK
- School of Health Sciences, University of Bristol, Bristol, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
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Systematic Review of the Effects of Cognitive and Behavioral Interventions on Fall-Related Psychological Concerns in Older Adults. J Aging Phys Act 2020; 28:155-168. [DOI: 10.1123/japa.2017-0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This systematic review aims to evaluate the efficacy of cognitive and behavioral interventions for improving fall-related psychological concerns. A systematic search yielded eight randomized controlled trials eligible for inclusion. All studies compared a cognitive and behavioral intervention with a control. The meta-analysis showed that cognitive and behavioral treatments had beneficial effects on fear of falling outcomes (lower score better) immediately after treatment (random-effects standardized mean difference [SMD]: −0.3, 95% confidence interval [CI] [−0.50, −0.10]) and at the longer term follow-up (random-effects SMD: −0.29, 95% CI [−0.49, −0.09]). Cognitive and behavioral treatments also showed a positive effect on falls efficacy outcomes (higher score better) immediately after treatment (fixed-effects SMD: 0.19, 95% CI [0.04, 0.34]) and over the longer term (fixed-effects SMD: 0.13, 95% CI [−0.00, 0.25]). However, the clinical significance of these effects on fear of falling and falls efficacy was unclear. Further work is required with best-practice comparators over a longer follow-up period.
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Van Tiem JM, Friberg JE, Wilson JR, Fitzwater L, Blum JM, Panos RJ, Reisinger HS, Moeckli J. Utilized or Underutilized: A Qualitative Analysis of Building Coherence During Early Implementation of a Tele-Intensive Care Unit. Telemed J E Health 2020; 26:1167-1177. [PMID: 31928388 DOI: 10.1089/tmj.2019.0135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Generating, reading, or interpreting data is a component of Telemedicine-Intensive Care Unit (Tele-ICU) utilization that has not been explored in the literature. Introduction: Using the idea of "coherence," a construct of Normalization Process Theory, we describe how intensive care unit (ICU) and Tele-ICU staff made sense of their shared work and how they made use of Tele-ICU together. Materials and Methods: We interviewed ICU and Tele-ICU staff involved in the implementation of Tele-ICU during site visits to a Tele-ICU hub and 3 ICUs, at preimplementation (43 interviews with 65 participants) and 6 months postimplementation (44 interviews with 67 participants). Data were analyzed using deductive coding techniques and lexical searches. Results: In the early implementation of Tele-ICU, ICU and Tele-ICU staff lacked consensus about how to share information and consequently how to make use of innovations in data tracking and interpretation offered by the Tele-ICU (e.g., acuity systems). Attempts to collaborate and create opportunities for utilization were supported by quality improvement (QI) initiatives. Discussion: Characterizing Tele-ICU utilization as an element of a QI process limited how ICU staff understood Tele-ICU as an innovation. It also did not promote an understanding of how the Tele-ICU used data and may therefore attenuate the larger promise of Tele-ICU as a potential tool for leveraging big data in critical care. Conclusions: Shared data practices lay the foundation for Tele-ICU program utilization but raise new questions about how the promise of big data can be operationalized for bedside ICU staff.
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Affiliation(s)
- Jennifer M Van Tiem
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Julia E Friberg
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Jaime R Wilson
- The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA.,Department of Nursing, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Lynn Fitzwater
- VISN 10/Cincinnati Tele-ICU System, Cincinnati, Ohio, USA
| | - James M Blum
- Department of Anesthesiology, Atlanta VA Healthcare System, Atlanta, Georgia, USA.,Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ralph J Panos
- VISN 10/Cincinnati Tele-ICU System, Cincinnati, Ohio, USA
| | - Heather Schacht Reisinger
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jane Moeckli
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA
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Rousseau N, Turner KM, Duncan E, O’Cathain A, Croot L, Yardley L, Hoddinott P. Attending to design when developing complex health interventions: A qualitative interview study with intervention developers and associated stakeholders. PLoS One 2019; 14:e0223615. [PMID: 31613913 PMCID: PMC6793869 DOI: 10.1371/journal.pone.0223615] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/24/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Guidance and frameworks exist to assist those developing health interventions but may offer limited discussion of 'design', the part of development concerned with generating ideas for and making decisions about an intervention's content, format and delivery. The aim of this paper is to describe and understand the views and experiences of developers and associated stakeholders in relation to how design occurs in health intervention development. METHODS Semi-structured interviews were conducted with 21 people who had developed complex interventions to improve health and/or who were relevant stakeholders (e.g. funders and publishers of intervention development work), regarding their views, experiences and approaches to intervention design. Sampling was purposive in terms of maximising diversity. A thematic inductive analysis was conducted. RESULTS Approaches to design varied substantially between intervention developers. This contrasted with consistency in other activities undertaken during development, such as literature review. Design also posed more challenges than other parts of development. We identified six 'modes' of design: informed; negotiated; structured; delegated; 'my baby'; and creative partnership. In understanding the differences between these different modes, and the challenges posed by intervention design, we identified three key themes: enabling creativity during the design process; working with different types of knowledge; and 'stabilising' (developing clear shared understandings of) the intervention development to enable design. CONCLUSIONS Design has received less attention than other activities undertaken when developing interventions to improve health. Developers take a variety of approaches to design and often find it challenging. Guidance for intervention development in health has tended to see design as proceeding in a predictable and controlled manner from acquired knowledge. Our study suggests that design rarely reflects this rational ideal. Future guidance on intervention development in healthcare should support developers to work effectively with different types of knowledge, to help design progress more smoothly and to maximise creativity.
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Affiliation(s)
- Nikki Rousseau
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Stirling, United Kingdom
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
| | - Katrina M. Turner
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Edward Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Stirling, United Kingdom
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Liz Croot
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Stirling, United Kingdom
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Dueñas EP, Ramírez LP, Ponce E, Curcio CL. [Effect on fear of falling and functionality of three intervention programs. A randomised clinical trial]. Rev Esp Geriatr Gerontol 2019; 54:68-74. [PMID: 30482460 DOI: 10.1016/j.regg.2018.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 09/16/2018] [Accepted: 09/25/2018] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The fear of falling has a high prevalence in the community, and intervention programs for this condition are scarce, making it is necessary to strengthen this type of therapy in order to prevent adverse consequences in the elderly population. OBJECTIVE To establish the effectiveness of three intervention programs in reducing the fear of falling and increasing functionality in elderly people in the city of Manizales. PARTICIPANTS AND METHODS A randomised trial was conducted on ambulatory elderly patients with fear of falling and functional limitation of the city of Manizales. A total of 125 individuals were randomised to one of three interventions: Tai Chi (TCh), cognitive behavioural therapy (CBT), and postural control (CP) exercises. The primary outcomes were: fear of falling (evaluated by the Falls Efficacy Scale [FES-I]), and functionality using the Short Physical Performance Battery (SPPB). The data was collected before initiating the interventions and after the 8 weeks intervention. RESULTS An intention-to-treat analysis was conducted on 119 elderly patients. The three interventions reduced the fear of falling and increased physical performance, with no significant differences observed between them (P=.13). As regards gait speed, differences were only found between the pre- and post-intervention with CP (P<.001). CONCLUSIONS The results suggest that the TCh, CBT and CP interventions helped the elderly to reduce their fear of falling. Only CP demonstrated an improvement in the speed of walking at the end of the eight weeks of intervention (identifier NCT03211429).
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Affiliation(s)
- Eliana Patricia Dueñas
- Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, Colombia; Departamento de Medicina Familiar, Universidad del Valle, Valle del Cauca, Colombia.
| | | | - Elizabeth Ponce
- Facultad de Psicología, Universidad de Manizales, Manizales, Colombia
| | - Carmen Lucía Curcio
- Grupo de Investigaciones en Gerontología y Geriatría, Universidad de Caldas, Manizales, Colombia
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Murray E, Ross J, Pal K, Li J, Dack C, Stevenson F, Sweeting M, Parrott S, Barnard M, Yardley L, Michie S, May C, Patterson D, Alkhaldi G, Fisher B, Farmer A, O’Donnell O. A web-based self-management programme for people with type 2 diabetes: the HeLP-Diabetes research programme including RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background
In the UK, 6% of the UK population have diabetes mellitus, 90% of whom have type 2 diabetes mellitus (T2DM). Diabetes mellitus accounts for 10% of NHS expenditure (£14B annually). Good self-management may improve health outcomes. NHS policy is to refer all people with T2DM to structured education, on diagnosis, to improve their self-management skills, with annual reinforcement thereafter. However, uptake remains low (5.6% in 2014–15). Almost all structured education is group based, which may not suit people who work, who have family or other caring commitments or who simply do not like group-based formats. Moreover, patient needs vary with time and a single education session at diagnosis is unlikely to meet these evolving needs. A web-based programme may increase uptake.
Objectives
Our aim was to develop, evaluate and implement a web-based self-management programme for people with T2DM at any stage of their illness journey, with the goal of improving access to, and uptake of, self-management support, thereby improving health outcomes in a cost-effective manner. Specific objectives were to (1) develop an evidence-based theoretically informed programme that was acceptable to patients and health-care professionals (HCPs) and that could be readily implemented within routine NHS care, (2) determine the clinical effectiveness and cost-effectiveness of the programme compared with usual care and (3) determine how best to integrate the programme into routine care.
Design
There were five linked work packages (WPs). WP A determined patient requirements and WP B determined HCP requirements for the self-management programme. WP C developed and user-tested the Healthy Living for People with type 2 Diabetes (HeLP-Diabetes) programme. WP D was an individually randomised controlled trial in primary care with a health economic analysis. WP E used a mixed-methods and case-study design to study the potential for implementing the HeLP-Diabetes programme within routine NHS practice.
Setting
English primary care.
Participants
People with T2DM (WPs A, D and E) or HCPs caring for people with T2DM (WPs B, C and E).
Intervention
The HeLP-Diabetes programme; an evidence-based theoretically informed web-based self-management programme for people with T2DM at all stages of their illness journey, developed using participatory design principles.
Main outcome measures
WPs A and B provided data on user ‘wants and needs’, including factors that would improve the uptake and accessibility of the HeLP-Diabetes programme. The outcome for WP C was the HeLP-Diabetes programme itself. The trial (WP D) had two outcomes measures: glycated haemoglobin (HbA1c) level and diabetes mellitus-related distress, as measured with the Problem Areas in Diabetes (PAID) scale. The implementation outcomes (WP E) were the adoption and uptake at clinical commissioning group, general practice and patient levels and the identification of key barriers and facilitators.
Results
Data from WPs A and B supported our holistic approach and addressed all areas of self-management (medical, emotional and role management). HCPs voiced concerns about linkage with the electronic medical records (EMRs) and supporting patients to use the programme. The HeLP-Diabetes programme was developed and user-tested in WP C. The trial (WP D) recruited to target (n = 374), achieved follow-up rates of over 80% and the intention-to-treat analysis showed that there was an additional improvement in HbA1c levels at 12 months in the intervention group [mean difference –0.24%, 95% confidence interval (CI) –0.44% to –0.049%]. There was no difference in overall PAID score levels (mean difference –1.5 points, 95% CI –3.9 to 0.9 points). The within-trial health economic analysis found that incremental costs were lower in the intervention group than in the control group (mean difference –£111, 95% CI –£384 to £136) and the quality-adjusted life-years (QALYs) were higher (mean difference 0.02 QALYs, 95% CI 0.000 to 0.044 QALYs), meaning that the HeLP-Diabetes programme group dominated the control group. In WP E, we found that the HeLP-Diabetes programme could be successfully implemented in primary care. General practices that supported people in registering for the HeLP-Diabetes programme had better uptake and registered patients from a wider demographic than those relying on patient self-registration. Some HCPs were reluctant to do this, as they did not see it as part of their professional role.
Limitations
We were unable to link the HeLP-Diabetes programme with the EMRs or to determine the effects of the HeLP-Diabetes programme on users in the implementation study.
Conclusions
The HeLP-Diabetes programme is an effective self-management support programme that is implementable in primary care.
Future work
The HeLP-Diabetes research team will explore the following in future work: research to determine how to improve patient uptake of self-management support; develop and evaluate a structured digital educational pathway for newly diagnosed people; develop and evaluate a digital T2DM prevention programme; and the national implementation of the HeLP-Diabetes programme.
Trial registration
Research Ethics Committee reference number 10/H0722/86 for WPs A–C; Research Ethics Committee reference number 12/LO/1571 and UK Clinical Research Network/National Institute for Health Research (NIHR) Portfolio 13563 for WP D; and Research Ethics Committee 13/EM/0033 for WP E. In addition, for WP D, the study was registered with the International Standard Randomised Controlled Trial Register as reference number ISRCTN02123133.
Funding details
This project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 6, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jamie Ross
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kingshuk Pal
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Charlotte Dack
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Michael Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Maria Barnard
- Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Susan Michie
- Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - David Patterson
- Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - Ghadah Alkhaldi
- Research Department of Primary Care and Population Health, University College London, London, UK
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Brian Fisher
- Patient Access to Electronic Records Systems Ltd (PAERS), Evergreen Life, Manchester, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Orla O’Donnell
- Research Department of Primary Care and Population Health, University College London, London, UK
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May CR, Cummings A, Girling M, Bracher M, Mair FS, May CM, Murray E, Myall M, Rapley T, Finch T. Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review. Implement Sci 2018; 13:80. [PMID: 29879986 PMCID: PMC5992634 DOI: 10.1186/s13012-018-0758-1] [Citation(s) in RCA: 316] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/24/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Normalization Process Theory (NPT) identifies, characterises and explains key mechanisms that promote and inhibit the implementation, embedding and integration of new health techniques, technologies and other complex interventions. A large body of literature that employs NPT to inform feasibility studies and process evaluations of complex healthcare interventions has now emerged. The aims of this review were to review this literature; to identify and characterise the uses and limits of NPT in research on the implementation and integration of healthcare interventions; and to explore NPT's contribution to understanding the dynamics of these processes. METHODS A qualitative systematic review was conducted. We searched Web of Science, Scopus and Google Scholar for articles with empirical data in peer-reviewed journals that cited either key papers presenting and developing NPT, or the NPT Online Toolkit ( www.normalizationprocess.org ). We included in the review only articles that used NPT as the primary approach to collection, analysis or reporting of data in studies of the implementation of healthcare techniques, technologies or other interventions. A structured data extraction instrument was used, and data were analysed qualitatively. RESULTS Searches revealed 3322 citations. We show that after eliminating 2337 duplicates and broken or junk URLs, 985 were screened as titles and abstracts. Of these, 101 were excluded because they did not fit the inclusion criteria for the review. This left 884 articles for full-text screening. Of these, 754 did not fit the inclusion criteria for the review. This left 130 papers presenting results from 108 identifiable studies to be included in the review. NPT appears to provide researchers and practitioners with a conceptual vocabulary for rigorous studies of implementation processes. It identifies, characterises and explains empirically identifiable mechanisms that motivate and shape implementation processes. Taken together, these mean that analyses using NPT can effectively assist in the explanation of the success or failure of specific implementation projects. Ten percent of papers included critiques of some aspect of NPT, with those that did mainly focusing on its terminology. However, two studies critiqued NPT emphasis on agency, and one study critiqued NPT for its normative focus. CONCLUSIONS This review demonstrates that researchers found NPT useful and applied it across a wide range of interventions. It has been effectively used to aid intervention development and implementation planning as well as evaluating and understanding implementation processes themselves. In particular, NPT appears to have offered a valuable set of conceptual tools to aid understanding of implementation as a dynamic process.
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Affiliation(s)
- Carl R. May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Amanda Cummings
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Girling
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike Bracher
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances S. Mair
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Christine M. May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Murray
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Michelle Myall
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tim Rapley
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tracy Finch
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Cognitive stimulation therapy in dementia care: exploring the views and experiences of service providers on the barriers and facilitators to implementation in practice using Normalization Process Theory. Int Psychogeriatr 2017; 29:1869-1878. [PMID: 28701238 DOI: 10.1017/s1041610217001272] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cognitive stimulation therapy (CST) is an evidence-based, cost-effective psychosocial intervention for people with dementia but is currently not a standard part of post-diagnostic care. This qualitative study explored the views and experiences of dementia care providers on the barriers and facilitators to its implementation in usual care. METHOD Thirty four semi-structured interviews (24 participants) were conducted across four dementia care sites in the North of England; ten were follow-up interviews. Data were analyzed using thematic analysis and then mapped to the Normalization Process Theory framework. RESULTS Participants considered CST a "good fit" with their "preferred" ways of working and goals of dementia care namely the provision of person-centered services. For facilitators delivering the intervention, compared to other behavioral interventions, CST was seen to offer benefits to their work and was easy to understand as an intervention. Training in CST and seeing benefits for clients were important motivators. Time and resources were crucial for the successful implementation of CST. Participants were keen to objectively measure benefits to participants but unsure how to do this. CONCLUSIONS CST is a cost-effective psychosocial intervention for people with dementia, recommended by national guidance. Despite our findings which show that, using the NPT framework, there are more facilitators than barriers to the implementation of CST, it is still not a standard part of post-diagnostic dementia care. Further research is needed to explore the reasons for this implementation gap in ensuring evidence-based care in translated into practice.
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