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Fini NA, Simpson D, Moore SA, Mahendran N, Eng JJ, Borschmann K, Moulaee Conradsson D, Chastin S, Churilov L, English C. How should we measure physical activity after stroke? An international consensus. Int J Stroke 2023; 18:1132-1142. [PMID: 37300499 PMCID: PMC10614172 DOI: 10.1177/17474930231184108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Physical activity is important for secondary stroke prevention. Currently, there is inconsistency of outcomes and tools used to measure physical activity following stroke. AIM To establish internationally agreed recommendations to enable consistent measurement of post-stroke physical activity. METHODS Stroke survivors and carers were surveyed online once regarding what is important in physical activity measurement. Three survey rounds with expert stroke researchers and clinicians were conducted using Keeney's Value-Focused Thinking Methodology. Survey 1 identified physical activity tools, outcomes, and measurement considerations which were ranked in Survey 2. Consensus recommendations on tools were then formulated by the consensus group based on survey responses. In Survey 3, participants reviewed ranked results and evidence gathered to determine their support for consensus recommendations. RESULTS Twenty-five stroke survivors, 5 carers, 18 researchers, and 17 clinicians from 16 countries participated. Time in moderate-vigorous physical activity and step count were identified as the most important outcomes to measure. Key measurement considerations included the ability to measure across frequency, intensity, duration domains in real-world settings; user-friendliness, comfort, and ability to detect changes. Consensus recommendations included using the Actigraph, Actical, and Activ8 devices for physical activity intensity; ActivPAL for duration and Step Activity Monitor for frequency; and the IPAQ and PASE questionnaires. Survey 3 indicated 100% support for device and 96% for questionnaire recommendations. CONCLUSIONS These consensus recommendations can guide selection of physical activity measurement tools and outcomes. Tool selection will depend on measurement purpose, user-knowledge, and resources. Comprehensive measurement requires the use of devices and questionnaires.
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Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
| | - Dawn Simpson
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia
- Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Sarah A Moore
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
- Stroke Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Niruthikha Mahendran
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- Physiotherapy Division, School of health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Janice J Eng
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
- Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Karen Borschmann
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- St Vincent’s Hospital, Melbourne, VIC, Australia
| | - David Moulaee Conradsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Women’s Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
| | - Sebastien Chastin
- Institute of Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Leonid Churilov
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
| | - Coralie English
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia
- Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Wan CS, Cheng H, Musgrave-Takeda M, Liu MG, Tobiano G, McMahon J, McInnes E. Barriers and facilitators to implementing pressure injury prevention and management guidelines in acute care: A mixed-methods systematic review. Int J Nurs Stud 2023; 145:104557. [PMID: 37453248 DOI: 10.1016/j.ijnurstu.2023.104557] [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: 02/28/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Evidence-based pressure injury prevention and management is a global health service priority. Low uptake of pressure injury guidelines leads to compromised patient outcomes. Understanding clinicians' and patients' views on the barriers and facilitators to implementing guidelines and mapping the identified barriers and facilitators to the Theoretical Domains Framework and behaviour change techniques will inform an end-user and theoretically informed intervention to improve guideline uptake in the acute care setting. OBJECTIVES To synthesise quantitative and qualitative evidence on i) hospital clinicians' and inpatients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines. DESIGN A convergent integrated mixed-methods systematic review was conducted using the JBI approach. DATA SOURCE English language peer-reviewed studies published from 2009 to August 2022 were identified from MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central Library. REVIEW METHODS Included studies reported: i) acute care hospital clinicians' and patients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines. The Mixed Methods Appraisal Tool was used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data, comparing clinicians' and patients' views. Barriers and facilitators associated with each main theme were mapped to the Theoretical Domains Framework and allocated to relevant behaviour change techniques. RESULTS Fifty-five out of 14,488 studies of variable quality (29 quantitative, 22 qualitative, 4 mixed-methods) met the inclusion criteria. Four main themes represent factors thought to influence the implementation of evidence-based guidelines: 1) nurse-led multidisciplinary care, 2) patient participation in care, 3) practicability of implementation and 4) attitudes towards pressure injury prevention and management. Most barriers identified by clinicians were related to the third theme, whilst for patients, there were multiple barriers under theme 2. Barriers were mainly mapped to the Knowledge domain and Environmental Context and Resources domain and were matched to the behaviour change techniques of "instruction on how to perform a behaviour" and "restructuring the physical environment". Most facilitators mentioned by clinicians and patients were related to themes 1 and 2, respectively, and mapped to the Environmental Context and Resources domain. All patient-related attitudes in theme 4 were facilitators. CONCLUSIONS These review findings highlight the most influential factors related to implementing evidence-based pressure injury care from clinicians' and patients' views and mapping these factors to the Theoretical Domains Framework and behaviour change techniques has contributed to developing a stakeholder-tailored implementation intervention in acute care settings. PROSPERO REGISTRATION CRD42021250885.
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Affiliation(s)
- Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - Heilok Cheng
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mika Musgrave-Takeda
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mark Guosheng Liu
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Georgia Tobiano
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Gold Coast University Hospital, Gold Coast Health Nursing and Midwifery Education and Research Unit, Queensland, Australia
| | - Jake McMahon
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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3
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Sassoon I, Kökciyan N, Modgil S, Parsons S. Argumentation schemes for clinical decision support. ARGUMENT & COMPUTATION 2021. [DOI: 10.3233/aac-200550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper demonstrates how argumentation schemes can be used in decision support systems that help clinicians in making treatment decisions. The work builds on the use of computational argumentation, a rigorous approach to reasoning with complex data that places strong emphasis on being able to justify and explain the decisions that are recommended. The main contribution of the paper is to present a novel set of specialised argumentation schemes that can be used in the context of a clinical decision support system to assist in reasoning about what treatments to offer. These schemes provide a mechanism for capturing clinical reasoning in such a way that it can be handled by the formal reasoning mechanisms of formal argumentation. The paper describes how the integration between argumentation schemes and formal argumentation may be carried out, sketches how this is achieved by an implementation that we have created and illustrates the overall process on a small set of case studies.
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Affiliation(s)
- Isabel Sassoon
- Department of Computer Science, Brunel University London, UK. E-mail:
| | - Nadin Kökciyan
- School of Informatics, University of Edinburgh, UK. E-mail:
| | - Sanjay Modgil
- Department of Informatics, King’s College London, UK. E-mail:
| | - Simon Parsons
- Department of Computer Science, University of Lincoln, UK. E-mail:
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A nurse-led multicomponent intervention supported by advanced electronic health records to improve the acute management of stroke patients: A pre- and post-intervention study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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André B, Grønning K, Jacobsen FF, Haugan G. "Joy of life" in nursing homes. Healthcare personnel experiences of the implementation of the national strategy. A qualitative study with content analysis of interviews. BMC Health Serv Res 2021; 21:771. [PMID: 34348715 PMCID: PMC8335868 DOI: 10.1186/s12913-021-06801-w] [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: 07/14/2020] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nursing homes are under strong pressure to provide good care to the residents. In Norway, municipalities have applied the ‘Joy-of-Life-Nursing-Home’ strategy to increase a health-promoting perception that focuses on the older persons` resources. Implementations represent introducing changes to the healthcare personnel; however, changing one’s working approaches, routines and working culture may be demanding. On this background, we explored how the ‘Joy-of-Life-Nursing-Home’ strategy is perceived by the employees in retrospective, over a period after the implementation and which challenges the employees experience with this implementation. Method We used a qualitative approach and interviewed 14 healthcare personnel working in nursing homes in one Norwegian municipality, which had implemented the ‘Joy-of-Life-Nursing-Home’ strategy. The analysis was conducted following Kvale’s approach to qualitative content analysis. Results The main categories were: (a) the characteristics of care activities before implementations of ‘Joy-of-Life-Nursing-Home’, (b) how ‘Joy-of-Life-Nursing-Home’ influenced the care activities, and (c) challenges with the implementation of ‘Joy-of-Life-Nursing-Home’. Some of the informants spoke well about the implementation concerning the care quality stating “to see the joy in the eyes of the resident then I feel we have succeeded”. For informants who experienced resistance toward the implementation, they felt it was too much to document, it was too complicated, and the requirements were too many. Conclusions Quality of care seems to have increased after the implementation, as perceived by the informants. Nevertheless, the fact that the informants seemed to be divided into two different groups related to their main perspective of the implementation is concerning. One group has positive experiences with the implementations process and the benefits of it, while the other group focuses on lack of benefits and problems with the implementation process. To understand what facilitates and hinders the implementation, research on contextual factors like work environment and leadership is recommended.
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Affiliation(s)
- Beate André
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway. .,NTNU Center for Health Promotion Research, 7491, Trondheim, Norway.
| | - Kjersti Grønning
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway.,NTNU Center for Health Promotion Research, 7491, Trondheim, Norway
| | - Frode F Jacobsen
- Centre for Care Research, Western Norway University of Applied Sciences, Bergen, Norway.,Institute for Health and Care Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,VID Specialized University, Bergen, Norway
| | - Gørill Haugan
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway.,NTNU Center for Health Promotion Research, 7491, Trondheim, Norway
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McInnes E, Dale S, Craig L, Phillips R, Fasugba O, Schadewaldt V, Cheung NW, Cadilhac DA, Grimshaw JM, Levi C, Considine J, McElduff P, Gerraty R, Fitzgerald M, Ward J, D’Este C, Middleton S. Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T 3 trial): a qualitative study. Implement Sci 2020; 15:99. [PMID: 33148343 PMCID: PMC7640433 DOI: 10.1186/s13012-020-01057-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The implementation of evidence-based protocols for stroke management in the emergency department (ED) for the appropriate triage, administration of tissue plasminogen activator to eligible patients, management of fever, hyperglycaemia and swallowing, and prompt transfer to a stroke unit were evaluated in an Australian cluster-randomised trial (T3 trial) conducted at 26 emergency departments. There was no reduction in 90-day death or dependency nor improved processes of ED care. We conducted an a priori planned process influential factors that impacted upon protocol uptake. METHODS Qualitative face-to-face interviews were conducted with purposively selected ED and stroke clinicians from two high- and two low-performing intervention sites about their views on factors that influenced protocol uptake. All Trial State Co-ordinators (n = 3) who supported the implementation at the 13 intervention sites were also interviewed. Data were analysed thematically using normalisation process theory as a sensitising framework to understand key findings, and compared and contrasted between interviewee groups. RESULTS Twenty-five ED and stroke clinicians, and three Trial State Co-ordinators were interviewed. Three major themes represented key influences on evidence uptake: (i) Readiness to change: reflected strategies to mobilise and engage clinical teams to foster cognitive participation and collective action; (ii) Fidelity to the protocols: reflected that beliefs about the evidence underpinning the protocols impeded the development of a shared understanding about the applicability of the protocols in the ED context (coherence); and (iii) Boundaries of care: reflected that appraisal (reflexive monitoring) by ED and stroke teams about their respective boundaries of clinical practice impeded uptake of the protocols. CONCLUSIONS Despite initial high 'buy-in' from clinicians, a theoretically informed and comprehensive implementation strategy was unable to overcome system and clinician level barriers. Initiatives to drive change and integrate protocols rested largely with senior nurses who had to overcome contextual factors that fell outside their control, including low medical engagement, beliefs about the supporting evidence and perceptions of professional boundaries. To maximise uptake of evidence and adherence to intervention fidelity in complex clinical settings such as ED cost-effective strategies are needed to overcome these barriers. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( ACTRN12614000939695 ).
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Affiliation(s)
- Elizabeth McInnes
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Level 4, Daniel Mannix Building, Brunswick Street, Fitzroy, Victoria 3065 Australia
| | - Simeon Dale
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, Victoria Street, Darlinghurst, New South Wales 2010 Australia
| | - Louise Craig
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, Victoria Street, Darlinghurst, New South Wales 2010 Australia
| | - Rosemary Phillips
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, Victoria Street, Darlinghurst, New South Wales 2010 Australia
| | - Oyebola Fasugba
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Level 2, Signadou Building, Australian Catholic University, 223 Antill Street, Watson, Australian Capital Territory 2602 Australia
| | - Verena Schadewaldt
- Department of Neurosurgery, University of Melbourne and Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050 Australia
- Formerly: Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Victoria, Australia
| | - N. Wah Cheung
- Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Westmead, Sydney, New South Wales Australia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria Australia
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital – General Campus, Centre for Practice-Changing Research (CPCR), 501 Smyth Road, Room 1286, Ottawa, Ontario K1H 8 L6 Canada
- Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8 M5 Canada
| | - Chris Levi
- The Sydney Partnership for Health Education Research & Enterprise (SPHERE), University of New South Wales, Liverpool, New South Wales Australia
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria 3220 Australia
| | - Patrick McElduff
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales Australia
| | - Richard Gerraty
- Department of Medicine, Monash University, Melbourne, Victoria 3800 Australia
- Neurosciences Clinical Institute, Epworth Hospital, Richmond, Victoria 3121 Australia
| | - Mark Fitzgerald
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria 3800 Australia
- Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Australia
| | - Jeanette Ward
- Nulungu Research Institute, University of Notre Dame Australia, Broome, Western Australia Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory 0200 Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales 2308 Australia
| | - Sandy Middleton
- Nursing Research Institute - St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, Victoria Street, Darlinghurst, New South Wales 2010 Australia
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Andrew NE, Kim J, Cadilhac DA, Sundararajan V, Thrift AG, Churilov L, Lannin NA, Nelson M, Srikanth V, Kilkenny MF. Protocol for evaluation of enhanced models of primary care in the management of stroke and other chronic disease (PRECISE): A data linkage healthcare evaluation study. Int J Popul Data Sci 2019; 4:1097. [PMID: 34095531 PMCID: PMC8142961 DOI: 10.23889/ijpds.v4i1.1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The growing burden of chronic diseases means some governments have been providing financial incentives for multidisciplinary care and self-management support delivered within primary care. Currently, population-based evaluations of the effectiveness of these policies are lacking. AIM To outline the methodological approach for our study that is designed to evaluate the effectiveness (including cost) of primary care policies for chronic diseases in Australia using stroke as a case study. METHODS Person-level linkages will be undertaken between registrants from the Australian Stroke Clinical Registry (AuSCR) and (i) Government-held Medicare Australia claims data, to identify receipt or not of chronic disease management and care coordination primary care items; (ii) state government-held hospital data, to define outcomes; and (iii) government-held pharmaceutical and aged care claims data, to define covariates. N=1500 randomly selected AuSCR registrants will be sent surveys to obtain patient experience information. In Australia, unique identifiers are unavailable. Therefore, personal-identifiers will be submitted to government data linkage units. Researchers will merge the de-identified datasets for analysis using a project identifier. An economic evaluation will also be undertaken. ANALYSIS The index event will be the first stroke recorded in the AuSCR. Multivariable competing risks Poisson regression for multiple events, adjusted by a propensity score, will be used to test for differences in the rates of hospital presentations and medication adherence for different care (policy) types. Our estimated sample size of 25,000 patients will provide 80% estimated power (ɑ>0.05) to detect a 6-8% difference in rates. The incremental costs per Quality-adjusted life years gained of community-based care following the acute event will be estimated from a health sector perspective. CONCLUSION Completion of this study will provide a novel and comprehensive evaluation of the effectiveness and cost-effectiveness of Australian primary care policies. Its success will enable us to highlight the value of data-linkage for this type of research.
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Affiliation(s)
- NE Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - J Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - DA Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - V Sundararajan
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - AG Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - L Churilov
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - NA Lannin
- School of Allied Health, Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - M Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Victoria, Australia
| | - V Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - MF Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
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Fergie L, Campbell KA, Coleman-Haynes T, Ussher M, Cooper S, Coleman T. Stop smoking practitioner consensus on barriers and facilitators to smoking cessation in pregnancy and how to address these: A modified Delphi survey. Addict Behav Rep 2019; 9:100164. [PMID: 31193880 PMCID: PMC6543497 DOI: 10.1016/j.abrep.2019.100164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Pregnant women can experience barriers and facilitators towards achieving smoking cessation. We sought consensus from smoking cessation practitioners on how influential pre-identified barriers and facilitators can be on pregnant women's smoking behaviour, and how difficult these might be to manage. Suggestions for techniques that could help overcome the barriers or enhance the facilitators were elicited and consensus sought on the appropriateness for their use in practice. Methods Forty-four practitioners who provided cessation support to pregnant women completed a three-round modified Delphi survey. Round one sought consensus on the ‘influence’ and ‘difficulty’ of the barriers and facilitators, and gathered respondents' suggestions on ways to address these. Rounds two and three sought further consensus on the barriers and facilitators and on ‘appropriateness’ of the respondent-suggested techniques. The techniques were coded for behaviour change techniques (BCTs) content using existing taxonomies. Results Barriers and facilitators considered to be the most important mainly related to the influence of significant others and the women's motivation & self-efficacy. Having a supportive partner was considered the most influential, whereas lack of support from partner was the only barrier that reached consensus as being difficult to manage. Barriers relating to social norms were also considered influential, however these received poor coverage of respondent-suggested techniques. Those considered the easiest to address mainly related to aspects of cessation support, including misconceptions surrounding the use of nicotine replacement therapy (NRT). Barriers and facilitators relating to the women's motivation & self-efficacy, such as the want to protect the baby, were also considered as being particularly easy to address. Fifty of the 54 respondent-suggested techniques reached consensus as being appropriate. Those considered the most appropriate ranged from providing support early, giving correct information on NRT, highlighting risks and benefits and reinforcing motivating beliefs. Thirty-three BCTs were identified from the respondent-suggested techniques. ‘Social support (unspecified)’, ‘Tailor interactions appropriately’ and ‘Problem solving’ were the most frequently coded BCTs. Conclusions Involving partners in quit attempts was advocated. Existing support could be potentially improved by establishing appropriate ways to address barriers relating to pregnant smokers' ‘social norms’. In general, providing consistent and motivating support seemed favourable. Significant others, women's motivation and self-efficacy influence quit attempts. Having an unsupportive partner was considered the most difficult barrier to address. Suggestions on how to address barriers relating to social norms were lacking. Giving consistent support and boosting women's motivation to quit were advocated. Enhancing women's knowledge on NRT use was deemed easy to do and beneficial.
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Affiliation(s)
- Libby Fergie
- Division of Primary Care, School of Medicine, University of Nottingham, UK
| | | | - Tom Coleman-Haynes
- Division of Primary Care, School of Medicine, University of Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, UK.,Institute for Social Marketing, University of Stirling, UK
| | - Sue Cooper
- Division of Primary Care, School of Medicine, University of Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, School of Medicine, University of Nottingham, UK
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Stathatou PM, Kampragou E, Grigoropoulou H, Assimacopoulos D, Karavitis C, Gironás J. Creating an enabling environment for WR&R implementation. WATER SCIENCE AND TECHNOLOGY : A JOURNAL OF THE INTERNATIONAL ASSOCIATION ON WATER POLLUTION RESEARCH 2017; 76:1555-1564. [PMID: 28953481 DOI: 10.2166/wst.2017.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Reclaimed water is receiving growing attention worldwide as an effective solution for alleviating the growing water scarcity in many areas. Despite the various benefits associated with reclaimed water, water recycling and reuse (WR&R) practices are not widely applied around the world. This is mostly due to complex and inadequate local legal and institutional frameworks and socio-economic structures, which pose barriers to wider WR&R implementation. An integrated approach is therefore needed while planning the implementation of WR&R schemes, considering all the potential barriers, and aiming to develop favourable conditions for enhancing reclaimed water use. This paper proposes a comprehensive methodology supporting the development of an enabling environment for WR&R implementation. The political, economic, social, technical, legal and institutional factors that may influence positively (drivers) or negatively (barriers) WR&R implementation in the regional water systems are identified, through the mapping of local stakeholder perceptions. The identified barriers are further analysed, following a Cross-Impact/System analysis, to recognize the most significant barriers inhibiting system transition, and to prioritize the enabling instruments and arrangements that are needed to boost WR&R implementation. The proposed methodology was applied in the Copiapó River Basin in Chile, which faces severe water scarcity. Through the analysis, it was observed that barriers outweigh drivers for the implementation of WR&R schemes in the Copiapó River Basin, while the key barriers which could be useful for policy formulation towards an enabling environment in the area concern the unclear legal framework regarding the ownership of treated wastewater, the lack of environmental policies focusing on pollution control, the limited integration of reclaimed water use in current land use and development policies, the limited public awareness on WR&R, and the limited availability of governmental funding sources for WR&R.
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Affiliation(s)
- P-M Stathatou
- School of Chemical Engineering, National Technical University of Athens, 9 Heroon Polytechneiou str., Athens 15780, Greece E-mail:
| | - E Kampragou
- School of Chemical Engineering, National Technical University of Athens, 9 Heroon Polytechneiou str., Athens 15780, Greece E-mail:
| | - H Grigoropoulou
- School of Chemical Engineering, National Technical University of Athens, 9 Heroon Polytechneiou str., Athens 15780, Greece E-mail:
| | - D Assimacopoulos
- School of Chemical Engineering, National Technical University of Athens, 9 Heroon Polytechneiou str., Athens 15780, Greece E-mail:
| | - C Karavitis
- Department of Natural Resources Development and Agricultural Engineering, Agricultural University of Athens, 75 Iera Odos, Athens 11855, Greece
| | - J Gironás
- Departamento de Ingeniería Hidráulica y Ambiental, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro de Desarrollo Urbano Sustentable CONICYT/FONDAP/15110020, Santiago, Chile; Centro Nacional de Investigación para la Gestión Integrada de Desastres Naturales CONICYT/FONDAP/15110017, Santiago, Chile and Centro Interdisciplinario de Cambio Global, Pontificia Universidad Católica de Chile, Santiago, Chile
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10
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André B, Sjøvold E. What characterizes the work culture at a hospital unit that successfully implements change - a correlation study. BMC Health Serv Res 2017; 17:486. [PMID: 28705155 PMCID: PMC5513374 DOI: 10.1186/s12913-017-2436-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background To successfully achieve change in healthcare, a balance between technology and “people ware”, the human recourses, is necessary. However, the human aspect of the change implementation process has received less attention than the technological issues. The aim was to explore the factors that characterize the work culture in a hospital unit that successfully implemented change compared with the factors that characterize the work culture of a hospital unit with unsuccessful implementation. Method The Systematizing Person-Group Relations method was used for gathering and analyzing data to explore what dominate the behavior in a particular work environment identifying challenges, limitations and opportunities. This method applied six different dimensions, each representing different behavior in a work culture: Synergy, Withdrawal, Opposition, Dependence, Control and Nurture. We compared two different units at the same hospital, one that successfully implemented change and one that was unsuccessful. Results There were significant statistical differences between healthcare personnel working at a unit that successfully implemented change contrasted with the unit with unsuccessful implementation. These significant differences were found in both the synergy and control dimensions, which are important positive qualities in a work culture. Conclusion The results of this study show that healthcare personnel at a unit with a successful implementation of change have a working environment with many positive qualities. This indicates that a work environment with a high focus on goal achievement and task orientation can handle the challenges of implementing changes.
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Affiliation(s)
- Beate André
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7004, Trondheim, NO, Norway. .,NTNU Center for Health Promotion Research, Trondheim, Norway.
| | - Endre Sjøvold
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, NTNU, Trondheim, Norway
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