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Dunphy R, Blane DN. Understanding exercise referrals in primary care: a qualitative study of General Practitioners and Physiotherapists. Physiotherapy 2024; 124:1-8. [PMID: 38776568 DOI: 10.1016/j.physio.2024.04.348] [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: 06/27/2023] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Physical inactivity is estimated to cost the UK National Health Service over £7.4 billion per year. Healthcare practitioners have a key role in supporting increases in physical activity (PA) levels, including referring to exercise referral schemes. To date, there has been little research into practitioner perspectives on referrals to exercise schemes. OBJECTIVES To explore the views and experiences of General Practitioners (GPs) and physiotherapists in relation to factors which influence referral and adherence to exercise referral schemes. DESIGN SETTING AND PARTICIPANTS Qualitative study of primary care-based practitioners in Glasgow, UK. METHODS Semi-structured interviews were conducted with 14 practitioners (seven GPs and seven physiotherapists). Interviews were recorded and analysed thematically. RESULTS Four themes are presented. Firstly, all people, including healthcare practitioners, bring inherent biases which are influenced by their background, experiences and worldviews to a consultation which impact their approach to PA promotion. Secondly, clinical time pressures are a major barrier to effective PA promotion. Thirdly, patient-led, compassionate care which seeks to fully understand a patient is the most vital component of behaviour change, with suggestions that promoting peer support and the use of personal anecdotes to normalise vulnerabilities might be helpful. Lastly, providing ongoing support for change was felt to be beneficial to PA promotion. This is often accessed through exercise referral schemes and improved by better collaboration between exercise providers and referring practitioners. CONCLUSION Practitioners believed exercise referrals could be improved with more targeted training in behaviour change facilitation, support for multidisciplinary working, and enhanced communication between the programmes and referrers. Additionally, supporting behaviour change requires time for compassionate care and fully understanding patients' motivations and beliefs. Lack of time was felt to be the greatest current barrier to effective PA promotion. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Rebekah Dunphy
- Department of Physiotherapy, NHS Greater Glasgow & Clyde, Glasgow, UK.
| | - David N Blane
- General Practice & Primary Care, School of Health & Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow G12 8TB, UK
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Ioannou E, Humphreys H, Homer C, Purvis A. Barriers and system improvements for physical activity promotion after gestational diabetes: A qualitative exploration of the views of healthcare professionals. Diabet Med 2024:e15426. [PMID: 39153179 DOI: 10.1111/dme.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/22/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024]
Abstract
AIM Physical activity is an important behaviour for managing the ten times increased risk of type 2 diabetes after gestational diabetes. Previous studies exploring physical activity promotion in healthcare focus on general practitioners but have not explored the gestational diabetes pathway. Therefore, this paper explores the barriers to and suggestions for, activity promotion along the gestational diabetes healthcare pathway. METHODS The paper was written in accordance with the Standards for Reporting Qualitative Research. Patient and Public Involvement with women who had lived experiences of gestational diabetes informed purposeful sampling by identifying which healthcare professional roles should be targeted in participant recruitment. Participants were recruited through word-of-mouth, that is, email and connections with local healthcare service leads. Twelve participants took part in semi-structured one-to-one interviews, analysed using reflexive thematic analysis. RESULTS Participants included a Public Health Midwife (n = 1), Diabetes Midwifes (n = 3), Diabetes Dietitian (n = 1), Diabetes Consultants (n = 2), Diabetes Specialist Nurse (n = 1), general practitioners (n = 2), Practice nurse (n = 1) and a Dietitian from the UK National Diabetes Prevention Program (n = 1). Six themes were generated: 'management of gestational diabetes takes precedent', 'poor continuity of care', 'lack of capacity to promote PA', 'beliefs about the acceptability of PA promotion', 'resources to support conversations about PA' and 'adapting healthcare services for women post-gestational diabetes'. CONCLUSIONS During pregnancy messaging around physical activity is consistent, yet this is specific for managing gestational diabetes and is not followed through postnatally. Improvements in continuity of care are necessary, in addition to ensuring the availability and links with wider exercise and activity schemes.
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Affiliation(s)
- Elysa Ioannou
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Helen Humphreys
- Centre for Behavioural Science and Applied Psychology (CeBSAP), Sheffield Hallam University, Sheffield, UK
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Alison Purvis
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
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Brust M, Gebhardt WA, Ter Hoeve N, Numans ME, Kiefte-de Jong JC. Exploring timing and delivery of lifestyle advice following an acute cardiac event hospitalization: The cardiac patient's perspective. PATIENT EDUCATION AND COUNSELING 2024; 124:108279. [PMID: 38565073 DOI: 10.1016/j.pec.2024.108279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To explore the perspective of cardiac patients regarding the timing and manner of delivering lifestyle advice following an acute cardiac event hospitalization. METHODS Dutch cardiac patients who experienced a cardiac event hospitalization participated in a semi-structured interview (n = 14) or a cross-sectional survey study (n = 119). RESULTS Our findings indicate that cardiac patients are receptive to lifestyle advice throughout the care trajectory. Advice delivered by a cardiologist had the highest self-reported impact. Furthermore, receiving advice at multiple phases during the care trajectory was associated with a greater intention to change lifestyle (B = 0.37, CI = 0.17 - 0.57). Patients favored clear-cut, feasible, and friendly but confronting advice. Moreover, they stressed the importance of advice being aligned with their identity and beliefs about the causes of their disease. CONCLUSION The period following an acute cardiac event provides a unique opportunity to offer tailored and patient-centered lifestyle advice. This "teachable window" for lifestyle change, when used wisely, may improve health outcomes for cardiac patients. PRACTICE IMPLICATIONS Healthcare professionals should initiate lifestyle advice already during hospitalization and continue during follow-up appointments and cardiac rehabilitation. Advice should be feasible and empathy-based, as well as tailored to the patient's needs, values, and perceptions of the causes of their cardiovascular disease.
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Affiliation(s)
- Michelle Brust
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Winifred A Gebhardt
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, the Netherlands.
| | - Nienke Ter Hoeve
- Capri Cardiac Rehabilitation, Rotterdam, the Netherlands; Erasmus University Medical Centre, Department of Rehabilitation Medicine, Rotterdam, the Netherlands.
| | - Mattijs E Numans
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
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Goldthorpe J, Kilbee L, Pretty I, Cotterill S, Hart J, Peters S. Supporting post-pandemic recovery: a qualitative study of the capabilities, opportunities and motivations to deliver oral health behaviour change messages to parents of young children in community settings. BMC Oral Health 2024; 24:580. [PMID: 38762726 PMCID: PMC11102627 DOI: 10.1186/s12903-024-04344-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/07/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic exacerbated vulnerabilities and inequalities in children's oral health, and treatment activity virtually ceased during periods of lockdown. Primary care dentistry is still in the post-pandemic recovery phase, and it may be some years before normal service is resumed in NHS dentistry. However, opportunities to support the dental workforce through offering some preventative care in outreach settings may exist. This has the additional benefit of potentially reaching children who do not routinely see a dentist. The aim of this research was therefore to explore views around upskilling practitioners working in early years educational and care settings to support families of pre-school aged children to adopt and maintain preventative oral health behaviours. METHODS Using the Capability, Opportunity and Motivation model of behaviour (COM-B) to structure our data collection and analysis, we conducted semi-structured interviews with 16 practitioners (dental and non-dental) and analysed the data using deductive framework analysis. RESULTS The data were a good fit with the COM-B model, and further themes were developed within each construct, representing insights from the data. CONCLUSION Early years practitioners can reach vulnerable children who are not usually brought to see a dentist, and have the capability, opportunity and motivation to support the oral health behaviours of families of children in their care. Further research is needed to identify training needs (oral health and behaviour change knowledge and skills), acceptability to parents, and supporting dental practice teams to work in partnership with early years settings.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Health Research, University of Manchester, Manchester, UK
| | - Lauren Kilbee
- Manchester Centre for Health Psychology, Division of Health Research, University of Manchester, Manchester, UK
| | - Iain Pretty
- Division of Medical Sciences, Colgate Palmolive University of Manchester Dental Health Unit, Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jo Hart
- Division of Medical Education, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Sarah Peters
- Manchester Centre for Health Psychology, Division of Health Research, University of Manchester, Manchester, UK.
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Waheed MA, Liu L. Perceptions of Family Physicians About Applying AI in Primary Health Care: Case Study From a Premier Health Care Organization. JMIR AI 2024; 3:e40781. [PMID: 38875531 PMCID: PMC11063883 DOI: 10.2196/40781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 05/25/2023] [Accepted: 03/07/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND The COVID-19 pandemic has led to the rapid proliferation of artificial intelligence (AI), which was not previously anticipated; this is an unforeseen development. The use of AI in health care settings is increasing, as it proves to be a promising tool for transforming health care systems, improving operational and business processes, and efficiently simplifying health care tasks for family physicians and health care administrators. Therefore, it is necessary to assess the perspective of family physicians on AI and its impact on their job roles. OBJECTIVE This study aims to determine the impact of AI on the management and practices of Qatar's Primary Health Care Corporation (PHCC) in improving health care tasks and service delivery. Furthermore, it seeks to evaluate the impact of AI on family physicians' job roles, including associated risks and ethical ramifications from their perspective. METHODS We conducted a cross-sectional survey and sent a web-based questionnaire survey link to 724 practicing family physicians at the PHCC. In total, we received 102 eligible responses. RESULTS Of the 102 respondents, 72 (70.6%) were men and 94 (92.2%) were aged between 35 and 54 years. In addition, 58 (56.9%) of the 102 respondents were consultants. The overall awareness of AI was 80 (78.4%) out of 102, with no difference between gender (P=.06) and age groups (P=.12). AI is perceived to play a positive role in improving health care practices at PHCC (P<.001), managing health care tasks (P<.001), and positively impacting health care service delivery (P<.001). Family physicians also perceived that their clinical, administrative, and opportunistic health care management roles were positively influenced by AI (P<.001). Furthermore, perceptions of family physicians indicate that AI improves operational and human resource management (P<.001), does not undermine patient-physician relationships (P<.001), and is not considered superior to human physicians in the clinical judgment process (P<.001). However, its inclusion is believed to decrease patient satisfaction (P<.001). AI decision-making and accountability were recognized as ethical risks, along with data protection and confidentiality. The optimism regarding using AI for future medical decisions was low among family physicians. CONCLUSIONS This study indicated a positive perception among family physicians regarding AI integration into primary care settings. AI demonstrates significant potential for enhancing health care task management and overall service delivery at the PHCC. It augments family physicians' roles without replacing them and proves beneficial for operational efficiency, human resource management, and public health during pandemics. While the implementation of AI is anticipated to bring benefits, the careful consideration of ethical, privacy, confidentiality, and patient-centric concerns is essential. These insights provide valuable guidance for the strategic integration of AI into health care systems, with a focus on maintaining high-quality patient care and addressing the multifaceted challenges that arise during this transformative process.
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Affiliation(s)
| | - Lu Liu
- Bath Business School, Bath Spa University, Bath, United Kingdom
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Kwasnicka D, Potthoff S, Hagger MS, Vandelanotte C, Rebar A, Short CE, Crook D, Gardner B. Challenging assumptions underlying physical activity promotion for health care professionals in Australia: A data-prompted interview study. Health Promot J Austr 2024; 35:542-550. [PMID: 37537885 DOI: 10.1002/hpja.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023] Open
Abstract
ISSUE ADDRESSED Interventions targeting health care professionals' behaviours are assumed to support them in learning how to give behavioural advice to patients, but such assumptions are rarely examined. This study investigated whether key assumptions were held regarding the design and delivery of physical activity interventions among health care professionals in applied health care settings. This study was part of the 'Physical Activity Tailored intervention in Hospital Staff' randomised controlled trial of three variants of a web-based intervention. METHODS We used data-prompted interviews to explore whether the interventions were delivered and operated as intended in health care professionals working in four hospitals in Western Australia (N = 25). Data were analysed using codebook thematic analysis. RESULTS Five themes were constructed: (1) health care professionals' perceived role in changing patients' health behaviours; (2) work-related barriers to physical activity intervention adherence; (3) health care professionals' use of behaviour change techniques; (4) contamination between groups; and (5) perceptions of intervention tailoring. CONCLUSIONS The intervention was not experienced by participants, nor did they implement the intervention guidance, in the way we expected. For example, not all health care professionals felt responsible for providing behaviour change advice, time and shift constraints were key barriers to intervention participation, and contamination effects were difficult to avoid. SO WHAT?: Our study challenges assumptions about how health care professionals respond to behaviour change advice and possible knock-on benefits for patients. Applying our learnings may improve the implementation of health promotion interventions in health care settings.
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Affiliation(s)
- Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- SWPS University of Social Sciences and Humanities, Faculty of Psychology, Wroclaw, Poland
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Martin S Hagger
- Department of Psychology, University of California, Merced, USA
- Department of Sport Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Amanda Rebar
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Camille E Short
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, Parkville, Victoria, Australia
- Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Dawn Crook
- Serco, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Keyworth C, Conner M, Johnson J, Epton T, Vogt KS, Armitage CJ. Impacts of the COVID-19 public health emergency on healthcare professional delivery of opportunistic behaviour change interventions: a retrospective cohort study. BMC Health Serv Res 2024; 24:167. [PMID: 38317160 PMCID: PMC10845453 DOI: 10.1186/s12913-023-10522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/23/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The public health policy "Making Every Contact Count" (MECC) compels healthcare professionals to deliver health behaviour change interventions during routine consultations. As healthcare systems continue their recovery from the impacts of the COVID-19 public health emergency, supporting people to modify health behaviours is more important now than when the policy was introduced. The present study aims to: (a) examine changes in healthcare professionals' awareness of, and engagement with the policy over a five-year period, (b) examine the psychosocial drivers associated with delivering behaviour change interventions, and (c) identify targets to increase healthcare professionals' delivery of interventions. METHODS Comparison of data from two independent representative surveys of NHS healthcare professionals working in the UK. In both surveys (July-September 2017; N = 1387, and February-March 2022; N = 1008), participants were asked to report: (1) awareness of the MECC policy, (2) the prevalence of MECC-related practice (perceived patient benefit, how often interventions were delivered, and time spent delivering interventions), and (3) perceptions of capabilities, opportunities and motivations to deliver behaviour change interventions. T- tests (independent-samples), MANOVA, multiple linear regression, and chi-square analyses were used to generate comparisons between the surveys. RESULTS Awareness of the policy increased from 2017 (31.4%) to 2022 (52.0%). However, in 2022 compared with 2017, healthcare professionals reported (a) fewer patients would benefit from behaviour change interventions (49.1% versus 55.9%), (b) they delivered behaviour change interventions to a lower proportion of patients (38.0% versus 50.0%), and (c) they spent a lower proportion of the consultation time delivering interventions (26.5% versus 35.3%). Further, in 2022, compared with 2017, healthcare professionals reported fewer physical opportunities, fewer social opportunities, and fewer psychological capabilities to deliver behaviour change interventions. In the 2022 survey, perceptions of patient benefit and delivery of interventions was associated with greater perceptions of opportunities and motivations. CONCLUSIONS Health behaviour change interventions remain an important part of routine healthcare in the continued recovery from COVID-19 public health emergency, however reported engagement with MECC-related practices appears to have reduced over time. Future research should consider how healthcare professionals identify patients who might benefit from opportunistic behaviour change interventions, and to increase capabilities, opportunities, and motivations to deliver interventions during routine consultations.
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Affiliation(s)
- Chris Keyworth
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK.
| | - Mark Conner
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, Manchester, UK
| | - Katharina S Vogt
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9PL, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, M13 9PL, Manchester, UK
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Maxwell-Smith C, Breare H, Dominguez Garcia A, Sim TF, Blackford K, Chih HJ, Jancey J, Mullan BA. Pharmacists' perceptions and delivery of health behaviour change recommendations: Mapping the COM-B model. Res Social Adm Pharm 2024; 20:115-123. [PMID: 37926620 DOI: 10.1016/j.sapharm.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Pharmacists are trusted and accessible healthcare professionals who are well-positioned to deliver brief health behaviour change technique-based interventions for chronic health conditions. However, little is known about the factors influencing pharmacists' use of behaviour change techniques and their capacity to deliver these interventions within community pharmacy. OBJECTIVES This study employed the COM-B model to explore the factors that explain pharmacists' delivery of behaviour change techniques in practice. A secondary objective was to ascertain whether capability, opportunity, and motivation are associated with and explain significant variance in the use of behaviour change techniques during patient interactions. METHODS Two-hundred and eleven Australian pharmacists (mean age = 36.1, SD = 10.7) completed a survey on their capability, opportunity, and motivation to deliver behaviour change techniques, and their delivery and frequency of use in practice. RESULTS Most pharmacists (91.3%) use behaviour change techniques during patient interactions. Results from a simple linear regression showed that a composite COM score was associated with pharmacists' behaviour change technique use F(1,195) = 47.12, β = 0.44, 95 % CI [0.09, 0.16], p < .001, and their frequency of use (F(1,198) = 44.19, β = 0.43, 95 % CI [0.02, 0.06], p < .001). While capability, opportunity, and motivation were individually associated with the range and frequency of behaviour change technique used, motivation was the only significant variable in the composite model for range (β = 0.35, 95 % CI [0.11, 0.41], p < .001) and frequency of behaviour change technique use (β = 0.22, 95 % CI [0.01, 0.09], p < .05). CONCLUSIONS Pharmacist motivation was the most important construct explaining behaviour change technique use. Interventions should seek to foster pharmacist motivation and may benefit from adopting COM-B as a behaviour change framework, to understand the factors influencing the delivery of behaviour change interventions.
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Affiliation(s)
- Chloe Maxwell-Smith
- Behavioural Science and Health Research Group, Curtin University, Bentley, Western Australia, Australia; School of Population Health, Curtin University, Bentley, Western Australia, Australia; EnAble Institute, Curtin University, Bentley, Western Australia, Australia.
| | - Hayley Breare
- Behavioural Science and Health Research Group, Curtin University, Bentley, Western Australia, Australia; School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Alejandro Dominguez Garcia
- Behavioural Science and Health Research Group, Curtin University, Bentley, Western Australia, Australia; School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Tin Fei Sim
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia; Pharmaceutical Society of Australia, Australia
| | - Krysten Blackford
- School of Population Health, Curtin University, Bentley, Western Australia, Australia; Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Hui Jun Chih
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Jonine Jancey
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Barbara A Mullan
- Behavioural Science and Health Research Group, Curtin University, Bentley, Western Australia, Australia; School of Population Health, Curtin University, Bentley, Western Australia, Australia; EnAble Institute, Curtin University, Bentley, Western Australia, Australia
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Breare H, Mullan B, Kerr DA, Maxwell-Smith C. Training Australian Dietitians in Behavior Change Techniques Through Educational Workshops: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49723. [PMID: 38048151 PMCID: PMC10728788 DOI: 10.2196/49723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/20/2023] [Accepted: 09/05/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The use of education alone as a technique to change behavior in interventions is usually insufficient, particularly in health interventions. Behavior change techniques have been shown to be effective in fostering positive changes in health behaviors such as diet and physical activity. The upskilling of health professionals can increase perceived capability and motivation toward eliciting change in clients' behaviors. However, to date, dietitians have received limited training in behavior change and have expressed a need for continuous professional development. OBJECTIVE The study objectives are to (1) develop and evaluate the effectiveness and acceptability of two 2-hour behavior change workshops on changing dietitians behavior (ie, range of behavior change techniques used and frequency of use) across 3 time points; (2) determine if participation in these workshops will elicit changes in dietitians' perceived capability, opportunity, and motivation toward using behavior change techniques; and (3) determine the acceptability of the training and its application in practice by dietitians. METHODS We will recruit registered dietitians (N=140) in Australia to participate in this randomized controlled trial. Participants will be randomly assigned to either the intervention or 3-month waitlist control condition and complete outcome measures at 3 time points: baseline, after the workshop, and follow-up at 3 months. Both groups will complete 2 workshops on behavior change that are guided by the COM-B (Capability, Opportunity, Motivation, and Behavior) Model and embedded with behavior change techniques. The primary outcome is changes in behavior, (ie, the range of behavior change techniques used and their frequency of use). Secondary outcomes include changes in perceived capability, opportunity, motivation, and preparedness as a health professional toward delivering behavior change techniques. The acceptability of the workshops will also be assessed after the workshop through the postworkshop survey and semistructured interviews. A series of 2-way repeated measures ANOVAs and regressions will be used. Qualitative data will be analyzed using thematic analysis. RESULTS Participant recruitment commenced in June 2023. The results of the study are expected to be published in November 2024. The results will allow us to assess comparisons between the intervention and waitlist control groups, as well as changes in perceived capability, opportunity, motivation, and preparedness over a 3-month period. It will also provide an understanding of the acceptability of the training as a form of continuous professional development for dietitians. CONCLUSIONS If found to be effective, the results of this 2-arm randomized controlled trial will guide future training and continuous professional development for health professionals in changing behavior in practice. Our findings will contribute to our understanding of the application of behavior change techniques in practice with clients and identify components of COM-B where dietitians may need future support. TRIAL REGISTRATION ACTRN12623000525684; https://www.anzctr.org.au/ACTRN12623000525684.aspx. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/49723.
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Affiliation(s)
- Hayley Breare
- School of Population Health, Curtin University, Bentley, Australia
- Behavioural Science and Health Research Group, Curtin University, Bentley, Australia
| | - Barbara Mullan
- School of Population Health, Curtin University, Bentley, Australia
- Behavioural Science and Health Research Group, Curtin University, Bentley, Australia
| | - Deborah A Kerr
- Behavioural Science and Health Research Group, Curtin University, Bentley, Australia
| | - Chloe Maxwell-Smith
- School of Population Health, Curtin University, Bentley, Australia
- Behavioural Science and Health Research Group, Curtin University, Bentley, Australia
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Turner R, Byrne-Davis L, Michael P, Coupe N, Holtom C, Smith C, Hart J. Experiences of implementing the 'Making Every Contact Count' initiative into a UK integrated care system: an interview study. J Public Health (Oxf) 2023; 45:894-903. [PMID: 37717953 PMCID: PMC10689001 DOI: 10.1093/pubmed/fdad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/20/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND The 'Making Every Contact Count' (MECC) approach is in line with the current National Health Service (NHS) strategy to improve and prevent health conditions in England. Despite its importance and value for preventative healthcare, implementation of MECC varies. The aim of this study was to explore the barriers and facilitators of implementing MECC and MECC training into an integrated care system (ICS). METHODS Remote semi-structured interviews were conducted with staff across an ICS in the North West of England who were involved in implementing and delivering MECC across the region. Data were analysed initially using an inductive thematic analysis approach and then interpreted using the 'Capability, Opportunity, Motivation = Behaviour' (COM-B) model of behaviour change. RESULTS We interviewed nine stakeholders and identified three superordinate themes: (1) macro-level barriers and facilitators, e.g. funding; (2) organizational level barriers and facilitators, e.g. time and resource; and (3) individual-level barriers/facilitators for both MECC trainers and MECC agents. CONCLUSIONS MECC has potential to meet the needs of the public's health, but barriers to its implementation exist. MECC must be successfully embedded into organizations and regions in which it is implemented, which relies on further development of an appropriate infrastructure including sustainable funding and a shift in culture to value preventative healthcare.
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Affiliation(s)
- Rebecca Turner
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, UK
| | - Lucie Byrne-Davis
- Division of Medical Education, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PLG, UK
| | - Panayiotis Michael
- Division of Medical Education, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PLG, UK
| | - Nia Coupe
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, UK
| | - Caroline Holtom
- Public Health North West, NHS England, North West, London L3 4BL, UK
| | - Cheryl Smith
- Public Health, Lancashire County Council, Lancashire L39 2DF, UK
| | - Jo Hart
- Division of Medical Education, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PLG, UK
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Alsop T, Lehman E, Brauer S, Forbes R, Hanson CL, Healy G, Milton K, Reid H, Rosbergen I, Gomersall S. What should all health professionals know about movement behaviour change? An international Delphi-based consensus statement. Br J Sports Med 2023; 57:1419-1427. [PMID: 37793699 DOI: 10.1136/bjsports-2023-106870] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
The WHO has called for action to integrate physical activity promotion into healthcare settings, yet there is a lack of consensus on the competencies required by health professionals to deliver effective movement behaviour change support. The objective of this study was to establish key competencies relevant for all health professionals to support individuals to change their movement behaviours. Consensus was obtained using a three-phase Delphi process. Participants with expertise in physical activity and sedentary behaviour were asked to report what knowledge, skills and attributes they believed health professionals should possess in relation to movement behaviour change. Proposed competencies were developed and rated for importance. Participants were asked to indicate agreement for inclusion, with consensus defined as group level agreement of at least 80%. Participants from 11 countries, working in academic (55%), clinical (30%) or combined academic/clinical (13%) roles reached consensus on 11 competencies across 3 rounds (n=40, n=36 and n=34, respectively). Some competencies considered specific to certain disciplines did not qualify for inclusion. Participants agreed that health professionals should recognise, take ownership of, and practise interprofessional collaboration in supporting movement behaviour change; support positive culture around these behaviours; communicate using person-centred approaches that consider determinants, barriers and facilitators of movement behaviours; explain the health impacts of these behaviours; and recognise how their own behaviour influences movement behaviour change support. This consensus defines 11 competencies for health professionals, which may serve as a catalyst for building a culture of advocacy for movement behaviour change across health disciplines.
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Affiliation(s)
- Tahlia Alsop
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Emily Lehman
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Sandra Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Roma Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Genevieve Healy
- School of Human Movement and Nutrition Sciences, Health and Wellbeing Centre for Research and Innovation, The University of Queensland, St Lucia, Queensland, Australia
| | - Karen Milton
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Hamish Reid
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Ingrid Rosbergen
- Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Sjaan Gomersall
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- School of Human Movement and Nutrition Sciences, Health and Wellbeing Centre for Research and Innovation, The University of Queensland, St Lucia, Queensland, Australia
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12
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Parchment A, Lawrence W, Rahman E, Townsend N, Wainwright E, Wainwright D. 'Making every contact count' with patients with musculoskeletal conditions: a qualitative exploration of acceptability to physiotherapists. BMC Health Serv Res 2023; 23:1125. [PMID: 37858090 PMCID: PMC10588214 DOI: 10.1186/s12913-023-10126-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
AIM To qualitatively explore physiotherapists' experiences and acceptability of implementing 'Making Every Contact Count Healthy Conversation Skills' (MECC HCS) in routine practice with patients with musculoskeletal (MSK) conditions. METHODS This article reports the second phase of a mixed method, sequential explanatory study. Physiotherapists trained in and delivering MECC HCS in their practice were invited to take part in semi-structured interviews. We hoped to develop a rich, in-depth understanding of their use and perceptions of the brief intervention and to contextualise findings from the first phase of the study. Qualitative data were analysed using Reflexive Thematic Analysis. RESULTS Physiotherapists valued MECC HCS as being integral to their practice, promoting a person-centred approach to supporting behaviour change and enhancing self-management in patients with MSK conditions and pain. It was believed that this brief intervention could reduce workload pressure for physiotherapists and have significant wider benefits for health services. Time limitations associated with appointments did, however, pose as a challenge to MECC HCS delivery, and it was felt that more organisational-level support was needed to sustain it. CONCLUSIONS These findings support our quantitative data, collected in the first phase of this study. MECC HCS is a highly acceptable brief intervention that can be delivered in physiotherapy care to support behaviour change in patients with MSK conditions. Future roll-out may be optimised within organisations by providing regular refresher training and adopting a MECC champion.
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Affiliation(s)
- Amelia Parchment
- Department for Health, University of Bath, Bath, BA2 7AY, England, UK.
- NIHR Applied Research Collaboration- Greater Manchester, University of Manchester, Manchester, M13 9PL, England.
| | - Wendy Lawrence
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, England, UK
| | - Em Rahman
- Public Health Workforce Development, Southern House, Health Education England, Winchester, SO21 2RU, England, UK
| | - Nick Townsend
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, England, UK
| | - Elaine Wainwright
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - David Wainwright
- Department for Health, University of Bath, Bath, BA2 7AY, England, UK
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13
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Mills A. Promoting health through nurse-led healthy conversations. Nurs Stand 2023; 38:46-50. [PMID: 36911971 DOI: 10.7748/ns.2023.e11912] [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] [Accepted: 09/05/2022] [Indexed: 03/14/2023]
Abstract
Nurses in all settings have an important role in preventing non-communicable diseases such as cardiovascular disease, cancer, respiratory disease and diabetes mellitus. They have multiple daily opportunities in their practice to discuss health with people, with the aim of supporting behaviour changes that reduce the risk of non-communicable diseases and the associated health-related and economic challenges. Incorporating the principles of healthy conversations into all daily interactions provides opportunities for nurses collectively to promote health on an individual basis to millions of people. However, many nurses have not received training in such behaviour change interventions. This article explains the principles and potential benefits of healthy conversations, and emphasises the importance of training to promote nurses' knowledge, skills, confidence and motivation to engage in such conversations.
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Affiliation(s)
- Anne Mills
- Department of Medical Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, England
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14
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Liddelow C, Mullan BA, Breare H, Sim TF, Haywood D. A call for action: Educating pharmacists and pharmacy students in behaviour change techniques. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100287. [PMID: 37397030 PMCID: PMC10314283 DOI: 10.1016/j.rcsop.2023.100287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/04/2023] [Accepted: 06/09/2023] [Indexed: 07/04/2023] Open
Abstract
The increasing impact of chronic disease, including cancer and heart disease on mortality signifies a need for the upskilling of health professionals in health behaviour change. Solely providing education and information to patients is generally not sufficient to change behaviour, and for any change to be sustained. The nature of pharmaceutical practice allows pharmacists to have frequent contact with patients in the community. Historically, pharmacists have often effectively engaged with patients to assist with behaviour change initiatives related to smoking cessation, weight loss or medication adherence. Unfortunately, such initiatives do not work for everyone, and more tailored and varied interventions are urgently needed to reduce the effects of chronic disease. In addition, with greater inaccessibility to hospitals and GP's (e.g., appointment wait times), it is imperative that pharmacists are upskilled in providing opportunistic health behaviour change techniques and interventions. Pharmacists need to practice to their full scope consistently and confidently, including the use of behavioural interventions. The following commentary therefore describes and provides recommendations for the upskilling of pharmacists and pharmacy students in opportunistic behaviour change. We outline nine key evidence-based behaviour change techniques, the active-ingredients of a behaviour change intervention, that are relevant to common encounters in professional practice by pharmacists, such as improving adherence to medications/treatments and health promotion initiatives. These include social support (practical and emotional), problem solving, anticipated regret, habit formation, behaviour substitution, restructuring the environment, information about others' approval, pros and cons, and monitoring and providing feedback on behaviour. Recommendations are then provided for how this upskilling can be taught to pharmacists and pharmacy students, as well as how they can use these techniques in their everyday practice.
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Affiliation(s)
- Caitlin Liddelow
- School of Psychology, University of Wollongong, Wollongong, New South Wales, 2500, Australia
| | - Barbara A. Mullan
- enAble Institute, Curtin University, Bentley, Western Australia, 6102, Australia
- Western Australian Cancer Prevention Research Unit, Curtin University, Bentley, Western Australia, 6102, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, 6102, Australia
| | - Hayley Breare
- enAble Institute, Curtin University, Bentley, Western Australia, 6102, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, 6102, Australia
| | - Tin Fei Sim
- School of Pharmacy, Curtin Medical School, Curtin University, Bentley, Western Australia 6102, Australia
| | - Darren Haywood
- St. Vincent's Hospital Melbourne, Mental Health, Fitzroy, Victoria 3065, Australia
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia
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15
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Cornell S, Brander RW, Peden AE. Preventing selfie-related incidents: Taking a public health approach to reduce unnecessary burden on emergency medicine services. Emerg Med Australas 2023; 35:691-693. [PMID: 37454361 DOI: 10.1111/1742-6723.14219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 07/18/2023]
Abstract
Unintentional deaths from selfies have received limited exposure in emergency medicine literature; yet trauma remains the leading cause of death and disability in children and young adults, and most of those implicated in a selfie incident are in this demographic. Selfie-related injuries and deaths may be a relatively new phenomenon, but data suggest they are a public health hazard that is not going away. Emergency medicine practitioners may have a role to play in the primary and secondary prevention of selfie incidents, including delivering opportunistic behaviour change messaging to those who are at risk of being injured or killed in a selfie-related incident, particularly young (14-25 years) males. Emergency medicine specialists should be aware of the dangers of selfie-related incidents and understand their polytraumatic presentation.
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Affiliation(s)
- Samuel Cornell
- Beach Safety Research Group, The University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Robert W Brander
- Beach Safety Research Group, The University of New South Wales, Sydney, New South Wales, Australia
- School of Biological, Earth and Environmental Sciences, The University of New South Wales, Sydney, New South Wales, Australia
| | - Amy E Peden
- Beach Safety Research Group, The University of New South Wales, Sydney, New South Wales, Australia
- School of Biological, Earth and Environmental Sciences, The University of New South Wales, Sydney, New South Wales, Australia
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16
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Asher RC, Clarke ED, Bucher T, Shrewsbury VA, Roberts S, Collins CE. Impact and evaluation of an online culinary nutrition course for health, education and industry professionals to promote vegetable knowledge and consumption. J Hum Nutr Diet 2023; 36:967-980. [PMID: 36321462 PMCID: PMC10947242 DOI: 10.1111/jhn.13109] [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: 06/29/2022] [Accepted: 10/16/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Poor diet, including inadequate vegetable intake, is a leading risk factor for noncommunicable disease. Culinary and nutrition education provided to trainee and practising health and education professionals is an emerging strategy to promote improved dietary intake, including vegetable consumption. We evaluated the impact and feasibility of an online culinary medicine and nutrition (CM/CN) short course for health, education and vegetable industry professionals. The course aimed to improve participants' skills and confidence to prepare vegetables, knowledge of evidence-based nutrition information and recommendations for improving vegetable consumption and diet quality. METHODS A pre-post study consisting of two separate groups participating in two course rounds recruited practising professionals (n = 30) working in health; community, adult and/or culinary education; and the vegetable industry. Evaluation assessed diet quality, vegetable consumption barriers, cooking and food skill confidence, nutrition knowledge and process measures. RESULTS Seventeen participants (68%) completed the programme. Pre- to postintervention statistically significant increases in vegetables (M 1.3, SD 2.2), fruit (M 1.6, SD 3.1), and breads and cereal (M 1.1, SD 1.7) intakes were observed. Statistically significant increases and large effect sizes for mean food skill confidence scores (M 8.9, SD 15.4, Cohen's d 0.56) and nutrition knowledge scores (M 6.2, SD 15.4, Cohen's d 0.83) were also observed pre- to postintervention. CONCLUSIONS The short online course was feasible and improved diet quality, food skill confidence and nutrition knowledge. Online CM/CN education for practising professionals represents a promising area of research. Future research involving a larger study sample and a more rigorous study design such as a randomised control trial is warranted.
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Affiliation(s)
- Roberta C. Asher
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
| | - Erin D. Clarke
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
| | - Tamara Bucher
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
- School of Environmental and Life Sciences, College of EngineeringScience and EnvironmentCallaghanAustralia
| | - Vanessa A. Shrewsbury
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
| | | | - Clare E. Collins
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
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17
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Rodrigues AM, Kemp E, Aquino MRJ, Wilson R, Vasiljevic M, McBride K, Robson C, Loraine M, Harland J, Haighton C. Understanding the implementation of 'Making Every Contact Count' (MECC) delivered by healthcare professionals in a mental health hospital: protocol for a pragmatic formative process evaluation. Health Psychol Behav Med 2023; 11:2174698. [PMID: 36760477 PMCID: PMC9904297 DOI: 10.1080/21642850.2023.2174698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
Background 'Making Every Contact Count' (MECC) is a public health strategy supporting public-facing workers to use opportunities during routine contacts to enable health behaviour change. A mental health hospital in the North East of England is currently implementing a programme to embed MECC across the hospital supporting weight management ('A Weight Off Your Mind'). Bespoke MECC training has been developed to improve staff confidence in discussing physical activity, healthy eating, and related behaviour change with service users. This article describes the protocol for a pragmatic formative process evaluation to inform the implementation plan for MECC and facilitate successful implementation of the bespoke MECC training at scale. Methods/Design An 18-month, mixed method pragmatic formative process evaluation, including qualitative research, surveys, document review and stakeholder engagement. This project is conducted within a mental health inpatient setting in the North East of England. Programme documents will be reviewed, mapped against MECC national guidelines, Behaviour Change Techniques (BCTs) and intervention functions within the Behaviour Change Wheel. A cross-sectional survey (n = 365) and qualitative semi-structured interviews (n = 30) will be conducted with healthcare practitioners delivering MECC to assess capability, opportunity and motivation. Data collection and fidelity procedures will be examined, including design, training and delivery dimensions of fidelity. Interviews with service users (n = 20) will also be conducted. Discussion Anticipated outcomes include developing recommendations to overcome barriers to delivery of and access to MECC, including whether to either support the use of the existing MECC protocol or tailor the MECC training programme. The findings are anticipated to improve fidelity of MECC training within mental health inpatient settings as well as provide evidence for MECC training at a national level. We also expect findings to influence strategic plans, policy, and practice specific to MECC and inform best practice in implementing wider brief intervention programmes.
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Affiliation(s)
- Angela M. Rodrigues
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
- Fuse – Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Emma Kemp
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | | | - Rob Wilson
- Newcastle Business School, Northumbria University, Newcastle-upon-Tyne, UK
| | - Milica Vasiljevic
- Fuse – Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Department of Psychology, Durham University, Durham, UK
| | - Kate McBride
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, UK
| | - Craig Robson
- Northumbria Healthcare NHS Foundation TrustNorth Tyneside General Hospital, North Shields, UK
| | | | - Jill Harland
- Northumbria Healthcare NHS Foundation TrustNorth Tyneside General Hospital, North Shields, UK
| | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
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18
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Asher RC, Bucher T, Shrewsbury VA, Clarke ED, Herbert J, Roberts S, Meeder A, Collins CE. Facilitators and barriers to providing culinary nutrition, culinary medicine and behaviour change support: An online cross-sectional survey of Australian health and education professionals. J Hum Nutr Diet 2023; 36:252-265. [PMID: 35651300 PMCID: PMC10084112 DOI: 10.1111/jhn.13044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/04/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND An Australia wide cross-sectional online survey examined facilitators and barriers of health and education professionals to providing culinary nutrition (CN) and culinary medicine (CM) education and behaviour change support in usual practice, in addition to identifying continuing professional development (CPD) needs in this domain. METHODS Survey items included socio-demographic characteristics, cooking and food skills confidence, nutrition knowledge (PKB-7), fruit and vegetable intake (FAVVA) and CPD needs. Data were summarised descriptively. RESULTS Of 277 participants, 65% were likely/somewhat likely to participate in CN CPD. Mean (SD) cooking and food skill confidence scores were 73 (17.5) and 107.2 (24), out of 98 and 147, respectively. Mean PKB-7 score was 3.7 (1.4), out of 7. Mean FAVVA score was 98 (29), out of 190. CONCLUSIONS Gaps in knowledge and limited time were the greatest modifiable barriers to providing CM/CN education and behaviour change support in practice. Health and education professionals are interested in CPD conducted by dietitians and culinary professionals to enhance their knowledge of CM/CN and behaviour change support.
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Affiliation(s)
- Roberta C Asher
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia
| | - Tamara Bucher
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,School of Environmental and Life Sciences, College of Engineering, Science and Environment, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
| | - Vanessa A Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
| | - Erin D Clarke
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
| | - Jaimee Herbert
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia
| | - Steven Roberts
- Rijk Zwaan Australia Pty. Ltd., Daylesford, VIC, Australia
| | - Annette Meeder
- Rijk Zwaan Zaadteelt en Zaadhandel B.V., De Lier, The Netherlands
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
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19
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Haywood D, Mullan BA, Liddelow C, Rossell S, Castle D. A call for the increased education and use of behaviour change techniques in mental health services. Gen Hosp Psychiatry 2023; 80:64-65. [PMID: 36404164 DOI: 10.1016/j.genhosppsych.2022.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Darren Haywood
- Department of Mental Health, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia; School of Population Health, Curtin University, Perth, Australia.
| | - Barbara A Mullan
- School of Population Health, Curtin University, Perth, Australia; EnAble Institute, Curtin University, Perth, Australia
| | - Caitlin Liddelow
- Global Alliance for Mental Health and Sport, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Susan Rossell
- Department of Mental Health, St Vincent's Hospital Melbourne, Melbourne, Australia; Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - David Castle
- Department of Psychiatry, University of Toronto, Toronto, Canada
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20
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McCloskey AP, Lunn A, Traynor MJ, Lim EJ, Tse Y, McCabe PG, Mistry RD, Vasey N, Pickering A, Rathbone AP. KidzMed e-learning to upskill student pharmacists to teach pill swallowing to children. PLoS One 2023; 18:e0282070. [PMID: 36928840 PMCID: PMC10019696 DOI: 10.1371/journal.pone.0282070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/07/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Appropriate medication use is essential in ensuring optimal pharmacotherapeutic outcomes. It is mistakenly assumed that adults can swallow solid oral dosage forms (SODFs, e.g. tablets/capsules colloquially referred to as 'pills'), without difficulty and that children cannot. KidzMed is a 'pill swallowing' training programme designed to teach effective SODF use in patients of all ages. It may be utilised by healthcare professionals to assist patients taking SODFs. E-learning was essential for training during COVID pandemic to reduce viral transmission. The aim of this study was to explore UK student pharmacists views of e-learning to support swallowing solid oral dosage forms. METHODS This study used pre- and post-intervention online surveys on Microsoft Forms to evaluate self-directed eLearning about pill swallowing on MPharm programmes at three UK Universities using a 13-item survey. A combination of five-point Likert Scales and free-text items were used. The eLearning was available via the virtual learning environment at the University and embedded within existing curriculum. Descriptive statistical analysis was used to explore responses. RESULTS In total, 113 of 340 (33%) students completed the survey. Seventy-eight percent (n = 65) reported the eLearning would enable them to teach adults and children to swallow SODFs successfully. Learners either agreed or strongly agreed that they felt comfortable to teach patients (95%, n = 62/113) and parents or carers (94%, n = 60) to swallow medications having completed the e-learning. Student pharmacists generally found eLearning as an acceptable way to reflect on their own experiences of 'pill' swallowing and how to support patients to swallow SODFs. CONCLUSION The KidzMed eLearning was well received by student pharmacists. Further work is needed to explore whether skills translates into real life application in the clinical settings.
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Affiliation(s)
- Alice P. McCloskey
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- * E-mail:
| | - Andrew Lunn
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, United Kingdom
| | - Michael J. Traynor
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Emma J. Lim
- The Great North Children’s Hospital, Newcastle-upon-Tyne, United Kingdom
- Institute of Health and Society Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Yincent Tse
- The Great North Children’s Hospital, Newcastle-upon-Tyne, United Kingdom
- Newcastle University Medical School, Newcastle-upon-Tyne, United Kingdom
| | - Philippa G. McCabe
- School of Computer Science and Mathematics Liverpool John Moores University, Liverpool, United Kingdom
| | - Ravi D. Mistry
- The Great North Children’s Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Nicola Vasey
- The Great North Children’s Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Ailsa Pickering
- The Great North Children’s Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Adam P. Rathbone
- Newcastle University School of Pharmacy, Newcastle-upon-Tyne, United Kingdom
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JM S, K P, S W, H C, AS A, H C, J C, RJ C, J G, J H, RJQ M, C W. The experiences and perceptions of female breast cancer patients regarding weight management during and after treatment for oestrogen-receptor positive disease: a qualitative study. BMC Cancer 2022; 22:1189. [DOI: 10.1186/s12885-022-10238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Weight gain is commonly observed during and after breast cancer treatment and is associated with poorer survival outcomes, notably in women with oestrogen-receptor positive disease. The aim of this qualitative study was to investigate the experiences and perceptions of oestrogen-receptor positive (ER +) female breast cancer patients (BCPs) regarding weight management behaviours during and after treatment. Secondly, to gain insight into the experiences of healthcare professionals (HCPs) regarding the provision of weight management advice to patients undergoing treatment.
Methods
Four focus groups involving 16 BCPs having a median (range) age of 51 (35–70 y) and three focus groups involving 21 HCPs aged 46 (29–62) were held at a university campus, local cancer support centre or clinical site. Data were analysed using Framework analysis.
Results
Four overarching themes (and 10 subthemes) were identified: (1) Treatment; (2) Support for lifestyle behaviour change; (3) Information availability for BCPs; (4) Knowledge of current evidence amongst HCPs. The physical and psychological consequences of treatment influenced motivation for weight management amongst BCPs. Social support for health promoting behaviours was viewed as important but was conflicting, requiring context-specific considerations. BCPs said they would have welcomed access to credible information (guided by HCPs) about the potential detrimental health effects of excess body weight and weight gain, together with advice on weight management via healthy eating and physical activity. HCPs felt that they had insufficient knowledge of public health dietary and physical activity recommendations or evidence-based interventions to confidently offer such advice. HCPs expressed concern that raising weight management issues would exacerbate distress or invoke feelings of guilt amongst BCPs, and cited time pressures on patient consultations as additional barriers to providing weight management support.
Conclusion
The study yielded novel insights into factors influencing weight management behaviours amongst overweight ER + BCPs. The results suggest that evidence-based information and support, which addresses key physical and psychological challenges to physical activity and dietary behaviours, offers the best route to sustainable weight management in this population.
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Mullan B, Liddelow C, Haywood D, Breare H. Behavior Change Training for Health Professionals: Evaluation of a 2-Hour Workshop. JMIR Form Res 2022; 6:e42010. [DOI: 10.2196/42010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Rates of noncommunicable diseases continue to rise worldwide. Many of these diseases are a result of engaging in risk behaviors. Without lifestyle and behavioral intervention, noncommunicable diseases can worsen and develop into more debilitating diseases. Behavioral interventions are an effective strategy to reduce the burden of disease. Behavior change techniques can be described as the “active ingredients” in behavior change and address the components that need to be altered in order for the target behavior to change. Health professionals, such as pharmacists and nurses, can engage in opportunistic behavior change with their patients, to encourage positive health behaviors.
Objective
We aimed to develop, implement, and evaluate a behavior change workshop targeted at health professionals in Australia, with the goal of increasing knowledge of behavior change techniques and psychological variables.
Methods
A prospective study design was used to develop and evaluate a 2-hour behavior change workshop targeted at health professionals. The workshop was developed based on the Capability, Opportunity, Motivation, and Behavior Model and had five core objectives: (1) to detail the role of health professionals in delivering optimal care, (2) to demonstrate opportunities to change behavior, (3) to describe principles of behavior change, (4) to explain behavior change techniques, and (5) to determine the most appropriate behavior change techniques to use and when to use them. A total of 10 workshops were conducted. To evaluate the workshops and identify any potential long-term changes in behavior, we collected pre- and postworkshop data on knowledge and psychological constructs from the attendees.
Results
A final sample of 41 health professionals comprising general practitioners, nurses, and pharmacists completed the pre- and postworkshop surveys. Following the workshops, there were significant improvements in knowledge of behavior change techniques (t40=–5.27, P<.001), subjective norms (t40=–3.49, P=.001), descriptive norms (t40=–3.65, P<.001), perceived behavioral control (t40=–3.30, P=.002), and intention (t36=–3.32, P=.002); each had a large effect size. There was no significant difference in postworkshop attitude (t40=0.78, P=.44). The participants also found the workshops to be highly acceptable.
Conclusions
A 2-hour, theoretically informed workshop designed to facilitate the use of behavior change techniques by health professionals was shown to be largely effective. The workshops resulted in increases in knowledge, descriptive and subjective norms, perceived behavioral control, and intention, but not in attitude. The intervention was also shown to be highly acceptable, with the large majority of participants deeming the intervention to be needed, useful, appropriate, and applicable, as well as interesting and worth their time. Future research should examine the lasting impacts of the workshop on health professionals’ practices.
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Leather JZ, Keyworth C, Kapur N, Campbell SM, Armitage CJ. Examining drivers of self-harm guideline implementation by general practitioners: A qualitative analysis using the theoretical domains framework. Br J Health Psychol 2022; 27:1275-1295. [PMID: 35416355 PMCID: PMC9790562 DOI: 10.1111/bjhp.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/29/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study aimed to (1) examine barriers and enablers to General Practitioners' (GP) use of National Institute for Health and Care Excellence (NICE) guidelines for self-harm and (2) recommend potential intervention strategies to improve implementation of them in primary care. DESIGN Qualitative interview study. METHODS Twenty-one telephone interviews, semi-structured around the capabilities, opportunities and motivations model of behaviour change (COM-B), were conducted with GPs in the United Kingdom. The Theoretical Domains Framework was employed as an analytical framework. Using the Behaviour Change Wheel, Behaviour Change Techniques (BCTs), intervention functions and exemplar interventions were identified. RESULTS GPs valued additional knowledge about self-harm risk assessments (knowledge), and communication skills were considered to be fundamental to high-pressure consultations (cognitive and interpersonal skills). GPs did not engage with the guidelines due to concerns that they would be a distraction from patient cues about risk during consultations (memory, attention and decision processes), and perceptions that following the guidance is difficult due to time pressures and lack of access to mental health referrals (environmental context and resources). Clinical uncertainty surrounding longer term care for people that self-harm, particularly patients that are waiting for or cannot access a referral, drives GPs to rely on their professional judgement over the guidance (beliefs about capabilities). CONCLUSIONS Three key drivers related to information and skill needs, guideline engagement and clinical uncertainty need to be addressed to support GPs to be able to assess and manage self-harm. Five intervention functions and ten BCT groups were identified as potential avenues for intervention design.
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Affiliation(s)
- Jessica Z. Leather
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Manchester Centre for Health PsychologyDivision of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK
| | | | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Centre for Mental Health and SafetyUniversity of ManchesterManchester Academic Health Science CentreManchesterUK,Greater Manchester Mental Health NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Stephen M. Campbell
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Centre for Primary Care and Health Services ResearchSchool of Health SciencesUniversity of ManchesterManchesterUK
| | - Christopher J. Armitage
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchester Academic Health Science CentreManchesterUK,Manchester Centre for Health PsychologyDivision of Psychology and Mental HealthSchool of Health SciencesUniversity of ManchesterManchesterUK,Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK,NIHR Manchester Biomedical Research CentreManchester University NHS Foundation TrustManchester Academic Health Science CentreThe Nowgen CentreManchesterUK
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Reid H, Smith R, Williamson W, Baldock J, Caterson J, Kluzek S, Jones N, Copeland R. Use of the behaviour change wheel to improve everyday person-centred conversations on physical activity across healthcare. BMC Public Health 2022; 22:1784. [PMID: 36127688 PMCID: PMC9487060 DOI: 10.1186/s12889-022-14178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/09/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An implementation gap exists between the evidence supporting physical activity in the prevention and management of long-term medical conditions and clinical practice. Person-centred conversations, i.e. focussing on the values, preferences and aspirations of each individual, are required from healthcare professionals. However, many currently lack the capability, opportunity, and motivation to have these conversations. This study uses the Behaviour Change Wheel (BCW) to inform the development of practical and educational resources to help bridge this gap. METHODS The BCW provides a theoretical approach to enable the systematic development of behaviour change interventions. Authors followed the described eight-step process, considered results from a scoping review, consulted clinical working groups, tested and developed ideas across clinical pathways, and agreed on solutions to each stage by consensus. RESULTS The behavioural diagnosis identified healthcare professionals' initiation of person-centred conversations on physical activity at all appropriate opportunities in routine medical care as a suitable primary target for interventions. Six intervention functions and five policy categories met the APEASE criteria. We mapped 17 Behavioural Change Techniques onto BCW intervention functions to define intervention strategies. CONCLUSIONS This study uses the BCW to outline a coherent approach for intervention development to improve healthcare professionals' frequency and quality of conversations on physical activity across clinical practice. Time-sensitive and role-specific resources might help healthcare professionals understand the focus of their intervention. Educational resources aimed at healthcare professionals and patients could have mutual benefit, should fit into existing care pathways and support professional development. A trusted information source with single-point access via the internet is likely to improve accessibility. Future evaluation of resources built and coded using this framework is required to establish the effectiveness of this approach and help improve understanding of what works to change conversations around physical activity in clinical practice.
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Affiliation(s)
- Hamish Reid
- Moving Medicine, Faculty of Sport and Exercise Medicine, 6 Hill Square, Edinburgh, UK
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Ralph Smith
- Oxford University Hospital NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Wilby Williamson
- School of Medicine, Trinity College Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - James Baldock
- Oxford University Hospital NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Jessica Caterson
- Imperial College Healthcare NHS Trust, Praed Street, London, GB W2 1NY UK
| | - Stefan Kluzek
- School of Medicine, University of Nottingham, Medical School, Nottingham, NG7 2UH UK
| | - Natasha Jones
- Moving Medicine, Faculty of Sport and Exercise Medicine, 6 Hill Square, Edinburgh, UK
- Oxford University Hospital NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
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Harrison D, Wilson R, Graham A, Brown K, Hesselgreaves H, Ciesielska M. Making every contact count with seldom-heard groups? A qualitative evaluation of voluntary and community sector (VCS) implementation of a public health behaviour change programme in England. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3193-e3206. [PMID: 35218264 PMCID: PMC9544506 DOI: 10.1111/hsc.13764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/19/2021] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
Making Every Contact Count (MECC) is a national, long-term public health strategy in England. It supports public-facing workers to use opportunities during routine contacts to enable healthy lifestyle changes. This paper reports the findings from an external evaluation of voluntary and community sector (VCS) delivery of MECC in the North East of England, which focused on engaging under-represented client groups. The study aimed to (a) Establish if (and how) MECC had impacted the workforce, including changes to staff knowledge, confidence and behaviour; (b) Identify benefits, challenges and unintended consequences; and (c) Explore outcomes for service users. A multi-stage qualitative design focused on understanding both process and outcomes. The study utilised three data collection methods, including a journey mapping workshop (n = 20), semi-structured interviews with delivery leads, VCS workers and volunteers who had accessed MECC training (n = 11), and focus group discussions with clients (n = 22). The findings illustrated positive early outcomes, including improvements in self-reported staff knowledge and confidence as well as emerging examples of organisational culture shift and individual behaviour change. Alongside this, the data provided a rich picture of barriers and challenges which are examined at different levels-national programme, local programme, VCS sector, partner organisation, worker and client. The research highlights clear successes of the VCS delivery model. However, it is presented as a 'double-edged sword,' in light of associated challenges such as sector-level funding uncertainty and accessibility of MECC resources to diverse client groups. The discussion considers issues related to the measurement and attribution of behaviour change outcomes for brief interventions, as well as fidelity, legacy and long-term sustainability challenges. The recommendations call for system-level analysis and comparison of different MECC implementation models, to improve our understanding of challenges, opportunities and programme reach for behaviour change intervention programmes-particularly in relation to seldom-heard client groups.
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Affiliation(s)
- Deborah Harrison
- Newcastle Business SchoolNorthumbria UniversityNewcastle‐upon‐TyneUK
| | - Rob Wilson
- Newcastle Business SchoolNorthumbria UniversityNewcastle‐upon‐TyneUK
| | - Andy Graham
- Public Health ConsultantLocal GovernmentNorth East EnglandUK
| | - Kristina Brown
- Newcastle Business SchoolNorthumbria UniversityNewcastle‐upon‐TyneUK
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Khadjesari Z, Brown TJ, Ramsey AT, Goodfellow H, El-Toukhy S, Abroms LC, Jopling H, Dierker Viik A, Amato MS. Novel Implementation Strategy to Electronically Screen and Signpost Patients to Health Behavior Apps: Mixed Methods Implementation Study (OptiMine Study). JMIR Form Res 2022; 6:e34271. [PMID: 35816374 PMCID: PMC9315888 DOI: 10.2196/34271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/12/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Behavior change apps have the potential to provide individual support on a population scale at low cost, but they face numerous barriers to implementation. Electronic health records (EHRs) in acute care hospitals provide a valuable resource for identifying patients at risk, who may benefit from behavior change apps. A novel, emerging implementation strategy is to use digital technologies not only for providing support to help-seeking individuals but also for signposting patients at risk to support services (also called proactive referral in the United States). OBJECTIVE The OptiMine study aimed to increase the reach of behavior change apps by implementing electronic signposting for smoking cessation and alcohol reduction in a large, at-risk population that was identified through an acute care hospital EHR. METHODS This 3-phase, mixed methods implementation study assessed the acceptability, feasibility, and reach of electronic signposting to behavior change apps by using a hospital's EHR system to identify patients who are at risk. Phase 1 explored the acceptability of the implementation strategy among the patients and staff through focus groups. Phase 2 investigated the feasibility of using the hospital EHR to identify patients with target risk behaviors and contact them via SMS text message, email, or patient portal. Phase 3 assessed the impact of SMS text messages sent to patients who were identified as smokers or risky drinkers, which signposted them to behavior change apps. The primary outcome was the proportion of participants who clicked on the embedded link in the SMS text message to access information about the apps. The acceptability of the SMS text messages among the patients who had received them was also explored in a web-based survey. RESULTS Our electronic signposting strategy-using SMS text messages to promote health behavior change apps to patients at risk-was found to be acceptable and feasible and had good reach. The hospital sent 1526 SMS text messages, signposting patients to either the National Health Service Smokefree or Drink Free Days apps. A total of 13.56% (207/1526) of the patients clicked on the embedded link to the apps, which exceeded our 5% a priori success criterion. Patients and staff contributed to the SMS text message content and delivery approach, which were perceived as acceptable before and after the delivery of the SMS text messages. The feasibility of the SMS text message format was determined and the target population was identified by mining the EHR. CONCLUSIONS The OptiMine study demonstrated the proof of concept for this novel implementation strategy, which used SMS text messages to signpost at-risk individuals to behavior change apps at scale. The level of reach exceeded our a priori success criterion in a non-help-seeking population of patients receiving unsolicited SMS text messages, disconnected from hospital visits. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/23669.
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Affiliation(s)
- Zarnie Khadjesari
- Behavioural and Implementation Science Research Group, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Tracey J Brown
- Behavioural and Implementation Science Research Group, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Henry Goodfellow
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Sherine El-Toukhy
- Division of Intramural Research, The National Institute on Minority Health and Health Disparities, The National Institutes of Health, Bethesda, MD, United States
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington DC, DC, United States
| | - Helena Jopling
- Department of Public Health, West Suffolk NHS Foundation Trust, Bury St Edmunds, United Kingdom
| | - Arden Dierker Viik
- Department of Public Health, West Suffolk NHS Foundation Trust, Bury St Edmunds, United Kingdom
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Parchment A, Lawrence W, Rahman E, Townsend N, Wainwright E, Wainwright D. How useful is the Making Every Contact Count Healthy Conversation Skills approach for supporting people with musculoskeletal conditions? J Public Health (Oxf) 2022; 30:2389-2405. [PMID: 35530417 PMCID: PMC9067897 DOI: 10.1007/s10389-022-01718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/16/2022] [Indexed: 11/29/2022] Open
Abstract
Aim To explore the current use and perceptions of the Wessex model of Making Every Contact Count (MECC), incorporating Healthy Conversation Skills (HCS), focussing specifically on physiotherapists supporting people living with musculoskeletal conditions. Methods A mixed method, sequential explanatory design was employed. This article reports the first phase of the study, in which an online questionnaire was administered, consisting of items relating to perceived acceptability, appropriateness, feasibility, sustainability, and uptake of MECC HCS. Barriers and facilitators to MECC HCS delivery were additionally explored and mapped to the Theoretical Domains Framework. Results Seventy-one professionals responded, including 15 physiotherapists supporting people with MSK conditions. Across professional groups, MECC HCS was found to be highly acceptable, appropriate, and feasible. A significant interaction between perceived sustainability of MECC HCS and the location in which professionals worked was observed. Physiotherapists reported using their MECC HCS at least daily; however, there were discrepancies between the number of their patients they believed could benefit from behaviour change intervention, and the number to whom they reported actually delivering MECC HCS. Perceived barriers and facilitators to MECC HCS implementation mapped mostly to ‘Environmental Context and Resources’ on the Theoretical Domains Framework. Conclusions The Wessex model of MECC is a promising brief or very brief intervention for physiotherapists supporting individuals with musculoskeletal conditions. Barriers associated with the sustainability of the intervention within organisations must be addressed in order to enhance future implementation. Further rollout of this intervention may be beneficial for meeting the goals of the NHS and Public Health England in prevention of chronic MSK conditions and promotion of musculoskeletal health.
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Affiliation(s)
- Amelia Parchment
- Department for Health, University of Bath, Bath, England BA2 7AY UK
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, England SO16 6YD UK
| | - Em Rahman
- Public Health Workforce Development, Southern House, Health Education England, Winchester, England SO21 2RU UK
| | - Nick Townsend
- Department for Health, University of Bath, Bath, England BA2 7AY UK
| | - Elaine Wainwright
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - David Wainwright
- Department for Health, University of Bath, Bath, England BA2 7AY UK
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Whittaker EM, Levy AR, Matata B, Kinnafick FE, Midgley AW. Using Behavior Change Interventions in Cardiac and Pulmonary Rehabilitation: Perspectives from Healthcare Professionals in the United Kingdom. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041980. [PMID: 35206176 PMCID: PMC8872220 DOI: 10.3390/ijerph19041980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 02/01/2023]
Abstract
This study explores healthcare professionals’ experiences of using behavior change interventions in clinical practice. Semi-structured qualitative interviews were conducted with 11 healthcare professionals working in a cardiac and pulmonary rehabilitation National Health Service Trust in the United Kingdom. Interviews were transcribed and analyzed using inductive thematic analysis. Four overarching themes representing healthcare practitioners’ perceptions of using behavior change interventions were identified: (1) reliance on experiential learning, (2) knowledge transition, (3) existing professional development programs, and (4) barriers and facilitators for continued professional development. The results are discussed in relation to the implications they may have for behavior change training in clinical healthcare practice. Healthcare professionals require bespoke and formalized training to optimize their delivery of behavior change interventions in cardiac and pulmonary rehabilitation. Doing so will enhance intervention fidelity and implementation that can potentially ameliorate patient rehabilitation outcomes.
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Affiliation(s)
- Eleanor M. Whittaker
- Department of Psychology, Edge Hill University, Lancashire L39 4QP, UK;
- Health Research Institute, Edge Hill University, Lancashire L39 4QP, UK;
| | - Andrew R. Levy
- Department of Psychology, Edge Hill University, Lancashire L39 4QP, UK;
- Health Research Institute, Edge Hill University, Lancashire L39 4QP, UK;
- Correspondence:
| | - Bashir Matata
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool L14 3PE, UK;
| | - Florence E. Kinnafick
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK;
| | - Adrian W. Midgley
- Health Research Institute, Edge Hill University, Lancashire L39 4QP, UK;
- Department of Sport and Physical Activity, Edge Hill University, Lancashire L39 4QP, UK
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Meade O, O'Brien M, Mc Sharry J, Lawless A, Coughlan S, Hart J, Hayes C, Keyworth C, Lavoie KL, Murphy AW, Murphy P, Noone C, O'Reilly O, Byrne M. Enhancing the implementation of the Making Every Contact Count brief behavioural intervention programme in Ireland: protocol for the Making MECC Work research programme. HRB Open Res 2022; 5:6. [PMID: 35224443 PMCID: PMC8847722 DOI: 10.12688/hrbopenres.13481.1] [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] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Brief behavioural interventions offered by healthcare professionals to target health behavioural risk factors (e.g. physical activity, diet, smoking and drug and alcohol use) can positively impact patient health outcomes. The Irish Health Service Executive (HSE) Making Every Contact Count (MECC) Programme supports healthcare professionals to offer patients brief opportunistic behavioural interventions during routine consultations. The potential for MECC to impact public health depends on its uptake and implementation. Aim: This protocol outlines the 'Making MECC Work' research programme, a HSE/Health Behaviour Change Research Group collaboration to develop an implementation strategy to optimise uptake of MECC in Ireland. The programme will answer three research questions: (1) What determines delivery of MECC brief interventions by healthcare professionals at individual and organisational levels? (2) What are patient attitudes towards, and experiences of, receiving MECC interventions from healthcare professionals? (3) What evidence-informed implementation strategy options can be consensually developed with key stakeholders to optimise MECC implementation? Methods: In Work Package 1, we will examine determinants of MECC delivery by healthcare professionals using a multi-methods approach, including: (WP1.1) a national survey of healthcare professionals who have participated in MECC eLearning training and (WP1.2) a qualitative interview study with relevant healthcare professionals and HSE staff. In Work Package 2, we will examine patient attitudes towards, and experiences of, MECC using qualitative interviews. Work Package 3 will combine findings from Work Packages 1 and 2 using the Behaviour Change Wheel to identify and develop testable implementation strategy options (WP 3.1). Strategies will be refined and prioritised using a key stakeholder consensus process to develop a collaborative implementation blueprint to optimise and scale-up MECC (WP3.2). Discussion: Research programme outputs are expected to positively support the integration of MECC brief behaviour change interventions into the Irish healthcare system and inform the scale-up of behaviour change interventions internationally.
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Affiliation(s)
- Oonagh Meade
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
| | - Maria O'Brien
- National Heart Programme, Integrated Care Programme for Chronic Disease, Clinical Design and Innovation, Office of the Chief Clinical Officer, Health Services Executive, Áras Sláinte, Wilton Road, Cork, T12 XRR0, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
| | - Agatha Lawless
- Health & Wellbeing, Strategy and Research, Healthcare Strategy, c/o Health Promotion and Improvement Office, Health Service Executive, Waterford, X91 T256, Ireland
| | - Sandra Coughlan
- Strategic Planning and Transformation, Health Service Executive, Cork, T12 WP62, Ireland
| | - Jo Hart
- School of Medical Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Catherine Hayes
- Public Health and Primary Care, School of Medicine, Trinity College Dubin, Dublin, D02 R590, Ireland
| | - Chris Keyworth
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Kim L Lavoie
- Montréal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital Sacré-Cœur de Montréal, Montréal, Quebec, QC H4J 1C5, Canada
- Department of Psychology, University of Quebec at Montréal, Montréal, Quebec, QC H2L 2C4, Canada
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, School of Medicine, NUI Galway, Galway, Ireland
| | - Patrick Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, School of Medicine, NUI Galway, Galway, Ireland
| | - Chris Noone
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
| | - Orlaith O'Reilly
- Health and Wellbeing Division, HSE South East, Public Health Department, Health Service Executive, Kilkenny, Ireland
| | - Health Psychology Public Advisory Panel
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
- National Heart Programme, Integrated Care Programme for Chronic Disease, Clinical Design and Innovation, Office of the Chief Clinical Officer, Health Services Executive, Áras Sláinte, Wilton Road, Cork, T12 XRR0, Ireland
- Health & Wellbeing, Strategy and Research, Healthcare Strategy, c/o Health Promotion and Improvement Office, Health Service Executive, Waterford, X91 T256, Ireland
- Strategic Planning and Transformation, Health Service Executive, Cork, T12 WP62, Ireland
- School of Medical Sciences, University of Manchester, Manchester, M13 9PT, UK
- Public Health and Primary Care, School of Medicine, Trinity College Dubin, Dublin, D02 R590, Ireland
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
- Montréal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital Sacré-Cœur de Montréal, Montréal, Quebec, QC H4J 1C5, Canada
- Department of Psychology, University of Quebec at Montréal, Montréal, Quebec, QC H2L 2C4, Canada
- Health Research Board Primary Care Clinical Trials Network Ireland, School of Medicine, NUI Galway, Galway, Ireland
- Health and Wellbeing Division, HSE South East, Public Health Department, Health Service Executive, Kilkenny, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
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Obesity and Diet Predict Attitudes towards Health Promotion in Pre-Registered Nurses and Midwives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413419. [PMID: 34949025 PMCID: PMC8708316 DOI: 10.3390/ijerph182413419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 12/03/2022]
Abstract
Nurses and midwives are integral to public health promotion; in the UK, they are advised to act as role models by their governing body, but overweight or obesity rates are high. We explored whether obesity and dietary habits are related to attitudes towards healthy role modelling and health promotion practice. A total of 346 pre-registered UK nurses and midwives (92.6% female; 18–53 years) completed an online survey. Items included body composition, dietary habits assessed by the Lifestyle Behaviour Questionnaire (LBQ), attitudes towards being role models for health (RA: role attitudes) and attitudes toward health promotion practice (ATHPP): 33.8% of the sample self-reported as overweight or obese; 67.6% did not consume 5-a-day portions of fruit/veg; 31.5% reported a healthy diet; and 89.6% believed their diet could be healthier. Positive RA was significantly linked to health promotion engagement (HP) (ß = 0.33, p < 0.001). Positive ATHPP was significantly predicted by lower BMI (ß = −0.08, p = 0.078), positive RA (ß = 0.67, p < 0.001), lower HP (ß = −0.25, p < 0.001) and male gender (ß = 0.09, p = 0.02). Greater confidence in patients valuing healthcare professional’s advice was predicted by healthier diet (ß = 0.11, p = 0.03), lower BMI (ß = −0. 16, p < 0.01), more positive RA (ß = 0.14, p < 0.01) as well as HP engagement during training (ß = 0.20, p < 0.01). One’s own motivation to promote health, similarly to ATHPP, was predicted by RA (ß = 0.17, p = 0.001) and previous HP engagement (ß = 0.39, p < 0.001). Findings show that overweight and obesity are prevalent in pre-registered nurses and midwives; the majority did not consume a healthy diet. Individual’s body composition, diet and attitudes towards role modelling are positively associated with their attitudes towards, and confidence in, health promotion practice. Experiences of health promotion practice during training can have either a positive or a negative influence on attitudes. Mentors and educators could actively promote healthy lifestyles for pre-registered nurses and midwives and facilitate more opportunities for health promotion practice during placements, which includes time for reflection.
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Tuohy D, Fahy A, Murphy L. Student nurses and midwives' experiences of teaching and learning about 'making every contact count' health behaviour change programme: Descriptive qualitative study. Nurse Educ Pract 2021; 57:103246. [PMID: 34717167 DOI: 10.1016/j.nepr.2021.103246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/01/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
AIM/OBJECTIVE To explore nursing/midwifery students' experiences of the teaching and learning of units one and two of a national undergraduate curriculum. BACKGROUND The 'National Undergraduate Curriculum for Chronic Disease Prevention and Management: Making Every Contact Count' (MECC) is part of Ireland's national policy to support the prevention of chronic disease by promoting health behaviour change. This is being implemented as a programme within the Irish Health Service and is also being delivered, for the first time in undergraduate medical, allied health and nursing/midwifery education by tertiary education institutes. DESIGN Qualitative descriptive research. METHODS Purposeful sampling was used to recruit participants (n = 17) from an undergraduate nursing/midwifery programme (n = 131) in one tertiary level Irish institution. Four focus groups were undertaken by two members of the research team, who were not part of the module teaching team. Each focus group was guided by a semi-structured interview guide, recorded and transcribed verbatim. Thematic data analysis was undertaken. RESULTS Three main themes were identified, namely: Building foundations and making connections; Personal responsibility and the Ah factor: now I understand. CONCLUSION Findings indicate that students had a positive learning experience whilst also highlighting the students' transition to lifelong learning encompassing adult learning and personal responsibility.
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Affiliation(s)
- Dympna Tuohy
- Department of Nursing and Midwifery, Health Sciences Building, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Anne Fahy
- Department of Nursing and Midwifery, Health Sciences Building, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Louise Murphy
- School of Nursing and Midwifery, Áras Moyola, National University of Ireland Galway, Galway, Ireland.
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Making Every Contact Count and Healthy Conversation Skills as very brief or brief behaviour change interventions: a scoping review. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01653-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Abstract
Aim
To identify and map the available evidence regarding the implementation of Making Every Contact Count and/or Healthy Conversation Skills for both staff delivering and service users receiving the brief or very brief intervention/s.
Methods
A scoping review approach was used to rapidly map and provide an overview of the relevant literature, identify gaps in knowledge, and inform further, related research. Articles investigating experiences, perceptions and impact of Making Every Contact Count and/or Healthy Conversation Skills were included. Quantitative, qualitative, and mixed methods studies were eligible for inclusion, as were reviews and reports.
Results
Twenty-two articles were included in total. Healthy Conversation Skills training was found to be acceptable, and had a positive impact on staff confidence and competence in supporting behaviour change, across studies. Some positive effects of intervention exposure on the sedentary behaviour and dietary quality of service users were evidenced. Changes in confidence following Making Every Contact Count training were varied, as was perceived acceptability of the intervention for staff. Two studies highlighted positive impacts of the intervention on service user health; however, statistical significance was not reported. The perceived barriers and facilitators of implementation for both interventions mapped mostly to ‘Environmental Context and Resources’ on the Theoretical Domains Framework.
Conclusion
Healthy Conversation Skills is an acceptable and effective behaviour change intervention that could provide a consistent approach to Making Every Contact Count training and evaluation. Further research is warranted to evaluate this approach for more staff and service user groups.
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Hollis JL, Kocanda L, Seward K, Collins C, Tully B, Hunter M, Foureur M, Lawrence W, MacDonald-Wicks L, Schumacher T. The impact of Healthy Conversation Skills training on health professionals' barriers to having behaviour change conversations: a pre-post survey using the Theoretical Domains Framework. BMC Health Serv Res 2021; 21:880. [PMID: 34452634 PMCID: PMC8394191 DOI: 10.1186/s12913-021-06893-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/12/2021] [Indexed: 12/05/2022] Open
Abstract
Background Changing people’s behaviour by giving advice and instruction, as traditionally provided in healthcare consultations, is usually ineffective. Healthy Conversation Skills (HCS) training enhances health professionals’ communication skills and ability to empower and motivate people in health behaviour change. Guided by the Theoretical Domains Framework (TDF), this study examined the impact of HCS training on health professional barriers to conducting behaviour change conversations in both clinical and non-clinical settings. Secondary aims were to i) identify health professionals’ barriers to having behaviour change conversations, and explore the ii) effect of HCS training on health professionals’ competence and attitudes to adopting HCS, iii) feasibility, acceptability and appropriateness of using HCS in their clinical and non-clinical roles, and iv) acceptability and quality of HCS training. Methods HCS training was conducted in October-November 2019 and February 2020. Pre-training (T1), post-training (T2) and follow-up (T3; 6-10 weeks post-training) surveys collected data on demographics and changes in competence, confidence, importance and usefulness (10-point Likert scale, where 10 = highest score) of conducting behaviour change conversations. Validated items assessing barriers to having these conversations were based on eight TDF domains. Post-training acceptability and quality of training was assessed. Data were summarised using descriptive statistics, and differences between TDF domain scores at the specific time points were analysed using Wilcoxon matched-pairs signed-rank tests. Results Sixty-four participants consented to complete surveys (97% women; 16% identified as Aboriginal), with 37 employed in clinical settings and 27 in non-clinical settings. The training improved scores for the TDF domains of skills (T1: median (interquartile range) = 4.7(3.3-5.3); T3 = 5.7(5.3-6.0), p < 0.01), belief about capabilities (T1 = 4.7(3.3-6.0); T3 = 5.7(5.0-6.0), p < 0.01), and goals (T1 = 4.3(3.7-5.0); T3 = 4.7(4.3-5.3), p < 0.01) at follow-up. Competence in using ‘open discovery questions’ increased post-training (T1 = 25% of responses; T2 = 96% of responses; T3 = 87% of responses, p < 0.001), as did participants’ confidence for having behaviour change conversations (T1 = 6.0(4.7-7.6); T2 = 8.1(7.1-8.8), p < 0.001), including an increased confidence in having behaviour change conversations with Aboriginal clients (T1 = 5.0(2.7-6.3); T2 = 7.6(6.4-8.3), p < 0.001). Conclusions Provision of additional support strategies to address intentions; memory, attention and decision processes; and behavioural regulation may enhance adoption and maintenance of HCS in routine practice. Wider implementation of HCS training could be an effective strategy to building capacity and support health professionals to use a person-centred, opportunistic approach to health behaviour change. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06893-4.
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Affiliation(s)
- Jenna L Hollis
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia. .,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia. .,Hunter Medical Research Institute, Newcastle, New South Wales, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia. .,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.
| | - Lucy Kocanda
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Rural Health, University of Newcastle, Tamworth, New South Wales, Australia
| | - Kirsty Seward
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Clare Collins
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Mandy Hunter
- Hunter New England Local Health District Nursing and Midwifery Services, Newcastle, New South Wales, Australia
| | - Maralyn Foureur
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia.,Nursing and Midwifery Research Centre, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,NIHR, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lesley MacDonald-Wicks
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tracy Schumacher
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Rural Health, University of Newcastle, Tamworth, New South Wales, Australia
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Asher RC, Shrewsbury VA, Bucher T, Collins CE. Culinary medicine and culinary nutrition education for individuals with the capacity to influence health related behaviour change: A scoping review. J Hum Nutr Diet 2021; 35:388-395. [PMID: 34415642 DOI: 10.1111/jhn.12944] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Culinary medicine (CM) or culinary nutrition (CN) education provided to professionals with the capacity to influence behaviour change is an emerging strategy to promote diet quality and reduce the burden of diet related chronic disease in adults. The purpose of this scoping review was to synthesise current research describing CM/CN education provided to or by health, education and culinary professionals, or students of these disciplines. METHODS Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was used. Eleven electronic databases were searched in March 2019. Included studies were: (i) nutrition, health or lifestyle programs with a CM/CN component; (ii) study participants or programs facilitated by people working or training in health, community and/or adult education, or culinary roles where facilitator training was described; (iii) reported in the English language; and (iv) published from 2003. RESULTS In total, 33 studies were included. Nineteen studies delivered programs to general population groups and were facilitated by health professionals and/or health university students. Fourteen studies delivered CM/CN training to health professionals or students. Studies reported changes in participants' culinary skill and nutrition knowledge (n = 18), changes in dietary intake (n = 13), attitudes and behaviour change in healthy eating and cooking (n = 4), and competency in nutrition counselling and knowledge (n = 7). CONCLUSIONS Further research examining the effectiveness of CM/CN programs, and that describes optimal content, format and timing of the programs, is needed. Research evaluating the impact of training in CM/CN to education and culinary professionals on healthy cooking behaviours of their patients/clients is warranted.
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Affiliation(s)
- Roberta C Asher
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, USA.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa A Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, USA.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - Tamara Bucher
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia.,School of Environmental and Life Sciences, College of Engineering, Science and Environment, The University of Newcastle, Newcastle, NSW, USA
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
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Shrestha N, Pedisic Z, Jurakic D, Biddle SJH, Parker A. Physical activity and sedentary behaviour counselling: Attitudes and practices of mental health professionals. PLoS One 2021; 16:e0254684. [PMID: 34270611 PMCID: PMC8284800 DOI: 10.1371/journal.pone.0254684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 07/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background Despite recent interest in the mental health benefits of increasing physical activity (PA) and reducing sedentary behaviour (SB), little is known about PA and SB counselling provided by mental health professionals. Therefore, the aim of this study was to explore the attitudes and practices of mental health professionals in recommending more PA and less SB to their clients. Methods Quantitative data were collected using a modified version of the Exercise in Mental Illness Questionnaire in a sample of 17 Australian mental health professionals. The collected data were reported using percentages (for categorical data) and means and standard deviations (for numerical data). Additionally, in focus group discussions, 10 mental health professionals provided in-depth information about their clinical practice, facilitators, and perceived barriers in recommending more PA and less SB. They also provided suggestions on how to potentially improve their PA and SB counselling practices. The focus groups were audio-recorded, transcribed and analysed using thematic analysis. Results Only 35.3% of participants have undergone formal training in recommending PA in the treatment of mental illness. Most participants (64.7%) ranked PA counselling among the top three types of mental health treatment. All participants reported recommending PA to their clients at least “occasionally”, while 88% of them also provided SB counselling. However, the recommendations provided were usually not specific. The most commonly reported barriers for providing PA and SB counselling were a lack of knowledge and confidence. Participants also believed that, if they were more active themselves, they would be in a better position to recommend PA to their clients, by sharing their own experience of evidence-informed strategies designed to increase PA and reduce SB. Conclusion The findings of this study indicate that mental health professionals commonly provide generic PA and SB counselling to their clients. PA and SB counselling in the mental health setting could be improved by: including training on PA and SB counselling in formal education and continued professional training for mental health professionals; implementing interventions to increase PA and reduce SB among mental health professionals themselves; and ensuring support from an exercise or PA promotion specialist as a part of a multi-disciplinary approach to mental health care.
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Affiliation(s)
- Nipun Shrestha
- Institute for Health and Sport, Victoria University, Footscray, Australia
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Footscray, Australia
| | - Danijel Jurakic
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Stuart J. H. Biddle
- Physically Active Lifestyles Research Group (USQ‐PALs), Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Alexandra Parker
- Institute for Health and Sport, Victoria University, Footscray, Australia
- Orygen, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- * E-mail:
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Semper K, Hernon J, Wynter T, Baker K, Saxton JM. Physical activity advice in the UK bowel cancer screening setting: qualitative healthcare professional perspectives. Health Promot Int 2021; 37:6307147. [PMID: 34151969 DOI: 10.1093/heapro/daab088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Providing physical activity advice in the bowel cancer screening setting could help to reduce the risk of cancer and cardiometabolic disease in older adults. This study investigated the views of healthcare professionals (HCPs) regarding the provision of physical activity advice as part of the UK Bowel Cancer Screening Programme. A purposive sample of HCPs (aged 22-63 years, with 1-26 years of experience) from four bowel cancer screening disciplines (four endoscopists, four colorectal surgeons, four staff nurses and four specialist screening practitioners) were recruited from a large National Health Service gastroenterology unit. Data collection used individual interviews and focus groups, with topics being guided by an a priori topic guide. All interviews and focus groups were audio-recorded and transcribed verbatim. Three key themes, which contextualize the views and perceptions of HCPs recruited to the study, emerged from the framework analysis: (i) appraisal of the concept; (ii) perceived barriers to implementation; (iii) steps to implementation. While the general concept was viewed positively, there were differences of opinion and a range of perceived barriers were revealed. Ideas for effective implementation were also presented, taking into consideration the need for time efficiencies and importance of optimizing effectiveness. This qualitative study provided important insights into the perceptions of HCPs regarding the provision of physical activity advice in the bowel cancer screening setting, and yielded novel ideas for effective implementation.
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Affiliation(s)
- Kelly Semper
- Norfolk County Council, Tydd St Mary, Lincolnshire, UK
| | - James Hernon
- Department of General Surgery, Norfolk and Norwich University Hospital Foundation Trust, Norfolk, UK
| | - Trevor Wynter
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - John M Saxton
- Department of Sport, Health & Exercise Science, University of Hull, Hull, UK
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When primary care providers and smokers meet: a systematic review and metasynthesis. NPJ Prim Care Respir Med 2021; 31:31. [PMID: 34075057 PMCID: PMC8169673 DOI: 10.1038/s41533-021-00245-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients' motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Delivering Opportunistic Behavior Change Interventions: a Systematic Review of Systematic Reviews. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:319-331. [PMID: 32067156 PMCID: PMC7056685 DOI: 10.1007/s11121-020-01087-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Opportunities for healthcare professionals to deliver health behavior change interventions are often missed, but understanding the barriers and enablers to this activity is limited by a focus on defined specialisms/health conditions. This systematic review of systematic reviews collates all the evidence across professional groups to provide guidance to policy makers for implementing healthcare professional delivery of behavior change interventions. Eight electronic databases were searched for systematic reviews reporting patient-facing healthcare professionals’ (e.g., general practitioners, nurses) barriers and enablers to delivering behavior change interventions (diet, physical activity, alcohol reduction, smoking cessation, and weight management). A narrative synthesis was conducted. Thirty-six systematic reviews were included. Four themes emerged as both barriers and enablers: (1) perceptions of the knowledge or skills needed to support behavior change with patients, (2) perceptions of the healthcare professional role, (3) beliefs about resources and support needed, and (4) healthcare professionals’ own health behavior. There were four cross-disciplinary barriers: (1) perceived lack of time, (2) perceived lack of prioritization of health behavior change, (3) negative attitudes towards patients and perceptions of patient risk, and (4) perceptions of patient motivation. The three enablers were as follows: (1) training, (2) context, and (3) attitudes towards delivering interventions. To enhance healthcare professionals’ delivery of behavior change interventions, policy makers should (a) address perceptions about patient need for interventions, (b) support diverse professional groups to identify opportunities to deliver interventions, and (c) encourage professionals to focus on prevention and management of health conditions.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK.
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Rachel Calam
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9PL, Manchester, UK
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Identifying targets for interventions to support public adherence to government instructions to reduce transmission of SARS-CoV-2. BMC Public Health 2021; 21:522. [PMID: 33731056 PMCID: PMC7967094 DOI: 10.1186/s12889-021-10574-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background SARS-CoV-2 lacks sentience and can only be spread through human behaviour. Government instructions to the general public include: (a) limiting time spent outside the home, (b) staying more than 1 m away from people outside the household at all times, and (c) maintaining hand hygiene. Current evidence suggests high rates of adherence to such instructions, but interventions to sustain adherence to government instructions in the long term can only be developed if we know why people do or do not adhere to them. The aims were to assess levels of public adherence to government instructions to reduce transmission of SARS-CoV-2, but more importantly to gauge why people were or were not adhering to instructions. Methods Cross-sectional survey of 2252 adults who were representative of the UK population. Data were analysed descriptively, and using one-sample t-tests, within-participants ANOVA and multiple linear regression. Results The sample reported mostly adhering to UK government instructions to reduce SARS-CoV-2 transmission, with 5% or fewer people reporting active resistance to instructions. People generally reported high levels of capability, opportunity and motivation to follow the instructions, but perceived relatively few physical and social opportunities. Multiple linear regression analyses showed that better adherence was associated with older age, being a woman, having a white ethnic background, and with perceiving greater levels of capabilities, opportunities and motivations. Conclusions Interventions targeted at people with black, Asian and minority ethnic backgrounds, men and younger people that focus on increasing capabilities, providing greater opportunities and boosting motivations are needed to support continued adherence to government instructions to reduce SARS-CoV-2 transmission. Further research is required to track changes in people’s capabilities, opportunities, motivations and behaviours in response to the ongoing emergency, any changes in government instructions, and to adapt the present procedures to other emergency situations.
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Patients' experiences of behaviour change interventions delivered by general practitioners during routine consultations: A nationally representative survey. Health Expect 2021; 24:819-832. [PMID: 33662180 PMCID: PMC8235898 DOI: 10.1111/hex.13221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background Consistent with the ‘Making Every Contact Count’ UK public health policy, general practitioners (GPs) are expected to provide patients with behaviour change interventions opportunistically. However, there is a belief widely held among GPs that patients neither want or need such interventions. We aimed to understand the following: (a) the characteristics of people attending GP appointments, (b) patients' needs for health behaviour change, (c) perceptions of appropriateness and helpfulness of interventions, and (d) factors associated with recall of receipt of interventions. Methods Cross‐sectional nationally representative online survey of UK adults who had attended GP clinics in the preceding four weeks (n = 3028). Data were analysed using descriptive statistics and binary logistic regression. Results 94.5% (n = 2862) of patients breached at least one health behaviour guideline, and 55.1% reported never having had a conversation with their GP about health behaviours. The majority of patients perceived intervention as appropriate (range 84.2%‐87.4% across behaviours) and helpful (range 82.8%‐85.9% across behaviours). Being male (OR = 1.412, 95% CI 1.217, 1.639), having a long‐term condition (OR = 1.514, 95% CI 1.287, 1.782) and a higher number of repeat GP visits (OR = 1.016, 95% CI 1.010, 1.023) were among factors associated with recall of receipt of interventions. Conclusions Patients perceived behaviour change intervention during routine GP consultations as appropriate and helpful, yet there are variations in the likelihood of receiving interventions according to sociodemographic factors. GPs could adopt a more proactive approach to behaviour change in patient consultations with the broad approval of patients. Patient or public contribution The questionnaire was piloted among a convenience sample prior to distribution.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Joanna Goldthorpe
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rachel Calam
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Bull ER, Dale H. Improving community health and social care practitioners' confidence, perceived competence and intention to use behaviour change techniques in health behaviour change conversations. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:270-283. [PMID: 32643231 DOI: 10.1111/hsc.13090] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
Community health and social care practitioners play an increasingly important role in the health promotion agenda, but lack confidence in having effective health behaviour change (HBC) conversations with members of the public. This study reports the development and evaluation of a training intervention based on health psychology to improve health and social care practitioner self-rated confidence, competence and intention to use five behaviour change techniques (BCTs) in their HBC conversations. A 2-day behavioural science interprofessional skills training course plus online learning module was designed for health and social care staff across North East Scotland, teaching five evidence-based BCTs (e.g. Action Planning), plus person-centred communication skills. Participants rated confidence, competence and future intention to use the BCTs on likert scales (1-10) pre-course and post-course, and provided acceptability data. 177 participants aged 20-64 took part, qualitative and quantitative data suggested that the course had high acceptability. Paired samples t tests (n = 120 with complete data) showed significant improvements in confidence, competence and intention following the course, which remained significant with a conservative analysis (n = 174) assuming no change for missing data. Perceived competence in Action Planning increased most during the course (mean change 3.09). In conclusion, health psychology-based skills training can improve practitioner confidence, competence and intention to use evidence-based BCTs; further evaluation is needed to assess practice change.
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Affiliation(s)
- Eleanor R Bull
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
- Psychology Services, NHS Education for Scotland, Edinburgh, UK
| | - Hannah Dale
- Psychology Services, NHS Education for Scotland, Edinburgh, UK
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Killeen SL, Callaghan SL, Jacob CM, Hanson MA, McAuliffe FM. "It only takes two minutes to ask"-a qualitative study with women on using the FIGO Nutrition Checklist in pregnancy. Int J Gynaecol Obstet 2020; 151 Suppl 1:45-50. [PMID: 32894591 PMCID: PMC7589222 DOI: 10.1002/ijgo.13322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective To gain an in‐depth understanding of how the FIGO Nutrition Checklist could work in clinical practice, from the perspective of pregnant women. Methods This qualitative study was part of a pilot study of the FIGO Nutrition Checklist in the antenatal department of a tertiary‐level university maternity hospital in Dublin, Ireland. Individual semistructured phone interviews were conducted with pregnant women who had completed the FIGO Nutrition Checklist as part of the pilot. Interviews were transcribed verbatim and analyzed using content analysis after manual coding of transcripts. Themes and subthemes are described. Results Ten interviews were completed. Subthemes related to the FIGO Nutrition Checklist emerged including ease of use and comprehension. Participants discussed how the tool could add value to their appointment by supporting initiation of nutrition conversations and highlighting nutritional issues. The first trimester was identified as the highest priority for using the FIGO Nutrition Checklist. The convenience of having nutrition addressed as part of standard care, rather than a separate appointment, also emerged. Conclusion Women in this study had a desire for nutrition and weight to be addressed by clinicians during routine antenatal appointments. The findings support using the FIGO Nutrition Checklist to address this. Pregnant women want to discuss nutrition and weight with their doctors during routine care. The FIGO Nutrition Checklist is an acceptable tool to support this.
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Affiliation(s)
- Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Shauna L Callaghan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Chandni Maria Jacob
- Institute of Developmental Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Mark A Hanson
- Institute of Developmental Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
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Leather JZ, O'Connor RC, Quinlivan L, Kapur N, Campbell S, Armitage CJ. Healthcare professionals' implementation of national guidelines with patients who self-harm. J Psychiatr Res 2020; 130:405-411. [PMID: 32891028 PMCID: PMC7450264 DOI: 10.1016/j.jpsychires.2020.08.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/22/2020] [Accepted: 08/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND National guidelines for the short-term management of self-harm are aimed at healthcare professionals who may be involved in the care of people who have self-harmed. However, evidence from small-scale studies globally suggest there is a lack of awareness of such guidelines among some groups of healthcare professionals. For the first time in a large representative sample of patient-facing healthcare professionals, we aimed to identify: (a) which healthcare professionals are aware of guidelines for the management of self-harm; (b) the perceived availability of training; (c) the use of risk screening tools; and (d) the extent to which healthcare professionals implement guidelines for the management of self-harm. METHODS 1020 UK healthcare professionals completed a cross-sectional survey online. RESULTS 85.6% (873/1020) of the sample had heard of the national guidelines, but only 24.3% (248/1020) knew "a fair amount" or more about them. Of the respondents who had previously encountered a patient who had self-harmed or was at risk of repeat self-harm, the guidelines were implemented in fewer than 50% (M = 43.89%, SD = 38.79) of encounters. 31% (312/1020) of the sample had received training in managing self-harm and, contrary to guidelines, 2.25% (23/1020) of the sample had used self-harm risk screening tools. CONCLUSIONS Our findings highlight a need to improve knowledge of self-harm management guidelines, and identifies professional groups where awareness and knowledge is currently low. Further work is required to develop interventions to change healthcare professional practice with respect to the implementation of self-harm management guidelines.
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Affiliation(s)
- Jessica Z Leather
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK; Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Coupland 1, Oxford Road, Manchester, M13 9PL, UK.
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK; Centre for Mental Health and Safety, University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Navneet Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK; Centre for Mental Health and Safety, University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK; Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Coupland 1, Oxford Road, Manchester, M13 9PL, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The Nowgen Centre, 29 Grafton Street, Manchester, M13 9WL, UK
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44
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Albert FA, Crowe MJ, Malau-Aduli AEO, Malau-Aduli BS. Physical Activity Promotion: A Systematic Review of The Perceptions of Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4358. [PMID: 32570715 PMCID: PMC7345303 DOI: 10.3390/ijerph17124358] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 12/18/2022]
Abstract
Physical activity (PA) is a cost-effective and non-pharmacological foundation for the prevention and management of chronic and complex diseases. Healthcare professionals could be viable conduits for PA promotion. However, the evidence regarding the effectiveness and benefits of the current forms of PA promotion are inconclusive. Healthcare professionals' perceptions on key determinants impact on the optimum promotion of PA were explored in this review. Thirty-four (34) studies were identified after systematically searching seven databases for peer-reviewed articles published within the last decade. PA advice or counselling was the most recorded form of PA promotion, limited counselling time was the most reported obstacle while providing incentives was viewed as a key facilitator. There is widespread consensus among healthcare professionals (HCPs) on some aspects of PA promotion. Utilisation of all PA promotional pathways to their full potential could be an essential turning point towards the optimal success of PA promotional goals. Hence, strategies are required to broaden chronic disease treatment methods to include preventive and integrative PA promotion approaches particularly, between frontline HCPs (e.g., GPs) and PA specialists (e.g., EPs). Future studies could explore the functionality of GP to EP referral pathways to determining what currently works and areas requiring further development.
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Affiliation(s)
- Francis A. Albert
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
| | - Melissa J. Crowe
- Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia;
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Perceptions of receiving behaviour change interventions from GPs during routine consultations: A qualitative study. PLoS One 2020; 15:e0233399. [PMID: 32437462 PMCID: PMC7241720 DOI: 10.1371/journal.pone.0233399] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/04/2020] [Indexed: 01/19/2023] Open
Abstract
General Practitioners (GPs) are expected to provide patients with health behaviour change interventions, yet little is known about the views of patients themselves. We aimed to understand recent patients': (1) general expectations about GPs delivering health behaviour change interventions during routine consultations (including perceptions of appropriateness and helpfulness for receiving interventions), (2) perceptions of responsibility for GPs to talk about health behaviours, and (3) experiences of receiving behaviour change interventions. Twenty-four semi-structured interviews were conducted with people who had recently attended a routine GP consultation. Data were analysed thematically. Three major themes were identified: (1) acceptability of discussions about behaviour change, (2) establishing clinician-patient rapport, and (3) healthcare professionals as a credible source and well placed to offer behaviour change interventions. Most patients were positive about, and were willing to accept behaviour change interventions from their GP during a routine consultation. Although behaviour change was perceived as a sensitive topic for patients, the doctor-patient relationship was perceived to provide an effective platform to discuss behaviour change, with the GP perceived as an appropriate and important healthcare professional from whom to receive advice. Contrary to the views of GPs, behaviour change interventions were perceived by patients as appropriate and helpful during routine medical consultations, particularly where behaviour change could have a positive effect on long-term condition management. Behaviour change interventions delivered by GPs during routine consultations could be used effectively in time-restricted consultations.
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Affiliation(s)
- Chris Keyworth
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Tracy Epton
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Joanna Goldthorpe
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Rachel Calam
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Christopher J. Armitage
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Acceptability, reliability, and validity of a brief measure of capabilities, opportunities, and motivations ("COM-B"). Br J Health Psychol 2020; 25:474-501. [PMID: 32314500 DOI: 10.1111/bjhp.12417] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/23/2020] [Indexed: 11/30/2022]
Abstract
Objectives The Capabilities, Opportunities, Motivations, Behaviour (COM-B) model is being used extensively to inform intervention design, but there is no standard measure with which to test the predictive validity of COM or to assess the impact of interventions on COM. We describe the development, reliability, validity, and acceptability of a generic 6-item self-evaluation COM questionnaire. Design and methods The questionnaire was formulated by behaviour change experts. Acceptability was tested in two independent samples of health care professionals (N = 13 and N = 85, respectively) and a sample of people with low socio-economic status (N = 214). Acceptability (missing data analyses and user feedback), reliability (test-retest reliability and Bland-Altman plots) and validity (floor and ceiling effects, Pearson's correlation coefficient [r], exploratory factor analysis [EFA], and confirmatory factor analysis [CFA] were tested using a national survey of 1,387 health care professionals. Results The questionnaire demonstrated acceptability (missing data for individual items: 5.9-7.7% at baseline and 18.1-32.5% at follow-up), reliability (ICCs .554-.833), and validity (floor effects 0.6-5.5% and ceiling effects 4.1-22.9%; pairwise correlations rs significantly <1.0). The regression models accounted for between 21 and 47% of the variance in behaviour. CFA (three-factor model) demonstrated a good model fit, (χ2 [6] = 7.34, p = .29, RMSEA = .02, CFI = .99, TLI = .99, BIC = 13,510.420, AIC = 13,428.067). Conclusions The novel six-item questionnaire shows evidence of acceptability, validity, and reliability for self-evaluating capabilities, opportunities, and motivations. Future research should aim to use this tool in different populations to obtain further support for its reliability and validity. Statement of contribution What is already known on the subject? The Capability, Opportunity, Motivation (COM), Behaviour (-B) model is being used extensively to inform intervention design. The lack of an accepted universal measure hinders progress in behaviour change. What does this study add? There is evidence of acceptability, validity, and reliability for self-evaluating COM. Our measure may be sufficiently generic for any behaviour or population, although this requires further testing.
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Affiliation(s)
- Chris Keyworth
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Tracy Epton
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Joanna Goldthorpe
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Rachel Calam
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Christopher J Armitage
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, UK
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Pattison L, Mason J, Deshpande A. Comment on: Scoping review and international multi-centre cohort study investigating teaching, knowledge and beliefs regarding physical activity as a health intervention among medical students: A comparison between Singapore and the UK. Singapore Med J 2020; 60:655. [PMID: 31889204 DOI: 10.11622/smedj.2019161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Laura Pattison
- Warwick Medical School, Warwick University, Coventry, United Kingdom
| | - James Mason
- Warwick Medical School, Warwick University, Coventry, United Kingdom
| | - Anvay Deshpande
- Warwick Medical School, Warwick University, Coventry, United Kingdom
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48
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Barrett S, Begg S, Sloane A, Kingsley M. Surgeons and preventive health: a mixed methods study of current practice, beliefs and attitudes influencing health promotion activities amongst public hospital surgeons. BMC Health Serv Res 2019; 19:358. [PMID: 31170990 PMCID: PMC6555744 DOI: 10.1186/s12913-019-4186-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/28/2019] [Indexed: 01/17/2023] Open
Abstract
Background Little is known about the participation of surgeons in preventative health activities in the non-admitted hospital care setting. The aim of this study was to identify which preventive health activities surgeons practice and to explore their attitudes towards preventive health. Methods A mixed methods study was conducted using a sequential explanatory design. Quantitative results were obtained from a self-reported clinician survey (n = 16) and a Generalized Estimating Equation was used to assess the relationship between dependent (preventive health practice) and independent (confidence and knowledge in preventive health practice, years of practice, and attitudinal factors) variables. Using a building approach to integration, results from the quantitative analyses informed design of the interview guide. Surgeons’ beliefs and attitudes were explored using in-depth, semi structured interviews with a purposeful sample of surgeons (n = 14). Responses were collected, independently coded and analysed using a qualitative descriptive approach. Results In accordance with a contiguous narrative approach to integration, the quantitative and qualitative findings are reported separately. The clinician survey found that the surgeons carried out preventive health activities at low levels. Preventive health advice was predominantly verbal in nature, and few surgeons provided written material or referred patients to additional services. The GEE analyses indicated that the following factors best predicted the tendency to undertake preventive health activities: years of clinical practice (p = 0.041), and the perceived work priority placed on preventive health (p = 0.008). Interviews generated four themes that influenced the tendency of surgeons to undertake preventive health activities: perceptions of their role in preventive health, perceived motivation of patients, hospital structure, and facilitating factors. In regards to enabling factors that are likely to increase preventive health practice, surgeons unanimously advocated for referral pathways into specialist behaviour change programs that they could facilitate within their relatively brief consulting time. Conclusions The findings suggests that the majority of public hospital surgeons engage in routine preventive health advice at a low level. The high volume of non-admitted surgical consultations undertaken annually, coupled with medium to high self-reported knowledge and confidence in addressing behavioural risk factors, support an increased involvement of surgeons in preventive health practice. Electronic supplementary material The online version of this article (10.1186/s12913-019-4186-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | | | - Michael Kingsley
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.
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Goldthorpe J, Epton T, Keyworth C, Calam R, Armitage C. Who is responsible for keeping children healthy? A qualitative exploration of the views of children aged 8-10 years old. BMJ Open 2019; 9:e025245. [PMID: 31133579 PMCID: PMC6538025 DOI: 10.1136/bmjopen-2018-025245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The issue of who is responsible for children's physical health is complex, with implications for targeting and developing strategies for health promotion and interventions to improve health. While there is evidence to suggest that children are able to construct notions of responsibility in relation to other areas of their lives, very little research has explored children's views of responsibility for their own health. The aim of this study was to explore children's views about who they feel is responsible for keeping them healthy. DESIGN Focus groups were used to gather qualitative data using a semistructured topic guide. Interpretative phenomenological analysis was used in an iterative, double hermeneutic approach to analyse the data. SETTING Focus groups took place in two UK primary schools in deprived inner city areas. PARTICIPANTS 20 children aged 8-10 years took part in one of two focus groups (10 children in each group). RESULTS Three overarching themes were identified: (1) individual and collective responsibility, (2) marketing and conflict with taking responsibility, and (3) what people and organisations can do to help children to take responsibility. Children feel that they, parents, families, school staff, medical professionals, food producers, retail outlets, supermarkets, advertisers and the government are all responsible for their health and should thus demonstrate responsibility through their behaviours around children's health. CONCLUSIONS AND IMPLICATIONS Children's views were consistent with constructs of responsibility as both a moral obligation and a set of behaviours, and with wider sociopolitical philosophies of individual and collective responsibility. These findings further support a focus on integrated, system-wide approaches to children's health.
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Affiliation(s)
- Joanna Goldthorpe
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Tracy Epton
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Chris Keyworth
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Rachel Calam
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Christopher Armitage
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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50
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Lencucha R, Shikako-Thomas K. Examining the intersection of policy and occupational therapy: A scoping review. The Canadian Journal of Occupational Therapy 2019; 86:185-195. [DOI: 10.1177/0008417419833183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Policy has direct bearing on occupational therapy practice and is a key dimension of the environment. To date, there has not been a synthesis of how policy is addressed in the occupational therapy literature. Purpose. The purpose of this review is to identify and analyze the ways that policy is addressed in the occupational therapy literature. Method. We conducted a scoping review of literature on policy and occupational therapy. Articles were analyzed deductively using a policy framework and inductively to identify overarching themes. Findings. Sixty-four papers were included for analysis. We present the descriptive information of the included articles according to policy type, sphere of action, stage of policy development, level, and actors. The qualitative analysis uncovered two broad concepts: “awareness” about the relationship between policy and practice and messages pertaining to “action.” Implications. There are numerous areas for further research into the policy–occupational therapy nexus, as policy has numerous pathways to shape practice. Practitioners will benefit from better understanding these pathways and actively engaging to align policy with the values of the profession.
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