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Batcup C, Bonner C, Ayre J. What makes an action plan "100% me"? Think aloud interviews about CVD prevention tools for varying health literacy needs. Health Promot J Austr 2024; 35:68-78. [PMID: 36916638 DOI: 10.1002/hpja.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
ISSUE ADDRESSED Health behaviour change can be difficult to maintain. Action plans can address this issue, however, there has been little qualitative research to understand how to optimise action plan interventions. This study explored how people engage with a specific type of action plan intervention, the "volitional help sheet," in a cardiovascular disease (CVD) prevention context. METHODS Twenty adults in the target age for CVD risk assessment (45 to 74 years) with varying health literacy participated in interviews and created an action plan to change their behaviour. Transcripts were analysed using framework analysis. RESULTS Participants described how engagement with plans was related to how personally relevant the target behaviour and the options within the plan were. Also important was participants visualising themselves enacting the plan when deciding which option to choose. Amongst participants who already engaged in a target behaviour, some did not perceive the plan was useful; others perceived the plan as a helpful prompt or a formalisation of existing plans. For some, the barriers to behaviour change were out of the scope of an action plan, highlighting the need for alternative supports. CONCLUSION This study provides qualitative insights into unanticipated ways that people with varying health literacy use action plans, providing new guidance for future developers. SO WHAT?: Not all action plans are created equal. Careful selection of behavioural targets and plan options and encouraging users to imagine the plan may enhance user engagement. Alternative behaviour change strategies should be available if key barriers cannot be addressed by the plan.
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Affiliation(s)
- Carys Batcup
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, NSW, Australia
| | - Carissa Bonner
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, NSW, Australia
| | - Julie Ayre
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, NSW, Australia
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Bytyçi-Katanolli A, Obas KA, Ramadani Q, Fota N, Jerliu N, Merten S, Gerold J, Zahorka M, Kwiatkowski M, Probst-Hensch N. Effectiveness of behavioural change interventions on physical activity, diet and body mass index of public primary healthcare users in Kosovo: the KOSCO cohort. BMJ Open 2023; 13:e071100. [PMID: 37813529 PMCID: PMC10565199 DOI: 10.1136/bmjopen-2022-071100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/13/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Prevalent physical inactivity and poor nutrition contribute to high non-communicable disease (NCD) morbidity and mortality in Kosovo. To improve health services for patients with NCD the Accessible Quality Healthcare project developed behaviour change interventions following the principles of the WHO Package of Essential NCD (PEN) protocol. They were implemented into the public primary healthcare (PHC) system of five early-stage implementation municipalities (ESIM, 2018) and seven late-stage implementation municipalities (2020). OBJECTIVE To assess the effect of the behaviour change interventions; motivational stages of behaviour change for physical activity and nutrition; and body mass index (BMI). DESIGN Prospective cohort study. DATA COLLECTION AND ANALYSIS We included 891 public PHC users aged 40 years and above, who were enrolled in the KOSCO (Kosovo Non-Communicable Disease Cohort) cohort in 2019 and followed-up biannually until February 2021. The PHC users who consulted for themselves any health service were approached and recruited for cohort participation. Each participant contributed up to four self-reports of nutrition and physical activity, and up to three reports of motivation to change for a better lifestyle. These outcomes were modelled prospectively with robust mixed-effects Poisson regressions. The association between behaviour change interventions and BMI was quantified using linear regression. RESULTS There was a high rate of smokers 20.5% and obesity 53.1%, and high rates of self-reported diagnoses of diabetes: 57.1%; hypertension 62.6%. We found no effect of residing in an ESIM, but adherence to both guidelines was higher in ESIM at the latest follow-up time point. ESIM residence was also associated with a twofold increase in the probability of reporting a high motivation for a better lifestyle and with a statistically non-significant decrease in BMI of -0.14 kg/m2 (95% CI: -0.46 to 0.19) at the latest follow-up. CONCLUSION The longitudinal results extend evidence on the effect of WHO PEN protocol in promoting physical activity and nutritional behaviour in the Kosovo context.
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Affiliation(s)
- Ariana Bytyçi-Katanolli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Katrina Ann Obas
- Qualitätsmanagement & Patientensicherheit, Universitätsspital Zürich, Zurich, Switzerland
| | | | - Nicu Fota
- Accessible Quality Healthcare Project, Prishtina, Kosovo
| | - Naim Jerliu
- National Institute of Public Health Kosovo, Prishtina, Kosovo
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Sonja Merten
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Jana Gerold
- University of Basel, Basel, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | - Marek Kwiatkowski
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Toft BS, Rodkjaer L, Andersen AB, de Thurah A, Nielsen B, Nielsen CP, Hørlück JT, Kallestrup L, Schougaard LMV, Ludvigsen MS, Hoybye MT, Ellegaard T, Bekker H. Measures used to assess interventions for increasing patient involvement in Danish healthcare setting: a rapid review. BMJ Open 2022; 12:e064067. [PMID: 36572495 PMCID: PMC9806071 DOI: 10.1136/bmjopen-2022-064067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To identify measures used within Denmark evaluating any type of intervention designed to facilitate patient involvement in healthcare. DESIGN Environmental scan employing rapid review methods. DATA SOURCES MEDLINE, PsycInfo and CINAHL were searched from 6-9 April 2021 from database inception up to the date of the search. ELIGIBILITY CRITERIA Quantitative, observational and mixed methods studies with empirical data on outcomes used to assess any type of intervention aiming to increase patient involvement with their healthcare. Language limitations were Danish and English. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data from 10% of the included studies and, due to their agreement, the data from the rest were extracted by first author. Data were analysed with reference to existing categories of measuring person-centred care; findings were synthesised using narrative summaries. Adapted Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were used to guide reporting. RESULTS Among 3767 records, 43 studies met the inclusion criteria, including 74 different measures used to evaluate interventions aimed at increasing patient involvement within healthcare in Danish hospital and community settings. Generic measures assessed: patient engagement (n=3); supporting self-management (n=8); supporting shared decision-making (n=9); patient satisfaction and experiences of care (n=11); health-related patient-reported outcome (n=20). CONCLUSIONS Across Denmark, complex interventions designed to improve patient involvement with healthcare vary in their goals and content. Some targeting healthcare professionals, some patient health literacy and some service infrastructure. A plethora of measures assess the impact of these interventions on patient, professional and service delivery outcomes. Few measures assessed patient involvement directly, and it is unclear which proxy measures capture indicators of perceived involvement. Lack of conceptual clarity between intervention goals, the components of change and measures makes it difficult to see what types of intervention can best support change in services to ensure patients are more effectively involved in their healthcare.
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Affiliation(s)
- Bente Skovsby Toft
- Research Centre of Patient Involvement, Århus Universitetshospital, Aarhus, Denmark
| | - Lotte Rodkjaer
- Research Centre of Patient Involvement, Århus Universitetshospital, Aarhus, Denmark
- Infectious Diseases, Aarhus University, Aarhus, Denmark
| | - Anne Bendix Andersen
- Research Centre of Health and Welfare Technology, Viborg Regional Hospital, Viborg, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Berit Nielsen
- Department of Public Health, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
| | - Camilla Palmhøj Nielsen
- Department of Public Health, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
| | - Jens Thusgård Hørlück
- Social and Health Services and Labour Market, Defactum, Aarhus, Midtjylland, Denmark
| | - Lisbeth Kallestrup
- Department of Quality and Patient Involvement, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mette Spliid Ludvigsen
- Department of Clinical Medicine, Randers Regional Hospital, Randers, Midtjylland, Denmark
- Faculty of Nursing and Health Sciences, Nord University, Bodo, Nordland, Norway
| | - Mette Terp Hoybye
- Interdisciplinary Research Unit, Elective Surgery Center, Regionshospitalet Silkeborg, Silkeborg, Midtjylland, Denmark
| | | | - Hilary Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Tyldesley-Marshall N, Grove A, Ghosh I, Kudrna L, Ayorinde A, Singh M, Mehaan E, Clarke A, Taylor-Phillips S, Al-Khudairy L. Investigating informed choice in screening programmes: a mixed methods analysis. BMC Public Health 2022; 22:2319. [PMID: 36510247 PMCID: PMC9743591 DOI: 10.1186/s12889-022-14685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Screening programmes aim to identify individuals at higher risk of developing a disease or condition. While globally, there is agreement that people who attend screening should be fully informed, there is no consensus about how this should be achieved. We conducted a mixed methods study across eight different countries to understand how countries address informed choice across two screening programmes: breast cancer and fetal trisomy anomaly screening. METHODS Fourteen senior level employees from organisations who produce and deliver decision aids to assist informed choice were interviewed, and their decision aids (n = 15) were evaluated using documentary analysis. RESULTS We discovered that attempts to achieve informed choice via decision aids generate two key tensions (i) between improving informed choice and increasing uptake and (ii) between improving informed choice and comprehensibility of the information presented. Comprehensibility is fundamentally at tension with an aim of being fully informed. These tensions emerged in both the interviews and documentary analysis. CONCLUSION We conclude that organisations need to decide whether their overarching aim is ensuring high levels of uptake or maximising informed choice to participate in screening programmes. Consideration must then be given to all levels of development and distribution of information produced to reflect each organisation's aim. The comprehensibility of the DA must also be considered, as this may be reduced when informed choice is prioritised.
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Affiliation(s)
- Natalie Tyldesley-Marshall
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Amy Grove
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK ,grid.7372.10000 0000 8809 1613Public Health and Health Technology Assessment and Implementation Science, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Iman Ghosh
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Laura Kudrna
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK ,grid.6572.60000 0004 1936 7486Present address : Institute of Applied Health Research, University of Birmingham, B15 2TT Edgbaston, UK
| | - Abimbola Ayorinde
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Megha Singh
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Edward Mehaan
- grid.1002.30000 0004 1936 7857Monash University, Wellington Road, VIC 3800 Clayton, Melbourne, Australia
| | - Aileen Clarke
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Sian Taylor-Phillips
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Lena Al-Khudairy
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
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Gültzow T, Smit ES, Crutzen R, Jolani S, Hoving C, Dirksen CD. Effects of an Explicit Value Clarification Method With Computer-Tailored Advice on the Effectiveness of a Web-Based Smoking Cessation Decision Aid: Findings From a Randomized Controlled Trial. J Med Internet Res 2022; 24:e34246. [PMID: 35838773 PMCID: PMC9338418 DOI: 10.2196/34246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/17/2022] [Accepted: 04/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Smoking continues to be a driver of mortality. Various forms of evidence-based cessation assistance exist; however, their use is limited. The choice between them may also induce decisional conflict. Offering decision aids (DAs) may be beneficial; however, insights into their effective elements are lacking. Objective This study tested the added value of an effective element (ie, an “explicit value clarification method” paired with computer-tailored advice indicating the most fitting cessation assistance) of a web-based smoking cessation DA. Methods A web-based randomized controlled trial was conducted among smokers motivated to stop smoking within 6 months. The intervention group received a DA with the aforementioned elements, and the control group received the same DA without these elements. The primary outcome measure was 7-day point prevalence abstinence 6 months after baseline (time point 3 [t=3]). Secondary outcome measures were 7-day point prevalence of abstinence 1 month after baseline (time point 2 [t=2]), evidence-based cessation assistance use (t=2 and t=3), and decisional conflict (immediately after DA; time point 1). Logistic and linear regression analyses were performed to assess the outcomes. Analyses were conducted following 2 (decisional conflict) and 3 (smoking cessation) outcome scenarios: complete cases, worst-case scenario (assuming that dropouts still smoked), and multiple imputations. A priori sample size calculation indicated that 796 participants were needed. The participants were mainly recruited on the web (eg, social media). All the data were self-reported. Results Overall, 2375 participants were randomized (intervention n=1164, 49.01%), of whom 599 (25.22%; intervention n=275, 45.91%) completed the DAs, and 276 (11.62%; intervention n=143, 51.81%), 97 (4.08%; intervention n=54, 55.67%), and 103 (4.34%; intervention n=56, 54.37%) completed time point 1, t=2, and t=3, respectively. More participants stopped smoking in the intervention group (23/63, 37%) than in the control group (14/52, 27%) after 6 months; however, this was only statistically significant in the worst-case scenario (crude P=.02; adjusted P=.04). Effects on the secondary outcomes were only observed for smoking abstinence after 1 month (15/55, 27%, compared with 7/46, 15%, in the crude and adjusted models, respectively; P=.02) and for cessation assistance uptake after 1 month (26/56, 46% compared with 18/47, 38% only in the crude model; P=.04) and 6 months (38/61, 62% compared with 26/50, 52%; crude P=.01; adjusted P=.02) but only in the worst-case scenario. Nonuse attrition was 34.19% higher in the intervention group than in the control group (P<.001). Conclusions Currently, we cannot confidently recommend the inclusion of explicit value clarification methods and computer-tailored advice. However, they might result in higher nonuse attrition rates, thereby limiting their potential. As a lack of statistical power may have influenced the outcomes, we recommend replicating this study with some adaptations based on the lessons learned. Trial Registration Netherlands Trial Register NL8270; https://www.trialregister.nl/trial/8270 International Registered Report Identifier (IRRID) RR2-10.2196/21772
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Affiliation(s)
- Thomas Gültzow
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.,Department of Work & Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Eline Suzanne Smit
- Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Shahab Jolani
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Ciska Hoving
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, Netherlands
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Khanna A, Fix GM PhD, McCullough M PhD, Herbst A MPH, Li M, Miano D, Barker A MS, Wiener RS. Implementing Shared Decision-Making for Lung Cancer Screening across a Veterans Health Administration Hospital Network. Ann Am Thorac Soc 2021. [PMID: 34678137 DOI: 10.1513/AnnalsATS.202105-620SD] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Shared-decision making (SDM) for lung cancer screening (LCS) is recommended by multiple organizations, reflecting a larger movement towards patient-centered care. Yet SDM for LCS does not routinely occur due to barriers at multiple levels. Moreover, how best to implement SDM into routine clinical practice remains unknown. There is a need for a novel approach to overcome multi-level barriers and ensure high-quality SDM for LCS is integrated into routine practice. We present the protocol for our US Department of Veteran Affairs (VA) funded study. Our protocol is designed to implement and evaluate a multi-level, tailored approach to SDM for LCS in routine clinical practice within the VA New England Health Care Network, comprising eight medical centers. In this prospective, pragmatic hybrid implementation-effectiveness study, we will first conduct a formative evaluation of barriers to SDM for LCS at each level of the socioecological model, which will inform our tailored implementation plan. We will then sequentially introduce components of our tailored, multi-level approach to implementing SDM for LCS across VA New England. Finally, using mixed methods, we will evaluate the implementation and its impact on Effectiveness (primary outcome, defined as patient-centeredness of SDM), as well as implementation outcomes informed by the RE-AIM implementation science framework (i.e., Reach to patients, Adoption by providers, Implementation fidelity). Tailored implementation will address identified challenges to achieving policy recommendations for SDM for LCS in VA New England, inform nationwide implementation of SDM for LCS, and address stakeholder interests in promoting more patient-centered interactions across the VA.
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