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Fowler JA, Buckley L, Viskovich S, Muir M, Dean JA. Healthcare providers perspectives on digital, self-guided mental health programs for LGBTQIA+ individuals: A cross-sectional online survey. Psychiatry Res 2024; 335:115873. [PMID: 38555827 DOI: 10.1016/j.psychres.2024.115873] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 03/07/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Digital, self-guided mental health programs are a promising avenue for mental health support for LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual plus additional sexuality, gender, and romantic identities) people - however, healthcare providers (HCPs) perspectives on programs are largely unknown. The aim of this study was to explore these perspectives. A cross-sectional online survey was distributed across Australia, with a final sample of 540 HCPs from a range of disciplines. Most respondents (419, 81.2 %), reported that digital, self-guided mental health programs would be useful, but 74.5 % (n = 380) also reported that they had concerns. Thematic analysis of open-text responses showed that HCPs believe programs may help overcome access barriers and could be useful as part of a wider care journey. Others were concerned about patient safety, and whether programs could be appropriately tailored to LGBTQIA+ experiences. Content analysis of open-text responses showed affirming language and imagery, content on LGBTQIA+ people's unique challenges, wider health information, and connections to community were important to include in programs. HCPs advocated for programs that offered broad and sub-population specific information. These findings show that HCPs are enthusiastic about digital, self-guided mental health programs, but care should be taken to address key concerns to facilitate future implementation.
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Affiliation(s)
- James A Fowler
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, Brisbane, QLD 4006, Australia.
| | - Lisa Buckley
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, Brisbane, QLD 4006, Australia
| | - Shelley Viskovich
- The University of Queensland, Faculty of Health and Behavioral Sciences, School of Psychology, St Lucia, Brisbane, QLD 4027, Australia
| | - Miranda Muir
- The University of Queensland, Faculty of Health and Behavioral Sciences, School of Psychology, St Lucia, Brisbane, QLD 4027, Australia
| | - Judith A Dean
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, Brisbane, QLD 4006, Australia
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P P, A R, E B, Z M, Z D, M H, R H, C F. Initiatives for promoting educator wellbeing: a Delphi study. BMC Psychol 2024; 12:220. [PMID: 38649952 PMCID: PMC11036615 DOI: 10.1186/s40359-024-01724-7] [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: 04/20/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Growing demands on educators have resulted in increased levels of burnout and stress and decreasing wellbeing. This study aimed to establish expert consensus on the key characteristics required in prospective educator wellbeing initiatives. METHODS The Delphi approach is a process of forecasting that is based on the aggregated opinion of panel members (or experts) within a field of study. Using a Delphi approach, academic and practitioner expertise were sought over a two-rounds, with 17 and 14 participants in each round respectively. The study aimed to identify how systemic factors (e.g., leadership) could be utilised to promote educator wellbeing. The study also sought expert consensus on enablers and barriers for engagement in educator wellbeing initiatives. RESULTS Findings highlighted the importance of fostering positive relationships with colleagues, communities and families, and the active role of wellbeing teams to promote wellbeing initiatives. The need for leaders to address their own wellbeing and build trust within teams was also identified. Panel members identified the need for prospective funding to prioritise wellbeing initiatives. There was also a preference for ongoing initiatives rather than stand-alone wellbeing events that conveyed the ongoing importance of managing one's wellbeing. CONCLUSIONS This paper presents practical recommendations that can be used to inform the development and evaluation of future initiatives and policy. Applying the consensus derived from this study is likely to make wellbeing initiatives more viable and facilitate uptake amongst educators.
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Affiliation(s)
- Patrick P
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo, VIC 3800, Clayton, Australia.
| | - Reupert A
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo, VIC 3800, Clayton, Australia
| | - Berger E
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo, VIC 3800, Clayton, Australia
- Monash Rural Health, Monash University, Warragul, Australia
| | - Morris Z
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo, VIC 3800, Clayton, Australia
| | - Diamond Z
- School of Education, Culture & Society, Faculty of Education, Monash University, Clayton, Australia
| | - Hammer M
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo, VIC 3800, Clayton, Australia
| | - Hine R
- Monash Rural Health, Monash University, Warragul, Australia
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McLeod LJ, Hine DW, Milfont TL, Dorner Z, Tassell-Matamua NA, Maris RDC, Kitson JC, Stahlmann-Brown P. Protecting and restoring freshwater biodiversity across urban areas in Aotearoa New Zealand: Citizens' reporting of pollution in stormwater drains and waterways. J Environ Manage 2024; 351:120019. [PMID: 38181685 DOI: 10.1016/j.jenvman.2024.120019] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/07/2024]
Abstract
Urbanization poses numerous challenges to freshwater biodiversity. This paper describes two studies with the joint aim of demonstrating the benefits of applying a systematic behaviour change framework and providing the foundational knowledge to inform future behavior change work to protect and restore urban freshwater biodiversity. In Study 1 we used a mixed-methods research design, involving 14 key informant interviews followed by an online survey targeting 17 freshwater biodiversity experts and another targeting a representative sample of 550 urban residents, to identify and prioritize the most promising resident behaviors to target to reduce stormwater pollution and improve natural waterway habitats in urban areas. Study 2 focused on the top-ranked short-term behavior identified in Study 1, citizen reporting of pollution in stormwater drains and waterways. We surveyed a representative sample of 1901 urban residents across Aoteraoa New Zealand to identify four main determinants influencing this behavior: awareness and uncertainty about reporting, lack of opportunity to report, social motivation and personal motivation to report, and five potential target audiences: 'Supportive', 'Unaware but receptive', 'Motivated but lack support', 'Reluctant', and 'Not my problem'. We make recommendations for the most appropriate intervention designs to target each of these audience segments to promote the reporting of stormwater pollution in urban areas. This knowledge will allow for a more coordinated and effective approach for addressing the 'human element' that lies at the heart of many urban freshwater management problems.
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Affiliation(s)
- Lynette J McLeod
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand.
| | - Donald W Hine
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Taciano L Milfont
- Ministry for the Environment and School of Psychology, University of Waikato, Tauranga, New Zealand
| | - Zack Dorner
- Department of Environment Management, Lincoln University, Lincoln, New Zealand
| | - Natasha A Tassell-Matamua
- Centre for Indigenous Psychologies, School of Psychology, Massey University, Manawatū, New Zealand; Te Ātiawa, Ngāti Makea kei Rarotonga, New Zealand
| | - Robbie D C Maris
- Waikato Management School, University of Waikato, Hamilton, New Zealand
| | - Jane C Kitson
- Kitson Consulting Ltd, Invercargill, New Zealand; Waitaha, Kāti Māmoe, Ngāi Tahu, New Zealand
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Collier ES, Blomqvist J, Crawford J, McCambridge J, Bendtsen M. Exploratory mixed methods analysis of self-authored content from participants in a digital alcohol intervention trial. Subst Abuse Treat Prev Policy 2023; 18:60. [PMID: 37898782 PMCID: PMC10613385 DOI: 10.1186/s13011-023-00569-4] [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: 06/29/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Digital interventions readily permit data capture of participant engagement with them. If future interventions are intended to be more interactive, tailored, or a useful resource offered to users, it may be valuable to examine such data. One module available in a digital alcohol intervention recently tested in a randomised control trial offered participants the opportunity to self-author prompts that were sent to them by a text message at a time of their choosing. This study thus aimed to evaluate these self-authored prompts to increase knowledge on how individuals negotiate behaviour change and assess whether intervention content can be improved in the future. METHODS The self-authored prompts were evaluated qualitatively using a combination of content and thematic analysis. The identified themes and subcategories are exemplified using anonymized quotes, and the frequency that each identified theme was coded for among the prompts was calculated. Associations between baseline characteristics and the odds of authoring a prompt at all, as well as a prompt within each theme, were investigated using logistic regression. RESULTS Five themes were identified (Encouragement Style, Level of Awareness, Reminders of reasons to reduce/quit, Strategies to reduce/quit, and Timescale), all with several subcategories. The prompts module was more likely to be used by women and older individuals, as well as those for whom reducing alcohol consumption was perceived as important, or who felt they had the know-how to do so. Participants who had immediate access to the support tool (intervention group) were more than twice as likely to author a prompt (OR = 2.36; probability of association > 99%) compared to those with 4-month delayed access (control group). CONCLUSIONS Individuals who engaged with the prompts module showed evidence of using the information provided in the support tool in an active way, with several showing goal setting and making plans to change their drinking behaviour. Individuals also used this opportunity to remind themselves of personal and specific reasons they wanted to change their drinking, as well as to encourage themselves to do so.
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Affiliation(s)
- Elizabeth S Collier
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden.
- Division of Bioeconomy and Health, Perception and Design Unit, RISE Research Institutes of Sweden, Stockholm, 114 28, Sweden.
| | - Jenny Blomqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden
| | - Joel Crawford
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, United Kingdom
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden
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Keyworth C, Quinlivan L, Leather JZ, O'Connor RC, Armitage CJ. Does refining an intervention based on participant feedback increase acceptability? An experimental approach. BMC Public Health 2023; 23:1598. [PMID: 37608317 PMCID: PMC10463387 DOI: 10.1186/s12889-023-16344-w] [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: 01/23/2023] [Accepted: 07/19/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Participant feedback is an important consideration for increasing intervention acceptability, yet whether incorporating such feedback actually improves acceptability is rarely tested. PURPOSE The present study describes a theory-based approach to assessing whether refining an intervention based on participant feedback increases acceptability. METHODS Three hundred and ninety-three UK adults who had previously self-harmed were exposed to the same intervention at baseline and, six months later, were randomly allocated to receive either: (a) the same version of the intervention (control group), or (b) a version of the intervention that had been refined following participant feedback (experimental group). The main outcome measure was acceptability ratings for each of the seven domains specified in the Theoretical Framework of Acceptability (TFA). RESULTS Mixed ANOVAs, with control versus experimental group as the between-participants factor and time (baseline versus follow-up) as the within participants factor showed no significant changes in acceptability. CONCLUSIONS The null effects reported here imply that participants found both the original and modified versions of the intervention equally acceptable, and that our process of refining an intervention based on participant feedback did not impact on acceptability. Nevertheless, we have operationalised a robust approach for examining whether participant feedback impacts on the acceptability of an intervention. Further research is required to understand better how participant feedback should be incorporated into the development of healthcare interventions.
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Affiliation(s)
- Chris Keyworth
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Jessica Z Leather
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
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Passero L, Srinivasan S, Grewe ME, Leeman J, Berg J, Reuland D, Roberts MC. Development and initial testing of a multi-stakeholder intervention for Lynch syndrome cascade screening: an intervention mapping approach. BMC Health Serv Res 2022; 22:1411. [PMID: 36434579 PMCID: PMC9694070 DOI: 10.1186/s12913-022-08732-6] [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: 04/22/2022] [Accepted: 10/25/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Lynch syndrome is an underdiagnosed hereditary condition carrying an increased lifetime risk for colorectal and endometrial cancer and affecting nearly 1 million people in the United States. Cascade screening, systematic screening through family members of affected patients, could improve identification of Lynch syndrome, but this strategy is underused due to multi-level barriers including low knowledge about Lynch syndrome, low access to genetics services, and challenging family dynamics. METHODS We used intervention mapping, a 6-step methodology to create stakeholder-driven interventions that meet the needs of a target population, to develop an intervention to improve cascade screening for Lynch syndrome. The intervention development process was guided by input from key stakeholders in Lynch syndrome care and patients. We conducted usability testing on the intervention with Lynch syndrome patients using qualitative semi-structured interviewing and rapid qualitative analysis. RESULTS We developed a workbook intervention named Let's Talk that addresses gaps in knowledge, skills, self-efficacy, outcome expectancy and other perceived barriers to cascade screening for Lynch syndrome. Let's Talk contained educational content, goal setting activities, communication planning prompts and supplemental resources for patients to plan family communication. Evidence-based methods used in the workbook included information chunking, guided practice, goal setting and gain-framing. We conducted usability testing focused on the complexity and relative advantage of the intervention through 45-min virtual interviews with 10 adult patients with Lynch syndrome recruited from a national advocacy organization in the United States. Usability testing results suggested the intervention was acceptable in terms of complexity and relative advantage to other available resources, but additional information for communication with young or distant family members and a web-based platform could enhance the intervention's usability. CONCLUSIONS Intervention mapping provided a framework for intervention development that addressed the unique needs of Lynch syndrome patients in overcoming barriers to cascade screening. Future work is needed to transform Let's Talk into a web-based tool and evaluate the effectiveness of the intervention in clinical practice with patients and genetic counselors. Intervention mapping can be useful to researchers as an evidence-based technique to develop stakeholder-centered interventions for addressing the needs of other unique populations.
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Affiliation(s)
- Lauren Passero
- grid.10698.360000000122483208Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC Chapel Hill, US
| | - Swetha Srinivasan
- grid.10698.360000000122483208Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC Chapel Hill, US
| | - Mary E. Grewe
- grid.10698.360000000122483208North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, NC Chapel Hill, US
| | - Jennifer Leeman
- grid.10698.360000000122483208School of Nursing, University of North Carolina at Chapel Hill, NC Chapel Hill, US
| | - Jonathan Berg
- grid.10698.360000000122483208School of Medicine, University of North Carolina at Chapel Hill, NC Chapel Hill, US
| | - Daniel Reuland
- grid.10698.360000000122483208School of Medicine, University of North Carolina at Chapel Hill, NC Chapel Hill, US
| | - Megan C. Roberts
- grid.10698.360000000122483208Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC Chapel Hill, US
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Kókai LL, van der Bijl MF, Hagger MS, Ó Ceallaigh DT, Rohde KIM, van Kippersluis H, Burdorf A, Duvekot JJ, van Lennep JER, Wijtzes AI. Needs and preferences of women with prior severe preeclampsia regarding app-based cardiovascular health promotion. BMC Womens Health 2022; 22:427. [PMID: 36309668 DOI: 10.1186/s12905-022-02004-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/29/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Women with prior severe preeclampsia are at an increased risk for cardiovascular diseases later in life compared to women who had a normotensive pregnancy. The objective of this study was to assess their needs and preferences regarding app-based cardiovascular health promotion. METHODS Patients (n = 35) of the Follow-Up PreEClampsia Outpatient Clinic (FUPEC), Erasmus MC, the Netherlands, participated in an anonymous online survey. The main outcomes under study were women's needs for health behavior promotion, and their preferences with respect to intervention delivery. Descriptive statistics were used to evaluate needs, and thematic analysis was used to analyze preferences. RESULTS Women's primary need for health behavior promotion pertained to their fat and sugar intake and physical activity; for some, to their mental health (practices), fruit and vegetable intake, salt intake, and water intake; and for a few, to their alcohol and tobacco use. Most women preferred an app-based intervention to include, in descending order: the tracking of health-related metrics, an interactive platform, the use of behavior change strategies, the provision of information, and personalization. CONCLUSION Cardiovascular health promotion targeting women with prior severe preeclampsia should feel relevant to its audience. App-based interventions are likely to be well received if they target fat and sugar intake and physical activity. These interventions should preferably track health-related metrics, be interactive, contain behavior change strategies, provide information, and be personalized. Adopting these findings during intervention design could potentially increase uptake, behavior change, and behavior change maintenance in this population.
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Middleton N, Hadjigeorgiou E, Kolokotroni O, Christodoulides V, Koliandri I, Nicolaou C, Papadopoulou M, Kouta C, Karanikola M, Baum A. Identifying barriers to the educational role of midwives in Cyprus and defining determinants in behaviour terms using the Behaviour Change Wheel: a mixed-method formative study. BMC Health Serv Res 2022; 22:1233. [PMID: 36199135 PMCID: PMC9534462 DOI: 10.1186/s12913-022-08599-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/23/2022] [Indexed: 12/01/2022] Open
Abstract
Background Τhe Baby Buddy Cyprus webapp was co-created with parents and health professionals within a Participatory Action Research framework. While using Baby Buddy in routine consultations can support the educational role of mother–child healthcare providers (HP), antenatal education (AE) may be currently perceived as a formal activity within the physical space of the antenatal class. We aimed to gain an understanding of influences on midwives engaging in an educational role during routine appointments and identify potential interventions using the Behaviour Change Wheel (BCW) framework. Methods This is a formative mixed-methods research study, with a convergent parallel design, guided by the COM-B model and related Theoretical Domains Framework (TDF). Complimentary methods were used to collect information from in-training and registered midwives: focus group (N = 11), questionnaire survey (N = 24) and Nominal Group Technique during workshops (N = 40). Deductive content analysis of qualitative data and quantitative survey analysis shaped the behaviour diagnosis along the 6 COM-B and 14 TDF domains, and informed the selection of relevant intervention functions and related Behaviour Change Techniques from the BCW taxonomy. Results AE is viewed as a core function of the professional role, yet neither supported nor prioritized by current practices. Problematic areas relate to organizational context, such as weak interprofessional collaboration and lack of policy, protocols and resources. In addition, medicalization of birth and related socio-cultural norms, pertaining to users and providers, are sustaining alienation of the midwife and conditions of power dynamics. AE was perceived as a means to enhance the autonomy of the profession but there might be issues with procedural knowledge and the need for skill development was identified. Several intervention functions were identified as promising, however cognitive re-framing through strategic communication and modelling may also be needed both in terms of providing “credible models” for the role itself as well as re-framing AE through the concept of “making every contact count”. Conclusions AE is currently perceived to be a ‘bad fit’ with routine practice. The study identified several barriers to the educational role of midwives, influencing Capacity, Opportunity and Motivation. While digital tools, such as Baby Buddy, can facilitate aspects of the process, a much wider behaviour and system change intervention is needed to enhance midwives’ educational role and professional identity. In addition to proposing a theory-driven research-informed intervention, the process functioned as a participatory learning experience through collective reflection. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08599-7.
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Affiliation(s)
- Nicos Middleton
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus. .,Birth Forward, Non-Governmental Organization, Nicosia, Cyprus.
| | - Eleni Hadjigeorgiou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Ourania Kolokotroni
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.,Birth Forward, Non-Governmental Organization, Nicosia, Cyprus.,Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Ioanna Koliandri
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Christiana Nicolaou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Maria Papadopoulou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Christiana Kouta
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Maria Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Alison Baum
- Best Beginnings, Registered Charity Organization, London, UK
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Wang V, D’Adolf J, Decosimo K, Robinson K, Choate A, Bruening R, Sperber N, Mahanna E, Van Houtven CH, Allen KD, Colón-Emeric C, Damush TM, Hastings SN. Adapting to CONNECT: modifying a nursing home-based team-building intervention to improve hospital care team interactions, functioning, and implementation readiness. BMC Health Serv Res 2022; 22:968. [PMID: 35906589 PMCID: PMC9335996 DOI: 10.1186/s12913-022-08270-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/29/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Clinical interventions often need to be adapted from their original design when they are applied to new settings. There is a growing literature describing frameworks and approaches to deploying and documenting adaptations of evidence-based practices in healthcare. Still, intervention modifications are often limited in detail and justification, which may prevent rigorous evaluation of interventions and intervention adaptation effectiveness in new contexts. We describe our approach in a case study, combining two complementary intervention adaptation frameworks to modify CONNECT for Quality, a provider-facing team building and communication intervention designed to facilitate implementation of a new clinical program. METHODS This process of intervention adaptation involved the use of the Planned Adaptation Framework and the Framework for Reporting Adaptations and Modifications, for systematically identifying key drivers, core and non-core components of interventions for documenting planned and unplanned changes to intervention design. RESULTS The CONNECT intervention's original context and setting is first described and then compared with its new application. This lays the groundwork for the intentional modifications to intervention design, which are developed before intervention delivery to participating providers. The unpredictable nature of implementation in real-world practice required unplanned adaptations, which were also considered and documented. Attendance and participation rates were examined and qualitative assessment of reported participant experience supported the feasibility and acceptability of adaptations of the original CONNECT intervention in a new clinical context. CONCLUSION This approach may serve as a useful guide for intervention implementation efforts applied in diverse clinical contexts and subsequent evaluations of intervention effectiveness. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov ( NCT03300336 ) on September 28, 2017.
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Affiliation(s)
- Virginia Wang
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University School of Medicine, Durham, NC USA
| | - Joshua D’Adolf
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA
| | - Kasey Decosimo
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA
| | - Katina Robinson
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA
| | - Ashley Choate
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA
| | - Rebecca Bruening
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA
| | - Nina Sperber
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
| | - Elizabeth Mahanna
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA
| | - Courtney H. Van Houtven
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
| | - Kelli D. Allen
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA ,grid.10698.360000000122483208Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Cathleen Colón-Emeric
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University School of Medicine, Durham, NC USA ,grid.512153.1Geriatric Research Education and Clinical Center, Durham VA Health Care System, Durham, NC USA
| | - Teresa M. Damush
- grid.280828.80000 0000 9681 3540Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, IN USA ,grid.257413.60000 0001 2287 3919Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN USA ,grid.448342.d0000 0001 2287 2027Regenstrief Institute, Inc., Indianapolis, IN USA
| | - Susan N. Hastings
- grid.512153.1Health Services Research and Development Center of Innovation, Durham VA Health Care System, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University School of Medicine, Durham, NC USA ,grid.10698.360000000122483208Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.26009.3d0000 0004 1936 7961Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC USA
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Baker A, Cornwell P, Gustafsson L, Stewart C, Lannin NA. Developing tailored theoretically informed goal-setting interventions for rehabilitation services: a co-design approach. BMC Health Serv Res 2022; 22:811. [PMID: 35733190 PMCID: PMC9214993 DOI: 10.1186/s12913-022-08047-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background Several active ingredients contribute to the purposes and mechanisms of goal-setting in rehabilitation. Active ingredients in the goal-setting process include, interdisciplinary teamworking, shared decision-making, having meaningful and specific goals, and including action planning, coping planning, feedback, and review. Clinicians have expressed barriers and enablers to implementing these active ingredients in rehabilitation teams. Interventions designed to improve goal-setting practices need to be tailored to address context specific barriers and enablers. Attempts to understand and enhance goal-setting practices in rehabilitation settings should be supported using theory, process models and determinant frameworks. Few studies have been undertaken to enhance goal-setting practices in varied case-mix rehabilitation settings. Methods This study is part of a larger program of research guided by the Knowledge to Action (KTA) framework. A multisite, participatory, codesign approach was used in five sites to address three stages of the KTA. (1) Focus groups were conducted to understand barriers and enablers to implementing goal-setting at each site. Following the focus groups three staff co-design workshops and one consumer workshop were run at each site to (2) adapt knowledge to local context, and to (3) select and tailor interventions to improve goal-setting practices. Focus groups were analysed using the Theoretical Domains Framework (TDF) and informed the selection of behaviour change techniques incorporated into the implementation plan. Results Barriers and enablers identified in this study were consistent with previous research. Clinicians lacked knowledge and understanding of the differences between a goal and an action plan often confusing both terms. Clinicians were unable to demonstrate an understanding of the importance of comprehensive action planning and review processes that extended beyond initial goal-setting. Interventions developed across the sites included staff training modules, a client held workbook, educational rehabilitation service flyers, interdisciplinary goal-based case conference templates, communication goal boards and a key worker model. Implementation plans were specifically established for each site. Conclusions Rehabilitation teams continue to struggle to incorporate a truly client-centred, interdisciplinary model of goal-setting in rehabilitation. Whilst clinicians continue to lack understanding of how they can use aspects of goal-setting to enhance client outcomes and autonomy in rehabilitation settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08047-6.
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Affiliation(s)
- Amanda Baker
- School of Allied Health Sciences, Griffith University, Brisbane, Australia. .,Clinical Excellence Division, Statewide Rehabilitation Clinical Network, Queensland Health, Brisbane, Australia. .,Physiotherapy Department, Sunshine Coast University Hospital, Allied Health, Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD, Australia.
| | - Petrea Cornwell
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Louise Gustafsson
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Claire Stewart
- Physiotherapy Department, Sunshine Coast University Hospital, Allied Health, Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
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11
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Nixon LS, Hudson N, Culley L, Lakhanpaul M, Robertson N, Johnson MRD, McFeeters M, Johal N, Hamlyn-Williams C, Boo YY, Lakhanpaul M. Key considerations when involving children in health intervention design: reflections on working in partnership with South Asian children in the UK on a tailored Management and Intervention for Asthma (MIA) study. Res Involv Engagem 2022; 8:9. [PMID: 35227322 PMCID: PMC8883750 DOI: 10.1186/s40900-022-00342-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
Participatory research is an empowering process through which individuals can increase control over their lives, and allows researchers/clinicians to gain a clearer understanding of a child's needs. However, involving children in participatory research is still relatively novel, despite national and international mandates to engage children in decision making. This paper draws on the learnings from designing the Management and Intervention for Asthma (MIA) study, which used a collaborative participatory method to develop an intervention-planning framework for South Asian children with asthma. There are currently 1 million children in the UK receiving treatment for asthma, making it one of the most prevalent chronic childhood illnesses. Symptoms of asthma are often underrecognized in children from South Asian communities in the UK, contributing to increased disease severity and increased attendance at the emergency department compared to White British children. Despite this, ethnic minorities are often excluded from research and thus absent from the 'evidence base', making it essential to hear their perspectives if health inequalities are to be successfully addressed. We worked alongside healthcare professionals, community facilitators, parents, and children to identify the key concerns and priorities they had and then designed the framework around their needs. Reflecting on the process, we identified several key considerations that need to be addressed when co-developing interventions with children. These include the power dynamics between the parent/researcher and child; navigating the consent/assent process; how parental involvement might affect the research; establishing a convenient time and location; how to keep children engaged throughout the process; tailoring activities to different levels of ability; and accounting for cultural differences. These factors were considered by the researchers when designing the study, however, implementing them was not without its challenges and highlighted the need for researchers to develop expertise in this field. Tailoring existing research methods allowed us to explore children's perceptions, priorities, and experiences of illness more effectively. However, involving children in participatory research is a complex undertaking, and researchers need to ensure that they have the expertise, time, and resources necessary to be able to fully support the needs of child participants before deciding to commit to this approach.
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Affiliation(s)
- Laura S. Nixon
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Nicky Hudson
- School of Applied Social Sciences, De Montfort University, Leicester, UK
| | - Lorraine Culley
- School of Applied Social Sciences, De Montfort University, Leicester, UK
| | - Maya Lakhanpaul
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Noelle Robertson
- Department of Neuroscience Psychology and Behaviour, University of Leicester, Leicester, UK
| | | | - Melanie McFeeters
- NHS England, Direct Commissioning, Midlands Region, Leicestershire, UK
| | | | | | - Yebeen Ysabelle Boo
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
- Aceso Global Health Consultants Ltd., London, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
- Community Paediatrics, Whittington NHS Trust, London, UK
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12
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Bohlen LC, Michie S, de Bruin M, Rothman AJ, Kelly MP, Groarke HNK, Carey RN, Hale J, Johnston M. Do Combinations of Behavior Change Techniques That Occur Frequently in Interventions Reflect Underlying Theory? Ann Behav Med 2021; 54:827-842. [PMID: 32959875 PMCID: PMC7646153 DOI: 10.1093/abm/kaaa078] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Behavioral interventions typically include multiple behavior change techniques (BCTs). The theory informing the selection of BCTs for an intervention may be stated explicitly or remain unreported, thus impeding the identification of links between theory and behavior change outcomes. PURPOSE This study aimed to identify groups of BCTs commonly occurring together in behavior change interventions and examine whether behavior change theories underlying these groups could be identified. METHODS The study involved three phases: (a) a factor analysis to identify groups of co-occurring BCTs from 277 behavior change intervention reports; (b) examining expert consensus (n = 25) about links between BCT groups and behavioral theories; (c) a comparison of the expert-linked theories with theories explicitly mentioned by authors of the 277 intervention reports. RESULTS Five groups of co-occurring BCTs (range: 3-13 BCTs per group) were identified through factor analysis. Experts agreed on five links (≥80% of experts), comprising three BCT groups and five behavior change theories. Four of the five BCT group-theory links agreed by experts were also stated by study authors in intervention reports using similar groups of BCTs. CONCLUSIONS It is possible to identify groups of BCTs frequently used together in interventions. Experts made shared inferences about behavior change theory underlying these BCT groups, suggesting that it may be possible to propose a theoretical basis for interventions where authors do not explicitly put forward a theory. These results advance our understanding of theory use in multicomponent interventions and build the evidence base for further understanding theory-based intervention development and evaluation.
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Affiliation(s)
- Lauren Connell Bohlen
- Department of Clinical, Educational and Health Psychology, University College London, Torrington Place, London, UK.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, Torrington Place, London, UK
| | - Marijn de Bruin
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK.,Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, Netherlands
| | | | - Michael P Kelly
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Hilary N K Groarke
- Department of Clinical, Educational and Health Psychology, University College London, Torrington Place, London, UK
| | - Rachel N Carey
- Department of Clinical, Educational and Health Psychology, University College London, Torrington Place, London, UK
| | - Joanna Hale
- Department of Clinical, Educational and Health Psychology, University College London, Torrington Place, London, UK
| | - Marie Johnston
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
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13
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Nalule Y, Buxton H, Ir P, Leang S, Macintyre A, Pors P, Samol C, Dreibelbis R. Hand hygiene during facility-based childbirth in Cambodia: a theory-driven, mixed-methods observational study. BMC Pregnancy Childbirth 2021; 21:429. [PMID: 34139995 PMCID: PMC8212449 DOI: 10.1186/s12884-021-03901-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022] Open
Abstract
Background Despite current efforts to improve hand hygiene in health care facilities, compliance among birth attendants remains low. Current improvement strategies are inadequate, largely focusing on a limited set of known behavioural determinants or addressing hand hygiene as part of a generalized set of hygiene behaviours. To inform the design of a facility –based hand hygiene behaviour change intervention in Kampong Chhnang, Cambodia, a theory-driven formative research study was conducted to investigate the context specific behaviours and determinants of handwashing during labour and delivery among birth attendants. Methods This formative mixed-methods research followed a sequential explanatory design and was conducted across eight healthcare facilities. The hand hygiene practices of all birth attendants present during the labour and delivery of 45 women were directly observed and compliance with hand hygiene protocols assessed in analysis. Semi-structured, interactive interviews were subsequently conducted with 20 key healthcare workers to explore the corresponding cognitive, emotional, and environmental drivers of hand hygiene behaviours. Results Birth attendants’ compliance with hand hygiene protocol was 18% prior to performing labour, delivery and newborn aftercare procedures. Hand hygiene compliance did not differ by facility type or attendants’ qualification, but differed by shift with adequate hand hygiene less likely to be observed during the night shift (p = 0.03). The midwives’ hand hygiene practices were influenced by cognitive, psychological, environmental and contextual factors including habits, gloving norms, time, workload, inadequate knowledge and infection risk perception. Conclusion The resulting insights from formative research suggest a multi-component improvement intervention that addresses the different key behaviour determinants to be designed for the labour and delivery room. A combination of disruption of the physical environment via nudges and cues, participatory education to the midwives and the promotion of new norms using social influence and affiliation may increase the birth attendants’ hand hygiene compliance in our study settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03901-7.
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Affiliation(s)
- Yolisa Nalule
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - Helen Buxton
- Division of Psychiatry, University College London, London, W1T 7BN, UK
| | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Supheap Leang
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | | | | | - Robert Dreibelbis
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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14
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Hawkes RE, Miles LM, French DP. The theoretical basis of a nationally implemented type 2 diabetes prevention programme: how is the programme expected to produce changes in behaviour? Int J Behav Nutr Phys Act 2021; 18:64. [PMID: 33985524 PMCID: PMC8117267 DOI: 10.1186/s12966-021-01134-7] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It is considered best practice to provide clear theoretical descriptions of how behaviour change interventions should produce changes in behaviour. Commissioners of the National Health Service Diabetes Prevention Programme (NHS-DPP) specified that the four independent provider organisations must explicitly describe the behaviour change theory underpinning their interventions. The nationally implemented programme, launched in 2016, aims to prevent progression to Type 2 diabetes in high-risk adults through changing diet and physical activity behaviours. This study aimed to: (a) develop a logic model describing how the NHS-DPP is expected to work, and (b) document the behaviour change theories underpinning providers' NHS-DPP interventions. METHODS A logic model detailing how the programme should work in changing diet and activity behaviours was extracted from information in three specification documents underpinning the NHS-DPP. To establish how each of the four providers expected their interventions to produce behavioural changes, information was extracted from their programme plans, staff training materials, and audio-recorded observations of mandatory staff training courses attended in 2018. All materials were coded using Michie and Prestwich's Theory Coding Scheme. RESULTS The NHS-DPP logic model included information provision to lead to behaviour change intentions, followed by a self-regulatory cycle including action planning and monitoring behaviour. None of the providers described an explicit logic model of how their programme will produce behavioural changes. Two providers stated their programmes were informed by the COM-B (Capability Opportunity Motivation - Behaviour) framework, the other two described targeting factors from multiple theories such as Self-Regulation Theory and Self-Determination Theory. All providers cited examples of proposed links between some theoretical constructs and behaviour change techniques (BCTs), but none linked all BCTs to specified constructs. Some discrepancies were noted between the theory described in providers' programme plans and theory described in staff training. CONCLUSIONS A variety of behaviour change theories were used by each provider. This may explain the variation between providers in BCTs selected in intervention design, and the mismatch between theory described in providers' programme plans and staff training. Without a logic model describing how they expect their interventions to work, justification for intervention contents in providers' programmes is not clear.
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Affiliation(s)
- Rhiannon E. Hawkes
- Manchester Centre of Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Lisa M. Miles
- Manchester Centre of Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - David P. French
- Manchester Centre of Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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15
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Ahamad MG, Tanin F. Mental model-based repeated multifaceted (MRM) intervention design: a conceptual framework for improving preventive health behaviors and outcomes. BMC Res Notes 2021; 14:103. [PMID: 33741049 PMCID: PMC7977269 DOI: 10.1186/s13104-021-05516-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Field interventions employed to improve preventive health behaviors and outcomes generally use well-established approaches; however, recent studies have reported that health education and promotional interventions have little to no impact on health behaviors, especially in low- and middle-income countries. We aimed to develop a conceptual framework to improve intervention designs that would internalize these concerns and limitations. Results We identified three major experimental design- and implementation-related concerns associated with mental models, including the balance between the treatment and control groups, the treatment group’s willingness to adopt suggested behaviors, and the type, length, frequency, intensity, and sequence of treatments. To minimize the influence of these aspects of an experimental design, we proposed a mental model-based repeated multifaceted (MRM) intervention design framework, which represents a supportive intervention design for the improvement of health education and promotional programs. The framework offers a step-by-step method that can be used for experimental and treatment design and outcome analysis, and that addresses potential implementation challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05516-9.
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Affiliation(s)
- Mazbahul G Ahamad
- University of Nebraska-Lincoln, 140 Keim Hall, 1825 N 38th St, Lincoln, NE, 68583, USA.
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16
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Patey AM, Grimshaw JM, Francis JJ. Changing behaviour, 'more or less': do implementation and de-implementation interventions include different behaviour change techniques? Implement Sci 2021; 16:20. [PMID: 33632274 PMCID: PMC7905859 DOI: 10.1186/s13012-021-01089-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Decreasing ineffective or harmful healthcare practices (de-implementation) may require different approaches than those used to promote uptake of effective practices (implementation). Few psychological theories differentiate between processes involved in decreasing, versus increasing, behaviour. However, it is unknown whether implementation and de-implementation interventions already use different approaches. We used the behaviour change technique (BCT) taxonomy (version 1) (which includes 93 BCTs organised into 12 groupings) to investigate whether implementation and de-implementation interventions for clinician behaviour change use different BCTs. METHODS Intervention descriptions in 181 articles from three systematic reviews in the Cochrane Library were coded for (a) implementation versus de-implementation and (b) intervention content (BCTs) using the BCT taxonomy (v1). BCT frequencies were calculated and compared using Pearson's chi-squared (χ2), Yates' continuity correction and Fisher's exact test, where appropriate. Identified BCTs were ranked according to frequency and rankings for de-implementation versus implementation interventions were compared and described. RESULTS Twenty-nine and 25 BCTs were identified in implementation and de-implementation interventions respectively. Feedback on behaviour was identified more frequently in implementation than de-implementation (Χ2(2, n=178) = 15.693, p = .000057). Three BCTs were identified more frequently in de-implementation than implementation: Behaviour substitution (Χ2(2, n=178) = 14.561, p = .0001; Yates' continuity correction); Monitoring of behaviour by others without feedback (Χ2(2, n=178) = 16.187, p = .000057; Yates' continuity correction); and Restructuring social environment (p = .000273; Fisher's 2-sided exact test). CONCLUSIONS There were some significant differences between BCTs reported in implementation and de-implementation interventions suggesting that researchers may have implicit theories about different BCTs required for de-implementation and implementation. These findings do not imply that the BCTs identified as targeting implementation or de-implementation are effective, rather simply that they were more frequently used. These findings require replication for a wider range of clinical behaviours. The continued accumulation of additional knowledge and evidence into whether implementation and de-implementation is different will serve to better inform researchers and, subsequently, improve methods for intervention design.
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Affiliation(s)
- Andrea M Patey
- School of Health Sciences, City, University of London, 10 Northampton Square, London, EC1V 0HB, UK. .,Centre of Implementation Research, Ottawa Hospital Research Institute - General Campus, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.
| | - Jeremy M Grimshaw
- Centre of Implementation Research, Ottawa Hospital Research Institute - General Campus, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Jill J Francis
- School of Health Sciences, City, University of London, 10 Northampton Square, London, EC1V 0HB, UK.,Centre of Implementation Research, Ottawa Hospital Research Institute - General Campus, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Health Sciences, University of Melbourne, Melbourne, Victoria, 3010, Australia
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17
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Sands M, Aunger R. Development of a behaviour change intervention using a theory-based approach, Behaviour Centred Design, to increase nurses' hand hygiene compliance in the US hospitals. Implement Sci Commun 2021; 2:23. [PMID: 33602328 PMCID: PMC7893924 DOI: 10.1186/s43058-021-00124-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/01/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A behaviour change campaign is unlikely to be effective if its intervention is not carefully designed. While numerous frameworks are widely used to develop and evaluate interventions, the steps detailing how to create an intervention are not as clear because the process of linking behaviour analysis to the intervention design is seldom discussed. We document the application of the Behaviour Centred Design (BCD) approach to the development of an intervention to improve hand hygiene (HH) rates among nurses' hospital units in the USA. METHODS Intervention development is divided into the first three steps of the BCD approach: Assess, Build, and Create. The Assess step centres on understanding the target behaviour. The Build step expands the knowledge of the target behaviour and population through formative research which leads to a creative brief that explains the focus of the intervention. In the Create step, the creative brief guides the intervention design. RESULTS Drawing from the main findings of the Asses and Build steps, a focal insight was developed positing that nurses can rediscover the meaning and purpose of their role as a nurse and thus as a caregiver by practicing HH; in the process of cleaning their hands, nurses are living up to their ideal nurse-self. The focal insight was linked linguistically into a theory and change. The outcome was a simple intervention, called the Mainspring Intervention, which consisted of three major parts: a self-affirmation exercise to reduce defensiveness, a message that challenged nurses' perceptions about their HH practice, and an implementation intention activity to help nurses link HH behaviour to a cue. CONCLUSIONS We detailed the creation of an original HH intervention that used the BCD approach. The intervention is relatively simple compared to most HH initiatives in the literature, both in terms of having relatively few components to the intervention and relatively easy field implementation. This intervention will allow us to test how specific psychological processes contribute to the problem of low HH rates, how our proposed intervention changes these processes in the hospital setting, and how the expected change in nurses' cognition transforms over time because of the intervention.
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Affiliation(s)
- Madeline Sands
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
- University of Arizona College of Medicine, Tucson, Arizona USA
| | - Robert Aunger
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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18
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Lawani MA, Turgeon Y, Côté L, Légaré F, Witteman HO, Morin M, Kroger E, Voyer P, Rodriguez C, Giguere A. User-centered and theory-based design of a professional training program on shared decision-making with older adults living with neurocognitive disorders: a mixed-methods study. BMC Med Inform Decis Mak 2021; 21:59. [PMID: 33596874 PMCID: PMC7888116 DOI: 10.1186/s12911-021-01396-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We know little about the best approaches to design training for healthcare professionals. We thus studied how user-centered and theory-based design contribute to the development of a distance learning program for professionals, to increase their shared decision-making (SDM) with older adults living with neurocognitive disorders and their caregivers. METHODS In this mixed-methods study, healthcare professionals who worked in family medicine clinics and homecare services evaluated a training program in a user-centered approach with several iterative phases of quantitative and qualitative evaluation, each followed by modifications. The program comprised an e-learning activity and five evidence summaries. A subsample assessed the e-learning activity during semi-structured think-aloud sessions. A second subsample assessed the evidence summaries they received by email. All participants completed a theory-based questionnaire to assess their intention to adopt SDM. Descriptive statistical analyses and qualitative thematic analyses were integrated at each round to prioritize training improvements with regard to the determinants most likely to influence participants' intention. RESULTS Of 106 participants, 98 completed their evaluations of either the e-learning activity or evidence summary (93%). The professions most represented were physicians (60%) and nurses (15%). Professionals valued the e-learning component to gain knowledge on the theory and practice of SDM, and the evidence summaries to apply the knowledge gained through the e-learning activity to diverse clinical contexts. The iterative design process allowed addressing most weaknesses reported. Participants' intentions to adopt SDM and to use the summaries were high at baseline and remained positive as the rounds progressed. Attitude and social influence significantly influenced participants' intention to use the evidence summaries (P < 0.0001). Despite strong intention and the tailoring of tools to users, certain factors external to the training program can still influence the effective use of these tools and the adoption of SDM in practice. CONCLUSIONS A theory-based and user-centered design approach for continuing professional development interventions on SDM with older adults living with neurocognitive disorders and their caregivers appeared useful to identify the most important determinants of learners' intentions to use SDM in their practice, and validate our initial interpretations of learners' assessments during the subsequent evaluation round.
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Affiliation(s)
- Moulikatou Adouni Lawani
- Laval University, Pavillon Ferdinand-Vandry, Room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Yves Turgeon
- CISSS de la Gaspésie – Service externe de gériatrie ambulatoire, 455 rue Mgr Ross Est, Chandler, QC G0C 1K0 Canada
| | - Luc Côté
- Laval University, Pavillon Ferdinand-Vandry, Room 1323, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - France Légaré
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Pavillon Landry-Poulin, Door A-1-2, 4th floor, Room 4578, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
| | - Holly O. Witteman
- Laval University, Pavillon Ferdinand-Vandry, Room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Michèle Morin
- Laval University, Pavillon Ferdinand-Vandry, room 4211, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Edeltraut Kroger
- Quebec Excellence Centre in Aging, St-Sacrement Hospital, 1050 chemin Ste-Foy, Quebec, QC G1S 4L8 Canada
| | - Philippe Voyer
- Pavillon Ferdinand-Vandry, Room 3445, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Charo Rodriguez
- Departmentof Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC H3S 1Z1 Canada
| | - Anik Giguere
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 2nd floor, Room 2416, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
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19
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Nobles J, Summerbell C, Brown T, Jago R, Moore T. A secondary analysis of the childhood obesity prevention Cochrane Review through a wider determinants of health lens: implications for research funders, researchers, policymakers and practitioners. Int J Behav Nutr Phys Act 2021; 18:22. [PMID: 33563281 PMCID: PMC7874658 DOI: 10.1186/s12966-021-01082-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/06/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) are often regarded as the gold standard of evidence, and subsequently go on to inform policymaking. Cochrane Reviews synthesise this type of evidence to create recommendations for practice, policy, and future research. Here, we critically appraise the RCTs included in the childhood obesity prevention Cochrane Review to understand the focus of these interventions when examined through a wider determinants of health (WDoH) lens. METHODS We conducted a secondary analysis of the interventions included in the Cochrane Review on "Interventions for Preventing Obesity in Children", published since 1993. All 153 RCTs were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings against the 226 perceived causes of obesity. RESULTS The proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0-5 years, 6-12 years, 13-18 years). CONCLUSIONS This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which better accounts for the complexity of obesity.
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Affiliation(s)
- James Nobles
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
- Fuse, NIHR Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- The NIHR ARC North East & North Cumbria (NIHR ARC NENC), Newcastle upon Tyne, UK
| | - Tamara Brown
- Cochrane Vascular, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Russell Jago
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Theresa Moore
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Methods Support Unit, Editorial and Methods Department, Cochrane, London, UK
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Mooses K, Vihalemm T, Uibu M, Mägi K, Korp L, Kalma M, Mäestu E, Kull M. Developing a comprehensive school-based physical activity program with flexible design - from pilot to national program. BMC Public Health 2021; 21:92. [PMID: 33413288 PMCID: PMC7791753 DOI: 10.1186/s12889-020-10111-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/21/2020] [Indexed: 02/05/2023] Open
Abstract
This article focuses on the process of designing the vital, participatory school-based intervention program aiming to increase the physical activity in schools. The program analyzed is Estonian nationwide comprehensive physical activity program Schools in Motion (SiM) that recently received European Commission's #BeActive Education Award. The program has a good performance in terms of willingness of schools to participate in co-creation of program development, the high interest to join the program and zero dropouts, and strong partnership with ministries which enables to actively participate in policy making. Authors analyze the key elements of the planning, piloting, implementation, and scaling phases of the SiM program and share their lessons learnt in co-working with schools. The difficulties faced during the development process, the strengths and challenges associated with an interdisciplinary approach, and involvement of schools as experts have been addressed.
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Affiliation(s)
- Kerli Mooses
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Ujula 4, 51008, Tartu, Estonia.,Institute of Computer Science, Faculty of Science and Technology, University of Tartu, Narva mnt 18, 51009, Tartu, Estonia
| | - Triin Vihalemm
- Institute of Social Studies, Faculty of Social Sciences, University of Tartu, Lossi 36, 51003, Tartu, Estonia
| | - Marko Uibu
- Institute of Social Studies, Faculty of Social Sciences, University of Tartu, Lossi 36, 51003, Tartu, Estonia
| | - Katrin Mägi
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Ujula 4, 51008, Tartu, Estonia
| | - Leene Korp
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Ujula 4, 51008, Tartu, Estonia.,Institute of Social Studies, Faculty of Social Sciences, University of Tartu, Lossi 36, 51003, Tartu, Estonia
| | - Maarja Kalma
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Ujula 4, 51008, Tartu, Estonia
| | - Evelin Mäestu
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Ujula 4, 51008, Tartu, Estonia.
| | - Merike Kull
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Ujula 4, 51008, Tartu, Estonia
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21
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Burgermaster M, Rudel R, Seres D. Dietary Sodium Restriction for Heart Failure: A Systematic Review of Intervention Outcomes and Behavioral Determinants. Am J Med 2020; 133:1391-1402. [PMID: 32682866 PMCID: PMC7704603 DOI: 10.1016/j.amjmed.2020.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/04/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022]
Abstract
The 1500 mg/d dietary sodium restriction commonly recommended for patients with heart failure has recently been questioned. Poor adherence to sodium-restricted diets makes assessing the efficacy of sodium restriction challenging. Therefore, successful behavioral interventions are needed. We reviewed sodium restriction trials and descriptive studies of sodium restriction to: 1) determine if sodium restriction was achieved in interventions among heart failure patients; and 2) characterize predictors of successful dietary sodium restriction. Among 638 identified studies, 10 intervention trials, and 25 descriptive studies met inclusion criteria. We used content analysis to extract information about sodium restriction and behavioral determinants of sodium restriction. Dietary sodium was reduced in 7 trials; none achieved 1500 mg/d (range 1938-4564 mg/d). The interventions implemented in the interventional trials emphasized knowledge, skills, and self-regulation strategies, but few addressed the determinants correlated with successful sodium restriction in the descriptive studies (eg, social/cultural norms, social support, taste preferences, food access, self-efficacy). Findings suggest that incorporating determinants predictive of successful dietary sodium restriction may improve the success of interventional trials. Without effective interventions to deploy in trials, the safety and efficacy of sodium restriction remains unknown.
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Affiliation(s)
- Marissa Burgermaster
- Departments of Nutritional Sciences and Population Health, College of Natural Sciences and Dell Medical School, University of Texas at Austin.
| | | | - David Seres
- Department of Medicine, Columbia University Medical Center, New York, NY; Institute of Human Nutrition, Columbia University, New York, NY
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22
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Fahim C, Acai A, McConnell MM, Wright FC, Sonnadara RR, Simunovic M. Use of the theoretical domains framework and behaviour change wheel to develop a novel intervention to improve the quality of multidisciplinary cancer conference decision-making. BMC Health Serv Res 2020; 20:578. [PMID: 32580767 PMCID: PMC7313182 DOI: 10.1186/s12913-020-05255-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/27/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Multidisciplinary Cancer Conferences (MCCs) are prospective meetings involving cancer specialists to discuss treatment plans for patients with cancer. Despite reported gaps in MCC quality, there have been few efforts to improve its functioning. The purpose of this study was to use theoretically-rooted knowledge translation (KT) theories and frameworks to inform the development of a strategy to improve MCC decision-making quality. METHODS A multi-phased approach was used to design an intervention titled the KT-MCC Strategy. First, key informant interviews framed using the Theoretical Domains Framework (TDF) were conducted with MCC participants to identify barriers and facilitators to optimal MCC decision-making. Second, identified TDF domains were mapped to corresponding strategies using the COM-B Behavior Change Wheel to develop the KT-MCC Strategy. Finally, focus groups with MCC participants were held to confirm acceptability of the proposed KT-MCC Strategy. RESULTS Data saturation was reached at n = 21 interviews. Twenty-seven barrier themes and 13 facilitator themes were ascribed to 11 and 10 TDF domains, respectively. Differences in reported barriers by physician specialty were observed. The resulting KT-MCC Strategy included workshops, chair training, team training, standardized intake forms and a synoptic discussion checklist, and, audit and feedback. Focus groups (n = 3, participants 18) confirmed the acceptability of the identified interventions. CONCLUSION Myriad factors were found to influence MCC decision making. We present a novel application of the TDF and COM-B to the context of MCCs. We comprehensively describe the barriers and facilitators that impact MCC decision making and propose strategies that may positively impact the quality of MCC decision making.
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Affiliation(s)
- Christine Fahim
- Department of Health Research Methods, McMaster University, Evidence and Impact, Hamilton, ON, Canada. .,Johns Hopkins University, Bloomberg School of Public Health, Hampton House, Room 663, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Anita Acai
- Department of Surgery, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada
| | - Meghan M McConnell
- Department of Innovation in Medical Education, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - Frances C Wright
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto Room T2 057, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
| | - Ranil R Sonnadara
- Department of Surgery, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada
| | - Marko Simunovic
- Department of Health Research Methods, McMaster University, Evidence and Impact, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada
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Sommerich CM, Lavender SA, Evans KD, Sanders EBN, Joines S, Lamar S, Radin Umar RZ, Yen WT, Park S. Collaborating with radiographers to address their work-related musculoskeletal discomfort. Appl Ergon 2020; 85:103069. [PMID: 32174357 DOI: 10.1016/j.apergo.2020.103069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 01/20/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
The prevalence of musculoskeletal (MSK) symptoms in radiographers is high, similar to other healthcare occupations that involve high levels of physical exertion (e.g. patient handling; grasping and moving equipment). Reports of interventions to reduce MSK discomfort in radiographers are limited. A participatory approach was used to investigate daily challenges, needs, and opportunities for developing interventions to address exposures to many of the risk factors that contribute to MSK symptoms in radiographers. In this paper, we present the expressed needs of experienced radiographers (including assistance with patient handling, security, supportive design of equipment and work spaces), along with their evaluations of several intervention concepts intended to address some of those needs. We also report results from tests of three prototype interventions stemming from this participatory process that demonstrate the potential for new engineering control concepts to reduce the physical effort associated with some of the most common tasks radiographers perform.
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Affiliation(s)
- Carolyn M Sommerich
- College of Medicine, The Ohio State University, USA; College of Engineering, The Ohio State University, USA.
| | - Steven A Lavender
- College of Medicine, The Ohio State University, USA; College of Engineering, The Ohio State University, USA
| | - Kevin D Evans
- College of Medicine, The Ohio State University, USA.
| | | | - Sharon Joines
- North Carolina State University, School of Design, USA.
| | | | | | - Wei-Ting Yen
- College of Engineering, The Ohio State University, USA.
| | - SangHyun Park
- College of Engineering, The Ohio State University, USA.
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24
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Fletcher-Miles H, Gammon J, Williams S, Hunt J. A scoping review to assess the impact of public education campaigns to affect behavior change pertaining to antimicrobial resistance. Am J Infect Control 2020; 48:433-442. [PMID: 31444097 DOI: 10.1016/j.ajic.2019.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Years of global antibiotic misuse has led to the progression of antimicrobial resistance (AMR), posing a direct threat to public health. To impact AMR and maintain antimicrobial viability, educational interventions toward fostering positive AMR behavior change have been employed with some success. METHODS This scoping review sought to identify research-supporting use of public educational AMR campaigns, and their efficacy toward informing positive AMR behaviors to inform current debate. To enable credible and reflexive examination of a wide variety of literature, Arksey and O'Malley's (2005) methodological framework was used. RESULTS Three primary themes were identified: (1) behavior change and theoretical underpinnings, (2) intervention paradigm, and (3) educational engagement. From 94 abstracts identified, 31 articles were chosen for review. More attention is required to identify elements of intervention design that inform and sustain behavior change, and the impact of how an intervention is delivered and targeted is needed to limit assumptions of population homogeneity, which potentially limits intervention efficacy. Moreover, research on the impact of hospital-based inpatient interventions is needed. CONCLUSIONS The existing body of research fails to provide robust evidence to support sound evidential interventions supported by theoretical justifications. Furthermore, interventions to ensure long-term sustained behavior change are unclear and not addressed.
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Affiliation(s)
| | - John Gammon
- College of Human and Health Sciences, Swansea University, Wales, United Kingdom
| | - Sharon Williams
- College of Human and Health Sciences, Swansea University, Wales, United Kingdom
| | - Julian Hunt
- College of Human and Health Sciences, Swansea University, Wales, United Kingdom
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25
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Davis SM, Jones A, Jaynes ME, Woodrum KN, Canaday M, Allen L, Mallow JA. Designing a multifaceted telehealth intervention for a rural population using a model for developing complex interventions in nursing. BMC Nurs 2020; 19:9. [PMID: 32042264 PMCID: PMC7001246 DOI: 10.1186/s12912-020-0400-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Telehealth interventions offer an evidenced-based approach to providing cost-effective care, education, and timely communication at a distance. Yet, despite its widespread use, telehealth has not reached full potential, especially in rural areas, due to the complex process of designing and implementing telehealth programs. The objective of this paper is to explore the use of a theory-based approach, the Model for Developing Complex Interventions in Nursing, to design a pilot telehealth intervention program for a rural population with multiple chronic conditions. METHODS In order to develop a robust, evidenced based intervention that suits the needs of the community, stakeholders, and healthcare agencies involved, a design team comprised of state representatives, telehealth experts, and patient advocates was convened. Each design team meeting was guided by major model constructs (i.e., problem identification, defining the target population and objectives, measurement theory selection, building and planning the intervention protocol). Overarching the process was a review of the literature to ensure that the developed intervention was congruent with evidence-based practice and underlying the entire process was scope of practice considerations. RESULTS Ten design team meetings were held over a six-month period. An adaptive pilot intervention targeting home and community-based Medicaid Waiver Program participants in a rural environment with a primary objective of preventing re-institutionalizations was developed and accepted for implementation. To promote intervention effectiveness, asynchronous (i.e., remote patient monitoring) and synchronous (i.e., nursing assessment of pain and mental health and care coordination) telehealth approaches were selected to address the multiple comorbidities of the target population. An economic evaluation plan was developed and included in the pilot program to assess intervention cost efficiency. CONCLUSIONS The Model for Developing Complex Interventions in Nursing provided a simple, structured process for designing a multifaceted telehealth intervention to minimize re-institutionalization of participants with multiple chronic conditions. This structured process may promote efficient development of other complex telehealth interventions in time and resource constrained settings. This paper provides detailed examples of how the model was operationalized.
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Affiliation(s)
- Stephen M. Davis
- Department of Health Policy, Management, and Leadership, Robert C. Byrd Health Sciences Center, School of Public Health, West Virginia University, PO Box 9190, Morgantown, WV 26506-9190 USA
- Department of Emergency Medicine, West Virginia University, PO Box 9149, Morgantown, WV 26506 USA
| | - Amanda Jones
- Department of Health Policy, Management, and Leadership, Robert C. Byrd Health Sciences Center, School of Public Health, West Virginia University, PO Box 9190, Morgantown, WV 26506-9190 USA
| | - Margaret E. Jaynes
- Departments of Neurology & Pediatrics, West Virginia University, PO Box 9214, Morgantown, WV 26506 USA
| | - Kori N. Woodrum
- Department of Health Policy, Management, and Leadership, Robert C. Byrd Health Sciences Center, School of Public Health, West Virginia University, PO Box 9190, Morgantown, WV 26506-9190 USA
| | - Marcus Canaday
- Take Me Home, West Virginia, Bureau for Medical Services, Charleston, WV 25301 USA
| | - Lindsay Allen
- Department of Health Policy, Management, and Leadership, Robert C. Byrd Health Sciences Center, School of Public Health, West Virginia University, PO Box 9190, Morgantown, WV 26506-9190 USA
| | - Jennifer A. Mallow
- Adult Health Department, School of Nursing, West Virginia University, PO Box 9600, Morgantown, WV 26506 USA
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Biggs K, Hind D, Gossage-Worrall R, Sprange K, White D, Wright J, Chatters R, Berry K, Papaioannou D, Bradburn M, Walters SJ, Cooper C. Challenges in the design, planning and implementation of trials evaluating group interventions. Trials 2020; 21:116. [PMID: 31996259 PMCID: PMC6990578 DOI: 10.1186/s13063-019-3807-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Group interventions are interventions delivered to groups of people rather than to individuals and are used in healthcare for mental health recovery, behaviour change, peer support, self-management and/or health education. Evaluating group interventions in randomised controlled trials (RCTs) presents trialists with a set of practical problems, which are not present in RCTs of one-to-one interventions and which may not be immediately obvious. Methods Case-based approach summarising Sheffield trials unit’s experience in the design and implementation of five group interventions. We reviewed participant recruitment and attrition, facilitator training and attrition, attendance at the group sessions, group size and fidelity aspects across five RCTs. Results Median recruitment across the five trials was 3.2 (range 1.7–21.0) participants per site per month. Group intervention trials involve a delay in starting the intervention for some participants, until sufficient numbers are available to start a group. There was no evidence that the timing of consent, relative to randomisation, affected post-randomisation attrition which was a matter of concern for all trial teams. Group facilitator attrition was common in studies where facilitators were employed by the health system rather than the by the grant holder and led to the early closure of one trial; research sites responded by training ‘back-up’ and new facilitators. Trials specified that participants had to attend a median of 62.5% (range 16.7%–80%) of sessions, in order to receive a ‘therapeutic dose’; a median of 76.7% (range 42.9%–97.8%) received a therapeutic dose. Across the five trials, 75.3% of all sessions went ahead without the pre-specified ideal group size. A variety of methods were used to assess the fidelity of group interventions at a group and individual level across the five trials. Conclusion This is the first paper to provide an empirical basis for planning group intervention trials. Investigators should expect delays/difficulties in recruiting groups of the optimal size, plan for both facilitator and participant attrition, and consider how group attendance and group size affects treatment fidelity. Trial registration ISRCTN17993825 registered on 11/10/2016, ISRCTN28645428 registered on 11/04/2012, ISRCTN61215213 registered on 11/05/2011, ISRCTN67209155 registered on 22/03/2012, ISRCTN19447796 registered on 20/03/2014.
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Affiliation(s)
- Katie Biggs
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Daniel Hind
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Rebecca Gossage-Worrall
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit (NCTU), University of Nottingham, Nottingham, UK
| | - David White
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Jessica Wright
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Robin Chatters
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Katherine Berry
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Diana Papaioannou
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Mike Bradburn
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Stephen J Walters
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Cindy Cooper
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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Cherniack M, Berger S, Namazi S, Henning R, Punnett L. A Participatory Action Research Approach to Mental Health Interventions among Corrections Officers: Standardizing Priorities and Maintaining Design Autonomy. Occup Health Sci 2019; 3:387-407. [PMID: 37180051 PMCID: PMC10174268 DOI: 10.1007/s41542-019-00051-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A central dilemma in Participatory Action Research (PAR) is to establish participant decision authority on interventions while adhering to rigorous research practices. We faced this dilemma as part of an ongoing multi-site field research project in the corrections sector, where semi-autonomous union-based Design Teams (DTs) address worker health issues and design interventions. Employee focus groups and surveys elicited areas of concern, pointing to four topics in particular: overtime and sleep, work-family balance, physical fitness, and mental health; these were later expanded to eight priority areas. Quantitative rankings were generated by focus groups of line-level employees and supervisors. A multi-level, iterative priority selection process averaged focus group ratings of topic importance and also difficulty to address separately. Areas of job stress and mental health had highest importance but were also considered most difficult to address. A labor-management steering committee reviewed and endorsed the rankings and transmitted these to newly formed DTs. In principle, each DT was free to establish a different topic for initial intervention but they all chose the most important and difficult to address topics. This structured multi-tiered participatory process preserved ownership by all parties. Balancing participant autonomy and efficient prioritization of topics among multiple interest groups in this PAR effort met research methods needs and also made it easier for DTs to focus on the difficult and stigmatized area of mental health in the correctional workforce.
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Affiliation(s)
| | - Sarah Berger
- University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA
| | - Sara Namazi
- UConn Health, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Robert Henning
- University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA
| | - Laura Punnett
- University of Massachusetts Lowell, One University Avenue, Lowell, MA 01854, USA
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Buttenheim AM, Levy MZ, Castillo-Neyra R, McGuire M, Toledo Vizcarra AM, Mollesaca Riveros LM, Meza J, Borrini-Mayori K, Naquira C, Behrman J, Paz-Soldan VA. A behavioral design approach to improving a Chagas disease vector control campaign in Peru. BMC Public Health 2019; 19:1272. [PMID: 31533762 PMCID: PMC6751594 DOI: 10.1186/s12889-019-7525-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/21/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Individual behavior change is a critical ingredient in efforts to improve global health. Central to the focus on behavior has been a growing understanding of how the human brain makes decisions, from motivations and mindsets to unconscious biases and cognitive shortcuts. Recent work in the field of behavioral economics and related fields has contributed to a rich menu of insights and principles that can be engineered into global health programs to increase impact and reach. However, there is little research on the process of designing and testing interventions informed by behavioral insights. METHODS In a study focused on increasing household participation in a Chagas disease vector control campaign in Arequipa, Peru, we applied Datta and Mullainathan's "behavioral design" approach to formulate and test specific interventions. In this Technical Advance article we describe the behavioral design approach in detail, including the Define, Diagnosis, Design, and Test phases. We also show how the interventions designed through the behavioral design process were adapted for a pragmatic randomized controlled field trial. RESULTS The behavioral design framework provided a systematic methodology for defining the behavior of interest, diagnosing reasons for household reluctance or refusal to participate, designing interventions to address actionable bottlenecks, and then testing those interventions in a rigorous counterfactual context. Behavioral design offered us a broader range of strategies and approaches than are typically used in vector control campaigns. CONCLUSIONS Careful attention to how behavioral design may affect internal and external validity of evaluations and the scalability of interventions is needed going forward. We recommend behavioral design as a useful complement to other intervention design and evaluation approaches in global health programs.
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Affiliation(s)
- Alison M. Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Boulevard, 416 Fagin Hall, Philadelphia, PA 19104 USA
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology, and Informatics, Perleman School of Medicine of the University of Pennsylvana, Philadelphia, PA USA
| | - Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology, and Informatics, Perleman School of Medicine of the University of Pennsylvana, Philadelphia, PA USA
| | - Molly McGuire
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
- Chagas Disease Working Group, Arequipa, Peru
| | | | | | - Julio Meza
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Katty Borrini-Mayori
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Naquira
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jere Behrman
- Department of Economics, University of Pennsylvania, Philadelphia, PA USA
| | - Valerie A. Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
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McLeod LJ, Hine DW. Using Audience Segmentation to Understand Nonparticipation in Invasive Mammal Management in Australia. Environ Manage 2019; 64:213-229. [PMID: 31209552 DOI: 10.1007/s00267-019-01176-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 05/30/2019] [Indexed: 06/09/2023]
Abstract
Invasive mammals threaten agriculture, biodiversity, and community health. Yet many landholders fail to engage in control activities recommended by experts. We surveyed a representative sample of 731 Western Australian rural landholders. The survey assessed landholders' participation in a range of activities to control invasive mammals, as well as their capabilities, opportunities, and motivation for engaging in such activities. We found that over half of our respondents had not participated in any individual or group activities to control invasive mammals during the previous 12 months. Using latent profile analysis, we identified six homogeneous subgroups of nonparticipating landholders, each with their distinct psycho-graphic profiles: Unaware, Unskilled, and Unmotivated, Aware but Unskilled and Doubtful, Unskilled and Time Poor, Disinterested, Skilled but Dismissive, and Capable but Unmotivated. Our results indicate that engagement specialists should not treat nonparticipating landholders as a single homogeneous group. Nonparticipators differ considerably in terms of their capabilities, opportunities, and motivations, and require targeted engagement strategies informed by these differences.
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Affiliation(s)
- Lynette J McLeod
- School of Psychology, University of New England, Armidale, NSW, 2351, Australia.
| | - Donald W Hine
- School of Psychology, University of New England, Armidale, NSW, 2351, Australia
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Gilhooly D, Green SA, McCann C, Black N, Moonesinghe SR. Barriers and facilitators to the successful development, implementation and evaluation of care bundles in acute care in hospital: a scoping review. Implement Sci 2019; 14:47. [PMID: 31060625 PMCID: PMC6501296 DOI: 10.1186/s13012-019-0894-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
Abstract
Background Care bundles are small sets of evidence-based recommendations, designed to support the implementation of evidence-based best clinical practice. However, there is variation in the design and implementation of care bundles, which may impact on the fidelity of delivery and subsequently their clinical effectiveness. Methods A scoping review was carried out using the Arksey and O’Malley framework to identify the literature reporting on the design, implementation and evaluation of care bundles. The Embase, CINAHL, Cochrane and Ovid MEDLINE databases were searched for manuscripts published between 2001 and November 2017; hand-searching of references and citations was also undertaken. Data were initially assessed using a quality assessment tool, the Downs and Black checklist, prior to further analysis and narrative synthesis. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) criteria. Results Twenty-eight thousand six hundred ninety-two publications were screened and 348 articles retrieved in full text. Ninety-nine peer-reviewed quantitative publications were included for data extraction. These consisted of one randomised crossover trial, one randomised cluster trial, one case-control study, 20 prospective cohort studies and 76 non-parallel cohort studies. Twenty-three percent of studies were classified as poor based on Downs and Black checklist, and reporting of implementation strategies lacked structure. Negative associations were found between the number of elements in a bundle and compliance (Spearman’s rho = − 0.47, non-parallel cohort and − 0.65, prospective cohort studies), and between the complexity of elements and compliance (p < 0.001, chi-squared = 23.05). Implementation strategies associated with improved compliance included evaluative and iterative approaches, development of stakeholder relationships and education and training strategies. Conclusion Care bundles with a small number of simple elements have better compliance rates. Standardised reporting of implementation strategies may help to implement care bundles into clinical practice with high fidelity. Trial Registration This review was registered on the PROSPERO database: CRD 42015029963 in December 2015. Electronic supplementary material The online version of this article (10.1186/s13012-019-0894-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Gilhooly
- UCLH NIHR Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, NW1 2BU, UK.
| | - S A Green
- NIHR CLAHRC Northwest London, Imperial College London Chelsea and Westminster Hospital, London, SW10 9NH, UK.,Department of Health Services Research Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - C McCann
- UCLH NIHR Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, NW1 2BU, UK
| | - N Black
- Department of Health Services Research Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - S R Moonesinghe
- Division of Surgery and Interventional Science Charles Bell House, University College London, London, W1W 7TS, UK.,Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, Churchill House, 35 Red Lion Square, London, WC1R 4SG, UK
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31
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Kim B, McCullough MB, Simmons MM, Bolton RE, Hyde J, Drainoni ML, Fincke BG, McInnes DK. A novel application of process mapping in a criminal justice setting to examine implementation of peer support for veterans leaving incarceration. Health Justice 2019; 7:3. [PMID: 30915620 PMCID: PMC6718000 DOI: 10.1186/s40352-019-0085-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 03/12/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Between 12,000 and 16,000 veterans leave incarceration every year, yet resources are limited for reentry support that helps veterans remain connected to VA and community health care and services after leaving incarceration. Homelessness and criminal justice recidivism may result when such follow-up and support are lacking. In order to determine where gaps exist in current reentry support efforts, we developed a novel methodological adaptation of process mapping (a visualization technique being increasingly used in health care to identify gaps in services and linkages) in the context of a larger implementation study of a peer-support intervention to link veterans to health-related services after incarceration ( https://clinicaltrials.gov/ , NCT02964897, registered November 4, 2016) to support their reentry into the community. METHODS We employed process mapping to analyze qualitative interviews with staff from organizations providing reentry support. Interview data were used to generate process maps specifying the sequence of events and the multiple parties that connect veterans to post-incarceration services. Process maps were then analyzed for uncertainties, gaps, and bottlenecks. RESULTS We found that reentry programs lack systematic means of identifying soon-to-be released veterans who may become their clients; veterans in prisons/jails, and recently released, lack information about reentry supports and how to access them; and veterans' whereabouts between their release and their health care appointments are often unknown to reentry and health care teams. These system-level shortcomings informed our intervention development and implementation planning of peer-support services for veterans' reentry. CONCLUSIONS Systematic information sharing that is inherent to process mapping makes more transparent the research needed, helping to engage participants and operational partners who are critical for successful implementation of interventions to improve reentry support for veterans leaving incarceration. Even beyond our immediate study, process mapping based on qualitative interview data enables visualization of data that is useful for 1) verifying the research team's interpretation of interviewee's accounts, 2) specifying the events that occur within processes that the implementation is targeting (identifying knowledge gaps and inefficiencies), and 3) articulating and tracking the pre- to post-implementation changes clearly to support dissemination of evidence-based health care practices for justice-involved populations.
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Affiliation(s)
- Bo Kim
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Megan B. McCullough
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
| | | | - Rendelle E. Bolton
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Brandeis University Heller School for Social Policy and Management, Waltham, MA USA
| | - Justeen Hyde
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
| | - Mari-Lynn Drainoni
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
- Boston University School of Medicine, Boston, MA USA
| | - B. Graeme Fincke
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
| | - D. Keith McInnes
- VA Center for Healthcare Organization and Implementation Research, Bedford/Boston, MA USA
- Boston University School of Public Health, Boston, MA USA
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Abstract
A pressing goal in global development and other sectors is often to understand what drives people’s behaviors, and how to influence them. Yet designing behavior change interventions is often an unsystematic process, hobbled by insufficient understanding of contextual and perceptual behavioral drivers and a narrow focus on limited research methods to assess them. We propose a toolkit (CUBES) of two solutions to help programs arrive at more effective interventions. First, we introduce a novel framework of behavior, which is a practical tool for programs to structure potential drivers and match corresponding interventions. This evidence-based framework was developed through extensive cross-sectoral literature research and refined through application in large-scale global development programs. Second, we propose a set of descriptive, experimental, and simulation approaches that can enhance and expand the methods commonly used in global development. Since not all methods are equally suited to capture the different types of drivers of behavior, we present a decision aid for method selection. We recommend that existing commonly used methods, such as observations and surveys, use CUBES as a scaffold and incorporate validated measures of specific types of drivers in order to comprehensively test all the potential components of a target behavior. We also recommend under-used methods from sectors such as market research, experimental psychology, and decision science, which programs can use to extend their toolkit and test the importance and impact of key enablers and barriers. The CUBES toolkit enables programs across sectors to streamline the process of conceptualizing, designing, and optimizing interventions, and ultimately to change behaviors and achieve targeted outcomes.
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Affiliation(s)
- Elisabeth Engl
- Surgo Foundation, Washington, District of Columbia, 20001, USA
| | - Sema K Sgaier
- Surgo Foundation, Washington, District of Columbia, 20001, USA.,Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
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Nadler MB, Bainbridge D, Fong AJ, Sussman J, Tomasone JR, Neil-Sztramko SE. Moving Cancer Care Ontario's Exercise for People with Cancer guidelines into oncology practice: using the Theoretical Domains Framework to validate a questionnaire. Support Care Cancer 2019; 27:1965-8. [PMID: 30762143 DOI: 10.1007/s00520-019-04689-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/05/2019] [Indexed: 12/20/2022]
Abstract
Evidence supporting the benefits of exercise surrounding cancer treatment has led to internationally published guidelines, with minimal uptake by oncology care providers (OCPs). There is a need to understand how to implement research evidence into practice. Our team developed a questionnaire to assess OCPs' knowledge of exercise guidelines and barriers/facilitators to exercise counseling and program referral. We validated the questionnaire using the Theoretical Domains Framework, a knowledge translation (KT) framework used to implement evidence-based guidelines into practice. In this commentary, we describe this process and the rationale for integrating a KT framework into intervention development and implementation in oncology practice. The revised questionnaire, entitled Clinicians Perspectives on Exercise in Patients with Cancer (CliPEC), is shared to facilitate the implementation process and allow for comparison across oncology practices.
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Desveaux L, McBrien K, Barnieh L, Ivers NM. Mapping variation in intervention design: a systematic review to develop a program theory for patient navigator programs. Syst Rev 2019; 8:8. [PMID: 30621796 PMCID: PMC6323765 DOI: 10.1186/s13643-018-0920-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/18/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is a great deal of variation in the design and delivery of patient navigator (PN) programs, making it difficult to design or adopt these interventions in new contexts. We (1) systematically reviewed the literature to generate a preliminary program theory to describe how patient navigator interventions are designed and delivered; and (2) describe how the resulting program theory was applied in context to inform a prototype for a patient navigator program. METHODS The current study includes a secondary review of a larger systematic review. We reviewed studies included in the primary review to identify those that designed and evaluated programs to assist patients in accessing and/or adhering to care. We conducted a content analysis of included publications to describe the barriers targeted by PN interventions and the navigator activities addressing those barriers. A program theory was constructed by mapping patient navigator activities to corresponding constructs within the capability-opportunity-motivation model of behavior change (COM-B) model of behavior change. The program theory was then presented to individuals with chronic disease, healthcare providers, and system stakeholders, and refined iteratively based on feedback. RESULTS Twenty one publications describing 19 patient navigator interventions were included. A total of 17 unique patient navigator activities were reported. The most common included providing education, facilitating referrals, providing social and emotional support, and supporting self-management. The majority of navigator activities targeted barriers to physical opportunity, including facilitating insurance claims, assistance with scheduling, and providing transportation. Across all interventions, navigator activities were designed to target a total of 20 patient barriers. Among interventions reporting positive effects, over two thirds targeted knowledge barriers, problems with scheduling, proactive re-scheduling following a missed appointment, and insurance. The final program design included a total of 13 navigator activities-10 informed by the original program theory and 3 unique activities informed by stakeholders. CONCLUSIONS There is considerable heterogeneity in intervention content across patient navigator interventions. Our results provide a schema from which to develop PN interventions and illustrate how an evidence-based model was used to develop a real-world PN intervention. Our findings also highlight a critical need to improve the reporting of intervention components to facilitate translation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013005857.
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Affiliation(s)
- Laura Desveaux
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave Toronto, Toronto, Ontario, M5S 1B2, Canada. .,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, Ontario, Canada.
| | - Kerry McBrien
- Department of Family Medicine, University of Calgary, G012, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4 N1, Canada.,Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Lianne Barnieh
- Department of Medicine, University of Calgary, 1403 29th Street NW, Calgary, Alberta, T2N 2 T9, Canada
| | - Noah M Ivers
- Women's College Research Institute and Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Ave Toronto, Toronto, Ontario, M5S 1B2, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Women's College Hospital and University of Toronto, 76 Grenville Ave, Toronto, Ontario, Canada
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Knight GM, Costelloe C, Deeny SR, Moore LSP, Hopkins S, Johnson AP, Robotham JV, Holmes AH. Quantifying where human acquisition of antibiotic resistance occurs: a mathematical modelling study. BMC Med 2018; 16:137. [PMID: 30134939 PMCID: PMC6106940 DOI: 10.1186/s12916-018-1121-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 07/09/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Antibiotic-resistant bacteria (ARB) are selected by the use of antibiotics. The rational design of interventions to reduce levels of antibiotic resistance requires a greater understanding of how and where ARB are acquired. Our aim was to determine whether acquisition of ARB occurs more often in the community or hospital setting. METHODS We used a mathematical model of the natural history of ARB to estimate how many ARB were acquired in each of these two environments, as well as to determine key parameters for further investigation. To do this, we explored a range of realistic parameter combinations and considered a case study of parameters for an important subset of resistant strains in England. RESULTS If we consider all people with ARB in the total population (community and hospital), the majority, under most clinically derived parameter combinations, acquired their resistance in the community, despite higher levels of antibiotic use and transmission of ARB in the hospital. However, if we focus on just the hospital population, under most parameter combinations a greater proportion of this population acquired ARB in the hospital. CONCLUSIONS It is likely that the majority of ARB are being acquired in the community, suggesting that efforts to reduce overall ARB carriage should focus on reducing antibiotic usage and transmission in the community setting. However, our framework highlights the need for better pathogen-specific data on antibiotic exposure, ARB clearance and transmission parameters, as well as the link between carriage of ARB and health impact. This is important to determine whether interventions should target total ARB carriage or hospital-acquired ARB carriage, as the latter often dominated in hospital populations.
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Affiliation(s)
- Gwenan M Knight
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.
| | - Céire Costelloe
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
| | | | - Luke S P Moore
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Susan Hopkins
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.,Antimicrobial Resistance Programme, Public Health England, London, UK.,Royal Free London NHS Foundation Trust Healthcare, London, UK.,Division of Healthcare-Associated Infection & Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - Alan P Johnson
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.,Division of Healthcare-Associated Infection & Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - Julie V Robotham
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.,Antimicrobial Resistance Programme, Public Health England, London, UK.,Modelling and Economics Unit, National Infection Service, Public Health England and Health Protection Research Unit in Modelling Methodology, London, UK
| | - Alison H Holmes
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.,Imperial College Healthcare NHS Trust, London, UK
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Baker P, Coole C, Drummond A, McDaid C, Khan S, Thomson L, Hewitt C, McNamara I, McDonald D, Fitch J, Rangan A. Development of an occupational advice intervention for patients undergoing lower limb arthroplasty (the OPAL study). BMC Health Serv Res 2018; 18:504. [PMID: 29950166 PMCID: PMC6022501 DOI: 10.1186/s12913-018-3238-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/27/2018] [Indexed: 11/23/2022] Open
Abstract
Background There are an increasing number of patients of working age undergoing hip and knee replacements. Currently there is variation in the advice and support given about sickness absence, recovery to usual activities and return to work after these procedures. Earlier, sustainable, return to work improves the health of patients and benefits their employers and society. An intervention that encourages and supports early recovery to usual activities, including work, has the potential to reduce the health and socioeconomic burden of hip and knee replacements. Methods/design A two-phase research programme delivered over 27 months will be used to develop and subsequently test the feasibility of an occupational advice intervention to facilitate return to work and usual activities in patients undergoing lower limb arthroplasty. The 2 phases will incorporate a six-stage intervention mapping process: Phase 1: Intervention mapping stages 1–3:Needs assessment (including rapid evidence synthesis, prospective cohort analysis and structured stakeholder interviews) Identification of intended outcomes and performance objectives Selection of theory-based methods and practical strategies
Phase 2: Intervention mapping stages 4–6:Development of components and materials for the occupational advice intervention using a modified Delphi process Adoption and implementation of the intervention Evaluation and feasibility testing
The study will be undertaken in four National Health Service (NHS) hospitals in the United Kingdom and two Higher Education Institutions. Discussion OPAL (Occupational advice for Patients undergoing Arthroplasty of the Lower limb) aims to develop an occupational advice intervention to support early recovery to usual activities including work, which is tailored to the requirements of patients undergoing hip and knee replacements. The developed intervention will then be assessed with a specific focus on evaluating its feasibility as a potential trial intervention to improve speed of recovery to usual activities including work. Trial registration The study was registered retrospectively with the International Standard Randomised Controlled Trials Number (ISRCTN): 27426982 (Date 20/12/2016) and the International prospective register of systematic reviews (PROSPERO): CRD42016045235 (Date 04/08/2016).
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Affiliation(s)
- Paul Baker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, England, UK.
| | - Carol Coole
- The University of Nottingham, Nottingham, England, UK
| | | | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, The University of York, York, England, UK
| | - Sayeed Khan
- The University of Nottingham, Nottingham, England, UK
| | | | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, The University of York, York, England, UK
| | - Iain McNamara
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, England, UK
| | | | - Judith Fitch
- British Orthopaedic Association Patient Liaison Group (BOA PLG), London, England, UK
| | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, England, UK.,York Trials Unit, Department of Health Sciences, The University of York, York, England, UK.,Faculty of Medical Sciences, University of Oxford, Oxford, England, UK
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Naughton C, Beard C, Tzouvara V, Pegram A, Verity R, Eley R, Hingley D. A dementia communication training intervention based on the VERA framework for pre-registration nurses: Part I developing and testing an implementation strategy. Nurse Educ Today 2018; 63:94-100. [PMID: 29407268 DOI: 10.1016/j.nedt.2018.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/07/2017] [Accepted: 01/19/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND People living with dementia experience progressive difficulty in expressing physical and emotional needs. Health care staff including student nurses require training to develop compensatory communication strategies. However, there is no standardised foundation level dementia communication training within pre-registration curricula. AIM This article describes the theoretical underpinnings and development of a foundation level dementia communication skills training based on the VERA (Validation, Emotion, Reassurance, Activity) framework. METHOD The training strategies drew on behavioural change theory using the COM-B model and Gagné's 9 Events of Instruction. The VERA framework was operationalised using a multicomponent teaching strategy. The intervention was refined based on quality improvement Plan-Do-Study-Act cycles with feedback from people living with dementia, facilitators and student nurses. Data collection used semi-structured questionnaires (n = 51) and four focus group (n = 19) interviews with students. Data analysis involved descriptive statistics and thematic analysis. RESULTS The intervention was a 2.5-hour face-to-face training session delivered at the start of students' older adult unit placement with follow-up reflection sessions during placement. Training was delivered to 51 students, all students described the training as useful and would recommend it to their peers. Elements of the training that were highly valued were: opportunities to express concerns in caring for people with dementia, applying the VERA framework using role play and outlining realistic expectations of VERA. Students recognised the need for on-going training especially for more complex patients. CONCLUSION Combining behaviour change and education theory with stakeholder feedback strengthened the development of VERA as a foundation level dementia communication training for pre-registration nurses.
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Affiliation(s)
- Corina Naughton
- School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Brookfield Health Sciences Complex, College Road, Cork T12 AK54, Ireland.
| | - Chloe Beard
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA, United Kingdom
| | - Vasiliki Tzouvara
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA, United Kingdom.
| | - Anne Pegram
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA, United Kingdom.
| | - Rebecca Verity
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA, United Kingdom.
| | - Rhiannon Eley
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA, United Kingdom.
| | - David Hingley
- Department of Adult and Mental Health Nursing, Faculty of Health Social Care and Education, Anglia Ruskin University, Chelmsford CM1 1SQ, United Kingdom.
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Pope L, Garnett B, Dibble M. Lessons Learned Through the Implementation of an eHealth Physical Activity Gaming Intervention with High School Youth. Games Health J 2018; 7:136-142. [PMID: 29393679 DOI: 10.1089/g4h.2017.0164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To encourage high school students to meet physical activity goals using a newly developed game, and to document the feasibility, benefits, and challenges of using an electronic gaming application to promote physical activity in high school students. MATERIALS AND METHODS Working with youth and game designers an electronic game, Camp Conquer, was developed to motivate high school students to meet physical activity goals. One-hundred-five high school students were recruited to participate in a 12-week pilot test of the game and randomly assigned to a Game Condition or Control Condition. Students in both conditions received a FitBit to track their activity, and participants in the Game Condition received access to Camp Conquer. Number of steps and active minutes each day were tracked for all participants. FitBit use, game logins, and qualitative feedback from researchers, school personnel, and participants were used to determine intervention engagement. RESULTS The majority of study participants did not consistently wear their FitBit or engage with the gaming intervention. Numerous design challenges and barriers to successful implementation such as the randomized design, absence of a true school-based champion, ease of use, and game glitches were identified. CONCLUSION Developing games is an exciting technique for motivating the completion of a variety of health behaviors. Although the present intervention was not successful in increasing physical activity in high school students, important lessons were learned regarding how to best structure a gaming intervention for the high school population.
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Affiliation(s)
- Lizzy Pope
- 1 Department of Nutrition and Food Sciences, University of Vermont College of Agriculture and Life Science , Burlington, Vermont
| | - Bernice Garnett
- 2 Department of Education, University of Vermont College of Education and Social Services , Burlington, Vermont
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Lacey SJ, Street TD. Measuring healthy behaviours using the stages of change model: an investigation into the physical activity and nutrition behaviours of Australian miners. Biopsychosoc Med 2017; 11:30. [PMID: 29213300 PMCID: PMC5715498 DOI: 10.1186/s13030-017-0115-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Obesity is one of the fastest growing modern day epidemics affecting preventable disease and premature deaths. Healthy lifestyle behaviours, such as physical activity and nutritional consumption, have been shown to reduce the likelihood of obesity and obesity related health risks. Originally designed for measurement of unhealthy behaviours, the Stages of Change model, describes 'precontemplators' as individuals who engage in the unhealthy behaviour, are unaware that their behaviour is problematic, and are resistant to change. The aim of this study was to refine and assess the measures of the Stages of Change model in order to achieve a concise and reliable classification of precontemplators, in the context of healthy behaviours. Methods Eight hundred and ninety-seven employees participated in a health survey measuring current health behaviours and stage of change. This study compared a traditional precontemplation measure to a modified version in the assessment of two healthy behaviours: physical activity and fruit and vegetable consumption. Results The modified measure was more accurate and captured fewer individuals currently meeting the guideline for both physical activity and nutrition, compared to the traditional measure of stages of change. However, across all stages of change, the measure incorrectly classified some employees with regards to meeting health guidelines. Conclusions When applied to healthy behaviours, the stages of change measure for precontemplation should be further refined to reflect knowledge that the behaviour is unhealthy, and apathy to change. Additionally, measures should define health guidelines to increase reliable classification across all stages of change. The findings can be applied to inform the design and implementation of health promotion strategies targeting obesity related lifestyle behaviours in the general population.
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Affiliation(s)
- Sarah J Lacey
- Wesley Medical Research, PO Box 499, Toowong, QLD 4066 Australia
| | - Tamara D Street
- Wesley Medical Research, PO Box 499, Toowong, QLD 4066 Australia
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Scorgie F, Vearey J, Oliff M, Stadler J, Venables E, Chersich MF, Delany-Moretlwe S. 'Leaving no one behind': reflections on the design of community-based HIV prevention for migrants in Johannesburg's inner-city hostels and informal settlements. BMC Public Health 2017; 17:482. [PMID: 28527472 PMCID: PMC5438852 DOI: 10.1186/s12889-017-4351-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Unmanaged urban growth in southern and eastern Africa has led to a growth of informal housing in cities, which are home to poor, marginalised populations, and associated with the highest HIV prevalence in urban areas. This article describes and reflects on the authors' experiences in designing and implementing an HIV intervention originally intended for migrant men living in single-sex hostels of inner-city Johannesburg. It shows how formative research findings were incorporated into project design, substantially shifting the scope of the original project. METHODS Formative research activities were undertaken to better understand the demand- and supply-side barriers to delivering HIV prevention activities within this community. These included community mapping, a baseline survey (n = 1458) and client-simulation exercise in local public sector clinics. The intervention was designed and implemented in the study setting over a period of 18 months. Implementation was assessed by way of a process evaluation of selected project components. RESULTS The project scope expanded to include women living in adjacent informal settlements. Concurrent sexual partnerships between these women and male hostel residents were common, and HIV prevalence was higher among women (56%) than men (24%). Overwhelmingly, hostel residents were internal migrants from another province, and most felt 'alienated' from the rest of the city. While men prioritised the need for jobs, women were more concerned about water, sanitation, housing and poverty alleviation. Most women (70%) regarded their community as unsafe (cf. 47% of men). In the final intervention, project objectives were modified and HIV prevention activities were embedded within a broader health and development focus. 'Community health clubs' were established to build residents' capacity to promote health and longer term well-being, and to initiate and sustain change within their communities. CONCLUSIONS To improve efforts to address HIV in urban informal settings, intervention designers must acknowledge and engage with the priorities set by the marginalised communities that live here, which may well encompass more pressing issues associated with daily survival.
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Affiliation(s)
- Fiona Scorgie
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jo Vearey
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Centre for Migration & Society, University of the Witwatersrand, Johannesburg, South Africa
| | - Monique Oliff
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wellsense International, Kilifi, Kenya
| | - Jonathan Stadler
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Emilie Venables
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Matthew F. Chersich
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Colquhoun HL, Squires JE, Kolehmainen N, Fraser C, Grimshaw JM. Methods for designing interventions to change healthcare professionals' behaviour: a systematic review. Implement Sci 2017; 12:30. [PMID: 28259168 PMCID: PMC5336662 DOI: 10.1186/s13012-017-0560-5] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 02/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews consistently indicate that interventions to change healthcare professional (HCP) behaviour are haphazardly designed and poorly specified. Clarity about methods for designing and specifying interventions is needed. The objective of this review was to identify published methods for designing interventions to change HCP behaviour. METHODS A search of MEDLINE, Embase, and PsycINFO was conducted from 1996 to April 2015. Using inclusion/exclusion criteria, a broad screen of abstracts by one rater was followed by a strict screen of full text for all potentially relevant papers by three raters. An inductive approach was first applied to the included studies to identify commonalities and differences between the descriptions of methods across the papers. Based on this process and knowledge of related literatures, we developed a data extraction framework that included, e.g. level of change (e.g. individual versus organization); context of development; a brief description of the method; tasks included in the method (e.g. barrier identification, component selection, use of theory). RESULTS 3966 titles and abstracts and 64 full-text papers were screened to yield 15 papers included in the review, each outlining one design method. All of the papers reported methods developed within a specific context. Thirteen papers included barrier identification and 13 included linking barriers to intervention components; although not the same 13 papers. Thirteen papers targeted individual HCPs with only one paper targeting change across individual, organization, and system levels. The use of theory and user engagement were included in 13/15 and 13/15 papers, respectively. CONCLUSIONS There is an agreement across methods of four tasks that need to be completed when designing individual-level interventions: identifying barriers, selecting intervention components, using theory, and engaging end-users. Methods also consist of further additional tasks. Examples of methods for designing the organisation and system-level interventions were limited. Further analysis of design tasks could facilitate the development of detailed guidelines for designing interventions.
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Affiliation(s)
- Heather L Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
| | - Janet E Squires
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Ottawa, Ontario, K1H 8L6, Canada.,School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Niina Kolehmainen
- Institute of Health and Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Health Sciences Building Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Centre for Practice Changing Research, Ottawa, Ontario, K1H 8L6, Canada.,Department of Medicine, Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
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Brooke HL, Atkin AJ, Corder K, Brage S, van Sluijs EM. Frequency and duration of physical activity bouts in school-aged children: A comparison within and between days. Prev Med Rep 2016; 4:585-590. [PMID: 27843758 PMCID: PMC5107648 DOI: 10.1016/j.pmedr.2016.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 10/18/2016] [Accepted: 10/23/2016] [Indexed: 11/24/2022] Open
Abstract
Understanding how physical activity (PA) patterns vary within and between days may guide PA promotion in young people. We aimed to 1) describe and compare the frequency (bouts/day) and duration (min/bout) of bouts of moderate-to-vigorous intensity PA (MVPA) on weekdays vs. weekends and in-school vs. out-of-school, and 2) assess associations of bout frequency and duration in these time-segments with overall PA. We used cross-sectional accelerometer data from 2737 children (aged 6-19 years) in the United States National Health and Nutrition Examination Survey (NHANES) 2003-2006. A bout was defined as MVPA (≥ 2000 counts per minute [cpm]) lasting ≥ 3 min. Adjusted Wald tests were used to assess differences in bout characteristics between time-segments. Linear regression was used to examine the association of time-segment specific bout characteristics with daily minutes of MVPA and PA volume (average cpm). Bout frequency was higher on weekdays than weekends (median [IQR] 4.3 [2.2-7.2] vs. 3.0 [1.0-6.5] bouts/day, p < 0.001); however, bout duration did not differ (4.7 [4.0-5.7] vs. 4.5 [3.7-5.8] min/bout, p = 0.33). More bouts were accumulated out-of-school compared with in-school (2.2 [1.0-4.0] vs. 1.8 [0.8-3.2] bouts/day, p < 0.001), but bout duration was similar (4.7 [3.8-5.8] vs. 4.5 [3.8-5.7] min/bout, p = 0.158). For all time-segments, the frequency and duration of bouts of MVPA were independently and positively associated with overall MVPA and PA volume. In conclusion, the characteristics of children's PA vary within and between days; accounting for this in intervention design may improve future interventions. However, increasing bout frequency or duration in any time-segment may be beneficial for overall PA.
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Affiliation(s)
- Hannah L Brooke
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Andrew J Atkin
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Kirsten Corder
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Soren Brage
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Esther Mf van Sluijs
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
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Strachan CE, Kana M, Martin S, Dada J, Wandera N, Marasciulo M, Counihan H, Kolawole M, Babale T, Hamade P, Meek SR, Baba E. The use of formative research to inform the design of a seasonal malaria chemoprevention intervention in northern Nigeria. Malar J 2016; 15:474. [PMID: 27634539 PMCID: PMC5025607 DOI: 10.1186/s12936-016-1526-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 09/07/2016] [Indexed: 12/03/2022] Open
Abstract
Background Experience of seasonal malaria chemoprevention (SMC) is growing in the Sahel sub-region of Africa, though there remains insufficient evidence to recommend a standard deployment strategy. In 2012, a project was initiated in Katsina state, northern Nigeria, to design an appropriate and effective community-based delivery approach for SMC, in consultation with local stakeholders. Formative research (FR) was conducted locally to explore the potential feasibility and acceptability of SMC and to highlight information gaps and practical considerations to inform the intervention design. Methods The FR adopted qualitative methods; 36 in-depth interviews and 18 focus group discussions were conducted across 13 target groups active across the health system and within the community. Analysis followed the ‘framework’ approach. The process for incorporating the FR results into the project design was iterative which was initiated by a week-long ‘intervention design’ workshop with relevant stakeholders. Results The FR highlighted both supportive and hindering factors to be considered in the intervention design. Malaria control was identified as a community priority, the community health workers were a trusted resource and the local leadership exerted strong influence over household decisions. However, there were perceived challenges with quality of care at both community and health facility levels, referral linkage and supportive supervision were weak, literacy levels lower than anticipated and there was the potential for suspicion of ‘outside’ interventions. There was broad consensus across target groups that community-based SMC drug delivery would better enable a high coverage of beneficiaries and potentially garner wider community support. A mixed approach was recommended, including both community fixed-point and household-to-household SMC delivery. The FR findings were used to inform the overall distribution strategy, mechanisms for integration into the health system, capacity building and training approaches, supportive interventions to strengthen the health system, and the social mobilization strategy. Conclusions Formative research played a valuable role in exploring local socio-cultural contexts and health system realities. Both opportunities and challenges for the introduction of SMC delivery were highlighted, which were appropriately considered in the design of the project.
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Affiliation(s)
- Clare E Strachan
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK. .,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Musa Kana
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.,Department of Community Medicine, Kaduna State University, Kaduna, Nigeria.,EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Sandrine Martin
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK
| | - John Dada
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK
| | - Naome Wandera
- Inspire Sustainable Development Agency, Baden Powel House, Buganda Road, Kampala, Uganda
| | - Madeleine Marasciulo
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK
| | - Helen Counihan
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK
| | - Maxwell Kolawole
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK
| | - Tanimu Babale
- Katsina State Ministry of Health, State Secretariat Complex, IBB Way, Katsina, Nigeria
| | - Prudence Hamade
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK
| | - Sylvia R Meek
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK
| | - Ebenezer Baba
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK
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Greenland K, Chipungu J, Chilengi R, Curtis V. Theory-based formative research on oral rehydration salts and zinc use in Lusaka, Zambia. BMC Public Health 2016; 16:312. [PMID: 27067003 PMCID: PMC4828827 DOI: 10.1186/s12889-016-2984-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 03/24/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A theoretically grounded formative research study was carried out to investigate behaviour related to the use of Oral Rehydration Salts (ORS) and zinc tablets. The purpose was to inform the design of the behaviour change component of the Programme for Awareness and Elimination of Diarrhoea in Lusaka Province, Zambia, which aims to reduce childhood morbidity and mortality from diarrhoeal disease. METHODS Fourteen behaviour trials were conducted among caregivers of children under-five with diarrhoea. Caregivers were recruited from two clinics situated in rural and peri-urban Lusaka. Trials took ten days and data were captured using video, observation and repeated interviews. Additional data were collected through focus group discussions with mothers, observations in clinics and pharmacies and interviews with clinic and pharmacy staff. Findings were organised according to categories of behavioural determinants from Evo-Eco theory. RESULTS Participants were all familiar with ORS and most knew its purpose. ORS use was motivated by symptoms of dehydration, rather than the start of a diarrhoea episode, and was stopped when the child had visibly recovered energy. Only four of 14 behaviour trial participants were observed to correctly prepare ORS. Errors were mainly associated with measurement, resulting in a solution that was too concentrated. ORS was not observed to be given to children at clinics. Although zinc was unknown in this population, it was positively received by mothers keen to learn whether zinc would work better than alternative treatments to stop diarrhoea. CONCLUSIONS ORS was sub-optimally prepared and used at home. It was not used while waiting to be seen at a clinic. In homes, the behaviour change intervention should promote early and continued use of correctly prepared ORS. In the longer-term, these behaviours may best be encouraged by changing the product design or sachet size. Despite its unfamiliarity, this population was well disposed to the use of zinc as a treatment for diarrhoea; when zinc is new to a population, promoting zinc as a solution to stopping diarrhoea, which mothers seek, may drive initial trial. Ensuring the availability of zinc in public clinics and private pharmacies prior to commencement of any promotion activities is crucial.
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Affiliation(s)
- Katie Greenland
- Department of Disease Control, Faculty for Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, P.O. Box 34681, Lusaka, 10101, Zambia
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, P.O. Box 34681, Lusaka, 10101, Zambia
| | - Valerie Curtis
- Department of Disease Control, Faculty for Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Abstract
Understanding and changing eating behaviours are central to the work of Nutrition Society members working in both research and applied settings. The present paper describes a recently published resource to guide the design of interventions to change behaviour, The Behaviour Change Wheel: A Guide to Designing Interventions (BCW Guide). This is a practical guide to intervention design that brings together recently-developed theory-based tools in behavioural science into a coherent step-by-step design process. It is based on the BCW, a synthesis of nineteen frameworks of behaviour change found in the research literature. The BCW has at its core a model of behaviour known as 'capability', 'opportunity', 'motivation' and 'behaviour'. The model recognises that behaviour is part of an interacting system involving all these components. The BCW identifies different intervention options that can be applied to changing each of the components and policies that can be adopted to deliver those intervention options. The book shows how the BCW links to theory-based frameworks to understand behaviour such as the Theoretical Domains Framework and the recently developed Behaviour Change Technique Taxonomy v1 for specifying intervention content. In essence, it shows how to link what is understood about a given behaviour to types of intervention likely to be effective and then translate this into a locally relevant intervention. In addition, the present paper sets out some principles of intervention design.
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Schölmerich VLN, Ghorashi H, Denktaş S, Groenewegen P. Caught in the middle? How women deal with conflicting pregnancy-advice from health professionals and their social networks. Midwifery 2016; 35:62-9. [PMID: 27060402 DOI: 10.1016/j.midw.2016.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 02/16/2016] [Accepted: 02/20/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE to investigate how pregnant women deal with conflicting advice from their social networks and their caregivers and how this influenced their pregnancy-related behaviours. DESIGN AND METHODS a qualitative study based on face-to-face interviews and focus-groups. We applied an inductive analysis technique closely following the 'Gioia method'. SETTING impoverished neighbourhoods in Rotterdam, the Netherlands. PARTICIPANTS 40 women who were pregnant, or had given birth within the last 12 months. 12 women were Native Dutch, 16 had a Moroccan background, and 12 had a Turkish background. FINDINGS all women faced a misalignment of advice by health professionals and social networks. For the native Dutch respondents, this misalignment did not seem to present a challenge. They had a strongly articulated preference for the advice of health professionals, and did not fear any social consequences for openly following their advice. For the women with a Turkish/Moroccan background, however, this discrepancy in advice presented a dilemma. Following one piece of advice seemed to exclude also following the other one, which would possibly entail social consequences. These women employed one of the three strategies to deal with this dilemma: a) avoiding the dilemma (secretly not following the advice of one side), b) embracing the dilemma (combining conflicting advice), and c) resolving the dilemma (communicating between both sides). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE we argue that the currently popular interventions geared towards increasing the health literacy of non-Western ethnic minority pregnant women and improving communication between ethnic minority clients and caregivers are not sufficient, and might even exacerbate the dilemma some pregnant women face. As an alternative, we recommend involving not only caregivers but also women's social network in intervention efforts. Interventions could aim to increase the negotiation capacity of the target group, but also to increase the health literacy of the members of their social network to enable the circulation of 'new' information within a rather homogeneous, tight-knit network.
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Affiliation(s)
- Vera L N Schölmerich
- Department of Social & Behavioral Sciences, Erasmus University College, Erasmus University Rotterdam, Nieuwemarkt 1A, 3011HP Rotterdam, The Netherlands.
| | - Halleh Ghorashi
- Department of Sociology, VU University Amsterdam, De Boelelaan 1081, Amsterdam 1081 HV, The Netherlands.
| | - Semiha Denktaş
- Department of Social & Behavioral Sciences, Erasmus University College, Erasmus University Rotterdam, Nieuwemarkt 1A, 3011HP Rotterdam, The Netherlands.
| | - Peter Groenewegen
- Department of Organizational Sciences, VU University Amsterdam, De Boelelaan 1081, Amsterdam 1081 HV, The Netherlands.
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Moxley DP, Calligan HF. Positioning the arts for intervention design research in the human services. Eval Program Plann 2015; 53:34-43. [PMID: 26262890 DOI: 10.1016/j.evalprogplan.2015.07.013] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 07/25/2015] [Accepted: 07/28/2015] [Indexed: 06/04/2023]
Abstract
The arts have been integral to the human experience fostering innovation in social arrangements, strengthening group cohesion, and merging esthetics with the utilitarian properties of technology. For intervention design research in the human services the arts can harness innovation and creativity in meeting human needs and addressing social issues. Given their capacities to stimulate expression of first person experience through interpretative strategies, the arts can equip people and groups, including researchers, with opportunities to express primary experiential knowledge through creative means, portray useful ways of meeting human needs, educate others about the social issues people experience, and formulate intervention strategies or even models to address the causes and consequences of those issues. In this paper, the authors discuss how the arts can inform and deepen human service intervention design and development and, as a result, advance innovation in the human services. They offer a rationale supporting the inclusion of the arts in the design of human service interventions, examine the contributions of the arts to the formulation of intervention concept and developmental research to further improve interventions, and consider how the arts can advance the reflexivity of intervention designers. The authors draw implications for how researchers can position the arts in the nine steps of intervention design and development the authors offer in this paper.
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Affiliation(s)
- David P Moxley
- Anne and Henry Zarrow School of Social Work, University of Oklahoma, Norman, OK, United States.
| | - Holly Feen Calligan
- Art Education-Art Therapy Program, College of Education, Wayne State University, United States
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McLeod LJ, Hine DW, Bengsen AJ. Born to roam? Surveying cat owners in Tasmania, Australia, to identify the drivers and barriers to cat containment. Prev Vet Med 2015; 122:339-44. [PMID: 26603046 DOI: 10.1016/j.prevetmed.2015.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/29/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
Free-roaming domestic cats, Felis catus, are a major public nuisance in neighbourhoods across the world, and have been linked to biodiversity loss and a host of community health problems. Owners who let their cats roam, also place their cats at risk of serious injury. One management strategy that is gaining considerable support involves encouraging cat owners to contain their pets within their property. Contemporary behaviour change models highlight the importance of identifying drivers and barriers that encourage and discourage target behaviours such as cat containment. Results from a random dial phone survey of 356 cat owners in northern Tasmania identified four distinct cat containment profiles: owners who contained their cat all the time, owners who only contained their cat at night, owners who sporadically contained their cat with no set routine, and owners who made no attempt to contain their pet. Our results indicated that cat-owners' decisions to contain or not contain their cats were guided by a range of factors including owners' beliefs about their ability to implement an effective containment strategy and their views about the physical and psychological needs of their cats. The results are discussed in terms of improving the behavioural effectiveness of cat containment interventions by selecting appropriate behavioural change tools for the identified drivers and barriers, and developing targeted engagement strategies and messaging.
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Affiliation(s)
- Lynette J McLeod
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, Australia.
| | - Donald W Hine
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, Australia
| | - Andrew J Bengsen
- Vertebrate Pest Research Unit, NSW Department of Primary Industries, Orange, Australia
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McLeod LJ, Hine DW, Please PM, Driver AB. Applying behavioral theories to invasive animal management: Towards an integrated framework. J Environ Manage 2015; 161:63-71. [PMID: 26151198 DOI: 10.1016/j.jenvman.2015.06.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 06/04/2023]
Abstract
Invasive species wreak an estimated $1.4 trillion in damages globally, each year. To have any hope of reducing this damage, best-practice control strategies must incorporate behavior change interventions. Traditional interventions, based on the knowledge-transfer model, assume that if land managers are properly educated about risks and strategies, they will develop supportive attitudes and implement appropriate control strategies. However, the social sciences have produced a large number of behavioral models and frameworks that demonstrate that knowledge transfer, by itself, fails to change behavior. The challenge then lies in knowing which behavioral model to choose, and when, from a potentially overwhelming 'universe'. In this paper, we review nine behavior theories relevant to invasive species management. We then introduce the Behavior Change Wheel as a tool for integrating these theories into a single practical framework. This framework links drivers of and barriers to behavior change with intervention strategies and policies, in what we consider, from an applied perspective, to be an important advance.
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Affiliation(s)
- Lynette J McLeod
- School of Behavioural Cognitive and Social Sciences, University of New England, Armidale, NSW 2350, Australia.
| | - Donald W Hine
- School of Behavioural Cognitive and Social Sciences, University of New England, Armidale, NSW 2350, Australia
| | - Patricia M Please
- School of Behavioural Cognitive and Social Sciences, University of New England, Armidale, NSW 2350, Australia; Urban Research Program, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia
| | - Aaron B Driver
- School of Behavioural Cognitive and Social Sciences, University of New England, Armidale, NSW 2350, Australia; ContentLogic, 1/173A Beardy Street, Armidale, NSW 2350, Australia
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Binkley CJ, Johnson KW, Abadi M, Thompson K, Shamblen SR, Young L, Zaksek B. Improving the oral health of residents with intellectual and developmental disabilities: an oral health strategy and pilot study. Eval Program Plann 2014; 47:54-63. [PMID: 25137553 PMCID: PMC4188479 DOI: 10.1016/j.evalprogplan.2014.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/17/2014] [Accepted: 07/21/2014] [Indexed: 06/03/2023]
Abstract
This article presents an oral health (OH) strategy and pilot study focusing on individuals with intellectual and/or developmental disabilities (IDD) living in group homes. The strategy consists of four components: (1) planned action in the form of the behavioral contract and caregiver OH action planning; (2) capacity building through didactic and observation learning training; (3) environmental adaptations consisting of additional oral heath devices and strategies to create a calm atmosphere; and (4) reinforcement by post-training coaching. A pilot study was conducted consisting of pre- and post-assessment data collected 1 week before and 1 week after implementing a 1-month OH strategy. The study sample comprised 11 group homes with 21 caregivers and 25 residents with IDD from one service organization in a Midwestern city. A process evaluation found high-quality implementation of the OH strategy as measured by dosage, fidelity, and caregiver reactions to implementing the strategy. Using repeated cross-sectional and repeated measures analyses, we found statistically significant positive changes in OH status and oral hygiene practices of residents. Caregiver self-efficacy as a mechanism of change was not adequately evaluated; however, positive change was found in some but not all types of caregiver OH support that were assessed. Lessons learned from implementing the pilot study intervention and evaluation are discussed, as are the next steps in conducting an efficacy study of the OH strategy.
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Affiliation(s)
- Catherine J Binkley
- Department of Surgical & Hospital Dentistry, School of Dentistry, University of Louisville, Louisville, KY 40292, United States.
| | - Knowlton W Johnson
- Pacific Institute for Research & Evaluation, 1300 S 4th Street, Louisville, KY 40208, United States.
| | - Melissa Abadi
- Pacific Institute for Research & Evaluation, 1300 S 4th Street, Louisville, KY 40208, United States.
| | - Kirsten Thompson
- Pacific Institute for Research & Evaluation, 1300 S 4th Street, Louisville, KY 40208, United States.
| | - Stephen R Shamblen
- Pacific Institute for Research & Evaluation, 1300 S 4th Street, Louisville, KY 40208, United States.
| | - Linda Young
- Pacific Institute for Research & Evaluation, 1300 S 4th Street, Louisville, KY 40208, United States.
| | - Brigit Zaksek
- Department of Surgical & Hospital Dentistry, School of Dentistry, University of Louisville, Louisville, KY 40292, United States.
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