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Steed L, Sheringham J, McClatchey K, Hammersley V, Marsh V, Morgan N, Jackson T, Holmes S, Taylor S, Pinnock H. IMP 2ART: development of a multi-level programme theory integrating the COM-B model and the iPARIHS framework, to enhance implementation of supported self-management of asthma in primary care. Implement Sci Commun 2023; 4:136. [PMID: 37957778 PMCID: PMC10644643 DOI: 10.1186/s43058-023-00515-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Supported asthma self-management, incorporating an asthma action plan and annual clinical review, has been recommended by UK/global guidelines for over three decades. However, implementation remains poor, as only around a third of individuals receive basic asthma care, according to the UKs leading respiratory charity Asthma and Lung UK. A systematic review of implementation studies recommended that a whole systems approach targeting patients, healthcare professional education, and organisations is needed to improve implementation of supported asthma self-management in primary care. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) is a national Hybrid-II implementation cluster randomised controlled trial that aims to evaluate such an approach. This paper describes the development of the implementation strategy for IMP2ART with particular focus on the integration of multiple level theories. METHODS The Medical Research Council design and evaluation of complex interventions framework and the Person-Based Approach to intervention development were used as guidance for stages of strategy development. Specifically, we (i) set up a multidisciplinary team (including practicing and academic clinicians, health psychologists, public health and patient colleagues), (ii) reviewed and integrated evidence and theory, (iii) developed guiding principles, (iv) developed prototype materials, and (v) conducted a pre-pilot study before final refinement. RESULTS The implementation strategy included resources for patients, team-based and individual healthcare professional education, practice audit and feedback, and an asthma review template, as well as a facilitator role accessible to primary care practices for 12 months. The synthesis of the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) and Capability, Opportunity, Motivation and Behaviour (COM-B) frameworks led to an evolved framework bringing together important implementation and behaviour change elements which will be used as a basis for the study process evaluation. CONCLUSIONS A description of rigorous implementation strategy development for the IMP2ART study is provided along with newly theorised integration of implementation and behaviour change science which may be of benefit to others targeting implementation in primary care. TRIAL REGISTRATION ISRCTN15448074. Registered on 2nd December 2019.
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Affiliation(s)
- Liz Steed
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, London, UK.
| | - Kirstie McClatchey
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Vicky Hammersley
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Viv Marsh
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Noelle Morgan
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Tracy Jackson
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Steve Holmes
- The Park Medical Practice, Shepton Mallet, UK
- Severn School of Primary Care, Health Education England (South West), Bristol, UK
| | - Stephanie Taylor
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
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Jenkins V, Starkings R, Teoh M, May S, Bloomfield D, Zammit C, Elwell-Sutton D, Betal D, Finlay J, Nicholson K, Kothari M, Santos R, Stewart E, Bell S, McKinna F, Matthews L. Patients' views and experiences on the supported self-management/patient-initiated follow up pathway for breast cancer. Support Care Cancer 2023; 31:658. [PMID: 37889343 PMCID: PMC10611591 DOI: 10.1007/s00520-023-08115-5] [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] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To explore patients' expectations and experience of Supportive Self-Management (SSM)/ Patient Initiated Follow Up (PIFU) following breast cancer treatments over a 12-month period. METHODS In total, 32/110 (29%) patient participants in the PRAGMATIC (Patients' experiences of a suppoRted self-manAGeMent pAThway In breast Cancer) study were interviewed at baseline, 3, 6, 9 and 12 months. Interviews in this sub-study used a mix-methods approach to explore understanding of the pathway, confidence in self-management, triggers to seek help and/or re-engage with the clinical breast team and impact of the COVID-19 pandemic. Responses to pre-assigned categories were summarised as counts/ percentages and collated in tabular or graphic format. Free responses were recorded verbatim and reviewed using framework analysis. RESULTS Participants regarded the SSM/PIFU pathway as a way to save time and money for them and the National Health Service (NHS) (14/32; 44%) and as a means of assuming responsibility for their own follow-up (18/32; 56%). Most maintained (very/somewhat) confidence in managing their BC follow-up care (baseline 31/32, 97%; 12 months 29/31, 93%). During the year, 19% (5/26) stopped endocrine therapy altogether because of side effects. Qualitative analysis revealed general satisfaction with SSM/PIFU and described the breast care nurses as reassuring and empathic. However, there was a lingering anxiety about identifying signs and symptoms correctly, particularly for those with screen-detected cancers. There was also uncertainty about who to contact for psychological support. The COVID-19 pandemic discouraged some participants from contacting the helpline as they did not want to overburden the NHS. CONCLUSIONS The results show that during the first year on the SSM/PIFU pathway, most patients felt confident managing their own care. Clinical teams should benefit from understanding patients' expectations and experiences and potentially modify the service for men with BC and/or those with screen-detected breast cancers.
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Affiliation(s)
- Valerie Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK.
| | - Rachel Starkings
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
| | - May Teoh
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - Shirley May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
| | - David Bloomfield
- University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
| | - Charles Zammit
- University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
| | - Debbie Elwell-Sutton
- University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
| | - Dibendu Betal
- University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - Judith Finlay
- University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - Kay Nicholson
- University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - Manish Kothari
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - Regina Santos
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - Elaine Stewart
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - Stephanie Bell
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - Fiona McKinna
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - Lucy Matthews
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
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Jenkins V, Matthews L, Solis-Trapala I, Gage H, May S, Williams P, Bloomfield D, Zammit C, Elwell-Sutton D, Betal D, Finlay J, Nicholson K, Kothari M, Santos R, Stewart E, Bell S, McKinna F, Teoh M. Patients' experiences of a suppoRted self-manAGeMent pAThway In breast Cancer (PRAGMATIC): quality of life and service use results. Support Care Cancer 2023; 31:570. [PMID: 37698629 PMCID: PMC10497681 DOI: 10.1007/s00520-023-08002-z] [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] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To describe trends and explore factors associated with quality of life (QoL) and psychological morbidity and assess breast cancer (BC) health service use over a 12-month period for patients joining the supported self-management (SSM)/patient-initiated follow-up (PIFU) pathway. METHODS Participants completed questionnaires at baseline, 3, 6, 9 and 12 months that measured QoL (FACT-B, EQ 5D-5L), self-efficacy (GSE), psychological morbidity (GHQ-12), roles and responsibilities (PRRS) and service use (cost diary). RESULTS 99/110 patients completed all timepoints; 32% (35/110) had received chemotherapy. The chemotherapy group had poorer QoL; FACT-B total score mean differences were 8.53 (95% CI: 3.42 to 13.64), 5.38 (95% CI: 0.17 to 10.58) and 8.00 (95% CI: 2.76 to 13.24) at 6, 9 and 12 months, respectively. The odds of psychological morbidity (GHQ12 >4) were 5.5-fold greater for those treated with chemotherapy. Financial and caring burdens (PRRS) were worse for this group (mean difference in change at 9 months 3.25 (95% CI: 0.42 to 6.07)). GSE and GHQ-12 scores impacted FACT-B total scores, indicating QoL decline for those with high baseline psychological morbidity. Chemotherapy patients or those with high psychological morbidity or were unable to carry out normal activities had the highest service costs. Over the 12 months, 68.2% participants phoned/emailed breast care nurses, and 53.3% visited a hospital breast clinician. CONCLUSION The data suggest that chemotherapy patients and/or those with heightened psychological morbidity might benefit from closer monitoring and/or supportive interventions whilst on the SSM/PIFU pathway. Reduced access due to COVID-19 could have affected service use.
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Affiliation(s)
- V Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK.
| | - L Matthews
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
| | - I Solis-Trapala
- School of Medicine, Keele University, University Road, Staffordshire, England, UK
| | - H Gage
- Surrey Health Economics Centre/Department of Clinical and Experimental Medicine, Leggett Building, University of Surrey, Guildford, Surrey, England, UK
| | - S May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, East Sussex, England, UK
| | - P Williams
- Department of Mathematics, University of Surrey, Guildford, Surrey, England, UK
| | - D Bloomfield
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - C Zammit
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - D Elwell-Sutton
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, East Sussex, England, UK
| | - D Betal
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - J Finlay
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - K Nicholson
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, England, UK
| | - M Kothari
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - R Santos
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - E Stewart
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
| | - S Bell
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - F McKinna
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
| | - M Teoh
- Surrey & Sussex Cancer Alliance, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, England, UK
- Ashford & St Peter's NHS Foundation Trust, London Road, Ashford, Surrey, England, UK
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Hancock NJ, Houghton J, Jones F. Integrating an approach to personalised self-management support in stroke and neurorehabilitation service contexts: People1st - a quality improvement initiative. Disabil Rehabil 2023; 45:3034-3045. [PMID: 36301996 DOI: 10.1080/09638288.2022.2127930] [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] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE People living with stroke and neurological conditions access rehabilitation at different times but self-management is often viewed as what happens post-discharge. Personalised models that integrate self-management support within everyday care are now advocated but this may require practitioners to change their behaviour to adopt and sustain new ways of working. The People1st project evaluated integration of an existing Supported Self-Management programme ("Bridges") across varied stroke and neurorehabilitation service contexts. MATERIALS AND METHODS Mixed-method evaluation of training for groups of healthcare practitioners across 24 UK National Health Service (NHS) Trusts, exploring how learning from Bridges was assimilated and enacted in practice, on an individual and collective basis. RESULTS Staff growth in confidence and skill around supported self-management was demonstrated. Transformations to practice included changes to: the structure of, and language used in, patient interactions; induction/training processes to increase potential for sustainability; and sharing of successes. Bridges helped practitioners make changes that brought them closer to their professional ideals. Engaged leadership was considered important for successful integration. CONCLUSIONS Bridges was successfully integrated within a wide range of stroke and neurorehabilitation service contexts, enabled by an approach in line with practitioners' values-based motivations. Further work is required to explore sustainability and impact on service users. Implications for rehabilitationPersonalised models of care and support for self-management are advocated for people living with stroke and neurological conditions; this requires practitioners to be supported to change behaviour and practices to adopt and sustain new ways of working.Staff from a wide variety of backgrounds in neurorehabilitation and stroke can learn collaboratively about self-management practices via the Bridges programme and can integrate those practices into their service contexts.Bridges can take practitioners closer to their professional ideals of caring and making a difference and empowers them to initiate change.Organisational commitment and engaged leadership are required to facilitate a culture of support for self-management in practice.
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Affiliation(s)
- Nicola J Hancock
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Julie Houghton
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona Jones
- Population Health Research Institute, St George's University of London, London, UK
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Healey EL, Lewis M, Corp N, Shivji NA, van der Windt DA, Babatunde OO, Simkins J, Bartlam B, Rowlands G, Protheroe J. Supported self-management for all with musculoskeletal pain: an inclusive approach to intervention development: the EASIER study. BMC Musculoskelet Disord 2023; 24:474. [PMID: 37301959 PMCID: PMC10257331 DOI: 10.1186/s12891-023-06452-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/21/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Supported self-management interventions for patients with musculoskeletal (MSK) conditions may not adequately support those with limited health literacy, leading to inequalities in care and variable outcomes. The aim of this study was to develop a model for inclusive supported self-management intervention(s) for MSK pain that take account of health literacy. METHODS A mixed methods study with four work-packages was conducted: work package 1: secondary analysis of existing data to identify potential targets for intervention; work package 2: evidence synthesis to assess effective components of self-management interventions taking into account health literacy; work package 3: views of community members and healthcare professionals (HCPs) on essential components; work package 4: triangulation of findings and an online modified Delphi approach to reach consensus on key components of a logic model. FINDINGS Findings identified targets for intervention as self-efficacy, illness perceptions, and pain catastrophizing. A range of intervention components were identified (e.g. information in diverse formats offered at specific times, action planning and visual demonstrations of exercise). Support should be multi-professional using a combination of delivery modes (e.g. remote, face-to-face). CONCLUSIONS This research has developed a patient-centred model for a multi-disciplinary, multi-modal approach to supported self-management for patients with MSK pain and varying levels of health literacy. The model is evidence-based and acceptable to both patients and HCPs, with potential for significant impact on the management of MSK pain and for improving patient health outcomes. Further work is needed to establish its efficacy.
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Affiliation(s)
- Emma L Healey
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Martyn Lewis
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Nadia Corp
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Noureen A Shivji
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Danielle A van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Opeyemi O Babatunde
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Joanna Simkins
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Musculoskeletal Outpatient Physiotherapy, Princess Royal Hospital, Apley Castle, Telford, TF1 6TF, UK
| | - Bernadette Bartlam
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Gill Rowlands
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Joanne Protheroe
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
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Avery L, Smith H, McPherson S, Hallsworth K. Feasibility and acceptability of an evidence-informed digital intervention to support self-management in people with non-alcoholic fatty liver disease: protocol for a non-randomised feasibility study (VITALISE). Pilot Feasibility Stud 2023; 9:62. [PMID: 37076916 PMCID: PMC10114296 DOI: 10.1186/s40814-023-01286-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/30/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of disease ranging from simple fatty liver to non-alcoholic steatohepatitis, cirrhosis, liver cancer and liver failure. NAFLD affects up to 30-40% of adults in Western countries and is directly linked to overweight and obesity. There are no approved drugs to specifically target NAFLD, therefore weight loss achieved through changes in dietary and physical activity behaviours is the recommended management approach. However, achieving and sustaining weight loss is challenging for patients with NAFLD. We developed a NAFLD-specific digital lifestyle intervention (VITALISE) to target changes in dietary and physical activity behaviours of patients with NAFLD to initiate weight loss and weight loss maintenance. This study aims to evaluate the feasibility and acceptability of VITALISE in a secondary care clinical setting. METHODS A single-centre, one-arm, prospective design will be used to assess the feasibility and acceptability of recruitment, uptake, engagement and completion of VITALISE. Health-related outcomes will be assessed at baseline and 6-months. An interim measure of self-reported weight, physical activity and self-efficacy will be recorded at 12-weeks. Qualitative semi-structured interviews conducted at 6 months follow up will further explore acceptability and feasibility and fidelity of receipt and enactment. The study aims to recruit 35 patients with newly diagnosed NAFLD over a 6-month time period. Eligible patients will have continuous access to VITALISE and monthly tele-coaching support for 6 months prior to follow-up with a hepatologist. DISCUSSION VITALISE offers access to evidence and theory-informed tailored dietary and physical activity support for patients with NAFLD. The intervention is designed for use by patients in their own time, outside of the hospital setting to overcome well documented challenges including attending additional appointments, and lack of time during routine appointments to adequately address lifestyle behaviour change. This feasibility study will determine the feasibility of VITALISE to support clinical care delivery. TRIAL REGISTRATION ISRCTN12893503.
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Affiliation(s)
- Leah Avery
- School of Health & Life Sciences, Teesside University, Tees Valley, Middlesbrough, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Hollie Smith
- School of Health & Life Sciences, Teesside University, Tees Valley, Middlesbrough, UK
| | - Stuart McPherson
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne, UK
| | - Kate Hallsworth
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
- NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne, UK.
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Forster A, Ozer S, Brindle R, Barnard L, Hardicre N, Crocker TF, Chenery M, Moreau L, Wright A, Burton LJ, Hartley S, Hulme C, Dawkins B, Holloway I, House A, Hewison J, Farrin A. An intervention to support stroke survivors and their carers in the longer term: results of a cluster randomised controlled feasibility trial (LoTS2Care). Pilot Feasibility Stud 2023; 9:40. [PMID: 36922866 PMCID: PMC10015731 DOI: 10.1186/s40814-023-01258-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/09/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND To address the limited provision of longer-term stroke care, we conducted a programme of research (LoTS2Care) to develop and test an intervention to form part of a replicable longer-term care strategy. New Start, a programme of facilitated self-management, was developed to be delivered at 6 months post-stroke by trained facilitators. Here, we report the findings from the final workstream of this programme, which aimed to evaluate the feasibility and acceptability of implementing a future definitive cluster randomised controlled trial of the developed intervention (New Start) to support stroke survivors and their carers in the longer term. METHODS A feasibility cluster randomised controlled trial was conducted in English and Welsh NHS stroke services. Stroke services (clusters) were randomised on a 1:1 basis to implement New Start or continue with usual care only. Community-dwelling stroke survivors between 4 and 6 months post-stroke were invited to participate in the trial by post. Outcome measures were collected via post at 3, 6 and 9 months after recruitment. Recruitment and follow-up rates, delivery and uptake of the intervention, data collection feasibility (including postal outcome measures of health and disability, mental well-being at 3, 6, and 9 months post-recruitment) and safety were assessed. RESULTS Ten stroke services were recruited. A total of 1127 stroke survivors were screened for participation, and 269 were registered (New Start, n = 145; usual care, n = 124). Retention was high with 239 (89%) stroke survivors being available for follow-up at 9 months, and high return rates of postal questionnaires were achieved (80.3% at 9 months). Intervention training was successfully delivered, and New Start was offered to 95.2% of trial participants in the intervention arm. Uptake was variable, however, ranging from 11.8 to 75.0%. There were no safety concerns. CONCLUSIONS Stroke service recruitment and longer-term stroke survivor postal recruitment and outcome data collection are feasible; however, refinement of intervention targeting and delivery is required prior to undertaking a definitive trial. TRIAL REGISTRATION ISRCTN38920246. Registered 22 June 2016 ( http://www.isrctn.com/ISRCTN38920246 ).
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Affiliation(s)
- Anne Forster
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Seline Ozer
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
| | - Richard Brindle
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lorna Barnard
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Natasha Hardicre
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Marie Chenery
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lauren Moreau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alan Wright
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK.,Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Division of Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Abstract
BACKGROUND The use of digital health or e-health is growing. The potential positive impact on IBD care from supported self-management using these tools emerged from a literature review carried out in preparation for a service improvement project. A patient-reported outcomes measure (PROM) with validation across IBD sub-types was already available for use. This internationally recognised tool has potential for use with existing or new e-health systems. AIMS In order to test the concept of using PROMs to support practice and follow up a small-scale pilot study was designed. The aim of the study was to understand if empowering patients to undertake supported self-management could lead in turn to improved flow through outpatient services. METHODS An audit was carried out of PROMs looking at quality of life (QoL) as well as disease activity using an electronic platform in real time at the point of patient contact. The disease activity indices used were the Harvey Bradshaw Index and the Simple Clinical Colitis Activity Index, due to the author's familiarity with these tools. RESULTS Of the 15 participants, 10 reported themselves as 'well' or 'well with questions' all participants reported an acceptance of supported remote self-management using e-health. CONCLUSION This evaluation led to PROMs being captured on a tablet in the outpatient setting in the pre-pandemic period. Allowing patients to use the PROM as a tool in the outpatient setting has led to longitudinal data being added to the e-health system for each individual. Well patients could be managed remotely, freeing capacity in outpatient clinics.
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Affiliation(s)
- Pearl Avery
- Patient Safety Practitioner, Dorset County Hospital Foundation Trust, Dorchester
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Murphy JK, Xie H, Nguyen VC, Chau LW, Oanh PT, Nhu TK, O'Neil J, Goldsmith CH, Van Hoi N, Ma Y, Lou H, Jones W, Minas H. Is supported self-management for depression effective for adults in community-based settings in Vietnam?: a modified stepped-wedge cluster randomized controlled trial. Int J Ment Health Syst 2020; 14:8. [PMID: 32071614 PMCID: PMC7014690 DOI: 10.1186/s13033-020-00342-1] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/03/2020] [Indexed: 11/30/2022] Open
Abstract
Background This study tested the effectiveness of a supported self-management (SSM) intervention to reduce symptoms of depression among adults compared with enhanced treatment as usual in community-based and primary care settings in Vietnam. Methods The cluster randomized trial included 376 adults in 32 communes in eight provinces. Eligible participants scored > 7 on the SRQ-20 depression scale. Patients with severe symptoms were excluded and referred to tertiary care. Randomization took place at the commune level. The immediate intervention group included 16 communes with 190 participants and the delayed group included 16 communes with 186 participants. Participants in communes randomized to the immediate intervention group received a two-month course of SSM, consisting of a workbook and supportive coaching. Those in communes randomized to the delayed group received enhanced treatment as usual and, for ethical purposes, received the SSM intervention after 4 months. The primary outcome is the effect of SSM on reduction in depression scores as indicated by a reduced proportion of participants with SRQ-20 scores > 7 at 2 months after commencement of SSM intervention. Blinding was not possible during intervention delivery but outcome assessors were blinded. Analysis was intention-to-treat. Results At 2 months, 26.4% of the intervention group and 42.3% of the delayed group had SRQ-20 scores > 7. The adjusted odds ratio of having depression between the intervention and control was 0.42 (p < 0.0001), 95% CI (0.28, 0.63). Receiving the intervention thus reduces the odds of having depression by 58%, compared with receiving the control after 2 months of treatment. No adverse events were reported. Conclusions Results suggest that SSM is effective for decreasing depression symptoms among adults in community-based settings in Vietnam. Trial Registration This trial is registered at ClinicalTrials.gov, number NCT03001063.
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Affiliation(s)
- Jill K Murphy
- 1Department of Psychiatry, Faculty of Medicine, University of British Columbia, Mood Disorders Centre, 2255 Westbrook Mall, Vancouver, BC V6T 2A1 Canada
| | - Hui Xie
- 2Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Vu Cong Nguyen
- 3Institute of Population, Health and Development, 132/18 Hoa Bang Street, Cau Giay, Hanoi, 122667 Vietnam
| | - Leena W Chau
- 4Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3 Canada
| | - Pham Thi Oanh
- 3Institute of Population, Health and Development, 132/18 Hoa Bang Street, Cau Giay, Hanoi, 122667 Vietnam
| | - Tran Kieu Nhu
- 3Institute of Population, Health and Development, 132/18 Hoa Bang Street, Cau Giay, Hanoi, 122667 Vietnam
| | - John O'Neil
- 4Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3 Canada
| | - Charles H Goldsmith
- 2Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Nguyen Van Hoi
- 5Ministry of Labour, Invalids and Social Affairs, 12 Ngo Quyen Street, Hoan Kiem District, Ha Noi, 159999 Vietnam
| | - Yue Ma
- 6BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Hayami Lou
- 4Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3 Canada
| | - Wayne Jones
- 4Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3 Canada
| | - Harry Minas
- 7Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053 Australia
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Frankland J, Brodie H, Cooke D, Foster C, Foster R, Gage H, Jordan J, Mesa-Eguiagaray I, Pickering R, Richardson A. Follow-up care after treatment for prostate cancer: evaluation of a supported self-management and remote surveillance programme. BMC Cancer 2019; 19:368. [PMID: 31014282 PMCID: PMC6480799 DOI: 10.1186/s12885-019-5561-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 11/22/2018] [Accepted: 03/31/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Alternative models of cancer follow-up care are needed to ameliorate pressure on services and better meet survivors' long-term needs. This paper reports an evaluation of a service improvement initiative for the follow-up care of prostate cancer patients based on remote monitoring and supported self-management. METHODS This multi-centred, historically controlled study compared patient reported outcomes of men experiencing the new Programme with men experiencing a traditional clinic appointment model of follow-up care, who were recruited in the period immediately prior to the introduction of the Programme. Data were collected by self-completed questionnaires, with follow up measurement at four and eight months post-baseline. The primary outcome was men's unmet survivorship needs, measured by the Cancer Survivors' Unmet Needs Survey. Secondary outcomes included cancer specific quality of life, psychological wellbeing and satisfaction with care. The analysis was intention to treat. Regression analyses were conducted for outcomes at each time point separately, controlling for pre-defined clinical and demographic variables. All outcome analyses are presented in the paper. Costs were compared between the two groups. RESULTS Six hundred and twenty-seven men (61%) were consented to take part in the study (293 in the Programme and 334 in the comparator group.) Regarding the primary measure of unmet survivorship needs, 25 of 26 comparisons favoured the Programme, of which 4 were statistically significant. For the secondary measures of activation for self-management, quality of life, psychological well-being and lifestyle, 20 of 32 comparisons favoured the Programme and 3 were statistically significant. There were 22 items on the satisfaction with care questionnaire and 13 were statistically significant. Per participant costs (British pounds, 2015) in the 8 month follow up period were slightly lower in the programme than in the comparator group (£289 versus £327). The Programme was acceptable to patients. CONCLUSION The Programme is shown to be broadly comparable to traditional follow-up care in all respects, adding to evidence of the viability of such models.
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Affiliation(s)
- Jane Frankland
- University of Southampton, School of Health Sciences, Highfield, Southampton, SO17 1BJ, UK.
| | - Hazel Brodie
- University of Southampton, School of Health Sciences, Highfield, Southampton, SO17 1BJ, UK
| | - Deborah Cooke
- University of Surrey, School of Health Sciences, Guildford, Surrey, GU2 7XH, UK
| | - Claire Foster
- University of Southampton, School of Health Sciences, Highfield, Southampton, SO17 1BJ, UK
| | - Rebecca Foster
- University of Southampton, School of Health Sciences, Highfield, Southampton, SO17 1BJ, UK
| | - Heather Gage
- Department of Clinical and Experimental Medicine, University of Surrey, Surrey Health Economics Centre, Guildford, Surrey, GU2 7XH, UK
| | - Jake Jordan
- Department of Clinical and Experimental Medicine, University of Surrey, Surrey Health Economics Centre, Guildford, Surrey, GU2 7XH, UK
| | - Ines Mesa-Eguiagaray
- University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Nine Edinburgh BioQuarter, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Ruth Pickering
- University of Southampton, Faculty of Medicine, Highfield, Southampton, SO17 1BJ, UK
| | - Alison Richardson
- University of Southampton, School of Health Sciences and University Hospital Southampton NHS Foundation Trust, Highfield, Southampton, SO17 1BJ, UK
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House A, Latchford G, Russell AM, Bryant L, Wright J, Graham E, Stansfield A, Ajjan R. Development of a supported self-management intervention for adults with type 2 diabetes and a learning disability. Pilot Feasibility Stud 2018; 4:106. [PMID: 29862037 PMCID: PMC5975532 DOI: 10.1186/s40814-018-0291-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/09/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although supported self-management is a well-recognised part of chronic disease management, it has not been routinely used as part of healthcare for adults with a learning disability. We developed an intervention for adults with a mild or moderate learning disability and type 2 diabetes, building on the principles of supported self-management with reasonable adjustments made for the target population. METHODS In five steps, we:Clarified the principles of supported self-management as reported in the published literatureIdentified the barriers to effective self-management of type 2 diabetes in adults with a learning disabilityReviewed existing materials that aim to support self-management of diabetes for people with a learning disabilitySynthesised the outputs from the first three phases and identified elements of supported self-management that were (a) most relevant to the needs of our target population and (b) most likely to be acceptable and useful to themImplemented and field tested the intervention. RESULTS The final intervention had four standardised components: (1) establishing the participant's daily routines and lifestyle, (2) identifying supporters and their roles, (3) using this information to inform setting realistic goals and providing materials to the patient and supporter to help them be achieved and (4) monitoring progress against goals.Of 41 people randomised in a feasibility RCT, thirty five (85%) completed the intervention sessions, with over three quarters of all participants (78%) attending at least three sessions.Twenty-three out of 40 (58%) participants were deemed to be very engaged with the sessions and 12/40 (30%) with the materials; 30 (73%) participants had another person present with them during at least one of their sessions; 15/41 (37%) were reported to have a very engaged main supporter, and 18/41 (44%) had a different person who was not their main supporter but who was engaged in the intervention implementation. CONCLUSIONS The intervention was feasible to deliver and, as judged by participation and engagement, acceptable to participants and those who supported them. TRIAL REGISTRATION Current Controlled Trials ISRCTN41897033 (registered 21/01/2013).
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Affiliation(s)
- Allan House
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Amy M. Russell
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Louise Bryant
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Elizabeth Graham
- Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | | | - Ramzi Ajjan
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
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12
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O'Dwyer JL, Russell AM, Bryant LD, Walwyn REA, Wright-Hughes AM, Graham EH, Wright JM, Meer S, Birtwistle J, Farrin AJ, House AO, Hulme CT. Developing and feasibility testing of data collection methods for an economic evaluation of a supported selfmanagement programme for adults with a learning disability and type 2 diabetes. Pilot Feasibility Stud 2018; 4:80. [PMID: 29713494 PMCID: PMC5911950 DOI: 10.1186/s40814-018-0266-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/30/2017] [Accepted: 03/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background The challenges of conducting research with hard to reach vulnerable groups are particularly pertinent for people with learning disabilities. Data collection methods for previous cost and cost-effectiveness analyses of health and social care interventions targeting people with learning disabilities have relied on health care/health insurance records or data collection forms completed by the service provider rather than by people with learning disabilities themselves. This paper reports on the development and testing of data collection methods for an economic evaluation within a randomised controlled trial (RCT) for a supported self-management programme for people with mild/moderate learning disabilities and type 2 diabetes. Methods A case finding study was conducted to identify types of health and social care use and data collection methods employed in previous studies with this population. Based on this evidence, resource use questionnaires for completion by GP staff and interviewer-administered participant questionnaires (covering a wider cost perspective and health-related quality of life) were tested within a feasibility RCT. Interviewer-administered questionnaires included the EQ-5D-3L (the NICE recommended measure for use in economic evaluation). Participants were adults > 18 years with a mild or moderate learning disability and type 2 diabetes, with mental capacity to give consent to research participation. Results Data collection for questionnaires completed by GP staff requesting data for the last 12 months proved time intensive and difficult. Whilst 82.3% (121/147) of questionnaires were returned, up to 17% of service use items were recorded as unknown. Subsequently, a shorter recall period (4 months) led to a higher return rate but with a higher rate of missing data. Missing data for interviewer-administered participant questionnaires was > 8% but the interviewers reported difficulty with participant recall. Almost 60% (48/80) of participants had difficulty completing the EQ-5D-3L. Conclusions Further investigation as to how service use can be recorded is recommended. Concerns about the reliability of identifying service use data directly from participants with a learning disability due to challenges in completion, specifically around recall, remain. The degree of difficulty to complete EQ-5D-3L indicates concerns regarding the appropriateness of using this measure in its current form in research with this population. Trial registration Current Controlled Trials ISRCTN41897033 (registered 21 January 2013).
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Affiliation(s)
- John L O'Dwyer
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Amy M Russell
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Louise D Bryant
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Rebecca E A Walwyn
- 2Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Alexandra M Wright-Hughes
- 2Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Elizabeth H Graham
- 2Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Judy M Wright
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Shaista Meer
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Jacqueline Birtwistle
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Amanda J Farrin
- 2Leeds Institute of Clinical Trials Research, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Allan O House
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
| | - Claire T Hulme
- 1Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL UK
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Murphy J, Goldsmith CH, Jones W, Oanh PT, Nguyen VC. The effectiveness of a Supported Self-management task-shifting intervention for adult depression in Vietnam communities: study protocol for a randomized controlled trial. Trials 2017; 18:209. [PMID: 28476148 PMCID: PMC5418759 DOI: 10.1186/s13063-017-1924-5] [Citation(s) in RCA: 5] [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: 01/11/2017] [Accepted: 03/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background Depressive disorders are one of the leading causes of disease and disability worldwide. In Vietnam, although epidemiological evidence suggests that depression rates are on par with global averages, services for depression are very limited. In a feasibility study that was implemented from 2013 to 2015, we found that a Supported Self-management (SSM) intervention showed promising results for adults with depression in the community in Vietnam. This paper describes the Mental Health in Adults and Children: Frugal Innovations (MAC-FI) trial protocol that will assess the effectiveness of the SSM intervention, delivered by primary care and social workers, to community-based populations of adults with depression in eight Vietnamese provinces. Methods/design The MAC-FI program will be assessed using a stepped-wedge, randomized controlled trial. Study participants are adults aged 18 years and over in eight provinces of Vietnam. Study participants will be screened at primary care centres and in the community by health and social workers using the Self-reporting Questionnaire-20 (SRQ-20). Patients scoring >7, indicating depression caseness, will be invited to participate in the study in either the SSM intervention group or the enhanced treatment as usual control group. Recruited participants will be further assessed using the World Health Organization’s Disability Assessment Scale (WHODAS 2.0) and the Cut-down, Annoyed, Guilty, Eye-opener (CAGE) Questionnaire for alcohol misuse. Intervention-group participants will receive the SSM intervention, delivered with the support of a social worker or social collaborator, for a period of 2 months. Control- group participants will receive treatment as usual and a leaflet with information about depression. SRQ-20, WHODAS 2.0 and CAGE scores will be taken by blinded outcome assessors at baseline, after 1 month and after 2 months. The primary analysis method will be intention-to-treat. Discussion This study has the potential to add to the knowledge base about the effectiveness of a SSM intervention for adult depression that has been validated for the Vietnamese context. This trial will also contribute to the growing body of evidence about the effectiveness of low-cost, task-shifting interventions for use in low-resource settings, where specialist mental health services are often limited. Trial registration Retrospectively registered at ClinicalTrials.gov, identifier: NCT03001063. Registered on 20 December 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1924-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jill Murphy
- Centre for Applied Research in Mental Health and Addictions, Simon Fraser University, Suite 2400, 515 W. Hastings Street, Vancouver, BC, V6B 5K3, Canada.
| | - Charles H Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Wayne Jones
- Centre for Applied Research in Mental Health and Addictions, Simon Fraser University, Suite 2400, 515 W. Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Pham Thi Oanh
- Institute of Population, Health and Development, 18 Lane 132, Hoa Bang, Yen Hoa, Hanoi, 122667, Vietnam
| | - Vu Cong Nguyen
- Institute of Population, Health and Development, 18 Lane 132, Hoa Bang, Yen Hoa, Hanoi, 122667, Vietnam
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Pinnock H, Parke HL, Panagioti M, Daines L, Pearce G, Epiphaniou E, Bower P, Sheikh A, Griffiths CJ, Taylor SJC. Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Med 2017; 15:64. [PMID: 28302126 PMCID: PMC5356253 DOI: 10.1186/s12916-017-0823-7] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/20/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Supported self-management has been recommended by asthma guidelines for three decades; improving current suboptimal implementation will require commitment from professionals, patients and healthcare organisations. The Practical Systematic Review of Self-Management Support (PRISMS) meta-review and Reducing Care Utilisation through Self-management Interventions (RECURSIVE) health economic review were commissioned to provide a systematic overview of supported self-management to inform implementation. We sought to investigate if supported asthma self-management reduces use of healthcare resources and improves asthma control; for which target groups it works; and which components and contextual factors contribute to effectiveness. Finally, we investigated the costs to healthcare services of providing supported self-management. METHODS We undertook a meta-review (systematic overview) of systematic reviews updated with randomised controlled trials (RCTs) published since the review search dates, and health economic meta-analysis of RCTs. Twelve electronic databases were searched in 2012 (updated in 2015; pre-publication update January 2017) for systematic reviews reporting RCTs (and update RCTs) evaluating supported asthma self-management. We assessed the quality of included studies and undertook a meta-analysis and narrative synthesis. RESULTS A total of 27 systematic reviews (n = 244 RCTs) and 13 update RCTs revealed that supported self-management can reduce hospitalisations, accident and emergency attendances and unscheduled consultations, and improve markers of control and quality of life for people with asthma across a range of cultural, demographic and healthcare settings. Core components are patient education, provision of an action plan and regular professional review. Self-management is most effective when delivered in the context of proactive long-term condition management. The total cost (n = 24 RCTs) of providing self-management support is offset by a reduction in hospitalisations and accident and emergency visits (standard mean difference 0.13, 95% confidence interval -0.09 to 0.34). CONCLUSIONS Evidence from a total of 270 RCTs confirms that supported self-management for asthma can reduce unscheduled care and improve asthma control, can be delivered effectively for diverse demographic and cultural groups, is applicable in a broad range of clinical settings, and does not significantly increase total healthcare costs. Informed by this comprehensive synthesis of the literature, clinicians, patient-interest groups, policy-makers and providers of healthcare services should prioritise provision of supported self-management for people with asthma as a core component of routine care. SYSTEMATIC REVIEW REGISTRATION RECURSIVE: PROSPERO CRD42012002694 ; PRISMS: PROSPERO does not register meta-reviews.
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Affiliation(s)
- Hilary Pinnock
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Hannah L. Parke
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Maria Panagioti
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Luke Daines
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Gemma Pearce
- Centre for Technology Enabled Health Research (CTEHR), Coventry University, Coventry, UK
| | - Eleni Epiphaniou
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Chris J. Griffiths
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie J. C. Taylor
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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