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Pointon L, Hinsby K, Keyworth C, Wainwright N, Bates J, Moores L, Johnson J. Exploring the experiences and perceptions of trainees undertaking a critical incident debrief training programme: A qualitative study. Int J Health Plann Manage 2024. [PMID: 38393977 DOI: 10.1002/hpm.3795] [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: 07/14/2022] [Revised: 09/21/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
RATIONALE, AIMS AND OBJECTIVES Critical incident debriefing is an occupational health tool for supporting healthcare workers following critical incidents. Demand for debriefing has increased following the Covid-19 pandemic. There is now a need for more trained debrief facilitators to meet demand, but there is a dearth of literature regarding how best to train facilitators. This study addressed this by exploring participant experiences of an online critical incident debrief training programme. METHODS We conducted semi-structured interviews with 14 individuals who received a 5-day training programme based on the Critical Incident Stress Management model. Participants were recruited from a range of professional disciplines including psychology, nursing and human resources within one British healthcare system. Data were analysed using thematic analysis. RESULTS The analysis produced three themes. Managing trainee experiences and expectations suggested that disciplinary heterogeneity in training groups supported inter-participant knowledge exchange. However, this variation also meant that training materials did not meet the learning needs of all participants. Modality of training suggested that while online learning was acceptable for some, others experienced screen fatigue and found it hard to build rapport with other participants. Systematic and organisational obstacles to training access and delivery suggested that lack of managerial support and organisational mental health stigma may be barriers to accessing training. CONCLUSION A 5-day online CISM-based training programme was acceptable to participants. Organisations implementing critical incident debrief training may benefit from (1) offering both in-person and online training options, and (2) tailoring course materials according to the disciplinary make-up of groups.
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Affiliation(s)
- Lucy Pointon
- School of Psychology, University of Leeds, Leeds, UK
- School of Justice, Security and Sustainability, Staffordshire University, Stoke-on-Trent, UK
| | - Kerry Hinsby
- Leeds and York Partnership Foundation Trust, Leeds, UK
| | | | | | - Jenny Bates
- Mid-Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Lucie Moores
- Mid-Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Armitage CJ, Keyworth C, Gartland N, Coleman A, Fishwick D, Johnson S, van Tongeren M. Utility of the capabilities, opportunities, motivations model for understanding changes in behavior. J Public Health (Oxf) 2024; 46:185-193. [PMID: 37758232 DOI: 10.1093/pubmed/fdad189] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Wearing face coverings to prevent airborne viral transmission has at times been legally mandated, followed by periods when rules were relaxed. The present study tracks changes in face covering and the impacts on people's perceptions of their capabilities, opportunities and motivations. METHODS Three-wave survey. At wave 1 (25 January-6 February 2022), 10 622 UK adults reported: (a) sociodemographic characteristics; (b) face covering in work, public transport and indoor leisure settings and (c) capabilities, opportunities and motivations. Measures were repeated 1-18 March 2022 and 20 May-6 June 2022. Data were analyzed descriptively, within-participants analysis of covariance (ANCOVA) and multiple linear regression. RESULTS Face covering decreased over time as rules around the wearing of face coverings relaxed. Perceptions of capabilities, opportunities and motivations to wear face coverings were consistently associated with the actual wearing of face coverings, with marked decreases in motivations over time. CONCLUSIONS Decreases in motivations seem to explain best the reasons for declining levels of face covering. Further work is required to develop interventions to change people's motivations and promote the wearing of face coverings, should they be required in the future.
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Affiliation(s)
- Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester M13 9PL, UK
| | - Chris Keyworth
- Department of Psychology, University of Leeds, Leeds LS2 9JT, UK
| | - Nicola Gartland
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Anna Coleman
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - David Fishwick
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Sheena Johnson
- Alliance Manchester Business School, University of Manchester, Manchester M15 6PB, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester M13 9PL, UK
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Keyworth C, Conner M, Johnson J, Epton T, Vogt KS, Armitage CJ. Impacts of the COVID-19 public health emergency on healthcare professional delivery of opportunistic behaviour change interventions: a retrospective cohort study. BMC Health Serv Res 2024; 24:167. [PMID: 38317160 PMCID: PMC10845453 DOI: 10.1186/s12913-023-10522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 09/09/2022] [Accepted: 12/23/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The public health policy "Making Every Contact Count" (MECC) compels healthcare professionals to deliver health behaviour change interventions during routine consultations. As healthcare systems continue their recovery from the impacts of the COVID-19 public health emergency, supporting people to modify health behaviours is more important now than when the policy was introduced. The present study aims to: (a) examine changes in healthcare professionals' awareness of, and engagement with the policy over a five-year period, (b) examine the psychosocial drivers associated with delivering behaviour change interventions, and (c) identify targets to increase healthcare professionals' delivery of interventions. METHODS Comparison of data from two independent representative surveys of NHS healthcare professionals working in the UK. In both surveys (July-September 2017; N = 1387, and February-March 2022; N = 1008), participants were asked to report: (1) awareness of the MECC policy, (2) the prevalence of MECC-related practice (perceived patient benefit, how often interventions were delivered, and time spent delivering interventions), and (3) perceptions of capabilities, opportunities and motivations to deliver behaviour change interventions. T- tests (independent-samples), MANOVA, multiple linear regression, and chi-square analyses were used to generate comparisons between the surveys. RESULTS Awareness of the policy increased from 2017 (31.4%) to 2022 (52.0%). However, in 2022 compared with 2017, healthcare professionals reported (a) fewer patients would benefit from behaviour change interventions (49.1% versus 55.9%), (b) they delivered behaviour change interventions to a lower proportion of patients (38.0% versus 50.0%), and (c) they spent a lower proportion of the consultation time delivering interventions (26.5% versus 35.3%). Further, in 2022, compared with 2017, healthcare professionals reported fewer physical opportunities, fewer social opportunities, and fewer psychological capabilities to deliver behaviour change interventions. In the 2022 survey, perceptions of patient benefit and delivery of interventions was associated with greater perceptions of opportunities and motivations. CONCLUSIONS Health behaviour change interventions remain an important part of routine healthcare in the continued recovery from COVID-19 public health emergency, however reported engagement with MECC-related practices appears to have reduced over time. Future research should consider how healthcare professionals identify patients who might benefit from opportunistic behaviour change interventions, and to increase capabilities, opportunities, and motivations to deliver interventions during routine consultations.
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Affiliation(s)
- Chris Keyworth
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK.
| | - Mark Conner
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, Manchester, UK
| | - Katharina S Vogt
- School of Psychology, University of Leeds, LS2 9JT, Leeds, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9PL, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, M13 9PL, Manchester, UK
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4
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Leather JZ, Keyworth C, Kapur N, Campbell SM, Armitage CJ. Implementation of national guidance for self-harm among general practice nurses: a qualitative exploration using the capabilities, opportunities, and motivations model of behaviour change (COM-B) and the theoretical domains framework. BMC Nurs 2023; 22:452. [PMID: 38041157 PMCID: PMC10693142 DOI: 10.1186/s12912-023-01360-3] [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: 09/23/2022] [Accepted: 05/27/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Patients who self-harm may consult with primary care nurses, who have a safeguarding responsibility to recognise and respond to self-harm. However, the responses of nursing staff to self-harm are poorly understood, and opportunities to identify self-harm and signpost towards treatment may be missed. It is unclear how to support nursing staff to implement national guidelines. AIMS Among primary care nursing staff to: [1] Examine reported barriers and enablers to nurses' use of, and adherence to, national guidance for self-harm; and [2] Recommend potential intervention strategies to improve implementation of the NICE guidelines. METHODS Twelve telephone interviews partly structured around the capabilities, opportunities and motivations model of behaviour change (COM-B) were conducted with primary care nurses in the United Kingdom. The Theoretical Domains Framework was used as an analytical framework, while the Behaviour Change Wheel was used to identify exemplar behaviour change techniques and intervention functions. RESULTS Nursing staff identified a need to learn more about risk factors (knowledge), and strategies to initiate sensitive conversations about self-harm (cognitive and interpersonal skills) to support their professional competencies (professional role and identity). Prompts may support recall of the guidance and support a patient centred approach to self-harm within practices (memory, attention, and decision making). GPs, and other practice nurses offer guidance and support (social influences), which helps nurses to navigate referrals and restricted appointment lengths (environmental context and influences). CONCLUSIONS Two converging sets of themes relating to information delivery and resource availability need to be targeted. Nine groups of behaviour change techniques, and five intervention functions offer candidate solutions for future intervention design. Key targets for change include practical training to redress conversational skill gaps about self-harm, the integration of national guidance with local resources and practice-level protocols to support decision-making, and creating opportunities for team-based mentoring.
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Affiliation(s)
- Jessica Z Leather
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK.
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK.
| | - Chris Keyworth
- The School of Psychology, The University of Leeds, Woodhouse Lane, Leeds, UK
| | - Nav Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Centre for Mental Health and Safety, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria, 0208, South Africa
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PY, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The Nowgen Centre, Manchester, UK
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Armitage CJ, Keyworth C, Gartland N, Coleman A, Fishwick D, Johnson S, van Tongeren M. Theory-based Trial to Promote Uptake and Sustained Use of Face Coverings During the COVID-19 Pandemic. Ann Behav Med 2023; 57:921-928. [PMID: 37656890 PMCID: PMC10578398 DOI: 10.1093/abm/kaad039] [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] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Transmission of airborne viruses can be mitigated by wearing face coverings but evidence suggests that face covering declines with the removal of relevant legislation, partly due to low automatic motivation. PURPOSE Test whether an intervention based on implementation intentions could support people's automatic motivation and promote face covering during the COVID-19 pandemic. METHODS Randomized controlled design. At baseline (May 20 to June 6, 2022), 7,835 UK adults reported how much time they spent wearing face coverings in work, public transport, and indoor leisure settings as well as their capabilities, opportunities, and motivations. 3,871 participants were randomized to form implementation intentions; 3,964 control participants completed questionnaires only. Measures were repeated 6 months postbaseline (November 1 to November 14, 2022). Data were analyzed using mixed measures ANOVAs and Bayes Factors to examine whether the observed data supported the experimental hypothesis. RESULTS The proportion of time spend wearing face coverings declined substantially across the 6-month study period, from 15.28% to 9.87% in work settings, 38.31% to 24.55% on public transport, and 9.58% to 7.85% in leisure settings. Bayes Factors indicated moderate relative evidence of no effect of implementation intentions on behavior in work and leisure settings, and inconclusive evidence of a positive effect on public transport. CONCLUSIONS In the context of declining COVID-19 rates and removal of legal mandates, implementation intentions were not effective in sustaining face covering. Further research is required to ensure that evidence-based interventions are prepared and deployed in the event of future pandemics.
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Affiliation(s)
- Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
| | - Chris Keyworth
- Department of Psychology, University of Leeds, Leeds, UK
| | - Nicola Gartland
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Anna Coleman
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - David Fishwick
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Sheena Johnson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
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Meade O, O'Brien M, Noone C, Lawless A, McSharry J, Deely H, Hart J, Hayes CB, Keyworth C, Lavoie K, McGowan O, Murphy AW, Murphy PJ, O'Reilly O, Byrne M. Exploring barriers and enablers to the delivery of Making Every Contact Count brief behavioural interventions in Ireland: A cross-sectional survey study. Br J Health Psychol 2023; 28:753-772. [PMID: 36843183 DOI: 10.1111/bjhp.12652] [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: 07/19/2022] [Accepted: 01/24/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVES The public health impact of the Irish Making Every Contact Count (MECC) brief intervention programme is dependent on delivery by health care professionals. We aimed to identify enablers and modifiable barriers to MECC intervention delivery to optimize MECC implementation. DESIGN Online cross-sectional survey design. METHODS Health care professionals (n = 4050) who completed MECC eLearning were invited to complete an online survey based on the Theoretical Domains Framework (TDF). Multiple regression analysis identified predictors of MECC delivery (logistic regression to predict delivery or not; linear regression to predict frequency of delivery). Data were visualized using Confidence Interval-Based Estimates of Relevance (CIBER). RESULTS Seventy-nine per cent of participants (n = 283/357) had delivered a MECC intervention. In the multiple logistic regression (Nagelkerke's R2 = .34), the significant enablers of intervention delivery were 'professional role' (OR = 1.86 [1.10, 3.15]) and 'intentions/goals' (OR = 4.75 [1.97, 11.45]); significant barriers included 'optimistic beliefs about consequences' (OR = .41 [.18, .94]) and 'negative emotions' (OR = .50 [.32, .77]). In the multiple linear regression (R2 = .29), the significant enablers of frequency of MECC delivery were 'intentions/goals' (b = 10.16, p = .02) and professional role (b = 6.72, p = .03); the significant barriers were 'negative emotions' (b = -4.74, p = .04) and 'barriers to prioritisation' (b = -5.00, p = .01). CIBER analyses suggested six predictive domains with substantial room for improvement: 'intentions and goals', 'barriers to prioritisation', 'environmental resources', 'beliefs about capabilities', 'negative emotions' and 'skills'. CONCLUSION Implementation interventions to enhance MECC delivery should target intentions and goals, beliefs about capabilities, negative emotions, environmental resources, skills and barriers to prioritization.
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Affiliation(s)
- Oonagh Meade
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Maria O'Brien
- Office of the Chief Clinical Officer, Health Services Executive, Cork, Ireland
| | - Chris Noone
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Agatha Lawless
- Making Every Contact Count, Health & Wellbeing, Strategy & Research, Health Services Executive, Waterford, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Helen Deely
- Strategy & Research, Healthcare Strategy, Health Service Exectutive, Dublin, Ireland
| | - Jo Hart
- University of Manchester, Manchester, UK
| | - Catherine B Hayes
- Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | | | - Kim Lavoie
- University of Quebec at Montreal (UQAM) & Montréal Behavioural Medicine Centre, CIUSSS-NIM, Montréal, Canada
| | - Orla McGowan
- Health Service Executive Health and Wellbeing, Dublin, Ireland
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
| | - Patrick J Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, Discipline of General Practice, University of Galway, Galway, Ireland
| | - Orlaith O'Reilly
- Office of the Chief Clinical Officer, Health Services Executive, Kilkenny, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Ireland
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Vogt KS, Johnson J, Conner M, Armitage CJ, Keyworth C. Barriers and enablers to delivering opportunistic behaviour change interventions during the COVID-19 pandemic: A qualitative study in healthcare professionals. Br J Health Psychol 2023; 28:773-792. [PMID: 36822594 DOI: 10.1111/bjhp.12653] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/18/2022] [Revised: 11/28/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND In line with public health policy, healthcare professionals (HCPs) working in the UK's National Health Service (NHS) are encouraged to deliver opportunistic health behaviour change interventions during routine consultations. The impact of the COVID-19 pandemic on healthcare delivery has been wide-ranging, but little is known about how the pandemic has affected the delivery of health behaviour change interventions. The present study aimed to examine the barriers and enablers to delivering opportunistic behaviour change interventions during the COVID-19 pandemic. METHODS Twenty-five qualitative semi-structured interviews were conducted in January 2022 with a range of patient-facing healthcare professionals (including nurses, physiotherapists, dieticians, doctors and midwives) working in the NHS. Data were analysed using reflexive thematic analysis. RESULTS Two overarching themes were generated: (1) the healthcare system's response to COVID-19, and (2) maintaining good HCP-patient relationships: reluctance and responsibility. COVID-19-related barriers included exacerbated staffing pressures and a perceived inability to use IT equipment to facilitate conversations about health behaviour change (due to poor internet connectivity or ill-equipped platforms). COVID-19-related enablers included the use of video consultations enabling less awkward and more honest conversations about health behaviours. However, some barriers and enablers remained the same as pre-pandemic, such as issues of role responsibility for discussing health behaviour change with patients, balancing holistic wellbeing advice with maintaining positive patient-HCP relationships, and reluctance to deliver opportunistic behaviour change interventions. DISCUSSION The increased use of remote consultations may facilitate the delivery of opportunistic health behaviour change interventions by healthcare professionals. However, there is also a strong need to improve staffing levels, in order that staff have the psychological and physical capabilities to engage patients in these conversations.
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Affiliation(s)
- Katharina Sophie Vogt
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
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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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9
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Knightley E, Koutsopoulou G, Keyworth C. Changes in office workers' lived experiences of their own eating habits since working from home due to the COVID-19 pandemic: An interpretative phenomenological analysis. Appetite 2023:106760. [PMID: 37423406 DOI: 10.1016/j.appet.2023.106760] [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: 11/22/2022] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 07/11/2023]
Abstract
In response to the unprecedented circumstances of the COVID-19 pandemic, there has been little insight into how office workers perceived their own eating behaviour in relation to their new home working environment. The sedentary nature of office-based jobs means that it is crucial that workers in these occupations engage in health behaviours that are beneficial to them. The present study aimed to explore how office workers perceive changes to their own eating behaviour since the transition to working from home (WFH) as a consequence of the pandemic. Semi-structured interviews were conducted with six volunteer office workers who previously worked in an office environment and who are now WFH. Data were analysed using interpretative phenomenological analysis, allowing the researcher to explore each account and understand their lived experiences. There were five superordinate themes: Healthy eating; time constraints; escaping the office; social cognitions; and food indulgence. Increased snacking behaviour since WFH was a major challenge, which was particularly potent during times of elevated stress. Furthermore, quality of nutrition since WFH appeared to coincide with the participants' wellbeing, such that this was reported as being worst at times of low wellbeing. Future studies must focus on developing strategies to improve the eating behaviours and the general wellbeing of office workers as they continue to WFH. These findings can then be utilised for the development of health promoting behaviours.
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Alzahrani A, Keyworth C, Wilson C, Johnson J. Causes of stress and poor wellbeing among paramedic students in Saudi Arabia and the United Kingdom: a cross-cultural qualitative study. BMC Health Serv Res 2023; 23:444. [PMID: 37147658 PMCID: PMC10163716 DOI: 10.1186/s12913-023-09374-y] [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: 02/10/2023] [Accepted: 04/05/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Paramedicine presents students with numerous challenges, including factors threatening their wellbeing. Over the last two decades studies have illustrated that paramedics and paramedic students are more likely to have mental disorders than the general population. These findings suggest that course-related factors could be important in contributing to poorer mental health. However, few studies have examined factors related to stress in paramedic students, and none of these have included paramedic students from cross-culture. To address this, the present study (1) explored paramedicine students' training experiences and other education-related factors that could affect their wellbeing, and (2) illustrated the possible differences and similarities between two cultures (Saudi Arabia and the UK) to determine whether the students' cultural environment influenced factors related to their wellbeing. METHODS A qualitative exploratory research design was used. Twenty semi-structured interviews were conducted with paramedicine students from the United Kingdom and Kingdom of Saudi Arabia (ten participants from each country). Reflexive thematic analysis was employed as the analytical approach in this study. RESULTS Four major themes were identified which captured the contributors to paramedic students' stress levels: (1) exposure to potentially traumatic events, (2) relationships and communication, illustrating the student's personal and professional experiences with others, (3) programme atmosphere, demonstrating the challenges and support students encounter during their coursework and training, and (4) career, elucidating the pressure of future career expectations and predictions. CONCLUSION The study revealed contributors to stress were similar in both countries. Better preparation can help to reduce the negative impacts of the possible traumatic events encountered on placements and supportive relationships, especially with proctors, can boost student wellbeing. Universities are able to address both these factors and help foster a positive environment for paramedicine students. As such, these results should help educators and policymakers when identifying and delivering interventions to support paramedic students.
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Affiliation(s)
- Adnan Alzahrani
- School of Psychology, University of Leeds, Leeds, LS29JT, UK.
- Department of Basic Science, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, 11466, Saudi Arabia.
| | - Chris Keyworth
- School of Psychology, University of Leeds, Leeds, LS29JT, UK
| | - Caitlin Wilson
- School of Psychology, University of Leeds, Leeds, LS29JT, UK
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, LS29JT, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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11
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Evans TS, Dhir P, Radley D, Duarte C, Keyworth C, Homer C, Hill AJ, Hawkes R, Matu J, McKenna J, Ells LJ. Does the design of the NHS Low-Calorie Diet Programme have fidelity to the programme specification? A documentary review of service parameters and behaviour change content in a type 2 diabetes intervention. Diabet Med 2023; 40:e15022. [PMID: 36479706 DOI: 10.1111/dme.15022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 09/23/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND NHS England commissioned four independent service providers to pilot low-calorie diet programmes to drive weight loss, improve glycaemia and potentially achieve remission of Type 2 Diabetes across 10 localities. Intervention fidelity might contribute to programme success. Previous research has illustrated a drift in fidelity in the design and delivery of other national diabetes programmes. AIMS (1) To describe and compare the programme designs across the four service providers; (2) To assess the fidelity of programme designs to the NHS England service specification. METHODS The NHS England service specification documents and each provider's programme design documents were double-coded for key intervention content using the Template for Intervention Description and Replication Framework and the Behaviour Change Technique (BCT) Taxonomy. RESULTS The four providers demonstrated fidelity to most but not all of the service parameters stipulated in the NHS England service specification. Providers included between 74% and 87% of the 23 BCTs identified in the NHS specification. Twelve of these BCTs were included by all four providers; two BCTs were consistently absent. An additional seven to 24 BCTs were included across providers. CONCLUSIONS A loss of fidelity for some service parameters and BCTs was identified across the provider's designs; this may have important consequences for programme delivery and thus programme outcomes. Furthermore, there was a large degree of variation between providers in the presence and dosage of additional BCTs. How these findings relate to the fidelity of programme delivery and variation in programme outcomes and experiences across providers will be examined.
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Affiliation(s)
- Tamla S Evans
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Pooja Dhir
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - Duncan Radley
- Obesity Institute and Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Cristiana Duarte
- School of Education, Language and Psychology, York St John University, York, UK
| | - Chris Keyworth
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Andy J Hill
- Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Rhiannon Hawkes
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Jamie Matu
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
| | - James McKenna
- Obesity Institute and Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Louisa J Ells
- Obesity Institute and School of Health, Leeds Beckett University, Leeds, UK
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12
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Johnson J, Pointon L, Keyworth C, Wainwright N, Moores L, Bates J, Hinsby K. Evaluation of a training programme for critical incident debrief facilitators. Occup Med (Lond) 2023; 73:103-108. [PMID: 36516291 PMCID: PMC10016050 DOI: 10.1093/occmed/kqac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Critical incident debriefs are a commonly used occupational health tool for supporting staff after traumatic work incidents. However, there is a dearth of literature evaluating training programmes for debrief facilitators. AIMS To evaluate a 5-day training programme to equip healthcare, social care and voluntary, community and social enterprise sector staff to act as post-incident peer supporters and debrief facilitators. METHODS A mixed-methods, single-arm, before-and-after study. Data were collected at baseline and post-training. The quantitative outcome measure was 'Confidence'; the sum of two items measuring confidence in (i) supporting peers after critical incidents and (ii) facilitating post-incident structured team discussions. At post-training, quantitative and qualitative feedback regarding experiences and perceptions of the training was also gathered. RESULTS We recruited 45 participants between October 2021 and January 2022. Confidence in supporting peers following incidents and facilitating post-incident structured team discussions increased significantly following the training, t(35) = -6.77, P < 0.001. A majority of participants reported they would do things differently because of the training and that they found the training relevant, useful and engaging. Summative content analysis of qualitative feedback indicated that participants (i) believed the role plays were an important learning tool and (ii) thought it was important that the trainer was engaging. Some participants would have preferred in-person delivery. CONCLUSIONS Participants valued training in post-incident peer support and debriefing skills. Organizations implementing post-incident support pathways could usefully include this training and ensure optimal uptake and engagement by (i) providing in-person and online delivery options and (ii) including role play as a learning technique.
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Affiliation(s)
- J Johnson
- School of Psychology, Lifton Place, University of Leeds, Leeds LS29JT, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford BD96RJ, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2033, Australia
| | - L Pointon
- School of Psychology, Lifton Place, University of Leeds, Leeds LS29JT, UK
| | - C Keyworth
- School of Psychology, Lifton Place, University of Leeds, Leeds LS29JT, UK
| | - N Wainwright
- Mid-Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - L Moores
- Mid-Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - J Bates
- Mid-Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - K Hinsby
- Leeds and York Partnership NHS Foundation Trust, Leeds LS73JX, UK
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13
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Armitage CJ, Keyworth C, Gartland N, Coleman A, Fishwick D, Johnson S, van Tongeren M. Identifying targets for interventions to support public use of face coverings. Br J Health Psychol 2023; 28:208-220. [PMID: 36047478 PMCID: PMC10087948 DOI: 10.1111/bjhp.12620] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 04/21/2022] [Revised: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Interventions to promote the wearing of face coverings if required in the future can only be developed if we know why people do or do not wear them. Study aims were, therefore, to assess public adherence to wearing face coverings to reduce transmission of SARS-CoV-2 and to gauge why people were or were not wearing face coverings in work, public transport, and indoor leisure settings. DESIGN Cross-sectional survey. METHODS 10,622 adults (25 January-6 February 2022) who were representative of the UK population were asked about their (a) wearing of face coverings in work, public transport, and leisure settings; (b) sociodemographic characteristics; and (c) perceptions of capabilities, opportunities, and motivations ("COM-B"). Data were analysed descriptively, using within-participants ANOVA and multiple linear regression. RESULTS Participants reported mostly wearing face coverings in public transport settings (>80%), but substantially less in work (<50%) and leisure (<30%) contexts. Perceptions of capabilities, opportunities, and motivations to wear face coverings were consistently associated with the actual wearing of face coverings across the three settings, but there were marked deficits in automatic motivation and social opportunity. People living in England, describing themselves as White, and men were least likely to wear face coverings. CONCLUSIONS Interventions targeted at men, people living in England, and those describing themselves as White that focus on increasing capabilities, providing greater opportunities and boosting motivations are suggested to promote the wearing of face coverings, with particular focus on addressing automatic motivation and social opportunity.
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Affiliation(s)
- Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Chris Keyworth
- Department of Psychology, University of Leeds, Leeds, UK
| | - Nicola Gartland
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Anna Coleman
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - David Fishwick
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Sheena Johnson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
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14
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Keyworth C, Alzahrani A, Pointon L, Hinsby K, Wainwright N, Moores L, Bates J, Johnson J. Barriers and enablers to accessing support services offered by staff wellbeing hubs: A qualitative study. Front Psychol 2022; 13:1008913. [DOI: 10.3389/fpsyg.2022.1008913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
BackgroundInternational efforts have been made to develop appropriate interventions to support the mental health needs of healthcare professionals in response to COVID-19. However, fewer staff have accessed these than expected, despite experiencing elevated levels of mental distress since the onset of the pandemic. Consequently, we aimed to examine the barriers and enablers for healthcare professionals in accessing interventions offered by a Staff Mental Health and Wellbeing Hub.MethodsTwenty-five semi-structured interviews were conducted with healthcare, social care and voluntary, community and social enterprise (VCSE) sector staff. Data were analysed using thematic analysis.ResultsFour key themes were identified: (1) Environment and Atmosphere in the Workplace; (2) The Impacts of COVID-19; (3) Confidentiality; and (4) Awareness and Communication of Resources. Organisational environments were perceived as an important enabler of accessing the hub services for mental health and wellbeing support. This included the importance of recognising and responding to the ongoing pressures of COVID-19- specific challenges. Ensuring and communicating aspects of confidentiality, and ensuring clear and consistent communication of the benefits of the Hub may encourage help-seeking for mental health challenges among healthcare professionals.DiscussionOur findings highlight important considerations to increase uptake and engagement with services to support the mental health and wellbeing of healthcare professionals and associated staff and volunteers. Organisations aiming to increase employee uptake of these services should regularly circulate consistent and clear emails about what these services offer, provide training and information for managers so they can support staff to access these services and ensure access is confidential.
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15
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Keyworth C, Quinlivan L, Leather JZ, Armitage CJ. Exploring the acceptability of a brief online theory-based intervention to prevent and reduce self-harm: a theoretically framed qualitative study. BJPsych Open 2022; 8:e184. [PMID: 36221254 PMCID: PMC9634605 DOI: 10.1192/bjo.2022.568] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The volitional help sheet for self-harm equips people with the means of responding automatically to triggers for self-harm with coping strategies. Improving acceptability may be crucial to increasing effectiveness and reach. The Theoretical Framework of Acceptability (TFA) was developed to guide the assessment of intervention acceptability, but to date, no studies have applied the TFA to understand acceptability of interventions for self-harm. AIMS To apply the TFA to (a) explore people's experiences of a brief intervention to reduce repeat self-harm; and (b) understand the most prominent aspects of intervention acceptability, to make recommendations for intervention refinements and successful implementation. METHOD Sixteen semi-structured interviews were conducted with people who had previously self-harmed. The TFA informed a framework analysis in which findings were mapped onto the TFA. RESULTS Four TFA domains were identified that were associated with acceptability of the volitional help sheet for self-harm: affective attitude, burden, intervention coherence and perceived effectiveness. People were generally positive about using the volitional help sheet (affective attitude), understood the volitional help sheet and how it worked (intervention coherence), highlighted engagement as a motivating factor in using the volitional help sheet (perceived burden) and described how the volitional help sheet could be implemented by healthcare professionals (perceived effectiveness). CONCLUSIONS Further modifications could still be made, but it is hoped that this intervention provides a useful tool for individuals to construct their own personalised implementation intentions, and as part of longer-term support for preventing self-harm as delivered by healthcare professionals.
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Affiliation(s)
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
| | - Jessica Z Leather
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; and Manchester Centre for Health Psychology, University of Manchester, UK
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Manchester Centre for Health Psychology, University of Manchester, UK; and Manchester Academic Health Science Centre, Manchester University Foundation Trust, UK
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16
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Mitchell AEP, Galli F, Keyworth C, Vegni E, Salas E. Editorial: Coronavirus Disease (COVID-19): The Mental Health, Resilience, and Communication Resources for the Short- and Long-term Challenges Faced by Healthcare Workers. Front Psychol 2022; 13:904328. [PMID: 35519636 PMCID: PMC9062173 DOI: 10.3389/fpsyg.2022.904328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrew E P Mitchell
- Faculty of Health and Social Care, University of Chester, Chester, United Kingdom
| | - Federica Galli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Chris Keyworth
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Eduardo Salas
- Department of Psychology, Rice University, Houston, TX, United States
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17
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Goldthorpe J, Vaughan M, Keyworth C, Epton T, Calam R, Armitage C. What are the environmental factors that affect implementation of the Manchester Healthy Schools programme? A qualitative exploration of staff perspectives. BMJ Open 2022; 12:e048683. [PMID: 35487719 PMCID: PMC9058701 DOI: 10.1136/bmjopen-2021-048683] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Primary/elementary schools are crucial settings for early weight management interventions but effects on children's weight are small. This may be because the environments in which these schools are situated support unhealthy behaviours that lead to weight gain (obesogenic environments). Staff working in schools have a unique insight into the environmental factors that might affect their efforts to support child health and weight management interventions. The aim of this study is to explore the views of staff in relation to the perceived effects of the environmental context in which they deliver a child health promotion intervention. METHODS Staff from five schools involved in delivering the Manchester Healthy Schools programme were interviewed (N=19). These interviews were transcribed verbatim and analysed thematically. RESULTS Three themes were produced: opportunities to be healthy; importance of funding, resources and governance; and resources available to households and neighbourhoods. CONCLUSION The views of school staff were consistent with themes identified in other relevant literature. Although there were serendipitous opportunities to capitalise on local resources, such as using nearby land and leisure facilities for outdoor physical activities, many barriers relating to local environmental and resource features were reported. Joined up, multi-agency solutions such as place-based approaches might be able to offer schools some resource-based support; however, more research is needed to establish the best way to achieve the best outcomes for children.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
| | - Matthew Vaughan
- Division of Health Sciences, School of Health Sciences,The University of Manchester, Manchester, UK
| | - Chris Keyworth
- School of Psychology, The University of Leeds, Leeds, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
| | - Rachel Calam
- Division of Health Sciences, School of Health Sciences,The University of Manchester, Manchester, UK
| | - Chris Armitage
- Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
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18
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Leather JZ, Keyworth C, Epton T, Goldthorpe J, Ulph F, Armitage CJ. "We want to live a little longer and our family want[s] us around": A summative content analysis of adherence to COVID-19-related guidelines using the Theoretical Domains Framework. Br J Health Psychol 2022; 27:1119-1152. [PMID: 35319141 PMCID: PMC9111475 DOI: 10.1111/bjhp.12591] [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] [Indexed: 11/27/2022]
Abstract
Objective Public adherence to COVID‐19‐related government guidance varied during the initial lockdown in the UK, but the determinants of public adherence to such guidance are unclear. We capture spontaneous reflections on adherence to UK government guidance from a representative UK sample, and use the TDF to identify key determinants of COVID‐related behaviours. Design The design was cross‐sectional. Methods Qualitative data were collected from a large sample of UK adults (N = 2,252) via an online questionnaire as part of a wider survey about the UK public’s responses to the government’s COVID‐19‐related guidance. Summative content analysis was used to identify key guideline terms in the data, followed by latent analysis to interpret the underlying meanings behind the terms using the TDF as an analytical framework. Results Six TDF domains were identified in the data: Environmental Context and Resources; Beliefs about Consequences; Social Influences; Memory, Attention and Decision Processes; Emotion; and Knowledge. Although the samples were motivated and capable of adhering, limitations in their environments, resources, and social support mechanisms restricted behaviour. Self‐reported adherence was sensitive to positive and negative beliefs about the effectiveness of the measures, in addition to interpretations of the terms ‘essential’ and ‘necessary’ in the guidance. Conclusions Despite extensive structural obstacles to adherence, the majority of the British public were able to follow government COVID‐19‐related instructions, provided they had sufficient resources, social support, and positive perceptions about the effectiveness of the measures. Ambiguities surrounding key terminology in the guidance left room for interpretation, which may have contributed to non‐adherence.
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Affiliation(s)
- Jessica Z Leather
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, UK
| | | | - Tracy Epton
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Joanna Goldthorpe
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Fiona Ulph
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Christopher J Armitage
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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19
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Keyworth C, Quinlivan L, Leather JZ, O’Connor RC, Armitage CJ. The association between COVID-19-related fear and reported self-harm in a national survey of people with a lifetime history of self-harm. BMC Psychiatry 2022; 22:68. [PMID: 35105313 PMCID: PMC8807142 DOI: 10.1186/s12888-021-03625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relatively little is known about the characteristics of people living in the community who have previously self-harmed and may benefit from interventions during and after COVID-19. We therefore aimed to: (a) examine the relationship between reported self-harm and COVID-19-related fear, and (b) describe the characteristics of a community sample of people who reported a lifetime history of self-harm. METHODS A cross-sectional national online survey of UK adults who reported a lifetime history of self-harm (n = 1029) was conducted. Data were collected May - June 2020. Main outcomes were self-reported COVID-19-related fear (based on the Fear of COVID-19 scale [FCV-19S]), lifetime history of COVID-19, and lifetime history of self-harm. Data were analysed using descriptive statistics and binary logistic regression. Chi-square was used to compare characteristics of our sample with available national data. RESULTS Overall, 75.1, 40.2 and 74.3% of the total sample reported lifetime suicidal ideation, suicidal attempts and non-suicidal self-harm respectively. When adjusting for age, sex, ethnicity, social grade, and exposure to death and suicide, binary logistic regression showed higher levels of perceived symptomatic (or physiological) reactions to COVID-19 were associated with suicidal ideation (OR = 1.22, 95%CI 1.07, 1.39) and suicidal attempts (OR = 3.91, 95%CI 1.18, 12.96) in the past week. CONCLUSIONS Results suggest an urgent need to consider the impact of COVID-19 on people with a lifetime history of self-harm when designing interventions to help support people in reducing suicidal ideation and suicidal attempts. Experiencing symptomatic reactions of fear in particular is associated with self-harm. Helping to support people to develop coping plans in response to threat-related fear is likely to help people at risk of repeat self-harm during public health emergencies.
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Affiliation(s)
| | - Leah Quinlivan
- grid.5379.80000000121662407NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Jess Z. Leather
- grid.5379.80000000121662407NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK ,grid.5379.80000000121662407Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Rory C. O’Connor
- grid.8756.c0000 0001 2193 314XSuicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Christopher J. Armitage
- grid.5379.80000000121662407NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK ,grid.5379.80000000121662407Manchester Centre for Health Psychology, University of Manchester, Manchester, UK ,grid.5379.80000000121662407Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, M13 9PL UK
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20
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Meade O, O'Brien M, Mc Sharry J, Lawless A, Coughlan S, Hart J, Hayes C, Keyworth C, Lavoie KL, Murphy AW, Murphy P, Noone C, O'Reilly O, Byrne M. Enhancing the implementation of the Making Every Contact Count brief behavioural intervention programme in Ireland: protocol for the Making MECC Work research programme. HRB Open Res 2022; 5:6. [PMID: 35224443 PMCID: PMC8847722 DOI: 10.12688/hrbopenres.13481.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Brief behavioural interventions offered by healthcare professionals to target health behavioural risk factors (e.g. physical activity, diet, smoking and drug and alcohol use) can positively impact patient health outcomes. The Irish Health Service Executive (HSE) Making Every Contact Count (MECC) Programme supports healthcare professionals to offer patients brief opportunistic behavioural interventions during routine consultations. The potential for MECC to impact public health depends on its uptake and implementation. Aim: This protocol outlines the ‘Making MECC Work’ research programme, a HSE/Health Behaviour Change Research Group collaboration to develop an implementation strategy to optimise uptake of MECC in Ireland. The programme will answer three research questions: (1) What determines delivery of MECC brief interventions by healthcare professionals at individual and organisational levels? (2) What are patient attitudes towards, and experiences of, receiving MECC interventions from healthcare professionals? (3) What evidence-informed implementation strategy options can be consensually developed with key stakeholders to optimise MECC implementation? Methods: In Work Package 1, we will examine determinants of MECC delivery by healthcare professionals using a multi-methods approach, including: (WP1.1) a national survey of healthcare professionals who have participated in MECC eLearning training and (WP1.2) a qualitative interview study with relevant healthcare professionals and HSE staff. In Work Package 2, we will examine patient attitudes towards, and experiences of, MECC using qualitative interviews. Work Package 3 will combine findings from Work Packages 1 and 2 using the Behaviour Change Wheel to identify and develop testable implementation strategy options (WP 3.1). Strategies will be refined and prioritised using a key stakeholder consensus process to develop a collaborative implementation blueprint to optimise and scale-up MECC (WP3.2). Discussion: Research programme outputs are expected to positively support the integration of MECC brief behaviour change interventions into the Irish healthcare system and inform the scale-up of behaviour change interventions internationally.
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Affiliation(s)
- Oonagh Meade
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
| | - Maria O'Brien
- National Heart Programme, Integrated Care Programme for Chronic Disease, Clinical Design and Innovation, Office of the Chief Clinical Officer, Health Services Executive, Áras Sláinte, Wilton Road, Cork, T12 XRR0, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
| | - Agatha Lawless
- Health & Wellbeing, Strategy and Research, Healthcare Strategy, c/o Health Promotion and Improvement Office, Health Service Executive, Waterford, X91 T256, Ireland
| | - Sandra Coughlan
- Strategic Planning and Transformation, Health Service Executive, Cork, T12 WP62, Ireland
| | - Jo Hart
- School of Medical Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Catherine Hayes
- Public Health and Primary Care, School of Medicine, Trinity College Dubin, Dublin, D02 R590, Ireland
| | - Chris Keyworth
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Kim L Lavoie
- Montréal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital Sacré-Cœur de Montréal, Montréal, Quebec, QC H4J 1C5, Canada
- Department of Psychology, University of Quebec at Montréal, Montréal, Quebec, QC H2L 2C4, Canada
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, School of Medicine, NUI Galway, Galway, Ireland
| | - Patrick Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, School of Medicine, NUI Galway, Galway, Ireland
| | - Chris Noone
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
| | - Orlaith O'Reilly
- Health and Wellbeing Division, HSE South East, Public Health Department, Health Service Executive, Kilkenny, Ireland
| | | | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, H91 EV56, Ireland
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21
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Keyworth C, O'Connor R, Quinlivan L, Armitage CJ. Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation. J Med Internet Res 2021; 23:e28349. [PMID: 34518153 PMCID: PMC8479604 DOI: 10.2196/28349] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/14/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The volitional help sheet (VHS) for self-harm equips people with a means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of its efficacy, improving acceptability and making the intervention available in a web-based format may be crucial to increasing effectiveness and reach. OBJECTIVE This study aims to use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the VHS, examine for whom and under what circumstances this intervention is more or less acceptable, and develop a series of recommendations for how the VHS can be used to support people in reducing repeat self-harm. METHODS We explored acceptability in two phases. First, our patient and public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated into a web-based format. Second, a representative sample of adults in the United Kingdom who had previously self-harmed were recruited via a YouGov survey (N=514) and were asked to rate the acceptability of the VHS based on the seven constructs of the TFA, namely, affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Data were analyzed using descriptive statistics, one-tailed t tests, and binary logistic regression. A directed content analysis approach was used to analyze qualitative data. RESULTS Participants in the web-based survey rated the VHS as positive (affective attitude; t457=4.72; P<.001); were confident using it (self-efficacy; t457=9.54; P<.001); felt they did not have to give up any benefits, profits, or values when using it (opportunity costs; t439=-15.51; P<.001); understood it and how it worked (intervention coherence; t464=11.90; P<.001); and were confident that it would achieve its purpose (perceived effectiveness; t466=2.04; P=.04). The TFA domain burden appeared to be an important indicator of acceptability. Lower levels of perceived burden when using the VHS tool were more prevalent among younger adults aged 18-24 years (OR 3.63, 95% CI 1.50-8.78), people of White ethnic background (OR 3.02, 95% CI 1.06-8.613), and people without a long-term health condition (OR 1.53, 95% CI 1.01-2.30). Perceived modifications to further improve acceptability included improved formatting (burden), the feature to add new situations and responses or amend existing ones (ethicality), and clearer instructions and further detail about the purpose of the VHS (intervention coherence). CONCLUSIONS Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of White ethnic backgrounds, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and people with long-term health conditions.
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Affiliation(s)
- Chris Keyworth
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Rory O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Leah Quinlivan
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, United Kingdom
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, United Kingdom.,Manchester Centre for Health Psychology, The University of Manchester, Manchester, United Kingdom.,Manchester University NHS Foundation Trust, The University of Manchester, Manchester, United Kingdom
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22
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Dekker J, Amitami M, Berman AH, Brown H, Cleal B, Figueiras MJ, Finney Rutten LJ, Fors EA, Griva K, Gu J, Keyworth C, Kleinstäuber M, Lahmann C, Lau JTF, Leplow B, Li L, Malmberg Gavelin H, Mewes R, Mo PKH, Mullan B, Penedo FJ, Prins J, Rodríguez Rodríguez T, Simpson SA, Stauder A, Tuomisto MT, Weiss DJ, Nater UM. Definition and Characteristics of Behavioral Medicine, and Main Tasks and Goals of the International Society of Behavioral Medicine-an International Delphi Study. Int J Behav Med 2021; 28:268-276. [PMID: 32909153 PMCID: PMC8121730 DOI: 10.1007/s12529-020-09928-y] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND In the past decades, behavioral medicine has attained global recognition. Due to its global reach, a critical need has emerged to consider whether the original definition of behavioral medicine is still valid, comprehensive, and inclusive, and to reconsider the main tasks and goals of the International Society of Behavioral Medicine (ISBM), as the umbrella organization in the field. The purpose of the present study was to (i) update the definition and scope of behavioral medicine and its defining characteristics; and (ii) develop a proposal on ISBM's main tasks and goals. METHOD Our study used the Delphi method. A core group prepared a discussion paper. An international Delphi panel rated questions and provided comments. The panel intended to reach an a priori defined level of consensus (i.e., 70%). RESULTS The international panel reached consensus on an updated definition and scope of behavioral medicine as a field of research and practice that builds on collaboration among multiple disciplines. These disciplines are concerned with development and application of behavioral and biomedical evidence across the disease continuum in clinical and public health domains. Consensus was reached on a proposal for ISBM's main tasks and goals focused on supporting communication and collaboration across disciplines and participating organizations; stimulating research, education, and practice; and supporting individuals and organizations in the field. CONCLUSION The consensus on definition and scope of behavioral medicine and ISBM's tasks and goals provides a foundational step toward achieving these goals.
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Affiliation(s)
- Joost Dekker
- Department of Rehabilitation Medicine and Department of Psychiatry, Amsterdam University Medical Centers, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.
| | - Marie Amitami
- Community-Based Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Anne H Berman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Stockholm Region, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Helen Brown
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Bryan Cleal
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Maria João Figueiras
- Psychology Department, College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Egil A Fors
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Maria Kleinstäuber
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joseph T F Lau
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territory, Hong Kong, China
| | - Bernd Leplow
- Institute for Psychology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Li Li
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hanna Malmberg Gavelin
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Australia
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Ricarda Mewes
- Outpatient Unit for Research, Teaching, and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territory, Hong Kong, China
| | - Barbara Mullan
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Judith Prins
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Teresa Rodríguez Rodríguez
- Science and Technology Department, University Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos, Cuba
- Cienfuegos Medical School, Cienfuegos, Cuba
| | - Sharon A Simpson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Adrienne Stauder
- Institute of Behavioural Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - Martti T Tuomisto
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Deborah Jones Weiss
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Urs M Nater
- Faculty of Psychology, University of Vienna, Vienna, Austria
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23
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Keyworth C, Epton T, Byrne-Davis L, Leather JZ, Armitage CJ. What challenges do UK adults face when adhering to COVID-19-related instructions? Cross-sectional survey in a representative sample. Prev Med 2021; 147:106458. [PMID: 33607123 PMCID: PMC7885673 DOI: 10.1016/j.ypmed.2021.106458] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 01/05/2023]
Abstract
Adherence to government COVID-19-related instructions is reported to be high, but the psychosocial impacts of measures such as self-isolation and physical distancing could undermine long-term adherence to containment measures. The first step in designing interventions to mitigate the impacts of adhering to COVID-19-related instructions is to identify what are the most prevalent challenges and what characterises the people facing them. A cross-sectional survey was administered to a representative sample of the UK population (N = 2252), of whom n = 2139 (94.9%) reported adhering to the UK government's COVID-19-related instructions, and were included in the final analysis. Data were analysed using descriptive statistics and binary logistic regression. Of the people who reported adhering to UK government's COVID-19-related instructions, 80.3% reported experiencing challenges. Adults aged 55 years or over (OR = 1.939, 95%CI 1.331-2.825) and men (OR = 0.489, 95%CI 0.393-0.608) were least likely to report challenges. Adjusting to changes in daily routine (reported by 48.7% of the sample), mental health (reported by 41.4% of the sample) and physical health (reported by 31.5% of the sample) were the most prevalent challenges. For the first time, the present study quantifies the extent to which people experienced challenges when adhering to government COVID-19-related instructions. Few people reported experiencing no challenges when adhering to COVID-19-related instructions. Interventions to address the effects of changes in daily routine, mental health challenges, and physical health challenges should be prioritised, with a focus on key subgroups including women, younger adults, and people without care commitments.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, M13 9PL, United Kingdom; NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom.
| | - Tracy Epton
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, M13 9PL, United Kingdom.
| | - Lucie Byrne-Davis
- Division of Medical Education, School of Medical Sciences, The University of Manchester, M13 9PL, United Kingdom.
| | - Jessica Z Leather
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, M13 9PL, United Kingdom; NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom.
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, M13 9PL, United Kingdom; NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom.
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24
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Abstract
Opportunities for healthcare professionals to deliver health behavior change interventions are often missed, but understanding the barriers and enablers to this activity is limited by a focus on defined specialisms/health conditions. This systematic review of systematic reviews collates all the evidence across professional groups to provide guidance to policy makers for implementing healthcare professional delivery of behavior change interventions. Eight electronic databases were searched for systematic reviews reporting patient-facing healthcare professionals’ (e.g., general practitioners, nurses) barriers and enablers to delivering behavior change interventions (diet, physical activity, alcohol reduction, smoking cessation, and weight management). A narrative synthesis was conducted. Thirty-six systematic reviews were included. Four themes emerged as both barriers and enablers: (1) perceptions of the knowledge or skills needed to support behavior change with patients, (2) perceptions of the healthcare professional role, (3) beliefs about resources and support needed, and (4) healthcare professionals’ own health behavior. There were four cross-disciplinary barriers: (1) perceived lack of time, (2) perceived lack of prioritization of health behavior change, (3) negative attitudes towards patients and perceptions of patient risk, and (4) perceptions of patient motivation. The three enablers were as follows: (1) training, (2) context, and (3) attitudes towards delivering interventions. To enhance healthcare professionals’ delivery of behavior change interventions, policy makers should (a) address perceptions about patient need for interventions, (b) support diverse professional groups to identify opportunities to deliver interventions, and (c) encourage professionals to focus on prevention and management of health conditions.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK.
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Rachel Calam
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9PL, Manchester, UK
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25
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Patients' experiences of behaviour change interventions delivered by general practitioners during routine consultations: A nationally representative survey. Health Expect 2021; 24:819-832. [PMID: 33662180 PMCID: PMC8235898 DOI: 10.1111/hex.13221] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background Consistent with the ‘Making Every Contact Count’ UK public health policy, general practitioners (GPs) are expected to provide patients with behaviour change interventions opportunistically. However, there is a belief widely held among GPs that patients neither want or need such interventions. We aimed to understand the following: (a) the characteristics of people attending GP appointments, (b) patients' needs for health behaviour change, (c) perceptions of appropriateness and helpfulness of interventions, and (d) factors associated with recall of receipt of interventions. Methods Cross‐sectional nationally representative online survey of UK adults who had attended GP clinics in the preceding four weeks (n = 3028). Data were analysed using descriptive statistics and binary logistic regression. Results 94.5% (n = 2862) of patients breached at least one health behaviour guideline, and 55.1% reported never having had a conversation with their GP about health behaviours. The majority of patients perceived intervention as appropriate (range 84.2%‐87.4% across behaviours) and helpful (range 82.8%‐85.9% across behaviours). Being male (OR = 1.412, 95% CI 1.217, 1.639), having a long‐term condition (OR = 1.514, 95% CI 1.287, 1.782) and a higher number of repeat GP visits (OR = 1.016, 95% CI 1.010, 1.023) were among factors associated with recall of receipt of interventions. Conclusions Patients perceived behaviour change intervention during routine GP consultations as appropriate and helpful, yet there are variations in the likelihood of receiving interventions according to sociodemographic factors. GPs could adopt a more proactive approach to behaviour change in patient consultations with the broad approval of patients. Patient or public contribution The questionnaire was piloted among a convenience sample prior to distribution.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Joanna Goldthorpe
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rachel Calam
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Divisional of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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26
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Lawes-Wickwar S, Ghio D, Tang MY, Keyworth C, Stanescu S, Westbrook J, Jenkinson E, Kassianos AP, Scanlan D, Garnett N, Laidlaw L, Howlett N, Carr N, Stanulewicz N, Guest E, Watson D, Sutherland L, Byrne-Davis L, Chater A, Hart J, Armitage CJ, Shorter GW, Swanson V, Epton T. A Rapid Systematic Review of Public Responses to Health Messages Encouraging Vaccination against Infectious Diseases in a Pandemic or Epidemic. Vaccines (Basel) 2021; 9:72. [PMID: 33498395 PMCID: PMC7909419 DOI: 10.3390/vaccines9020072] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 12/18/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 01/08/2023] Open
Abstract
Public health teams need to understand how the public responds to vaccination messages in a pandemic or epidemic to inform successful campaigns encouraging the uptake of new vaccines as they become available. A rapid systematic review was performed by searching PsycINFO, MEDLINE, healthevidence.org, OSF Preprints and PsyArXiv Preprints in May 2020 for studies including at least one health message promoting vaccine uptake of airborne-, droplet- and fomite-spread viruses. Included studies were assessed for quality using the Mixed Methods Appraisal Tool (MMAT) or the Assessment of Multiple Systematic Reviews (AMSTAR), and for patient and public involvement (PPI) in the research. Thirty-five articles were included. Most reported messages for seasonal influenza (n = 11; 31%) or H1N1 (n = 11; 31%). Evidence from moderate to high quality studies for improving vaccine uptake included providing information about virus risks and vaccination safety, as well as addressing vaccine misunderstandings, offering vaccination reminders, including vaccination clinic details, and delivering mixed media campaigns across hospitals or communities. Behavioural influences (beliefs and intentions) were improved when: shorter, risk-reducing or relative risk framing messages were used; the benefits of vaccination to society were emphasised; and beliefs about capability and concerns among target populations (e.g., vaccine safety) were addressed. Clear, credible, messages in a language target groups can understand were associated with higher acceptability. Two studies (6%) described PPI in the research process. Future campaigns should consider the beliefs and information needs of target populations in their design, including ensuring that vaccine eligibility and availability is clear, and messages are accessible. More high quality research is needed to demonstrate the effects of messaging interventions on actual vaccine uptake.
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Affiliation(s)
- Sadie Lawes-Wickwar
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Daniela Ghio
- Department of Psychology, Faculty of Health and Society, University of Salford, Manchester M6 6PU, UK;
| | - Mei Yee Tang
- Behavioural Science Policy Research Unit, Population Health Sciences, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Chris Keyworth
- Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK; (C.K.); (L.B.-D.); (J.H.); (C.J.A.); (T.E.)
| | - Sabina Stanescu
- School of Psychology, University of Southampton, Southampton SO17 1BJ, UK;
| | | | - Elizabeth Jenkinson
- Department of Health and Social Sciences, University of West England, Bristol BS16 1QY, UK; (E.J.); (N.G.); (E.G.)
| | - Angelos P. Kassianos
- Department of Applied Health Research, University College London, London WC1E 6BT, UK;
| | - Daniel Scanlan
- Department of Communication, Policy, and Research, Education Support, London N5 1EW, UK;
| | - Natalie Garnett
- Department of Health and Social Sciences, University of West England, Bristol BS16 1QY, UK; (E.J.); (N.G.); (E.G.)
| | - Lynn Laidlaw
- Public Contributor, Health Psychology Exchange Patient and Public Involvement (PPI) Group, UK;
| | - Neil Howlett
- Department of Psychology, Sports, and Geography, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hertfordshire AL10 9AB, UK;
| | - Natalie Carr
- Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Manchester M15 6BH, UK;
| | - Natalia Stanulewicz
- Faculty of Health and Life Sciences, School of Applied Social Sciences, De Montfort University, Leicester LE1 9BH, UK;
| | - Ella Guest
- Department of Health and Social Sciences, University of West England, Bristol BS16 1QY, UK; (E.J.); (N.G.); (E.G.)
| | - Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
| | | | - Lucie Byrne-Davis
- Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK; (C.K.); (L.B.-D.); (J.H.); (C.J.A.); (T.E.)
- Division of Medical Education, University of Manchester, Manchester M13 9PT, UK
| | - Angel Chater
- Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, Bedfordshire MK41 9EA, UK;
| | - Jo Hart
- Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK; (C.K.); (L.B.-D.); (J.H.); (C.J.A.); (T.E.)
- Division of Medical Education, University of Manchester, Manchester M13 9PT, UK
| | - Christopher J. Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK; (C.K.); (L.B.-D.); (J.H.); (C.J.A.); (T.E.)
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
- Manchester Academic Health Science Centre, Health Innovation Manchester, Manchester M13 9NQ, UK
| | - Gillian W. Shorter
- Centre for Improving Health Related Quality of Life, Queen’s University Belfast, Belfast BT7 1NN, UK;
| | - Vivien Swanson
- Department of Psychology, University of Stirling, Stirling FK9 4LA, UK;
| | - Tracy Epton
- Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK; (C.K.); (L.B.-D.); (J.H.); (C.J.A.); (T.E.)
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27
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Tyler N, Planner C, Byrne M, Blakeman T, Keers RN, Wright O, Pascall Jones P, Giles S, Keyworth C, Hodkinson A, Taylor CDJ, Armitage CJ, Campbell S, Panagioti M. Developing Best Practice Guidance for Discharge Planning Using the RAND/UCLA Appropriateness Method. Front Psychiatry 2021; 12:789418. [PMID: 34925112 PMCID: PMC8680088 DOI: 10.3389/fpsyt.2021.789418] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Discharge from acute mental health inpatient units is often a vulnerable period for patients. Multiple professionals and agencies are involved and processes and procedures are not standardized, often resulting in communication delays and co-ordination failures. Early and appropriate discharge planning and standardization of procedures could make inpatient care safer. Aim: To inform the development of a multi-component best practice guidance for discharge planning (including the 6 component SAFER patient flow bundle) to support safer patient transition from mental health hospitals to the community. Methods: Using the RAND/UCLA Appropriateness method, a panel of 10 professional stakeholders (psychiatrists, psychiatric nurses, clinical psychologists, pharmacists, academics, and policy makers) rated evidence-based statements. Six hundred and sixty-eight statements corresponding to 10 potential components of discharge planning best practice were rated on a 9-point integer scale for clarity, appropriateness and feasibility (median ≥ 7-9) using an online questionnaire then remote online face-to-face meetings. Results: Five of the six "SAFER" patient flow bundle components were appropriate and feasible for inpatient mental health. One component, "Early Flow," was rated inappropriate as mental health settings require more flexibility. Overall, 285 statements were rated as appropriate and feasible. Forty-four statements were considered appropriate but not feasible to implement. Discussion: This consensus study has identified components of a best practice guidance/intervention for discharge planning for UK mental health settings. Although some components describe processes that already happen in everyday clinical interactions (i.e., review by a senior clinician), standardizing such processes could have important safety benefits alongside a tailored and timely approach to post-discharge care.
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Affiliation(s)
- Natasha Tyler
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Matthew Byrne
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Thomas Blakeman
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Richard N Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Oliver Wright
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, United Kingdom
| | - Paul Pascall Jones
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, United Kingdom
| | - Sally Giles
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Chris Keyworth
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Christopher D J Taylor
- Secondary Care Psychological Therapies Service, Pennine Care National Health Service (NHS) Foundation Trust, Bury, United Kingdom.,Division of Psychology and Mental Health, Manchester Academic Health Science Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Christopher J Armitage
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom.,University National Health Service (NHS) Foundation Trust Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,National Institute of Health Research (NIHR) Manchester Biomedical Research Council, Manchester, United Kingdom
| | - Stephen Campbell
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute of Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,National Institute for Health Research, School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Goldthorpe J, Epton T, Keyworth C, Calam R, Brooks J, Armitage C. What do children, parents and staff think about a healthy lifestyles intervention delivered in primary schools? a qualitative study. BMJ Open 2020; 10:e038625. [PMID: 32819951 PMCID: PMC7440822 DOI: 10.1136/bmjopen-2020-038625] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Primary schools are crucial settings for early weight management interventions but effects on children's weight are small and evidence shows that deficiencies in intervention implementation may be responsible. Very little is known about the roles of multiple stakeholders in the process of implementation. We used a multiple-stakeholder qualitative research approach to explore the implementation of an intervention developed to improve the diet and increase the levels of physical activity for children living in some of the most deprived areas of England. DESIGN For this qualitative study, interviews and focus groups were carried out using semi-structured topic guides. Data were analysed thematically. SETTING Seven primary schools (pupils aged 4 to 11) in Manchester, England. PARTICIPANTS We conducted 14 focus groups with children aged 5 to 10 years and interviews with 19 staff members and 17 parents. INTERVENTION Manchester Healthy Schools (MHS) is a multicomponent intervention, developed to improve diet and physical activity in schools with the aim of reducing and preventing childhood obesity. RESULTS Three themes were developed from the data: common understandings of health and health behaviours; congruence and consistency of messages; negotiations of responsibility. CONCLUSION All participant groups had a common conceptualisation of health as having physical and psychological components and that action could be taken in childhood to change behaviours that protect long-term health. When parents and staff felt a shared sense of responsibility for children's health and levels of congruence between home and school norms around diet and physical activity were high, parents and children were more likely to accept the policies implemented as part of MHS. Effective two-way communication between home and school is therefore vital for successful implementation of this intervention.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
| | - Tracy Epton
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
| | - Chris Keyworth
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
| | - Rachel Calam
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Chris Armitage
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Goldthorpe J, Epton T, Keyworth C, Calam R, Armitage CJ. Are primary/elementary school-based interventions effective in preventing/ameliorating excess weight gain? A systematic review of systematic reviews. Obes Rev 2020; 21:e13001. [PMID: 32162477 DOI: 10.1111/obr.13001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/21/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Abstract
This systematic review of systematic reviews addresses a current gap in evidence by synthesizing findings relating to weight management interventions set entirely in primary/elementary schools targeting, diet, and/or physical activity as key strategies. Eight databases were searched for systematic reviews of trials of school-based interventions targeting children aged 4 to 12 years that looked at biometric and behavioral outcomes. From the 10 selected systematic reviews, we found that interventions designed to promote physical activity or reduce sedentary behavior were most effective for weight loss. Interventions designed to improve diet and nutrition had a small effect on behavioral and cognitive outcomes, and these outcomes could be enhanced through the use of experiential learning. The most effective interventions involved a range of stakeholders in the development process and included parents and families in implementation. This systematic review of systematic reviews offers evidence-based guidance for the development and implementation of multistrategy weight-management interventions in primary/elementary schools.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Rachel Calam
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Zochonis Building, University of Manchester, M13 9PL, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Coupland 1 Building University of Manchester, M13 9PL, UK Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Perceptions of receiving behaviour change interventions from GPs during routine consultations: A qualitative study. PLoS One 2020; 15:e0233399. [PMID: 32437462 PMCID: PMC7241720 DOI: 10.1371/journal.pone.0233399] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/04/2020] [Indexed: 01/19/2023] Open
Abstract
General Practitioners (GPs) are expected to provide patients with health behaviour change interventions, yet little is known about the views of patients themselves. We aimed to understand recent patients': (1) general expectations about GPs delivering health behaviour change interventions during routine consultations (including perceptions of appropriateness and helpfulness for receiving interventions), (2) perceptions of responsibility for GPs to talk about health behaviours, and (3) experiences of receiving behaviour change interventions. Twenty-four semi-structured interviews were conducted with people who had recently attended a routine GP consultation. Data were analysed thematically. Three major themes were identified: (1) acceptability of discussions about behaviour change, (2) establishing clinician-patient rapport, and (3) healthcare professionals as a credible source and well placed to offer behaviour change interventions. Most patients were positive about, and were willing to accept behaviour change interventions from their GP during a routine consultation. Although behaviour change was perceived as a sensitive topic for patients, the doctor-patient relationship was perceived to provide an effective platform to discuss behaviour change, with the GP perceived as an appropriate and important healthcare professional from whom to receive advice. Contrary to the views of GPs, behaviour change interventions were perceived by patients as appropriate and helpful during routine medical consultations, particularly where behaviour change could have a positive effect on long-term condition management. Behaviour change interventions delivered by GPs during routine consultations could be used effectively in time-restricted consultations.
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Affiliation(s)
- Chris Keyworth
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Tracy Epton
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Joanna Goldthorpe
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Rachel Calam
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Christopher J. Armitage
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Acceptability, reliability, and validity of a brief measure of capabilities, opportunities, and motivations ("COM-B"). Br J Health Psychol 2020; 25:474-501. [PMID: 32314500 DOI: 10.1111/bjhp.12417] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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: 10/02/2019] [Revised: 03/23/2020] [Indexed: 11/30/2022]
Abstract
Objectives The Capabilities, Opportunities, Motivations, Behaviour (COM-B) model is being used extensively to inform intervention design, but there is no standard measure with which to test the predictive validity of COM or to assess the impact of interventions on COM. We describe the development, reliability, validity, and acceptability of a generic 6-item self-evaluation COM questionnaire. Design and methods The questionnaire was formulated by behaviour change experts. Acceptability was tested in two independent samples of health care professionals (N = 13 and N = 85, respectively) and a sample of people with low socio-economic status (N = 214). Acceptability (missing data analyses and user feedback), reliability (test-retest reliability and Bland-Altman plots) and validity (floor and ceiling effects, Pearson's correlation coefficient [r], exploratory factor analysis [EFA], and confirmatory factor analysis [CFA] were tested using a national survey of 1,387 health care professionals. Results The questionnaire demonstrated acceptability (missing data for individual items: 5.9-7.7% at baseline and 18.1-32.5% at follow-up), reliability (ICCs .554-.833), and validity (floor effects 0.6-5.5% and ceiling effects 4.1-22.9%; pairwise correlations rs significantly <1.0). The regression models accounted for between 21 and 47% of the variance in behaviour. CFA (three-factor model) demonstrated a good model fit, (χ2 [6] = 7.34, p = .29, RMSEA = .02, CFI = .99, TLI = .99, BIC = 13,510.420, AIC = 13,428.067). Conclusions The novel six-item questionnaire shows evidence of acceptability, validity, and reliability for self-evaluating capabilities, opportunities, and motivations. Future research should aim to use this tool in different populations to obtain further support for its reliability and validity. Statement of contribution What is already known on the subject? The Capability, Opportunity, Motivation (COM), Behaviour (-B) model is being used extensively to inform intervention design. The lack of an accepted universal measure hinders progress in behaviour change. What does this study add? There is evidence of acceptability, validity, and reliability for self-evaluating COM. Our measure may be sufficiently generic for any behaviour or population, although this requires further testing.
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Affiliation(s)
- Chris Keyworth
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Tracy Epton
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Joanna Goldthorpe
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Rachel Calam
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Christopher J Armitage
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, UK
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Findley A, Smith DM, Hesketh K, Keyworth C. Exploring womens' experiences and decision making about physical activity during pregnancy and following birth: a qualitative study. BMC Pregnancy Childbirth 2020; 20:54. [PMID: 32000706 PMCID: PMC6993510 DOI: 10.1186/s12884-019-2707-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 07/23/2019] [Accepted: 12/26/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Physical activity (PA) tends to decline during pregnancy, and remains low in the early postpartum period, despite the known physical and psychological benefits. This study aimed to explore: (1) women's experiences of PA during pregnancy and following birth; and (2) decision-making processes related to PA during this time. METHODS Semi-structured telephone interviews were conducted with 16 women who were either pregnant or had recently given birth. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS There were two over-arching themes: (1) ownership of body, which consisted of the sub-themes: others try to take ownership, important to maintain fitness into pregnancy and motherhood, expectations of PA, and pressure to conform; and (2) unknown territory, which consisted of the sub-themes: engaging in PA with caution, and unclear advice. Decision-making about PA during pregnancy was influenced by: pressure from others who felt responsible to protect the woman from coming to harm; pressure from social media to lose weight postpartum; participant's beliefs about the benefits of maintaining fitness and participants expectations of how active they thought they would be able to be during pregnancy. Participants felt that pregnancy was an 'unknown territory' in terms of the unfamiliar feelings in their body and the inability to continually monitor their baby for reassurance of baby's health. Advice received from midwives was often lacking, or not tailored to the individual. Advice from friends and family was often regarded as incorrect, but still caused doubt and fear of PA during pregnancy. CONCLUSIONS These findings contribute to the understanding of women's experiences of PA during pregnancy and post-partum, and their decision-making processes about PA during pregnancy. Developing accurate and tailored advice as part of midwifery care, that considers the physical and psychological aspects of engaging in PA during pregnancy, will help to ensure that women are supported to make informed decisions about their PA behaviour.
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Affiliation(s)
- Amy Findley
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Coupland 1 Building, Room G.3, Oxford Road, Manchester, M13 9PL, UK
| | - Debbie M Smith
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Coupland 1 Building, Room G.3, Oxford Road, Manchester, M13 9PL, UK.,School of Social and Health Sciences, Leeds Trinity University, Leeds, England
| | - Kathryn Hesketh
- MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Coupland 1 Building, Room G.3, Oxford Road, Manchester, M13 9PL, UK.
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Abstract
OBJECTIVE The issue of who is responsible for children's physical health is complex, with implications for targeting and developing strategies for health promotion and interventions to improve health. While there is evidence to suggest that children are able to construct notions of responsibility in relation to other areas of their lives, very little research has explored children's views of responsibility for their own health. The aim of this study was to explore children's views about who they feel is responsible for keeping them healthy. DESIGN Focus groups were used to gather qualitative data using a semistructured topic guide. Interpretative phenomenological analysis was used in an iterative, double hermeneutic approach to analyse the data. SETTING Focus groups took place in two UK primary schools in deprived inner city areas. PARTICIPANTS 20 children aged 8-10 years took part in one of two focus groups (10 children in each group). RESULTS Three overarching themes were identified: (1) individual and collective responsibility, (2) marketing and conflict with taking responsibility, and (3) what people and organisations can do to help children to take responsibility. Children feel that they, parents, families, school staff, medical professionals, food producers, retail outlets, supermarkets, advertisers and the government are all responsible for their health and should thus demonstrate responsibility through their behaviours around children's health. CONCLUSIONS AND IMPLICATIONS Children's views were consistent with constructs of responsibility as both a moral obligation and a set of behaviours, and with wider sociopolitical philosophies of individual and collective responsibility. These findings further support a focus on integrated, system-wide approaches to children's health.
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Affiliation(s)
- Joanna Goldthorpe
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Tracy Epton
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Chris Keyworth
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Rachel Calam
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Christopher Armitage
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. 'It's difficult, I think it's complicated': Health care professionals' barriers and enablers to providing opportunistic behaviour change interventions during routine medical consultations. Br J Health Psychol 2019; 24:571-592. [PMID: 30977291 PMCID: PMC6766974 DOI: 10.1111/bjhp.12368] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 07/18/2018] [Revised: 02/15/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Internationally, public health strategies encourage health care professionals to deliver opportunistic behaviour change interventions. The present study: (1) examines the barriers and enablers to delivering interventions during routine consultations, and (2) provides recommendations for the design of interventions to increase delivery of opportunistic behaviour change interventions. DESIGN Qualitative interview study. METHODS Twenty-eight semi-structured interviews were conducted with patient-facing health care professionals. The Behaviour Change Wheel informed a framework analysis in which findings were mapped onto the Theoretical Domains Framework (TDF). Intervention functions and behaviour change techniques (BCTs) targeting each TDF domain were identified. RESULTS Health care professionals understood the importance of opportunistic behaviour change interventions (beliefs about consequences), but were sceptical about their capabilities to facilitate behaviour change with patients (beliefs about capabilities). Some clinicians were unwilling to discuss behaviours perceived as unrelated to the patient's visit (social/professional role and identity). Discipline-specific tasks were prioritized, and delivering interventions was perceived as psychologically burdensome. One-to-one contact was favoured over busy hospital settings (environmental context and resources). Seven intervention functions (training, restriction, environmental restructuring, enablement, education, persuasion, and modelling) and eight BCT groupings (antecedents, associations, comparison of outcomes, covert learning, feedback and monitoring, natural consequences, reward and threat, and self-belief) were identified. CONCLUSIONS Across disciplines, health care professionals see the value of opportunistic behaviour change interventions. Barriers related to workload, the clinical environment, competence, and perceptions of the health care professional role must be addressed, using appropriate intervention functions and BCTs, in order to support health care professionals to increase the delivery of interventions in routine practice. Statement of contribution What is already known on this subject? Brief, opportunistic interventions can be a cost effective way of addressing population health problems. Public health policies compel health care professionals to deliver behaviour change interventions opportunistically. Health care professionals do not always deliver interventions opportunistically during routine medical consultations; however the barriers and enablers are currently unclear. What does this study add? This is the first study to examine cross-disciplinary barriers and enablers to delivering opportunistic behaviour change interventions. Across diverse professional groups, working in different medical professions, participants saw the value of delivering opportunistic behaviour change interventions. Targeting key theoretical domains that are shared across professional groups may be useful for increasing the delivery of opportunistic behaviour change interventions.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Rachel Calam
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre and Manchester University NHS Foundation Trust (MFT), and NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, UK
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Keyworth C, Hart J, Armitage CJ, Tully MP. What maximizes the effectiveness and implementation of technology-based interventions to support healthcare professional practice? A systematic literature review. BMC Med Inform Decis Mak 2018; 18:93. [PMID: 30404638 PMCID: PMC6223001 DOI: 10.1186/s12911-018-0661-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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: 03/27/2018] [Accepted: 09/27/2018] [Indexed: 02/02/2023] Open
Abstract
Background Technological support may be crucial in optimizing healthcare professional practice and improving patient outcomes. A focus on electronic health records has left other technological supports relatively neglected. Additionally, there has been no comparison between different types of technology-based interventions, and the importance of delivery setting on the implementation of technology-based interventions to change professional practice. Consequently, there is a need to synthesise and examine intervention characteristics using a methodology suited to identifying important features of effective interventions, and the barriers and facilitators to implementation. Three aims were addressed: to identify interventions with a technological component that are successful at changing professional practice, to determine if and how such interventions are theory-based, and to examine barriers and facilitators to successful implementation. Methods A literature review informed by realist review methods was conducted involving a systematic search of studies reporting either: (1) behavior change interventions that included technology to support professional practice change; or (2) barriers and facilitators to implementation of technological interventions. Extracted data was quantitative and qualitative, and included setting, target professionals, and use of Behaviour Change Techniques (BCTs). The primary outcome was a change in professional practice. A thematic analysis was conducted on studies reporting barriers and facilitators of implementation. Results Sixty-nine studies met the inclusion criteria; 48 (27 randomized controlled trials) reported behavior change interventions and 21 reported practicalities of implementation. The most successful technological intervention was decision support providing healthcare professionals with knowledge and/or person-specific information to assist with patient management. Successful technologies were more likely to operationalise BCTs, particularly “instruction on how to perform the behavior”. Facilitators of implementation included aligning studies with organisational initiatives, ensuring senior peer endorsement, and integration into clinical workload. Barriers included organisational challenges, and design, content and technical issues of technology-based interventions. Conclusions Technological interventions must focus on providing decision support for clinical practice using recognized behavior change techniques. Interventions must consider organizational context, clinical workload, and have clearly defined benefits for improving practice and patient outcomes. Electronic supplementary material The online version of this article (10.1186/s12911-018-0661-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Keyworth
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK.
| | - J Hart
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK.,Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK
| | - C J Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - M P Tully
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, M13 9PL, UK
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Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Are healthcare professionals delivering opportunistic behaviour change interventions? A multi-professional survey of engagement with public health policy. Implement Sci 2018; 13:122. [PMID: 30241557 PMCID: PMC6151030 DOI: 10.1186/s13012-018-0814-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 06/11/2018] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND "Making Every Contact Count" (MECC), a public health policy in the UK, compels healthcare professionals to deliver opportunistic health behaviour change interventions to patients during routine medical consultations. Professionals' awareness of, and engagement with, the policy is unclear. This study examined (1) awareness of the MECC policy, and (2) the prevalence of MECC-related practice in relation to (a) perceived patient benefit, (b) how often healthcare professionals deliver interventions during routine consultations, and (c) the time spent on this activity. METHODS Cross-sectional national survey was administered in 2017 of 1387 healthcare professionals working in the UK's National Health Service (NHS). Descriptive statistics were used to assess awareness and practice consistent with the MECC policy. Chi-square was used to gauge the potential representativeness of our sample compared to NHS employment data. RESULTS 31.4% of healthcare professionals reported having heard of the policy; nevertheless, healthcare professionals perceived a need to provide patients with opportunistic behaviour change interventions in 55.9% (32,946/58,906) of consultations. However, healthcare professionals did not deliver interventions on 50.0% of occasions in which they perceived a need. Where behaviour change interventions were delivered to patients, this constituted 35.3% of the appointment time. CONCLUSIONS Policy makers must address the gap between the proportion of patients that healthcare professionals perceive would benefit from opportunistic behaviour change interventions and those receiving them (an estimated 50.0%; 16,473 additional patients could have benefited). Future research should consider how healthcare professionals identify patients who might benefit from opportunistic behaviour change interventions and developing training for efficient delivery of interventions.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland 1 Building-Room G3, Oxford Road, Manchester, M13 9PL, UK.
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK
| | - Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK
| | - Rachel Calam
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
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Keyworth C, Nelson PA, Bundy C, Pye SR, Griffiths CEM, Cordingley L. Does message framing affect changes in behavioural intentions in people with psoriasis? A randomized exploratory study examining health risk communication. PSYCHOL HEALTH MED 2018; 23:763-778. [PMID: 29380626 DOI: 10.1080/13548506.2018.1427876] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Message framing is important in health communication research to encourage behaviour change. Psoriasis, a long-term inflammatory skin condition, has additional comorbidities including high levels of anxiety and cardiovascular disease (CVD), making message framing particularly important. This experimental study aimed to: (1) identify whether health messages about psoriasis presented as either gain- or loss-framed were more effective for prompting changes in behavioural intentions (BI), (2) examine whether BI were driven by a desire to improve psoriasis or reduce CVD risk; (3) examine emotional reactions to message frame; and (4) examine predictors of BI. A two by two experiment examined the effects on BI of message frame (loss vs. gain) and message focus (psoriasis symptom reduction vs. CVD risk reduction). Participants with psoriasis (n = 217) were randomly allocated to one of four evidence-based health messages related to either smoking, alcohol, diet or physical activity, using an online questionnaire. BI was the primary outcome. Analysis of variance tests and hierarchical multiple regression analyses were conducted. A significant frame by focus interaction was found for BI to reduce alcohol intake (p = .023); loss-framed messages were more effective for CVD risk reduction information, whilst gain-framed messages were more effective for psoriasis symptom reduction information. Message framing effects were not found for BI for increased physical activity and improving diet. High CVD risk was a significant predictor of increased BI for both alcohol reduction (β = .290, p < .01) and increased physical activity (β = -.231, p < .001). Message framing may be an important factor to consider depending on the health benefit emphasised (disease symptom reduction or CVD risk reduction) and patient-stated priorities. Condition-specific health messages in psoriasis populations may increase the likelihood of message effectiveness for alcohol reduction.
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Affiliation(s)
- C Keyworth
- a Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences , The University of Manchester , Manchester , UK
| | - P A Nelson
- b Centre for Dermatology Research, Manchester Academic Health Science Centre , The University of Manchester , Manchester , UK.,c NIHR Manchester Biomedical Research Centre , The University of Manchester , Manchester , UK
| | - C Bundy
- d School of Healthcare Sciences , Cardiff University , Cardiff , UK
| | - S R Pye
- e Division of Population Health, Health Services Research & Primary Care, Manchester Academic Health Science Centre , The University of Manchester , Manchester , UK
| | - C E M Griffiths
- b Centre for Dermatology Research, Manchester Academic Health Science Centre , The University of Manchester , Manchester , UK.,c NIHR Manchester Biomedical Research Centre , The University of Manchester , Manchester , UK.,f Salford Royal NHS Foundation Trust , Manchester , UK
| | - L Cordingley
- c NIHR Manchester Biomedical Research Centre , The University of Manchester , Manchester , UK.,g Division of Musculoskeletal and Dermatological Research, Manchester Academic Health Science Centre , The University of Manchester , Manchester , UK
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Keyworth C, Hart J, Thoong H, Ferguson J, Tully M. A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe. JMIR Hum Factors 2017; 4:e17. [PMID: 28765104 PMCID: PMC5558044 DOI: 10.2196/humanfactors.7153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/19/2016] [Revised: 03/23/2017] [Accepted: 04/20/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. OBJECTIVE Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. METHODS Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. RESULTS MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors' e-portfolio). The participants were able to provide examples of how they would use "If-Then" plans for patient management. Technology, as opposed to other methods of learning (eg, traditional "paper based" learning), was seen as a positive advancement for continued learning. CONCLUSIONS MyPrescribe was perceived as an acceptable and feasible learning tool for changing prescribing practices, with participants suggesting that it would make an important addition to medical prescribers' training in reflective practice. MyPrescribe is a novel theory-based technological innovation that provides the platform for doctors to create personalized implementation intentions. Applying the COM-B model allows for a more detailed understanding of the perceived mechanisms behind prescribing practices and the ways in which interventions aimed at changing professional practice can be implemented.
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Affiliation(s)
- Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jo Hart
- Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Hong Thoong
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jane Ferguson
- Health Management Group, Alliance Manchester Business School, Faculty of Humanities, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Mary Tully
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Ferguson J, Keyworth C, Tully MP. 'If no-one stops me, I'll make the mistake again': Changing prescribing behaviours through feedback; A Perceptual Control Theory perspective'. Res Social Adm Pharm 2017; 14:241-247. [PMID: 28283306 DOI: 10.1016/j.sapharm.2017.03.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [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: 11/07/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Doctors at all levels make prescribing errors which can prolong patients' hospital stay, increase the risk of death, and place a significant financial burden on the health system. Doctors have previously reported receiving little or no feedback on their prescribing errors. The effectiveness of feedback in modifying future practice varies widely, depending on how feedback is delivered. To date there is little evidence about why and how feedback interventions do or do not work. Behavioural theories can be used to evaluate this process and provide explanatory accounts to inform recommendations for future interventions. OBJECTIVE To explore the experiences of prescribers receiving different methods of feedback about their prescribing errors. Perceptual Control Theory (PCT) was used as a theoretical framework to explain which aspects of feedback were most likely to influence prescribing behaviour. METHODS A secondary analysis of 31 semi-structured qualitative interviews with junior doctors who had taken part one of three studies in which they received feedback on their prescribing errors. A hybrid approach to analysis involved inductive thematic analysis, and deductive a priori template of codes using PCT as a framework to guide data analysis and interpretation. RESULTS Feedback was most useful for learning and most likely to influence future prescribing behaviour when it was timely, and provided a comprehensive, contextualised benchmark to which participants could compare their prescribing behaviours and current level of knowledge. Group discussions and completing directly-observed prescribing event forms were thought most likely to impact future prescribing; email feedback alone was perceived as least effective in changing prescribing behaviour. CONCLUSION Feedback has the potential to change future prescribing behaviour. Behaviour change can only take place if prescribers are made aware of these discrepancies, either via providing appropriate reference values or benchmarks before mistakes are made, or by providing timely and comprehensive feedback after mistakes are made.
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Affiliation(s)
- Jane Ferguson
- Manchester Pharmacy, School, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom.
| | - Chris Keyworth
- Manchester Pharmacy, School, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom.
| | - Mary P Tully
- Manchester Pharmacy, School, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom.
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Chisholm A, Nelson PA, Pearce CJ, Keyworth C, Griffiths CEM, Cordingley L, Bundy C. The role of personal models in clinical management: Exploring health care providers' beliefs about psoriasis. Br J Health Psychol 2015. [PMID: 26223822 DOI: 10.1111/bjhp.12148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Individuals' illness representations, including beliefs about psoriasis (a complex immune-mediated condition), and their emotional responses to the condition guide self-management behaviour. It is also plausible that health care providers' illness representations guide their own management of psoriasis. Patients commonly report poor health care experiences related to psoriasis, and the role of health care providers' beliefs, emotions, as well as their knowledge, experiences and behaviours ('personal models') in this is unexplored. This study aimed explore health care providers' personal models of psoriasis. DESIGN AND METHODS Qualitative analysis of 23 semi-structured interviews with health care professionals providing care for psoriasis patients was performed. Purposive sampling achieved maximum variation regarding participant discipline, level of experience, gender and age. The self-regulatory/common sense model informed data collection and initial data analysis. Principles of framework analysis were used to generate predetermined and emergent key issues related to practitioners' personal models. RESULTS Three types of personal model emerged. Sophisticated-Linear Model: 70% of practitioners recognized psoriasis as a complex condition but managed it as a skin condition. Mixed Model: 17% of practitioners recognized/managed some elements of psoriasis as complex and some as a skin condition. Sophisticated-Sophisticated Model: 13% recognized and managed psoriasis as a complex condition. Across the data set, five themes emerged illustrating key patterns underpinning these different models including (1) Recognising complexity, (2) Putting skin first, (3) Taking on the complexities of psoriasis with the patient, (4) Aiming for clearance, and (5) Affective experiences within psoriasis consultations. CONCLUSIONS Health care providers recognized psoriasis as a complex condition but commonly reported managing psoriasis as a simple skin condition. Providers' beliefs and management approaches varied in the extent to which they were consistent with one another; and their emotional experiences during consultations may vary depending upon their personal model. Findings could inform future dermatology training programmes by highlighting the role of health care providers' illness representations in clinical management of the condition. STATEMENT OF CONTRIBUTION What is already known on this subject? Health behaviour is predicted by underlying beliefs and emotions associated with an illness and its treatment. Few studies have examined health care providers' beliefs and emotions about the illnesses they manage in clinical practice. Many patients are dissatisfied with dermatology consultations and wish to be treated holistically. What does this study add? Qualitative exploration of health care providers' beliefs/emotions revealed their personal models of psoriasis. Providers' personal models of psoriasis vary in coherence and are often skin rather than whole person focused. Further investigation of health care providers' models of psoriasis and their impact on health outcomes is needed.
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Affiliation(s)
- Anna Chisholm
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK.,Manchester Centre for Health Psychology, University of Manchester, UK
| | - Pauline A Nelson
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK
| | - Christina J Pearce
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK
| | - Chris Keyworth
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK
| | - Christopher E M Griffiths
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK.,Salford Royal NHS Foundation Trust, Manchester, UK
| | - Lis Cordingley
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK.,Manchester Centre for Health Psychology, University of Manchester, UK
| | - Christine Bundy
- Manchester Centre for Dermatology Research, University of Manchester, UK.,Manchester Academic Health Science Centre, UK.,Manchester Centre for Health Psychology, University of Manchester, UK
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Keyworth C, Nelson PA, Griffiths CEM, Cordingley L, Bundy C. Do English healthcare settings use 'Choice Architecture' principles in promoting healthy lifestyles for people with psoriasis? An observational study. BMC Health Serv Res 2015; 15:215. [PMID: 26032696 PMCID: PMC4462178 DOI: 10.1186/s12913-015-0808-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/19/2015] [Indexed: 11/12/2022] Open
Abstract
Background The influence of environmental factors in shaping behaviour is becoming increasingly prominent in public health policy, but whether health promotion strategies use this knowledge is unknown. Health promotion is important in the management of psoriasis, a long-term inflammatory skin condition, and health centre waiting areas are ideal places to promote health information to such patients. We systematically examined patient information materials containing either general, or specific, health messages for patients with psoriasis. Methods An observation schedule was used to record the frequency and quality of leaflets and posters addressing lifestyle behaviour change in health centre waiting areas. Content analysis was used to analyse: frequency, characteristics and standard of the materials. Results Across 24 health centres 262 sources of lifestyle information were recorded (median per site = 10; range = 0–40). These were mainly: generic posters/displays of lifestyle support (n = 113); and generic materials in waiting areas (n = 98). Information quality was poor and poorly displayed, with no high quality psoriasis-specific patient materials evident. Conclusions There is little attempt to promote healthy lifestyle as an important aspect of psoriasis management in the clinic environment. Evidence about using environmental cues/techniques to prompt behaviour change in people with psoriasis does not currently inform the design and display of such information in standard health centre settings, which are prime locations for communicating messages about healthy lifestyle. Future research should test the efficacy and impact of theory-informed, high quality health promotion messages on health outcomes for patients with psoriasis.
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Affiliation(s)
- Chris Keyworth
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. .,Manchester Centre for Health Psychology. University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Pauline A Nelson
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Christopher E M Griffiths
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. .,Dermatology Centre, Salford Royal Hospital, Manchester Academic Health Science Centre, Manchester, UK.
| | - Lis Cordingley
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. .,Manchester Centre for Health Psychology. University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Chris Bundy
- Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. .,Manchester Centre for Health Psychology. University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Chapman AM, Keyworth C, Kember MR, Lennox AJJ, Williams CK. Adding Value to Power Station Captured CO2: Tolerant Zn and Mg Homogeneous Catalysts for Polycarbonate Polyol Production. ACS Catal 2015. [DOI: 10.1021/cs501798s] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A. M. Chapman
- Econic Technologies Ltd. Bio-incubator and ‡Department
of Chemistry, Imperial College London, London SW7 2AZ, U.K
| | - C. Keyworth
- Econic Technologies Ltd. Bio-incubator and ‡Department
of Chemistry, Imperial College London, London SW7 2AZ, U.K
| | - M. R. Kember
- Econic Technologies Ltd. Bio-incubator and ‡Department
of Chemistry, Imperial College London, London SW7 2AZ, U.K
| | - A. J. J. Lennox
- Econic Technologies Ltd. Bio-incubator and ‡Department
of Chemistry, Imperial College London, London SW7 2AZ, U.K
| | - C. K. Williams
- Econic Technologies Ltd. Bio-incubator and ‡Department
of Chemistry, Imperial College London, London SW7 2AZ, U.K
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Nelson P, Keyworth C, Chisholm A, Pearce C, Griffiths C, Cordingley L, Bundy C. ‘In someone's clinic but not in
mine
’ – clinicians’ views of supporting lifestyle behaviour change in patients with psoriasis: a qualitative interview study. Br J Dermatol 2014; 171:1116-22. [DOI: 10.1111/bjd.13231] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 02/04/2023]
Affiliation(s)
- P.A. Nelson
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - C. Keyworth
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - A. Chisholm
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - C.J. Pearce
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - C.E.M. Griffiths
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
- Salford Royal NHS Foundation Trust University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - L. Cordingley
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
- Manchester Centre for Health Psychology University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - C. Bundy
- Dermatology Research Centre University of Manchester Manchester Academic Health Science Centre Manchester U.K
- Manchester Centre for Health Psychology University of Manchester Manchester Academic Health Science Centre Manchester U.K
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Keyworth C, Nelson PA, Chisholm A, Griffiths CEM, Cordingley L, Bundy C. Providing lifestyle behaviour change support for patients with psoriasis: an assessment of the existing training competencies across medical and nursing health professionals. Br J Dermatol 2014; 171:602-8. [PMID: 24749866 DOI: 10.1111/bjd.13067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND Psoriasis is associated with unhealthy lifestyle behaviours which contribute to psoriasis onset and severity. Health professionals who manage patients with psoriasis are well placed to support lifestyle change but few feel confident to do so. Little is known about the extent to which health promotion and lifestyle behaviour change (LBC) skills are included within post-qualification training curricula. OBJECTIVES This study aimed to systematically examine the content of post-qualification U.K. training curricula for health professionals across General Practice and Dermatology for evidence of behaviour change skills relating to the promotion of healthy lifestyles. METHODS Core curricula documents from professional organizations were analysed for content to examine the extent to which curricula: (1) mentioned health promotion and LBC as part of the professional role; and/or (2) included health promotion and LBC as explicit training competencies or requirements for qualification. RESULTS Of the 11 core curricula documents analysed, we found 67 occurrences of terms related to LBC and health promotion. Most were in the General Practitioner curriculum (n = 42; 62·7%), followed by the Dermatology Specialist Nurse curriculum (n = 14; 20·9%) and Dermatologist curriculum (n = 11; 16·4%). No occurrences were found in the General Practitioner with a Special Interest in Dermatology curriculum. LBC knowledge, skills and attitudes were not clearly specified and only basic level LBC competencies were included. CONCLUSIONS Development of post-qualification curricula would ensure health professionals are equipped with the necessary knowledge, skills and attitudes to support LBC for patients with psoriasis. This is of particular relevance, given the evidence linking unhealthy lifestyles with psoriasis outcomes.
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Affiliation(s)
- C Keyworth
- Dermatology Research Centre, The University of Manchester, Manchester, U.K
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Keyworth C, Knopp J, Roughley K, Dickens C, Bold S, Coventry P. A mixed-methods pilot study of the acceptability and effectiveness of a brief meditation and mindfulness intervention for people with diabetes and coronary heart disease. Behav Med 2014; 40:53-64. [PMID: 24754440 PMCID: PMC4017270 DOI: 10.1080/08964289.2013.834865] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mindfulness-based interventions can successfully target negative perseverative cognitions such as worry and thought suppression, but their acceptability and effectiveness in people with long-term conditions is uncertain. We therefore pilot tested a six-week meditation and mindfulness intervention in people (n = 40) with diabetes mellitus and coronary heart disease. We used a sequential mixed-methods approach that measured change in worry and thought suppression and qualitatively explored acceptability, feasibility, and user experience with a focus group (n = 11) and in-depth interviews (n = 16). The intervention was highly acceptable, with 90% completing ≥5 sessions. Meditation and mindfulness skills led to improved sleep, greater relaxation, and more-accepting approaches to illness and illness experience. At the end of the six-week meditation course, worry, and thought suppression were significantly reduced. Positive impacts of mindfulness-based interventions on psychological health may relate to acquisition and development of meta-cognitive skills but this needs experimental confirmation.
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Knowles SE, Chew-Graham C, Coupe N, Adeyemi I, Keyworth C, Thampy H, Coventry PA. Better together? a naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems. Implement Sci 2013; 8:110. [PMID: 24053257 PMCID: PMC3848572 DOI: 10.1186/1748-5908-8-110] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 08/07/2013] [Indexed: 05/05/2023] Open
Abstract
Background Mental-physical multi-morbidities pose challenges for primary care services that traditionally focus on single diseases. Collaborative care models encourage inter-professional working to deliver better care for patients with multiple chronic conditions, such as depression and long-term physical health problems. Successive trials from the United States have shown that collaborative care effectively improves depression outcomes, even in people with long-term conditions (LTCs), but little is known about how to implement collaborative care in the United Kingdom. The aim of the study was to explore the extent to which collaborative care was implemented in a naturalistic National Health Service setting. Methods A naturalistic pilot study of collaborative care was undertaken in North West England. Primary care mental health professionals from IAPT (Increasing Access to Psychological Therapies) services and general practice nurses were trained to collaboratively identify and manage patients with co-morbid depression and long-term conditions. Qualitative interviews were performed with health professionals at the beginning and end of the pilot phase. Normalization Process Theory guided analysis. Results Health professionals adopted limited elements of the collaborative care model in practice. Although benefits of co-location in primary care practices were reported, including reduced stigma of accessing mental health treatment and greater ease of disposal for identified patients, existing norms around the division of mental and physical health work in primary care were maintained, limiting integration of the mental health practitioners into the practice setting. Neither the mental health practitioners nor the practice nurses perceived benefits to joint management of patients. Conclusions Established divisions between mental and physical health may pose particular challenges for multi-morbidity service delivery models such as collaborative care. Future work should explore patient perspectives about whether greater inter-professional working enhances experiences of care. The study demonstrates that research into implementation of novel treatments must consider how the introduction of innovation can be balanced with the need for integration into existing practice.
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Affiliation(s)
- Sarah E Knowles
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK.
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Coventry PA, Lovell K, Dickens C, Bower P, Chew-Graham C, Cherrington A, Garrett C, Gibbons CJ, Baguley C, Roughley K, Adeyemi I, Keyworth C, Waheed W, Hann M, Davies L, Jeeva F, Roberts C, Knowles S, Gask L. Update on the collaborative interventions for circulation and depression (COINCIDE) trial: changes to planned methodology of a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease. Trials 2013; 14:136. [PMID: 23663556 PMCID: PMC3660180 DOI: 10.1186/1745-6215-14-136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 04/18/2013] [Indexed: 11/30/2022] Open
Abstract
Background The COINCIDE trial aims to evaluate the effectiveness and cost-effectiveness of a collaborative care intervention for depression in people with diabetes and/or coronary heart disease attending English general practices. Design This update details changes to the cluster and patient recruitment strategy for the COINCIDE study. The original protocol was published in Trials (http://www.trialsjournal.com/content/pdf/1745-6215-13-139.pdf). Modifications were made to the recruitment targets in response to lower-than-expected patient recruitment at the first ten general practices recruited into the study. In order to boost patient numbers and retain statistical power, the number of general practices recruited was increased from 30 to 36. Follow-up period was shortened from 6 months to 4 months to ensure that patients recruited to the trial could be followed up by the end of the study. Results Patient recruitment began on the 01/05/2012 and is planned to be completed by the 30/04/2013. Recruitment for general practices was completed on 31/10/2012, by which time the target of 36 practices had been recruited. The main trial results will be published in a peer-reviewed journal. Conclusion The data from the trial will provide evidence on the effectiveness and cost-effectiveness of collaborative care for depression in people with diabetes and/or coronary heart disease. Trial registration Trial registration number: ISRCTN80309252
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Affiliation(s)
- Peter A Coventry
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK.
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Keyworth C, Peters S, Chisholm A, Hart J. Nursing students' perceptions of obesity and behaviour change: implications for undergraduate nurse education. Nurse Educ Today 2013; 33:481-485. [PMID: 22766203 DOI: 10.1016/j.nedt.2012.05.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/11/2012] [Accepted: 05/16/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Rates of obesity are rising and previous research suggests this is not effectively dealt with in healthcare settings. Nurses are increasingly involved in lifestyle management of patients, and understanding the barriers to discussing weight with patients is likely to increase successful weight management. Obesity management is a role that nursing students will need to be equipped with and more likely to be targeted for future training developments in tackling the increasing rates of obesity. OBJECTIVES To explore the perceptions of obesity, potential barriers to successful patient weight management and training needs of nursing students. METHODS Qualitative, semi-structured interviews were conducted with 20 nursing students. Audiotaped interviews were transcribed verbatim and analysed using an inductive thematic approach informed by principles of grounded theory. RESULTS Participants reported the challenge of managing obesity in healthcare practice, such as the impact of negative attitudes in healthcare practice on patient care. Although perceived as core to their training, nursing students lacked the confidence and techniques to discuss weight management with patients. Participants also perceived the nursing curriculum as lacking a focus on obesity, and reported a need for advanced communication skills training. CONCLUSION Although seen as important, nurses lack the skills to facilitate weight management, leading to nurses failing to broach the issue. PRACTICE IMPLICATIONS Nurse educators should consider the perceptions of current students when making curriculum developments in this area.
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Affiliation(s)
- Chris Keyworth
- School of Community Based Medicine, University of Manchester, Manchester, UK.
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Coventry PA, Lovell K, Dickens C, Bower P, Chew-Graham C, Cherrington A, Garrett C, Gibbons CJ, Baguley C, Roughley K, Adeyemi I, Keyworth C, Waheed W, Hann M, Davies L, Jeeva F, Roberts C, Knowles S, Gask L. Collaborative Interventions for Circulation and Depression (COINCIDE): study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease. Trials 2012; 13:139. [PMID: 22906179 PMCID: PMC3519809 DOI: 10.1186/1745-6215-13-139] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [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] [Received: 02/09/2012] [Accepted: 07/17/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Depression is up to two to three times as common in people with long-term conditions. It negatively affects medical management of disease and self-care behaviors, and leads to poorer quality of life and high costs in primary care. Screening and treatment of depression is increasingly prioritized, but despite initiatives to improve access and quality of care, depression remains under-detected and under-treated, especially in people with long-term conditions. Collaborative care is known to positively affect the process and outcome of care for people with depression and long-term conditions, but its effectiveness outside the USA is still relatively unknown. Furthermore, collaborative care has yet to be tested in settings that resemble more naturalistic settings that include patient choice and the usual care providers. The aim of this study was to test the effectiveness of a collaborative-care intervention, for people with depression and diabetes/coronary heart disease in National Health Service (NHS) primary care, in which low-intensity psychological treatment services are delivered by the usual care provider - Increasing Access to Psychological Therapies (IAPT) services. The study also aimed to evaluate the cost-effectiveness of the intervention over 6 months, and to assess qualitatively the extent to which collaborative care was implemented in the intervention general practices. METHODS This is a cluster randomized controlled trial of 30 general practices allocated to either collaborative care or usual care. Fifteen patients per practice will be recruited after a screening exercise to detect patients with recognized depression (≥10 on the nine-symptom Patient Health Questionnaire; PHQ-9). Patients in the collaborative-care arm with recognized depression will be offered a choice of evidence-based low-intensity psychological treatments based on cognitive and behavioral approaches. Patients will be case managed by psychological well-being practitioners employed by IAPT in partnership with a practice nurse and/or general practitioner. The primary outcome will be change in depressive symptoms at 6 months on the 90-item Symptoms Checklist (SCL-90). Secondary outcomes include change in health status, self-care behaviors, and self-efficacy. A qualitative process evaluation will be undertaken with patients and health practitioners to gauge the extent to which the collaborative-care model is implemented, and to explore sustainability beyond the clinical trial. DISCUSSION COINCIDE will assess whether collaborative care can improve patient-centered outcomes, and evaluate access to and quality of care of co-morbid depression of varying intensity in people with diabetes/coronary heart disease. Additionally, by working with usual care providers such as IAPT, and by identifying and evaluating interventions that are effective and appropriate for routine use in the NHS, the COINCIDE trial offers opportunities to address translational gaps between research and implementation. TRIAL REGISTRATION NUMBER ISRCTN80309252 TRIAL STATUS: Open.
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Affiliation(s)
- Peter A Coventry
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery & Social Work and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Chris Dickens
- Peninsula College of Medicine and Dentistry, University of Exeter and Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), Exeter, Devon, UK
| | - Peter Bower
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Carolyn Chew-Graham
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Andrea Cherrington
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Charlotte Garrett
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Chris J Gibbons
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Clare Baguley
- IAPT North West Programme Field Lead, NHS North West, UK
| | - Kate Roughley
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Isabel Adeyemi
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Chris Keyworth
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Mark Hann
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Linda Davies
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Farheen Jeeva
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Chris Roberts
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sarah Knowles
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Linda Gask
- Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Bullimore SP, Keyworth C. Finding diabetics--a method of screening in general practice. Br J Gen Pract 1997; 47:371-4. [PMID: 9231472 PMCID: PMC1313029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND It is well known that many diabetic patients go undiagnosed until complications have started to develop. Screening can be expensive in time and money, and ineffective, and is therefore unpopular with general practitioners (GPs). AIM This study aimed to develop a screening method that was cost-effective and practical within the setting of an ordinary general practice. METHOD Urine-testing sticks for glucose were sent with an explanatory letter to all (1736) non-diabetic subjects over 50 years old in a general practice. At the same time, diabetic recall and care were audited and improved in the practice. RESULTS Reply slips were received from 1204 patients (69.4%). Of these, 2.6% were positive and 97.4% were negative. Eight new diabetic patients were therefore found at a cost of 78.25 pounds each. CONCLUSION This method of screening a selected part of a general practice population is practical and effective. Apart from the human cost, the financial cost of finding a new diabetic patient is small compared with that of caring for a diabetic patient who is blind or an amputee.
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