A scoping review of evaluation frameworks and their applicability to real-world physical activity and dietary change programme evaluation.

BACKGROUND: Physical activity and dietary change programmes play a central role in addressing public health priorities. Programme evaluation contributes to the evidence-base about these programmes; and helps justify and inform policy, programme and funding decisions. A range of evaluation frameworks have been published, but there is uncertainty about their usability and applicability to different programmes and evaluation objectives, and the extent to which they are appropriate for practitioner-led or researcher-led evaluation. This review appraises the frameworks that may be applicable to evaluation of physical activity and/or dietary change programmes, and develops a typology of the frameworks to help guide decision making by practitioners, commissioners and evaluators. METHODS: A scoping review approach was used. This included a systematic search and consultation with evaluation experts to identify evaluation frameworks and to develop a set of evaluation components to appraise them. Data related to each framework's general characteristics and components were extracted. This was used to construct a typology of the frameworks based on their intended programme type, evaluation objective and format. Each framework was then mapped against the evaluation components to generate an overview of the guidance included within each framework. RESULTS: The review identified 71 frameworks. These were described variously in terms of purpose, content, or applicability to different programme contexts. The mapping of frameworks highlighted areas of overlap and strengths and limitations in the available guidance. Gaps within the frameworks which may warrant further development included guidance on participatory approaches, non-health and unanticipated outcomes, wider contextual and implementation factors, and sustainability. CONCLUSIONS: Our typology and mapping signpost to frameworks where guidance on specific components can be found, where there is overlap, and where there are gaps in the guidance. Practitioners and evaluators can use these to identify, agree upon and apply appropriate frameworks. Researchers can use them to identify evaluation components where there is already guidance available and where further development may be useful. This should help focus research efforts where it is most needed and promote the uptake and use of evaluation frameworks in practice to improve the quality of evaluation and reporting.

Characteristics of Out-of-Care Patients Who Required a Referral for Re-engagement Services by Public Health Bridge Counselors Following a Brief Clinic-Based Retention Intervention.

The NC-LINK Project initiated both clinic-based retention services and state public health bridge counselor-based (SBCs) re-engagement services to retain and re-engage people living with HIV infection (PLWH) in care. The goal of this project is to compare efforts between clinic-based retention and SBC re-engagement services to determine whether patients are more or less likely to remain in HIV care services. Clinic appointment data were used to identify patients who were last seen more than 6-9 months prior. Patients either received clinic-based retention services only or were subsequently referred to the SBC re-engagement intervention if the retention services were unsuccessful. The frequency of re-engagement in care (180 days) and HIV suppression (VLS, within 1 year) was examined for patients in these two groups. The SBC group was less likely to have VLS at the visit prior to referral (adjusted OR 2.04, 95% CI 1.53, 2.72). Patients who were referred to the SBC were less likely to re-engage in care within 180 days as compared to those who received clinic-based retention services only (adjusted OR 0.29, 95% CI 0.21, 0.41).

The Effectiveness of an Intervention Program for Fathers of Hospitalized Preterm Infants on Paternal Support and Attachment 1 Month After Discharge.

This aim of this study was to evaluate the effectiveness of an early intervention program to reduce paternal stress and increase fathering ability after a preterm infant's admission to the special care nursery and to influence paternal support for the mother and the father's attachment to the infant 1 month later. A historical comparison study was designed and an empowerment intervention strategy for the fathers of preterm infants was implemented. Forty-one fathers of preterm infants in the control group received routine care, and 41 fathers of preterm infants in the intervention group received an early fatherhood intervention program in the special care nursery. Both groups were followed 1 month after discharge. Fathers in the intervention group had significantly lower stress and higher fathering ability at their infant's discharge, provided better support to the mother in child-rearing, and had better father-infant attachment 1 month after discharge than fathers in the control group. Under cultural and hospitals' common practices, such an intervention can help the father to establish his fatherhood early and later enhance his supporting role to the mother and his relationship to the preterm infant. Nurses should include teaching childcare to fathers of preterm infants.

Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals.

BACKGROUND: Since 2010, intensive care can be offered in the Netherlands at 24+0 weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care. METHODS: Online nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice. RESULTS: One hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals. CONCLUSIONS: Dutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents' opinions are needed in order to develop a national framework. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02782650 , retrospectively registered May 2016.

Incidence of repeat testing and diagnoses of Chlamydia trachomatis and Neisseria gonorrhoea in swingers, homosexual and heterosexual men and women at two large Dutch STI clinics, 2006-2013.

OBJECTIVE: Swingers, that is, heterosexuals who as a couple have sex with others, including group sex and bisexual behaviour, are an older-aged risk group for STIs. Here, we report on their repeat testing (reattendance) and STI yield compared with other heterosexuals and men who have sex with men (MSM, homosexual men) at two Dutch STI clinics. METHODS: Swingers are routinely (since 2006, South Limburg, registration-completeness: 99%) or partially (since 2010, Amsterdam, registration-completeness: 20%) included in the clinic patient registries. Data (retrospective cohort) are analysed to assess incidence (per 100 person-years (PY)) of reattendance and STI (Chlamydia trachomatis (CT) and/or Neisseria gonorrhoeae (NG)) and associated factors calculating HRs. RESULTS: In South Limburg 7714 and in Amsterdam 2070 swinger consultations were identified. Since 2010, swingers' incidence of reattendance was 48-57/100 PY. Incidence was lower in MSM (30-39/100 PY, HR 0.56; 95% CI 0.51 to 0.61, South Limburg; HR 0.88; 95% CI 0.80 to 0.96, Amsterdam), heterosexual men (8-14/100 PY, HR 0.16; 95% CI 0.15 to 0.17, South Limburg; HR 0.33; 95% CI 0.30 to 0.36, Amsterdam) and women (13-20/100 PY, HR 0.56; 95% CI 0.51 to 0.61, South Limburg; HR 0.46; 95% CI 0.42 to 0.51, Amsterdam). Swingers' STI incidence at reattendance was 11-12/100 PY. Incidence was similar in heterosexual men (14-15/100 PY; HR 1.19; 95% CI 0.90 to 1.57, South Limburg; HR 1.20; 95% CI 0.91 to 1.59, Amsterdam) and women (12-14/100 PY; HR 1.14; 95% CI 0.88 to 1.49, South Limburg; HR 0.98; 95% CI 0.74 to 1.29, Amsterdam) and higher in MSM (18-22/100 PY; HR 1.59; 95% CI 1.19 to 2.12, South Limburg; HR 1.80; 95% CI 1.36 to 2.37, Amsterdam). Risk factors for STI incidence were partner-notified (contact-tracing), symptoms and previous STI. Swingers' positivity at any clinic attendance was 3-4% for NG (ie, higher than other heterosexuals) and 6-8% for CT (ie, lower than heterosexuals overall but higher than older heterosexuals). CONCLUSIONS: Systematic identification reveals that swingers are part of the normal STI clinic populations. They frequently repeat test yet are likely under-recognised in clinics which not routinely ask about swinging. Given swingers' notable STI rates, usage of services is warranted, although use may be restricted, that is, to those with an STI risk factor (as did Dutch clinics). As swingers have dense sexual networks, enhancing contact-tracing may have high impact.

["Pflegestützpunkte": Care Support Centers in Germany. Where are We Heading? Results of the Evaluation of all 48 Care Support Centers in Baden-Württemberg]. / Pflegestützpunkte in Deutschland. Quo vadis? Ergebnisse der Evaluation aller baden-württembergischen Pflegestützpunkte.

"Pflegestützpunkte", care support centers in Germany. Where are we heading? Results of the evaluation of all 48 care support centers in Baden-Württemberg. Objectives: The quantitative part of the study was based on an analysis of the structures and concepts as well as the type of services and demand for counseling services for elderly and vulnerable people of all 48 care support centers in Baden-Württemberg. The qualitative part included interviews of employees of the care support centers on the underlying concepts of their organization. Objectives: The counseling infrastructure for elderly and vulnerable people needs to be improved in terms of transparency, networking and coordination of its services. According to the German Care Reform, care support centers, known as "Pflegestützpunkte," should solve this problem by placing all relevant counseling services under one roof. The objective of this study was to distinguish between the various care models of care support centers currently in existence and to investigate how different models meet legal requirements. Results and Conclusions: An evaluation of the interviews and surveys shows that not all legal requirements are met. The 4 main models of care support centers vary widely and are partially incomprehensible. It also remains unclear what role the care support centers play in counseling by health and nursing insurances. These needs for further development should be kept in mind in the planned expansion of care support centers.

The Pretravel Consultation.

Key components of the pretravel consultation include intake questions regarding the traveler's anticipated itinerary and medical history; immunizations; malaria prophylaxis; and personal protection measures against arthropod bites, traveler's diarrhea, and injury. Most vaccinations that are appropriate for international travelers are included in the routine domestic immunization schedule; only a few travel-specific vaccines must also be discussed. The most common vaccine-preventable illnesses in international travelers are influenza and hepatitis A. Malaria prophylaxis should be offered to travelers to endemic regions. Personal protection measures, such as applying an effective insect repellent to exposed skin and permethrin to clothing and using a permethrin-impregnated bed net, should be advised for travelers to the tropics. Clinicians should offer an antibiotic prescription that travelers can take with them in case of traveler's diarrhea. Additional topics to address during the pretravel consultation include the risk of injury from motor vehicle crashes and travel-specific risks such as altitude sickness, safe sex practices, and emergency medical evacuation insurance.

[Mobile dementia counseling as low-threshold assistance for caregiving relatives]. / Mobile Demenzberatung als niedrigschwelliges Hilfeangebot für pflegende Angehörige.

BACKGROUND: Comprehensive and easily accessible information and counseling for people with dementia and their caregivers can improve home care in many ways; however, for various reasons the affected persons rarely seek help and advice. When advice is sought the caregiving situation at home is mostly already in a crisis. The Rhine-Erft district, a rural area in Germany, improved its network of dementia care services by establishing a mobile gerontopsychiatric counseling service with a special focus on dementia. A multiprofessional and interdisciplinary team consisting of professional and voluntary personnel in a specially equipped bus offers free counseling at several public places in the district at least once a month. OBJECTIVES: The project was accompanied and scientifically evaluated by the authors of this article from 2012 to 2015. The German Ministry of Health funded the evaluation. The main objective of the scientific evaluation was to examine how to implement the mobile counseling in order to improve the situation for people with dementia and their informal caregivers. MATERIAL AND METHODS: A mixture of quantitative (e.g. standardized questionnaires) and qualitative (e.g. semi-structured interviews) methods was employed. RESULTS/CONCLUSION: The data show that the mobile counseling service fulfills an important role in the navigation into the healthcare system and contributes to the easing of caregiver burden. In particular, the low threshold of the service proved to be very effective. The mobile counseling service can reach those caregivers who would have sought professional advice too late or not at all.

Impact of a Brief Intervention for Substance Use on Acquisition of Sexually Transmitted Diseases Including HIV: Findings From an Urban Sexually Transmitted Disease Clinic Population.

BACKGROUND: Unhealthy substance use is associated with increased rates of sexually transmitted diseases (STDs), including HIV. The screening, brief intervention, and referral to treatment strategy is effective at reducing substance use over time. We investigated whether STD clinic patients who received a brief intervention (BI) had lower rates of STD/HIV acquisition over time than those who did not. METHODS: A retrospective sample of 7665 patients who screened positive for substance abuse or dependence between May 1, 2008, and December 31, 2010, was matched with STD and HIV surveillance registries for a 1-year follow-up period to determine incidence of STD and HIV infection. RESULTS: Overall, 44.6% (n = 3420) received BI; 7.0% of this population acquired a bacterial STD compared with 8.8% of persons who did not receive BI (P < 0.005). In multivariate analysis, BI had a protective effect against STD infection for men (odds ratio, 0.774; 95% confidence interval [CI], 0.63-0.96), after controlling for age, race/ethnicity, and sex of partner. There were 61 new HIV infections over the follow-up period; however, we found no significant association between BI and subsequent HIV diagnosis. CONCLUSIONS: Brief intervention is associated with a reduction in STD incidence among men who screen positive for substance abuse and should be considered as an STD prevention strategy. Further study is needed to identify mechanisms through which BI may impact STD outcomes.

Discussing Sexual Dysfunction with Chronic Kidney Disease Patients: Practice Patterns in the Office of the Nephrologist.

INTRODUCTION: Sexual dysfunction (SD) is a common problem in patients suffering from chronic kidney disease (CKD). Sexual health remains a difficult subject to detect and discuss. Although many studies have been performed on the incidence of SD, little is known about practice patterns when it concerns quality of life (QoL)-related questions such as SD in the nephrologists' practice. AIM: The aim of this study was to determine to which extent nephrologists, important renal care providers, discuss SD with their patients and their possible barriers toward discussing this subject. METHODS: A 50-item questionnaire was sent to all Dutch nephrologists (n = 312). MAIN OUTCOME MEASURES: The survey results. RESULTS: The response rate of the survey was 34.5%. Almost all responders (96.4%) stated to address SD in less than half of their new patients. The most important barrier not to discuss SD was patients not expressing their concern regarding SD spontaneously (70.8%). Other important barriers were: "the lack of a suitable moment to discuss" (61.9%) and "insufficient time" (46.9%). Eighty-five percent of the nephrologists stated that insufficient attention was paid to SD and treatment options during their training. Sixty-five percent of the respondents stated to be in need of extending their knowledge on the discussing of SD. CONCLUSIONS: Dutch nephrologists do not discuss problems with sexual function routinely. The lack of knowledge, suitable education, and insufficient time are factors causing undervaluation of SD in CKD patients. Implementation of competent sexual education and raising awareness among nephrologists on the importance of paying attention to SD could improve care and QoL for patients with CKD. More research should be performed among patients and other renal care providers to develop an adequate method to enhance our current system.

Racial Disparities in Seeking Care for Help Getting Pregnant.

BACKGROUND: Fertility counselling and treatment can help women achieve their desired family size; however, disparities exist in the utilisation of this care. METHODS: This study examines the persistence of a racial disparity in visiting a doctor for help getting pregnant by estimating the direct effect of this association using data from the Furthering Understanding of Cancer Health and Survivorship in Adult Women's Study, a population-based cohort study. This cohort included 1073 reproductive age women (22-45 years) with 28% reporting infertility. We fit log binomial models to quantify the magnitude of the racial difference in reported care seeking after adjustment for hypothesised mediators using inverse probability weighting. RESULTS: Compared with white women, black women were less likely to visit a doctor in the total population [adjusted risk ratio (RR) 0.57, 95% confidence interval (CI) 0.41, 0.80] and in the subgroup of women with infertility [RR 0.75, 95% CI 0.56, 0.99]. In addition, black women waited twice as long, on average, before seeking help compared with white women. CONCLUSIONS: There were notable racial differences in visiting a doctor for help getting pregnant in this study although reports of infertility were similar by race. These differences may be mitigated through improved communication about the range of counselling and treatment options available.

Transition experience of young adults with inflammatory bowel diseases (IBD): a mixed methods study.

BACKGROUND: Outcomes following transition can be poor; many young adults are ill prepared to take responsibility for their health care, older adolescents report incomplete understanding of medications, and parents remain largely responsible for their care. Good patient-provider relationships are associated with better adherence; however, the role of the relationship between post-transition patients and their providers has not been explored. The current study aimed to understand transition of young adults with inflammatory bowel diseases (IBD), the impact of the paediatric patient-provider relationship and what determines the adult patient-provider relationship. METHODS: This study examined the experience of young adults with Crohn's disease or ulcerative colitis (aged 18-30) after transition. Twenty-nine patients completed a 31-item online survey of their transition experience from paediatric to adult care. Responses were coded quantitatively and qualitatively, and qualitative responses were analysed by two independent raters. RESULTS: Positive themes regarding adult providers included independence, autonomy and trust, while negative themes included initial discomfort and confusing logistics. Five of six patients who reported 'terrifying' first visit experiences with their adult providers reported overall positive relationships. The earlier the diagnosis age, the less involved in medical decisions they were as an adult (r = 0.41, P = .03). Those who had a more positive experience with their paediatric providers were more likely to bring up confusion with their adult providers (r = .45, P = .04), and those who had a more positive experience with their adult providers were more likely to endorse collaborative medical decision-making (r = .57, P < .001). CONCLUSIONS: Patients diagnosed with IBD at a young age may need extra education and self-management strategies, as they were less likely to exhibit behaviours indicative of a successful transition to adult care. Additionally, transition programme development may benefit from the post-transition perspective across chronic illness populations.

[OptimaHl 60plus--Development, Implementation and Transfer of a Counselling Aid for Elderly People through Participation]. / OptimaHl 60plus--Entwicklung, Erprobung und Transfer eines Beratungsinstrumentes für ältere Menschen durch Partizipation.

One aim of the intervention study is the participatory development of a health-related counselling instrument using focus groups. The developed instrument is reduced to a limited number of health messages and easy to handle for elderly persons. A survey among General Practitioners and nursing services revealed that 73.4% can imagine using the instrument in their daily work. When developing such an intervention instrument, the target groups should participate to increase its empowerment and sustainability.

[Individualised parent counselling in paediatric practices for the reduction of second-hand smoke exposure of their children: a feasibility study]. / Individualisierte Beratung von Eltern in Kinderarztpraxen zur Reduktion der Passivrauchbelastung ihrer Kinder: eine Machbarkeitsstudie.

AIM: The aim of this study was to test the feasibility of a web-based programme provided by paediatric practices for counselling parents to reduce second-hand smoke exposure of their children. METHODS: Accompanying persons of children were systematically screened concerning tobacco smoking at their home in 2 Swiss paediatric practices. They were invited for programme participation if they or their partners smoked at home regularly. The web-based programme provided at least 1 computer-tailored counselling letter. Upto 3 additional counselling letters could be requested online by the participants over a period of 3 months. The letters were tailored according to the indoor smoking behaviour of the parents and considered individual barriers and resources for the establishment of a smoke-free home. Additionally, further information and advice could be requested on the programme website. Feasibility indicators were the participation rate, programme use, and programme evaluation by the participants. RESULTS: 3 055 (82.3%) of 3 712 accompanying persons of children in the paediatric practices were screened concerning tobacco smoking at their home. 96 (56.8%) of 169 eligible persons participated in the programme. 68 (70.8%) of the 96 programme participants could be reassessed at post assessment. 9 (15.0%) of 60 participants who provided a valid e-mail address requested more than one counselling letter. The counselling letters and the web-based programme were evaluated positively by the programme participants. CONCLUSION: Systematic screening combined with the provision of individually tailored counselling letters for parents to reduce second-hand smoke exposure of their children was feasible in paediatric practices. Possible strategies to in-crease the use and reach of the programme are -discussed.

[Structural and process quality in outpatient psychosocial cancer counselling centres. evaluating a major funding programme of the "Deutsche Krebshilfe e.V."]. / Struktur- und Prozessqualität in ambulanten psychosozialen Krebsberatungsstellen des Förderschwerpunktes "Psychosoziale Krebsberatung" der Deutschen Krebshilfe.

BACKGROUND: In 2007, the German Cancer Aid ("Deutsche Krebshilfe e.V.") initiated and funded a programme in 28 selected cancer counselling centres in Germany attempting to both promote and strengthen quality assured psychosocial cancer counselling as well as to ensure long-term financing. The accompanying evaluation programme aims to collect structural data of the institutions and to evaluate processes of quality assurance within the sample of cancer counselling centres. METHODS: On the basis of structured research within scientific databases and internet, as well as with the support of experts, characteristics of structural quality of cancer counselling centres were identified. Structural data were collected using a self-developed questionnaire and a semi-structured interview during the on-site visitations of the institutions. RESULTS: The results show homogeneity in some fields of structural quality such as individual psycho-oncological and social counselling, human resources, room facilities, quality assurance, diagnostics, documentation and public relations. Structural quality of the investigated centres appears more heterogeneous with regard to aspects such as availability and accessibility, barrier-free access, group support offers (counselling, sports, arts, etc.) as well as cooperation, financing and written mission statements. CONCLUSION: The investigated cancer counselling centres ensure mainly good minimum standards according to structural quality of cancer counselling. There is potential for further optimisation including cooperation, quality assurance, room facilities and being differentiated in terms of conceptual content and working concepts. Further achievements on quality assured cancer counselling can use the presented data as a basis for describing minimum standards and obligatory quality criteria.

The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States.

INTRODUCTION: Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV infected. METHODS: We determined the cost to sexually transmitted disease (STD) clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared with current testing practices. RESULTS: Criteria for offering rapid HIV testing and methods for delivering nonrapid test results varied among clinics before the trial. Rapid HIV testing cost an average of US $22/patient without brief risk reduction counseling and US $46/patient with counseling in these 7 clinics. Median start-up costs per clinic were US $1100 and US $16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of US $19,500 to a cost of US $40,700 without counseling and a cost of US $98,000 to US $153,900 with counseling. CONCLUSIONS: Universal rapid HIV testing in STD clinics with same-day results can be implemented at relatively low cost to STD clinics, if brief risk reduction counseling is not offered.

Pilot evaluation of the Making Employment Needs [MEN] count intervention: addressing behavioral and structural HIV risks in heterosexual black men.

Few community-based HIV interventions exist for Black men at heterosexual risk for HIV. None focus on structural HIV risks such as unemployment and unstable housing. This study involved a pilot evaluation of the MEN (Making Employment Needs) Count HIV intervention, a three session peer counselor-delivered program of HIV risk reduction and gender-equity counseling, and employment and housing case management. A single-arm intervention trial of MEN Count was conducted with Black men recruited from a community men's clinic and social services program. Eligible men were those who reported two or more sex partners in the past six months and current unemployment and/or recent homelessness. Most participants (68%) had a history of incarceration. Participants (N = 50) were surveyed on outcomes at baseline (Time 1), posttest (Time 2; 60-90 days after baseline), and two-month follow-up (Time 3). The majority of participants were retained in the program (86%) and the final follow-up survey (76%). McNemar tests revealed significant reductions in the past 30-day unprotected sex from Time 1 (74%) to Time 2 (47%) and to Time 3 (47%), and in homelessness from Time 1 (58%) to Time 3 (32%). Significant increases in employment from Time 1 (8%) to Time 2 (29%) and Time 3 (32%) were also seen. Participants completed a brief participant satisfaction survey at posttest. Most (n=28, 65%) rated the program as excellent, and an additional 10 (23%) rated it as good. Although there was no significant reduction in multiple sex partners, a trend was observed from Time 1 (56%) to Time 2 (44%) and Time 3 (42%). Findings suggest that the MEN Count model is a feasible and promising HIV prevention program for Black men at heterosexual risk for HIV. Larger scale implementation and more rigorous evaluation of MEN Count are needed to confirm the study findings.

Effect of home-based counselling on newborn care practices in southern Tanzania one year after implementation: a cluster-randomised controlled trial.

BACKGROUND: In Sub-Saharan Africa over one million newborns die annually. We developed a sustainable and scalable home-based counselling intervention for delivery by community volunteers in rural southern Tanzania to improve newborn care practices and survival. Here we report the effect on newborn care practices one year after full implementation. METHODS: All 132 wards in the 6-district study area were randomised to intervention or comparison groups. Starting in 2010, in intervention areas trained volunteers made home visits during pregnancy and after childbirth to promote recommended newborn care practices including hygiene, breastfeeding and identification and extra care for low birth weight babies. In 2011, in a representative sample of 5,240 households, we asked women who had given birth in the previous year both about counselling visits and their childbirth and newborn care practices. RESULTS: Four of 14 newborn care practices were more commonly reported in intervention than comparison areas: delaying the baby's first bath by at least six hours (81% versus 68%, OR 2.0 (95% CI 1.2-3.4)), exclusive breastfeeding in the three days after birth (83% versus 71%, OR 1.9 (95% CI 1.3-2.9)), putting nothing on the cord (87% versus 70%, OR 2.8 (95% CI 1.7-4.6)), and, for home births, tying the cord with a clean thread (69% versus 39%, OR 3.4 (95% CI 1.5-7.5)). For other behaviours there was little evidence of differences in reported practices between intervention and comparison areas including childbirth in a health facility or with a skilled attendant, thermal care practices, breastfeeding within an hour of birth and, for home births, the birth attendant having clean hands, cutting the cord with a clean blade and birth preparedness activities. CONCLUSIONS: A home-based counselling strategy using volunteers and designed for scale-up can improve newborn care behaviours in rural communities of southern Tanzania. Further research is needed to evaluate if, and at what cost, these gains will lead to improved newborn survival. TRIAL REGISTRATION: Trial Registration Number NCT01022788 (http://www.clinicaltrials.gov, 2009).

Health coaching in primary care: a feasibility model for diabetes care.

BACKGROUND: Health coaching is a new intervention offering a one-on-one focused self-management support program. This study implemented a health coaching pilot in primary care clinics in Eastern Ontario, Canada to evaluate the feasibility and acceptability of integrating health coaching into primary care for patients who were either at risk for or diagnosed with diabetes. METHODS: We implemented health coaching in three primary care practices. Patients with diabetes were offered six months of support from their health coach, including an initial face-to-face meeting and follow-up by email, telephone, or face-to-face according to patient preference. Feasibility was assessed through provider focus groups and qualitative data analysis methods. RESULTS: All three sites were able to implement the program. A number of themes emerged from the focus groups, including the importance of physician buy-in, wide variation in understanding and implementing of the health coach role, the significant impact of different systems of team communication, and the significant effect of organizational structure and patient readiness on Health coaches' capacity to perform their role. CONCLUSIONS: It is feasible to implement health coaching as an integrated program within small primary care clinics in Canada without adding additional resources into the daily practice. Practices should review their organizational and communication processes to ensure optimal support for health coaches if considering implementing this intervention.

Counseling cancer patients on complementary and alternative medicine. Background, theory, and implementation of nationwide counseling facilities.

BACKGROUND AND PURPOSE: Complementary and alternative medicine (CAM) is of high relevance in oncology. Only a minority of professionals feel competent in CAM. Our aim was to provide a strategy for establishing evidence-based counseling on CAM in oncology in the German health system. METHODS: We performed a systematic search of the literature on patient counseling concerning CAM. Of 811 articles identified in this search 51 met our inclusion criteria. Data from these articles were analyzed and adapted to the needs of German patients by a group of experts of the DEGRO ("Deutschen Gesellschaft für Radioonkologie") and the German Cancer Society. In the next step a strategy about how to integrate evidence-based counseling on CAM at cancer centers and oncological institutions was developed. RESULTS: First, evidence-based recommendations on CAM counseling were derived. The core of our strategy combines two levels of information provision: level 1 will be oncologists, radiotherapists and other specialists and level 2 oncological CAM experts. The latter group will serve as trainers and backup for complicated or advanced questions and for individual counseling of patients with complex needs. Professionals in level 1 will be offered special training. CONCLUSION: Evidence-based counseling on CAM is not only possible but also mandatory in order to meet patient information needs. Our proposal would allow for integrated counseling available at all oncological institutions and guarantee a high quality. Furthermore, provision of information on two different levels allows the effective use of resources (manpower and financing).