Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial.

BACKGROUND: This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45-75 years compared to usual care; and b) an implementation strategy. METHODS: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. RESULTS: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. CONCLUSIONS: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03136211 . Registered 2 May 2017, "retrospectively registered".

[Early detection of the problematic Internet use in adolescents, in pediatrics of primary care.] / Detección precoz del uso problemático de Internet en adolescentes, en pediatría de atención primaria.

OBJECTIVE: Use of the Internet has grown exponentially and adolescents are considered one of the most vulnerable groups in this new environment. Hence the problematic use of the Internet (PIU) at this stage has become a concern for a growing number of researchers. Taking into account the interest that this issue has generated at many levels, the aim of this paper is to find the prevalence of PIU among adolescents in the health area of Vigo (Spain). METHODS: Cross-sectional descriptive study. The PIU validated scale was applied to children between 10 and 16 years old, captured by systematic sampling with replacement in the primary care consultations of four health centers. A descriptive and bivariate analysis was performed. RESULTS: The questionnaire was applaid to 165 children, 51.2% men. Problematic Internet use was observed in 38.8% (95% CI: 31.7-46.4), higher in women (46.3%) than in men (31.8%), with no significant differences (p 0.07). By age groups, the positive rate on the scale reached 36.8% in the 13-14 year range and 48.6% in the 15-16 range. The item that reached the highest score was "When I am online, I feel that time flies and hours pass without me realizing it" (60.6%). CONCLUSIONS: The prevalence of UPI in children / adolescents is similar to that observed in Asian adolescents. This study is the first to apply a scale validated and adapted to the Spanish cultural context in the daily practice of Primary Care consultations. Its use would allow to identify the PIU in this context and intervene if necessary.

OBJETIVO: El uso de Internet ha crecido exponencialmente y los adolescentes son considerados uno de los grupos más vulnerables en este nuevo contexto. De ahí que el uso problemático de Internet (UPI) en esta etapa se haya convertido en una preocupación para un número creciente de investigadores. Teniendo en cuenta el interés que este tema ha generado en muchos niveles, el objetivo de este trabajo fue conocer la prevalencia del uso problemático de Internet entre los niños/adolescentes del área sanitaria de Vigo (España). METODOS: Se realizó un estudio descriptivo transversal. Se aplicó la escala validada EUPI-a a niños entre 10 y 16 años, captados por muestreo sistemático con reposición en las consultas de atención primaria de cuatro centros de salud. Se elaboró posteriormente un análisis descriptivo y bivariante. RESULTADOS: Se entregó el cuestionario a 165 niños, de los que el 51,2% eran varones. Se objetivó un uso problemático de Internet en el 38,8% (IC 95%: 31,7-46,4), mayor en mujeres (46,3%) que en varones (31,8%), aunque no se constataron diferencias estadísticamente significativas (p=0,07). Por grupos de edad, la tasa de positivos en la escala alcanzó un 36,8% en la franja de 13-14 años y un 48,6% en la de 15-16 años. El ítem que alcanzó mayor puntuación fue "Cuando me conecto siento que el tiempo vuela y pasan las horas sin darme cuenta" (60,6%). CONCLUSIONES: La prevalencia de UPI en niños/adolescentes es similar a la observada en adolescentes asiáticos. Este estudio es el primero en aplicar una escala validada y adaptada al contexto cultural español en la práctica diaria de una consulta de atención primaria. Su utilización en este entorno permitiría identificar el UPI e intervenir si fuera preciso.