Supporting people with type 2 diabetes in effective use of their medicine through mobile health technology integrated with clinical care (SuMMiT-D pilot): results of a feasibility randomised trial.

BACKGROUND: The purpose of this 6-month intervention pilot feasibility randomised trial was to test sending brief messages using mobile phones to promote self-management through taking medication as prescribed to people with type 2 diabetes. This was to inform the design and conduct of a future large-scale United Kingdom-based clinical trial and establish the feasibility of recruitment, the technology used, follow-up, and data collection. METHODS: A multicentre individually randomised, controlled parallel group trial in primary care, recruiting adults (≥ 35 years) with type 2 diabetes in England. Consenting participants were randomly allocated to receive short message system text messages up to four times a week, or usual care, for a period of 6 months; messages contained behavioural change techniques targeting medication use. The primary outcome was the rate of recruitment to randomisation of participants to the trial with a planned rate of 22 participants randomised per month. The study also aimed to establish the feasibility of follow-up at 6 months, with an aim of retaining more than 80% of participants. Data, including patient-reported measures, were collected at baseline and the end of the 6-month follow-up period, and a notes review was completed at 24 months. RESULTS: The trial took place between 26 November 2018 and 30 September 2019. In total 209 participants were randomly allocated to intervention (n = 103) or usual care (n = 106). The maximum rate of monthly recruitment to the trial was 60-80 participants per month. In total, 12,734 messages were sent to participants. Of these messages, 47 were identified as having failed to be sent by the service provider. Participants sent 2,864 messages to the automated messaging system. Baseline data from medical records were available for > 90% of participants with the exception of cholesterol (78.9%). At 6 months, a further HbA1c measurement was reported for 67% of participants. In total medical record data were available at 6 months for 207 (99.0%) of participants and completed self-report data were available for 177 (84.7%) of participants. CONCLUSION: The feasibility of a large-scale randomised evaluation of brief message intervention for people with type 2 diabetes appears to be high using this efficient design. Failure rate of sending messages is low, rapid recruitment was achieved among people with type 2 diabetes, clinical data is available on participants from routine medical records and self-report of economic measures was acceptable. TRIAL REGISTRATION: ISCTRN ISRCTN13404264. Registered on 10 October 2018.

Increasing Machine-Related Safety on Farms: Development of an Intervention Using the Behaviour Change Wheel Approach.

Farming is essential work, but it suffers from very high injury and fatality rates. Machinery, including tractors, are a leading cause of serious injuries and fatalities to farmers and farm workers in many countries. Herein, we document the systematic development of an evidence-based, theory-informed behaviour change intervention to increase machine-related safety on farms. Intervention development progressed through four phases. Phase 1 defined the problem in behavioural terms based a review of the literature, Phase 2 identified candidate intervention targets through a series of focus groups guided by the Capability-Opportunity-Motivation-Behaviour (COM-B) model and Phase 3 employed expert and stakeholder consultation guided by the Behaviour Change Wheel (BCW) to consider potential target behaviours and intervention components and finalise the intervention content. Phase 4 finalised the evaluation strategies with a team of agricultural advisors who supported the rollout and identified outcome measures for the first trial. The target intervention was the identification of blind spots of farm tractors, and three priority target behaviours (farm safety practices) were identified. Following Phase 3, the intervention comprised four components that are delivered in a group-based, face-to-face session with farmers. In Phase 4, the acceptability, feasibility, and fidelity of these components were identified as the outcome measures for the first trial of the intervention. The four-phase systematic method detailed here constitutes an initial template for developing theory-based, stakeholder-driven, behaviour-change-based interventions targeting farmers and reporting such developments.

Absorptive capacity in the adoption of innovations in health: a scoping review.

OBJECTIVE: The objective of this scoping review was to explore how absorptive capacity has been conceptualized and measured in studies of innovation adoption in health care organizations. INTRODUCTION: Current literature highlights the need to incorporate knowledge translation processes at the organizational and system level to enhance the adoption of new knowledge into practice. Absorptive capacity is a set of routines and processes characterized by knowledge acquisition, assimilation, transformation, and application. A key concept in organizational learning theory, absorptive capacity is thought to be critical to the adoption of new knowledge and innovations in organizations. To understand how absorptive capacity was conceptualized and measured in health care organizations, it was appropriate to conduct a scoping review to answer our research question. INCLUSION CRITERIA: This scoping review included published and unpublished primary studies (ie, experimental, quasi-experimental, observational, and qualitative study designs), as well as reviews that broadly focused on the adoption of innovations at the organizational level in health care, and framed innovation adoption as processes that rely on organizational learning and absorptive or learning capacity. METHODS: Searches included electronic databases (ie, MEDLINE, Embase, PsycINFO, CINAHL, and Scopus) and gray literature, as well as reference scanning of relevant studies. Study abstracts and full texts were screened for eligibility by two independent reviewers. Data extraction of relevant studies was also done independently by two reviewers. All discrepancies were addressed through discussion or adjudicated by a third reviewer. Synthesis of the extracted data focused on descriptive frequencies and counts of the results. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). RESULTS: The search strategies identified a total of 7433 citations. Sixteen papers were identified for inclusion, including a set of two companion papers, and data were extracted from 15 studies. We synthesized the objectives of the included studies and identified that researchers focused on at least one of the following aspects: i) exploring pre-existing capacity that affects improvement and innovation in health care settings; ii) describing factors influencing the spread and sustainability of organizations; iii) identifying measures and testing the knowledge application process; and iv) providing construct clarity. No new definitions were identified within this review; instead existing definitions were refined to suit the local context of the health care organization in which they were used. CONCLUSIONS: Given the rapidly changing and evolving nature of health care, it is important to understand both current best practices and an organization's ability to acquire, assimilate, transform, and apply these practices to their specific organization. While much research has gone into developing ways to implement knowledge translation, understanding an organization's internal structures and framework for seeking out and implementing new evidence as it relates to absorptive capacity is still a relatively novel concept.

Enhancing the translation of health behaviour change research into practice: a selective conceptual review of the synergy between implementation science and health psychology.

Health psychology is at the forefront of developing and disseminating evidence, theories, and methods that have improved the understanding of health behaviour change. However, current dissemination approaches may be insufficient for promoting broader application and impact of this evidence to benefit the health of patients and the public. Nevertheless, behaviour change theory/methods typically directed towards health behaviours are now used in implementation science to understand and support behaviour change in individuals at different health system levels whose own behaviour impacts delivering evidence-based health behaviour change interventions. Despite contributing to implementation science, health psychology is perhaps doing less to draw from it. A redoubled focus on implementation science in health psychology could provide novel prospects for enhancing the impact of health behaviour change evidence. We report a Health Psychology Review-specific review-of-reviews of trials of health behaviour change interventions published from inception to April 2020. We identified 34 reviews and assessed whether implementation readiness of behaviour change interventions was discussed. We then narratively review how implementation science has integrated theory/methods from health psychology and related discipline. Finally, we demonstrate how greater synergy between implementation science and health psychology could promote greater follow-through on advances made in the science of health behaviour change.

Symptoms of depression and anxiety in adults with type 1 diabetes: Associations with self-care behaviour, glycaemia and incident complications over four years - Results from diabetes MILES-Australia.

OBJECTIVE: To examine whether symptoms of depression or anxiety predict glycaemia and incident diabetes complications four years later, and whether diabetes self-care behaviours mediate these associations, in adults with type 1 diabetes (T1DM). METHODS: Data of 205 adults with T1DM from the 2011 and 2015 Diabetes MILES-Australia surveys were analysed. Variables of interest were: baseline depression and anxiety (PHQ-8 and GAD-7, respectively) symptoms; HbA1c and incident complications at four-year follow-up; and self-care behaviours at both time points. Longitudinal associations were analysed using structural equation modelling. RESULTS: Forty-two participants (20.6%) reported incident complications. Baseline depressive symptoms predicted higher HbA1c at follow-up indirectly via less optimal self-care at follow-up (ß = 0.19, P = 0.011). Baseline anxiety was not independently associated with HbA1c or self-care at follow-up (P ≥ 0.64). Neither depressive nor anxiety symptoms predicted incident complications, although depressive symptoms were associated with less optimal self-care at baseline (ß = -0.67, P < 0.001), and this predicted microvascular complications (ß = -0.38, P = 0.044); however, the indirect association via self-care was not significant (ß = 0.25, P = 0.067). LIMITATIONS: Participants were self-selected; all study variables were assessed using self-report measures; and adjusting for baseline HbA1c was not possible. CONCLUSIONS: Depressive symptoms predicted suboptimal self-care behaviour and glycaemic outcome four years later, while anxiety symptoms did not. The findings suggest that tailored diabetes care should take the potential impact of comorbid depression into consideration to help people improve their diabetes self-care and achieve best possible health outcomes.

Pharmacists' perceived role in supporting diabetes education and self-management in Ireland: a qualitative study.

Background: Support for people with diabetes is necessary for optimal self-management. Structured diabetes education programmes fulfil this need, but attendance rates are consistently low. The role of pharmacists has expanded but the profession remains underutilised in chronic disease management. The objective of this study is to explore pharmacists' perceived role in the support of diabetes education and self-management behaviours. Methods: A qualitative study using semi-structured interviews of community pharmacists in Ireland was conducted. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: Ten pharmacists were interviewed. The four themes identified illustrate the juxtaposition of pharmacists' potential in diabetes care with the realities of current pharmaceutical practice. One theme outlined the relationship between the person with diabetes and the pharmacist, 'Patient or customer: the nature of the pharmacist relationship'. Two themes described the pharmacists' role in supporting diabetes education and self-management, 'Beyond medication: pharmacists' current and potential role in diabetes management' and 'Need for diabetes education'. The final theme highlighted the barriers to a more engaged role in patient care, 'Barriers: "all the stuff that gets in the way"'. Conclusion: The relationship between pharmacists and people with diabetes could facilitate pharmacists in supporting diabetes self-management. However, variability across pharmacists' level of involvement and consistent resource barriers were noted. Pharmacists were poorly informed about structured diabetes education programmes. Further research is needed to explore this variability but there may be potential to enhance the pharmacist role in promoting attendance at structured diabetes education programmes.

Absorptive capacity in the adoption of innovations in health care: a scoping review protocol.

OBJECTIVE: To explore how absorptive capacity has been conceptualized and measured in studies of innovation adoption in health care organizations. INTRODUCTION: Current literature highlights the need to incorporate knowledge translation processes at the organizational and system level to enhance the adoption of new knowledge into practice. Absorptive capacity is a set of routines and processes characterized by knowledge acquisition, assimilation, transformation, and application. Absorptive capacity, a key concept in organizational learning theory, is thought to be critical to the adoption of new knowledge and innovations in organizations. INCLUSION CRITERIA: This scoping review will include primary studies (ie, experimental, quasi-experimental, observational, and qualitative study designs) and gray literature that broadly focus on the adoption of innovations at the organizational level in health care, and frame innovation adoption as processes that rely on organizational learning and absorptive or learning capacity. METHODS: Data sources will include comprehensive searches of electronic databases (eg, MEDLINE, Embase, PsycINFO, CINAHL, and Scopus), gray literature, and reference scanning of relevant studies. Study abstracts and full texts will be screened for eligibility by two reviewers, independently. Data extraction of relevant studies will also be done independently by two reviewers. All discrepancies will be addressed through further discussion or adjudicated by a third reviewer. Synthesis of the extracted data will focus on descriptive frequencies, counts, and thematic analysis and the results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR).

Translating a walking intervention for health professional delivery within primary care: A mixed-methods treatment fidelity assessment.

OBJECTIVES: Existing fidelity studies of physical activity interventions are limited in methodological quality and rigour, particularly those delivered by health care providers in clinical settings. The present study aimed to enhance and assess the fidelity of a walking intervention delivered by health care providers within general practice in line with the NIH Behavior Change Consortium treatment fidelity framework. DESIGN: Two practice nurses and six health care assistants delivered a theory-based walking intervention to 63 patients in their own practices. A cross-sectional mixed-methods study assessed fidelity related to treatment delivery and treatment receipt, from the perspectives of health care providers and patients. METHODS: All providers received training and demonstrated delivery competence prior to the trial. Delivery of intervention content was coded from audio-recordings using a standardized checklist. Qualitative interviews with 12 patients were conducted to assess patient perspectives of treatment receipt and analysed using framework analysis. RESULTS: Overall, 78% of intervention components were delivered as per the protocol (range 36-91%), with greater fidelity for components requiring active engagement from patients (e.g., completion of worksheets). The qualitative data highlighted differences in patients' comprehension of specific intervention components. Understanding of, and engagement with, motivational components aimed at improving self-efficacy was poorer than for volitional planning components. CONCLUSIONS: High levels of fidelity of delivery were demonstrated. However, patient-, provider-, and component-level factors impacted on treatment delivery and receipt. We recommend that methods for the enhancement and assessment of treatment fidelity are consistently implemented to enhance the rigour of physical activity intervention research. Statement of contribution What is already known on this subject? Physical activity interventions delivered within primary care by health professionals have so far demonstrated limited impact on behaviour change initiation and maintenance. Treatment fidelity enhancement and assessment strategies can support the successful translation of behaviour change interventions into real-life settings. Few studies have examined treatment fidelity within the context of physical activity interventions, particularly within clinical settings, and existing fidelity studies are limited by methodological quality and rigour. What does this study add? High levels of fidelity were found for a physical activity intervention delivered in primary care. Patient-, provider-, and component-level factors may impact on treatment delivery and receipt. The implementation of best practice fidelity recommendations can support near-optimal fidelity.

Adolescent Girls' Perceptions of Physical Activity: A Systematic Review of Qualitative Studies.

OBJECTIVE: To synthesize evidence from qualitative studies relating to adolescent girls' perceptions of physical activity participation. The protocol for this review is registered with PROSPERO (ID no. CRD42017054944). DATA SOURCE: PubMed, Sports Discus, Academic Search Complete, and Education Resources Information Centre. INCLUSION AND EXCLUSION CRITERIA: Studies reporting qualitative data that explored the views/opinions/perceptions of adolescent girls (>12 and <18 years old) published between 2001 and 2016 were included. Studies not in English, those focusing on school physical education or specific sports, and those including special populations were excluded. EXTRACTION: Study characteristics and results were extracted to a form developed by the authors and managed using NVivo 10 (QSR International's NVivo 10 software). Data were extracted by 1 reviewer, and a sample (25%) was checked by a second reviewer. SYNTHESIS: Data were synthesized using a thematic network and managed using NVivo 10. The validity of the included studies was assessed using the "Critical Appraisal Skills Programme (2018)" checklist. The ENTREQ and PRISMA statement was followed when reporting this qualitative synthesis. RESULTS: Of the 1818 studies identified in the search strategy, 24 met the inclusion criteria and were included in the analysis. Global themes were identified using a thematic network. These themes were "Gender Bias in Sport," "Motivation and Perceived Competence," "Competing Priorities during Adolescence," and "Meeting Societal Expectations." CONCLUSIONS: The results of this review provide insights into adolescent girls' views on physical activity. Future research is needed to investigate the potential impact of alternative activity programs on adolescent girls with appropriate follow-up. Researchers and individuals working with young girls must consider the role of perceived motor competence in participation and how this can impact their perceptions.

Barriers and facilitators to implementation of menu labelling interventions to support healthy food choices: a mixed methods systematic review protocol.

BACKGROUND: Menu labelling is continuing to gather public and legislative support as one of the potential environmental strategies for addressing the obesity pandemic. However, issues relating to implementation have been reported in countries where menu labelling has been introduced on a voluntary or mandatory basis. The aim of this mixed methods systematic review is to synthesise the empirical evidence on the barriers and facilitators to implementation of menu labelling interventions to support healthy food choices. METHODS: This review will use the 'best fit' framework synthesis approach to synthesise qualitative, quantitative and mixed methods evidence. Peer-reviewed publications will be accessed through PubMed, EMBASE, CINAHL, PsycINFO, Web of Science and Scopus. Grey literature will be accessed through Google Scholar, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies will be undertaken. There will be no restriction on menu labelling scheme or format, publication year or language; however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. At least two independent reviewers will perform study selection, data extraction and quality appraisal; if consensus is required, another independent reviewer will be consulted. A combination of deductive coding, using the Consolidated Framework for Implementation Research as the a priori framework, and inductive analysis, using secondary thematic analysis, will be used. The overall process will assist in the construction of a new evidence-based conceptual model regarding the implementation of menu labelling interventions. The new model will be assessed for bias and a sensitivity analysis performed. DISCUSSION: Given the growing consensus that a systemic, sustained portfolio of obesity prevention strategies, delivered at scale, is needed to address the obesity epidemic, greater understanding of the practical issues relating to implementation of such strategies is required. Findings from this review will be used to develop a set of best-practice guidelines to enhance the adoption, implementation and sustainability of menu labelling interventions across countries worldwide. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017083306.

Interventions to Improve Hand Hygiene Compliance in the ICU: A Systematic Review.

OBJECTIVES: To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described. DATA SOURCES: Systematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened. STUDY SELECTION: English language, peer-reviewed studies that evaluated an intervention to improve hand hygiene in an adult ICU setting, and reported hand hygiene compliance rates collected via observation, were included. DATA EXTRACTION: Data were extracted on the setting, participant characteristics, experimental design, hand hygiene measurement, intervention characteristics, and outcomes. Interventional components were categorized using the Behavior Change Wheel. Methodological quality was examined using the Downs and Black Checklist. DATA SYNTHESIS: Thirty-eight studies were included. The methodological quality of studies was poor, with studies scoring a mean of 8.6 of 24 (SD= 2.7). Over 90% of studies implemented a bundled intervention. The most frequently employed interventional strategies were education (78.9%), enablement (71.1%), training (68.4%), environmental restructuring (65.8%), and persuasion (65.8%). Intervention outcomes were variable, with a mean relative percentage change of 94.7% (SD= 195.7; range, 4.3-1155.4%) from pre to post intervention. CONCLUSIONS: This review demonstrates that best practice for improving hand hygiene in ICUs remains unestablished. Future research employing rigorous experimental designs, careful statistical analysis, and clearly described interventions is important.

Influences on Decision-Making Regarding Antipsychotic Prescribing in Nursing Home Residents With Dementia: A Systematic Review and Synthesis of Qualitative Evidence.

BACKGROUND: Antipsychotic prescribing is prevalent in nursing homes for the management of behavioral and psychological symptoms of dementia (BPSD), despite the known risks and limited effectiveness. Many studies have attempted to understand this continuing phenomenon, using qualitative research methods, and have generated varied and sometimes conflicting findings. To date, the totality of this qualitative evidence has not been systematically collated and synthesized. AIMS: To synthesize the findings from individual qualitative studies on decision-making and prescribing behaviors for antipsychotics in nursing home residents with dementia, with a view to informing intervention development and quality improvement in this field. METHODS: A systematic review and synthesis of qualitative evidence was conducted (PROSPERO protocol registration CRD42015029141). Six electronic databases were searched systematically from inception through July 2016 and supplemented by citation, reference, and gray literature searching. Studies were included if they used qualitative methods for both data collection and analysis, and explored antipsychotic prescribing in nursing homes for the purpose of managing BPSD. The Critical Appraisal Skills Program assessment tool was used for quality appraisal. A meta-ethnography was conducted to synthesize included studies. The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence in individual review findings. All stages were conducted by at least 2 independent reviewers. RESULTS: Of 1534 unique records identified, 18 met the inclusion criteria. Five key concepts emerged as influencing decision-making: organizational capacity; individual professional capability; communication and collaboration; attitudes; regulations and guidelines. A "line of argument" was synthesized and a conceptual model constructed, comparing this decision-making process to a dysfunctional negative feedback loop. Our synthesis indicates that when all stakeholders come together to communicate and collaborate as equal and empowered partners, this can result in a successful reduction in inappropriate antipsychotic prescribing. CONCLUSIONS: Antipsychotic prescribing in nursing home residents with dementia occurs in a complex environment involving the interplay of various stakeholders, the nursing home organization, and external influences. To improve the quality of antipsychotic prescribing in this cohort, a more holistic approach to BPSD management is required. Although we have found the issue of antipsychotic prescribing has been extensively explored using qualitative methods, there remains a need for research focusing on how best to change the prescribing behaviors identified.

Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care.

OBJECTIVE: Studies of patient safety in health care have traditionally focused on hospital medicine. However, recent years have seen more research located in primary care settings which have different features compared to secondary care. This study set out to synthesize published qualitative research concerning patient safety in primary care in order to build a conceptual model. METHOD: Meta-ethnography, an interpretive synthesis method whereby third order interpretations are produced that best describe the groups of findings contained in the reports of primary studies. RESULTS: Forty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients' perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface. The studies were focused predominantly on issues seen to either improve or compromise patient safety. These issues related to the characteristics or behaviour of patients, staff or clinical systems and interactions between staff, patients and staff, or people and systems. Electronic health records, protocols and guidelines could be seen to both degrade and improve patient safety in different circumstances. A conceptual reading of the studies pointed to patient safety as a subjective feeling or judgement grounded in moral views and with potentially hidden psychological consequences affecting care processes and relationships. The main threats to safety appeared to derive from 'grand' systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system. CONCLUSION: Overall, the findings underline the human elements in patient safety primary health care. The key to patient safety lies in effective face-to-face communication between patients and health care staff or between the different staff involved in the care of an individual patient. Electronic systems can compromise safety when they override the opportunities for face-to-face communication. The circumstances under which guidelines or protocols are seen to either compromise or improve patient safety needs further investigation.

Experience of breast cancer: burden, benefit, or both?

BACKGROUND: Transactional models of stress emphasize the role of appraisal of stress in adjustment to illness. The current qualitative study uses this framework to explore the subjective response to these stressors in women with breast cancer. Reappraisals or opportunities for growth from the experience are also examined. OBJECTIVE: The objective of this study was to explore the experience of stress in Irish women with breast cancer using the Stress-Coping Model. METHODS: The diaries of 30 women newly diagnosed with breast cancer were analyzed using thematic template analysis. A template of 5 themes based on elements of the Stress-Coping Model was defined prior to analysis. RESULTS: Six top-level and 14 second-level themes were defined in the final template. Following initial diagnosis of breast cancer, women viewed it as either a threat or a challenge. After diagnosis, however, other stressful events included treatment effects, loss of womanhood, and illness disclosure. Women described coping strategies and social interactions that both increased and decreased their stress. In tandem with negative consequences of breast cancer, women also reported benefit from the experience. CONCLUSIONS: Women differed in their identification of stressful events and subsequent coping strategies. Their reports also illustrated the complex relationships between appraisal of the event, personal resources, and social interactions, which can result in both positive and negative outcomes. IMPLICATIONS FOR PRACTICE: Appraisal of breast cancer can vary, and awareness of this by health professionals can facilitate adjustment. Women need advice in regard to disclosure of diagnosis to others and need more information on managing treatment effects.