Exploring the Use of the Behavior Change Technique Taxonomy and the Persuasive System Design Model in Defining Parent-Focused eHealth Interventions: Scoping Review.

BACKGROUND: Taxonomies and models are useful tools for defining eHealth content and intervention features, enabling comparison and analysis of research across studies and disciplines. The Behavior Change Technique Taxonomy version 1 (BCTTv1) was developed to decrease ambiguity in defining specific characteristics inherent in health interventions, but it was developed outside the context of digital technology. In contrast, the Persuasive System Design Model (PSDM) was developed to define and evaluate the persuasive content in software solutions but did not have a specific focus on health. Both the BCTTv1 and PSDM have been used to define eHealth interventions in the literature, with some researchers combining or reducing the taxonomies to simplify their application. It is unclear how well the taxonomies accurately define eHealth and whether they should be used alone or in combination. OBJECTIVE: This scoping review explored how the BCTTv1 and PSDM capture the content and intervention features of parent-focused eHealth as part of a program of studies investigating the use of technology to support parents with therapy home programs for children with special health care needs. It explored the active ingredients and persuasive technology features commonly found in parent-focused eHealth interventions for children with special health care needs and how the descriptions overlap and interact with respect to the BCTTv1 and PSDM taxonomies. METHODS: A scoping review was used to clarify concepts in the literature related to these taxonomies. Keywords related to parent-focused eHealth were defined and used to systematically search several electronic databases for parent-focused eHealth publications. Publications referencing the same intervention were combined to provide comprehensive intervention details. The data set was coded using codebooks developed from the taxonomies in NVivo (version 12; QSR International) and qualitatively analyzed using matrix queries. RESULTS: The systematic search found 23 parent-focused eHealth interventions described in 42 articles from various countries; delivered to parents with children aged 1 to 18 years; and covering medical, behavioral, and developmental issues. The predominant active ingredients and intervention features in parent-focused eHealth were concerned with teaching parents behavioral skills, encouraging them to practice and monitor the new skills, and tracking the outcomes of performing the new skills. No category had a complete set of active ingredients or intervention features coded. The two taxonomies conceptually captured different constructs even when their labels appeared to overlap in meaning. In addition, coding by category missed important active ingredients and intervention features. CONCLUSIONS: The taxonomies were found to code different constructs related to behavior change and persuasive technology, discouraging the merging or reduction of the taxonomies. This scoping review highlighted the benefit of using both taxonomies in their entirety to capture active ingredients and intervention features important for comparing and analyzing eHealth across different studies and disciplines. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-doi.org/10.15619/nzjp/47.1.05.

Telehealth delivery of paediatric rehabilitation for children with neurodisability: A mixed methods realist evaluation of contexts, mechanisms and outcomes.

BACKGROUND: Teledelivery of rehabilitation services has been proposed as a cost-effective option for supporting children with neurodisability and their families. However, little is understood of the conditions that support uptake of telehealth in paediatric rehabilitation, what is delivered during telehealth or perceptions of its outcomes. The aim of this study was to identify the context, process and outcomes of telehealth for children with neurodisability and their families. A secondary objective was to identify if variations in these aspects of telehealth occurred for Maori, the indigenous people of New Zealand. METHOD: A mixed-methods, three phase, realist evaluation identified context-mechanism-outcome configurations (CMOcs) of telehealth. In Phase 1, the Determinants of Implementation Behaviour Questionnaire indicated factors affecting practitioner uptake of telehealth (Context). In Phase 2, a casenote audit identified 'practitioner input' during telehealth (Mechanism). Phase 3 interviews with practitioners and parents explored 'parent response' to telehealth and practitioner and parent perceptions of its value (Mechanism and Outcomes). Subgroup analyses for Maori were planned. RESULTS: From Phase 1, practitioners (29/37, 78%) intended to use telehealth; however, few did so regularly (7/37, 22%). Positive experiences of telehealth were described by all practitioners (n = 5) and families (n = 7) in Phase 3. CMOcs explained that practitioners' offering of telehealth occurred when practitioners were confident, valued access to therapy over the familiarity of in-person delivery, and when practitioners used coaching-style communication. Parents were receptive to telehealth when they trusted practitioners, felt listened to and were offered telehealth as a choice. When telehealth occurred, access to therapy was timely and more consistent than in-person delivery. Child outcomes appeared to be positive. Confidence in offering telehealth to Maori was low. CONCLUSIONS: Initiatives to improve uptake of telehealth in paediatric rehabilitation should focus on creating conditions for practitioner implementation. Training in telehealth should include engagement with Maori. Adequate workspace and workplace culture change are required if telehealth is to be offered beyond the current 'early adopters'.

Community perceptions on the factors in the social food environment that influence dietary behaviour in cities of Kenya and Ghana: a Photovoice study.

OBJECTIVE: To explore communities' perspectives on the factors in the social food environment that influence dietary behaviours in African cities. DESIGN: A qualitative study using participatory photography (Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary behaviours. Follow-up in-depth interviews allowed participants to tell the 'stories' of their photographs. Thematic analysis was conducted, using data-driven and theory-driven (based on the socio-ecological model) approaches. SETTING: Three low-income areas of Nairobi (n 48) in Kenya and Accra (n 62) and Ho (n 32) in Ghana. PARTICIPANTS: Adolescents and adults, male and female aged ≥13 years. RESULTS: The 'people' who were most commonly reported as influencers of dietary behaviours within the social food environment included family members, friends, health workers and food vendors. They mainly influenced food purchase, preparation and consumption, through (1) considerations for family members' food preferences, (2) considerations for family members' health and nutrition needs, (3) social support by family and friends, (4) provision of nutritional advice and modelling food behaviour by parents and health professionals, (5) food vendors' services and social qualities. CONCLUSIONS: The family presents an opportunity for promoting healthy dietary behaviours among family members. Peer groups could be harnessed to promote healthy dietary behaviours among adolescents and youth. Empowering food vendors to provide healthier and safer food options could enhance healthier food sourcing, purchasing and consumption in African low-income urban communities.

Stakeholder perspectives of the sociotechnical requirements of a telehealth wheelchair assessment service in Aotearoa/New Zealand: A qualitative analysis.

INTRODUCTION: Telehealth is widely proposed to improve access and equity in provision of rehabilitation, including wheelchair assessment, yet the design requirements of telehealth wheelchair assessment that will be accepted and utilised at scale are unclear. Service design that addresses the existing inequities in outcomes for indigenous populations, such as Maori will be critical. The aim of this study was to examine the design requirements of a telehealth wheelchair assessment service from the perspectives of key stakeholders such as wheelchair users and their families, including indigenous (Maori) and health professionals including occupational therapist, and physiotherapist assessors and technicians. METHODS: Within a wider mixed methods design, inductive thematic analysis was applied to focus group and interview data from 23 assessors (19 occupational therapists and four physiotherapist assessors, one of whom was Maori) and 19 wheelchair users (three of whom were Maori). RESULTS: Eight themes were discerned with the final three themes emphasising the experiences of particular concern to Maori: (1) At the mercy of the system; (2) The hurdle of technology; (3) More efficient for all; (4) Lost information and connection; (5) Rights and the right way forward; (6) Cultural safety; (7) Whanaungatanga (relationship building); and (8) Summative disadvantage for Tangata whaikaha (Maori with disabilities). Themes reflected a recognition of risks and uncertainty associated with tele-delivered assessment. Conversely, advantages in access, equity, and professional competency were reimagined. Perspectives of Maori included both risks and advantages as perceived by Maori. CONCLUSION: Substantial dissatisfaction with current wheelchair assessment services among wheelchair users provides context to the impetus for a successful design of a telehealth assessment service. Training in conducting telehealth wheelchair assessment is essential incorporating culturally safe communication practices and support of wheelchair user autonomy while identifying solutions that achieve wheelchair user goals.

Factors influencing dietary behaviours in urban food environments in Africa: a systematic mapping review.

OBJECTIVE: To identify factors influencing dietary behaviours in urban food environments in Africa and identify areas for future research. DESIGN: We systematically reviewed published/grey literature (protocol CRD4201706893). Findings were compiled into a map using a socio-ecological model on four environmental levels: individual, social, physical and macro. SETTING: Urban food environments in Africa. PARTICIPANTS: Studies involving adolescents and adults (11-70 years, male/female). RESULTS: Thirty-nine studies were included (six adolescent, fifteen adolescent/adult combined and eighteen adult). Quantitative methods were most common (twenty-eight quantitative, nine qualitative and two mixed methods). Studies were from fifteen African countries. Seventy-seven factors influencing dietary behaviours were identified, with two-thirds at the individual level (45/77). Factors in the social (11/77), physical (12/77) and macro (9/77) environments were investigated less. Individual-level factors that specifically emerged for adolescents included self-esteem, body satisfaction, dieting, spoken language, school attendance, gender, body composition, pubertal development, BMI and fat mass. Studies involving adolescents investigated social environment-level factors more, for example, sharing food with friends. The physical food environment was more commonly explored in adults, for example, convenience/availability of food. Macro-level factors associated with dietary behaviours were food/drink advertising, religion and food prices. Factors associated with dietary behaviour were broadly similar for men and women. CONCLUSIONS: The dominance of studies exploring individual-level factors suggests a need for research to explore how social, physical and macro-level environments drive dietary behaviours of adolescents and adults in urban Africa. More studies are needed for adolescents and men, and studies widening the geographical scope to encompass all African countries.

Acceptability and feasibility of a café-based sustainable food intervention in the UK.

Dietary change is needed to improve health and reduce the environmental burden of food production and consumption. Using an Intervention Mapping approach, this study aimed to explore the views caterers and customers held towards point-of-choice interventions that promote healthy and environmentally friendly (EF) food and beverage choices at the University of Sheffield. Intervention options proposed during focus groups were devised using the Nuffield Bioethics ladder of intervention. Ten focus groups were held involving caterers (n = 16) and customers (n = 45). Thematic analysis was conducted on the transcripts of caterer and customer focus groups seperately, and then comparisons were made to identify concerns about the acceptability and feasibility of intervention options. Attitudes towards intervention options varied considerably amongst stakeholders, with the greatest disparity of opinion in the acceptability of interventions that restrict or limit personal choice, particularly with regards to meat consumption. Information provision was favoured as an acceptable intervention by both customers and caterers. However, labelling products in terms of their environmental impact was considered practically unfeasible. Social norms around eating also emerged as influencing the acceptability and feasibility of interventions with concerns raised about: shaming customers who chose meat, the exclusivity of vegan choices and the limited availability and appeal of meatless café options. Financial considerations were the main priority of caterers when discussing point-of-choice interventions. An acceptable and feasible café-based intervention ought to increase awareness and understanding of healthy and EF food choices, protect customer choice and avoid additional costs.

Participation-focused practices in paediatric rehabilitation for children with neurodisability in New Zealand: An observational study using MAPi audit tool.

BACKGROUND: Participation outcomes and family-centred services are now widely agreed standards of care in paediatric rehabilitation. Evidence suggests that adoption of these practices into usual care has been slow internationally, and no studies of participation-focused or family-centred practices in New Zealand have been undertaken to date. The aims of this study were to identify the extent that goal setting in paediatric rehabilitation services is participation focused and family centred and to profile clinicians' beliefs about these foci. METHODS: Observational study including a retrospective case note audit and questionnaire. Case notes ('charts') were audited for participation-focused goal-related practice. Subgroup analysis of audit data by service, profession and child ethnicity were completed using weighted mean differences. Clinicians whose case notes were audited completed a 42-item questionnaire on factors related to practice behaviour including text responses with each item. Numerical and text data were analysed descriptively. RESULTS: Five services were recruited (N = 46 clinicians) with case notes for 220 children audited. Auditors extracted 368 potentially participation-related goals (Mdn = 2 goals per child) with no goals extracted for 43 (20%) of case notes. Subsequent coding of extracted goals identified 61% reflected participation (225/368). Subgroup analysis revealed significant differences between services (p = 0.006) and professions (p < 0.001). Clinicians' reported valuing participation outcomes and family involvement and largely felt they did target participation. Skill gaps, absence of self-monitoring strategies and unsupportive professional and work cultures were cited as key challenges. CONCLUSIONS: Although valued by clinicians, participation-focused practice is unusual care in paediatric rehabilitation in New Zealand. Substantial gains in the quality of care for children with disabilities could be afforded through training in collaborative goal setting to target participation outcomes.

Dundee's Longitudinal Integrated Clerkship: drivers, implementation and early evaluation.

Dundee University School of Medicine established a pilot for a 40 week long comprehensive Longitudinal Integrated Clerkship (LIC) in 2016. Ten places for year 4 students are available which are shared between two regions of Scotland which are largely rural areas by UK definitions. This paper describes the drivers for the pilot, its implementation and early evaluation. For the evaluation, data were collected using focus groups and semi-structured interviews from the first cohort of seven students, four health service employed staff (two with leadership roles and two with regional student facing roles), 21 General Practitioner tutors, and from reflective audio-diaries kept by all students. Analysis was thematic, the themes being identified from the data. Summative assessment data were collated. Students reported positive learning experiences though access to secondary care learning linked to their patients was sometimes problematic. GP tutors were positive and enthusiastic about the programme and could see the potential benefits on recruitment to GP careers. Pre-existing workload pressures were a challenge. Summative assessment results were encouraging. The Dundee LIC is successful in delivering Dundee's year 4 curriculum. Ongoing development has been focused on improving awareness of the programme in secondary care services.

Occupational Performance Coaching for Stroke Survivors: A Pilot Randomized Controlled Trial.

OBJECTIVE: We examined the feasibility of study procedures and explored the potential efficacy of Occupational Performance Coaching for stroke survivors (OPC-Stroke), an intervention designed to improve participation after stroke. METHOD: In this pilot randomized controlled trial, 21 participants were randomized to receive the intervention or usual care. Recruitment, retention, and outcome completion rates were calculated. Direction of change and effect sizes were examined for the outcomes of participation, goal performance and satisfaction, goal self-efficacy, emotional well-being, and cognition. RESULTS: Rates of recruitment (66%) and retention (81%) were satisfactory. Participation scores improved for both groups with different trajectories. Results showed a moderate effect of OPC-Stroke for goal performance (η²partial d = .075) and satisfaction (η²partial d = .078) and a large effect for cognition (η²partial d = .167). Other outcome measures did not change as expected. CONCLUSION: Study procedures were generally feasible. Preliminary findings support testing to examine the efficacy of OPC-Stroke.

Predictors of place of death in South West Scotland 2000-2010: Retrospective cohort study.

BACKGROUND: Surveys suggest most people would prefer to die in their own home. AIM: To examine predictors of place of death over an 11-year period between 2000 and 2010 in Dumfries and Galloway, south west Scotland. DESIGN: Retrospective cohort study. SETTING/PARTICIPANTS: 19,697 Dumfries and Galloway residents who died in the region or elsewhere in Scotland. We explored the relation between age, gender, cause of death (cancer, respiratory, ischaemic heart disease, stroke and dementia) and place of death (acute hospital, cottage hospital, residential care and home) using regression models to show differences and trends. The main acute hospital in the region had a specialist palliative care unit. RESULTS: Fewer people died in their own homes (23.2% vs 29.6%) in 2010 than in 2000. Between 2007 and 2010, men were more likely to die at home than women (p < 0.001), while both sexes were less likely to die at home as they became older (p < 0.001) and in successive calendar years (p < 0.003). Older people with dementia as the cause of death were particularly unlikely to die in an acute hospital and very likely to die in a residential home (p < 0.001). Between 2007 and 2010, an increasing proportion of acute hospital deaths occurred in the specialist palliative care unit (6% vs 11% of all deaths in the study). CONCLUSION: The proportion of people dying at home fell during our survey. Place of death was strongly associated with age, calendar year and cause of death. A mismatch remains between stated preference for place of death and where death occurs.

Strategies Identified as Effective by Mothers During Occupational Performance Coaching.

AIMS: This study examined strategies mothers reported as effective in facilitating children's successful performance in activities they identified as goals during Occupational Performance Coaching (OPC). METHODS: Twenty-nine mothers of children with occupational performance issues engaged in OPC. A random sample of 44 /157 (28%) coaching sessions were video-recorded from which the audio recording was analyzed using a general inductive approach to explore the nature of strategies reported as effective by mothers. RESULTS: Two major themes emerged: (1) Context-focused; or (2) Child-focused. Context-focused strategies were characterized by mothers' actions that made the performance context more conducive to children's success. The emphasis of mothers' intention in Context-focused strategies was achievement of the task with minimal stress. Context-focused strategies included subthemes of Adjust Manner, Create Distance, Add Structure and Routine, and Teach. Child-focused strategies required higher levels of engagement with children in the application of strategies and were focused on children's skill development. Subthemes included Collaboration and Offer Choice. CONCLUSIONS: Mothers engaged in coaching identified strategies which they found supported children's performance, attesting to the existing capacity of mothers in identifying and evaluating effective ways of enhancing children's performance. Findings suggest the potential of coaching as a capacity-building, context-based intervention to improve children's performance.

The use of coaching in occupational therapy: an integrative review.

BACKGROUND/AIM: Coaching has been identified as a core enablement skill of occupational therapists. Occupational therapists have begun to embrace the use of coaching as a therapeutic tool to promote client-centeredness in their practice. As the use of coaching becomes more popular it is important to examine and evaluate coaching use in occupational therapy practice to clarify what is meant by coaching and inform future research and practice in this area. METHODS: An integrative literature review was conducted to examine how coaching is being used by occupational therapists, identify the similarities and differences between coaching interventions and to identify the empirical evidence for the use of coaching in occupational therapy. RESULTS: The literature search resulted in 24 articles describing 11 different interventions that reported use of coaching methods by occupational therapists with various populations. Similarities among interventions included goal setting, problem solving and an educational component. Differences in the directiveness of the occupational therapist were evident. The level of research evidence for individual interventions ranges from low to moderate. CONCLUSIONS: Differences are evident in the coaching theories and methods used in occupational therapy. While evidence of effectiveness of these interventions is promising, study designs used to date are vulnerable to bias and have had small sample sizes, limiting the strength of evidence. More research using clear descriptions of the coaching approach and more robust research methods is needed to better inform clinical practice.

Imminence of death among hospital inpatients: Prevalent cohort study.

BACKGROUND: There is a dearth of evidence on the proportion of the hospital population at any one time, that is in the last year of life, and therefore on how hospital policies and services can be oriented to their needs. AIM: To establish the likelihood of death within 12 months of a cohort of hospital inpatients on a given census date. DESIGN: Prevalent cohort study. PARTICIPANTS: In total, 10,743 inpatients in 25 Scottish teaching and general hospitals on 31 March 2010. RESULTS: In all, 3098 (28.8%) patients died during follow-up: 2.9% by 7 days, 8.9% by 30 days, 16.0% by 3 months, 21.2% by 6 months, 25.5% by 9 months and 28.8% by 12 months. Deaths during the index admission accounted for 32.3% of all deaths during the follow-up year. Mortality rose steeply with age and was three times higher at 1 year for patients aged 85 years and over compared to those who were under 60 years (45.6% vs 13.1%; p < 0.001). In multivariate analyses, men were more likely to die than women (odds ratio: 1.18, 95% confidence interval: 0.95-1.47) as were older patients (odds ratio: 4.99, 95% confidence interval: 3.94-6.33 for those who were 85 years and over compared to those who were under 60 years), deprived patients (odds ratio: 1.17, 95% confidence interval: 1.01-1.35 for most deprived compared to least deprived quintile) and those admitted to a medical specialty (odds ratio: 3.13, 95% confidence interval: 2.48-4.00 compared to surgical patients). CONCLUSION: Large numbers of hospital inpatients have entered the last year of their lives. Such data could assist in advocacy for these patients and should influence end-of-life care strategies in hospital.

Occupational performance coaching for stroke survivors: a pilot randomized controlled trial protocol.

BACKGROUND: Many stroke survivors report participation challenges. Occupational Performance Coaching for stroke survivors (OPC-Stroke) is designed to assist stroke survivors to develop the ability to plan and manage engagement in occupation. This approach combines emotional support, individualized education, and goal-focused problem solving to promote occupational engagement. PURPOSE: This study will explore the potential efficacy of OPC-Stroke and the feasibility of the research methods for use in a larger trial. METHOD: A pilot randomized controlled trial will be undertaken. Participants will be randomly assigned to receive 10 sessions of OPC-Stroke or usual care. Participation, perceived goal performance, satisfaction and self-efficacy, emotional well-being, and cognition will be measured at three time points. IMPLICATIONS: This research will test the potential usefulness of OPC-Stroke as well as the study methods, and thereby inform the continuing development of OPC-Stroke and further studies to measure its effectiveness.

Parent coaching to enhance community participation in young children with developmental disabilities: A pilot randomized controlled trial.

BACKGROUND: Parent coaching emerges as a preferred approach for enhancing performance and participation of children with developmental disabilities (DD), but limited clinical trials examine its effects on community participation. AIM: To evaluate whether parent coaching, specifically using Occupational Performance Coaching (OPC), enhances community participation among young children with DD. METHOD AND PROCEDURES: A pilot double-blind randomized controlled trial was conducted. Parents of 50 children with DD (31 male, 19 female, mean age 4 years 10 months) were randomly assigned to the OPC group (n = 25) or parent consultation group (n = 25). Each parent received a maximum of eight coaching sessions or consultations. The primary outcome was children's community participation as assessed through parent-report measures at baseline, pre-intervention, post-intervention, and an 8-week follow-up. OUTCOMES AND RESULTS: Both groups showed significant improvements in parent-identified, goal-specific community participation after the intervention (mean difference [MD]=2.26-2.56), and these improvements were sustained during the follow-up. Despite a trend favoring parent coaching, the group difference in the improvements was not evident (MD=0.18-0.28). Both groups displayed positive improvements in children's overall community involvement post-intervention (MD=0.32); however, the time effects were not statistically significant. CONCLUSIONS AND IMPLICATIONS: OPC, by coaching parents, could enhance goal-specific community participation in children with DD, producing effects similar to those achieved through parent consultation.

Occupational Performance Coaching for Children With Neurodisability: A Randomized Controlled Trial Protocol.

Background. Occupational Performance Coaching (OPC) is a goal-oriented approach in which client agency takes precedence in goal selection, analysis, choice of action, and evaluation of success. The intended outcomes of OPC are improved occupational performance and participation in clients' life situations. Randomized clinical trials are needed to determine the effectiveness of OPC. Purpose. This study protocol outlines a randomized controlled trial (RCT) of OPC compared to usual care with caregivers of children with neurodisability in improving child, caregiver, and family occupational performance. Method. A single-blind, 2-arm parallel-group, cluster RCT of OPC compared to usual care is planned. Therapists delivering the intervention (N = 14) are randomized to "OPC training" or "usual care" groups. The primary outcome is occupational performance improvement in caregiver (N = 84) identified goals. Implications. Findings will provide translational evidence of the effectiveness of OPC and clarify intervention processes. Areas of future OPC research and development will be indicated.

Realist process evaluation of occupational performance coaching: protocol.

INTRODUCTION: A cluster randomised controlled trial, the Meaning, Agency and Nurturing Autonomy (MANA) study, is underway comparing the effects of occupational performance coaching (OPC) and usual care on the social participation, health and well-being of children with neurodisability and their caregivers. This protocol presents the realist process evaluation which is occurring in parallel with the trial to allow testing and further refinement of OPC programme theory, as represented in its logic model. The aim of this realist evaluation is to examine what works, for whom, in the implementation of OPC with caregivers of children with neurodisability (in particular, Maori and Pasifika) in current service delivery contexts. METHODS AND ANALYSIS: Guided by OPC programme theory and realist evaluation processes, mixed-methods data collected from the MANA study OPC group will be analysed to elucidate when OPC works (outcomes), for whom, how (mechanisms) and under what circumstances (contexts). This will culminate in the synthesis of Intervention-Actor Context-Mechanism-Outcome configurations. Descriptive analyses will be reported for quantitative measures of treatment fidelity (OPC-Fidelity Measure), caregiver emotional response to OPC (Session Rating Scale) preintervention emotional state (Depression Stress and Anxiety Scale) and client outcomes (Canadian Occupational Performance Measure). Reflexive thematic analysis will be undertaken to analyse realist interviews with therapists who implemented OPC above and below fidelity thresholds and culturally focused interviews with clients of Maori or Pasifika ethnicity, informing understanding of the contexts influencing therapists' implementation of OPC with fidelity, and the mechanisms triggered within therapists or caregivers to elicit a response to the intervention. The MANA study trial outcomes will be reported separately. ETHICS AND DISSEMINATION: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee (20/STH/93). In all participating jurisdictions local area approval was obtained, involving a process of local Maori consultation. Results will be disseminated to all participants, and more broadly to clinicians and policy-makers through conference presentations and peer-reviewed journal publications, which will inform decision-making about resourcing and supporting effective delivery of OPC to optimise outcomes for children and caregivers. TRIAL REGISTRATION NUMBER: ACTRN12621000519853.

Effectiveness of shared medical appointments delivered in primary care for improving health outcomes in patients with long-term conditions: a systematic review of randomised controlled trials.

OBJECTIVES: To examine the effectiveness of shared medical appointments (SMAs) compared with one-to-one appointments in primary care for improving health outcomes and reducing demand on healthcare services by people with one or more long-term conditions (LTCs). DESIGN: A systematic review of the published literature. DATA SOURCES: Six databases, including MEDLINE and Web of Science, were searched 2013-2023. Relevant pre-2013 trials identified by forward and backward citation searches of the included trials were included. ELIGIBILITY CRITERIA: Randomised controlled trials of SMAs delivered in a primary care setting involving adults over 18 years with one or more LTCs. Studies were excluded if the SMA did not include one-to-one patient-clinician time. All countries were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS: Data were extracted and outcomes narratively synthesised, meta-analysis was undertaken where possible. RESULTS: Twenty-nine unique trials were included. SMA models varied in terms of components, mode of delivery and target population. Most trials recruited patients with a single LTC, most commonly diabetes (n=16). There was substantial heterogeneity in outcome measures. Meta-analysis showed that participants in SMA groups had lower diastolic blood pressure than those in usual care (d=-0.086, 95% CI=-0.16 to -0.02, n=10) (p=0.014). No statistically significant differences were found across other outcomes. Compared with usual care, SMAs had no significant effect on healthcare service use. For example, no difference between SMAs and usual care was found for admissions to emergency departments at follow-up (d=-0.094, 95% CI=-0.27 to 0.08, n=6, p=0.289). CONCLUSIONS: There was a little difference in the effectiveness of SMAs compared with usual care in terms of health outcomes or healthcare service use in the short-term (range 12 weeks to 24 months). To strengthen the evidence base, future studies should include a wider array of LTCs, standardised outcome measures and more details on SMA components to help inform economic evaluation. PROSPERO REGISTRATION NUMBER: CRD42020173084.

A more "normal" life: residents', family, staff, and managers' experience of active support at a residential facility for people with physical and intellectual impairments.

BACKGROUND: Active support (AS) has gained popularity as an approach for assisting people with intellectual disability to engage more fully in everyday activities. Although research has identified changes in the extent that residents are engaged in meaningful activities, the experience of stakeholders such as residents, staff, and family in AS is underexplored. METHOD: A general inductive approach was used to analyse focus group and interview transcripts of residents (n = 4), staff (n = 13), and family (n = 2) about their experience of involvement in an AS pilot project at one residential care facility in New Zealand. RESULTS: Three superordinate themes common to all stakeholders' experiences emerged: "living normal lives," "caring means doing with," and "engaging with risk." CONCLUSION: Transitioning to AS had been enriching but at times challenging for all stakeholders. Valuing resident autonomy and preparedness for greater exposure to risk are significant considerations in the implementation of AS.

New Zealand occupational therapists' views on evidence-based practice: a replicated survey of attitudes, confidence and behaviours.

BACKGROUND/AIM: Evidence-based practice is internationally recognised as an essential component of contemporary occupational therapy, and as being critical to the future of the profession. However, its uptake by therapists has been modest with barriers such as therapists attitudes, skills and organisational support frequently cited. This study explored New Zealand therapists' perceptions of their behaviours, skills and attitudes regarding evidence-based practice. METHOD: A survey comprising open and closed questions was emailed to all therapists holding practicing certificates who had consented to be contacted about research (n = 1587) with 30% (n = 473) of surveys returned. Therapists' evidence-based practice attitudes, skills and behaviours were examined using descriptive statistics. Relationships between therapists' perceptions of evidence-based practice and demographic characteristics of therapists were explored using Chi-square analysis. Text responses were analysed using content analysis. RESULTS: New Zealand therapists have a positive attitude towards evidence-based practice (84%), but report moderate reference to research literature (56%) during clinical decision-making and moderate (66%) to low (35%) levels of confidence in research-related skills. Therapists with training in evidence-based practice had higher levels of confidence, perceived research as more relevant to practice and reported less barriers to implementing evidence-based practice than other therapists. A perception that evidence-based practice is separate to clinical reasoning was widely held. CONCLUSION: New Zealand therapists' evidence-based practice behaviours, skills and attitudes are largely consistent with international comparisons. However, if New Zealand therapists are to enact the ideal of being 'evidence-based' then accessible training in evidence-based practice-related skills is indicated and should include education of what evidence-based practice means.