Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers.

BACKGROUND: Hepatitis C virus (HCV) infection is a significant global health burden, particularly among people who inject drugs. Rapid point-of-care HCV testing has emerged as a promising approach to improve HCV detection and linkage to care in harm reduction organizations such as needle and syringe programs. The objective of this study was to use an intersectionality lens to explore the barriers and enablers to point-of-care HCV testing in a needle and syringe program. METHODS: A qualitative study was conducted using semi-structured interviews with clients (people who inject drugs) and service providers in a large community organization focused on the prevention of sexually transmitted and blood borne infections and harm reduction in Montreal, Canada. An intersectionality lens was used alongside the Theoretical Domains Framework to guide the formulation of research questions as well as data collection, analysis, and interpretation. RESULTS: We interviewed 27 participants (15 clients, 12 providers). For clients, four themes emerged: (1) understanding and perceptions of HCV testing, (2) the role of an accessible and inclusive environment, (3) the interplay of emotions and motivations in decision-making, and (4) the impact of intersectional stigma related to HCV, behaviors, and identities. For providers, five themes emerged: (1) knowledge, skills, and confidence for HCV testing, (2) professional roles and their intersection with identity and lived experience, (3) resources and integration of services, (4) social and emotional factors, and (5) behavioral regulation and incentives for HCV testing. Intersectional stigma amplified access, emotional and informational barriers to HCV care for clients. In contrast, identity and lived experience acted as powerful enablers for providers in the provision of HCV care. CONCLUSION: The application of an intersectionality lens provides a nuanced understanding of multilevel barriers and enablers to point-of-care HCV testing. Findings underscore the need for tailored strategies that address stigma, improve provider roles and communication, and foster an inclusive environment for equitable HCV care. Using an intersectionality lens in implementation research can offer valuable insights, guiding the design of equity-focused implementation strategies.

One size doesn't fit all: methodological reflections in conducting community-based behavioural science research to tailor COVID-19 vaccination initiatives for public health priority populations.

BACKGROUND: Promoting the uptake of vaccination for infectious diseases such as COVID-19 remains a global challenge, necessitating collaborative efforts between public health units (PHUs) and communities. Applied behavioural science can play a crucial role in supporting PHUs' response by providing insights into human behaviour and informing tailored strategies to enhance vaccination uptake. Community engagement can help broaden the reach of behavioural science research by involving a more diverse range of populations and ensuring that strategies better represent the needs of specific communities. We developed and applied an approach to conducting community-based behavioural science research with ethnically and socioeconomically diverse populations to guide PHUs in tailoring their strategies to promote COVID-19 vaccination. This paper presents the community engagement methodology and the lessons learned in applying the methodology. METHODS: The community engagement methodology was developed based on integrated knowledge translation (iKT) and community-based participatory research (CBPR) principles. The study involved collaboration with PHUs and local communities in Ontario, Canada to identify priority groups for COVID-19 vaccination, understand factors influencing vaccine uptake and co-design strategies tailored to each community to promote vaccination. Community engagement was conducted across three large urban regions with individuals from Eastern European communities, African, Black, and Caribbean communities and low socioeconomic neighbourhoods. RESULTS: We developed and applied a seven-step methodology for conducting community-based behavioural science research: (1) aligning goals with system-level partners; (2) engaging with PHUs to understand priorities; (3) understanding community strengths and dynamics; (4) building relationships with each community; (5) establishing partnerships (community advisory groups); (6) involving community members in the research process; and (7) feeding back and interpreting research findings. Research partnerships were successfully established with members of prioritized communities, enabling recruitment of participants for theory-informed behavioural science interviews, interpretation of findings, and co-design of targeted recommendations for each PHU to improve COVID-19 vaccination uptake. Lessons learned include the importance of cultural sensitivity and awareness of sociopolitical context in tailoring community engagement, being agile to address the diverse and evolving priorities of PHUs, and building trust to achieve effective community engagement. CONCLUSION: Effective community engagement in behavioural science research can lead to more inclusive and representative research. The community engagement approach developed and applied in this study acknowledges the diversity of communities, recognizes the central role of PHUs, and can help in addressing complex public health challenges.

Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies.

BACKGROUND: The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use. OBJECTIVE: We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community. METHODS: We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences. RESULTS: Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by -6.79 days of use in the previous month (95% CI -9.59 to -4.00; P<.001). CONCLUSIONS: Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults. TRIAL REGISTRATION: PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959.

Development and Design of E_MOTIV: A Theory-Based Adaptive E-Learning Program to Support Nurses' Provision of Brief Behavior Change Counseling.

Brief counseling, when provided by adequately trained nurses, can motivate and support patient health behavior change. However, numerous barriers can impede nurses' capability and motivation to provide brief counseling. Theory-based interventions, as well as information and communication technologies, can support evidence-based practice by addressing these barriers. The purpose of this study was to document the development process of the E_MOTIV asynchronous, theory-based, adaptive e-learning program aimed at supporting nurses' provision of brief counseling for smoking cessation, healthy eating, and medication adherence. Development followed French's stepwise theory- and evidence-based approach: (1) identifying who needs to do what, differently, that is, provision of brief counseling in acute care settings by nurses; (2) identifying determinants of the provision of brief counseling; (3) identifying which intervention components and mode(s) of delivery could address determinants; and (4) developing and evaluating the program. The resulting E_MOTIV program, guided by the Theory of Planned Behavior, Cognitive Load Theory, and the concept of engagement, is unique in its adaptive functionality-personalizing program content and sequence to each learners' beliefs, motivation, and learning preferences. E_MOTIV is one of the first adaptive e-learning programs developed to support nurses' practice, and this study offers key insights for future work in the field.

[French translation, cultural adaptation and assessment of preliminary psychometric properties of the Protective Behavioral Strategies for Marijuana Scale]. / Traduction française, adaptation culturelle et évaluation des propriétés psychométriques préliminaires de l'échelle des stratégies de protection comportementale liées à la consommation de cannabis.

OBJECTIVE: Young adults (18- to 24-year-olds) constitute the age group with the highest proportion of cannabis users. In the context of legalization, it is important to promote lower-risk cannabis use. The Protective Behavioral Strategies for Marijuana Scale (PBSM-17) identifies strategies used by consumers. However, this scale is not available in French and is not adapted to the Canadian context. This article presents the process that led to the translation, cultural adaptation and evaluation of the preliminary psychometric properties of PBSM-17. METHOD: The methodological study was carried out in six steps. The first four steps led to the translation towards French and adaptation of the scale. A validation among 12 young people contributed to establish the criterion equivalency (step 5). The evaluation of psychometric properties (step 6) was carried out among 211 bilingual university students (61 % women; mean age 22 years old). RESULTS: The French version presents satisfactory preliminary psychometric properties: internal consistency is acceptable (α = 0.88); criterion equivalency was established between the French and the original English version (t (210) = 1.04, p = 0.30; 95% CI [-0.20, 0.63]). The scores obtained on both versions by the same participant were found to be strongly correlated (r = 0.95, p <0.001). CONCLUSION: The results support the use of the French version of PBSM-17. The proposed protective strategies can be used as a measurement tool and represent behaviors that can be targeted in a lower-risk cannabis use context.

OBJECTIF: Les jeunes de 18 à 24 ans constituent la plus grande proportion de consommateurs de cannabis. Dans un contexte de légalisation de cette substance, il importe de promouvoir une consommation à moindre risque. L'échelle Protective Behavioral Strategies for Marijuana Scale (PBSM-17) permet d'identifier les stratégies de protection comportementale utilisées chez les consommateurs. Toutefois, cette échelle n'est pas disponible en français et n'est pas adaptée au contexte canadien. Cet article présente la démarche ayant mené à la traduction, l'adaptation culturelle et l'évaluation des propriétés psychométriques préliminaires du PBSM-17. MÉTHODE: L'étude méthodologique s'est déroulée en six étapes. Les quatre premières étapes ont mené à la traduction et l'adaptation de l'échelle. La validation auprès de 12 jeunes a permis d'établir l'équivalence conceptuelle. L'évaluation des propriétés psychométriques a été réalisée auprès de 211 étudiants universitaires bilingues (61 % femme; âge moyen 22 ans). RÉSULTATS: La version traduite et adaptée présente des propriétés psychométriques préliminaires satisfaisantes : la cohérence interne est acceptable (α = 0,88); l'équivalence de critères (validité de construit) est établie entre la version française et la version anglaise (t (210) = 1,04, p = 0,30 ; IC 95 % [-0,20, 0,63]). Les scores obtenus aux deux versions par le même participant s'avèrent fortement corrélées (r = 0,95, p < 0,001). CONCLUSION: Les résultats soutiennent l'utilisation de la version française du PBSM-17. Les stratégies de protection proposées peuvent être utilisées comme outil de mesure et représentent des comportements à adopter dans un contexte d'usage du cannabis à moindre risque.

French Translation, Adaptation, and Initial Validation of the Nurses' Attitudes and Perceptions of Pain Assessment in Neonatal Intensive Care Questionnaire (NAPPAQ).

PURPOSE: The purpose of this study was to translate, adapt and conduct initial psychometric validation of the French version of the Nurses' Attitudes and Perceptions of Pain Assessment in neonatal intensive care Questionnaire (NAPPAQ) developed by Polkki in 2010. BACKGROUND: Assessing nurses' perceptions, attitudes and knowledge about pain management in preterm infants is important to improve neonatal practices. METHODS: A sample of French-speaking nurses (n = 147) from Quebec and France working in neonatal intensive care was selected to validate the 46-item questionnaire. A French translation of the NAPPAQ, which includes Part I and II, was undertaken prior to its administration. The FIPM questionnaire was added as a Part III. Internal consistency and instrument structure were examined using Cronbach's alphas, inter-item and inter-scale correlations and exploratory factor analysis. RESULTS: The NAPPAQ-FIPM is divided into three parts. Part I of the French version had a Cronbach's alpha of 0.64 and was composed of five factors. Part II had good total internal consistency (0.79) and adequate structure, established by inter-item correlations. Part III had good total internal consistency (0.76), and factor analysis findings suggested the presence of five factors. CONCLUSIONS: The NAPPAQ-FIPM can be used for research purposes. Parts II and III obtained adequate psychometrics results. However, further refinement of Part I could improve its content and internal structure.

Subsyndromal Delirium in Cardiac Surgery Patients: Risk Factors and Outcomes of the Different Trajectories.

BACKGROUND: Subsyndromal delirium (SSD), a subthreshold form of delirium, is related to longer length of stay and increased mortality rates among older adults. Risk factors and outcomes of SSD in cardiac surgery patients are not fully understood. OBJECTIVE: The aim of this study was to assess and describe the characteristics and outcomes related to trajectories of SSD and delirium in cardiac surgery patients. METHODS: In this secondary analysis of a retrospective case-control (1:1) cohort study, SSD was defined as a score between 1 and 3 on the Intensive Care Delirium Screening Checklist paired with an absence of diagnosis of delirium on the day of assessment. Potential risk factors (eg, age) and outcomes (eg, mortality) were identified from existing literature. Patients were grouped into 4 trajectories: (1) without SSD or delirium, (2) SSD only, (3) both, and (4) delirium only. These trajectories were contrasted using analysis of variance or χ2 test. RESULTS: Among the cohort of 346 patients, 110 patients did not present with SSD or delirium, 62 presented with only SSD, 69 presented with both, and 105 presented with only delirium. In comparison with patients without SSD or delirium, patients with SSD presented preoperative risk factors known for delirium (ie, older age, higher European System for Cardiac Operative Risk Evaluation II) but underwent less complicated surgical procedures, received fewer transfusions postoperatively, and had a lower positive fluid balance postoperatively than patients who presented with delirium. Patients with both SSD and delirium had worse outcomes in comparison with those with delirium only. CONCLUSION: This study stresses the importance for healthcare professionals to identify SSD and prevent its progression to delirium.

Designing, planning, and conducting systematic reviews and other knowledge syntheses: Six key practical recommendations to improve feasibility and efficiency.

BACKGROUND: Knowledge syntheses, such as systematic reviews, scoping reviews, and realist reviews, are crucial tools to guide nursing practice, policy, and research. However, conducting high-quality knowledge syntheses is a complex and time-consuming endeavor. It is imperative for nursing students, clinicians, and researchers to be aware of key practical recommendations regarding the conduct of knowledge syntheses to improve the feasibility and efficiency of such projects. AIM: The aim of this paper was to discuss key practical recommendations for designing, planning, and conducting knowledge syntheses relevant to nursing policy, practice, and research. METHODS: The recommendations discussed are based on best-practice guidance about knowledge synthesis methodology proposed by The Campbell Collaboration (Campbell systematic reviews: Policies and guidelines, 2020), Cochrane (Cochrane training, 2019), and the Joanna Briggs Institute (The Joanna Briggs Institute reviewers' manual, 2020) and on strategies used by the authors to improve the feasibility and efficiency of knowledge syntheses. RESULTS: This paper highlights six key practical recommendations that nursing students, clinicians, and researchers should take into account when deciding to embark on a knowledge synthesis project: (1) determining if (and why) knowledge synthesis should be conducted; (2) selecting the appropriate type of knowledge synthesis, as well as the associated methodological guidance and reporting standards; (3) developing a search strategy that balances sensitivity and specificity; (4) writing a protocol and obtaining feedback; (5) determining the resources required to conduct the different stages of the knowledge synthesis; and (6) keeping an audit trail. Fifteen common types of knowledge synthesis are presented with their definitions, relevant methodological guidance, and reporting standards. LINKING EVIDENCE TO ACTION: The recommendations discussed, used in conjunction with appropriate methodological guidelines, may help ensure the success of a knowledge synthesis project by providing best-practice and experience-based guidance to newcomers in the field.

Codeveloping a Virtual Patient Simulation to Foster Nurses' Relational Skills Consistent With Motivational Interviewing: A Situation of Antiretroviral Therapy Nonadherence.

BACKGROUND: Although helping people living with HIV manage their antiretroviral therapy is a core competency of HIV nursing care, no educational intervention has sought to strengthen this competency. Thus, we codeveloped a simulation of a virtual patient (VP) having difficulty adhering to treatment to foster the relational skills that nurses require in such situations. OBJECTIVE: This viewpoint paper aims to describe the codevelopment process and the content of VP simulation, as well as the challenges encountered and the strategies used to overcome them. METHODS: We use a collaborative and iterative approach to develop the simulation based on qualitative evidence, theoretical approaches (strengths-based nursing, motivational interviewing [MI], and adult learning theories), and expert recommendations. We carried out 2 main phases: (1) planning the simulation development and (2) designing the simulation content, sequence, and format. We created the script as if we were writing a choose-your-own-adventure book. All relational skills (behavior change counseling techniques derived from MI) were integrated into a nurse-patient dialogue. The logic of the simulation is as follows: if the nurse uses techniques consistent with MI (eg, open-ended questions, summarizing), a dialogue is opened up with the VP. If the nurse uses relational skills inconsistent with MI (eg, providing advice without asking for permission), the VP will react accordingly (eg, defensively). Learners have opportunities to assess and reflect on their interventions with the help of quizzes and feedback loops. RESULTS: Two main challenges are discussed. The most salient challenge was related to the second phase of the VP simulation development. The first was to start the project with divergent conceptions of how to approach the VP simulation-the simulation company's perspective of a procedural-type approach versus the clinical team's vision of a narrative approach. As a broad strategy, we came to a mutual understanding to develop a narrative-type VP simulation. It meshed with our conception of a nurse-patient relationship, the values of strengths-based nursing (a collaborative nurse-patient relationship), and the MI's counseling style. The second challenge was the complexity in designing realistic relational skills in preprogrammed and simulated nurse-patient dialogue while preserving an immersive learning experience. As a broad strategy, we created a collaborative and work-in-progress writing template as a shared working tool. CONCLUSIONS: Our experience may be helpful to anyone looking for practical cues and guidance in developing narrative VP simulations. As relational skills are used by all nurses-from novices to experts-and other health care practitioners, focusing on this clinical behavior is a good way to ensure the simulation's adaptability, sustainability, and efficiency.

Delirium After Cardiac Surgery and Cumulative Fluid Balance: A Case-Control Cohort Study.

OBJECTIVE: To assess a novel hypothesis to explain delirium after cardiac surgery through the relationship between cumulative fluid balance and delirium. This hypothesis involved an inflammatory process combined with a hypervolemic state, which could lead to venous congestion reaching the brain. DESIGN: Retrospective case-control (1:1) cohort study. SETTING: University-affiliated tertiary cardiology center. PARTICIPANTS: Cardiac surgery intensive care unit (ICU) patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Cumulative fluid balance was evaluated at 3 times: (1) upon arrival at the ICU after surgery, (2) 24 hours post-ICU arrival, and (3) 48 hours post-ICU arrival. A generalized estimated equation was used to model the association between cumulative fluid balance and delirium occurrence 24 hours later. Covariates were selected based on the statistical differences between cases and controls on delirium risk factors and clinical characteristics. The cohort included 346 patients, of which 39 (11%), 104 (30%), and 142 patients (41%) presented delirium at 24, 48, and 72 hours post-ICU arrival, respectively. The effect of time had an odds ratio (OR) of 2.14, 95% confidence interval (CI) 1.603 to 2.851, and a p value < 0.001. The cumulative fluid balance was associated with delirium occurrence (OR 1.20, 95% CI: 1.066-1.355, p = .003). History of neurological disorder, having both hearing and visual impairment, type of procedure, perioperative cerebral oximetry, mean pulmonary artery pressure pre-cardiopulmonary bypass (CPB), and mean arterial pressure post-CPB also contributed to delirium in the model. CONCLUSION: Delirium is associated with a cumulative fluid balance, but the extent through which this plays an etiologic role remains to be determined.

A web-based tailored nursing intervention (TAVIE en m@rche) aimed at increasing walking after an acute coronary syndrome: Multicentre randomized trial.

AIM: Evaluate a web-based tailored nursing intervention, TAVIE en m@rche, on increasing daily steps after an acute coronary syndrome. DESIGN: Parallel two-group multicentre randomized trial. METHODS: An experimental group receiving TAVIE en m@rche, was compared to  a control group receiving hyperlinks to public websites. Acute coronary syndrome patients who were insufficiently active were recruited from three coronary care units. Daily steps at 12 weeks were the primary outcome. Secondary outcomes included self-reported walking and moderate to vigorous physical activity (MVPA). Exploratory outcomes were angina frequency, emergency department visits, hospitalizations and secondary prevention programme attendance. RESULTS: Primary data were analysed for 39 participants. No significant effects were found. At 12 weeks 275.9 more daily steps and 1,464.3 more energy expenditure in MVPA were found in the experimental group relative to the control. No effects were found for angina frequency, emergency department visits, hospitalizations and secondary prevention programme attendance. CONCLUSION: The lack of effect on our primary result may be explained by the intervention goal that was mismatched to the needs of our mostly sufficiently active sample at randomization, resulting in no meaningful change in daily steps. Although the non-significantly greater increase in self-reported MVPA may represent gains in health among the participants that accessed TAVIE en m@rche, this result should be interpreted with caution. IMPACT: From 40%-60% of acute coronary syndrome patients self-report insufficient levels of physical activity. No effect was found on the primary outcome of daily steps. Although not significant, a greater increase in MVPA was found at 12 weeks. The primary outcome can be explained by most of the sample having attained the physical activity recommendation at randomization. Caution in interpreting the non-significant increase in MVPA is warranted due to attrition bias and statistical uncertainty. Future directions may consider the timing of randomization in relation to meeting the needs of insufficiently active acute coronary syndrome patients.

Using a Wireless Electroencephalography Device to Evaluate E-Health and E-Learning Interventions.

BACKGROUND: Measuring engagement and other reactions of patients and health professionals to e-health and e-learning interventions remains a challenge for researchers. OBJECTIVE: The aim of this pilot study was to assess the feasibility and acceptability of using a wireless electroencephalography (EEG) device to measure affective (anxiety, enjoyment, relaxation) and cognitive (attention, engagement, interest) reactions of patients and healthcare professionals during e-health or e-learning interventions. METHODS: Using a wireless EEG device, we measured patient (n = 6) and health professional (n = 7) reactions during a 10-minute session of an e-health or e-learning intervention. The following feasibility and acceptability indicators were assessed and compared for patients and healthcare professionals: number of eligible participants who consented to participate, reasons for refusal, time to install and calibrate the wireless EEG device, number of participants who completed the full 10-minute sessions, participant comfort when wearing the device, signal quality, and number of observations obtained for each reaction. The wireless EEG readings were compared to participant self-rating of their reactions. RESULTS: We obtained at least 75% of possible observations for attention, engagement, enjoyment, and interest. EEG scores were similar to self-reported scores, but they varied throughout the sessions, which gave information on participants' real-time reactions to the e-health/e-learning interventions. Results on the other indicators support the feasibility and acceptability of the wireless EEG device for both patients and professionals. DISCUSSION: Using the wireless EEG device was feasible and acceptable. Future studies must examine its use in other contexts of care and explore which components of the interventions affected participant reactions by combining wireless EEG and eye tracking.

Cervical Spine Collar Removal by Emergency Room Nurses: A Quality Improvement Project.

INTRODUCTION: The Canadian C-Spine Rule (CCR) is a clinical decision aid to facilitate the safe removal of cervical collars in the alert, orientated, low-risk adult trauma patient. Few health care settings have assessed initiatives to train charge nurses to use the CCR. This practice improvement project conducted in a secondary trauma center in Canada aimed to (1) train charge nurses of the emergency room to use the CCR, (2) monitor its use throughout the project period, and (3) compare the assessments of the charge nurses with those of emergency physicians. METHODS: The project began with the creation of an interdisciplinary team. Clinical guidelines were established by the interdisciplinary project team. Nine charge nurses of the emergency room were then trained to use the CCR (3 on each 8-hour shift). The use of the CCR was monitored throughout the project period, from June 1 to October 5, 2016. RESULTS: The 3 aims of this practice improvement project were attained successfully. Over a 5-month period, 114 patients were assessed with the CCR. Charge nurses removed the cervical collars for 54 of 114 patients (47%). A perfect agreement rate (114 of 114 patients, 100%) was attained between the assessments of the nurses and those of physicians. DISCUSSION: This project shows that the charge nurses of a secondary trauma center can use the CCR safely on alert, orientated, and low-risk adult trauma patients as demonstrated by the agreement in the assessments of emergency room nurses and physicians.

Evaluation of a Web-Based E-Learning Platform for Brief Motivational Interviewing by Nurses in Cardiovascular Care: A Pilot Study.

BACKGROUND: Brief motivational interviewing (MI) can contribute to reductions in morbidity and mortality related to coronary artery disease, through health behavior change. Brief MI, unlike more intensive interventions, was proposed to meet the needs of clinicians with little spare time. While the provision of face-to-face brief MI training on a large scale is complicated, Web-based e-learning is promising because of the flexibility it offers. OBJECTIVE: The primary objective of this pilot study was to examine the feasibility and acceptability of a Web-based e-learning platform for brief MI (MOTIV@CŒUR), which was evaluated by nurses in cardiovascular care. The secondary objective was to assess the preliminary effect of the training on nurses' perceived brief MI skills and self-reported clinical use of brief MI. METHODS: We conducted a single-group, pre-post pilot study involving nurses working in a coronary care unit to evaluate MOTIV@CŒUR, which is a Web-based e-learning platform for brief MI, consisting of two sessions lasting 30 and 20 minutes. MOTIV@CŒUR covers 4 real-life clinical situations through role-modeling videos showing nurse-client interactions. A brief introduction to MI is followed by role playing, during which a nurse practitioner evaluates clients' motivation to change and intervenes according to the principles of brief MI. The clinical situations target smoking, medication adherence, physical activity, and diet. Nurses were asked to complete both Web-based training sessions asynchronously within 20 days, which allowed assessment of the feasibility of the intervention. Data regarding acceptability and preliminary effects (perceived skills in brief MI, and self-reported clinical use of conviction and confidence interventions) were self-assessed through Web-based questionnaires 30 days (±5 days) after the first session. RESULTS: We enrolled 27 women and 4 men (mean age 37, SD 9 years) in March 2016. Of the 31 participants, 24 (77%, 95% CI 63%-91%) completed both sessions in ≤20 days. At 30 days, 28 of the 31 participants (90%) had completed at least one session. The training was rated as highly acceptable, with the highest scores observed for information quality (mean 6.26, SD 0.60; scale 0-7), perceived ease of use (mean 6.16, SD 0.78; scale 0-7), and system quality (mean 6.15, SD 0.58; scale 0-7). Posttraining scores for self-reported clinical use of confidence interventions were higher than pretraining scores (mean 34.72, SD 6.29 vs mean 31.48, SD 6.75, respectively; P=.03; scale 10-50). Other results were nonsignificant. CONCLUSIONS: Brief MI training using a Web-based e-learning platform including role-modeling videos is both feasible and acceptable according to cardiovascular care nurses. Further research is required to evaluate the e-learning platform in a randomized controlled trial. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 16510888; http://www.isrctn.com/ISRCTN16510888 (Archived by WebCite at http://www.webcitation.org/6jf7dr7bx).

Mapping the Cardiometabolic Patient Experience and Self-Care Behaviors to Inform Design, Implementation, and Persistent Use of Digital Health Care Solutions: Mixed Methods Study.

BACKGROUND: Cardiometabolic conditions including acute coronary syndrome (ACS) and type 2 diabetes (T2D) require comprehensive care and patient engagement in self-care behaviors, and the drivers of those behaviors at the individual and health system level are still poorly understood. OBJECTIVE: We aim to gain insights into self-care behaviors of individuals with cardiometabolic conditions. METHODS: A convenience sample of 98 adult patients with ACS and T2D was recruited in the United States, Germany, and Taiwan to participate in a mixed methods study using ethnographic methods. All participants completed 7-day web-based diaries tracking their level of engagement, and 48 completed 90-minute web-based semistructured interviews between February 4, 2021, and March 27, 2021, focusing on themes including moments of engagement. Qualitative analysis identified factors influencing self-care practices and a Patient Mind States Model prototype. RESULTS: Patient reports indicate that many patients feel social pressure to adhere to treatment. Patients' experience can be understood within 5 categories defined in terms of their degree of engagement and adherence ("ignoring," "struggling," "juggling," "controlling," and "reframing"). CONCLUSIONS: For people living with ACS and T2D, the self-care journey is defined by patterns of patient experiences, which can identify areas that tailored digital health care interventions may play a meaningful role.

Barriers and enablers to the implementation of patient-reported outcome and experience measures (PROMs/PREMs): protocol for an umbrella review.

BACKGROUND: Patient-reported outcome and experience measures (PROMs and PREMs, respectively) are evidence-based, standardized questionnaires that can be used to capture patients' perspectives of their health and health care. While substantial investments have been made in the implementation of PROMs and PREMs, their use remains fragmented and limited in many settings. Analysis of multi-level barriers and enablers to the implementation of PROMs and PREMs has been hampered by the lack of use of state-of-the-art implementation science frameworks. This umbrella review aims to consolidate available evidence from existing quantitative, qualitative, and mixed-methods systematic and scoping reviews covering factors that influence the implementation of PROMs and PREMs in healthcare settings. METHODS: An umbrella review of systematic and scoping reviews will be conducted following the guidelines of the Joanna Briggs Institute (JBI). Qualitative, quantitative, and mixed methods reviews of studies focusing on the implementation of PROMs and/or PREMs in all healthcare settings will be considered for inclusion. Eight bibliographical databases will be searched. All review steps will be conducted by two reviewers independently. Included reviews will be appraised and data will be extracted in four steps: (1) assessing the methodological quality of reviews using the JBI Critical Appraisal Checklist; (2) extracting data from included reviews; (3) theory-based coding of barriers and enablers using the Consolidated Framework for Implementation Research (CFIR) 2.0; and (4) identifying the barriers and enablers best supported by reviews using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. Findings will be presented in diagrammatic and tabular forms in a manner that aligns with the objective and scope of this umbrella review, along with a narrative summary. DISCUSSION: This umbrella review of quantitative, qualitative, and mixed-methods systematic and scoping reviews will inform policymakers, researchers, managers, and clinicians regarding which factors hamper or enable the adoption and sustained use of PROMs and PREMs in healthcare settings, and the level of confidence in the evidence supporting these factors. Findings will orient the selection and adaptation of implementation strategies tailored to the factors identified. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023421845.

Scoring Methods in Script Concordance Tests: An Exploratory Psychometric Study.

BACKGROUND: Despite the increasingly popular role of script concordance test (SCT) scoring methods in the evaluation of clinical reasoning, studies examining these methods in nursing are relatively scarce. This study explored the psychometric properties of five SCT scoring methods. METHOD: An SCT was administered to 12 experts and 43 learners. Scores were calculated using five methods and descriptive statistics. Differences in scores were assessed with the Mann-Whitney U test, and Spearman correlation coefficients were calculated for the different methods. RESULTS: The median scores of both experts and learners differed substantially according to the scoring method used. Learners' scores were statistically different from experts' scores (p < .01) for each method. Spearman coefficients (range, 0.44 to 0.95) were positive for the different methods. CONCLUSION: Further research is needed to refine the influence of SCT scoring methods for use in certifying assessment of clinical reasoning in nursing. [J Nurs Educ. 2023;62(10):549-555.].

Healthcare professional behaviour: health impact, prevalence of evidence-based behaviours, correlates and interventions.

Healthcare professional (HCP) behaviours are actions performed by individuals and teams for varying and often complex patient needs. However, gaps exist between evidence-informed care behaviours and the care provided. Implementation science seeks to develop generalizable principles and approaches to investigate and address care gaps, supporting HCP behaviour change while building a cumulative science. We highlight theory-informed approaches for defining HCP behaviour and investigating the prevalence of evidence-based care and known correlates and interventions to change professional practice. Behavioural sciences can be applied to develop implementation strategies to support HCP behaviour change and provide valid, reliable tools to evaluate these strategies. There are thousands of different behaviours performed by different HCPs across many contexts, requiring different implementation approaches. HCP behaviours can include activities related to promoting health and preventing illness, assessing and diagnosing illnesses, providing treatments, managing health conditions, managing the healthcare system and building therapeutic alliances. The key challenge is optimising behaviour change interventions that address barriers to and enablers of recommended practice. HCP behaviours may be determined by, but not limited to, Knowledge, Social influences, Intention, Emotions and Goals. Understanding HCP behaviour change is a critical to ensuring advances in health psychology are applied to maximize population health.