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1.
Clin Nurse Spec ; 33(5): 228-236, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31404001

RESUMO

PURPOSE: Develop an evidence-based clinical nurse specialist (CNS) preceptor protocol to enhance preceptor's skills and effectiveness and strengthen the preceptor-preceptee relationship and outcomes. DESCRIPTION: An effective CNS preceptor is a key variable to quality, timely, and fiscally responsible CNS transition and retention. Most preceptors receive no formal education or skill development. Literature searched from the previous 10 years explored CNS preceptor, preceptee, and preceptorship process. OUTCOMES: Protocol key components are development of the mutual collaborative relationship, shared meaning, understanding, goal setting, timelines, and evaluations. The planning phase of the protocol includes face-to-face meeting to identify overarching goals and establish a trusting collaborative relationship. The mutual iterative learning and growing phase includes identification of learning needs, goals, and strategies such as debriefing, reflective journaling, and mutual ongoing evaluation. The concluding phase includes formal evaluation. The outcome phase includes safe autonomous CNS practice, along with mutual growth and satisfaction. CONCLUSIONS: The literature informed the CNS preceptor protocol development. The protocol may be evaluated within a preceptor-preceptee relationship across multiple settings. Higher levels of CNS research are vital to identify evidence-based CNS preceptorship strategies. As CNSs are integrated into advanced practice roles, a structured preceptor protocol and education program is critical to provide quality outcomes.


Assuntos
Educação em Enfermagem/métodos , Enfermeiras Clínicas/educação , Preceptoria/organização & administração , Prática Clínica Baseada em Evidências , Humanos
2.
J Natl Black Nurses Assoc ; 30(1): 40-47, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31465684

RESUMO

The purpose of this article was to help healthcare practitioners understand the dynamics of Alzheimer's care giving and to introduce an evidence-based practice intervention to improve the caregiver's self-efficacy. Over 5 million people in the United States are afflicted with Alzheimer's disease and require a caregiver to assist with all areas of daily activity. Adult care giving is challenging for the caregiver, who is often a family member with little to no knowledge or skill in rendering care. African-American caregivers encounter an even greater challenge by overcoming cultural bias inherent in racial disparity. Evidence-based practice interventions are helpful in successfully rendering care while minimizing stress and burden. Healthcare providers must consider the caregiver, the dynamics of care giving, and cultural norms, in the plan of care to successfully care for the Alzheimer's patient along the trajectory of the disease.


Assuntos
Doença de Alzheimer/terapia , Cuidadores/psicologia , Planejamento de Assistência ao Paciente/organização & administração , Adulto , Afro-Americanos/psicologia , Características Culturais , Prática Clínica Baseada em Evidências , Humanos , Autoeficácia
4.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46653

RESUMO

Este livro contém 24 capítulos distribuídos em sete seções. Eles descrevem a institucionalização das áreas de Avaliação de Tecnologias de Saúde (ATS) e em Políticas Informadas por Evidências (PIE) no mundo e no Brasil; os desenhos de estudos para construção das evidências; os tipos de revisão que podem ajudar a tomada de decisão em saúde; as ferramentas necessárias para identificar e avaliar a qualidade dos estudos e das evidências; os mecanismos para implementação e monitoramento em avaliação de tecnologias de saúde; os aspectos relacionados ao direito e à ética em saúde; e as perspectivas para o futuro, como descreve uma das organizadoras da publicação.


Assuntos
Avaliação em Saúde , Prática Clínica Baseada em Evidências , Tecnologia Biomédica
5.
J Nurs Adm ; 49(7-8): 377-383, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31335520

RESUMO

A practice-focused academic-practice partnership merging the strengths and resources of 2 faith-based community organizations built evidence-based practice, nursing research, and innovative nursing programs. The unique partnership emphasizing quality care and patient outcomes resulted in hospital-acquired infection reduction, interventional research reducing readmissions, clinical redesign, increased percentage of bachelor's degree-prepared nurses, and dissemination through publication and presentation. Key elements to partnership success were shared mission and vision, program oversight, strong contract, and annual plans with specific measurable outcomes.


Assuntos
Comportamento Cooperativo , Prática Clínica Baseada em Evidências/métodos , Hospitais , Relações Interinstitucionais , Escolas de Enfermagem/organização & administração , Humanos , Modelos Organizacionais
6.
BMJ ; 366: l4185, 2019 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315828

RESUMO

OBJECTIVE: To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched. REVIEW METHODS: Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I2 statistic, and publication bias was evaluated. RESULTS: Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10). CONCLUSIONS: Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Dano ao Paciente/prevenção & controle , Dano ao Paciente/tendências , Estudos Transversais , Prática Clínica Baseada em Evidências/normas , Humanos , Estudos Observacionais como Assunto , Dano ao Paciente/mortalidade , Segurança do Paciente , Prevalência , Melhoria de Qualidade , Estudos Retrospectivos , Índice de Gravidade de Doença
7.
Nursing ; 49(8): 53-55, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31343535

RESUMO

Nurses wearing hair up and out of the face may be seen as outdated, but proponents say keeping hair up is an evidence-based practice that contributes to infection prevention and optimal patient outcomes. This article raises questions concerning hair restraint and infection control and explores the evidence.


Assuntos
Cabelo , Enfermagem , Infecção Hospitalar/prevenção & controle , Prática Clínica Baseada em Evidências , Cabelo/microbiologia , Humanos , Controle de Infecções/métodos , Restrição Física
8.
Implement Sci ; 14(1): 72, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307489

RESUMO

BACKGROUND: Economic evaluation can inform whether strategies designed to improve the quality of health care delivery and the uptake of evidence-based practices represent a cost-effective use of limited resources. We report a systematic review and critical appraisal of the application of health economic methods in improvement/implementation research. METHOD: A systematic literature search identified 1668 papers across the Agris, Embase, Global Health, HMIC, PsycINFO, Social Policy and Practice, MEDLINE and EconLit databases between 2004 and 2016. Abstracts were screened in Rayyan database, and key data extracted into Microsoft Excel. Evidence was critically appraised using the Quality of Health Economic Studies (QHES) framework. RESULTS: Thirty studies were included-all health economic studies that included implementation or improvement as a part of the evaluation. Studies were conducted mostly in Europe (62%) or North America (23%) and were largely hospital-based (70%). The field was split between improvement (N = 16) and implementation (N = 14) studies. The most common intervention evaluated (43%) was staffing reconfiguration, specifically changing from physician-led to nurse-led care delivery. Most studies (N = 19) were ex-post economic evaluations carried out empirically-of those, 17 were cost effectiveness analyses. We found four cost utility analyses that used economic modelling rather than empirical methods. Two cost-consequence analyses were also found. Specific implementation costs considered included costs associated with staff training in new care delivery pathways, the impacts of new processes on patient and carer costs and the costs of developing new care processes/pathways. Over half (55%) of the included studies were rated 'good' on QHES. Study quality was boosted through inclusion of appropriate comparators and reporting of incremental analysis (where relevant); and diminished through use of post-hoc subgroup analysis, limited reporting of the handling of uncertainty and justification for choice of discount rates. CONCLUSIONS: The quantity of published economic evaluations applied to the field of improvement and implementation research remains modest; however, quality is overall good. Implementation and improvement scientists should work closely with health economists to consider costs associated with improvement interventions and their associated implementation strategies. We offer a set of concrete recommendations to facilitate this endeavour.


Assuntos
Assistência à Saúde/economia , Prática Clínica Baseada em Evidências/economia , Ciência da Implementação , Modelos Econômicos , Melhoria de Qualidade/economia , Análise Custo-Benefício , Humanos
9.
Diagn. tratamento ; 24(2): [52-54], abr - jun 2019.
Artigo em Português | LILACS | ID: biblio-1015335
10.
Diagn. tratamento ; 24(2): [70-81], abr - jun 2019. tab
Artigo em Português | LILACS | ID: biblio-1015344

RESUMO

Contexto: A gota é uma doença articular metabólica inflamatória, caracterizada pelo acúmulo de cristais de monourato de sódio no líquido sinovial das articulações e em outros tecidos. Objetivo: apresentar as evidências de revisões sistemáticas Cochrane sobre efetividade e segurança de intervenções disponíveis para o manejo da gota. Métodos: Foram identificadas revisões sistemáticas a partir de busca na Biblioteca Cochrane. Dois autores avaliaram as revisões quanto aos critérios de elegibilidade das revisões encontradas e apresentaram síntese de seus achados. Resultados: Foram incluídas 13 revisões sistemáticas Cochrane (6 para gota aguda e 7 para gota crônica) que avaliaram intervenções medicamentosas sistêmicas e locais (tópica e intra-articular) e mudanças no estilo de vida. A confiança no corpo final das evidências encontradas variou de desconhecida a moderada entre os desfechos considerados. Os principais resultados mostraram que anti-inflamatórios não esteroidais (AINE) convencionais são tão efetivos quanto AINE inibidores da ciclo-oxigenase-2 e corticoides para controle da dor em pacientes com gota aguda. Para gota crônica, o alopurinol parece ser semelhante ao febuxostate e a benzbromarona na prevenção de crises de gota. Conclusão: Nenhum dos achados das revisões forneceu evidência de alta certeza sobre os efeitos das intervenções para gota, ou seja, estudos futuros podem, com variada probabilidade, modificar a estimativa que conhecemos hoje para os efeitos das intervenções avaliadas.


Assuntos
Revisão , Medicina Baseada em Evidências , Prática Clínica Baseada em Evidências , Tomada de Decisão Clínica , Gota
12.
BMC Public Health ; 19(1): 743, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196062

RESUMO

BACKGROUND: Smoking remains one of the major preventable causes of chronic diseases. Considering the promising evidence on the effectiveness of mobile technology for health behaviour change, along with the increasing adoption of smartphones, this review aims to systematically assess the adherence of popular mobile apps for smoking cessation to evidence-based guidelines. METHODS: The United Kingdom Android and iOS markets were searched in February 2018 to identify smoking cessation apps. After screening, 125 Android and 15 iOS apps were tested independently by two reviewers for adherence to the National Institute of Care and Excellence (NICE) Smoking Cessation Guidelines for Self-Help Materials and the Five A Guidelines for Smoking Cessation. Pearson chi square tests were run to examine differences between the two operating systems. RESULTS: A majority of apps across both operating systems had low adherence (fulfils 1-2 out of 5 guidelines) to the Five A Guidelines (65.7%) and low adherence (fulfils 1-3 out of 9 guidelines) to the NICE Smoking Cessation Guidelines for Self-Help Materials (63.6%). Only 15% of mobile apps provided information about the benefits of nicotine replacement therapy (NRT), and even fewer provided information regarding types of NRT products (7.1%) or how to use them (2.1%). In addition, only a minority of apps arrange follow-up appointments or provide additional support to help smokers quit. CONCLUSION: Similar to previous mobile app reviews dating back to 2014, our findings show that most mobile apps do not follow existing smoking cessation treatment guidelines, indicating little change regarding the availability of evidence-based mobile apps for smoking cessation in the UK market. Smokers seeking to quit, tobacco control policy makers and software developers need to work together to develop apps that are in line with the latest clinical guidelines and strategies to maximise effectiveness.


Assuntos
Prática Clínica Baseada em Evidências , Fidelidade a Diretrizes/estatística & dados numéricos , Guias como Assunto , Aplicativos Móveis/normas , Abandono do Hábito de Fumar/métodos , Humanos , Reino Unido
13.
Value Health ; 22(6): 739-749, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31198192

RESUMO

BACKGROUND: Real-world evidence (RWE) is increasingly used to inform health technology assessments for resource allocation, which are valuable tools for emerging economies such as in America. Nevertheless, the characteristics and uses in South America are unknown. OBJECTIVES: To identify sources, characteristics, and uses of RWE in Argentina, Brazil, Colombia, and Chile, and evaluate the context-specific challenges. The implications for future regulation and responsible management of RWE in the region are also considered. METHODS: A systematic literature review, database mapping, and targeted gray literature search were conducted to identify the sources and characteristics of RWE. Findings were validated by key opinion leaders attending workshops in 4 South American countries. RESULTS: A database mapping exercise revealed 407 unique databases. Geographic scope, database type, population, and outcomes captured were reported. Characteristics of national health information systems show efforts to collect interoperable data from service providers, insurers, and government agencies, but that initiatives are hampered by fragmentation, lack of stewardship, and resources. In South America, RWE is mainly used for pharmacovigilance and as pure academic research, but less so for health technology assessment decision making or pricing negotiations and not at all to inform early access schemes. CONCLUSIONS: The quality of real-world data in the case study countries vary and RWE is not consistently used in healthcare decision making. Authors recommend that future studies monitor the impact of digitalization and the potential effects of access to RWE on the quality of patient care.


Assuntos
Tomada de Decisões , Prática Clínica Baseada em Evidências/normas , Prática Clínica Baseada em Evidências/tendências , Humanos , América Latina
15.
Implement Sci ; 14(1): 63, 2019 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200730

RESUMO

BACKGROUND: In healthcare settings, system and organization leaders often control the selection and design of implementation strategies even though frontline workers may have the most intimate understanding of the care delivery process, and factors that optimize and constrain evidence-based practice implementation within the local system. Innovation tournaments, a structured participatory design strategy to crowdsource ideas, are a promising approach to participatory design that may increase the effectiveness of implementation strategies by involving end users (i.e., clinicians). We utilized a system-wide innovation tournament to garner ideas from clinicians about how to enhance the use of evidence-based practices (EBPs) within a large public behavioral health system. METHODS: Our innovation tournament occurred in three phases. First, we invited over 500 clinicians to share, through a web-based platform, their ideas regarding how their organizations could best support use of EBPs. Clinicians could rate and comment on ideas submitted by others. Second, submissions were judged by an expert panel (including behavioral scientists, system leaders, and payers) based on their rated enthusiasm for the idea. Third, we held a community-facing event during which the six clinicians who submitted winning ideas presented their strategies to 85 attendees representing a cross-section of clinicians and system and organizational leaders. RESULTS: We had a high rate of participation (12.3%), more than double the average rate of previous tournaments conducted in other settings (5%). A total of 65 ideas were submitted by 55 participants representing 38 organizations. The most common categories of ideas pertained to training (42%), financing and compensation (26%), clinician support and preparation tools (22%), and EBP-focused supervision (17%). The expert panel and clinicians differed on their ratings of the ideas, highlighting value of seeking input from multiple stakeholder groups when developing implementation strategies. CONCLUSIONS: Innovation tournaments are a useful and feasible methodology for engaging end users, system leaders, and behavioral scientists through a structured approach to developing implementation strategies. The process and resultant strategies engendered significant enthusiasm and engagement from participants at all levels of a healthcare system. Research is needed to compare the effectiveness of strategies developed through innovation tournaments to strategies developed through design approaches.


Assuntos
Medicina do Comportamento/organização & administração , Crowdsourcing , Prática Clínica Baseada em Evidências/organização & administração , Inovação Organizacional , Humanos , Projetos de Pesquisa
16.
Implement Sci ; 14(1): 66, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221201

RESUMO

BACKGROUND: Effective leadership for organizational change is critical to the implementation of evidence-based practices (EBPs). As organizational leaders in behavioral health organizations often are promoted from within the agency for their long-standing, effective work as counselors, they may lack formal training in leadership, management, or practice change. This study assesses a novel implementation leadership training designed to promote leadership skills and successful organizational change specific to EBP implementation. METHODS: We conducted a pre-post outcome evaluation of the Training in Implementation Practice Leadership (TRIPLE), delivered via three in-person, half-day training sessions, with interim coaching and technical support. Sixteen mid-level leaders (75% female, 94% Caucasian, mean age 37 years) from 8 substance abuse treatment agencies participated. Professional roles included clinical managers, quality improvement coordinators, and program directors. Participants completed surveys prior to the first and following the final session. At both time points, measures included the Implementation Leadership Scale, Implementation Climate Scale, and Organizational Readiness for Implementing Change Scale. At post-test, we added the Training Acceptability and Appropriateness Scale (TAAS), assessing participant satisfaction with the training. Qualitative interviews were conducted 6 to 8 months after the training. RESULTS: Most participants (86% and 79%, respectively) reported increased implementation leadership skills and implementation climate; paired samples t tests indicated these pre-post increases were statistically significant. Implementation leadership scores improved most markedly on the Proactive and Knowledgeable subscales. For implementation climate, participants reported the greatest increases in educational support and recognition for using EBP. Post-test scores on the TAAS also indicated that participants found the training program to be highly acceptable and appropriate for their needs. Qualitative results supported positive outcomes of training that resulted in both increased organizational implementation as well as leadership skills of participants. CONCLUSIONS: This training program represents an innovative, effective, and well-received implementation strategy for emerging behavioral healthcare leaders seeking to adopt or improve the delivery of EBPs. Reported implementation leadership skills and implementation climate improved following the training program, suggesting that TRIPLE may have helped fulfill a critical need for emerging behavioral healthcare leaders.


Assuntos
Prática Clínica Baseada em Evidências/organização & administração , Pessoal de Saúde/educação , Capacitação em Serviço , Liderança , Inovação Organizacional , Competência Profissional , Centros de Tratamento de Abuso de Substâncias , Adulto , Feminino , Humanos , Masculino
17.
BMC Health Serv Res ; 19(1): 362, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174530

RESUMO

BACKGROUND: Advance care planning (ACP) is the process of ongoing communication among patients, family and health care professionals regarding what plans for future care are preferred in the event that patients become unable to make their own decisions. Clinicians play an important role in ACP as both initiators and decision coaches. However, lack of training for clinicians has frequently been reported as the reason for low involvement in ACP discussions - hence the present review evaluates the effectiveness of ACP training programs for healthcare professionals to guide the development of novel training programs for them in the future. METHODS: A literature search for intervention studies was conducted independently by two reviewers in July 2018. Participants included all healthcare professionals working with adult patients suffering from terminal illness. The primary outcomes were the professionals' knowledge of and attitudes towards ACP, and self-perceived competence in ACP conversations. The Effective Public Health Practice Project appraisal tool was used to examine the quality of the studies included. RESULTS: A total of 4025 articles were identified, and ten eligible articles, covering 1081 participants, were included in the review. However, there is a lack of high quality randomized controlled trials of providing ACP training for nurses working in non-palliative care hospital settings. The overall quality of the intervention studies was moderate. All the studies included used instructional sessions in their interventions, while some contained group discussion, role-play and the use of advanced technology. The training programs increased the knowledge, attitudes towards shared decision-making, perceived communication skills, confidence, comfort and experiences concerned with discussing end-of-life (EOL) issues. Patient advocacy, job satisfaction and perceived level of adequate training for EOL care were improved. The use of 'decision aids' was rated as acceptable and clinically useful. CONCLUSIONS: Training for healthcare professionals in ACP has positive effects on their knowledge, attitude and skills. The use of decision aids and advanced technology, instructional sessions with role play, training content focused on ACP communication skills and the needs and experience of patient in the ACP process, and a values-based ACP process are all those factors that made the ACP training programs effective.


Assuntos
Planejamento Antecipado de Cuidados/normas , Diretivas Antecipadas , Pessoal de Saúde/educação , Tomada de Decisões , Prática Clínica Baseada em Evidências , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Implement Sci ; 14(1): 54, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146788

RESUMO

BACKGROUND: Individual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector. METHODS: As part of a pilot trial, 25 school mental health clinicians were randomized to BASIS (n = 12) or an attention control placebo (n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked. RESULTS: A series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls. CONCLUSION: Findings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018-Retrospectively registered.


Assuntos
Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências , Pessoal de Saúde/educação , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Escolar/organização & administração , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional , Projetos Piloto , Projetos de Pesquisa , Estados Unidos
19.
BMC Infect Dis ; 19(1): 496, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170921

RESUMO

BACKGROUND: HIV testing serves as a critical gateway for linkage and retention to care services, particularly in sub-Saharan African countries with high burden of HIV infections. However, the current progress towards addressing the first cascade of the 90-90-90 programme is largely contributed by women. This study aimed to map evidence on the intervention strategies to improve HIV uptake among men in sub-Saharan Africa. METHODS: We conducted a scoping review guided by Arksey and O'Malley's (2005) framework and Levac et al. (2010) recommendation for methodological enhancement for scoping review studies. We searched for eligible articles from electronic databases such as PubMed/MEDLINE; American Doctoral Dissertations via EBSCO host; Union Catalogue of Theses and Dissertations (UCTD); SA ePublications via SABINET Online; World Cat Dissertations; Theses via OCLC; and Google Scholar. We included studies from January 1990 to August 2018. We used the PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. The Mixed Method Appraisal Tool version 2018 was used to determine the methodological quality of the included studies. We further used NVivo version 11 to aid with content thematic analysis. RESULTS: This study revealed that teaching men about HIV; Community-Based HIV testing; Home-Based HIV testing; Antenatal Care HIV testing; HIV testing incentives and HIV Self-testing are important strategies to improving HIV testing among men in sub-Saharan Africa. The need for improving programmes aimed at giving more information to men about HIV that are specifically tailored for men, especially given their poor uptake of HIV testing services was also found. This study further revealed the need for implementing Universal Test and Treat among HIV positive men found through community-based testing strategies, while suggesting the importance of restructuring home-based HIV testing visits to address the gap posed by mobile populations. CONCLUSION: The community HIV testing, as well as, HIV self-testing strategies showed great potential to increase HIV uptake among men in sub-Saharan Africa. However, to address poor linkage to care, ART should be initiated soon after HIV diagnosis is concluded during community testing services. We also recommend more research aimed at addressing the quality of HIV self-testing kits, as well as, improving the monitoring systems of the distributed HIV self-testing kits.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Programas de Rastreamento , Participação do Paciente/estatística & dados numéricos , Adulto , África ao Sul do Saara/epidemiologia , Atitude Frente a Saúde , Demografia/estatística & dados numéricos , Prática Clínica Baseada em Evidências , Feminino , Geografia , HIV , Infecções por HIV/transmissão , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Testes Sorológicos
20.
BMC Public Health ; 19(1): 774, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208375

RESUMO

BACKGROUND: Regular physical activity (PA) has been recommended for the management of HIV and AIDS. The purpose of this study was to develop a contextualised intervention for promoting PA among women living with HIV and AIDS (WLWHA) of low socioeconomic status (SES). A secondary aim of the study was to optimise the PA intervention using behavioural theory/ frameworks derived from preliminary studies and the literature. METHODS: The Behaviour Change Wheel (BCW) for designing behaviour change interventions was used. This method was further supplemented by evidence from the literature, systematic literature review (SLR), a concurrent mixed methods study and two cross-sectional studies. The SLR aided in determining the theoretical frameworks to inform the intervention, the specific PA behaviours to be targeted by the intervention, the intervention functions, the intervention policy category and the mode of delivery of the intervention. The concurrent mixed methods study was used to identify key factors that needed to change in order for participants to engage in regular PA. The first cross-sectional study was used to determine the gender to be targeted by the study. The second cross-sectional study was used to determine the domain and intensity of PA to target in the intervention. RESULTS: A face-to-face context-sensitive PA intervention employing 14 behavioural change techniques was designed. The PA intervention (a) utilised the Transtheoretical model of behaviour change and the Social Cognitive theory as the underpinning theoretical frameworks (b) included convenient PAs, such as walking, doing simple home-based exercises, engaging in activities of daily living or doing simple exercises at the community centre (c) used education, reward, training in PA, modelling exercise activities and enablement to increase the opportunity to engage in PA as intervention functions (d) used service provision as policy priorities, and (e) used a direct face-to-face mode of delivery. CONCLUSIONS: The PA intervention emphasises behavioural techniques for increasing PA participation, such as goal-setting, self-monitoring, strategies for overcoming PA barriers, social support and rewards. The intervention employs strategies that highlight low-cost local PA resources and opportunities to help HIV infected women of low SES to participate in PA. The BCW provides a useful and comprehensive framework for the development of evidence and theory-based PA interventions for PLWHA of low SES. The BCW can thus be used in the development of interventions that 'talk' to policy by bridging the health inequality gap.


Assuntos
Síndrome de Imunodeficiência Adquirida/terapia , Exercício/psicologia , Infecções por HIV/terapia , Promoção da Saúde/organização & administração , Pobreza , Síndrome de Imunodeficiência Adquirida/epidemiologia , Estudos Transversais , Prática Clínica Baseada em Evidências , Feminino , Infecções por HIV/epidemiologia , Promoção da Saúde/métodos , Humanos , Revisão Sistemática como Assunto
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