Using the Awareness, Motivation, Skills, and Opportunity Framework for Health Promotion in a Primary Care Network.

Purpose. To use the Awareness, Motivation, Skills, and Opportunity (AMSO) framework as a foundation for service delivery in a primary care network (PCN). Method. The AMSO framework (awareness, motivation, skills, opportunity) was integrated into PCN program design: Health Basics (8 weeks with monthly follow-up) focused on healthy living and Happiness Basics (6 weeks) used positive psychology. Evaluation included quality of life (QofL) and participant experience; weight, body mass index, and waist circumference were included for Health Basics. Data were analyzed using descriptive statistics, paired t tests, and thematic analysis. Setting. PCN in western Canada with midsized urban center and surrounding areas. Participants. Health Basics-adults with or at risk for chronic disease (n = 103). Happiness Basics-adults with depression, languishing, or flourishing (n = 124). Results. Changes were evident in weight loss, body mass index, waist circumference, and QofL (p < .05) for Health Basics participants. The participants also reported being more active, eating healthier, having a more positive mind-set, and having confidence in making lifestyle changes. Happiness Basics participants' QofL improved in all domains (p < .05) except the physical summary score (p = .079). Happiness participants described positive experiences and learned new skills. Conclusion. The AMSO framework was successfully implemented in our PCN. Recommendations are included to improve program effectiveness and use.

Implementation of a nutrition support protocol increases the proportion of mechanically ventilated patients reaching enteral nutrition targets in the adult intensive care unit.

BACKGROUND: Despite the evidence that enteral feeding reduces morbidity in critically ill patients and is preferred to parenteral nutrition, the delivery of enteral nutrition (EN) is often inadequate. The purpose of this study was to determine whether implementation of an evidence-based nutrition support (NS) protocol could improve EN delivery. METHODS: An NS protocol incorporating available scientific evidence; data from a retrospective survey of 30 intensive care unit (ICU) patients; and input from dietitians, intensive care physicians, surgeons, nurses, and pharmacists was developed. The impact of this protocol was evaluated prospectively in 123 consecutive adult patients admitted to a multisystem ICU who were eligible for EN. RESULTS: The percentage of patients who received at least 80% of their estimated energy requirements during their ICU stay increased from 20% before implementation of the NS protocol to 60% after implementation (p < .001). After adjusting for confounders, those in the postimplementation group received significantly more kcal/kg/d than the preimplementation group (3.71 kcal/kg/d; 95% confidence interval, 1.64 to 5.78; p = .001). Parenteral nutrition use [corrected] was reduced in the postimplementation group (1.6 vs 13%, p = .02). There was no difference in time to initiation of enteral nutrition between groups (1.76 days preprotocol vs 1.44 days postprotocol implementation, p = .9). CONCLUSIONS: The development and use of an evidence-based NS protocol improved the proportion of enterally fed ICU patients meeting their calculated nutrition requirements.