What am I doing here? Enablers and barriers to community-based cardiac rehabilitation attendance: a qualitative study utilising a behavioural science approach

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Community Engaged Scholars Programme (CES-P), PPI Ignite, National University of Ireland, Galway Background Despite the well-established benefits of cardiovascular prevention and rehabilitation, programme uptake rates remain suboptimal. Delivering cardiac rehabilitation (CR) in the community offers an alternative model of care that may help address the challenges that exist around uptake and accessibility of CR. Yet in comparison to traditional hospital based CR programmes less is known about the enablers and barriers that may be unique to attending community based CR programmes. Purpose This study aimed to identify enablers and barriers to attending and completing a community-based CR programme from the patient perspective. Methods Individuals who were referred to a 12 week, interdisciplinary, multi-component community-based CR programme were invited to take part in semi-structured interviews. Reasons for attending or not attending the programme and for completing or not completing the full programme were discussed. Purposeful sampling was used to obtain variation in age, gender, and level of engagement with the programme. Interviews were transcribed verbatim and analysed using framework analysis guided by the Capability Opportunity Motivation (COM B) Model and the Theoretical Domains Framework, to explore initial attendance and programme completion. Results Data saturation was achieved with sixteen participants. The majority of the identified barriers and enablers were common to both initial programme attendance and completion of programme. Having the social opportunity to receive support from peers, family members and staff was seen as an important enabler. While ease of access to a programme based in the community enabled attendance and completion, for some, distance to the cardiac rehabilitation centre was a barrier. Further barriers related to capability issues regarding poor physical health, time, work commitments and travel. Key motivational enablers included, beliefs around consequences, improved health status, knowledge, goals, intentions and personality. Identity was an important determinant of attendance as participants discussed their understanding of "what am I doing here?" Some participants identified themselves as the type of person who would benefit from the programme and others did not. For example, some felt the programme would suit those who needed motivation to enhance their health and some felt the programme was more or less suited to people of different ages and fitness levels. Conclusion The results suggest that interventions to enhance attendance at community-based CR need to address multiple factors related to capability, opportunity and motivation. While there is no one model of cardiovascular prevention and rehabilitation that will meet the needs of all patients, patients should be offered community based programmes as part of a choice of options that fit their needs and personal preferences.

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Using Theoretical Domains Framework for Exploring Appropriate Sitting Posture Determinants Among Office Workers: A Content Analysis Study

Health Scope ◽

10.5812/jhealthscope.108354 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Parisa Hosseini-Koukamari ◽

Mohtasham Ghaffari ◽

Sedigheh Sadat Tavafian ◽

Ali Ramezankhani

Keyword(s):

Content Analysis ◽

Theoretical Domains Framework ◽

Office Workers ◽

Structured Interviews ◽

Framework Analysis ◽

Related Factors ◽

Convenience Sample ◽

Sitting Posture ◽

Starting Point ◽

Structured Interventions

Background: Sedentary occupations frequently expose employees to prolonged periods with poor posture, which has been considered as the cause of musculoskeletal disorder. Objectives: The study set out to identify the related factors of a taking healthy sitting posture in office workers. Methods: This qualitative study aimed to use the theoretical domains framework (TDF) to investigate perceived determinants to taking a proper sitting posture in office workers. Semi-structured interviews with 25 office workers according to purposive sampling was conducted with a convenience sample of university office workers in Iran. Recorded interviews were transcribed into MAXQDA version 10. Directed content analysis and framework analysis were used for drawing the 12 domains of the TDF. Results: Explored themes were mapped onto the TDF domains, including skills, knowledge, behavioral regulation, goals, environmental context and resources, social influences, beliefs about capability, intentions, emotion, beliefs about consequences, memory, and attention and reinforcement. Conclusions: This study is a theoretical starting point in making structured interventions to change improper sitting posture among office workers. Also, the identified factors provide organizational managers with a wide list of factors by which they can encourage their employees to use proper postures in the workplace, leading to a significant reduction in job absenteeism and insurance fees associated with health problems. In addition, this study enriches the literature by providing additional empirical evidence for the TDF theory.

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Barriers to home bowel screening test in South Asians in the UK

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1342 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

L Smith ◽

S Howcutt ◽

P Saini ◽

J Brett ◽

C Henshall ◽

...

Keyword(s):

Screening Test ◽

South Asians ◽

Theoretical Domains Framework ◽

Target Population ◽

Bowel Cancer ◽

Structured Interviews ◽

Framework Analysis ◽

Home Test ◽

Early Results ◽

The Uk

Abstract Background Bowel cancer is common and accounts for 10% of all cancer mortality. Early detection significantly reduces mortality. In the UK, the NHS Bowel Cancer Screening Programme invites adults aged 60-74 years to carry out a home screening test biennially. The national target for test completion is 60%; completion is substantially lower (∼30%) amongst South Asian populations. Our aim was to develop a community-based intervention to increase completion of the home bowel screening test in South Asians. Methods Multi-methods comprising two stages: 1) group and individual interviews with South Asians aged 50-74 years purposively sampled from community groups for maximum variation. Semi-structured interviews based on the Theoretical Domains Framework (TDF) investigated determinants of bowel screening completion. Interviews were recorded, transcribed, and analysed using framework analysis and findings mapped onto the COM-B Behaviour Change Wheel; 2) Co-production of intervention during two workshops with key stakeholders and target population. Results To-date 25 adults recruited of Indian, Pakistani and Bangladeshi ethnicity with variation in age, gender, first language, faith, and compliance with bowel screening. Key barriers and TDF domains that they mapped to were: - lack of knowledge about bowel cancer and screening; lack of language, literacy and physical ability (skills) to carry out the home test; confidence to carry it out correctly (belief about capabilities); appropriate space and time to carry out the test (environmental context and resources); putting off undertaking the test (memory attention and decision processes); risk perception and fear of cancer (emotions). Enablers were: social influences from peers; goals and motivations. Conclusions Early results suggest an intervention comprising education, persuasion, modelling and enablement functions could increase completion of the home test. Key messages Community engagement and working with community leaders enhanced the success of recruitment. The TDF was a useful framework for identifying barriers to home bowel screening test by South Asians in the South East of England.

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Enabling Better Physical Activity and Screen Time Behaviours for Adolescents from Middle Eastern Backgrounds: Semi-Structured Interviews with Parents

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312787 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12787

Author(s):

Nematullah Hayba ◽

Yumeng Shi ◽

Margaret Allman-Farinelli

Keyword(s):

Physical Activity ◽

Screen Time ◽

Culturally Responsive ◽

Middle Eastern ◽

Theoretical Domains Framework ◽

Cultural Barriers ◽

Structured Interviews ◽

Community Based ◽

Lower Socioeconomic ◽

The Social

The unrelenting obesity pandemic in Middle Eastern (ME) adolescents living in Australia warrants culturally responsive and locally engineered interventions. Given the influence of parents on the lifestyle behaviours of adolescents, this qualitative study aimed to capture the opinions of ME parents on the barriers and enablers to sufficient physical activity and limiting screen time behaviours in adolescents. Semi-structured interviews were conducted with 26 ME parents (female) aged 35–59 years old, most of whom resided in lower socioeconomic areas (n = 19). A reflexive thematic analysis using the Theoretical Domains Framework and the Capability, Opportunity, Motivation-Behaviour model was performed for coding. Parents voiced confidence in their knowledge of the importance of physical activity and limiting screen time but were less optimistic in their ability to enable change in behaviours, especially for older adolescents without outside support. Despite adolescents having the necessary skills to engage in a wide array of sports, the parents admitted deep fears regarding the safety of the social environment and restricted their children’s independent mobility. Gender differences were noted, with parents reporting older girls expressing disinterest in sports and having limited physical opportunities to participate in sports at school. It may be that a community-based participatory framework is needed to improve physical activity opportunities and to address specific physical, social, and cultural barriers.

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Connecting primary care patients to community-based physical activity: a qualitative study of health professional and patient views

BJGP Open ◽

10.3399/bjgpopen20x101100 ◽

2020 ◽

Vol 4 (3) ◽

pp. bjgpopen20X101100

Author(s):

Sharon Ann Carstairs ◽

Rayna H Rogowsky ◽

Kathryn B Cunningham ◽

Frank Sullivan ◽

Gozde Ozakinci

Keyword(s):

Physical Activity ◽

Primary Care ◽

Health Professionals ◽

Theoretical Domains Framework ◽

Barriers And Facilitators ◽

Structured Interviews ◽

Community Based ◽

Healthcare Settings ◽

Primary Care Patients ◽

Exercise Programmes

BackgroundInconclusive evidence supporting referrals from health professionals to gym-based exercise programmes has raised concern for the roll-out of such schemes, and highlights the importance of developing links between healthcare settings and community-based opportunities to improve physical activity (PA) levels.AimThis study aimed to identify methods, and explore barriers and facilitators, of connecting primary care patients with PA opportunities from the perspectives of both health professionals (HPs) and patients, using the example of jogscotland.Design & settingAn exploratory study utilising semi-structured interviews with primary care patients (n = 14) and HPs (n = 14) from one UK NHS board was conducted.MethodPatient and HP transcripts were analysed separately using thematic analysis. Potential methods of connection were identified. The Capability, Opportunity, Motivation, behavioural (COM-B) model and theoretical domains framework (TDF) were employed to facilitate identification of barriers and facilitators for connecting primary care to community jogscotland groups.ResultsThree methods of connecting patients to community-based groups were identified: informal passive signposting, informal active signposting, and formal referral or prescribing. Barriers and facilitators for patient connection fell into five TDF domains for HPs and two COM-B model components for patients.ConclusionFor patients, HPs raising the topic of PA can help to justify, facilitate, and motivate action to change. The workload associated with connecting patients with community-based opportunities is central to implementation by HPs. Integrative resource solutions and social support for patients can provide a greater variety of PA options and the vital information and support for connecting with local opportunities, such as jogscotland.

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‘A bridge to normal’: a qualitative study of Indonesian women’s attendance in a phase two cardiac rehabilitation programme

European Journal of Cardiovascular Nursing ◽

10.1177/1474515119864208 ◽

2019 ◽

Vol 18 (8) ◽

pp. 744-752 ◽

Cited By ~ 1

Author(s):

Sutantri Sutantri ◽

Fiona Cuthill ◽

Aisha Holloway

Keyword(s):

Cardiac Rehabilitation ◽

Social Roles ◽

Rehabilitation Programme ◽

Structured Interviews ◽

Framework Analysis ◽

Cardiac Rehabilitation Programme ◽

Mortality And Morbidity ◽

Qualitative Research Design ◽

Collection Data

Background: Cardiac rehabilitation is effective in reducing mortality and morbidity, in improving life expectancy and quality of life for people with cardiovascular disease. Despite these recognised benefits, women’s attendance rates in cardiac rehabilitation programmes remain suboptimal. Aims: This paper details the study that explored factors that influence women’s attendance of a phase two cardiac rehabilitation programme in Indonesia Methods: An exploratory qualitative research design was used in the study. Semi-structured interviews were used as the main method of data collection. Data were collected from June to September 2016. Twenty-three women aged between 30 and 66 years were interviewed. Transcribed interview data were analysed using a qualitative framework analysis. Results: Three major themes were inferred from the analysis: (a) a bridge to normal; (b) connecting with others; and (c) contextual factors. The first theme is illustrated by two subthemes: ‘making my heart work again’ and ‘performing social roles’. The second theme was illustrated by the following subthemes: ‘exchanging knowledge and experience’ and ‘developing a give-and-take relationship’. The third theme was illustrated by three subthemes: ‘recommendations from the staff’, ‘family support’ and ‘availability of health insurance’. Conclusion: Women’s attendance in cardiac rehabilitation in Indonesia is mainly influenced by their expectations and desire to be able to resume their previous social roles in the family and society. The findings of this study can assist healthcare professionals to understand better the needs of women and the fit between women’s needs and existing cardiac rehabilitation programmes. Such understanding could provide direction for more effective approaches to the cardiac rehabilitation programmes that are currently offered in Indonesia.

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Bridging the gap from hospital discharge to cardiac rehabilitation using the intervention mapping approach (BRIDGE2CARE)

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.426 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

P Keessen ◽

ICD Van Duijvenbode ◽

CHM Latour ◽

RA Kraaijenhagen ◽

V Janssen ◽

...

Keyword(s):

Psychological Distress ◽

Side Effects ◽

Cardiac Rehabilitation ◽

Hospital Discharge ◽

Intervention Mapping ◽

Physical Activities ◽

Public Institution ◽

Support Needs ◽

Structured Interviews ◽

Daily Physical Activities

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Dutch Research Council INTRODUCTION Cardiac rehabilitation (CR) is the cornerstone of secondary prevention. After hospital discharge, patients have to wait for participation in CR while often feeling overwhelmed by their cardiac event and in need of tailored information and support. PURPOSE The objective of this study was to develop a remote (digital) intervention to bridge the gap from hospital discharge to CR. METHODS We developed an intervention by completing the first three steps of the intervention mapping protocol. Step 1: identification of information- and support needs from the literature and semi-structured interviews. Step 2: Describing performance objectives for the intervention and selecting determinants. Step 3: Generation of program themes and theory based change methods. RESULTS (Step 1) The following Information- and support needs were identified from the literature (n = 33) and semi structured interviews (n = 22): information about pathology and intervention, medication and side effects, daily physical activities, psychological distress, body signals and social support. Advanced communication and pedagogical skills of the health care provider and the ability to build trust were described as important prerequisites for the intervention. (Step 2) The following performance objectives were formulated: (1) Patients gain knowledge on how their cardiac illness and procedure affects their bodies and health, (2) Patients gain knowledge about medication and side effects, (3) Patients know which daily physical activities they can and can’t do after hospital discharge and are physically active, (4) Patients and informal caregivers can deal with psychological distress and know how to discriminate between harmful and harmless body signals. Objectives were described per determinant (knowledge, skill, attitude, social influence, self-efficacy and outcome expectation). (Step 3) A comprehensive remote intervention was developed using theory based coaching strategies, a digital patient platform and information videoclips. CONCLUSION This study describes the information and support needs of patients after cardiac hospitalization and offers a remote intervention that bridges the gap form hospital discharge to CR. Abstract Figure. BRIDGE2CARE

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Influences on the uptake of health and wellbeing apps and curated app portals: a think aloud and interview study. (Preprint)

10.2196/preprints.27173 ◽

2021 ◽

Author(s):

Dorothy Szinay ◽

Olga Perski ◽

Andy Jones ◽

Tim Chadborn ◽

Jamie Brown ◽

...

Keyword(s):

Data Protection ◽

Social Influences ◽

Theoretical Domains Framework ◽

Literacy Skills ◽

Structured Interviews ◽

Framework Analysis ◽

Health And Wellbeing ◽

Perceived Utility ◽

Address Data ◽

Important People

BACKGROUND Health and wellbeing smartphone apps can be identified through different routes, including via curated health app portals, but little is known about people’s experiences of this. OBJECTIVE This study explored how people select health apps online and their views on curated portals. METHODS Eighteen UK-based adults were recruited and asked to verbalise their thoughts whilst searching for a health or wellbeing app online, including on two curated health app portals. This was followed by semi-structured interviews. Data were analysed using Framework Analysis, informed by the COM-B model and the Theoretical Domains Framework. RESULTS Searching for health and wellbeing apps online was described as a ‘minefield’. App uptake appeared to be influenced by i) capabilities (e.g. app literacy skills, health and app awareness), ii) opportunities (e.g. app aesthetics, cost and social influences) and iii) motivation (e.g. the perceived utility and accuracy of the app, and transparency about data protection). Social influences and the percieved utility of an app, in particular, were important. People were not previously aware of curated portals but found the concept appealing and likely to engender trust and address data protection concerns. While apps listed on these were perceived as more trustworthy, their presentation was considered disappointing. CONCLUSIONS The uptake of health and wellbeing apps appear primarily influenced by social influences and the perceived utility of the app. With curated health app portals perceived as credible, app uptake via such portals may mitigate concerns related to data protection and accuracy, but their implementation must better meet user needs. CLINICALTRIAL NA

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Maternal and child health nurses’ experiences of implementing two community-based breastfeeding interventions in Victoria, Australia: A mixed methods process evaluation

Australian Journal of Child and Family Health Nursing ◽

10.33235/ajcfhn.16.1.4-14 ◽

2019 ◽

Vol 16 (1) ◽

pp. 4-14 ◽

Cited By ~ 1

Author(s):

Rhian L Cramer ◽

Helen L McLachlan ◽

Touran Shafiei ◽

Lisa H Amir ◽

Meabh Cullinane ◽

...

Keyword(s):

Child Health ◽

Maternal And Child Health ◽

Randomised Trial ◽

Cluster Randomised Trial ◽

Breastfeeding Initiation ◽

Structured Interviews ◽

Breastfeeding Support ◽

Community Based ◽

Significant Drop ◽

And Child Health

Despite high rates of breastfeeding initiation in Australia, there is a significant drop in breastfeeding rates in the early postpartum period, and Australian government breastfeeding targets are not being met. The Supporting breastfeeding In Local Communities (SILC) trial was a three-arm cluster randomised trial implemented in 10 Victorian local government areas (LGAs). It aimed to determine whether early home-based breastfeeding support by a maternal and child health nurse (MCH nurse) with or without access to a community-based breastfeeding drop-in centre increased the proportion of infants receiving ‘any’ breast milk at four months. Focus groups, a written questionnaire and semi-structured interviews were undertaken to explore the interventions from the perspective of the SILC-MCH nurses (n=13) and coordinators (n=6), who established and implemented the interventions. Inductive thematic analysis was used to identify themes, then findings further examined using Diffusion of Innovations Theory as a framework. SILC-MCH nurses and coordinators reported high levels of satisfaction, valuing the opportunity to improve breastfeeding in our community; and having focused breastfeeding time with women in their own homes. They felt the SILC interventions offered benefits to women, nurses and the MCH service. Implementing new interventions into existing, complex community health services presented unforeseen challenges, which were different in each LGA and were in part due to the complexity of the individual LGAs and not the interventions themselves. These findings will help inform the planning and development of future programs aimed at improving breastfeeding and other interventions in MCH.

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The psychosocial response to a terrorist attack at Manchester Arena, 2017: a process evaluation

BMC Psychology ◽

10.1186/s40359-021-00527-4 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Daniel Hind ◽

Kate Allsopp ◽

Prathiba Chitsabesan ◽

Paul French

Keyword(s):

Young People ◽

Process Evaluation ◽

Terrorist Attack ◽

Health Sector ◽

Routine Data ◽

Recovery Phase ◽

Normalisation Process Theory ◽

Structured Interviews ◽

Framework Analysis ◽

Response Phase

Abstract Background A 2017 terrorist attack in Manchester, UK, affected large numbers of adults and young people. During the response phase (first seven weeks), a multi-sector collaborative co-ordinated a decentralised response. In the subsequent recovery phase they implemented a centralised assertive outreach programme, ‘The Resilience Hub’, to screen and refer those affected. We present a process evaluation conducted after 1 year. Methods Case study, involving a logic modelling approach, aggregate routine data, and semi-structured interviews topic guides based on the Inter-Agency Collaboration Framework and May’s Normalisation Process Theory. Leaders from health, education and voluntary sectors (n = 21) and frontline Resilience Hub workers (n = 6) were sampled for maximum variation or theoretically, then consented and interviewed. Framework analysis of transcripts was undertaken by two researchers. Results Devolved government, a collaborative culture, and existing clinical networks meant that, in the response phase, a collaboration was quickly established between health and education. All but one leader evaluated the response positively, although they were not involved in pre-disaster statutory planning. However, despite overwhelming positive feedback there were clear difficulties. (1) Some voluntary sector colleagues felt that it took some time for them to be involved. (2) Other VCSE organisations were accused of inappropriate, harmful use of early intervention. (3) The health sector were accused of overlooking those below the threshold for clinical treatment. (4) There was a perception that there were barriers to information sharing across organisations, which was particularly evident in relation to attempts to outreach to first responders and other professionals who may have been affected by the incident. (5) Hub workers encountered barriers to referring people who live outside of Greater Manchester. After 1 year of the recovery phase, 877 children and young people and 2375 adults had completed screening via the Resilience Hub, 79% of whom lived outside Greater Manchester. Conclusions The psychosocial response to terrorist attacks and other contingencies should be planned and practiced before the event, including reviews of communications, protocols, data sharing procedures and workforce capacity. Further research is needed to understand how the health and voluntary sectors can best collaborate in the wake of future incidents.

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Rationale and design of remotely-supervised cardiac rehabilitation study in patients with obstructive sleep apnea

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.207 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

J Hnatiak ◽

O Ludka ◽

L Batalik ◽

P Winnige ◽

F Dosbaba

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cardiac Rehabilitation ◽

Public Institution ◽

Moderate Intensity ◽

Newly Diagnosed ◽

Cpap Therapy ◽

Phone Calls ◽

Obstructive Sleep ◽

Home Conditions

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Ministry of Health Czech Republic; identification of organization 65269705 Background Although continuous positive airway pressure (CPAP) is currently still the gold standard for therapy of moderate to severe obstructive sleep apnea (OSA), another alternative or adjunct effective therapeutic options exist. Lifestyle intervention focused on nutrition and weight reduction, regular exercise, sleep hygiene, smoking and alcohol restriction represents a recommended therapeutic strategy for OSA. Though this intervention represents an effective tool for improving objective and subjective parameters of OSA, it’s effectivity depends on components of the intervention, OSA severity and gender. Comprehensive remotely-supervised cardiac rehabilitation (CR) represents possible training intervention in home conditions using elements of telemedicine. Purpose This prospective study aims to investigate the feasibility and effect of a remotely-supervised CR in patients with newly diagnosed OSA with Apnea-Hypopnea Index greater than 15 episodes per hour. Methods This monocentric study is designed as a prospective, parallel, randomised, controlled trial of remotely-supervised 12-week CR in male patients between 40-60 years old with newly diagnosed OSA indicated to CPAP therapy. The sample size is calculated by 0,05 level of significance and 80% statistical power on 25 participants in each group. The Intervention group will undergo comprehensive remotely-supervised CR in home conditions with teleconsultation (contains telecoaching, telemonitoring) via regular phone calls and e-mails at least 1-2 times a week. The intervention will include nutrition, health-related lifestyle and behavioral changes recommendations, and at least 5 times a week 30 minutes of moderate-intensity aerobic training, 10 minutes of inspiratory and expiratory muscle training with breathing device and 10 minutes of oropharyngeal exercise along with individually titrated CPAP therapy. The control group will undergo individually titrated CPAP therapy only. The participants in both groups will go through the following assessments before and after this study: polysomnography, spirometry, anthropometry and body composition examination, laboratory values examination, quality of life questionnaires, Epworth sleepiness scale, 6-min walking test. Conclusions: Comprehensive remotely-supervised CR, as mentioned in this study, may represent an adjunct therapy with a promising future in patients with OSA. The study is occupied with a current issue and can also bring new possibilities and experiences in remote rehabilitation.

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