scholarly journals Is an opportunistic primary care-based intervention for non-responders to bowel screening feasible and acceptable? A mixed-methods feasibility study in Scotland

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016307 ◽  
Author(s):  
Natalia Calanzani ◽  
Debbie Cavers ◽  
Gabriele Vojt ◽  
Sheina Orbell ◽  
Robert J C Steele ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Feasibility Study ◽  
Occult Blood ◽  
Secondary Outcome ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Test Kit ◽  
General Practices ◽  
Primary Care Professionals

ObjectivesWe aimed to test whether a brief, opportunistic intervention in general practice was a feasible and acceptable way to engage with bowel screening non-responders.DesignThis was a feasibility study testing an intervention which comprised a brief conversation during routine consultation, provision of a patient leaflet and instructions to request a replacement faecal occult blood test kit. A mixed-methods approach to evaluation was adopted. Data were collected from proformas completed after each intervention, from the Bowel Screening Centre database and from questionnaires. Semi-structured interviews were carried out. We used descriptive statistics, content and framework analysis to determine intervention feasibility and acceptability.ParticipantsBowel screening non-responders (as defined by the Scottish Bowel Screening Centre) and primary care professionals working in five general practices in Lothian, Scotland.Primary and secondary outcome measuresSeveral predefined feasibility parameters were assessed, including numbers of patients engaging in conversation, requesting a replacement kit and returning it, and willingness of primary care professionals to deliver the intervention.ResultsThe intervention was offered to 258 patients in five general practices: 220 (87.0%) engaged with the intervention, 60 (23.3%) requested a new kit, 22 (8.5%) kits were completed and returned. Interviews and questionnaires suggest that the intervention was feasible, acceptable and consistent with an existing health prevention agenda. Reported challenges referred to work-related pressures, time constraints and practice priorities.ConclusionsThis intervention was acceptable and resulted in a modest increase in non-responders participating in bowel screening, although outlined challenges may affect sustained implementation. The strategy is also aligned with the increasing role of primary care in promoting bowel screening.

scholarly journals The PROMISES study: a mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040268
Author(s):  
Danielle Ashworth ◽  
Pankhuri Sharma ◽  
Sergio A Silverio ◽  
Simi Khan ◽  
Nishtha Kathuria ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Barriers And Facilitators ◽  
Rural India ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Thematic Framework

IntroductionIndia has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test.MethodsA pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India.ResultsBefore training, ASHAs’ knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators.ConclusionThis study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings.

scholarly journals Using RE-AIM to examine the potential public health impact of an integrated collaborative care intervention for weight and depression management in primary care: Results from the RAINBOW trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248339
Author(s):  
Megan A. Lewis ◽  
Laura K. Wagner ◽  
Lisa G. Rosas ◽  
Nan Lv ◽  
Elizabeth M. Venditti ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Collaborative Care ◽  
Health Impact ◽  
Public Health Impact ◽  
Integrative Approach ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Care Intervention ◽  
The Impact

Background An integrated collaborative care intervention was used to treat primary care patients with comorbid obesity and depression in a randomized clinical trial. To increase wider uptake and dissemination, information is needed on translational potential. Methods The trial collected longitudinal, qualitative data at baseline, 6 months (end of intensive treatment), 12 months (end of maintenance treatment), and 24 months (end of follow-up). Semi-structured interviews (n = 142) were conducted with 54 out of 409 randomly selected trial participants and 37 other stakeholders, such as recruitment staff, intervention staff, and clinicians. Using a Framework Analysis approach, we examined themes across time and stakeholder groups according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Results At baseline, participants and other stakeholders reported being skeptical of the collaborative care approach related to some RE-AIM dimensions. However, over time they indicated greater confidence regarding the potential for future public health impact. They also provided information on barriers and actionable information to enhance program reach, effectiveness, adoption, implementation, and maintenance. Conclusions RE-AIM provided a useful framework for understanding how to increase the impact of a collaborative and integrative approach for treating comorbid obesity and depression. It also demonstrates the utility of using the framework as a planning tool early in the evidence-generation pipeline.

scholarly journals Personality disorder co-morbidity in primary care ‘Improving Access to Psychological Therapy’ (IAPT) services: a qualitative study exploring patient perspectives on treatment experience

2020 ◽  
pp. 1-15
Author(s):  
Gary Lamph ◽  
John Baker ◽  
Tommy Dickinson ◽  
Karina Lovell
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Personality Disorder ◽  
Qualitative Study ◽  
Patient Group ◽  
Stepped Care ◽  
Research Approach ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Co Morbidity

Abstract Background: High numbers of people present with common mental health disorders and co-morbid personality disorder traits in primary care ‘Improving Access to Psychological Therapies’ (IAPT) services in England and they receive sub-optimal treatments. No previous studies have explored the treatment experiences or needs of this patient population in England. Aims: This qualitative study explored the treatment experiences of patients (n = 22) with common mental health difficulties and co-morbid personality disorder as indicated by a score of 3 or more on the ‘Standardised Assessment of Personality – Abbreviated Scale’ (SAPAS) in receipt of primary care-based IAPT treatment. Method: A qualitative health research approach was used. Qualitative individual face-to-face semi-structured interviews were conducted. All interviews were audio recorded, data were transcribed verbatim and analysed using a framework analysis approach. Results: Findings revealed a need to adapt away from prescriptive cognitive behavioural therapy (CBT) treatment models towards more flexible, personalised and individualised treatment with this patient group. Time to emotionally offload, build a therapeutic relationship and link past experiences to presenting problems were highlighted as important. Conclusions: For the first time, the needs and treatment experiences of this patient group have been explored. This paper provides a unique patient experience insight that should be considered when exploring new approaches to working with and developing effective interventions via a stepped care approach.

scholarly journals Psychological Therapy for Postnatal Depression in UK Primary Care Mental Health Services: A Qualitative Investigation Using Framework Analysis

2019 ◽  
Vol 28 (12) ◽  
pp. 3519-3532
Author(s):  
Holly Hadfield ◽  
Suzanne Glendenning ◽  
Penny Bee ◽  
Anja Wittkowski
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Postnatal Depression ◽  
Psychological Therapy ◽  
Negative Consequences ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Parenting Support ◽  
Psychological Therapies ◽  
Current Psychological

Abstract Objectives Postnatal depression (PND) can have negative consequences for mother and infant. Current psychological therapies are effective in treating depression but improvements in mother-infant outcomes have not yet been established. We aimed to capture mothers’ experiences of therapy for PND with a focus on parenting-related outcomes. We also sought their views on including parenting support within interventions. Methods Fourteen mothers who received psychological therapy in the United Kingdom’s National Health Service (NHS) participated in semi-structured interviews. Data were audio-recorded, transcribed, coded and analysed using Framework Analysis. Results Three main themes were identified: ‘The experience of therapy’, ‘Therapy outcomes’ and ‘Views about parenting interventions for postnatal depression’. The main themes were underpinned by other themes. Overall the findings revealed that mothers perceived therapy as helpful in improving mood, confidence as a parent and relationship with their infant. Mothers valued the process of normalising their experiences within group therapy and by their therapists because it reduced any shame and stigma associated with PND. Mothers thought parenting support within therapy would be acceptable if delivered collaboratively. Conclusions Primary care-based psychological therapy for PND was perceived as helpful and acceptable. It clearly met some of the mothers’ goals, especially if their beliefs about being a ‘bad mother’ was challenged and modified. Barriers to engagement, such as childcare issues and therapist’s knowledge about perinatal mental health, would also need to be overcome. Finally, mother-infant interventions should be further explored as an adjunct treatment option.

scholarly journals Mixed methods study protocol to examine perceptions of family medicine among long-term patients of a family medicine clinic in Japan

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037113
Author(s):  
Kotaro Sato ◽  
Ryoko Michinobu ◽  
Tesshu Kusaba
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Family Medicine ◽  
Phase I ◽  
Phase Ii ◽  
Medical Specialty ◽  
Structured Interviews ◽  
Two Phase ◽  
Care Systems

IntroductionFamily physicians or general practitioners play central roles in many countries’ primary care systems, but family medicine (FM) remains relatively unestablished in Japan. Previous studies in Japan have examined the general population’s understanding of FM as a medical specialty, but none have explored this topic using actual FM clinic patients. Here, we describe a protocol to explore the perceptions of FM among long-term patients of one of Japan’s oldest FM clinics.Methods and analysisThe study will be conducted at the Motowanishi Family Clinic in Hokkaido, Japan, using patients who have attended the clinic for over 10 years. The analysis will adopt a two-phase explanatory sequential mixed methods design. During phase I, quantitative data from participants’ medical records will be collected and reviewed, and patients’ perceptions of FM will be assessed through a questionnaire. The correlations between participants’ knowledge that the clinic specialises in FM and various characteristics will be examined. In phase II, qualitative data will be collected through semi-structured interviews of approximately 10 participants selected using maximum variation sampling based on phase I results. A thematic analysis will be conducted in phase II to identify patients’ perceptions and changes in perceptions. Finally, each theme identified in phase II will be transformed into a quantitative variable to analyse the relationships between the phases. A joint display will be used to integrate the phases’ findings and examine how phase II results explain phase I results.Ethics and disseminationThe institutional review board of the Japan Primary Care Association has approved this research (2019-003). The results will be presented at the association’s annual academic meeting and submitted for publication in relevant journals. The findings will also be provided to the patients via the clinic’s internal newsletter.

Behavioural change in primary care professionals undertaking online education in dementia care in general practice

2019 ◽  
Vol 25 (3) ◽  
pp. 244 ◽  
Author(s):  
Michael W. Bentley ◽  
Rohan Kerr ◽  
Margaret Ginger ◽  
Jacob Karagoz
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Online Education ◽  
Behavioural Change ◽  
Dementia Care ◽  
Practice Nurses ◽  
People With Dementia ◽  
General Practices ◽  
Primary Care Professionals ◽  
Systematic Framework

A challenge facing general practice is improving the diagnosis, management and care of people with dementia. Training and education for primary care professionals about knowledge and attitudes about dementia is needed. Online resources can provide educational opportunities for health professionals with limited access to dementia training. An online educational resource (four modules over 3 h) was designed to assist primary care practitioners to develop a systematic framework to identify, diagnose and manage patients with dementia within their practice. Interviews and questionnaires (knowledge, attitudes, confidence and behavioural intentions), with practice nurses and international medical graduates working in general practices, were used to evaluate the resource. Participants’ knowledge, confidence and attitudes about dementia increased after completing the modules. Participants had strong intentions to apply a systematic framework to identify and manage dementia. In post-module interviews, participants reported increased awareness, knowledge and confidence in assessing and managing people with dementia, corroborating the questionnaire results. This project has demonstrated some early changes in clinical behaviour around dementia care in general practice. Promoting the value of applying a systematic framework with colleagues and co-workers could increase awareness of, and participation in, dementia assessment by other primary care professionals within general practices.

scholarly journals Effects of mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians: a mixed-methods study

BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101621 ◽  
Author(s):  
Herman van Wietmarschen ◽  
Bram Tjaden ◽  
Marja van Vliet ◽  
Marieke Battjes-Fries ◽  
Miek Jong
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Perceived Stress ◽  
Primary Care Physicians ◽  
Mindfulness Training ◽  
Structured Interviews ◽  
Self Reflection ◽  
Self Compassion ◽  
High Workload ◽  
Compassion Scale

BackgroundPrimary care physicians are subjected to a high workload, which can lead to stress and a high incidence of burnout. A mindfulness training course was developed and implemented for primary care physicians to better cope with stress and improve job functioning.AimTo gain insight into the effects of the mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians.Design & settingA pragmatic mixed-methods pre–post design in which physicians received 8 weeks of mindfulness training.MethodParticipants completed validated questionnaires on perceived stress (Perceived Stress Scale [PSS]), self-compassion (Self-Compassion Scale [SCS]), and self-reflection (Groningen Reflection Ability Scale [GRAS]) before the training, directly after, and 6 months later. Semi-structured interviews were conducted with six participants after the training and a content analysis was performed to gain in depth understanding of experiences.ResultsA total of 54 physicians participated in the study. PSS was reduced (mean difference [MD] -4.5, P<0.001), SCS improved (MD = 0.5, P<0.001), and GRAS improved (MD = 3.3, P<0.001), directly after the 8-week training compared with before training. Six months later, PSS was still reduced (MD = -2.9, P = 0.025) and SCS improved (MD = 0.7, P<0.001). GRAS did not remain significant (MD = 2.5, P = 0.120). Qualitative analysis revealed four themes: being more aware of their own feelings and thoughts; being better able to accept situations; experiencing more peacefulness; and having more openness to the self and others.ConclusionMindfulness training might be an effective approach for improving stress resilience, self-compassion, and self-reflection in primary care physicians.

scholarly journals Pharmacist joint-working with general practices: evaluating the Sheffield Primary Care Pharmacy Programme. A mixed-methods study

BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101611 ◽  
Author(s):  
Iuri Marques ◽  
Nicola Jane Gray ◽  
Jo Tsoneva ◽  
Peter Magirr ◽  
Alison Blenkinsopp
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Community Pharmacy ◽  
Care Delivery ◽  
Care Pathway ◽  
Large City ◽  
Pharmacy Practice ◽  
Mixed Methods Study ◽  
Cross Sectional Survey ◽  
General Practices

BackgroundThe NHS in the UK supports pharmacists’ deployment into general practices. This article reports on the implementation and impact of the Primary Care Pharmacy Programme (PCPP). The programme is a care delivery model that was undertaken at scale across a city in which community pharmacists (CPs) were matched with general practices and performed clinical duties for one half-day per week.AimTo investigate (a) challenges of integration of CPs in general practices, and (b) the perceived impact on care delivery and community pharmacy practice.Design & settingThis mixed-methods study was conducted with CPs, community pharmacy employers (CPEs), scheme commissioners (SCs), and patients in Sheffield.MethodSemi-structured interviews (n = 22) took place with CPs (n = 12), CPEs (n = 2), SCs (n = 3), and patients (n = 5). A cross-sectional survey of PCPP pharmacists (n = 47, 66%) was also used. A descriptive analysis of patient feedback forms was undertaken and a database of pharmacist activities was created.ResultsEighty-six of 88 practices deployed a pharmacist. Although community pharmacy contracting and backfill arrangements were sometimes complicated, timely deployment was achieved. Development of closer relationships appeared to facilitate extension of initially agreed roles, including transition from ‘backroom’ to patient-facing clinical work. CPs gained understanding of GP processes and patients’ primary care pathway, allowing them to follow up work at the community pharmacy in a more timely way, positively impacting on patients' and healthcare professionals’ perceived delivery of care.ConclusionThe PCPP scheme was the first of its kind to achieve almost universal uptake by GPs throughout a large city. The study findings reveal the potential for CP–GP joint-working in increasing perceived positive care delivery and reducing fragmented care, and can inform future implementation at scale and at practice level.

scholarly journals Nutritionists and the comprehensive care of overweight individuals in primary care

2019 ◽  
Vol 32 ◽  
Author(s):  
Ana Luisa Souza de Paiva MOURA ◽  
Elisabetta RECINE
Keyword(s):  
Primary Care ◽  
Theoretical Domains Framework ◽  
Federal District ◽  
Theoretical Framework ◽  
Noncommunicable Diseases ◽  
Care Model ◽  
Structured Interviews ◽  
Appropriate Care ◽  
Different Types ◽  
Primary Care Professionals

ABSTRACT Objective This study sought to highlight the different types of challenges for the integral care of overweight individuals in primary care based on the perception of nutritionists. Methods This is a qualitative study with primary care professionals from the Federal District, Brazil. Semi-structured interviews were conducted to understand the perceptions regarding the organization of integral care. The analysis of the data was based on the theoretical framework Theoretical Domains Framework. Results Challenges related to 10 of the 12 different domains proposed by the theoretical framework were identifi ed. These challenges are related to the capability, opportunity and motivation of workers to act to offer moreeffective care. Conclusion The different nature of the barriers identifi ed were overlapped, which reveal the need for professional qualifi cation along with the consolidation of an appropriate care model for chronic noncommunicable diseases such as obesity.

Sign in / Sign up

Export Citation Format

Share Document