Knowledge mobilisation: a UK co-creation study to devise strategies to amend lay and practitioner atopic eczema mindlines to improve consultation experiences and self-management practices in primary care

ObjectiveTo devise strategies to amend lay and practitioner atopic eczema mindlines ‘collectively reinforced, internalised tacit guidelines’, to improve consultation experiences and self-management practices in primary care.DesignCo-creation workshops informed by the Co:Create Coproduction Matrix.SettingConference centre in central England and via remote communication.ParticipantsLay people with, and parents of children with, atopic eczema, practitioners, a researcher and a facilitator (n=22).ResultsEczema mindline amendment needs to address people and parents of children with the condition, practitioners and wider society in parallel. For lay people trust and ‘realness’ of amendment activity was vital and practitioners wanted practical, locally relevant, hints and tips, tailored, ‘no faff’ approaches. To improve consultation experiences and self-management practices, five key, consistent, evidence-based messages need to be instilled into eczema mindlines: (1) eczema is more than just dry skin, (2) eczema does not just go away, (3) moisturisers are for every day, (4) steroid creams are okay when you need them and (5) you know your child’s eczema best.ConclusionThis co-creation study provides original insights into what eczema knowledge should be mobilised, who needs to have this knowledge, how this should be achieved to amend existing mindlines to improve consultation experiences and self-management practices in primary care.The remaining challenge is to refine, implement and evaluate the effectiveness of strategies developed to instil the five core messages and erase outdated or inaccurate information.

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Knowledge mobilisation: an ethnographic study of the influence of practitioner mindlines on atopic eczema self-management in primary care in the UK

BMJ Open ◽

10.1136/bmjopen-2018-025220 ◽

2019 ◽

Vol 9 (7) ◽

pp. e025220 ◽

Cited By ~ 1

Author(s):

Fiona Cowdell

Keyword(s):

Primary Care ◽

Atopic Eczema ◽

Ethnographic Study ◽

Self Management ◽

Useful Knowledge ◽

Inaccurate Information ◽

Technological Developments ◽

Primary Care Practitioners ◽

Context Specific ◽

The Uk

ObjectiveTo explore how atopic eczema specific mindlines are developed by primary care practitioners.DesignEthnographic study.SettingOne large, urban general practice in central England.ParticipantsIn observation, all practitioners and support staff in the practice and in interviews a diverse group of practitioners (n=16).ResultsObservation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Three themes were identified: beliefs about eczema, eczema knowledge and approaches to self-management. Eczema mindlines are set against a backdrop of it being a low priority and not managed as a long-term condition. Practitioners believed that eczema is simple to manage with little change in treatments available and prescribing limited by local formularies. Practice is largely based on tacit knowledge and experience. Self-management is expected but not often explicitly facilitated. Clinical decisions are made from knowledge accumulated over time. Societal and technological developments have altered the way in which practitioner mindlines are developed; in eczema, for most, they are relatively static.ConclusionsThe outstanding challenge is to find novel, profession and context-specific, simple, pragmatic strategies to revise or modify practitioner mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information thus potentially improve quality of eczema care.

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Knowledge mobilisation: an ethnographic study of the influence of lay mindlines on eczema self-management in primary care in the UK

BMJ Open ◽

10.1136/bmjopen-2018-021498 ◽

2018 ◽

Vol 8 (8) ◽

pp. e021498 ◽

Cited By ~ 4

Author(s):

Fiona Cowdell

Keyword(s):

Primary Care ◽

General Practice ◽

Secondary Care ◽

Ethnographic Study ◽

Self Management ◽

Knowledge Mobilisation ◽

Useful Knowledge ◽

Inaccurate Information ◽

Ethnographic Approach ◽

The Uk

ObjectiveTo investigate the way in which mindlines, ‘collectively reinforced, internalised tacit guidelines’, are constructed among lay people with eczema in primary care.DesignEthnographic study.SettingObservation in one general practice in the UK and interviews across central England.ParticipantsIn observation, patients in the participating general practice regardless of presenting complaint and in interviews, people with eczema or parents of children with eczema (n=16).ResultsObservation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Four themes were identified: doctor knows best; not worth bothering the doctor; I need to manage this myself; and how I know what to do. Themes were set within the context of four broad typologies of lay people’s approach to self-management: content to self-manage; content to accept practitioner management; self-managing by default; and those referred to secondary care.ConclusionsThis study is the first to examine how lay eczema mindlines are developed and to recognise typologies of people with different need for, and receptiveness to, information. Lay eczema mindlines are constructed in many ways. The outstanding challenge is to find strategies to revise or modify these mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information.

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Dermatology in primary care: an audit of the proportion of patients who present to general practice with a dermatological problem that could be self-managed

British Journal of General Practice ◽

10.3399/bjgp20x711053 ◽

2020 ◽

Vol 70 (suppl 1) ◽

pp. bjgp20X711053

Author(s):

Luamar Dolfini ◽

Yogesh Patel

Keyword(s):

Primary Care ◽

General Practice ◽

Acne Vulgaris ◽

Clinical Information ◽

Electronic Record ◽

Self Management ◽

Considerable Proportion ◽

Dry Skin ◽

Record System ◽

Common Skin

BackgroundA considerable proportion of GPs’ workload is dermatological. It is important to investigate what common skin conditions encountered in primary care can be self-managed, in an effort to alleviate the burden on primary care.AimThe purpose of the audit was to identify the proportion of consultations that are dermatological in nature and analyse potential for self-management by patients.MethodData was collected using the patient electronic record system (EMIS) in general practice. A search was made for all consultations from the 17 April to 15 May 2019, which included all new presenting complaints that were dermatological in nature. The criteria for self-management included advising over the counter (OTC) medication or reassurance. On the other hand, a case was deemed not self-manageable if prescription only medication (POM) was prescribed or if a referral to dermatology was made.ResultsThere were a total of 2175 consultations, where 246 (11.31%) cases were dermatological. Of the 246, 80 cases (32.5%) could be self-managed. There were 46 different dermatological presenting complaints of which the 5 most common included: rash (51 cases), dermatitis (44 cases), acne vulgaris (13 cases), moles (12 cases), dry skin (11 cases). None of the acne or moles cases could be self-managed, whereas 23%, 68.2%, 72.7% of rashes, dermatitis, and dry skin cases, respectively, could be self-managed.ConclusionCertain dermatological conditions have more potential for self-management than others. Research into teledermatology as a means of addressing patient concern and providing clinical information is important in order to reduce unnecessary consultations.

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A solution-focused approach to understanding patient motivation in diabetes self-management: Gender differences and implications for primary care

Chronic Illness ◽

10.1177/1742395317736372 ◽

2017 ◽

Vol 14 (4) ◽

pp. 243-255 ◽

Cited By ~ 5

Author(s):

Tajudaullah Bhaloo ◽

Michael Juma ◽

Christine Criscuolo-Higgins

Keyword(s):

Primary Care ◽

Management Practices ◽

Strong Support ◽

Sampling Strategy ◽

Care Team ◽

Support Network ◽

Self Management ◽

Patient Motivation ◽

Patients With Diabetes ◽

Solution Focused

Objective Healthcare providers often neglect to recognize the role they play in motivating patients with diabetes to perform self-management. Our aims were to understand what motivates patients with diabetes to implement recommended self-management practices and understand the role of the primary care team in patient motivation. Methods We use a solution-focused qualitative approach, supplemented with a quantitative scale. We used a purposive sampling strategy to invite patients with uncontrolled diabetes. Semi-structured telephone interviews were conducted and analyzed using content and thematic analysis. Results Key motivators were strong support systems that included family and friends, the physician’s communication style and message, fear of deterioration, and other intrinsic factors. Female family members were described as supportive; not all married women felt supported by their husbands. Women were more influenced by empathy and concern from their doctor, compared to men who were motivated by improved health literacy. Women with few family or friends were more disadvantaged, regardless of race/ethnicity. Discussion While physicians play a vital role in motivating their patients, female patients may depend on this empathy more than males. The interdisciplinary care team can play an important role in helping patients create a support network where it may not exist.

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Can lay people deliver asthma self-management education as effectively as primary care based practice nurses?

Thorax ◽

10.1136/thx.2007.084251 ◽

2008 ◽

Vol 63 (9) ◽

pp. 778-783 ◽

Cited By ~ 26

Author(s):

M R Partridge ◽

A-L Caress ◽

C Brown ◽

J Hennings ◽

K Luker ◽

...

Keyword(s):

Primary Care ◽

Management Education ◽

Self Management ◽

Practice Nurses ◽

Lay People

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Integrating nurses’ experiences with supporting behaviour change for cardiovascular prevention into a self-management internet platform in Finland and the Netherlands: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2018-023480 ◽

2019 ◽

Vol 9 (6) ◽

pp. e023480

Author(s):

Cathrien RL Beishuizen ◽

Ulrika Akenine ◽

Mariagnese Barbera ◽

Anna Rosenberg ◽

Mandana Fallah Pour ◽

...

Keyword(s):

Primary Care ◽

The Netherlands ◽

Best Practices ◽

Behaviour Change ◽

Cardiovascular Prevention ◽

Self Management ◽

Online Support ◽

Focus Group Study ◽

Remote Communication ◽

Internet Platform

ObjectivesGlobal ageing is linked to an increased burden of cardiovascular disease and dementia, which calls for better prevention strategies. Self-management and eHealth applications are regarded as promising strategies to support prevention. The aim of this study was to explore nurses’ best practices concerning behaviour change guidance for cardiovascular (CV) prevention in order to learn how to optimally integrate them into a coach-supported internet platform for CV self-management.DesignQualitative focus group study in Finland and the Netherlands. Discussions were audiotaped and transcribed. Data were thematically analysed following principles of grounded theory.SettingDutch and Finnish primary care settings.ParticipantsSix Finnish and seven Dutch primary care nurses with experience in CV prevention.ResultsSimilar best practices were found in both countries and comprised of (1) establishing a relationship of trust, (2) managing awareness and expectations and (3) appropriate timing and monitoring of the process of behaviour change. However, the Finnish and Dutch nurses used different approaches for accomplishment of these practices, which was reflected in their recommendations for online support. Both groups emphasised that online support should be combined with human support and integrated into regular care. Finnish nurses had more confidence in patient self-management and remote communication than Dutch nurses, who emphasised the importance of face-to-face contact and preferred to keep control of medical aspects of prevention.ConclusionsDifferences in Dutch and Finnish’s nurses’ practices for supporting CV prevention appear to reflect their local healthcare practices, which should be taken into account when designing internet platforms for health self-management. Including cognitive health as a goal of CV prevention might stimulate motivation for health behaviour change.Trial registration numberISRCTN48151589; Pre-results.

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