Is integration of healthy lifestyle promotion into primary care feasible? Discussion and consensus sessions between clinicians and researchers

Abstract BackgroundDespite clear recommendations supporting healthy lifestyle promotion interventions for the primary prevention of CVD in low-risk patients, a considerable number of these people continue to receive inappropriate statin prescriptions. The present study reports on the structured process based on theory and evidence carried out for the design of de-implementation strategies to reduce the inappropriate prescription of statins and to increase the promotion of healthy lifestyles, in CVD prevention practice of primary care professionals for patients with low cardiovascular risk.MethodsA phase I formative study following a structured theory-informed process combining the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW) was conducted, comprising: semi-structured interviews (n=5) with primary care professionals to delimitate and define the problem in behavioral terms; focus groups (4 groups with 21 physicians; 1 group with 6 patients) to identify the determinants of potentially inappropriate prescribing [PIP] of statins and healthy lifestyle promotion actions; mapping of behavioral change interventions operationalized as de-implementation strategies for addressing identified determinants; and consensus techniques for the prioritization of strategies based on perceived effectiveness, feasibility and acceptability.ResultsNumerous multilevel determinants of both PIP of statins and healthy lifestyle promotion embracing almost all of the TDF dimensions have been identified. Guided by the BCW established procedure, 13 potential de-implementation strategies have been mapped to identified determinants. Those assessed as potentially more feasible, acceptable and potentially effective by the professionals themselves were: 1) Information/knowledge dissemination strategies: a corporate dissemination campaign on “Abandonment of Low-Value Practices”; a Clinical Pathway for the primary prevention of CVD in low-risk patients, accompanied with audiovisual and paper-based training resources; 2) Strategies for presenting relevant information for decision-making: an audit/feedback system regarding CVD prevention practice performance indicators; and 3) Strategies for helping clinical decisions: reminders, alerts, and a decision support tool incorporated into the REGICOR CVD risk calculator in the electronic clinical record.DiscussionThe methodology established by the TDF/BWC for the design of behavior change interventions has been useful for the development of de-implementation strategies targeting the decision-making process of clinicians to favor the uptake of recommended clinical practice for CVD prevention in low-risk patients.TRIAL REGISTRATIONClinicaltrials.gov identifier: NCT04022850. Registered 17 July 2019, https://www.clinicaltrials.gov/ct2/show/NCT04022850

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Framing the Epidemic: NGOs and the Fight Against HIV/AIDS in Russia

Russian Politics ◽

10.1163/2451-8921-00304003 ◽

2018 ◽

Vol 3 (4) ◽

pp. 486-512 ◽

Cited By ~ 2

Author(s):

Ulla Pape

Keyword(s):

Healthy Lifestyle ◽

Moral Problem ◽

Traditional Values ◽

Security Threat ◽

Governmental Organizations ◽

Non Governmental Organizations ◽

Mobilization Potential ◽

Healthy Lifestyle Promotion ◽

Russian State ◽

Moral Framing

With more than one million people living with HIV, Russia is facing the biggest HIV epidemic in Europe and is one of the few countries in the world where infection rates are increasing. The response to the epidemic is shaped by the way Russian state actors and non-governmental organizations (NGOs) view the issue of HIV and how they define policy priorities. In order to understand the factors that underlie HIV policies in Russia, this contribution analyses the framing of HIV. It thereby makes use of framing theory. Based on document analysis and interviews with NGO experts, the article differentiates between four main framings in Russia: the framing of HIV as a medical issue, as a security threat, as a moral problem or as a human rights concern. In Russia, the moral framing of HIV has become dominant over the past decade. The epidemic is increasingly viewed as the result of harmful influences from the West which need to be overcome. As a result, Russia has departed from evidence-based approaches to HIV. Instead, it solely focuses on strengthening so-called “traditional values”, e.g. by engaging in healthy lifestyle promotion. The moral framing of HIV has also impacted the mobilization potential of Russian NGOs, as it favour those organizations that relate to the dominant framing of HIV and support government priorities.

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Healthy lifestyle promotion in primary schools through the board game Kaledo: a pilot cluster randomized trial

European Journal of Pediatrics ◽

10.1007/s00431-018-3091-4 ◽

2018 ◽

Vol 177 (9) ◽

pp. 1371-1375 ◽

Cited By ~ 7

Author(s):

Emanuela Viggiano ◽

Alessandro Viggiano ◽

Anna Di Costanzo ◽

Adela Viggiano ◽

Andrea Viggiano ◽

...

Keyword(s):

Randomized Trial ◽

Primary Schools ◽

Healthy Lifestyle ◽

Cluster Randomized Trial ◽

Board Game ◽

Healthy Lifestyle Promotion ◽

Cluster Randomized

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The Role of Healthy Lifestyle Promotion, Counseling, and Follow-up in Noncommunicable Diseases Prevention

The Journal of Pediatrics ◽

10.1016/j.jpeds.2019.10.061 ◽

2020 ◽

Vol 217 ◽

pp. 221-223.e1 ◽

Cited By ~ 1

Author(s):

Tudor Lucian Pop ◽

Leyla Namazova-Baranova ◽

Julije Mestrovic ◽

Luigi Nigri ◽

Mehmet Vural ◽

...

Keyword(s):

Healthy Lifestyle ◽

Noncommunicable Diseases ◽

Healthy Lifestyle Promotion

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A patient-centredness improvement study for efficacy of behaviour change for healthy lifestyle and weight loss in a student-run free clinic

Family Practice ◽

10.1093/fampra/cmaa057 ◽

2020 ◽

Author(s):

Spencer Lessans ◽

Xamil Vega ◽

Brandon Foley ◽

Alexia Bossan ◽

Alexandra Baker ◽

...

Keyword(s):

Primary Care ◽

Needs Assessment ◽

Weight Management ◽

Behaviour Change ◽

Response Rate ◽

Healthy Lifestyle ◽

Clinic Visit ◽

Free Clinic ◽

Behaviour Change Interventions ◽

Patient Responsiveness

Abstract Background Primary care is the ideal place to implement behaviour change interventions for weight management. However, most primary care physicians are not managing patient weight as a standard of care due to lack of knowledge, skills and reimbursement. Generating more physicians who are familiar and comfortable with providing weight management is essential in leveraging a global change. In our university free clinic, medical students provide healthy lifestyle counselling using shared decision making to each patient at every clinic visit. Objective Improve the efficacy of behaviour change interventions via increased patient responsiveness and adherence. Methods The needs assessment demonstrated a subpar patient response rate to check-ins regarding behavioural change goals. In the first and second interventions, check-in message structure and contact schedule were varied to maximize patient responsiveness and goal achievement. Results In the needs assessment, 58% of patients responded to follow-ups and 58% of patients accomplished their goal. The first intervention cycle resulted in an improvement of responsiveness to 70% and accomplishment of goals to 59%. The second intervention cycle resulted in an improvement of responsiveness to 78% and accomplishment of goals to 74%. Conclusions Messages that were frequent, unique, succinct and delivered within 4 weeks after the clinic visit resulted in the highest response rate and goal attainment. Other primary care clinics can use these interventions to increase patient completion of implemented behaviour changes for a healthier lifestyle.

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