Qualitative evaluation of primary care providers experiences of a training programme to offer brief behaviour change counselling on risk factors for non-communicable diseases in South Africa

Background: We are facing a global epidemic of non-communicable disease (NCDs), which has been linked with four risky lifestyle behaviours. It is recommended that primary care providers (PCPs) provide individual brief behaviour change counselling (BBCC) as part of everyday primarycare, however currently training is required to build capacity. Local training programmes are not sufficient to achieve competence.Aim: This study aimed to redesign the current training for PCPs in South Africa, around a new model for BBCC that would offer a standardised approach to addressing patients’ risky lifestyle behaviours.Setting: The study population included clinical nurse practitioners and primary care doctors in the Western Cape Province.Methods: The analyse, design, develop, implement and evaluate (ADDIE) model provided a systematic approach to the analysis of learning needs, the design and development of the training programme, its implementation and initial evaluation.Results: This study designed a new training programme for PCPs in BBCC, which was based on a conceptual model that combined the 5As (ask, alert, assess, assist and arrange) with a guiding style derived from motivational interviewing. The programme was developed as an eight-hour training programme that combined theory, modelling and simulated practice with feedback, for either clinical nurse practitioners or primary care doctors.Conclusion: This was the first attempt at developing and implementing a best practice BBCC training programme in our context, targeting a variety of PCPs, and addressing different risk factors.

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A situational analysis of training for behaviour change counselling for primary care providers, South Africa

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v7i1.731 ◽

2015 ◽

Vol 7 (1) ◽

Cited By ~ 2

Author(s):

Zelra Malan ◽

Bob Mash ◽

Katherine Everett-Murphy

Keyword(s):

Primary Care ◽

Behaviour Change ◽

Lifestyle Modification ◽

Qualitative Interviews ◽

Healthcare Providers ◽

Primary Care Providers ◽

Situational Analysis ◽

Care Providers ◽

Record Keeping ◽

Behaviour Change Counselling

Background: Non-communicable diseases and associated risk factors (smoking, alcohol abuse, physical inactivity and unhealthy diet) are a major contributor to primary care morbidity and the burden of disease. The need for healthcare-provider training in evidence-based lifestyle interventions has been acknowledged by the National Department of Health. However, local studies suggest that counselling on lifestyle modification from healthcare providers is inadequate and this may, in part, be attributable to a lack of training.Aim: This study aimed to assess the current training courses for primary healthcare providers in the Western Cape.Setting: Stellenbosch University and University of Cape Town.Methods: Qualitative interviews were conducted with six key informants (trainers of primary care nurses and registrars in family medicine) and two focus groups (nine nurses and eight doctors) from both Stellenbosch University and the University of Cape Town.Results: Trainers lack confidence in the effectiveness of behaviour change counselling and in current approaches to training. Current training is limited by time constraints and is not integrated throughout the curriculum – there is a focus on theory rather than modelling and practice, as well as a lack of both formative and summative assessment. Implementation of training is limited by a lack of patient education materials, poor continuity of care and record keeping, conflicting lifestyle messages and an unsupportive organisational culture.Conclusion: Revising the approach to current training is necessary in order to improve primary care providers’ behaviour change counselling skills. Primary care facilities need to create a more conducive environment that is supportive of behaviour change counselling.

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Abstract P720: Primary Stroke Prevention by Primary Care Providers: An Unmet Need

Stroke ◽

10.1161/str.52.suppl_1.p720 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Raymond Reichwein ◽

Alicia Richardson ◽

Cesar Velasco

Keyword(s):

Risk Factors ◽

Primary Care ◽

Primary Prevention ◽

Care Setting ◽

Stroke Risk ◽

Primary Care Setting ◽

Primary Care Providers ◽

Large Vessel ◽

Care Providers ◽

Stroke Risk Factors

Introduction: The majority of patients who present with acute ischemic stroke (AIS) have known stroke risk factors which are not optimally managed. It has been suggested that a CHADS-VASC score can assist with primary prevention by calculating future stroke risk. This however, has not been widely adapted in the primary care setting. Methods: From 2018-2019, 686 AIS patients were included in retrospective analysis. Data elements included: historical stroke risk factors, historical CHADS-VASC score, antiplatelet/anticoagulant use at time of presentation, discharge location, and mRS. Results: Of the 686 AIS patients, 77% were age > 60, and 52% were male. Etiology subtypes were small vessel/lacunar 20%, large vessel 22%, cardioembolic 20%, undetermined 31% (cryptogenic 15%), and other determined 5%. On presentation, the majority of patients had 2 or more stroke risk factors and a calculated historical CHADS-VASC score > 2 (Table 1). Over half of the patients with large vessel or small vessel/lacunar etiology were not on any antiplatelets and 53% of patients with known history of atrial fibrillation weren’t on anticoagulants. Forty-nine percent of patients had a mRS > 3 at discharge. Conclusion: Patients with several stroke risk factors are sub optimally managed by primary care providers. Primary prevention education for PCPs in management of higher stroke risk individuals and additional analysis of the CHADS-VASC tool for this setting is needed. If widely adapted, this tool may prevent strokes by providing adequate risk reduction in the primary care setting.

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Are primary care physicians aware of peripheral artery disease risk reduction and management in the Saudi healthcare transformation era? A health cluster observational study

Vascular ◽

10.1177/17085381211044397 ◽

2021 ◽

pp. 170853812110443

Author(s):

Sultan Alsheikh ◽

Hesham AlGhofili ◽

Omar A Alayed ◽

Abdulkareem Aldrak ◽

Kaisor Iqbal ◽

...

Keyword(s):

Risk Factors ◽

Primary Care ◽

Saudi Arabia ◽

Risk Reduction ◽

Peripheral Artery Disease ◽

Primary Care Physicians ◽

Primary Care Providers ◽

Care Providers ◽

Peripheral Artery ◽

Artery Disease

Introduction Patients with peripheral artery disease (PAD) are often underdiagnosed and undertreated. This study aimed to assess the knowledge of the recommended target levels of blood pressure, low-density lipoprotein cholesterol, glycosylated hemoglobin A1C, and knowledge and attitude about PAD risk reduction therapies among physicians working in primary care settings in Saudi Arabia. Methods This observational cross-sectional study included family medicine consultants, residents, and general practitioners working in a health cluster in the capital city of Saudi Arabia using a self-administered questionnaire. Results Of the 129 physicians who completed the survey, 55% had completed PAD-related continuing medical education hours within the past 2 years. Despite this, the knowledge score of the recommended target levels was high in only 13.2% of the participants. Antiplatelet therapy was prescribed by 68.2% of the participants. Conclusion Here we identified the knowledge and action gaps among primary care providers in Saudi Arabia. Physicians had an excellent attitude about screening for and counseling about risk factors. However, they showed less interference in reducing these risk factors. We recommend addressing these knowledge gaps early in medical school and residency programs.

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Patient-level predictors of detection of depressive symptoms, referral, and uptake of depression counseling among chronic care patients in KwaZulu-Natal, South Africa

Global Mental Health ◽

10.1017/gmh.2020.11 ◽

2020 ◽

Vol 7 ◽

Author(s):

Christopher G. Kemp ◽

Ntokozo Mntambo ◽

Max Bachmann ◽

Arvin Bhana ◽

Deepa Rao ◽

...

Keyword(s):

South Africa ◽

Primary Care ◽

Depressive Symptoms ◽

Primary Care Providers ◽

Depression Treatment ◽

Care Providers ◽

Low Resource Settings ◽

Low Resource ◽

Patient Level ◽

Kwazulu Natal

Abstract Background Integration of depression treatment into primary care could improve patient outcomes in low-resource settings. Losses along the depression care cascade limit integrated service effectiveness. This study identified patient-level factors that predicted detection of depressive symptoms by nurses, referral for depression treatment, and uptake of counseling, as part of integrated care in KwaZulu-Natal, South Africa. Methods This was an analysis of baseline data from a prospective cohort. Participants were adult patients with at least moderate depressive symptoms at primary care facilities in Amajuba, KwaZulu-Natal, South Africa. Participants were screened for depressive symptoms prior to routine assessment by a nurse. Generalized linear mixed-effects models were used to estimate associations between patient characteristics and service delivery outcomes. Results Data from 412 participants were analyzed. Nurses successfully detected depressive symptoms in 208 [50.5%, 95% confidence interval (CI) 38.9–62.0] participants; of these, they referred 76 (36.5%, 95% CI 20.3–56.5) for depression treatment; of these, 18 (23.7%, 95% CI 10.7–44.6) attended at least one session of depression counseling. Depressive symptom severity, alcohol use severity, and perceived stress were associated with detection. Similar factors did not drive referral or counseling uptake. Conclusions Nurses detected patients with depressive symptoms at rates comparable to primary care providers in high-resource settings, though gaps in referral and uptake persist. Nurses were more likely to detect symptoms among patients in more severe mental distress. Implementation strategies for integrated mental health care in low-resource settings should target improved rates of detection, referral, and uptake.

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Risk factors underlying depressive symptoms among parents/primary care providers of kids with autism spectrum disorder: A study from Muscat, Oman

Perspectives In Psychiatric Care ◽

10.1111/ppc.12374 ◽

2019 ◽

Vol 55 (4) ◽

pp. 600-606 ◽

Cited By ~ 1

Author(s):

Muna Alshekaili ◽

Naser Al‐Balushi ◽

Mohammed Al‐Alawi ◽

Hassan Mirza ◽

Salim Al‐Huseini ◽

...

Keyword(s):

Risk Factors ◽

Primary Care ◽

Autism Spectrum Disorder ◽

Depressive Symptoms ◽

Primary Care Providers ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Care Providers

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Abstract TP389: Utilizing A Stroke Protocol to Improve Stroke Prevention Education

Stroke ◽

10.1161/str.48.suppl_1.tp389 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Allison Wells ◽

Lisa Bellamy ◽

Keyword(s):

Risk Factors ◽

Primary Care ◽

Stroke Prevention ◽

Primary Care Providers ◽

Care Providers ◽

Office Visits ◽

Prevention Education ◽

Prevention Protocol ◽

Primary Care Office ◽

Stroke Education

Background: Although stroke is a preventable disease, it remains a leading cause of death and disability in the United States. Public knowledge of stroke prevention is relatively low. Stroke education is necessary to improve this knowledge deficit. Primary care providers play an important role in stroke education due to their ability to reach more patients and their ability to help manage the patient’s modifiable risk factors. The purpose of this project is twofold: to increase stroke knowledge in patients and to increase the amount of stroke education provided by the primary care provider. Methods: A stroke prevention protocol was created for primary care providers to utilize. The protocol helps the provider decide which patients benefit the most from stroke prevention education. If the patient has more than four stroke risk factors, the provider should initiate the stroke prevention protocol. The protocol assists the provider in delivering the stroke prevention education. Brochures were created for the provider to give to the patient. The goal of the project is to include five providers in Kentucky primary care offices. Each provider will complete an evaluation of the protocol after using it for a month. Results: Although the implementation is currently in progress, it is anticipated that the stroke protocol will improve stroke prevention education in the primary care office. Ultimately, practice will be changed by increasing the number of people who receive stroke prevention information by their primary care provider. Conclusion: Stroke education can be incorporated into primary care office visits to improve community awareness regarding stroke prevention. It is anticipated that the implementation of the stroke protocol will increase the amount of stroke education delivered to patients in the primary care setting. The evaluations completed by each healthcare provider are predicted to reflect an increase in the number of patients who receive stroke education. These evaluations will include the healthcare provider’s insight of the protocol which will assist in improving it for future use in primary care office visits.

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Record rewards: the effects of targeted quality incentives on the recording of risk factors by primary care providers

Health Economics ◽

10.1002/hec.1440 ◽

2009 ◽

pp. n/a-n/a ◽

Cited By ~ 11

Author(s):

Matt Sutton ◽

Ross Elder ◽

Bruce Guthrie ◽

Graham Watt

Keyword(s):

Risk Factors ◽

Primary Care ◽

Primary Care Providers ◽

Care Providers

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Knowledge and practices of primary care providers on skin cancer and skin self-examination

Revista da Escola de Enfermagem da USP ◽

10.1590/s1980-220x2017039703359 ◽

2018 ◽

Vol 52 (0) ◽

Cited By ~ 1

Author(s):

İlknur Göl ◽

Özüm Erkin

Keyword(s):

Risk Factors ◽

Primary Care ◽

Skin Cancer ◽

Cancer Risk ◽

Primary Care Providers ◽

Health Centers ◽

Care Providers ◽

Cancer Risk Factors ◽

Skin Cancer Risk ◽

Self Examination

ABSTRACT Objective To determine the knowledge and practices related to skin cancer and skin self-examination of primary care providers. Method This cross-sectional descriptive study was conducted in Turkey. The study was carried out in primary health centers such as family health centers, community health centers, early cancer detection centers and family planning centers in 2016-2017. Participants’ socio-demographic characteristics, their knowledge and practices related to skin cancer, skin cancer risk factors and skin self-examination were determined. Results The study population included 94 primary care providers. The symptoms of which the participants were most aware were changes in the color of moles or skin spots (95.71%), and of which participants were the least aware was the itching of a mole (71.43%). Among participants, the most recognized risk factor was having fair skin (97.14%), whereas the least known was the presence of birthmarks (24.29%). The mean scores the participants obtained from the questionnaire were as follows: 5.39±1.61 for skin cancer risk factors and 10.47±2.73 for skin cancer symptoms. Of the participants, 14.29% received training on skin self-examination, 38.57% knew how to perform skin self-examination, and 67.14% did not perform skin self-examination. Of the participants, 61.7% did not perform skin self-examination because they did not know what to look for. Of the participants, 85.71% did not have continuing education/workshop about skin self-examination after graduation. Conclusion Although the primary care providers’ knowledge of skin cancer symptoms was adequate, their knowledge of skin cancer risk factors was not sufficient. Primary care providers’ knowledge of skin self-examination was good, but they did not perform skin self-examination adequately.

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