Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

Abstract Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

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Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

10.21203/rs.3.rs-59646/v1 ◽

2020 ◽

Author(s):

Eva Seckler ◽

Verena Regauer ◽

Melanie Krüger ◽

Anna Gabriel ◽

Joachim Hermsdörfer ◽

...

Keyword(s):

Primary Care ◽

Data Collection ◽

Older People ◽

Process Evaluation ◽

Feasibility Study ◽

Health Professionals ◽

Implementation Strategy ◽

Care Pathway ◽

Balance Disorders ◽

Telephone Helpline

Abstract BackgroundCommunity-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a Care Pathway (CPW) to improve their mobility and participation by offering standardised approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial.MethodsThis 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s guidance for developing and evaluating complex interventions. Patients with VDB (≥ 65 years), GPs and PTs in primary care were included. Intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. Implementation strategy contained specific educational trainings and a telephone helpline. Data for mixed-method process evaluation was collected via standardised questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data via content analysis.ResultsA total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rate GP practices: 27,8%; PT practices: 38,5%). 91% of patients and all health professionals completed the study. The health professionals responded well to the educational trainings, the utilization of the telephone helpline was low (one call each from GPs and PTs). Routine in the intervention’s application and positive attitudes were emphasised as facilitators for the interventions’ implementation, whereas lack of time was mentioned as a barrier. Despite of difficulties in GPs’ adherence to intervention protocol, GPs, PTs and patients benefited from the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences.ConclusionAlthough the process evaluation provides good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need of improvement in recruitment, the GPs’ intervention part and data collection procedures. Findings will inform the main trial to prove the interventions effectiveness in a cluster RCT.Trial registrationDeutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered); Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017

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Choosing Healthy Eating for Infant Health (CHErIsH) study: protocol for a feasibility study

BMJ Open ◽

10.1136/bmjopen-2019-029607 ◽

2019 ◽

Vol 9 (8) ◽

pp. e029607

Author(s):

Karen Matvienko-Sikar ◽

Elaine Toomey ◽

Michelle Queally ◽

Caragh Flannery ◽

Kate O Neill ◽

...

Keyword(s):

Primary Care ◽

Childhood Obesity ◽

Infant Feeding ◽

Process Evaluation ◽

Feasibility Study ◽

Healthy Eating ◽

Implementation Strategy ◽

Infant Health ◽

Intervention Delivery ◽

Electronic Delivery

IntroductionChildhood obesity is a public health challenge. There is evidence for associations between parents’ feeding behaviours and childhood obesity risk. Primary care provides a unique opportunity for delivery of infant feeding interventions for childhood obesity prevention. Implementation strategies are needed to support infant feeding intervention delivery. The Choosing Healthy Eating for Infant Health (CHErIsH) intervention is a complex infant feeding intervention delivered at infant vaccination visits, alongside a healthcare professional (HCP)-level implementation strategy to support delivery.Methods and analysisThis protocol provides a description of a non-randomised feasibility study of an infant feeding intervention and implementation strategy, with an embedded process evaluation and economic evaluation. Intervention participants will be parents of infants aged ≤6 weeks at recruitment, attending a participating HCP in a primary care practice. The intervention will be delivered at the infant’s 2, 4, 6, 12 and 13 month vaccination visits and involves brief verbal infant feeding messages and additional resources, including a leaflet, magnet, infant bib and sign-posting to an information website. The implementation strategy encompasses a local opinion leader, HCP training delivered prior to intervention delivery, electronic delivery prompts and additional resources, including a training manual, poster and support from the research team. An embedded mixed-methods process evaluation will examine the acceptability and feasibility of the intervention, the implementation strategy and study processes including data collection. Qualitative interviews will explore parent and HCP experiences and perspectives of delivery and receipt of the intervention and implementation strategy. Self-report surveys will examine fidelity of delivery and receipt, and acceptability, suitability and comprehensiveness of the intervention, implementation strategy and study processes. Data from electronic delivery prompts will also be collected to examine implementation of the intervention. A cost–outcome description will be conducted to measure costs of the intervention and the implementation strategy.Ethics and disseminationThis study received approval from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Study findings will be disseminated via peer-reviewed publications and conference presentations.

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Development of a complex intervention to improve mobility and participation of older people with vertigo, dizziness and balance disorders in primary care: a mixed methods study

10.21203/rs.3.rs-120696/v1 ◽

2020 ◽

Author(s):

Verena Regauer ◽

Eva Seckler ◽

Eva Grill ◽

Richard Ippisch ◽

Klaus Jahn ◽

...

Keyword(s):

Primary Care ◽

Mixed Methods ◽

Older People ◽

Behaviour Change ◽

Complex Intervention ◽

Implementation Strategy ◽

Care Pathway ◽

Mixed Methods Design ◽

Balance Disorders ◽

Specific Implementation

Abstract Background: Vertigo, dizziness and balance disorders (VDB) are common in older individuals and cause restrictions in mobility and participation. Due to a multifactorial aetiology, health care is often overutilitised, but many patients are also treated insufficiently in primary care. The purpose of this study was to develop a care pathway as a complex intervention to improve mobility and participation in older people with VDB in primary care.Methods: The development followed the UK Medical Research Council guidance using a mixed-methods design with individual and group interviews carried out with patients, physical therapists (PTs), general practitioners (GPs), nurses working in community care and a multi-professional expert panel to create a first draft of a care pathway (CPW) and an implementation strategy using the Consolidated Framework of Implementation Research and the Expert recommendations for Implementing Change. Subsequently, small expert groups modelling of specific components of CPW was carried out, with GPs, medical specialists and PTs. The Behaviour Change Wheel was applied to design the intervention´s behaviour change. To explicate theoretical assumptions, we adopted Kellogg´s Logic Model to consolidate the hypothesized chain of causes leading to patient-relevant outcomes.Results: Individual interviews with patients showed that VDB symptoms need to be taken more seriously by GPs. Patients demanded age-specific treatment offers, group sessions or a continuous mentoring by a PT. GPs required a specific guideline for diagnostics and treatment options adding psycho-social interventions. Specific assignment to and a standardized approach during physical therapy was desired by PTs. Nurses favoured a multi-professional documentation system. The structured three-day expert workshop resulted in a first draft of CPW and potential implementation strategies. Subsequent modelling resulted in a CPW with components and appropriate training materials for involved health professionals. A specific implementation strategy is now available.Conclusion: Mixed-methods design proved to be a suitable approach to develop a complex intervention and its implementation. We will subsequently test the intervention for its acceptability and feasibility in a feasibility study accompanied by a comprehensive process evaluation to inform a subsequent effectiveness trial.Trial Registration: The research project is registered in “Projektdatenbank Versorgungsforschung Deutschland” (Project-ID: VfD_MobilE-PHY_17_003910; date of registration: 30.11.2017).

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Development of a complex intervention to improve mobility and participation of older people with vertigo, dizziness and balance disorders in primary care: a mixed methods study

BMC Family Practice ◽

10.1186/s12875-021-01441-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Verena Regauer ◽

Eva Seckler ◽

Eva Grill ◽

Richard Ippisch ◽

Klaus Jahn ◽

...

Keyword(s):

Primary Care ◽

Mixed Methods ◽

Older People ◽

Behaviour Change ◽

Complex Intervention ◽

Implementation Strategy ◽

Care Pathway ◽

Mixed Methods Design ◽

Balance Disorders ◽

Specific Implementation

Abstract Background Vertigo, dizziness and balance disorders (VDB) are common in older people and cause restrictions in mobility and social participation. Due to a multifactorial aetiology, health care is often overutilised, but many patients are also treated insufficiently in primary care. The purpose of this study was to develop a care pathway as a complex intervention to improve mobility and participation in older people with VDB in primary care. Methods The development process followed the UK Medical Research Council guidance using a mixed-methods design with individual and group interviews carried out with patients, physical therapists (PTs), general practitioners (GPs), nurses working in community care and a multi-professional expert panel to create a first draft of a care pathway (CPW) and implementation strategy using the Consolidated Framework of Implementation Research and the Expert recommendations for Implementing Change. Subsequently, small expert group modelling of specific components of the CPW was carried out, with GPs, medical specialists and PTs. The Behaviour Change Wheel was applied to design the intervention´s approach to behaviour change. To derive theoretical assumptions, we adopted Kellogg´s Logic Model to consolidate the hypothesized chain of causes leading to patient-relevant outcomes. Results Individual interviews with patients showed that VDB symptoms need to be taken more seriously by GPs. Patients demanded age-specific treatment offers, group sessions or a continuous mentoring by a PT. GPs required a specific guideline for diagnostics and treatment options including psychosocial interventions. Specific assignment to and a standardized approach during physical therapy were desired by PTs. Nurses favoured a multi-professional documentation system. The structured three-day expert workshop resulted in a first draft of CPW and potential implementation strategies. Subsequent modelling resulted in a CPW with components and appropriate training materials for involved health professionals. A specific implementation strategy is now available. Conclusion A mixed-methods design was suggested to be a suitable approach to develop a complex intervention and its implementation strategy. We will subsequently test the intervention for its acceptability and feasibility in a feasibility study accompanied by a comprehensive process evaluation to inform a subsequent effectiveness trial. Trial Registration The research project is registered in “Projektdatenbank Versorgungsforschung Deutschland” (Project-ID: VfD_MobilE-PHY_17_003910; date of registration: 30.11.2017).

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Health professionals’ perspectives on exercise referral and physical activity promotion in primary care: Findings from a process evaluation of the National Exercise Referral Scheme in Wales

Health Education Journal ◽

10.1177/0017896914559785 ◽

2014 ◽

Vol 74 (6) ◽

pp. 743-757 ◽

Cited By ~ 29

Author(s):

Nafees U Din ◽

Graham F Moore ◽

Simon Murphy ◽

Clare Wilkinson ◽

Nefyn H Williams

Keyword(s):

Physical Activity ◽

Primary Care ◽

Process Evaluation ◽

Health Professionals ◽

Physical Activity Promotion ◽

Activity Promotion ◽

Exercise Referral ◽

Exercise Referral Scheme

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Conceptions of the professionals about their attributions in the Expanded Nucleus of Family Health

Psico-USF ◽

10.1590/1413-82712019240405 ◽

2019 ◽

Vol 24 (4) ◽

pp. 661-671

Author(s):

Meyrielle Belotti ◽

Alexandra Iglesias ◽

Luziane Zacché Avellar

Keyword(s):

Primary Care ◽

Qualitative Research ◽

Content Analysis ◽

Data Collection ◽

Focus Groups ◽

Health Professionals ◽

Family Health ◽

Work Processes ◽

The Family ◽

Specialized Care

Abstract The article aims to analyze the conceptions conferred by the health professionals that compose the Expanded Nuclei of Family Health (NASF) on their work assignments. This is a qualitative research, in which was used, for the data collection, eight focus groups, with a total of 43 participants. The data were submitted to content analysis. The results outlined the following categories: integrating NASF work with the Family Health Teams (ESF); developing specialized care; promoting intersectionality; contributing to the promotion of teamwork in Primary Care (AB) and strengthening AB. The study indicates the importance of a better understanding of the functions of the NASF, so that it does not restrict the opportunity to perform specialized care in AB. It is pointed out, the need for adjustments in the work processes of the ESF, in order to enable the shared work in the AB.

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