scholarly journals Physical Activity Coaching Implementation Among Physiotherapists and SCI Peer Mentors: Behavioural Determinants and Effects

2021 ◽  
Author(s):  
Hattie Shu ◽  
Kathleen Martin Ginis ◽  
Catherine Le Cornu Levett ◽  
Chris McBride ◽  
Kristen Walden ◽  
...  
Keyword(s):  
Physical Activity ◽  
Theoretical Domains Framework ◽  
Community Setting ◽  
Implementation Process ◽  
Patient Discharge ◽  
Implementation Intervention ◽  
Implementation Framework ◽  
Knowledge To Action ◽  
Behavioural Determinants ◽  
Cord Injury

Abstract Background: The most profound drop in physical activity among people with spinal cord injury (SCI) is observed in the months following discharge from rehabilitation. The ProACTIVE SCI intervention has previously demonstrated large-sized effects on physical activity among people with SCI in the community setting. If implemented successfully during the transition from hospital to community setting, this intervention may help improve physical activity at a critical, yet understudied, timepoint for people with SCI. The purpose of this study is to evaluate the effects of an implementation intervention on physical activity coaching behaviour and its determinants to inform future adaptation of the intervention for sustained implementation.Methods: This study employed a single group, pre-post design. The Knowledge to Action Framework supplemented by the Quality Implementation Framework were used to engage end-users in adapting the intervention and implementation process. The implementation intervention consisted of training (instructions, demonstration, behavioural practice, feedback), provision of educational resources, the addition of a physical activity prompt in patient discharge forms, and engagement of champions. The determinants of physical activity coaching were evaluated using a survey based on the Theoretical Domains Framework (TDF), administered before and immediately following training. Paired two-tailed t-tests were conducted to detect a significant within-subject effect over time on physical activity coaching determinants.Results: A total of ten participants attended training and completed the TDF survey. No significant differences were observed in any of the current physical activity coaching behaviours evaluated during the training period. However, participants reported significant improvements in physical activity coaching behavioural determinants including knowledge, skills, beliefs about capabilities, environmental context and resources, social influences, behavioural regulation, and memory, attention and decision processes (ps<0.05).Conclusions: Improvements in determinants signal the potential for changes in physical activity coaching behaviour. Determinant scores that remained low will be targeted to inform the ongoing adaptation of the implementation intervention. This study serves as an example of using the TDF, the Knowledge to Action Framework, and the Quality Implementation Framework to guide adaptation and implementation of an intervention.Trial Registration: U.S. National Library of Medicine, NCT04493606. Registered 29 July 2020, https://clinicaltrials.gov/ct2/show/NCT04493606

scholarly journals Development of a hospital deprescribing implementation framework: A focus group study with geriatricians and pharmacists

2019 ◽  
Vol 49 (1) ◽  
pp. 102-110 ◽  
Author(s):  
Sion Scott ◽  
Michael J Twigg ◽  
Allan Clark ◽  
Carol Farrow ◽  
Helen May ◽  
...  
Keyword(s):  
Patient Monitoring ◽  
Hospital Setting ◽  
Theoretical Domains Framework ◽  
Evidence Based ◽  
Focus Group Study ◽  
Implementation Framework ◽  
Barriers And Enablers ◽  
Behavioural Determinants ◽  
Caregiver Attachment ◽  
Influence Perceptions

Abstract Background over 50% of older people in hospital are prescribed a pre-admission medicine that is potentially inappropriate; however, deprescribing by geriatricians and pharmacists is limited. This study aimed to characterise geriatricians’ and pharmacists’ barriers and enablers to deprescribing in hospital. It also intended to develop a framework of intervention components to facilitate implementation of hospital deprescribing. Methods fifty-four geriatricians and pharmacists representing four UK hospitals attended eight focus groups. We designed a topic guide to invite discussions about barriers and enablers to deprescribing. After thematic analysis, themes were mapped to the theoretical domains framework (TDF), enabling prioritisation of domains for behaviour change. We then identified evidence-based intervention components for changing behaviour within prioritised TDF domains. Results geriatricians and pharmacists described several deprescribing enablers in the hospital setting including alignment with their role and generalist knowledge, and routine patient monitoring. Five prioritised TDF domains represent the key barriers and enabler: patient and caregiver attachment to medication (social influence); perceptions that deprescribing is riskier than continuing to prescribe (beliefs about consequences); pharmacists’ working patterns limiting capacity to support deprescribing (environmental context and resources); deprescribing being a low hospital priority (goals) and incentives to deprescribe (reinforcement). Prioritised TDF domains aligned with 44 evidence-based intervention components to address the barriers and enabler to hospital deprescribing. Conclusion the behavioural determinants and their associated intervention components provide a hospital deprescribing implementation framework (hDIF). Intervention components should be selected from the hDIF to provide a theory and evidence-based intervention tailored to hospital contexts.

scholarly journals Using the theoretical domains framework to inform strategies to support dietitians undertaking body composition assessments in routine clinical care

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chloe J. D. Jobber ◽  
Shelley A. Wilkinson ◽  
Elyssa K. Hughes ◽  
Fiona Nave ◽  
Barbara S. van der Meij
Keyword(s):  
Body Composition ◽  
Clinical Care ◽  
Theoretical Domains Framework ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Tertiary Hospital ◽  
Environmental Context ◽  
Routine Practice ◽  
Body Composition Assessment ◽  
Knowledge To Action

Abstract Background Malnutrition, sarcopenia and cachexia are clinical wasting syndromes characterised by muscle loss. Systematic monitoring by body composition assessment (BCA) is recommended for the diagnosis, treatment and monitoring of the syndrome(s). This study investigated practices, competency, and attitudes of Australian dietitians regarding BCA, to inform a local implementation process. Methods Applying the Action cycle in the Knowledge to Action framework, surveys were distributed to the 26 dietitians of an 800-bed tertiary hospital. The survey assessed barriers and enablers to performing routine BCA in clinical care. Results were categorised using the Theoretical Domains Framework (TDF) and suitable interventions mapped using the Behaviour Change Wheel. Results Twenty-two dietitians (84.6%) completed the survey. Barriers to BCA were identified in all TDF domains, particularly in Knowledge, Skills, Social/professional role and identity, Beliefs about capabilities, and Environmental context and resources. Enablers existed in domains of: Skills; Beliefs about consequences; Goals; Environmental context and resources; Social influences; Intentions; Optimism; Reinforcement. Conclusions This study showed that hospital dietitians experience individual, team, and organisational barriers to adopt BCAs in clinical practice. We were able to formulate targeted implementation strategies to overcome these barriers to assist BCA adoption into routine practice.

scholarly journals Exploring Barriers and Enablers to Dietitians Completing Body Composition Assessments as Part of Routine Clinical Care 

2020 ◽  
Author(s):  
Chloe Jobber ◽  
Shelley Wilkinson ◽  
Elyssa Hughes ◽  
Fiona Nave ◽  
Barbara van der Meij
Keyword(s):  
Body Composition ◽  
Clinical Care ◽  
Theoretical Domains Framework ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Routine Practice ◽  
Muscle Loss ◽  
Body Composition Assessment ◽  
Knowledge To Action ◽  
Barriers And Enablers

Abstract Background: Malnutrition, sarcopenia and cachexia are clinical wasting syndromes characterised by muscle loss. Systematic monitoring by body composition assessment (BCA) is recommended for the diagnosis, treatment and monitoring of the syndrome(s). However, limited literature exists regarding integration of BCA into routine practice. This study investigated practices, competency, and attitudes of Australian dietitians regarding BCA, to inform a local implementation process.Methods:Applying the Action cycle in the Knowledge to Action framework, surveys were distributed to the 26 dietitians in our department. The survey assessed barriers and enablers to performing routine BCA in clinical care. Results were categorised using the Theoretical Domains Framework (TDF) and suitable interventions mapped using the Behaviour Change Wheel. Results:Twenty-two dietitians (84.6%) completed the survey. Barriers to BCA were identified in all TDF domains. Enablers existed in domains of: Skills; Beliefs about consequences; Goals; Environmental context and resources; Social influences; Intentions; Optimism; Reinforcement. Conclusions:This study showed that hospital dietitians experience numerous individual, team, and organisational barriers to adopt BCAs in clinical practice. Information on barriers and enablers and implementation strategies have been suggested to overcome these barriers to assist BCA adoption into routine practice.

Users’ experiences of an evidence-informed health information website for spinal cord injury: A prospective qualitative study across the hospital and community setting (Preprint)

2020 ◽  
Author(s):  
Christina Cassady ◽  
William Ben Mortenson ◽  
Andrea F Townson ◽  
Shannon Sproule ◽  
Janice Jennifer Eng
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Health Information ◽  
Information Needs ◽  
Information Source ◽  
Family Members ◽  
Hospital Setting ◽  
Community Setting ◽  
Therapeutic Education ◽  
Cord Injury

BACKGROUND Access to quality health information is essential for self-management after serious injuries such as spinal cord injury (SCI). OBJECTIVE The goal of this study was to evaluate the role of a consumer website in addressing the information needs of persons and families with SCI, as well as its impact on their knowledge and behaviour. METHODS Persons with SCI and family members were recruited from 3 settings: an acute hospital, a rehabilitation hospital, and an SCI community organization to acquire perspectives from early after injury to the chronic stage. Participants were introduced to the Spinal Cord Injury Research Evidence (SCIRE) Community website, which was an internet site developed to provide evidence-informed health information about SCI in everyday language. After using the SCIRE Community website for 4 weeks, semi-structured individual interviews were conducted to explore purposes of use, user experience, and impact on knowledge and behaviour. Interview transcripts were analyzed using qualitative thematic analysis. RESULTS The participants were 24 individuals (18 persons with SCI and 6 family members). Thirteen participants completed the study in a hospital setting and 11 participants in a community setting. We identified 3 main themes in the data: (1) ‘An internet tool to support and empower persons and families’ described the empowering nature of access to an independent information source which enabled persons and families with SCI to take a more active role in their care; (2) ‘an accessible source of credible information’ described how users valued easy to access content with oversight by experts (i.e., perceived to be trustworthy); and (3) ‘Opportunities to increase impact’ outlined suggestions on creating opportunities to engage with content through active learning strategies and community connections. CONCLUSIONS Persons and families with SCI valued having access to an independent online health information website, especially early after injury, as it helped to empower autonomy and facilitated better communication between persons and families and healthcare providers. Our study provides support for the value of internet-based health information as a supplementary tool for therapeutic education for persons and families with serious health conditions such as SCI.

scholarly journals Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John Downey ◽  
Katie Shearn ◽  
Nicola Brown ◽  
Ross Wadey ◽  
Jeff Breckon
Keyword(s):  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Developed Countries ◽  
Realist Evaluation ◽  
Service Planning ◽  
Service Development ◽  
Activity Levels ◽  
Programme Theory ◽  
Implementation Framework ◽  
Exercise Referral

Abstract Background Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom. Methods An eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework. Results Three programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice. Conclusions The findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development.

scholarly journals Using the Theoretical Domains Framework to investigate clinicians’ behavioural determinants of antimicrobial prescribing in Qatar

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i20-i22
Author(s):  
H Talkhan ◽  
D Stewart ◽  
T McIntosh ◽  
H Ziglam ◽  
P V Abdulrouf ◽  
...  
Keyword(s):  
Systematic Review ◽  
Scale Score ◽  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Free Text ◽  
Behaviour Change Interventions ◽  
Antimicrobial Prescribing ◽  
Behavioural Determinants ◽  
Inferential Analysis ◽  
Determinants Of Implementation

Abstract Introduction A recent systematic review by Talkhan et al demonstrated the need for theoretically based behaviour change interventions in this area. [1] For development of such complex interventions, emphasis should be placed on using theory to systematically identify behavioural determinants of antimicrobial prescribing. Aim To identify and quantify clinicians’ behavioural determinants of antimicrobial prescribing in Qatar. Methods This cross-sectional survey is part of a multi-phase explanatory, sequential mixed methods PhD project in Qatar. Questionnaires were distributed (online and paper based) to all doctors (~4,000) and pharmacists (~400) within Hamad Medical Corporation (HMC, the main healthcare provider). The questionnaire was developed with reference to the Determinants of Implementation Behaviour Questionnaire (a generic questionnaire derived from the 14 theoretical domains of the Theoretical Domains Framework, TDF). [2] Each item was presented as a 5-point Likert scale (scored 5=Strongly agree to 1=Strongly disagree). Personal and practice demographics were also collected for data contextualisation. The draft questionnaire was reviewed for face/content validity by an expert panel of six researchers in Qatar and the UK with experience in the use of the TDF, followed by ‘Think aloud’ testing and piloting. Analysis investigated the behavioural determinants and influential factors through descriptive, principal component analysis (PCA) and inferential analysis. Ethics approval was granted from a UK university and HMC. Results In total, 535 responses were received, 339 (63.4%) from doctors and 196 (36.6%) from pharmacists. Respondents were predominantly male, 346 (64.7%). Just over half (n=285, 53.3%) had ≤ 5 years’ experience as health professionals. PCA showed a three component (C) solution with components incorporating a number of questionnaire items labelled: ‘Guidelines compliance’ (C1 with 8 items), ‘Influences on prescribing’ (C2 with 7 items) and ‘Self-efficacy’ (C3 with 5 items) in prescribing/recommendation activity. A scale score for each respondent was calculated through summation of Likert scores for the relevant questionnaire items within each component. These scales had high internal reliability (Cronbach’s alpha all &gt;0.7) showing consistency in response between component items indicating statistical appropriateness for developing scales. The median score (possible scale range, midpoint) for each scale was C1, 32 (8 to 40, 24), C2, 26 (7 to 35, 21) and C3, 20, (5 to 25, 15). By way of example Table 1 shows levels of agreement for items in C2. This shows lower levels of agreement than C1 scale with the median scale score (26) closer to the midpoint (21) indicating that respondents had less positive views. Inferential analysis using these scale scores and free text analysis is in progress. Conclusion A theoretical basis was used throughout providing insights to behavioural determinants for the development of a theory-based behaviour change intervention. Preliminary results suggest that social influences, staff development and quality monitoring may be useful targets for behaviour change interventions to improve antimicrobial prescribing practice. Limitations include potential social desirability bias and focus on one healthcare organisation/country in the Middle East which may limit generalisability of findings. More in-depth exploration is required to select and test appropriate linked theory-based behaviour change techniques. References 1. Talkhan H, Stewart D, McIntosh T, Ziglam H Palli Valapila, A; Moza Sulaiman H, Diab M, Cunningham S. The use of theory in the development and evalu​ation of behaviour change interventions to improve antimicrobial prescribing: a systematic review. J Antimicrob Chemother. 2020;75(9):2394–2410, Available from https://doi.org/10.1093/jac/dkaa154 [Accessed 12 Oct 2020]. 2. Huijg JM, Gebhardt WA, Dusseldorp E, Verheijden MW, van der Zouwe N, Middelkoop BJ, Crone MR. Measuring determinants of implementation behaviour: psychometric properties of a questionnaire based on the Theoretical Domains Framework. Implement. Sci. 2014;9(1):33.

scholarly journals The effect of level of injury and physical activity on heart rate variability following spinal cord injury

2017 ◽  
Vol 42 (2) ◽  
pp. 212-219 ◽  
Author(s):  
Athanasios Kyriakides ◽  
Dimitrios Poulikakos ◽  
Angeliki Galata ◽  
Dimitrios Konstantinou ◽  
Elias Panagiotopoulos ◽  
...  
Keyword(s):  
Physical Activity ◽  
Spinal Cord ◽  
Heart Rate ◽  
Spinal Cord Injury ◽  
Heart Rate Variability ◽  
Cord Injury

Metabolic syndrome in people with a long-standing spinal cord injury: associations with physical activity and capacity

2016 ◽  
Vol 41 (11) ◽  
pp. 1190-1196 ◽  
Author(s):  
Sonja de Groot ◽  
Jacinthe J. Adriaansen ◽  
Marga Tepper ◽  
Govert J. Snoek ◽  
Lucas H.V. van der Woude ◽  
...  
Keyword(s):  
Physical Activity ◽  
Metabolic Syndrome ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Aerobic Capacity ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Metabolic Syndrome ◽  
Cord Injury ◽  
Peak Aerobic Capacity

This study investigated (i) the prevalence of the metabolic syndrome (MetS) in people with a long-standing spinal cord injury (SCI); (ii) whether personal or lesion characteristics are determinants of the MetS; and (iii) the association with physical activity or peak aerobic capacity on the MetS. In a cross-sectional study, persons with SCI (N = 223; time since injury of ≥10 years) were tested. The individual components of the MetS were assessed together with the physical activity measured by the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), while peak aerobic capacity was tested during a graded wheelchair exercise test on a treadmill. Thirty-nine percent of the participants had MetS. In a multivariate logistic regression analyses and after performing a backward regression analysis, only age and education were significant determinants of the MetS. A 10-year increase in age leads to a 1.5 times more chance to have the MetS. Furthermore, people with a low education will multiply the relative risk of MetS compared with people with high education by almost 2. With and without correcting for confounders, no significant relationship was found between PASIPD or peak aerobic capacity and the MetS. It can be concluded that the prevalence of the MetS is high (39%) in people with a long-standing SCI but is comparable to the general Dutch population. Older people and those with a lower education level are most at risk for the MetS. Physical activity and peak aerobic fitness were not related to the MetS in this group with a long-standing SCI.

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