Designing a Cancer Prevention Collaborative Goal Setting Application for Primary Care Patients: An Iterative, Patient-led Process (Preprint)

2021 ◽  
Author(s):  
Daniel Resnick ◽  
Matthew D Kearney ◽  
Jazmine M Smith ◽  
Allison Bautista ◽  
Liz Jones ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Prevention ◽  
Goal Setting ◽  
Mobile Application ◽  
Primary Care Physicians ◽  
Structured Interviews ◽  
Health Goals ◽  
System Usability Scale ◽  
Primary Care Patients ◽  
Beta Version

BACKGROUND There remains a need to engage at-risk primary care populations in cancer prevention behaviors, yet primary care physicians often lack the time or resources to discuss these behaviors with their patients. OBJECTIVE The objective of the study was to evaluate the content, usability, and acceptability of a mobile application that leverages insights from goal-setting and social networks literature to facilitate cancer prevention goal setting, tracking, and sharing between Non-Hispanic Black primary care patients and their social ties. METHODS We recruited participants from two primary care clinics in Philadelphia using non-probabilistic purposive sampling. We conducted semi-structured interviews with 5 to 7 participants over three weeks to solicit feedback on paper mock-ups of the application, iteratively adapting these mock-ups after each set of interviews. Thereafter, and informed by initial feedback, we created an electronic beta-version of the application and sought acceptability and usability feedback from a different set of participants. Then we conducted content analysis of all user responses to search for unifying themes on acceptability and usability of both the initial mock-ups and beta-version of the application. We further assessed application usability using questions derived from the System Usability Scale (SUS). RESULTS Thirty-three Non-Hispanic Black primary care patients participated in the study. The mean age was 49 (SD ± 13) and 79% identified as female. Semi-structured interviews revealed three primary generalizable insights from our target population: 1) the framing of each goal and its relevance to cancer impacted the likelihood the goal would be chosen; 2) participants thought that sharing health goals with others facilitates health behaviors; and 3) most participants found it motivating to see other users’ goal progress, while still collaborating with these users on their health goals. An overarching insight that permeated across each theme was the participants’ desire to customize and personalize the app. Usability testing revealed that 100% of participants found the application easy to use and 76% of participants reported they would like to use this application frequently. CONCLUSIONS Cancer prevention in the modern era must include options that are accessible to all, but this does not mean that all options must be universal. This study’s iterative process led to the development of a cancer prevention mobile application that Non-Hispanic Black primary care patients deemed usable and acceptable and yielded a number of noteworthy insights about what intended end-users value in setting and accomplishing health goals.

scholarly journals Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients: Pilot Testing a New Application (Preprint)

2020 ◽  
Author(s):  
Daniel Resnick ◽  
Marilyn M. Schapira ◽  
Jazmine M. Smith ◽  
Allison Bautista ◽  
Chang Xu ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Prevention ◽  
Goal Setting ◽  
Behavioral Change ◽  
Mobile Application ◽  
Primary Care Providers ◽  
Care Providers ◽  
System Usability Scale ◽  
Primary Care Patients ◽  
The Mean

BACKGROUND Many newly diagnosed cancers are associated with modifiable lifestyle behaviors, such as diet, exercise, smoking cessation, and maintaining a healthy weight. Despite this, primary care providers rarely discuss cancer prevention behaviors with their patients. OBJECTIVE To assess the usability, acceptability and engagement of the Healthier Together mobile application, which is designed to promote cancer prevention behaviors among Non-Hispanic Black primary care patients, utilizing social network and goal setting theories of behavior change. METHODS In an eight-week pilot study, we enrolled primary care patients (n=41) and provided these participants with a cancer prevention mobile application that allowed them to select, track, and share progress on cancer prevention goals with other users. We assessed application usability with the System Usability Scale (SUS). We assessed app acceptability by qualitatively analyzing open-ended responses about participants’ overall experience with the app. We assessed participant engagement by analyzing the built-in data capture, including how many times participants checked in (out of a maximum of eight) during the study. RESULTS Of 41 participants, the mean age was 51 (SD: 12) and 31 (76%) were women. App use data was captured for all participants and 34 (83%) completed the exit survey and interview. The mean SUS score was 87 (SD ±12; median 90; IQR 78-95). Analysis of open-ended responses revealed several key themes, with participants complementing the application’s ease of use and health behavior promoting features, while also commenting on the need for more feedback and social interactions through the application. On average, participants checked in 5.7 times (SD: 2.7) out of eight possible opportunities. Thirty-one participants (76%) checked in during at least 4 of the 8 weeks. Secondary analyses revealed that participants often accomplished their set goal (mean: 5.1, SD: 2.7) for each week. Qualitative analysis of comments participants left within the app after each weekly check-in revealed several themes on how the app assisted participants in behavioral change, highlighting that some participants built up exercise programs, ate healthier foods, lost a significant amount of weight, and stopped smoking during the study. CONCLUSIONS The implementation of a mobile cancer prevention goal setting application in a primary care setting was feasible with high usability, acceptability, and engagement from participants. User feedback revealed an influence on health behaviors. These findings suggest the promise of the HT application to facilitate behavioral change to reduce cancer risk among Non-Hispanic Black primary care patients.

scholarly journals Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M.-C. Audétat ◽  
S. Cairo Notari ◽  
J. Sader ◽  
C. Ritz ◽  
T. Fassier ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Reasoning ◽  
Primary Care Physicians ◽  
Video Sequence ◽  
Structured Interview ◽  
Ambulatory Setting ◽  
Structured Interviews ◽  
Stimulated Recall ◽  
Study Results

Abstract Background Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients. Methods A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a “button camera” (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches. Conclusion Study results will contribute to the scientific community’s overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient’s care and treatments.

scholarly journals Administrative Work and Job Role Beliefs in Primary Care Physicians: An Analysis of Semi-Structured Interviews

SAGE Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 215824401989909
Author(s):  
Eric Apaydin
Keyword(s):  
Primary Care ◽  
Los Angeles ◽  
Primary Care Physicians ◽  
Theory Approach ◽  
Structured Interviews ◽  
Job Roles ◽  
Face To Face ◽  
Administrative Work ◽  
Job Role ◽  
The Relationship

Primary care physicians face increasing amounts of administrative work (e.g., entering notes into electronic health records, managing insurance issues, delivering test results, etc.) outside of face-to-face patient visits. The objective of this study is to qualitatively describe the experience that primary care physicians have with administrative work, with an emphasis on their beliefs about their job role. I conducted semi-structured interviews with 28 family physicians and internists in Chicago, Los Angeles, and Miami and qualitatively analyzed themes from interview transcripts using the grounded theory approach. Two major themes concerning the relationship between primary care physicians and administrative work were discovered: (a) Administrative work was not central to primary care physicians’ job role beliefs, and (b) “below license” work should be delegated to nonphysicians. Job roles should be considered in future efforts to reduce physician administrative work in primary care.

scholarly journals Investigating information-seeking behaviors of primary care physicians who care for older depressed patients and their family caregivers: a pilot study

2005 ◽  
Vol 26 (4) ◽  
pp. 111 ◽  
Author(s):  
Mary Jo Dorsey ◽  
Ellen Detlefsen
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Information Seeking ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Structured Interviews ◽  
Depressed Patients ◽  
Types Of Information ◽  
Primary Care Practices ◽  
Information Seeking Behaviors

Objective – To describe preliminary findings from a study of information-seeking behaviors of primary care physicians who care for elderly and depressed patients, and the correlation between what is sought versus what is provided to the patient and (or) caregiver. Setting – Physicians in two large ambulatory primary care practices throughout urban Pittsburgh, Pennsylvania, who take care of geriatric patients. Methods – Structured interviews, with common questions, will be conducted with 12 primary care physicians to determine patterns of information-seeking behaviors. Environmental scans of physicians' offices for evidence of their existing information behaviors will complement the information obtained from the interviews. Results – This pilot study provides an analysis of the resources primary care physicians use to seek information to provide to patients and caregivers. Analyses show types of information sought, time spent seeking information, and methods used to find information given to patients. Conclusions – With mounting evidence of the Internet being used for patient self care, it is essential to understand if primary care physicians understand the scope and breadth of information readily available to their patients. The primary care physician needs to be aware of the types of information made available to their patients and the caregivers who are inclined to obtain information for the patient.

Physicians’ accounts of frontline tensions when implementing pilot projects to improve primary care

2018 ◽  
Vol 32 (1) ◽  
pp. 39-55 ◽  
Author(s):  
Elizabeth Mansfield ◽  
Onil Bhattacharyya ◽  
Jennifer Christian ◽  
Gary Naglie ◽  
Vicky Steriopoulos ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Primary Care Physicians ◽  
Pilot Project ◽  
Models Of Care ◽  
Structured Interviews ◽  
Pilot Projects ◽  
Additional Time ◽  
Content Type ◽  
The Impact

Purpose Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

Facilitators and barriers for promoting healthy eating among primary care patients: results of a qualitative study among practice nurses

2021 ◽  
Author(s):  
Geertruida J Groenendijk-van Woudenbergh ◽  
Marlies C van Hell-Cromwijk ◽  
Ytje J J van der Veen ◽  
Hylkje F Algra ◽  
Willemieke Kroeze
Keyword(s):  
Primary Care ◽  
Communication Skills ◽  
Healthy Eating ◽  
Patient Encounter ◽  
Structured Interviews ◽  
Good Communication ◽  
Practice Nurses ◽  
Professional Characteristics ◽  
Primary Care Patients ◽  
Facilitators And Barriers

Abstract Background Practice nurses have an important role in promoting healthy eating to prevent or delay long-term complications from chronic lifestyle-related diseases. Objective To identify the facilitators and barriers encountered by practice nurses at a professional level when promoting healthy eating among patients. Methods Face-to-face semi-structured interviews were conducted with 21 Dutch practice nurses. Data were recorded, transcribed and analysed using inductive thematic analysis. Results Two main themes were determined: professional characteristics and professional–patient encounter. Professional characteristics included good communication skills and experience facilitated the successful promotion of healthy eating, while a lack of communication skills and lack of knowledge about diet were perceived as barriers. The most frequently identified facilitators for professional–patient encounter included ensuring a personal connection with patients, creating food awareness, focussing on small changes, adopting a tailored approach, motivating and arranging extra consultations. Barriers included lack of skills to raise the topic, lack of persistence, inability to find a common understanding, lack of competence in handling patients’ own choices and underuse of existing educational materials. Conclusions Further research using the identified facilitators and barriers for promoting healthy eating in primary care patients with chronic diseases could assist in the development of future training programmes for practice nurses.

Ethical Implications of Cultural Barriers to the Depression Diagnosis: Conversations with Primary Care Physicians

2020 ◽  
Vol 51 (9) ◽  
pp. 683-701
Author(s):  
Diana Cagliero
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Ethical Issues ◽  
Treatment Options ◽  
Cross Cultural ◽  
Cultural Barriers ◽  
Structured Interviews ◽  
Cultural Backgrounds ◽  
Ethical Implications

This article explores ethical issues raised by Primary Care Physicians (PCPs) when diagnosing depression and caring for cross-cultural patients. This study was conducted in three primary care clinics within a major metropolitan area in the Southeastern United States. The PCPs were from a variety of ethnocultural backgrounds including South Asian, Hispanic, East Asian and Caucasian. While medical education training and guidelines aim to teach physicians about the nuances of cross-cultural patient interaction, PCPs report that past experiences guide them in navigating cross-cultural conversations and patient care. In this study, semi-structured interviews were conducted with seven PCPs which were transcribed and underwent thematic analysis to explore how patients’ cultural backgrounds and understanding of depression affected PCPs’ reasoning and diagnosing of depression in patients from different cultural backgrounds. Ethical issues that arose included: limiting treatment options, expressing a patient’s mental health diagnosis in a biomedical sense to reduce stigma, and somatization of mental health symptoms. Ethical implications, such as lack of autonomy, unnecessary testing, and the possible misuse of healthcare resources are discussed.

scholarly journals Effects of mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians: a mixed-methods study

BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101621 ◽  
Author(s):  
Herman van Wietmarschen ◽  
Bram Tjaden ◽  
Marja van Vliet ◽  
Marieke Battjes-Fries ◽  
Miek Jong
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Perceived Stress ◽  
Primary Care Physicians ◽  
Mindfulness Training ◽  
Structured Interviews ◽  
Self Reflection ◽  
Self Compassion ◽  
High Workload ◽  
Compassion Scale

BackgroundPrimary care physicians are subjected to a high workload, which can lead to stress and a high incidence of burnout. A mindfulness training course was developed and implemented for primary care physicians to better cope with stress and improve job functioning.AimTo gain insight into the effects of the mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians.Design & settingA pragmatic mixed-methods pre–post design in which physicians received 8 weeks of mindfulness training.MethodParticipants completed validated questionnaires on perceived stress (Perceived Stress Scale [PSS]), self-compassion (Self-Compassion Scale [SCS]), and self-reflection (Groningen Reflection Ability Scale [GRAS]) before the training, directly after, and 6 months later. Semi-structured interviews were conducted with six participants after the training and a content analysis was performed to gain in depth understanding of experiences.ResultsA total of 54 physicians participated in the study. PSS was reduced (mean difference [MD] -4.5, P<0.001), SCS improved (MD = 0.5, P<0.001), and GRAS improved (MD = 3.3, P<0.001), directly after the 8-week training compared with before training. Six months later, PSS was still reduced (MD = -2.9, P = 0.025) and SCS improved (MD = 0.7, P<0.001). GRAS did not remain significant (MD = 2.5, P = 0.120). Qualitative analysis revealed four themes: being more aware of their own feelings and thoughts; being better able to accept situations; experiencing more peacefulness; and having more openness to the self and others.ConclusionMindfulness training might be an effective approach for improving stress resilience, self-compassion, and self-reflection in primary care physicians.

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