Implementation of coordinated healthy lifestyle promotion in primary care : Process and outcomes

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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GPs’ experiences of children with anxiety disorders in primary care: a qualitative study

British Journal of General Practice ◽

10.3399/bjgp17x693473 ◽

2017 ◽

Vol 67 (665) ◽

pp. e888-e898 ◽

Cited By ~ 7

Author(s):

Doireann O’Brien ◽

Kate Harvey ◽

Bridget Young ◽

Tessa Reardon ◽

Cathy Creswell

Keyword(s):

Primary Care ◽

Anxiety Disorders ◽

Emotional Disorders ◽

Medical Training ◽

Comparative Method ◽

Significant Proportion ◽

Childhood Anxiety ◽

Care Process ◽

Structured Interviews ◽

Specialist Services

BackgroundAnxiety disorders have a median age of onset of 11 years and are the most common emotional disorders in childhood; however, a significant proportion of those affected do not access professional support. In the UK, GPs are often the first medical professional that families see so are in a prime position to support children with anxiety disorders; however, currently there is little research available on GPs’ perspectives on and experiences of supporting children with these disorders.AimTo explore the experiences of GPs in relation to identification, management, and access to specialist services for children (<12 years) with anxiety disorders.Design and settingTwenty semi-structured interviews were conducted with GPs in primary care throughout England.MethodGPs reflected a diverse group in relation to the ethnic and socioeconomic profile of registered patients, GP age, sex, professional status, previous engagement with research, and practice size and location. Purposive sampling was used to recruit GPs until theoretical saturation was reached. Data were analysed using a constant comparative method of thematic analysis.ResultsData from 20 semi-structured interviews were organised into three themes: decision making, responsibility, and emotional response, with an overarching theme of GPs feeling ill equipped. These themes were retrospectively analysed to illustrate their role at different stages in the primary care process (identification, management, and access to specialist services).ConclusionGPs feel ill equipped to manage and support childhood anxiety disorders, demonstrating a need for medical training to include greater emphasis on children’s mental health, as well as potential for greater collaboration between primary and specialist services.

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