scholarly journals Improving Clinicians’ Implementation of Guidelines to Help Women Stop Smoking in Pregnancy: Developing Evidence-Based Print and Video Materials

Author(s):  
Jo M. Longman ◽  
Catherine Adams ◽  
Christine Paul ◽  
James McLennan ◽  
Megan E. Passey

Smoking in pregnancy remains a public health challenge. Our team developed a comprehensive intervention using the Behaviour Change Wheel to support clinicians’ implementation of guidelines on supporting women to stop smoking in pregnancy. Integral to the intervention was a suite of evidence-based video and print materials. This paper describes the rationale and process for developing these materials. Comprehensive mixed methods research was undertaken to identify the key barriers and enablers for clinicians in implementing the guidelines. This research identified which behaviours required change, and which behaviour change techniques were best suited to effecting that change. Materials were developed based on this understanding, in a collaborative process with multiple stakeholders, and their feasibility and acceptability explored in a small trial. Materials developed included leadership, clinician and client resources. There are considerable advantages to systematically and collaboratively developing materials which are integral to a behaviour-change intervention even though it is resource intensive to do so.

Obesity Facts ◽  
2021 ◽  
pp. 1-14
Author(s):  
R. James Stubbs ◽  
Cristiana Duarte ◽  
António L. Palmeira ◽  
Falko F. Sniehotta ◽  
Graham Horgan ◽  
...  

<b><i>Background:</i></b> Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. <b><i>The Project:</i></b> First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. <b><i>Impact:</i></b> The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Veena A. Satyanarayana ◽  
Cath Jackson ◽  
Kamran Siddiqi ◽  
Prabha S. Chandra ◽  
Rumana Huque ◽  
...  

Abstract Background Home exposure to secondhand smoke (SHS) is highly prevalent amongst pregnant women in low- and middle-income countries like India and Bangladesh. The literature on the efficacy of behaviour change interventions to reduce home exposure to SHS in pregnancy is scarce. Methods We employed a theory and evidence-based approach to develop an intervention using pregnant women as agents of change for their husband’s smoking behaviours at home. A systematic review of SHS behaviour change interventions led us to focus on developing a multicomponent intervention and informed selection of behaviour change techniques (BCTs) for review in a modified Delphi survey. The modified Delphi survey provided expert consensus on the most effective BCTs in reducing home exposure to SHS. Finally, a qualitative interview study provided context and detailed understanding of knowledge, attitudes and practices around SHS. This insight informed the content and delivery of the proposed intervention components. Results The final intervention consisted of four components: a report on saliva cotinine levels of the pregnant woman, a picture booklet containing information about SHS and its impact on health as well strategies to negotiate a smoke-free home, a letter from the future baby to their father encouraging him to provide a smoke-free home, and automated voice reminder and motivational messages delivered to husbands on their mobile phone. Intervention delivery was in a single face-to-face session with a research assistant who explained the cotinine report, discussed key strategies for ensuring a smoke-free environment at home and practised with pregnant women how they would share the booklet and letter with their husband and supportive family members. Conclusion A theory and evidence-based approach informed the development of a multicomponent behaviour change intervention, described here. The acceptability and feasibility of the intervention which was subsequently tested in a pilot RCT in India and Bangladesh will be published later.


Author(s):  
Fizzah B. Abidi ◽  
Libby Laing ◽  
Sue Cooper ◽  
Tim Coleman ◽  
Katarzyna A. Campbell

Smoking during pregnancy is a global health problem which has devastating health implications. Behavioural support is an important part of smoking cessation support for pregnant women. Research has identified barriers and facilitators (B&Fs) and effective behaviour change techniques (BCTs) to aid women’s quit attempts. However, the extent to which and how these BCTs are used in practice is unclear. The research aimed to establish experts’ views on how behavioural support can be optimised and techniques operationalised in clinical practice, by identifying ways to address known B&Fs for smoking cessation in pregnancy. A focus group discussion took place with six experts, which highlighted how BCTs can be used in practice to support women in their quit attempts. A thematic analysis was conducted to elicit overarching themes. Five themes were found: involving the family, empowering women, using incentives to boost motivation, using practical techniques to help women with their quit attempts and managing expectations about nicotine replacement therapy. Empowering women to make their own decisions and encouraging small positive changes in smoking habits, using visual aids (e.g., growth charts) to inform women of the harms of smoking to the baby and treating families holistically were deemed important.


Author(s):  
Catherine Chamberlain ◽  
Alison O'Mara-Eves ◽  
Jessie Porter ◽  
Tim Coleman ◽  
Susan M Perlen ◽  
...  

2020 ◽  
Author(s):  
Sarah Kourouche ◽  
Kate Curtis ◽  
Belinda Munroe ◽  
Jack Lyons ◽  
Ian Carey ◽  
...  

Abstract Background: Ineffective or delayed treatment of patients with blunt chest wall injury results in high rates of morbidity and mortality. A blunt chest injury care bundle protocol (ChIP) was developed and implemented to improve evidence-based care for these patients at two regional hospitals in Australia. ChIP is an early notification system to notify specialist clinician ‘responders’ to prescribe and commence treatment for patients with blunt chest injury in the emergency department (ED). A multi-pronged implementation strategy developed using the Behaviour Change Wheel (BCW), including seven intervention functions and 15 behaviour change techniques, guided implementation. Fidelity to the implementation strategy was high, with 97.5% fully or partially implemented. Implementation fidelity is the extent to which an intervention has been implemented as intended; it affects the internal and external validity of implementation. This study evaluates the fidelity of intervention delivery (fidelity, dose and reach) at two hospitals. Methods: Pre-post implementation evaluation study. The characteristics of patients, rate of ChIP activations and components of ChIP received by eligible patients were compared pre (1 July 2015 to 21 November 2017) and post (22 November 2017 to 30 June 2019) intervention. Sample medians were compared using the non-parametric median test, with the 95% confidence of the difference estimated using the Hodges-Lehmann estimate. Differences in proportions for categorical data were compared with two-sample z-test. Logistic regression was used to adjust for group differences. Results: Overall, 97.1% of eligible patients received ChIP over the 19-month post-implementation period. Compared to the pre-implementation group the post-implementation group, were more likely to receive evidence-based treatments including high flow nasal cannula (OR=6.8 (4.8,9.6)), incentive spirometry in ED (OR=7.5 (3.2,17.6)), regular analgesia (OR=2.4 (1.5,3.8)), regional analgesia (OR=2.8 (1.5, 5.3)), Patient controlled analgesia (OR=1.8 (1.3,2.4)), and multiple specialist team reviews e.g. ICU liaison (OR=10.7 (6.9,16.7)). Conclusions: High fidelity of delivery was achieved and sustained for ChIP for the implementation of a complex intervention in the emergency context with a robust implementation plan based on theoretical frameworks. Findings from this evaluation can inform future implementation of ChIP and other multidisciplinary interventions in an emergency or acute care context. Trial registration: ANZCTR: ACTRN12618001548224, approved 17/09/2018


Author(s):  
Catherine Chamberlain ◽  
Alison O'Mara-Eves ◽  
Sandy Oliver ◽  
Jenny R Caird ◽  
Susan M Perlen ◽  
...  

1989 ◽  
Vol 11 (2) ◽  
pp. 124-130 ◽  
Author(s):  
Richard J. Madeley ◽  
Pamela A. Gillies ◽  
F. Lindsay Power ◽  
E. Malcolm Symonds

2020 ◽  
Vol 37 (4) ◽  
pp. 493-498
Author(s):  
Michelle D Sherman ◽  
Stephanie A Hooker

Abstract Background Approximately 40% of deaths in the USA are attributable to modifiable health behaviours. Despite clear recommendations and practice guidelines, primary care physicians (PCPs) generally do not dedicate much time to addressing health behaviours, thereby missing opportunities to improve patient well-being. Objective(s) To examine what health behaviour change techniques PCPs use with their patients, including frequency of use, confidence in and perceived effectiveness of those interventions. Methods Using a cross-sectional study design, family medicine resident and faculty physicians (n = 68) from three residency training programs completed an anonymous online survey. Questions explored their use of, confidence in and perceived effectiveness of health behaviour change interventions for six domains: physical activity, healthy eating, medication adherence, smoking cessation, sleep and alcohol reduction. Qualitative responses to open-ended questions were double coded by two independent raters. PCPs’ open-ended responses to questions regarding specific intervention techniques were coded using an evidence-based behaviour change taxonomy. Results Although PCPs indicated that they address health behaviour topics quite frequently with their patients, they reported only moderate confidence and low-to-moderate perceived effectiveness with their interventions. The most frequently cited technique was providing instruction (telling patients what to do). PCPs reported lowest frequency of addressing, lowest confidence and lowest effectiveness regarding helping patients decrease their use of alcohol. Insufficient time and perceived low patient motivation were commonly cited barriers. Conclusion These findings highlight the need for the development and evaluation of educational curricula to teach physicians brief, evidence-based approaches to helping patients make these changes in their health-related behaviours.


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