Knowledge, Beliefs and Practices of People diagnosed with Type-1 Diabetes towards Diabetes Mellitus and Diabetic Foot Syndrome

Background: Diabetes Mellitus (DM) is associated with significant morbidity and mortality. Diabetic foot syndrome is one of the most common devastating preventable complications of diabetes mellitus (DM). Objectives: We aimed to evaluate the knowledge, Beliefs and Practices (KBP) among Omani patients with type 1 diabetes mellitus (T1DM) regarding DM and Diabetes foot. Design: A cross sectional descriptive study was used. Settings: A secondary care, polyclinic named Bawshar in Muscat, Oman where patients were seen three days per week. Sample Size:A convenient sample of 100 participants between age group 16 to 30 years were involved. Materials and methods: A validated semi- structured questionnaire was used to assess KBP of T1DM with six domains. During the study period from November 2019 to December 2019. .The data was analysed by using Statistical Package for the Social Sciences (SPSS) Statistics Inc., Chicago, US version 20. Results: There were 50 females, 50 males; 5 % of patients were illiterate and 30% of them were working. 65% were students. Only 50% checked their foot regularly and only 55% check there blood glucose regularly .57% don’t know the cause of diabetes, 25% don’t know the complications of the same while 20% don’t know cause of diabetic foot and 25% don’t know the symptoms of diabetic foot. 20% beliefs checking blood glucose is the responsibility of the doctor and 85% beliefs walking bare foot is high risk factor for DM foot. Conclusions: In reality healthcare providers must be trained to counsel people with DM to plan adequate interventions that enable an understanding of the offered information. A well-structured ,Behaviour change counselling (BCC) like Motivational interviewing (MI)are considered the ideal practices for this patients, to prevent DM complications.

Assessing Physician’s Motivational Communication Skills: The development of the Motivational Communication Competency Assessment Test (MC-CAT) (Preprint)

BACKGROUND Training physicians to provide effective behaviour change counselling (BCC) using approaches like motivational communication (MC) is an important aspect of non-communicable chronic disease (NCD) prevention and management. However, existing evaluation tools for MC skills are complex, invasive, time consuming, and impractical for use within the medical context. OBJECTIVE The objective of this study was to develop and validate a short, web-based tool evaluating healthcare providers (HCPs) skills in MC, the Motivational Communication Competency Assessment Test (MC-CAT). METHODS Between 2016 and 2021, starting with a set of core 11 MC competencies previously identified and using a 5-step mixed-methods integrated knowledge translation (iKT) approach, the MC-CAT was created by: 1) developing a series of four base cases and a scoring scheme; 2) validating the base cases and scoring scheme with international experts; 3) creating three alternative versions of the four base cases (to create a bank of 16 cases, four of each type of ‘base’ case) and translating the cases into French; 4) integrating the cases into the online MC-CAT platform; and 5) conducting initial internal validity assessments with university health students. RESULTS The MC-CAT assesses MC competency in 20 minutes by presenting HCPs with 4 out of a possible 16 cases (randomly selected and ordered) addressing various behavioural targets (e.g., smoking, physical activity, diet, medication adherence). Individual and global competency scores are calculated automatically for the 11 competency items across the 4 cases providing automatic scores out of 100. From the factorial analysis of variance for the difference in competency and ranking scores, no significant differences were identified between the different case versions across individual and global competency and ranking scores (p’s > 0.05). Initial tests of internal consistency for rank order among 24 student participants were in the ‘acceptable’ range (alpha = 0.78). CONCLUSIONS Results suggest the MC-CAT is an internally valid tool to facilitate the evaluation of MC competencies among HCPs, and is ready to undergo comprehensive psychometric property analyses with a national sample of healthcare providers. Once psychometric property assessments have been completed, this tool is expected to facilitate the assessment of MC skills among HCPs, skills that will better support patients to adopt healthier lifestyles, which will significantly reduce the personal, social, and economic burden of NCDs.

Is fidelity to a complex behaviour change intervention associated with patient outcomes? Exploring the relationship between dietitian adherence and competence and the nutritional status of intervention patients in a successful stepped-wedge randomised clinical trial of eating as treatment (EAT)

BackgroundBehavioural medicine is characterised by findings for the effectiveness and efficacy of complex behaviour change interventions. Comparatively, scant attention has been paid to key intervention components or mechanisms of action. Evaluating relationships between process variables (fidelity) and intervention effects is central to addressing this imbalance. Accordingly, in the current study, we sought to explore the magnitude and direction of effect between fidelity predictors (dietitian adherence and competence) and intervention effects (patient nutritional status) during the intervention phase of a real-world, stepped-wedge evaluation of ‘EAT: Eating As Treatment’.MethodsThe EAT clinical trial was conducted within five major Australian hospitals located in Queensland, Western Australia, Victoria and South Australia between 2013 and 2016. EAT is a dietitian-delivered health behaviour change intervention designed to reduce malnutrition in head and neck cancer (HNC) patients undergoing radiotherapy. Dietitian adherence and competence ratings were derived from a 20% random sample of audio-recorded dietetic consultations (n=194) conducted after dietitians (n=18) were trained in EAT. Sessions were coded by trained, independent, coders using a study checklist, the Behaviour Change Counselling Index (BECCI) and items from the Cognitive Therapy Scale-Revised (CTS-R). Patient nutritional status was measured using the Patient-Generated Subjective Global Assessment (PGSGA).ResultsDietitian adherence to a written nutrition plan (β=7.62, 95% CI=0.65 to 14.58,p=0.032), dietitian adherence to behaviour change counselling (β=0.69, 95% CI =0.02 to 1.38,p=0.045) and competence in delivering behaviour change counselling (β=3.50, 95% CI =0.47 to 6.53,p=0.024) were significant predictors of patient nutritional status. Dietitian adherence and competence ratings were higher during consultations with intervention patients at greater risk of malnutrition.ConclusionsThis study contributes new insights into the relationship between fidelity and treatment outcome by demonstrating that dietitian adherence and competence is greater when working with more challenging patients. This is likely central to the demonstrated success of the EAT intervention in reducing malnutrition and highlights the importance of ensuring that providers are adequately equipped to flexibly integrate intervention elements according to patient need.Trial registrationThis study is a process analysis of a stepped-wedge randomised controlled trial prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12613000320752; Date of registration 21/03/2013).

Training physicians in motivational communication to improve behaviour change counselling competency: A behavioural medicine approach to NCD prevention and management

Background Despite the importance of changing health behaviours in the context of preventing and managing non-communicable chronic diseases (NCD's), physician use of evidence-based behaviour change counselling (BCC) is low, and BCC skills competency is generally poor. Motivational communication (MC) is a patient-centred, evidence-based BCC approach used by healthcare providers, designed to increase patient motivation to adopt a healthy lifestyle. MC-based approaches improved a range of health behaviours (smoking, diet, physical activity) in patients with NCDs, leading to increased demand for physician training. Despite the widespread dissemination of training programs, data on their efficacy in achieving competency among physicians is limited. This is likely due to a lack of consensus on the core communication competencies to be achieved, and in the absence of acceptable, valid and reliable tools to measure skill acquisition. Results Using an integrated knowledge translation (iKT) approach that engaged 199 international physicians, behaviour change experts and health administrators, we have identified 11 core evidence-based communication competencies that physicians should acquire in the context of NCD prevention/management. They have been incorporated into a basic 4 hr face-to-face MC training program called “LEARN THE BASICs”. To assess MC competency, we have also developed a reliable, engaging, efficient, 'user-friendly' case-based digital assessment tool called the MC-Competency Assessment Test (MC-CAT). Conclusions Strategies for optimizing and tailoring this program, including finding the most cost-effective training dose, the impact of supplemental training components (e.g., in person vs. digital coaching; booster sessions), and delivery modes (e.g., face-to-face vs digital/online), will be discussed in the context of optimizing implementation success.

22.B. Workshop: Behavioural insights and public health

Many of today's most pressing public health challenges have a strong behavioural component. Behavioural, psychosocial, and environmental factors play a major role in the development and progression of chronic diseases. Eliminating those risks would make it possible to prevent at least 80% of cardiovascular diseases, 75% of diabetes, and 40% of cancers. Behavioural insights provide an empirically informed perspective on how individuals make decisions, including the important recognition that even subtle changes in the environment can have meaningful impacts on behaviour. This workshop will provide examples from the literature and recent government initiatives that incorporate concepts from behavioural sciences in order to improve health, decision-making, and government efficiency. The examples highlight the potential for behavioural sciences to improve the effectiveness of public health policy at low cost. Although incorporating insights from behavioural sciences into public health policy has the potential to improve population health, its integration into government public health programs and policies requires careful design and continual evaluation of such interventions. Limitations and drawbacks of the approach will be discussed. The aim of this workshop is to broaden our understanding of measures that have originated from behavioural sciences and have a lot to offer to public health. This workshop also seeks to contribute to capacity building in knowledge translation and evidence-informed decision-making in public health. The workshop will consist of five presentations providing an overview of topical issues in the field of behaviour change and knowledge translation, followed by an interactive audience discussion. The first presentations will provide insights into current behaviour change theories. The second presentation will discuss the possibilities of using behaviour change principles in the development and adoption of health policies showcasing the recently adopted Canadian Association of Cardiovascular Prevention and Rehabilitation Guide and the Food Guide. The third presentation will highlight the challenges in tackling physician's ability to effectively conduct behaviour change counselling with their patients in the context of chronic disease prevention. The fourth presentation will introduce the free academic meta-search engine - Motrial, which has a great potential in evaluating the randomized controlled trials and fuelling meta-analyses and systematic reviews in return of better quality. The fifth presentation will introduce a novel WHO/Europe guide on brief interventions for NCDs risk factors. Further to the reflection on the current knowledge base, an audience discussion will give attendees the opportunity to share their opinions regarding challenges and opportunities in behaviour change and knowledge translation to improve people's health and well-being. Key messages The application of behavioural insights into public health has its opportunities and challenges. Because behavioural insights is a very promising, yet a relatively new field, the research literature remains thin, and policy can sometimes get ahead of science.

Assessing Adherence, Competence and Differentiation in a Stepped-Wedge Randomised Clinical Trial of a Complex Behaviour Change Intervention

Background: A key challenge in behavioural medicine is developing interventions that can be delivered adequately (i.e., with fidelity) within real-world consultations. Accordingly, clinical trials should (but tend not to) report what is actually delivered (adherence), how well (competence) and the distinction between intervention and comparator conditions (differentiation). Purpose: To address this important clinical and research priority, we apply best practice guidelines to evaluate fidelity within a real-world, stepped-wedge evaluation of “EAT: Eating As Treatment”, a new dietitian delivered health behaviour change intervention designed to reduce malnutrition in head and neck cancer (HNC) patients undergoing radiotherapy. Methods: Dietitians (n = 18) from five Australian hospitals delivered a period of routine care and following a randomly determined order each site received training and began delivering the EAT Intervention. A 20% random stratified sample of audio-recorded consultations (control n = 196; intervention n = 194) was coded by trained, independent, raters using a study specific checklist and the Behaviour Change Counselling Inventory. Intervention adherence and competence were examined relative to apriori benchmarks. Differentiation was examined by comparing control and intervention sessions (adherence, competence, non-specific factors, and dose), via multiple linear regression, logistic regression, or mixed-models. Results: Achievement of adherence benchmarks varied. The majority of sessions attained competence. Post-training consultations were clearly distinct from routine care regarding motivational and behavioural, but not generic, skills. Conclusions: Although what level of fidelity is “good enough” remains an important research question, findings support the real-world feasibility of integrating EAT into dietetic consultations with HNC patients and provide a foundation for interpreting treatment effects.

Cost of Implementing Complex Community Intervention for Healthier Lifestyle at Five Health Clinics in Malaysia

BackgroundA complex community intervention for behavioural change through the use of behaviour change counselling provided by community health promoters (CHPs) and utilisation of an E-health platform was designed to address an increasing number of obese and overweight women entering pregnancy. This paper describes a cost analysis of this novel intervention.MethodsThe analysis was performed from a provider’s perspective, and calculated in Malaysian ringgit (RM). Included were costs for purchase of clients’ progress monitoring equipment, including anthropometric measurement and information technology (IT) equipment; training and education of the CHPs and other healthcare personnel; and cost of contact between the clients and the providers; excluding costs for intervention planning and resource development; and research costs.ResultsAssuming that the intervention is running at a steady state; utilising existing facilities; and does not require additional time; total cost was RM 445,725.51 and average cost per intervention per person RM 3,073.97. About 50% of the total cost was for the purchase of IT equipment, 17% for the maintenance of the system and the remainder for consumables, emoluments and utilities.ConclusionsFindings of this study suggests that implementation of the intervention requires the provider to invest heavily in IT hardware and maintenance of the E-health platform. However, this analysis is likely an under-estimate of the actual cost as it was conducted from a provider’s perspective only and the intervention was assumed to have matured and running at a steady state; which may not be the case as changes were undertaken during its implementation to allow for maximum outcome.Trial registration number: NMRR-15-2333-28679Date of registration: 22 March 2016

Workshop: Behaviour change and knowledge translation: The unlocked potential to improve people’s health

Background Despite the complexities of modern healthcare it remains the case that human behaviour plays a critical role in health outcomes and in the efficacy of most treatments. We know that people get sick because of unhealthy behaviours. We know that the success of most healthcare interventions is highly dependent on patients’ willingness to adhere to self-care activities such as taking medications or performing self-examinations. Over the last decades well-validated, cost-effective behavioural medicine interventions have been developed. The field has contributed to strategies in health education, with techniques for modifying behaviour, and enhancing motivation and learning for health. More recently, multilevel intervention models, including environmental and policy variables, are being increasingly proposed and tested. Yet, for several reasons, only few such interventions have been translated into policy recommendations or implemented successfully in clinical practice. Through highlighting critical gaps in knowledge translation that can be addressed by integrating modern theoretical and methodological approaches across disciplines we hope to contribute to the development of effective and implementable behaviour change interventions for optimal population and individual health and well-being. Aim The aim of this workshop is to broaden our understanding of measures that have originated from behavioural sciences and have a lot to offer to public health. This workshop also seeks to contribute to capacity building in knowledge translation and evidence-informed decision-making in public health. Workshop structure The workshop will consist of five presentations providing an overview of topical issues in the field of behaviour change and knowledge translation, followed by an interactive audience discussion. The first presentations will introduce the most recent challenges in knowledge translation from the WHO/Europe perspective. The second presentation will discuss the possibilities of using behaviour change principles in the development and adoption of health policies showcasing the Canada’s newly adopted Food Guide. The third presentation will highlight the challenges in tackling physician’s ability to effectively conduct behaviour change counselling with their patients in the context of chronic disease prevention. The fourth presentation will make the link between the knowledge translation theory and practice, using the Behaviour Change Wheel theory. The fifth presentation will introduce the free academic meta-search engine - Motrial, which has a great potential in evaluating the randomized controlled trials and fuelling meta-analyses and systematic reviews in return of better quality. Further to the reflexion on the current knowledge base, an audience discussion will give attendees the opportunity to share their opinions regarding challenges and opportunities in knowledge translation to improve people’s health and well-being. Key messages Policy development and adoption can be considered as a behaviour change process. The application of behaviour change principles to the policy process may lead to greater stakeholder engagement and faster policy implementation.