scholarly journals Development and Evaluation of an HIV-Testing Intervention for Primary Care: Protocol for a Mixed Methods Study

10.2196/16486 ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. e16486
Author(s):  
Hanne Apers ◽  
Bea Vuylsteke ◽  
Jasna Loos ◽  
Tom Smekens ◽  
Jessika Deblonde ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Hiv Testing ◽  
Intervention Study ◽  
Intervention Mapping ◽  
Real Life ◽  
Surveillance Data ◽  
Evidence Based ◽  
Starting Point ◽  
Undiagnosed Hiv

Background Late diagnosis of HIV fosters HIV transmission and may lead to hidden HIV epidemics. In Belgium, mathematical modeling indicates a high prevalence of undiagnosed HIV infections among men who have sex with men of non-Belgian origin and among sub-Saharan African migrants. Promotion of HIV testing facilitates early diagnosis, but diagnostic opportunities are missed in primary care. Objective The intervention study aims to enhance provider-initiated HIV testing by GPs. This protocol presents the conceptual development, implementation, and evaluation of an HIV-testing intervention for Flemish general practitioners (GPs). Methods A mixed methods evaluation design is used. Guided by a simplified intervention mapping approach, an evidence-based intervention was developed in collaboration, guided by an interdisciplinary advisory board. The intervention consisted of an evidence-based tool (ie, “HIV-testing advice for primary care”) to support GPs in provider-initiated HIV testing. A modified stepped-wedge design compare two different intervention levels: (1) online dissemination of the HIV-testing advice and (2) dissemination with additional group-level training. Both conditions were compared against a control condition with no intervention. The effect of the intervention was measured using Poisson regression for national surveillance data. The primary outcome was the number of HIV diagnoses made by GPs. Secondary outcomes were HIV diagnoses among groups at risk for undiagnosed HIV, distribution of new diagnoses by CD4 cell count, number of HIV tests prescribed by GPs, and rate of new diagnoses by tests. To evaluate the intervention’s implementation, the GPs’ fidelity to the intervention and the intervention’s feasibility and acceptability by GPs were assessed through (web-based) surveys and in-depth telephone interviews. Results The study was funded in 2016 and ethically approved in January 2017. The implementation of the intervention started in January 2017 and ended in December 2018. Data was completed in October 2019 and was the starting point for the ongoing data analysis. The results are expected to be published in the second half of 2020. Conclusions Results of the intervention study will provide useful information on the intervention’s effectiveness among Flemish GPs and can inform further development of official testing guidelines. Limitations of this real-life intervention approach are potential spill-over effects, delay in access to surveillance data, and little detailed information on HIV-testing practices among GPs. Trial Registration ClinicalTrials.gov NCT04056156; https://clinicaltrials.gov/ct2/show/NCT04056156 International Registered Report Identifier (IRRID) DERR1-10.2196/16486

scholarly journals Development and Evaluation of an HIV-Testing Intervention for Primary Care: Protocol for a Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Hanne Apers ◽  
Bea Vuylsteke ◽  
Jasna Loos ◽  
Tom Smekens ◽  
Jessika Deblonde ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Hiv Testing ◽  
Intervention Study ◽  
Intervention Mapping ◽  
Real Life ◽  
Surveillance Data ◽  
Evidence Based ◽  
Starting Point ◽  
Undiagnosed Hiv

BACKGROUND Late diagnosis of HIV fosters HIV transmission and may lead to hidden HIV epidemics. In Belgium, mathematical modeling indicates a high prevalence of undiagnosed HIV infections among men who have sex with men of non-Belgian origin and among sub-Saharan African migrants. Promotion of HIV testing facilitates early diagnosis, but diagnostic opportunities are missed in primary care. OBJECTIVE The intervention study aims to enhance provider-initiated HIV testing by GPs. This protocol presents the conceptual development, implementation, and evaluation of an HIV-testing intervention for Flemish general practitioners (GPs). METHODS A mixed methods evaluation design is used. Guided by a simplified intervention mapping approach, an evidence-based intervention was developed in collaboration, guided by an interdisciplinary advisory board. The intervention consisted of an evidence-based tool (ie, “HIV-testing advice for primary care”) to support GPs in provider-initiated HIV testing. A modified stepped-wedge design compare two different intervention levels: (1) online dissemination of the HIV-testing advice and (2) dissemination with additional group-level training. Both conditions were compared against a control condition with no intervention. The effect of the intervention was measured using Poisson regression for national surveillance data. The primary outcome was the number of HIV diagnoses made by GPs. Secondary outcomes were HIV diagnoses among groups at risk for undiagnosed HIV, distribution of new diagnoses by CD4 cell count, number of HIV tests prescribed by GPs, and rate of new diagnoses by tests. To evaluate the intervention’s implementation, the GPs’ fidelity to the intervention and the intervention’s feasibility and acceptability by GPs were assessed through (web-based) surveys and in-depth telephone interviews. RESULTS The study was funded in 2016 and ethically approved in January 2017. The implementation of the intervention started in January 2017 and ended in December 2018. Data was completed in October 2019 and was the starting point for the ongoing data analysis. The results are expected to be published in the second half of 2020. CONCLUSIONS Results of the intervention study will provide useful information on the intervention’s effectiveness among Flemish GPs and can inform further development of official testing guidelines. Limitations of this real-life intervention approach are potential spill-over effects, delay in access to surveillance data, and little detailed information on HIV-testing practices among GPs. CLINICALTRIAL ClinicalTrials.gov NCT04056156; https://clinicaltrials.gov/ct2/show/NCT04056156 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16486

scholarly journals Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jocelyn Lebow ◽  
Cassandra Narr ◽  
Angela Mattke ◽  
Janna R. Gewirtz O’Brien ◽  
Marcie Billings ◽  
...  
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Mixed Methods ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Care Providers ◽  
Evidence Based Treatment

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

scholarly journals Development of a tool for coding safety-netting behaviours in primary care: a mixed-methods study using existing UK consultation recordings

2019 ◽  
Vol 69 (689) ◽  
pp. e869-e877 ◽  
Author(s):  
Peter J Edwards ◽  
Matthew J Ridd ◽  
Emily Sanderson ◽  
Rebecca K Barnes
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Time Course ◽  
Real Life ◽  
Mixed Methods Study ◽  
Diagnostic Uncertainty ◽  
Expected Time ◽  
Video And Audio ◽  
Communication Behaviours ◽  
Safety Netting

BackgroundSafety netting is recommended in a variety of clinical settings, yet there are no tools to record clinician safety-netting communication behaviours.AimTo develop and assess the inter-rater reliability (IRR) of a coding tool designed to assess safety-netting communication behaviours in primary care consultations.Design and settingA mixed-methods study using an existing dataset of video-and audio-recorded UK primary care consultations.MethodKey components that should be assessed in a coding tool were identified using the published literature and relevant guidelines. An iterative approach was utilised to continuously refine and generate new codes based on the application to real-life consultations. After the codebook had been generated, it was applied to 35 problems in 24 consultations independently by two coders. IRR scores were then calculated.ResultsThe tool allows for the identification and quantification of the key elements of safety-netting advice including: who initiates the advice and at which stage of the consultation; the number of symptoms or conditions the patient is advised to look out for; what action patients should take and how urgently; as well as capturing how patients respond to such advice plus important contextual codes such as the communication of diagnostic uncertainty, the expected time course of an illness, and any follow-up plans. The final tool had substantial levels of IRR with the mean average agreement for the final tool being 88% (κ = 0.66).ConclusionThe authors have developed a novel tool that can reliably code the extent of clinician safety-netting communication behaviours.

Understanding the dynamics of HIV testing services in South African primary care facilities

2018 ◽  
Author(s):  
Tonderai Mabuto ◽  
Bhakti Hansoti ◽  
Salome Charalambous ◽  
Christopher Hoffman
Keyword(s):  
Primary Care ◽  
Hiv Testing ◽  
South African ◽  
Care Facilities ◽  
Hiv Testing Services

Teaching Music Theory

2020 ◽  
Author(s):  
Jennifer Snodgrass
Keyword(s):  
Music Theory ◽  
Classroom Environment ◽  
Teaching And Learning ◽  
Undergraduate Research ◽  
Real Life ◽  
Aural Skills ◽  
New Faculty ◽  
Music Therapist ◽  
Starting Point ◽  
Teaching Music

Many innovative approaches to teaching are being used around the country, and there is an exciting energy about the scholarship of teaching and learning. But what is happening in the most effective music theory and aural skills classrooms? Based on 3 years of field study spanning 17 states, coupled with reflections from the author’s own teaching strategies, Teaching Music Theory: New Voices and Approaches highlights teaching approaches with substantial real-life examples from instructors across the country. The main premise of the text focuses on the question of “why.” Why do we assess in a particular way? Why are our curricula designed in a certain manner? Why should students master aural skills for their career as a performer, music educator, or music therapist? It is through the experiences shared in the text that many of these questions of “why” are answered. Along with answering some of the important questions of “why,” the book emphasizes topics such as classroom environment, undergraduate research and mentoring, assessment, and approaches to curriculum development. Teaching Music Theory: New Voices and Approaches is written in a conversational tone to provide a starting point of dialogue for students, new faculty members, and seasoned educators on any level. The pedagogical trends presented in this book provide a greater appreciation of outstanding teaching and thus an understanding of successful approaches in the classroom.

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