scholarly journals Is Promotion of Mobility in Older Patients Hospitalized for Medical Illness a Physician’s Job?—An Interview Study with Physicians in Denmark

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 74
Author(s):  
Mette Merete Pedersen ◽  
Rasmus Brødsgaard ◽  
Per Nilsen ◽  
Jeanette Wassar Kirk
Keyword(s):  
Older Patients ◽  
Social Influences ◽  
Theoretical Domains Framework ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Medical Illness ◽  
Medical Patients ◽  
Face To Face ◽  
Multiple Levels ◽  
Common Barriers

The aim of this study was to identify the most common barriers and facilitators physicians perceive regarding their role in the promotion of mobility in older adults hospitalized for medical illness as part of on an intervention to promote mobility. Twelve physicians at two medical departments were interviewed face-to-face using semi-structed interviews based on the Theoretical Domains Framework. The physicians’ perceived barriers to promoting mobility were: the patients being too ill, the department’s interior does not fit with mobility, a culture of bedrest, mobility not being part their job, lack of time and resources and unwillingness to accept an extra workload. The facilitators for encouraging mobility were enhanced cross-professional cooperation focusing on mobility, physician encouragement of mobility and patient independence in e.g., picking up beverages and clothes. The identified barriers and facilitators reflected both individual and social influences on physicians’ behaviors to achieve increased mobility in hospitalized older medical patients and suggest that targeting multiple levels is necessary to influence physicians’ propensity to promote mobility.

scholarly journals Perceived Barriers and Facilitators to Breaking Up Sitting Time among Desk-Based Office Workers: A Qualitative Investigation Using the TDF and COM-B

2019 ◽  
Vol 16 (16) ◽  
pp. 2903 ◽  
Author(s):  
Samson O. Ojo ◽  
Daniel P. Bailey ◽  
David J. Hewson ◽  
Angel M. Chater
Keyword(s):  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Office Workers ◽  
Sitting Time ◽  
Future Research ◽  
Behaviour Change Techniques ◽  
Organisational Support ◽  
Sitting Behaviour

High amounts of sedentary behaviour, such as sitting, can lead to adverse health consequences. Interventions to break up prolonged sitting in the workplace have used active workstations, although few studies have used behaviour change theory. This study aimed to combine the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation to Behaviour system (COM-B) to investigate perceived barriers and facilitators to breaking up sitting in desk-based office workers. Semi-structured interviews with 25 desk-based employees investigated barriers and facilitators to breaking up sitting in the workplace. Seven core inductive themes were identified: ‘Knowledge-deficit sitting behaviour’, ‘Willingness to change’, ‘Tied to the desk’, ‘Organisational support and interpersonal influences’, ‘Competing motivations’, ‘Emotional influences’, and ‘Inadequate cognitive resources for action’. These themes were then deductively mapped to 11 of the 14 TDF domains and five of the six COM-B constructs. Participants believed that high amounts of sitting had adverse consequences but lacked knowledge regarding recommendations and were at times unmotivated to change. Physical and social opportunities were identified as key influences, including organisational support and height-adjustable desks. Future research should identify intervention functions, policy categories and behaviour change techniques to inform tailored interventions to change sitting behaviour of office workers.

scholarly journals Implementation strategies, and barriers and facilitators for implementation of physical activity at work: a scoping review

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Anne Garne-Dalgaard ◽  
Stephanie Mann ◽  
Thomas Viskum Gjelstrup Bredahl ◽  
Mette Jensen Stochkendahl
Keyword(s):  
Physical Activity ◽  
Scoping Review ◽  
Social Influences ◽  
Theoretical Domains Framework ◽  
Implementation Strategies ◽  
Professional Role ◽  
Environmental Context ◽  
Barriers And Facilitators ◽  
Factors Affecting ◽  
Study Characteristics

Abstract Background Inactivity and sedentary lifestyle have led experts to recommend an increase in structured, workplace-based physical activity (PA) initiatives. Previous studies on workplace-based PA have only shown moderate and short-term effects. This has been attributed to the lack of clear implementation strategies and understanding of factors that may hinder or enable uptake of PA. To ensure long-term, sustainable outcomes, there is a need for a better understanding of implementation strategies, and barriers and facilitators to workplace-based PA. Method A scoping review of studies investigating implementation approaches and factors affecting uptake of workplace-based PA was conducted. Qualitative and quantitative articles published in MEDLINE, Embase, Scopus, or PsycINFO between 2008 and 2018 evaluating the implementation of PA were included. Data on study characteristics, evaluation, and implementation methods applied were systematically extracted. Two reviewers extracted, coded, and organised factors affecting uptake using the Theoretical Domains Framework (TDF). Results After dual, blinded screening of titles and abstracts, 16 articles reporting on eight studies were included in the review. Several different methods of implementation were applied, including information meeting, kick-off events, and “change agents” as the most common. A total of 109 factors influencing implementation were identified, consisting of 57 barriers and 52 facilitators. Barriers most often related to the TDF domains Environmental Context and Resources (n = 34, 36.2%), Social influences (n = 13, 13.8%), and Social/Professional Role and Identity (n = 8, 8.5%). Likewise, facilitators most often related to the TDF domains Social influences (n = 17, 19.5%), Environmental Context and Resources (n = 16, 18.4%), and Social/Professional Role and Identity (n = 9, 10.3%). Conclusion Our review has highlighted the multilevel factors affecting the uptake of workplace-based PA and underpins the complexities in implementation of such initiatives. The published literature predominantly provides details from the employees’ perspectives on factors that need to be addressed and a lack of attention to these factors will cause them to hamper uptake of PA. The analysis of barriers and facilitators provides a theoretical foundation to guide future intervention design. However, further research is needed to fully understand the success or failure of implementation processes.

scholarly journals Using the COM-B model to identify barriers and facilitators towards adoption of a diet associated with cognitive function (MIND diet)

2020 ◽  
pp. 1-14
Author(s):  
Deirdre Timlin ◽  
Jacqueline M McCormack ◽  
Ellen EA Simpson
Keyword(s):  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Taste Preference ◽  
Later Life ◽  
Barriers And Facilitators ◽  
Face To Face ◽  
Time Work ◽  
The Uk ◽  
The Mind ◽  
Mind Diet

Abstract Objective: The aim of the study was to identify components of the COM-B (capability, opportunity, motivation and behaviour) model that influences behaviour to modify dietary patterns in 40–55-year-olds living in the UK, in order to influence the risk of cognitive decline in later life. Design: This is a qualitative study using the COM-B model and theoretical domains framework (TDF) to explore beliefs to adopting the Mediterranean-DASH Intervention for Neurodegenerative delay (MIND) diet. Setting: Northern Ireland. Participants: Twenty-five participants were recruited onto the study to take part in either a focus group or an interview. Participants were men and women aged between 40 and 55 years. Participants were recruited via email, Facebook and face to face. Results: Content analysis revealed that the main perceived barriers to the adoption of the MIND diet were time, work environment, taste preference and convenience. The main perceived facilitators reported were improved health, memory, planning and organisation, and access to good quality food. Conclusions: This study provides insight into the personal, social and environmental factors that participants report as barriers and facilitators to the adoption of the MIND diet among middle-aged adults living in the UK. More barriers to healthy dietary change were found than facilitators. Future interventions that increase capability, opportunity and motivation may be beneficial. The results from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.

scholarly journals Variations in Physical Activity and Sedentary Behavior During and After Hospitalization in Acutely Admitted Older Medical Patients: A Longitudinal Study

2021 ◽  
Author(s):  
Baker Nawfal Jawad ◽  
Janne Petersen ◽  
Ove Andersen ◽  
Mette Merete Pedersen
Keyword(s):  
Physical Activity ◽  
Sedentary Behavior ◽  
Older Patients ◽  
Functional Decline ◽  
Median Number ◽  
Medical Illness ◽  
Medical Patients ◽  
Small Peak ◽  
Objective Evidence ◽  
Diurnal Profile

Abstract Background: Inactivity and bedrest are frequent among older patients during hospitalization and are associated with functional decline. No longitudinal objective evidence exists on how patients' diurnal profile for physical activity changes during acute hospitalization and what happens when the patient is discharged to own home. By the use of accelerometers, this study aims to describe and compare the distribution of physical activity and sedentary behavior in acutely hospitalized older patients during hospitalization and after discharge. Methods: The study population consisted of 80 patients (+65 years) from the STAND-Cph trial, who were admitted with acute medical illness and were able to stand. Physical activity and sedentary behavior were measured as number of steps, uptime (walking/standing) and sedentary behavior (lying/sitting) per hour with an activity monitor worn on the thigh (activPAL3, PAL Technologies Ltd). The patients wore the monitor for three periods of one week: during hospitalization, after discharge, and four weeks after discharge. Results: The patients’ median age was 80 years [IQR: 75-88], 68% of the patients were female and The median DEMMI was 57 [IQR: 48-67]. The daily median uptime was 1.7 h [IQR: 1-2.8] during hospitalization, 4.0 h [IQR: 2.7-5.4] after discharge and 4.0 h [IQR: 2.8-5.8] four weeks after discharge. The median number of steps was 728 [IQR: 176-2089], 2207 [IQR: 1433-3148], and 2622 [IQR: 1714-3865], respectively. During hospitalization, a small peak was observed both for number of steps and uptime between 9-11 AM. However, the diurnal profile had no notable variation. At discharge and four weeks after discharge, the median of physical activity peaked 2-3 times and had mostly the same diurnal profile. Conclusion: Older hospitalized patients spend most of their time engaged in sedentary behavior, where their main activity peak is in the morning between 9-11 AM. The uptime doubles and the number of steps triples after discharge, where peaks of activity are seen throughout the day. This indicates that daily routines are disrupted during hospitalization and that older patients have the potential to be more physically active during hospitalization. This emphasizes the need for interventions that encourage physical activity throughout the day during hospitalization.

scholarly journals Barriers and enablers to access childhood cataract services across India. A qualitative study using the Theoretical Domains Framework (TDF) of behaviour change

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261308
Author(s):  
Sheeladevi Sethu ◽  
John G. Lawrenson ◽  
Ramesh Kekunnaya ◽  
Rahul Ali ◽  
Rishi R. Borah ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Social Influences ◽  
Theoretical Domains Framework ◽  
Analysis Data ◽  
Perceived Barriers ◽  
Early Presentation ◽  
Integrative Framework ◽  
Barriers And Enablers ◽  
Depth Interviews ◽  
Childhood Cataract

Early presentation for childhood cataract surgery is an important first step in preventing related visual impairment and blindness. In the absence of neonatal eye screening programmes in developing countries, the early identification of childhood cataract remains a major challenge. The primary aim of this study was to identify potential barriers to accessing childhood cataract services from the perspective of parents and carers, as a critical step towards increasing the timely uptake of cataract surgery. In-depth interviews were conducted using a pre-designed topic guide developed for this study to seek the views of parents and carers in nine geographic locations across eight states in India regarding their perceived barriers and enablers to accessing childhood cataract services. A total of 35 in-depth interviews were conducted including 30 at the hospital premises and 5 in the participants’ homes. All interviews were conducted in the local language and audio taped for further transcription and analysis. Data were organised using NVivo 11 and a thematic analysis was conducted utilising the Theoretical Domains Framework (TDF), an integrative framework of behavioural theories. The themes identified from interviews related to 11 out of 12 TDF domains. TDF domains associated with barriers included: ‘Environmental context and resources’, ‘Beliefs about consequences’ and ‘Social influences’. Reported enablers were identified in three theoretical domains: ‘Social influences’, ‘Beliefs about consequences’ and ‘Motivations and goals’. This comprehensive TDF approach enabled us to understand parents’ perceived barriers and enablers to accessing childhood cataract services, which could be targeted in future interventions to improve timely uptake.

scholarly journals Barriers and Facilitators for Referrals of Primary Care Patients to Blended Internet-Based Psychotherapy for Depression: Mixed Methods Study of General Practitioners’ Views (Preprint)

2020 ◽  
Author(s):  
Ingrid Titzler ◽  
Matthias Berking ◽  
Sandra Schlicker ◽  
Heleen Riper ◽  
David Daniel Ebert
Keyword(s):  
General Practitioners ◽  
Controlled Trial ◽  
Theoretical Domains Framework ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Prescribe Medication ◽  
Treatment Access ◽  
Referral Rates ◽  
Face To Face

BACKGROUND Major depressive disorder (MDD) is highly prevalent and often managed by general practitioners (GPs). GPs mostly prescribe medication and show low referral rates to psychotherapy. Many patients remain untreated. Blended psychotherapy (bPT) combines internet-based interventions with face-to-face psychotherapy and could increase treatment access and availability. Effectively implementing bPT in routine care requires an understanding of professional users’ perspectives and behavior. OBJECTIVE This study aims to identify barriers and facilitators perceived by GPs in referring patients to bPT. Explanations for variations in referral rates were examined. METHODS Semistructured interviews were conducted with 12 of 110 GPs participating in a German randomized controlled trial (RCT) to investigate barriers to and facilitators for referrals to bPT for MDD (10 web-based modules, app-based assessments, and 6 face-to-face sessions). The interview guide was based on the theoretical domains framework. The interviews were audio recorded and transcribed verbatim, and the qualitative content was analyzed by 2 independent coders (intercoder agreement, k=0.71). A follow-up survey with 12 interviewed GPs enabled the validation of emergent themes. The differences in the barriers and facilitators identified between groups with different characteristics (eg, GPs with high or low referral rates) were described. Correlations between referrals and characteristics, self-rated competences, and experiences managing depression of the RCT-GPs (n=76) were conducted. RESULTS GPs referred few patients to bPT, although varied in their referral rates, and interviewees referred more than twice as many patients as RCT-GPs (interview-GPs: mean 6.34, SD 9.42; RCT-GPs: mean 2.65, SD 3.92). A negative correlation was found between GPs’ referrals and their self-rated pharmacotherapeutic competence, <i>r</i>(73)=−0.31, <i>P</i>&lt;.001. The qualitative findings revealed a total of 19 barriers (B) and 29 facilitators (F), at the levels of GP (B=4 and F=11), patient (B=11 and F=9), GP practice (B=1 and F=3), and sociopolitical circumstances (B=3 and F=6). Key barriers stated by all interviewed GPs included “little knowledge about internet-based interventions” and “patients’ lack of familiarity with technology/internet/media” (number of statements, each k=22). Key facilitators were “perceived patient suitability, e.g. well-educated, young” (k=22) and “no conflict with GP’s role” (k=16). The follow-up survey showed a very high agreement rate of at least 75% for 71% (34/48) of the identified themes. Descriptive findings indicated differences between GPs with low and high referral rates in terms of which and how many barriers (low: mean 9.75, SD 1.83; high: mean 10.50, SD 2.38) and facilitators (low: mean 18.25, SD 4.13; high: mean 21.00; SD 3.92) they mentioned. CONCLUSIONS This study provides insights into factors influencing GPs’ referrals to bPT as gatekeepers to depression care. Barriers and facilitators should be considered when designing implementation strategies to enhance referral rates. The findings should be interpreted with care because of the small and self-selected sample and low response rates.

scholarly journals Barriers and Facilitators for Referrals of Primary Care Patients to Blended Internet-Based Psychotherapy for Depression: Mixed Methods Study of General Practitioners’ Views

10.2196/18642 ◽  
2020 ◽  
Vol 7 (8) ◽  
pp. e18642
Author(s):  
Ingrid Titzler ◽  
Matthias Berking ◽  
Sandra Schlicker ◽  
Heleen Riper ◽  
David Daniel Ebert
Keyword(s):  
General Practitioners ◽  
Controlled Trial ◽  
Theoretical Domains Framework ◽  
Implementation Strategies ◽  
Barriers And Facilitators ◽  
Prescribe Medication ◽  
Treatment Access ◽  
Referral Rates ◽  
Face To Face

Background Major depressive disorder (MDD) is highly prevalent and often managed by general practitioners (GPs). GPs mostly prescribe medication and show low referral rates to psychotherapy. Many patients remain untreated. Blended psychotherapy (bPT) combines internet-based interventions with face-to-face psychotherapy and could increase treatment access and availability. Effectively implementing bPT in routine care requires an understanding of professional users’ perspectives and behavior. Objective This study aims to identify barriers and facilitators perceived by GPs in referring patients to bPT. Explanations for variations in referral rates were examined. Methods Semistructured interviews were conducted with 12 of 110 GPs participating in a German randomized controlled trial (RCT) to investigate barriers to and facilitators for referrals to bPT for MDD (10 web-based modules, app-based assessments, and 6 face-to-face sessions). The interview guide was based on the theoretical domains framework. The interviews were audio recorded and transcribed verbatim, and the qualitative content was analyzed by 2 independent coders (intercoder agreement, k=0.71). A follow-up survey with 12 interviewed GPs enabled the validation of emergent themes. The differences in the barriers and facilitators identified between groups with different characteristics (eg, GPs with high or low referral rates) were described. Correlations between referrals and characteristics, self-rated competences, and experiences managing depression of the RCT-GPs (n=76) were conducted. Results GPs referred few patients to bPT, although varied in their referral rates, and interviewees referred more than twice as many patients as RCT-GPs (interview-GPs: mean 6.34, SD 9.42; RCT-GPs: mean 2.65, SD 3.92). A negative correlation was found between GPs’ referrals and their self-rated pharmacotherapeutic competence, r(73)=−0.31, P<.001. The qualitative findings revealed a total of 19 barriers (B) and 29 facilitators (F), at the levels of GP (B=4 and F=11), patient (B=11 and F=9), GP practice (B=1 and F=3), and sociopolitical circumstances (B=3 and F=6). Key barriers stated by all interviewed GPs included “little knowledge about internet-based interventions” and “patients’ lack of familiarity with technology/internet/media” (number of statements, each k=22). Key facilitators were “perceived patient suitability, e.g. well-educated, young” (k=22) and “no conflict with GP’s role” (k=16). The follow-up survey showed a very high agreement rate of at least 75% for 71% (34/48) of the identified themes. Descriptive findings indicated differences between GPs with low and high referral rates in terms of which and how many barriers (low: mean 9.75, SD 1.83; high: mean 10.50, SD 2.38) and facilitators (low: mean 18.25, SD 4.13; high: mean 21.00; SD 3.92) they mentioned. Conclusions This study provides insights into factors influencing GPs’ referrals to bPT as gatekeepers to depression care. Barriers and facilitators should be considered when designing implementation strategies to enhance referral rates. The findings should be interpreted with care because of the small and self-selected sample and low response rates.

scholarly journals Focus group findings on clinicians’ perceived barriers and facilitators to giving rights information to involuntary psychiatrics patients in British Columbia, Canada

2021 ◽  
Author(s):  
Iva W. Cheung ◽  
Diego S. Silva ◽  
Kimberly J. Miller ◽  
Erin E. Michalak ◽  
Charles H. Goldsmith
Keyword(s):  
Mental Health ◽  
British Columbia ◽  
Focus Group ◽  
Theoretical Domains Framework ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Team Approach ◽  
Regular Group ◽  
Patients Rights ◽  
Mental Health Act

Abstract Background In British Columbia, Canada, clinicians are responsible for giving information about rights to patients involuntarily hospitalized under the Mental Health Act. But a survey commissioned by the Ministry of Health and an investigation by the BC Office of the Ombudsperson found that patients were not consistently receiving rights information. Methods Focus groups were used to probe clinicians’ perceived barriers and facilitators to giving patients rights information. Focus group transcripts were thematically analyzed, and the themes were coded using the Theoretical Domains Framework to identify interventions that could encourage clinicians to consistently give patients complete rights information. Results Eighty-one psychiatric clinicians participated. Analysis identified these barriers: (a) clinicians receive inadequate training on the Mental Health Act and rights notification; (b) newly admitted patients might not be receptive to new information; (c) the tool used to communicate rights to patients is inadequate; (d) many patients don’t speak English; (e) clinicians have competing priorities during the admission process; (f) clinicians face pressure from other staff to give incomplete information; (g) the clinical workflow doesn’t facilitate follow-up and accountability; and (h) staff don’t receive enough support from their employer. The following facilitators were identified: (a) a team approach allows clinicians to share knowledge about the Mental Health Act and rights notification, (b) having one person take responsibility for rights information clarifies roles and increases accountability, (c) accreditation reminds clinicians of the importance of giving patients rights information, and (d) checklists remind clinicians of their rights-notification responsibilities. Conclusions These interventions may help clinicians give rights information more consistently: (a) training about the Mental Health Act and rights notification, (b) an accessible legal resource for clinicians and patients, (c) regular group sessions about rights for patients, (d) an improved rights-communication tool, in multiple languages, and (e) checklists, reminders, and accountability and feedback systems.

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