Ein pflegegeleitetes Sekundärpräventionsprogramm für Menschen nach einem akuten Koronarsyndrom aus Sicht von Gesundheitsexpertinnen und -experten in Österreich – eine qualitative Studie

Zusammenfassung Hintergrund Menschen nach akutem Koronarsyndrom weisen weiterhin ein hohes kardiovaskuläres Risiko auf. Eine pflegerische Intervention zur Verbesserung der Adhärenz von Betroffenen hinsichtlich der empfohlenen Präventionsmaßnahmen ist erforderlich. In deren Entwicklung sollen alle an der Versorgung beteiligten Personengruppen miteinbezogen werden, u. a. Gesundheitsexpertinnen und -experten. Ziel Ziel war es, die Ausrichtung eines dem österreichischen Kontext angepassten pflegegeleiteten Sekundärpräventionsprogramms für Menschen nach akutem Koronarsyndrom aus Sicht von Gesundheitsexpertinnen und -experten zu generieren. Methodik Die Entwicklung dieses Programms stützt sich methodisch auf das „intervention mapping“. Um die Inhalte der ersten 3 Schritte des Intervention mapping zu erarbeiten, wurden 2 Fokusgruppeninterviews und 13 Einzelinterviews mit 27 Gesundheitsexpertinnen und -experten durchgeführt. Die Datenanalyse erfolgte anhand der thematischen Analyse nach Braun und Clarke. Ergebnisse Die Ausrichtung des Programms bezieht sich auf die Bereiche „personenzentrierter Ansatz“, „Akutkrankenhaus als Initialpunkt“ und „persönliches Gespräch als zentrale Vermittlungsform“. Die erforderlichen strukturellen und personellen Rahmenbedingungen umfassen „Prioritätensetzung für die Patientenedukation im Akutkrankenhaus“, „Einrichtung einer Anlaufstelle“, „interdisziplinäre Zusammenarbeit“ und „gesetzliche Bestimmungen für die Patienteninformation“ sowie die Schaffung der Position einer „cardiac rehabilitation nurse“, welche speziell ausgebildetes Pflegepersonal übernehmen könnte. Ein vertieftes Krankheitsverständnis und ein reduzierter Angstzustand sollen die angestrebten Ergebnisse des Programms sein. Schlussfolgerung Das zu entwickelnde Programm kann dazu dienen, die nichtmedikamentöse Sekundärprävention bei den Betroffenen im Akutkrankenhaus zu initiieren und nach der Entlassung fortzuführen. Als Rahmenbedingungen müssen eine Anlaufstelle und die Funktion einer Cardiac rehabilitation nurse geschaffen werden. Somit kann diese spezialisierte Pflegeperson die Betroffenen in der Übergangsphase begleiten, während sie die Patientenedukation unter dem personenzentrierten Ansatz durchführt.

Coordination of sustainable financing for evidence-based youth mental health treatments: protocol for development and evaluation of the fiscal mapping process

Background Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health and economic impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies (hereafter, “service agencies”). Strategic planning tools are needed that can guide these service agencies in their coordination of sustainable funding for EBTs. This protocol describes a mixed-methods research project designed to (1) develop and (2) evaluate our novel fiscal mapping process that guides strategic planning efforts to finance the sustainment of EBTs in youth mental health services. Method Participants will be 48 expert stakeholder participants, including representatives from ten service agencies and their partners from funding agencies (various public and private sources) and intermediary organizations (which provide guidance and support on the delivery of specific EBTs). Aim 1 is to develop the fiscal mapping process: a multi-step, structured tool that guides service agencies in selecting the optimal combination of strategies for financing their EBT sustainment efforts. We will adapt the fiscal mapping process from an established intervention mapping process and will incorporate an existing compilation of 23 financing strategies. We will then engage participants in a modified Delphi exercise to achieve consensus on the fiscal mapping process steps and gather information that can inform the selection of strategies. Aim 2 is to evaluate preliminary impacts of the fiscal mapping process on service agencies’ EBT sustainment capacities (i.e., structures and processes that support sustainment) and outcomes (e.g., intentions to sustain). The ten agencies will pilot test the fiscal mapping process. We will evaluate how the fiscal mapping process impacts EBT sustainment capacities and outcomes using a comparative case study approach, incorporating data from focus groups and document review. After pilot testing, the stakeholder participants will conceptualize the process and outcomes of fiscal mapping in a participatory modeling exercise to help inform future use and evaluation of the tool. Discussion This project will generate the fiscal mapping process, which will facilitate the coordination of an array of financing strategies to sustain EBTs in community youth mental health services. This tool will promote the sustainment of youth-focused EBTs.

Co-Creation of a Multi-Component Health Literacy Intervention Targeting Both Patients with Mild to Severe Chronic Kidney Disease and Health Care Professionals

Limited health literacy (LHL) is common in chronic kidney disease (CKD) patients and frequently associated with worse self-management. Multi-component interventions targeted at patients and healthcare professionals (HCPs) are recommended, but evidence is limited. Therefore, this study aims to determine the objectives and strategies of such an intervention, and to develop, produce and evaluate it. For this purpose, we included CKD patients with LHL (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) from general practices, nephrology clinics and universities in an Intervention Mapping (IM) process. The determined intervention objectives especially address the patients’ competences in maintaining self-management in the long term, and communication competences of patients and HCPs. Patients preferred visual strategies and strategies supporting discussion of needs and barriers during consultations to written and digital strategies. Moreover, they preferred an individual approach to group meetings. We produced a four-component intervention, consisting of a visually attractive website and topic-based brochures, consultation cards for patients, and training on LHL for HCPs. Evaluation revealed that the intervention was useful, comprehensible and fitting for patients’ needs. Healthcare organizations need to use visual strategies more in patient education, be careful with digitalization and group meetings, and train HCPs to improve care for patients with LHL. Large-scale research on the effectiveness of similar HL interventions is needed.

Using intervention mapping to develop ‘ROSE’: an intervention to support peer workers in overdose response settings

Background Peer workers (those with lived/living experience of substance use working in overdose response settings) are at the forefront of overdose response initiatives in British Columbia (BC). Working in these settings can be stressful, with lasting social, mental and emotional impacts. Peer workers have also been disproportionately burdened by the current dual public health crises characterized by the onset of the COVID-19 pandemic and rise in illicit drug overdose deaths. It is therefore critical to develop supports tailored specifically to their realities. Methods We used the six steps outlined in the Intervention Mapping (IM) framework to identify needs of peer workers and design an intervention model to support peer workers in overdose response settings. Results Eight peer-led focus groups were conducted in community settings to identify peer workers’ needs and transcripts were analyzed using interpretive description. The strategies within the intervention model were informed by organizational development theory as well as by lived/living experience of peer workers. The support needs identified by peer workers were categorized into three key themes and these formed the basis of an intervention model titled ‘ROSE’; R stands for Recognition of peer work, O for Organizational support, S for Skill development and E for Everyone. The ROSE model aims to facilitate cultural changes within organizations, leading towards more equitable and just workplaces for peer workers. This, in turn, has the potential for positive socio-ecological impact. Conclusions Centering lived/living experience in the intervention mapping process led us to develop a framework for supporting peer workers in BC. The ROSE model can be used as a baseline for other organizations employing peer workers.

Promoting health behaviour change in the preconception period: An Intervention Mapping approach (Preprint)

BACKGROUND Half of women begin pregnancy above the healthy weight range, increasing the risk of complications and adversely affecting the lifelong health of their baby. Maternal obesity remains the strongest risk factor for offspring obesity across childhood, adolescence and adulthood. Previous research suggests that women should be encouraged to be within a healthy weight range before conception in order to improve health outcomes. OBJECTIVE We outline the application of the Intervention Mapping (IM) approach in developing an evidence-informed eHealth intervention to promote weight management. The intervention, based on psychological theories and behaviour change techniques, was developed for women with overweight or obesity who intend to become pregnant. The “Begin Better” eHealth intervention is part of an integrated program being evaluated in a clinical trial to assess if weight management before pregnancy can influence clinical outcomes for mother and baby. METHODS The current study documents steps 2 to 5 of a 6-step iterative intervention mapping approach informed by the Information-Motivation-Behavioural Skills (IMB) model and the findings of a previous interview study. We defined behaviour change objectives for each of the IMB behavioural determinants as well as theory-based behaviour change techniques (BCT) and practical strategies. We also utilised Persuasive Systems Design (PSD) principles to assist in translating these strategies to a digital environment. RESULTS The resultant intervention comprises nutrition and physical activity content, along with psychological strategies, which are notably absent from mainstream weight management programs. Strategies to increase motivation, garner social support and promote self-care are integral to maintaining engagement with the intervention, which aims to improve lifestyle behaviours and enhance wellbeing. Important elements include: tracking mechanisms for percentage progress towards goals to enable feedback on behaviours and outcomes; in-app messages of praise on entry of goals or habits; strategies to prompt habit formation and action planning via small, easily achievable steps toward positive change. CONCLUSIONS Design decisions and processes for idea generation about intervention content, format and delivery are often not reported. This study we respond to this gap in the literature and outline a process that is potentially transferable to the development of other interventions.

Management of Dental School During the COVID-19 Pandemic: Application of Intervention Mapping

Background: Coronavirus Diesease-2019 (COVID-19) outbreak has led to the suspension of the activities of dental schools. Therefore, reorganizing clinical settings and supporting services as quickly as possible has received much attention to reopen dental schools. The present study aimed to evaluate the applicability of the Intervention Mapping (IM) approach for designing, implementing, and evaluating an intervention program to prevent and control COVID-19 in dental schools.Methods: Following the IM protocol, six steps were completed in the planning and development of an intervention, targeting, and management of Dental School during the COVID-19 pandemic.Results: The information obtained from the needs assessment revealed that the COVID-19 outbreak prevention was associated with the use of personal protective equipment by all target groups, infection control measures taken in the environment, preparation of the environment and equipment, changes in the treatment plan according to the COVID-19 pandemic, changing the admission process of patients, and reduction of attendance of target groups in the school are linked with. In this study, determinant factors affecting the COVID-19 prevention at the individual level were identified based on the Protection Motivation Theory (PMT). In this program, various methods, such as presentation of information, modeling role, and persuasion measures, were utilized and the practical programs included educational films and group discussions implemented.Conclusions: Our findings indicated that intervention in dental environments on the basis of the IM process can develop a comprehensive and structured program in the dental school and hence can reduce the risk of the COVID-19 infection.

Determinants of Hypertension Self-management Behaviors: An Application of the Intervention Mapping Approach

Background: Hypertension is one of the key risk factors for several diseases. Objectives: The aim of this study was to determine the determinants of hypertension self-management behaviors (HSBs) based on intervention mapping approach. Methods: A cross-sectional study was conducted among 800 hypertensive patients in southwestern Iran in 2018. A structured questionnaire was applied for data collection. Data were analyzed using SPSS version 16. Results: The mean age of respondents was 58.25 years (SD: 12.10; age range: 30 - 74 years). The best predictors for HSBs were perceived barriers, outcome expectations, and self-efficacy. Conclusions: Our findings have implications for the evidence-based design of HSBs promotion interventions.

Development of an intervention to support reproductive health of garment factory workers in Cambodia: a qualitative study

ObjectivesThe aim of this study was to describe the development of an intervention to support the reproductive health of garment factory workers in Cambodia.DesignA qualitative study informed by intervention mapping which included semistructured interviews and participant observation, followed by intervention development activities including specifying possible behaviour change, designing the intervention, and producing and refining intervention content.SettingThe research was conducted by a multidisciplinary team with backgrounds in public health, linguistics, digital cultures and service delivery in a suburb of Phnom Penh where many garment factories cluster.ParticipantsGarment factory workers in Cambodia; typically young women aged under 30 years who have migrated from rural areas to Phnom Penh city.OutcomesAnalysis of reproductive health issues facing garment factory workers and metrics of videos developed.ResultsOur research identified some challenges that Cambodian garment factory workers experience regarding contraception and abortion. Concerns or experience of side-effects were identified as an important determinant leading to non-use of effective contraception and subsequent unintended pregnancy. Financial constraints and a desire to space pregnancies were the main reported reasons to seek an abortion. Information about medical abortion given to women by private providers was often verbal, with packaging and the drug information leaflet withheld. In order to address limitations in the provision of accessible reproductive health information for factory workers, and given their observed widespread use of social media, we decided to make three ‘edutainment’ videos about family planning. Key social media metrics of the videos were evaluated after 1 month.ConclusionsWe describe the development of an intervention to support reproductive health among garment factory workers in Cambodia. These videos could be further improved and additional videos could be developed. More work is required to develop appropriate and effective interventions to support reproductive health of garment factory workers in Cambodia.

Translating promoting factors and behavior change principles into the blended and technology supported intervention “Foxfit” to stimulate physical activity in children with asthma: Design study (Preprint)

BACKGROUND Children with asthma can decrease the impact of their disease by improving their physical activity (PA). However, healthcare providers lack in interventions for children with asthma that effectively increase their PA levels and achieve behavior change regarding PA. A technology supported approach can positively influence PA and physical functioning in children. OBJECTIVE The aim of this study was to develop a technology supported intervention that facilitates healthcare providers in promoting PA for children with asthma and to systematically describe this developmental process. METHODS Intervention mapping (IM) was applied to develop a blended and technology supported intervention in co-creation with children with asthma, their parents, and healthcare providers. According to the IM framework, the following steps were performed: 1) conduct a needs assessment; 2) define the intervention outcome, performance objectives, and change objectives; 3) select theory based intervention methods and strategies; 4) create components of the intervention and conduct pilot tests; 5) create an implementation plan; and 6) create an evaluation plan. RESULTS We developed the blended intervention “Foxfit” that consists of an app with a physical activity monitor (PAM) for children with asthma, and a web-based dashboard for their healthcare provider. The intervention focusses on PA in everyday life to improve social participation. Foxfit contains components based on behavior change principles and gamification: goal setting, rewards, action planning, (self-)monitoring, shaping knowledge, a gamified story, personal coaching and feedback, and a tailored approach. CONCLUSIONS The IM framework was very useful to systematically develop a technology supported intervention and to describe the translational process from scientific evidence, the needs and wishes of future users, and behavior change principles into this intervention. This has led to the technology supported intervention Foxfit that facilitates healthcare providers in promoting PA in children with asthma. The structured description of the development process and functional components shows the way behavior change techniques are incorporated in the intervention. CLINICALTRIAL Dutch Trial Register: NTR6658

Pilot Wellness Program With Adapted Social–Emotional Learning and COVID-19 Curriculum for Refugee Youth

Refugee children are less likely than their non-refugee peers to receive timely diagnoses and treatment for mental and/or behavioral health problems, despite facing multiple risk factors including potential exposure to trauma during premigration, migration, and postmigration experiences. Social–Emotional Learning offers preventive mental health education for children through well-established, evidenced-based curricula. Although there are clear benefits of Social–Emotional Learning curricula, which can help children achieve long-term success emotionally and academically, Social–Emotional Learning curricula are not easily accessible for refugee children, often because of language and socioeconomic barriers. In this pilot study, we evaluated the feasibility and acceptability of an adapted Social–Emotional Learning program that included culturally specific, multilingual, trauma-informed wellness, and physical education during the COVID-19 pandemic: EMPOWER (Emotions Program Outside the Clinic With Wellness Education for Refugees). We used the Intervention Mapping framework which guided the (1) planning, (2) program development, and (3) mixed-method evaluation of the feasibility and acceptability of the EMPOWER pilot. We found that this adaptation was well-received by Afghan refugee families and that COVID-19 safety measures were well-understood after participation. Challenges emerged around videoconferencing connectivity and around finding a common language for discussing emotions. Future iterations of the program and evaluations will require continued partnerships with community members and organizations. As we continue and expand EMPOWER, we aim to evaluate short-term improvement in Social–Emotional Learning competence as well as long-term mental and behavioral health outcomes for children and their families.