Modelling innovative interventions for optimising healthy lifestyle promotion in primary health care: "prescribe Vida Saludable" phase I research protocol

Alvaro Sanchez, Gonzalo Grandes, Josep M Cortada, Haizea Pombo, Laura Balague, Carlos Calderon, Alvaro Sanchez, Gonzalo Grandes, Josep M Cortada, Haizea Pombo, Laura Balague, Carlos Calderon

Abstract

Background: The adoption of a healthy lifestyle, including physical activity, a balanced diet, a moderate alcohol consumption and abstinence from smoking, are associated with large decreases in the incidence and mortality rates for the most common chronic diseases. That is why primary health care (PHC) services are trying, so far with less success than desirable, to promote healthy lifestyles among patients. The objective of this study is to design and model, under a participative collaboration framework between clinicians and researchers, interventions that are feasible and sustainable for the promotion of healthy lifestyles in PHC.

Methods and design: Phase I formative research and a quasi-experimental evaluation of the modelling and planning process will be undertaken in eight primary care centres (PCCs) of the Basque Health Service--OSAKIDETZA, of which four centres will be assigned for convenience to the Intervention Group (the others being Controls). Twelve structured study, discussion and consensus sessions supported by reviews of the literature and relevant documents, will be undertaken throughout 12 months. The first four sessions, including a descriptive strategic needs assessment, will lead to the prioritisation of a health promotion aim in each centre. In the remaining eight sessions, collaborative design of intervention strategies, on the basis of a planning process and pilot trials, will be carried out. The impact of the formative process on the practice of healthy lifestyle promotion, attitude towards health promotion and other factors associated with the optimisation of preventive clinical practice will be assessed, through pre- and post-programme evaluations and comparisons of the indicators measured in professionals from the centres assigned to the Intervention or Control Groups.

Discussion: There are four necessary factors for the outcome to be successful and result in important changes: (1) the commitment of professional and community partners who are involved; (2) their competence for change; (3) the active cooperation and participation of the interdisciplinary partners involved throughout the process of change; and (4) the availability of resources necessary to facilitate the change.

Figures

Figure 1
Figure 1
Operational organization of the formative process "Prescribe Vida Saludable" in the intervention centres. Note: HC, Health Centre; GP, General Practitioner; Nur, Nurse; Ped, Paediatrician; AS, Administrative Staff; Epi, Epidemiologist; Soc, Sociologist; Psi, Psychologist. Participation in Control health centres, Beraun HC: GP (5), Nur (4), Ped (1), AS (2), Social worker (1); Markina HC: GP (5), Nur (5), AS (3); Berango HC: GP (2), Nur (2), Ped (1), AS (1); and Zurbaran HC: GP (5), Nur (8), AS (3).

References

    1. Grandes G, Sánchez A, Cortada JM, Balague L, Calderon C, Arrazola A, Vergara I, Millan E, for the "Prescribe Vida Saludable" group Is integration of healthy lifestyle promotion into primary care feasible? Discussion and consensus sessions between clinicians and researchers. BMC Health Services Research. 2008;8:213.
    1. Michie S. Designing and implementing behaviour change interventions to improve population health. J Health Serv Res Policy. 2008;13:64–9. doi: 10.1258/jhsrp.2008.008014.
    1. Goldstein MG, Whitlock EP, DePue J. Multiple behavioral risk factor interventions in primary care: summary of research evidence. Am J Prev Med. 2004;27:61–79. doi: 10.1016/j.amepre.2004.04.023.
    1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003;362:1225–1230. doi: 10.1016/S0140-6736(03)14546-1.
    1. Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N. Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. Journal of Clinical Epidemiology. 2005;58:107–112. doi: 10.1016/j.jclinepi.2004.09.002.
    1. Kaner EFS, Dickinson HO, Beyer F, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews. 2007:CD004148.
    1. Lancaster T, Stead LF. Physician advice for smoking cessation. The Cochrane Database of Systematic Reviews. 2004:CD000165.
    1. Rice VH, Stead LF. Nursing interventions for smoking cessation. The Cochrane Database of Systematic Reviews. 2004:CD001188.
    1. Hillsdon M, Foster C, Thorogood M. Interventions for promoting physical activity. Cochrane Database Syst Rev. 2005:CD003180.
    1. Grandes G, Sánchez A, Ortega R, Torcal J, Montoya I, Lizarraga K, Serra J, PEPAF Group Effectiveness of physical activity advice and prescription by physicians in routine primary care: a cluster randomised trial. Arch Intern Med. 2009;169:694–701. doi: 10.1001/archinternmed.2009.23.
    1. Guide to Clinical Preventive Services . Counseling to Promote a Healthy Diet. Agency for Healthcare Research and Quality U.S. Department of Health and Human Services. 3
    1. Brunner EJ, Thorogood M, Rees K, Hewitt G. Dietary advice for reducing cardiovascular risk. The Cochrane Database of Systematic Reviews. 2005:CD002128.
    1. Priozzo S, Summerbell C, Cameron C, Glasziou P. Advice on low-fat diets for obesity. The Cochrane Database of Systematic Reviews. 2002:CD003640.
    1. Whitlock EP, Orleans CT, Pender N, Allan J. Evaluating primary care behavioural counselling interventions: an evidence-based approach. Am J Prev Med. 2002;22:267–284. doi: 10.1016/S0749-3797(02)00415-4.
    1. Michie S, Abraham C. Interventions to change health behaviours: evidence-based or evidence-inspired? Psychology & Health. 2004;19:29–49. doi: 10.1080/0887044031000141199.
    1. Green LW, Kreuter MW. Health Program Planning: An Educational and Ecological Approach. 4. NY: McGraw-Hill Higher Education; 2005.
    1. Bartholomew LK. Intervention Mapping: A process for developing theory and evidence-based health education programs. Health Education & Behavior. 1998;25:545–563. doi: 10.1177/109019819802500502.
    1. Hardeman W, Sutton S, Griffin S, Johnston M, White A, Wareham NJ, Kinmonth AL. A causal modelling approach to the development of theory-based behaviour change programmes for trial evaluation. Health Educ Res. 2005;20:676–87. doi: 10.1093/her/cyh022.
    1. Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychol. 2008;27:379–87. doi: 10.1037/0278-6133.27.3.379.
    1. National Institute for Health and Clinical Excellence . NICE Public Health Guidance. London: NICE; 2007. Behaviour change at population, community and individual levels.
    1. Ockene JK, Edgerton EA, Teutsch SM, Marion LN, Miller T, Genevro JL, Loveland-Cherry CJ, Fielding JE, Briss PA. Integrating evidence-based clinical and community strategies to improve health. Am J Prev Med. 2007;32:244–52. doi: 10.1016/j.amepre.2006.11.007.
    1. Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ. 1998;317:465–468.
    1. Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman A, O'Brien MA. Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001;39:II2–45.
    1. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8:1–72.
    1. Wensing M, Wollersheim H, Grol R. Organizational interventions to implement improvements in patient care: a structured review of reviews. Implement Sci. 2006;22:2. doi: 10.1186/1748-5908-1-2.
    1. Freemantle N, Harvey EL, Wolf F, Grimshaw JM, Grilli R, Bero LA. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000:CD000172.
    1. Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006;19:CD000259.
    1. Zwarenstein M, Bryant W. Interventions to promote collaboration between nurses and doctors. Cochrane Database Syst Rev. 2000:CD000072.
    1. Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Hammick M, Koppel I. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2008;23:CD002213.
    1. Schouten LM, Hulscher ME, van Everdingen JJ, Huijsman R, Grol RP. Evidence for the impact of quality improvement collaboratives: systematic review. BMJ. 2008;336:1491–4. doi: 10.1136/.
    1. Smith SM, Allwright S, O'Dowd T. Effectiveness of shared care across the interface between primary and specialty care in chronic disease management. Cochrane Database Syst Rev. 2007;18:CD004910.
    1. O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis DA, Haynes RB, Harvey EL. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007;17:CD000409.
    1. Jacobson VJ, Szilagyi P. Patient reminder and patient recall systems to improve immunization rates. Cochrane Database Syst Rev. 2005;20:CD003941.
    1. Hulscher ME, Wensing M, Grol RP, Weijden T van der, van Weel C. Interventions to improve the delivery of preventive services in primary care. Am J Public Health. 1999;89:737–746. doi: 10.2105/AJPH.89.5.737.
    1. Hulscher M, Wensing M, Weijen T van der, Grol R. Interventions to implement prevention in primary care. Cochrane Database of Systematic Reviews. 2006:CD000362.
    1. Grol R, Berwick DM, Wensing M. On the trail of quality and safety in health care. BMJ. 2008;336:74–6. doi: 10.1136/.
    1. Shaw B, Cheater F, Baker R, Gillies C, Hearnshaw H, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews. 2005:CD005470.
    1. National Institute for Health and Clinical Excellence . How to change practice: Understand, identify and overcome barriers. London: NICE; 2007.
    1. Green LA, Cifuentes M, Glasgow RE, Stange KC. Redesigning primary care practice to incorporate health behavior change: prescription for health round-2 results. Am J Prev Med. 2008;35:347–9. doi: 10.1016/j.amepre.2008.08.013.
    1. Kottke TE, Solberg LI. Optimizing practice through research: a preventive services case study. Am J Prev Med. 2007;33:505–506. doi: 10.1016/j.amepre.2007.08.003.
    1. Kottke TE, Solberg LI. Beyond efficacy testing redux. Am J Prev Med. 2004;27:104–105. doi: 10.1016/j.amepre.2004.04.027.
    1. Scott I. The evolving science of translating research evidence into clinical practice. Evidence-Based Medicine. 2007;12:4–7. doi: 10.1136/ebm.12.1.4.
    1. Medical Research Council . A framework for development and evaluation of complex interventions to improve health. London: Medical Research Council; 2000.
    1. Campbell NC, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F, Guthrie B, Lester H, Wilson P, Kinmonth AL. Designing and evaluating complex interventions to improve health care. BMJ. 2007;334:455–459. doi: 10.1136/.
    1. Medical Research Council . Developing and evaluating complex interventions: new guidance. London: Medical Research Council; 2008.
    1. Mercer SL, DeVinney BJ, Fine LJ, Green LW, Dougherty D. Study designs for effectiveness and translation research: identifying trade-offs. Am J Prev Med. 2007;33:139–154. doi: 10.1016/j.amepre.2007.04.005.
    1. Basque Government Health Department . Encuesta de salud de la C. A. del País Vasco 2002. Vitoria-Gasteiz: Servicio Central de Publicaciones del Gobierno Vasco; 2004.
    1. Basque Government Health Department . Encuesta de salud de la C. A. del País Vasco 2007. Vitoria-Gasteiz: Servicio Central de Publicaciones del Gobierno Vasco; 2004.
    1. Jones J, Hunter D. Qualitative research: Consensus methods for medical and health services research. BMJ. 1995;311:376–380.
    1. Hanlon JJ, Pickett GE. Public Health Administration and Practice. 8. Times Mirror/Mosby, St-Louis; 1984.
    1. Grandes G, Sanchez A, Cortada J, Calderon C, Balague L, Millan E, Arrazola A, Benavides R, Goiria B, Mujika J, Torcal J, Vergara I. Useful strategies for the promotion of healthy lifestyles in Primary Health Care. Informe Osteba, Departamento de Sanidad, Gobierno Vasco. 2008.
    1. Lopez-de-Munain J, Torcal J, Lopez V, Garay J. Prevention in Routine General Practice: Activity Patterns and Potential Promoting Factors. Prev Med. 2001;32:13–22. doi: 10.1006/pmed.2000.0777.
    1. Ohman-Strickland PA, John Orzano A, Nutting PA, Perry Dickinson W, Scott-Cawiezell J, Hahn K, Gibel M, Crabtree BF. Measuring organizational attributes of primary care practices: development of a new instrument. Health Serv Res. 2007;42:1257–73. doi: 10.1111/j.1475-6773.2006.00644.x.
    1. Glasgow RE, Klesges LM, Dzewaltowski DA, Estabrooks PA, Vogt TM. Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Educ Res. 2006;21:688–694. doi: 10.1093/her/cyl081.
    1. Beer M, Eisenstat RA, Spector B. Why change programs don't produce change. Harvard Business Review. 1990;68:158–66.
    1. Solberg LI. Improving medical practice: a conceptual framework. Ann Fam Med. 2007;5:251–6. doi: 10.1370/afm.666.
    1. Ruhe MC, Weyer SM, Zronek S, Wilkinson A, Wilkinson PS, Stange KC. Facilitating practice change: lessons from the STEP-UP clinical trial. Prev Med. 2005;40:729–734. doi: 10.1016/j.ypmed.2004.09.015.
    1. Cohen D, McDaniel RR, Jr, Crabtree BF, Ruhe MC, Weyer SM, Tallia A, Miller WL, Goodwin MA, Nutting P, Solberg LI, Zyzanski SJ, Jaén CR, Gilchrist V, Stange KC. A practice change model for quality improvement in primary care practice. J Healthc Manag. 2004;49:155–168.

Source: PubMed

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