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Developmental screening using caregiver report: an evaluation of screening tools and childhood developmental delays in South Africa ...
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Developmental screening using caregiver report: an evaluation of screening tools and childhood developmental delays in South Africa ...
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Factors Influencing Medical Personnel to Work in Primary Health Care Institutions: An Extended Theory of Planned Behavior
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In: International Journal of Environmental Research and Public Health; Volume 19; Issue 5; Pages: 2785 (2022)
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Valoración de la Calidad de la Práctica Fonoaudiológica en Atención Primaria de Salud ; Assessment of the Quality of Speech Therapy Practice in Primary Health Care
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Community-based pain programs commissioned by primary health networks: key findings from an online survey and consultation with program managers
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In: Australian Journal of Primary Health (2022)
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How to create social media contents based on Motivational Interviewing ...
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How to create social media contents based on Motivational Interviewing ...
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Acolhimento, Redes sociais e produção do cuidado na Atenção Básica em Saúde no Município do Rio de Janeiro, Brasil
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DEVELOPMENT OF A TOOL TO ASSESS REASONS FOR TREATMENT NONADHERENCE IN PRIMARY CARE SETTINGS
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In: Graduate Student Theses, Dissertations, & Professional Papers (2021)
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Synchronous teleconsultation in the management of temporomandibular disorder
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In: Revista CEFAC, Vol 23, Iss 4 (2021) (2021)
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Activities of speech-language-hearing therapists in the Extended Family Health and Primary Care Center from the perspective of team cooperation
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In: Revista CEFAC, Vol 23, Iss 2 (2021) (2021)
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Investigating eHealth behaviour change and health literacy approaches to optimise type 2 diabetes self-management interventions
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Abstract:
Background Type 2 diabetes is a metabolic condition characterised by high blood glucose levels. A key aspect of diabetes care is self-management. This involves behaviours such as weight management, healthy eating and physical activity. Knowledge about these behaviours is fundamental for effective self-management, but there is increasing emphasis on the importance of strategies to promote action, such as self-monitoring and problem-solving. An additional factor relevant to diabetes care is health literacy, the skills that allow a person to access, understand and act on health information. Low health literacy is associated with higher prevalence of type 2 diabetes, poorer blood glucose management, and lower diabetes knowledge. To address these issues, health literacy guidelines take a ‘universal precautions approach,’ in which everyone receives information that is easier to understand. These guidelines provide effective strategies for improving knowledge but are limited in scope for strategies to promote action. Further research is needed to investigate how strategies to promote action can be adapted for people with low health literacy and how these can be effectively implemented, such as via a universal precautions approach or tailoring to the individual. eHealth (health interventions that use information and communication technology) is a promising avenue for delivering ‘literacy-sensitive’ strategies to promote action. Diabetes eHealth is effective in general samples, and the technology can easily automate processes and tailor to the individual. However, despite these benefits, there is a risk that these interventions may exacerbate health inequality, particularly if uptake by people with low health literacy is poor. This risk could be mitigated by delivering eHealth in primary care settings as most people with diabetes will see a general practitioner (GP), though research is needed to investigate GP perspectives on how eHealth could help support their patients with diabetes, including their patients with low health literacy. Aims This thesis brings together the fields of behavioural science, health literacy and eHealth, and aims to: 1) explore how people with diabetes and varying health literacy levels conceptualise their experiences of diabetes self-management behaviours (Paper 1); 2) test eHealth behaviour change and health literacy in diabetes self-management iii the effects of applying health literacy principles to an eHealth action plan intervention and the effects of different methods of allocating plans to an individual, in samples of people with varying health literacy levels (Papers 2, 3 and 4); and 3) explore GP perspectives on diabetes eHealth, including perceived barriers and facilitators to uptake (Paper 5) and how eHealth could help them better support their patients with low health literacy (in this case, with a focus on patients from culturally and linguistically diverse backgrounds; Paper 6). Methods Qualitative: Papers 1, 5 and 6 involved semi-structured interviews with 25 GPs and 26 people with type 2 diabetes recruited in Western Sydney, Australia. Questions to people with diabetes asked about how they engaged in diabetes self-management, including how they get ‘back on track’, monitor blood glucose, and engage with eHealth. GPs were asked about how they support their patients’ diabetes self-management and their attitudes toward diabetes eHealth. Interviews were audio-recorded, transcribed and coded using Framework analysis to ensure rigour. Quantitative: Papers 2 (N=400), 3 (protocol paper) and 4 (N=2,370) involved two randomised trials that evaluated the effects of two action plan interventions to reduce unhealthy snacking. Participants were recruited through online research panels. Both studies investigated whether health literacy modified the effectiveness of two versions of an action plan: ‘literacy-sensitive’ or ‘standard’. The first used a general sample and had an additional ‘passive’ control group (an educational intervention). The second tested the two action plans in a sample of people with type 2 diabetes or an overweight/obese body mass index, and randomised participants to a method for allocating action plans (random, health literacy screening tool, and participant choice). Multiple linear regression predicted snacking scores at four-week follow-up, controlling for baseline snacking and correlates of health literacy (age, level of education, language spoken at home). Ethical approval was obtained from the University of Sydney Human Research Ethics Committee (project numbers 2017/224, 2017/622 and 2018/793) and Western Sydney Local Health District (reference number 5092 AU RED LNR/17/WMEAD/140). eHealth behaviour change and health literacy in diabetes self-management iv Results Aim 1 (Paper 1): Irrespective of health literacy level, many people with diabetes shared similar ideas about monitoring and problem-solving for self-management. There was also evidence of patterns in how participants talked about motivation and periods of low self-management. These were clustered into two sets of schemas: a ‘willpower orientation’ and a ‘problem-solving orientation’. Ideas pertaining to the willpower orientation were more apparent for people with limited health literacy, whereas ideas encompassed by the problem-solving orientation were more apparent for people with adequate health literacy. Aim 2: The effectiveness of two online action plans (literacy-sensitive or standard) depended on the health literacy of the participant. In the first trial (Paper 2), people with lower health literacy reduced unhealthy snacking to a greater extent using the literacysensitive action plan, whereas people with higher health literacy reduced unhealthy snacking to a greater extent using the standard action plan (b = 1.7, p = 0.03). People scoring 1 SD below the mean health literacy score who used the literacy-sensitive action plan reported eating 8 fewer serves of unhealthy snacks, whereas people scoring 1 SD above the mean health literacy score reported eating 6 more serves of unhealthy snacks using the same tool. Findings in the second trial (Papers 3 and 4) were consistent with those of the first: people scoring 1 SD below the mean health literacy score were predicted to consume 10 fewer serves of unhealthy snacks per week using the literacy-sensitive action plan, whereas those scoring 1 SD above the mean were predicted to consume 3 fewer serves using the standard action plan (b= -3.25, 95% CI: -6.55 to 0.05, p=0.05). There was weak evidence that using a health literacy screening tool was more effective than allowing the participant to choose. However, this should be interpreted with caution as the effect was driven by a small number of participants with extreme (but plausible) snacking scores. Aim 3: Paper 5 identified three themes related to diabetes eHealth in primary care: 1) GPs felt that their role in diabetes self-management was to foster independent and safe self-management; 2) GPs preferred face-to-face care and perceived it was important for delivery of care to their patients; and 3) some GPs were sceptical that the benefits of diabetes apps would outweigh the burden of implementing them. Across these themes, potential ‘facilitating features’ were identified, such as being explicit about how an app might overlap or diverge from GP’s goals, explaining how staff can continue their existing eHealth behaviour change and health literacy in diabetes self-management v roles through the app, improving documentation of care, facilitating communication, and prompting patients to see their doctor. In paper 6, GPs reported that the health literacy of a patient depended on the language in which information was communicated. Given that consultations were often conducted in English and health literacy skills might be higher in another language, GPs felt there was a role for both detailed and simple resources, in English and translated. GPs also discussed how having a shared language and culture helped them motivate their patients. By the same token, when language was not shared, it could be challenging to address misinformation in the community about diabetes management. Lastly, most GPs felt a diabetes app could be suitable for these patients, and even preferable to face-to-face care alone. Conclusion This body of work provides new evidence that health literacy may influence diabetes self-management, whether this is through the way that they come to understand their diabetes (Paper 1), the effectiveness of behavioural interventions (Papers 2-4), or their needs in primary care settings (Papers 5 and 6). Each study also highlights opportunities to optimise the design and evaluation of literacy-sensitive eHealth interventions for diabetes self-management that are delivered in primary care. More broadly, this thesis argues that future research would benefit from integrating the fields of health literacy and behavioural science. As eHealth behavioural interventions become more ubiquitous a multidisciplinary approach is increasingly important. There is a risk that eHealth may exacerbate rather than reduce health inequalities because they are not taken up by those who need them most. Findings from this thesis also emphasise that whilst a literacy-sensitive eHealth intervention delivered in primary care is acceptable to GPs, its success will be contingent on deliberate efforts to ensure the design meets the needs of people with low health literacy and the health professionals who support them. The findings from this thesis are being implemented in two ways: the qualitative findings informed the content of an app designed by Western Sydney Diabetes, and the quantitative findings will be integrated into a Diabetes NSW & ACT project to reduce unhealthy snacking for women with gestational diabetes. Lastly, a workshop will take place to develop health literacy guidelines for adapting strategies to promote action and set research priorities for future work in this area.
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Keyword:
behaviour change; diabetes; health literacy; mhealth; primary care; qualitative
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URL: https://hdl.handle.net/2123/22680
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Pra onde vamos? Uma análise de como se dá o acesso da população LGBT aos serviços de atenção básica em saúde em Caicó-RN
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Medeiros, Patricia Brandão de. - : Universidade Federal do Rio Grande do Norte, 2020. : Brasil, 2020. : UFRN, 2020. : Residência Multiprofissional em Atenção Básica, 2020
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Percepção e manifestação de competências colaborativas em discentes da graduação em saúde ; Perception and manifestation of collaborative competencies among undergraduate health students
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Improving Cultural Competence in Primary Care Providers Through Cultural Awareness Training
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Reni, Luz Elena. - : Spencer S. Eccles Health Sciences Library, University of Utah, 2020
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Mobile web application for use in the Extended Family Health and Primary Care Center: content and usability validation
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In: Revista CEFAC, Vol 22, Iss 3 (2020) (2020)
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Language-Concordant Primary Care Physicians for a Diverse Population: The View from California.
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In: Health equity, vol 3, iss 1 (2019)
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Translating/Creating a Culturally Responsive Spanish-Language Mobile App for Visit Preparation: Case Study of "Trans-Creation". ...
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