Background and aim Self-management support is an integral part of current chronic care guidelines. The success of self-management interventions varies between individual patients, suggesting a need for tailored self-management support. Understanding the role of patient factors in the current decision making of health professionals can support future tailoring of self-management interventions. The aim of this study is to identify the relative importance of patient factors in health professionals’ decision making regarding self-management support. Method A factorial survey was presented to primary care physicians and nurses. The survey consisted of clinical vignettes (case descriptions), in which 11 patient factors were systematically varied. Each care provider received a set of 12 vignettes. For each vignette, they decided whether they would give this patient self-management support and whether they expected this support to be successful. The associations between respondent decisions and patient factors were explored using ordered logit regression. Results The survey was completed by 60 general practitioners and 80 nurses. Self-management support was unlikely to be provided in a third of the vignettes. The most important patient factor in the decision to provide self-management support as well as in the expectation that self-management support would be successful was motivation, followed by patient-provider relationship and illness perception. Other factors, such as depression or anxiety, education level, self-efficacy and social support, had a small impact on decisions. Disease, disease severity, knowledge of disease, and age were relatively unimportant factors. Conclusion This is the first study to explore the relative importance of patient factors in decision making and the expectations regarding the provision of self-management support to chronic disease patients. By far, the most important factor considered was patient’s motivation; unmotivated patients were less likely to receive self-management support. Future tailored interventions should incorporate strategies to enhance motivation in unmotivated patients. Furthermore, care providers should be better equipped to promote motivational change in their patients.
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Contemporary social work is subjected to ongoing questions in terms of its effectiveness and accountability. It appears to be problematic for social workers to defend themselves in a proper manner. When they do so, they often seem to rely primarily on a rhetoric of good intentions and are thus unable to constructively asses the underlying principles of their work. These considerations have prompted the research outline that is presented in this paper.
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Supportive social interactions between nonparental adults (i.e. social work professionals, volunteers, and other parents that have contact with children but are not the primary caregiver), parents, and children are important for children’s well-being and development. Parenting styles, types of child behaviour, and location in the neighbourhood may influence these interactions. The aim of the present study was to identify when and how nonparental adults respond in interactions with other adults and children in the neighbourhood. A mixed-method study with vignettes and interviews (N = 114) was conducted to gain insight into which factors (parenting style, child behaviour, location in the neighbourhood) influence the nonparental adults’ intention to respond to children and/or parents. Nonparental adults indicated they were most likely to respond in the context of a permissive parenting style or a child’s externalising behaviour. Professionals more often felt responsible than parents and volunteers, although they did not respond more often. All three factors were related to the participants’ willingness to respond and promote a supportive social structure in the neighbourhood. Social work professionals and their organisations can use this study to identify social support interactions and to discuss their responsibilities.--Sociaal ondersteunende interacties tussen mede-opvoeders (zoals sociaal werk-professionals, vrijwilligers en andere ouders die contact met kinderen hebben, maar niet primair verantwoordelijk zijn) zijn belangrijk voor het welzijn en een positieve ontwikkeling van kinderen. Het doel van deze studie was inzicht geven in hoe mede-opvoeders reageren in interacties met andere opvoeders en kinderen in de buurt. Een mixed-method design met vignetten en interviews is toegepast om inzicht te krijgen in welke factoren (opvoedstijl, gedrag van een kind en locatie in de buurt) de reactie van mede-opvoeders beïnvloeden. Mede-opvoeders gaven aan dat ze het meest reageren in situaties waar sprake is van een permissieve opvoedingsstijl of externaliserend gedrag van een kind. Professionals voelen zich meer verantwoordelijk dan ouders en vrijwilligers, maar reageren niet vaker. Opvoedstijl, gedrag van het kind en locatie in de buurt hangen samen met de mate waarin respondenten reageren en om een ondersteunende sociale structuur in de buurt te bevorderen. Sociaal werkers en hun organisaties kunnen deze studie gebruiken om sociaal ondersteunende interacties te identificeren and over hun verantwoordelijkheid te discussiëren.
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ABSTRACT Purpose To explore the usefulness of conventional tests for assessing spatial neglect and contrast these tests with daily challenges encountered by patients after discharge from rehabilitation to home. Methods A mixed method prospective study of 15 patients with neglect after a righthemisphere stroke,51 month after discharge to home. Data were obtained from: (1) Catherine Bergego Scale (CBS), (2) star cancellation and figure copying and (3) observations and interviews. Qualitative data were analysed with content analysis and quantitative data with non-parametric statistics. The data were presented in a ‘mixing matrix’ and integrated by ‘following threads’. Finally, a synthesis was written into a vignette. Results The CBS significantly underestimated fluctuations and did not capture important items of neglect. The star cancellation and figure copying did not identify neglect in mildly affected participants. Left starting point in the star cancellation and a characteristic process of drawing in figure copying were observed in all participants. Conclusion Traditional numerical interpretations of paper-pencil tests inadequately confirmed mild neglect. Starting points of the star cancellation and observation of drawing should be incorporated into screening procedures. Assessment strategies need improvement to identify patients with subtle forms of neglect.
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Background: Around 13% of the world’s population suffers from obesity. More than 40% of people with obesity display emotional eating behaviour (eating in response to negative emotions or distress). It is an alternate to moreeffective coping strategies for negative emotions. Our study explored the opportunities for helping adults with emotional overeating using a virtual coach, aiming to identify preferences for tailored coaching strategies applicable in a personal virtual coach environment. Three different coaching strategies were tested: a validating, a focus-on-change, and a dialectical one – the latter being a synthesis of the first two strategies. Methods: A qualitative study used vignettes reflecting the two most relevant situations for people with emotional eating: 1. experiencing negative emotions, with ensuing food cravings; and 2. after losing control to emotional eating, with ensuing feelings of low self-esteem. Applied design: 2 situations × 3 coaching strategies. Participants: 71 adult women (Mage 44.4/years, range 19–70, SD = 12.86) with high scores on the DEBQ-emotional eating scale (Memo 3.65, range 1.69–4.92, SD = .69) with mean BMI 30.1 (range 18–46, SD = 6.53). They were recruited via dieticians’ practices, were randomly assigned to the conditions and asked how they would face and react to thepresented coaching strategies. Data were transcribed and a thematic analysis was conducted. Results: Qualitative results showed that participants valued both the validating coaching strategy and the focus-onchange strategy, but indicated that a combination of validation and focus-on-change provides both mental supportand practical advice. Data showed that participants differed in their level of awareness of the role that emotions play in their overeating and the need for emotion-regulation skills. Conclusion: The design of the virtual coach should be based on dialectical coaching strategies as preferred by participants with emotional eating behaviour. It should be tailored to the different stages of awareness of their emotions and individual emotion-regulation skills.
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The aim of this study was to investigate if physiotherapists had knowledge and skills in applying Bobath-based therapy (BB), also referred to as Neurodevelopmental Treatment, in the care of stroke patients and if they generally used the therapy in daily practice. This is because of the important emphasis placed on documenting the extent of the therapy given to the client groups compared in outcome studies measuring the efficacy of therapeutic interventions. The study took place as an intervention check for a large outcome study measuring the effects of BB therapy. BB therapy had been implemented on six wards, whereas six other wards did not use this approach. The physiotherapists (n /38) knowledge and skills in making decisions about applying the BB principles in all wards was measured in two steps. In step 1, the physiotherapists received a questionnaire focusing on their physiotherapy strategy, and Bobath education. In step 2, they received a case vignette describing a stroke patient and questions concerning the content of the physiotherapy provided to this patient. An expert panel judged the therapists responses to the questions of both steps. Of the physiotherapists working in the BB wards, 14 (74%) therapists generally used BB principles, whereas four (21%) therapists did not (one was uncertain). Of the physiotherapists working in the non-BB wards (n /19), three (16%) did use BB therapy whereas 10 (52%) therapists did not use the therapy (six responses were missing). The study showed that within the BB wards, the physiotherapists had followed sufficient BB education, as judged by a panel of experts, and demonstrated the knowledge and skills in applying the BB therapy, whereas in the other wards they did not. BB wards could therefore participate in the experimental group of the study measuring the effects of the Bobath therapy, and the non-BB wards could serve as proper control wards.
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Objectives: Emotional eating is recognized as a potential contributor to weight gain. Emotional eaters often hide their problems because of feelings of shame about their behavior, making it challenging to provide them with the necessary support. The introduction of a virtual coach might offer a potential solution in assisting them. To find out whether emotional eaters are receptive to online personalized coaching, we presented emotional eaters with two essential proto-typical problem situations for emotional eaters: “experiencing cravings” and “after giving in to cravings,” and asked them whether they preferred one of the three coaching strategies presented: Validating, Focus-on-Change and Dialectical.Methods: An experimental vignette study (2 × 3 design) was carried out. The vignettes featured two distinct personas, each representing one of the two common problem scenarios experienced by emotional eaters, along with three distinct coaching strategies for each scenario. To identify potential predictors for recognition of problem situations, questionnaires on emotional eating (DEBQ), personality traits (Big-5), well-being (PANAS), and BMI were administrated.Results: A total of 62% of the respondents identified themselves with “after giving in to cravings” and 47% with “experiencing cravings.” BMI, emotional eating and emotional stability appeared to be predictors in recognizing both the problem situations. In “experiencing cravings,” the participating women preferred Dialectical and the Validation coaching strategies. In the “after giving in to cravings” condition, they revealed a preference for the Dialectical and the Focus-on-Change coaching strategies.Conclusion: Using vignettes allowed a less threatening way of bringing up sensitive topics for emotional eaters. The personas representing the problem situations were reasonably well recognized. To further enhance this recognition, it is important for the design and content of the personas to be even more closely related to the typical problem scenarios of emotional eaters, rather than focusing on physical characteristics or social backgrounds. This way, users may be less distracted by these factors. With the knowledge gained about the predictors that may influence recognition of the problem situations, design for coaching can be more customized. The participants represented individuals with high emotional eating levels, enhancing external validity.
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The study of moral reasoning in relation to sustainable development is an emerging field within environmental education (EE) and education for sustainable development (ESD). The vignette method was used to evaluate the perception of the relationship between environmental and social issues in the Dutch upper elementary school children. This case study is placed within two broad areas of tension, namely between the need to address urgent environmental problems and to promote pluralistic democratic learning; and between the value of environment as an economic asset and deep ecology perspective. Results of this study indicate that the children are able to critically think about the moral dilemmas inherent in sustainable development and distinguish between different values in relation to environment. https://doi.org/10.1016/j.stueduc.2013.12.004 https://www.linkedin.com/in/helenkopnina/
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Background: The purpose of this study was to explore physiotherapists’ knowledge, attitude, and practice behavior in assessing and managing patients with non-specific, non-traumatic, acute- and subacute neck pain, with a focus on prognostic factors for chronification. Method: A qualitative study using in-depth semi-structured interviews was conducted with 13 physiotherapists working in primary care. A purposive sampling method served to seek the broadest perspectives. The knowledgeattitude and practice framework was used as an analytic lens throughout the process. Textual data were analyzed using qualitative content analysis with an inductive approach and constant comparison. Results: Seven main themes emerged from the data; physiotherapists self-estimated knowledge and attitude, role clarity, therapeutic relationship, internal- and external barriers to practice behavior, physiotherapists’ practice behaviors, and self-reflection. These findings are presented in an adjusted knowledge-attitude and practice behavior framework. Conclusion: A complex relationship was found between a physiotherapist’s knowledge about, attitude, and practice behavior concerning the diagnostic process and interventions for non-specific, non-traumatic, acute, and subacute neck pain. Overall, physiotherapists used a biopsychosocial view of patients with non-specific neck pain. Physiotherapists’ practice behaviors was influenced by individual attitudes towards their professional role and therapeutic relationship with the patient, and individual knowledge and skills, personal routines and habits, the feeling of powerlessness to modify patients’ external factors, and patients’ lack of willingness to a biopsychosocial approach influenced physiotherapists’ clinical decisions. In addition, we found self-reflection to have an essential role in developing self-estimated knowledge and change in attitude towards their therapeutic role and therapist-patient relationship.
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Background:More than 40% of the obese population suffer from emotional eating behaviour. They give in to overeating, because they lack effective coping strategies for negative emotions. Our studies explored the opportunities for helping emotional eaters with a virtual coach. Therefore the objective of this study was to identify preferences for coaching strategies for emotional eaters applicable in a personal virtual coach environment. Three different coaching strategies were tested: a validating, a focus-on-change, and a dialectical.Methods:Instruments: Vignettes, reflecting two most relevant situations for emotional eaters: 1. having food cravings experiencing negative emotions. 2. having given into overeating experiencing feelings of low self-esteem; DEBQ.Applied Design: 2 situations x 3 coaching strategies. Participants: 71 female emotional eaters (age mean 44, range 19-70) with high scores on the DEBQ (mean 3,6) with eventual overweight (mean BMI 30,2, range 18-45); recruited via dietist practices), were randomly assigned to the conditions and were asked how they would encounter and react to the presented coaching strategies. Data is obtained by thematic analyses.Findings:Qualitative results showed that emotional eaters clearly preferred dialectical coaching in both conditions. Although this preference is expressed for craving and overeating situations, the other coaching strategies were differently evaluated for both conditions. Our study showed emotional eaters have not only differences in preferences for coaching strategies, they are in different stages of knowledge about emotion regulation.Discussion:Design of the virtual coach should be based on integration of the validation and focus-on-change into dialectical coaching strategies as preferred by emotional eaters and has to tailor to the different stages of self-knowledge about emotion regulation.
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