Zoekresultaten

Implementation fidelity trajectories of a health promotion program in multidisciplinary settings

BACKGROUND: Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients' health behavior.METHODS: This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n = ± 70). Higher fidelity scores indicate a more complete implementation of the program's core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes.RESULTS: Three trajectories were identified as the following: 'stable high fidelity' (n = 9), 'moderate and improving fidelity' (n = 6), and 'unstable fidelity' (n = 2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period's start and end, support from physicians and physiotherapists, professionals' appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p < .05). Qualitative data showed that the stable high fidelity organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients' self-reported physical activity outcomes (adjusted model β = - 651.6, t(613) = - 1032, p = .303).CONCLUSIONS: Differences in organizational-level implementation fidelity trajectories did not result in outcome differences at patient-level. This suggests that an effective implementation fidelity trajectory is contingent on the local organization's conditions. More specifically, achieving stable high implementation fidelity required the management of tensions: realizing a localized change vision, while safeguarding the program's standardized core components and engaging the scarce physicians throughout the process. When scaling up evidence-informed health promotion programs, we propose to tailor the management of implementation tensions to local organizations' starting position, size, and circumstances.TRIAL REGISTRATION: The Netherlands National Trial Register NTR3961 . Registered 18 April 2013.

Setting Overweight adults in motion: the role of health beliefs.

Objective: Health beliefs of overweight adults who did and did not enter an exercise program were compared to identify possible factors that hamper people to increase physical exercise. Method: Participants (n = 116, 78 women and 38 men) were overweight adults without comorbidities. Self-report instruments examined the burden of suffering, beliefs related to physical exercise and obesity, somatic complaints, and obesity-related quality of life of new participants of exercise programs versus sedentary non-exercisers. Results: Mean BMI of exercisers was and of non-exercisers was 34.6 (7.0) and 32.8 (5.8) respectively. The exercisers were more often female, had fathers with less overweight, and considered overweight a more serious health problem. Fear of injury was higher and perceived health benefits were lower in the non-exercisers, who also more often attributed their overweight to physical causes and believed overweight to be irreversible. Body weight, age, education level, somatic complaints, and quality of life of the groups were comparable. Conclusion: With respect to health beliefs, overweight non-exercisers reported more fear of injury and perceived their overweight as more irreversible than exercisers. Considering these factors in intervention and public health promotion may help overweight sedentary people to start physical exercise.

Evaluation of an Oral Care Program to Improve the Oral Health of Home-Dwelling Older People

The aim of this study was to evaluate the impact of the implementation of an Oral Care Program on home care nurses' attitudes and knowledge about oral health (care) and the impact on older people's oral health. A pre-post study, without a control group, was conducted. A preventive Oral Care Program (OCP) was designed, focusing on home care nurses and older people, in collaboration with dental hygienists. Implementation was measured with questionnaires at baseline and after 6 months for home care nurses; for older people, implementation was measured at baseline and after 3 months with the Oral Health Assessment Tool and a questionnaire about oral (self) care between January 2018 and September 2019. Although the study design has limitations, the oral health of older people improved significantly after 3 months and the OCP was most beneficial for people with full dentures. The OCP improved knowledge and attitude of home care nurses. The program fitted well with the daily work routines of home care nurses. Individual-centered care plans for older people, education of home care nurses and the expertise of the dental hygienists have added value in home care nursing. Future implementations should focus on older people with natural teeth.

Should social programs target finances, health, or well-being

In recent years, both scientists and the general population gained awareness of the deep entanglement between finances, health, and well-being. People cannot be reduced to a set of problems to be tackled independently, thinking that somehow these solutions add up to solve the problem as a whole.4 Researchers pay increasing attention to how problems are related, and many lessons have been learned over time. Policy-makers and practitioners who understand the complex relationship between financial, physical, and mental well-being find themselves in the unique position to use these insights in how they design their programs. This paper provides an overview of academic and grey literature and the lessons we can learn from these studies.

Peer2Peer Student Support Program

An online education program for students sports studies on E-health to optimisme lifestyle coaching

Development of an online education program for students sports studies on e-health to optimise lifestyle coaching