The @RISK Study: Risk communication for patients with type 2 diabetes: design of a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Patients with type 2 diabetes mellitus (T2DM) have an increased risk to develop severe diabetes related complications, especially cardiovascular disease (CVD). The risk to develop CVD can be estimated by means of risk formulas. However, patients have difficulties to understand the outcomes of these formulas. As a result, they may not recognize the importance of changing lifestyle and taking medication in time. Therefore, it is important to develop risk communication methods, that will improve the patients' understanding of risks associated with having diabetes, which enables them to make informed choices about their diabetes care.</p> <p>The aim of this study is to investigate the effects of an intervention focussed on the communication of the absolute 10-year risk to develop CVD on risk perception, attitude and intention to change lifestyle behaviour in patients with T2DM. The conceptual framework of the intervention is based on the Theory of Planned Behaviour and the Self-regulation Theory.</p> <p>Methods</p> <p>A randomised controlled trial will be performed in the Diabetes Care System West-Friesland (DCS), a managed care system. Newly referred T2DM patients of the DCS, younger than 75 years will be eligible for the study. The intervention group will be exposed to risk communication on CVD, on top of standard managed care of the DCS. This intervention consists of a simple explanation on the causes and consequences of CVD, and possibilities for prevention. The probabilities of CVD in 10 year will be explained in natural frequencies and visualised by a population diagram. The control group will receive standard managed care. The primary outcome is appropriateness of risk perception. Secondary outcomes are attitude and intention to change lifestyle behaviour and illness perception. Differences between baseline and follow-up (2 and 12 weeks) between groups will be analysed according to the intention-to-treat principle. The study was powered on 120 patients in each group.</p> <p>Discussion</p> <p>This innovative risk communication method based on two behavioural theories might improve patient's appropriateness of risk perception and attitude concerning lifestyle change. With a better understanding of their CVD risk, patients will be able to make informed choices concerning diabetes care.</p> <p>Trail registration</p> <p>The trial is registered as NTR1556 in the Dutch Trial Register.</p

Creating and Breaking Habit in Healthcare Professional Behaviours to Improve Healthcare and Health

Healthcare professionals (HCPs) prescribe, provide advice, conduct examinations, perform surgical procedures, and engage in a range of clinical behaviours. Their clinical actions are characteristically performed repeatedly—sometimes multiple times per day—in the same physical locations with the same colleagues and patients, under constant time pressure, and competing demands. This repetition under pressure in a stable setting provides ideal circumstances for creating contingencies between physical and social cues and clinical actions. HCP behaviour provides an ideal setting in which to advance theory, methods, and interventions to better understand habit formation and habit reversal. Contemporary theoretical and methodological development in the psychology of habit has begun to be applied to understand and promote the formation, breaking, and replacement of habitual behaviour in HCPs. This chapter highlights key theoretical approaches, methods, and intervention techniques that have been applied to conceptualize, measure, develop, and break habit and automaticity in HCPs. These insights have the potential to synergistically contribute novel perspectives to the wider habit literature

Polysaccharide aggregation as a potential sink of marine dissolved organic carbon

The formation and sinking of biogenic particles mediate vertical mass fluxes and drive elemental cycling in the ocean1. Whereas marine sciences have focused primarily on particle production by phytoplankton growth, particle formation by the assembly of organic macromolecules has almost been neglected2, 3. Here we show, by means of a combined experimental and modelling study, that the formation of polysaccharide particles is an important pathway to convert dissolved into particulate organic carbon during phytoplankton blooms, and can be described in terms of aggregation kinetics. Our findings suggest that aggregation processes in the ocean cascade from the molecular scale up to the size of fast-settling particles, and give new insights into the cycling and export of biogeochemical key elements such as carbon, iron and thorium

Understanding angioplasty: An evaluation of a person-centred educational resource

Background: Coronary angioplasty is a common procedure that requires a short hospital stay. A pre-angioplasty clinic offers the opportunity to address unmet health information needs and provide tailored patient information. A person-centred DVD was developed and sent out to patients prior to attendance at a pre-angioplasty clinic, which enabled attendees to familiarise themselves with the angioplasty process and learn about secondary prevention through self-management of lifestyle change before clinic attendance. Aim: To establish the user acceptability of the DVD-based health information resource Understanding Angioplasty. Method: A prospective study of 712 consecutive patient admissions for elective coronary angioplasty at a single centre. Patients were sent the DVD 2–3 weeks prior to admission and asked to score their satisfaction with ease of use, presentation of content and usefulness, on a brief researcher-generated questionnaire. Results: Two hundred and fifty four questionnaires (response rate 36%) were returned. Summary scores show that the presentation of information and content was rated as good or excellent by 95% and 93% of participants respectively. Eighty six per cent of respondents (n=213) felt better prepared to ask clinic staff about their health after watching the DVD. Eighty six per cent (n=214) reported having enough information to support them to self-manage their lifestyle to improve their heart health. Ninety eight per cent (n=249) of respondents said they would recommend the DVD resource to others undergoing elective angioplasty and 70% (n=176) had watched the DVD with a family member or friend. Conclusion: The format and content of the DVD were considered highly acceptable by users and it was considered to be a useful resource to instigate questions in preparation for pre-angioplasty clinic attendance and to support self-management of lifestyle change and medicines. Further work is needed to establish whether it is effective in supporting self-management in the longer term