Training health professionals to support people with progressive neurological conditions to self-manage: A realist inquiry

Introduction Supporting patients to effectively self-manage their own conditions is known to be challenging for health professionals. It requires specific skills and often challenges existing practice. Supporting self-management among people with progressive neurological conditions may represent additional challenges due to the multiple evolving symptoms people with these conditions may experience. Methods Realist methods were used to investigate how training interventions that target health professionals working with people with progressive neurological conditions and aim to improve self-management support provision work, for whom and in what circumstances. Phase One (used for theory development) included a survey of 186 health professionals and a realist literature synthesis including 44 papers (supplemented by stakeholder advisory groups and five key informant interviews). Phase Two (used for theory refinement) involved the evaluation of a two-day training course in “Health Coaching Skills” delivered to twenty health professionals. Data were collected in Phase Two through observations of the training days, individual telephone interviews with participants and trainers (total = 33 interviews) and pre-and post-training questionnaires. Relevant formal theories informed the analysis. Results Four initial rough theories were developed in Phase One and subsequently refined in Phase Two. Context-mechanism-outcome configurations were generated during each stage and used to develop an overall programme theory. Key training mechanisms identified included critical reflection on current practice and the development of knowledge, skills and confidence. Training participants need to become convinced of the relevance of the training to their setting, a process which is influenced by their experiences of implementing the training. Conclusions Implementation patterns following training vary widely. Training tends to be most successful when participants build self-belief in the new skills, while also becoming convinced that patients will be responsive, and that their working patterns can accommodate a change in approach. Experiencing significant role conflict can inhibit change

Training in health coaching skills for health professionals who work with people with progressive neurological conditions: A realist evaluation

Background Supporting people to self‐manage their long‐term conditions is a UK policy priority. Health coaching is one approach health professionals can use to provide such support. There has been little research done on how to train clinicians in health coaching or how to target training to settings where it may be most effective. Objective To develop theories to describe how training health professionals in health coaching works, for whom and in what circumstances, with a focus on those working with people with progressive neurological conditions. Design Realist evaluation using mixed methods (participant observation, pre‐ and post‐training questionnaires, and telephone interviews with participants and trainers). Realist data analysis used to develop and refine theories. Intervention Two 1‐day face‐to‐face training sessions in health coaching with 11 weeks between first and second days. Setting and participants Twenty health‐care professionals who work with people with neurological conditions in the UK, two training facilitators. Results Four theories were developed using context‐mechanism‐outcome configurations to describe how training triggers critical reflection; builds knowledge, skills and confidence; how participants evaluate the relevance of the training; and their experiences of implementing the training. Some participants reported a major shift in practice, and others implemented the training in more limited ways. Discussion Fully embracing the role of coach is difficult for health professionals working in positions and settings where their clinical expertise appears most highly valued. Conclusions Training should address the practicality of using coaching approaches within existing roles, while organizations should consider their role in facilitating implementation

Drivers of predator killing by rural residents and recommendations for fostering coexistence in agricultural landscapes

Predators inhabiting human-dominated landscapes are vulnerable to various anthropogenic actions, including people killing them. We assess potential drivers of predator killing in an agricultural landscape in southern Chile, and discuss the implications for policies and interventions to promote coexistence. We evaluate five different types of motivation: (i) sociodemographics and household economy; (ii) livestock loss; (iii) predator encounter rates; (iv) knowledge of legal protection (all native predators are currently protected); and, (v) tolerance to livestock predation. As the killing of native predators is illegal, the prevalence of this behaviour by rural residents was estimated using a symmetrical forced-response randomised response technique (RRT), a method designed to ask sensitive questions. A total of 233 rural residents from randomly assigned sample units (4 km2) across the study region completed our questionnaire. More conspicuous species, such as hawks (Falconiformes sp), foxes (Lycalopex sp) and free-roaming domestic dogs (Canis lupus familiaris), were killed by a higher proportion of farmers than more cryptic species, like the felid güiña (Leopardus guigna), skunk (Conepatus chinga) and pumas (Puma concolor). The proportion of respondents admitting to killing predators was highest for hawks (mean= 0.46, SE= 0.08), foxes (mean= 0.29, SE= 0.08) and dogs (mean= 0.30, SE= 0.08) and lowest for güiña (mean= 0.10, SE = 0.09), which is the only species of conservation concern we examine (considered Vulnerable on the IUCN Red List). From our five motivation categories, past killing of predators was associated with higher reported predator encounter rates (guina, hawks), lower tolerance to livestock predation (hawks, dogs), higher reported livestock loss (dogs) and sociodemographics and household economy (foxes). Our results demonstrate that a one-size-fits-all approach to predator persecution is unlikely to reduce or eliminate illegal killings for the suite of species we examined. We identify and describe two main types of intervention that could foster coexistence, improvement of livestock management and domestic dog management in rural areas, as well as discussing the potential for social marketing

The transition to secondary progressive multiple sclerosis: an exploratory qualitative study of health professionals' experiences

Background: Identifying the transition from relapsing-remitting to secondary progressive multiple sclerosis (SPMS) can be challenging for clinicians. Little previous research has explored how professionals experience working with patients during this specific stage of the disease. We explored the experiences of a group of multidisciplinary professionals who support patients in the transition to SPMS, to describe this stage from a professional perspective. Methods: Qualitative semistructured interview study with 11 professionals (medical, nursing, and allied professionals; both specialists and generalists) working with patients with MS in South Wales, United Kingdom. Thematic analysis of the interview data was performed. Results: Two overarching themes were identified: the transition and providing support. The theme “transition” comprised issues related to recognizing and communicating about SPMS. Uncertainty influenced both recognizing the transition and knowing how to discuss it with patients. “Providing support” included descriptions of challenging aspects of patient care, providing support for carers, utilizing the multidisciplinary team, and working within service constraints. Providing adequate psychological support and engaging patients with self-management approaches were seen as particularly challenging. Conclusions: Caring for patients in the transition to SPMS generates specific challenges for professionals. Further research on health-care interactions and patients'/professionals' experiences around the transition phase may help to identify strategies for professional development and learning, and how to optimize patient experience at this difficult stage of disease

"You are just left to get on with it": qualitative study of patient and carer experiences of the transition to secondary progressive multiple sclerosis

Objectives Although the transition to secondary progressive multiple sclerosis (SPMS) is known to be a period of uncertainty for clinicians, who may find progressive disease challenging to objectively identify, little research has explored the experiences of patients and carers specifically during this transition period. Our objective was to explore what patients and their carers understand about their disease stage and describe their experiences and perspectives on the transition to SPMS. Design Semistructured qualitative interviews and subsequent validation focus groups were analysed using inductive thematic analysis. Setting South East Wales, UK. Participants 20 patients with MS and 13 carers were interviewed. Eight patients and two carers participated in focus groups. Results Four main themes around disease progression were identified. ‘Realisation’ describes how patients came to understand they had SPMS while ‘reaction’ describes their response to this realisation. The ‘realities’ of living with SPMS, including dealing with the healthcare system during this period, were described along with ‘future challenges’ envisaged by patients and carers. Conclusions Awareness that the transition to SPMS has occurred, and subsequent emotional reactions and coping strategies, varied widely between patients and their carers. The process of diagnosing the transition was often not transparent and some individuals wanted information to help them understand what the transition to SPMS meant for them

Associated factors and global adherence of cervical cancer screening in 2019:a systematic analysis and modelling study

BACKGROUND: Cervical cancer screening is vital for its prevention. Adherence is a crucial indicator that implies the individual willingness to take cervical cancer screening. We aimed to estimate the global and regional adherence rates of cervical cancer screening in 2019 and identify its associated factors among general women. METHOD: We searched studies in PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Database, ProQuest theses database and Google Web, without a lower time limit and until 23 June, 2021. Survey studies were considered eligible if they investigated cervical cancer screening adherence among general women, with data on sample size, the number of adherent subjects, and/or adherence rate. Random-effects were used to pool the odds ratios (ORs) of associated factors of adherence. Using modelling analysis, we estimated 2019 overall and age-specific adherence rates at the global and regional levels in women aged 20–69 years. RESULTS: Eight thousand two hundred ninety records were identified, and 153 articles were included. Being married (vs not married: OR, 1.34; 95% confidence interval [CI]: 1.23–1.46), higher educational attainment (higher than high school vs less than high school: OR, 1.44; 95% CI: 1.35–1.53), having healthcare (OR, 1.64; 95% CI: 1.43–1.88), former smoking (OR, 1.20; 95% CI: 1.07–1.34), physical activity (OR, 1.19; 95% CI: 1.05–1.36), parity (OR, 1.07; 95% CI: 1.01–1.12), and chronic disease (OR, 1.17; 95% CI: 1.04–1.32) were associated with better adherence, whereas obesity (vs normal: OR, 0.85; 95% CI: 0.74–0.97) and current smoking (vs former/never: OR, 0.64; 95% CI: 0.54–0.76) were associated with worse adherence. In 2019, the adherence was at 33.66% (95% CI: 23.34–39.30%) worldwide, and was higher in high-income countries (HICs) (75.66, 95% CI: 66.74–82.81%) than in low and middle-income countries (LMICs) (24.91, 95% CI: 14.30–30.24%). It varied across regions, the highest in the European region (65.36, 95% CI: 55.40–74.19%), but the lowest in the African region (5.28, 95% CI: 3.43–8.03%). CONCLUSIONS: Cervical cancer screening adherence remained low globally, exhibiting geographical discrepancy with HICs higher than LMICs. Further implementations of screening programs should comprehensively consider the local economy, social benefits, and demographic structure to adapt delivery for vulnerable or underserved women to boost screening adherence. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12992-022-00890-w

Interventions to improve the self-management support health professionals provide for people with progressive neurological conditions: protocol for a realist synthesis

Introduction Supporting self-management among people with long term conditions is recognised as an important component of health care. Progressive neurological conditions (PNCs), for example, Parkinson’s disease and Multiple Sclerosis are associated with problems such as fatigue and cognitive impairment which may make self-management more challenging. Health professionals may need to develop specific skills in order to provide effective self-management support for these patients. The review aims to develop explanatory theories about how health professional-targeted interventions to improve self-management support provision for people with PNCs operate in different circumstances. Methods and Analysis A realist synthesis of the evidence is proposed. There are two priority questions for the review to address. These relate to the role of a shared concept of self-management support within the healthcare team, and the need to tailor the support provided to the requirements of people with PNCs. Key stakeholders will be involved throughout the process. The initial search strategy uses terms relating to 1) self-management, 2) health professionals and 3) PNCs. Searching, data extraction and synthesis will occur in parallel. Studies will be prioritised for inclusion based on anticipated contribution to generating explanatory theories. Key informant interviews are planned to direct supplementary searches and help further refine the theories developed. Results will be expressed in the form of context-mechanism-outcome configurations. Dissemination Publication guidelines on realist synthesis will be followed. The results will be published in a peer-reviewed journal and made available to organisations involved in the provision of health professional training

Shifting mindsets: a realist synthesis of evidence from self-management support training

Context Accompanying the growing expectation of patient self-management is the need to ensure health care professionals (HCPs) have the required attitudes and skills to provide effective self-management support (SMS). Results from existing training interventions for HCPs in SMS have been mixed and the evidence base is weaker for certain settings, including supporting people with progressive neurological conditions (PNCs). We set out to understand how training operates, and to identify barriers and facilitators to training designed to support shifts in attitudes amongst HCPs. Methods We undertook a realist literature synthesis focused on: (i) the influence of how HCPs, teams and organisations view and adopt self-management; and (ii) how SMS needs to be tailored for people with PNCs. A traditional database search strategy was used alongside citation tracking, grey literature searching and stakeholder recommendations. We supplemented PNC-specific literature with data from other long-term conditions. Key informant interviews and stakeholder advisory group meetings informed the synthesis process. Realist context-mechanism-outcome configurations were generated and mapped onto the stages described in Mezirow's Transformative Learning Theory. Results Forty-four original articles were included (19 relating to PNCs), from which seven refined theories were developed. The theories identified important training elements (evidence provision, building skills and confidence, facilitating reflection and generating empathy). The significant influence of workplace factors as possible barriers or facilitators was highlighted. Embracing SMS often required challenging traditional professional role boundaries. Conclusion The integration of SMS into routine care is not an automatic outcome from training. A transformative learning process is often required to trigger the necessary mindset shift. Training should focus on how individual HCPs define and value SMS and how their work context (patient group and organisational constraints) influences this process. Proactively addressing potential contextual barriers may facilitate implementation. These findings could be applied to other types of training designed to shift attitudes amongst HCPs