"Talking on the Phone Is Very Cold"-Primary Health Care Nurses' Approach to Enabling Patient Participation in the Context of Chronic Diseases during the COVID-19 Pandemic

COVID-19; Chronic care; Patient participation; Primary health careCOVID-19; Atenció crònica; Participació del pacient; Atenció primària de salutCOVID-19; Atención crónica; Participación del paciente; Atención primariaStrengthening patient participation is considered a crucial element of primary health care (PHC) nurses' practice when working with chronically ill patients. The COVID-19 pandemic had extraordinary effects on PHC nursing routines and how chronically ill patients' could be involved in their own care. This study investigates the adaptation of Spanish PHC nurses' approaches to supporting the participation of patients living with chronic illness during the COVID-19 pandemic. To reach this goal, we interviewed 13 PHC nurses who practiced in PHC centers in Spain. The interviews were analyzed using thematic coding. Three themes emerged from the descriptions of the nurses: (1) High COVID-19-related workload, decreasing health promotion, and chronic care, (2) Emphasis on patients' and families' self-responsibility, (3) Expanded digital and telephone communication with fewer in-person consultations. Nurses felt especially challenged to uphold the support for vulnerable groups, such as older people or patients without family support. Future research should focus on how the participation of the most vulnerable chronic patients can be supported in the context of the growing relevance of remote care.This research was funded by the Stiftung Wohlfahrtspflege NRW (Public Welfare Foundation NRW) in the frame of funds for cross-sectional analyses regarding the subject of “Gesundheitskompetenz und Selbstmanagementförderung im Lebenslauf—Bedeutung im Kontext nutzerorientierter Versorgungsmodele (förges Q)” (Promotion of health literacy and self-management in the lifecourse—meanings in the context of user-oriented care models) (Ref.: SW-620 6852–6856) within the research network “Nutzerorientierte Versorgung: Förderung der Gesundheitskompetenz und des Selbstmanagements bei chronischer Krankheit und Pflegebedürftigkeit (förges)” (User-oriented care: Promotion of health literacy and self-management for chronic conditions and need of care)

“Talking on the Phone Is Very Cold” - Primary Health Care Nurses’ Approach to Enabling Patient Participation in the Context of Chronic Diseases during the COVID-19 Pandemic

Strengthening patient participation is considered a crucial element of primary health care (PHC) nurses’ practice when working with chronically ill patients. The COVID-19 pandemic had extraordinary effects on PHC nursing routines and how chronically ill patients’ could be involved in their own care. This study investigates the adaptation of Spanish PHC nurses’ approaches to supporting the participation of patients living with chronic illness during the COVID-19 pandemic. To reach this goal, we interviewed 13 PHC nurses who practiced in PHC centers in Spain. The interviews were analyzed using thematic coding. Three themes emerged from the descriptions of the nurses: (1) High COVID-19-related workload, decreasing health promotion, and chronic care, (2) Emphasis on patients’ and families’ self-responsibility, (3) Expanded digital and telephone communication with fewer in-person consultations. Nurses felt especially challenged to uphold the support for vulnerable groups, such as older people or patients without family support. Future research should focus on how the participation of the most vulnerable chronic patients can be supported in the context of the growing relevance of remote care

Complex multiple risk intervention topromote healthy behaviours in peoplebetween 45 to 75 years attended inprimary health care (EIRA study): study protocol for a hybrid trial

Background:Health promotion is a key process of current health systems. Primary Health Care (PHC) is the idealsetting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority ofthe adult population engages two or more risk behaviours, that is why a multiple intervention might be moreeffective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness andan implementation strategy of a complex multiple risk intervention to promote healthy behaviours in peoplebetween 45 to 75 years attended in PHC.Methods:This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing acomplex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. Thestudy focuses on people between 45 and 75 years who carry out two or more of the following unhealthybehaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level.The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in theroutine care of PHC practices according to the conceptual framework of the“5A’s”. It will have a maximum durationof 12 months and it will be carried out to three different levels (individual, group and community). Incremental costper quality-adjusted life year gained measured by the tariffs of the EuroQol-5D questionnaire will be estimated. Theimplementation strategy is based on the“Consolidated Framework for Implementation Research”, a set of discreteimplementation strategies and an evaluation framework. Discussion:EIRA study will determine the effectiveness and cost-effectiveness of a complex multiple riskintervention and will provide a better understanding of implementation processes of health promotioninterventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriersthat affect implementation of these interventions and to quantify the contextual factors that moderate theeffectiveness of implementation

Barriers to and enablers of the promotion of patient and family participation in primary healthcare nursing in Brazil, Germany and Spain: A qualitative study

Cuidador familiar; Educació del pacient; Participació del pacientCuidador familiar; Educación del paciente; Participación del pacienteFamily Caregiver; Patient education; Patient participationBackground: Most health systems are insufficiently prepared to promote the participation of chronically ill patients in their care. Strong primary health care (PHC) strengthens patients' resources and thus promotes their participation. The tasks of providing continuous care to people with chronic diseases and promoting self‐ management are the responsibility of PHC nurses. Recent research assessing enablers of or barriers to nurses' efforts to support patients' participation has mostly not considered the special situation of patients with chronic diseases or focused on the PHC setting. Objective: To investigate enablers of and barriers to PHC nurses' efforts to promote the participation of chronically ill patients in their care. Methods: We interviewed 34 practicing PHC nurses and 23 key informants with advanced knowledge of PHC nursing practice in Brazil, Germany and Spain. The data was analyzed using thematic coding. Results: We identified four categories of barriers and enablers. (1) Establishing bonds with patients: Interviewees emphasized that understanding patients' views and behaviours is important for PHC nurses. (2) Cooperation with relatives and families: Good relationships with families are fundamental, however conflicts within families could challenge PHC nurses efforts to strengthen participation. (3) Communication and cooperation within PHC teams: PHC nurses see Cooperative team structures as a potential enabler, while the dominance of a ‘biomedical’ approach to patient care is seen as a barrier. (4) Work environment: Interviewees agreed that increased workload is a barrier to patient participation. Discussion and Conclusions: Supporting patient participation should be acknowledged as an important responsibility for nurses by general practitioners and PHC planners. PHC nurses should be trained in communicative competence when discussing participation with chronically ill patients. Interprofessional education could strengthen other professionals' understanding of patient participation as a nursing task. Patient or Public Contribution: This study is part of a research project associated with the research network ‘forges: User‐oriented care: Promotion of health in the context of chronic diseases and care dependency’. The study's focus and provisional results were discussed continuously with partners in health and social care practice and presented to and discussed with the public at two conferences in which patient representatives, professionals and researchers participated

Reliability, validity and feasibility of the frail-vig index

The study aimed to assess the reliability of the scores, evidence of validity, and feasibility of the Frail-VIG index. A validation study mixing hospitalized and community-dwelling older people was designed. Intraclass correlation coefficient (ICC) was used to assess the inter-rater agreement and the reliability. The construct validity of the Frail-VIG index with respect to the Frailty Phenotype (FP) was evaluated by calculating the area under the receiver operating characteristic curve (AUC-ROC). Convergent validity with the Clinical Frailty Scale (CFS) was assessed using Pearson's correlation coefficients. The feasibility was evaluated by calculating the average time required to administer the Frail-VIG index and the percentage of unanswered responses. A sample of 527 older people (mean age of 81.61, 56.2% female) was included. The inter-rater agreement and test-retest reliability were very strong: 0.941 (95% CI, 0.890 to 0.969) and 0.976 (95% CI, 0.958 to 0.986), respectively. Results indicated adequate convergent validity of the Frail-VIG index with respect to the FP, AUC-ROC 0.704 (95% CI, 0.622 to 0.786), and a moderate to strong positive correlation between the Frail-VIG index and CFS (r = 0.635, 95% CI, 0.54 to 0.71). The Frail-VIG index administration required an average of 5.01 min, with only 0.34% of unanswered responses. The Frail-VIG index is a reliable, feasible, and valid instrument to assess the degree of frailty in hospitalized and community-dwelling older people

Research in primary care as an area of knowledge. SESPAS Report 2012

Atenció primària de la salut; Recerca; Medicina familiar i comunitàriaAtención primaria de la salud; Investigación; Medicina familiar y comunitariaPrimary health care; Research; Family medicineLa atención primaria de salud ofrece grandes oportunidades para la investigación. Constituye un área de conocimiento propio, que es necesario desarrollar para mejorar la calidad de sus servicios y la salud de los pacientes. Estas oportunidades son únicas para la investigación clínica de base poblacional, con un enfoque de promoción de la salud y de prevención de la enfermedad, ya sea primaria, secundaria o terciaria. Es prioritario investigar en el desarrollo del modelo biopsicosocial de atención, nuevos modelos de atención integrada y atención comunitaria. Cabe destacar la actividad y la estructura generada por la Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), que ha atraído a su alrededor gran parte de la actividad investigadora en atención primaria de salud en nuestro país. A pesar del esfuerzo de diversas instituciones y fundaciones, así como de unidades docentes y de investigación, el desarrollo de la investigación no ha alcanzado el volumen, la relevancia, la calidad y el impacto deseables. La presencia de los profesionales de atención primaria de salud en las estructuras de investigación sigue siendo escasa, y la inversión en proyectos y líneas de investigación propias es pobre. Para poder invertir esta situación se precisa una serie de medidas: consolidar estructuras organizativas de apoyo específicas, con adecuada dotación de personal y recursos económicos; facilitar que los profesionales puedan compatibilizar su labor clínica con una dedicación específica a la investigación, para que elaboren proyectos relevantes y consoliden líneas de investigación estables de contenidos acordes con el área de conocimiento propio, y que se apliquen a la mejora de la calidad y a la innovación de los servicios de atención primaria de salud.Primary care offers huge potential for research. This setting is an area of knowledge that must expand to improve the quality of its services and patients’ health. Population-based clinical studies with a focus on health promotion and primary, secondary and tertiary disease prevention offer unique research opportunities. Developing research in the biopsychosocial model of clinical practice and new models of integrated healthcare and community care is therefore a priority. The framework and activities carried out by the Research Network in Preventive Activities and Health Promotion have been instrumental in the development of research in primary care in Spain. Despite the efforts invested by various institutions, foundations, teaching and research departments in primary care research, the projected outputs in terms of volume, quality and impact have not been achieved. The involvement of primary care professionals in research platforms is insufficient, with scarce contribution toward investment in specific primary care research projects. To change the current status of research in primary care, a number of measures are required, namely, the consolidation of research organisms specific to primary care with adequate allocation of funding and staff, and the allocation of specific time for research to primary care professionals to enable them to produce significant projects and consolidate established research lines in their areas of expertise, with applications mainly in quality improvement and innovation of primary care services

Adaptación y validación de un cuestionario para evaluar las prácticas de autocuidado en población infantil sana residente en España

Altres ajuts: Departament de Salut (SLT006/17/00098) de la Generalitat de Catalunya per a la intensificació investigadora en el marc del Pla Estratègic de Recerca i Innovació en Salut (PERIS)Adaptar y validar el Child and Adolescent Self-Care Performance Questionnaire (CASPQ) al contexto de la población infantil sana de 8 a 12 años residente en España y evaluar sus propiedades métricas. Estudio de validación fundamentado en la Teoría Clásica de los Tests. Cuatro centros educativos participantes en el programa «Salut i Escola» de un centro de atención primaria de Barcelona (España). Un total de 498 alumnos y alumnas de educación primaria participaron en el estudio durante los primeros seis meses de 2016. Se realizó la adaptación cultural del cuestionario. Se evaluó el proceso de respuesta, la estructura factorial y se analizaron las relaciones de las puntuaciones del CASPQ con las del cuestionario KIDSCREEN-27. Asimismo, se evaluaron la consistencia interna y la reproducibilidad de las puntuaciones. Se obtuvieron 489 cuestionarios. El análisis factorial confirmatorio de su estructura teórica mostró un ajuste suficiente. Se observó una asociación positiva entre las puntuaciones del cuestionario y las del KIDSCREEN-27. La consistencia interna global fue satisfactoria; no obstante, la de cada factor fue marginal o moderada. La reproducibilidad de las puntuaciones fue óptima. El CASPQ adaptado a la población infantil sana de 8 a 12 años muestra unas propiedades métricas adecuadas y similares a las del cuestionario original. Por ello, es un instrumento útil para evaluar las prácticas de autocuidado y planificar intervenciones dirigidas a su promoción

Feasibility Study of an Educational Intervention to Improve Water Intake in Adolescent Soccer Players: A Two-Arm, Non-Randomized Controlled Cluster Trial

Futbol; Comportament; Promoció de la salut; Adolescent; Estat d’hidratació corporalFútbol; Comportamiento; Promoción de la salud; Adolescente; Estado de hidratación corporalSoccer; Behavior; Health promotion; Adolescent; Body hydration statusThis study aimed to assess the feasibility of an educational intervention on hydration behavior in adolescent soccer players. A pilot study of a two-arm, non-randomized controlled cluster trial was conducted. A total of 316 players aged 13-16 agreed to participate. The response variables were the players' participation in the intervention, their perception of the knowledge acquired, the usefulness and the overall assessment of the intervention. Hydration patterns and acquisition of knowledge on hydration behavior were also assessed. The intervention involved two elements: posters and a web app. A total of 259 adolescents completed the study (intervention group (IG) = 131; control group (CG) = 128). 80.6% of the players responded to the survey assessing the feasibility of the intervention. The mean number of correct answers regarding behavior was significantly higher in the IG (3.54; SD = 1.162) than in the CG (2.64; SD = 1.174) (p < 0.001). The water consumption pattern at all the clubs was ad libitum. Of the players, 10% did not drink any water at all during the game. In conclusion, this intervention has been shown to be feasible for implementation with adolescent soccer players. It suggests that hydration guidelines should be informed by personal factors and that ad libitum water consumption should be avoided