Book reviews

Teaching/Communication/Extension/Profession,

Reusable learning objects in healthcare education

This chapter will review the definition, development and characteristics of reusable learning objects (RLOs) and outline examples of how these resources are meeting the challenges of interprofessional learning. It will discuss the ways in which pedagogy is developed and expressed within RLOs and how this may impact on interprofessionality

Case studies of creating reusable inter professional e-learning objects

Reusable learning objects can play an important part in enhancing interprofessional learning. They provide flexible support to students of health care and provide an opportunity during the creation process, for interprofessional educators to share knowledge and understand more about each other’s roles. When creating learning objects, a development and evaluation framework including technical expertise and quality control at critical stages is important, however it is the interprofessional community brought together at workshops at the start of the development cycle and the underlying pedagogical design principles that ensure the materials are fit for purpose and guarantee reuse across professional groups

National evaluation of Partnerships for Older People Projects

Executive Summary The Partnership for Older People Projects (POPP) were funded by the Department of Health to develop services for older people, aimed at promoting their health, well-being and independence and preventing or delaying their need for higher intensity or institutional care. The evaluation found that a wide range of projects resulted in improved quality of life for participants and considerable savings, as well as better local working relationships. • Twenty-nine local authorities were involved as pilot sites, working with health and voluntary sector partners to develop services, with funding of £60m • Those projects developed ranged from low level services, such as lunch-clubs, to more formal preventive initiatives, such as hospital discharge and rapid response services • Over a quarter of a million people (264,637) used one or more of these services • The reduction in hospital emergency bed days resulted in considerable savings, to the extent that for every extra £1 spent on the POPP services, there has been approximately a £1.20 additional benefit in savings on emergency bed days. This is the headline estimate drawn from a statistically valid range of £0.80 to £1.60 saving on emergency bed days for every extra £1 spent on the projects. • Overnight hospital stays were seemingly reduced by 47% and use of Accident & Emergency departments by 29%. Reductions were also seen in physiotherapy/occupational therapy and clinic or outpatient appointments with a total cost reduction of £2,166 per person • A practical example of what works is pro-active case coordination services, where visits to A&E departments fell by 60%, hospital overnight stays were reduced by 48%, phone calls to GPs fell by 28%, visits to practice nurses reduced by 25% and GP appointments reduced by 10% • Efficiency gains in health service use appear to have been achieved without any adverse impact on the use of social care resources • The overwhelming majority of the POPP projects have been sustained, with only 3% being closed – either because they did not deliver the intended outcomes or because local strategic priorities had changed • PCTs have contributed to the sustainability of the POPP projects within all 29 pilot sites. Moreover, within almost half of the sites, one or more of the projects are being entirely sustained through PCT funding – a total of 20% of POPP projects. There are a further 14% of projects for which PCTs are providing at least half of the necessary ongoing funding • POPP services appear to have improved users’ quality of life, varying with the nature of individual projects; those providing services to individuals with complex needs were particularly successful, but low-level preventive projects also had an impact • All local projects involved older people in their design and management, although to varying degrees, including as members of steering or programme boards, in staff recruitment panels, as volunteers or in the evaluation • Improved relationships with health agencies and the voluntary sector in the locality were generally reported as a result of partnership working, although there were some difficulties securing the involvement of GP

Behavioural intervention to increase physical activity in adults with coronary heart disease in Jordan

Background: Patients with coronary heart disease often do not follow prescribed physical activity recommendations. The aim of this study was to assess the efficacy of a behavioural intervention to increase physical activity in patients with coronary heart disease not attending structured cardiac rehabilitation programmes. Methods: Parallel randomised controlled trial comparing 6-month multi-component behavioural change intervention (n = 71) with usual care (n = 85) was conducted in two hospitals in Jordan, Middle East. Intervention included one face-to-face individualised consultation, 6 telephone support calls (for goal-setting, feedback and self monitoring) and 18 reminder text messages. Patients were randomly allocated to the two groups by opening opaque sealed sequence envelopes. The patients and the researcher who provided the intervention and assessed the outcomes were not blinded. Outcomes were assessed at baseline and 6 months. Primary outcome was physical activity level, secondary outcomes were blood pressure, body mass index, exercise self-efficacy for exercise and health-related quality of life. Results: Intervention and control groups were comparable at baseline. Moderate physical activity significantly increased in the intervention group compared with control group (mean change (SD) of frequency: 0.23 (0.87) days/week versus -.06 (0.40); duration: 15.53 (90.15) minutes/week versus −3.67 (22.60) minutes/week; intensity: 31.05 (105.98) Metabolic equivalents (METs) versus 14.68 (90.40) METs). Effect size was 0.03 for moderate PA frequency, 0.02 for moderate PA duration and 0.01 for moderate PA intensity. Walking significantly increased in the intervention group compared with control group (mean change (SD) of frequency: 3.15 (2.75) days/week versus 0.37 (1.83) days/week; duration: 150.90 (124.47) minutes/week versus 24.05 (195.93) minutes/week; intensity: 495. 12 (413.74) METs versus 14.62 (265.06) METs). Effect size was 0.36 for walking frequency, 0.05 for walking duration, 0.32 for walking intensity and 0.29 for total PA intensity. Intervention participants had significantly lower blood pressure, lower body mass index, greater exercise self-efficacy and better health related quality of life at 6 months compared with controls. Conclusions: Multi-component behavioural intervention increases physical activity, and improves body composition, physiological and psychological outcomes in CHD patients not attending structured rehabilitation programmes. Trial registration: Current Controlled Trials retrospectively registered in 21-03-2012. ISRCTN4857059

The effectiveness of IMB-model based diabetes self-management education with type 2 diabetes patients in Jordan: clinical trial protocol

Abstract for AADE Annual Meeting conference: Background: According to the World Health Organization in 2014, 9% of adults over 18 years old are diagnosed with diabetes and more than 1.5 million deaths occur directly by diabetes in low and middle-income countries. Ajlouni et al (2008) estimated that approximately one million people in Jordan have been diagnosed with type 2 diabetes; a figure that is increasing. To prevent diabetes microvascular and macro vascular complications, increased efforts and attention need to be directed towards improving glycaemic levels and improving metabolic outcomes through appropriate glycaemic management and this may be best achieved through educating patients in self-management of diabetes. Barriers in diabetes self-management behaviours were found to be consistent with Information-Motivation-Behavioural skills (IMB) Model of behavioural change. 2- Aim: to examine the effects of IMB Model-based Diabetes Self-Management Educational (DSME) intervention on three self-management activities: patients’ eating habits, physical activity and medications management, in patients who attend the (NCDEG). 3- Research protocol and methods: A two group trial with randomised allocation of 230 participants on 1:1 average for both groups. Intervention group will receive the educational intervention. Control group will receive usual clinical care and referral to diabetes educational consultation if required. This study will implement an individualised DSME program based on Information-Motivation-Behavioural (IMB) skills theory. IMB behavioural change theory assumption proposes that health-related behaviour information, motivation and behavioural skills are primary determinants of promoting health behaviour. Researcher will use a validated DSME toolkit and will be delivered using motivational interviewing techniques through two face-to-face sessions (one at the beginning and one at the end) and several phone calls intervention for each participant during a period of 3 months from participation. Both groups will be assessed at 2 follow-up times (after 3 months and 6 months) for self-management knowledge, motivation, behavioural skills, diabetes level (HbA1c), blood pressure and weight from baseline assessment (time of participation). After delivering the intervention to participants in the intervention group immediately (after 3 month), a purposive sampling approach will be used to choose 15 participants for an interview to ask them to evaluate the process of implementing of the educational intervention. 4- Implications for practice/research: This clinical trial will make a knowledge contribution about conceptualizing behavioural change techniques as well as individually and culturally tailored needs, within self-management educational intervention for patients with DM. Moreover, this trial designed on three main operations: assessing, implementation and evaluation. Competently, each operation is constructed on IMB model elements, which will provide a comprehensive understanding of how Jordanian patients’ Knowledge, Motivation, Behavioural skills and metabolic outcomes changes overtime, in tandem with performing self-management behaviours over three main points of time, pre-and-post intervention and post follow up

Perceived Facilitators and Barriers to Nigerian Nurses’ Engagement in Health Promoting Behaviors: A Socio-Ecological Model Approach

Nurses make up the single largest healthcare professional group in the Nigerian healthcare system. As frontline healthcare providers, they promote healthy lifestyles to patients and families. However, the determinants of Nigerian nurses’ personal health promoting behaviors (HPBs) remain unknown. Utilizing the socio-ecological model (SEM) approach, this study aimed to explore the perceived facilitators and barriers to Nigerian nurses’ engagement in HPBs. HPBs were operationalized to comprise of healthy dietary behaviors, engagement in physical activity, low-risk alcohol consumption, and non-smoking behaviors. Our study was carried out in a large sub-urban tertiary health facility in Nigeria. Data collection was via face-to-face semi-structured interviews and participants were registered nurses (n = 18). Interview data were transcribed verbatim and analyzed thematically to produce nine themes that were mapped onto corresponding levels of influence on the SEM. Findings show that in Nigeria, nurses perceive there to be a lack of organizational and policy level initiatives and interventions to facilitate their engagement in HPBs. The determinants of Nigerian nurses’ HPBs span across all five levels of the SEM. Nurses perceived more barriers to healthy lifestyle behaviors than facilitators. Engagement in healthy behaviors was heavily influenced by: societal and organizational infrastructure and perceived value for public health; job-related factors such as occupational stress, high workload, lack of protected breaks, and shift-work; cultural and religious beliefs; financial issues; and health-related knowledge. Organizations should provide facilities and services to support healthy lifestyle choices in Nigeria nurses. Government policies should prioritize the promotion of health through the workplace setting, by advocating the development, implementation, regulation, and monitoring of healthy lifestyle policies

Understanding technology adoption and use by healthcare proferssionals using models of technology acceptance and q-methodology

This study explores the use of models of technology acceptance (TAM and UTAUT) to understand technology adoption and use among healthcare professionals (HCPs) in the clinical area in Sub-Saharan Africa (SSA). Six themes were developed from both models and this generated forty-six specific statements that explore those barriers and motivators to e-health adoption and use in clinical practice. Each HCP ranked each of the statements based on how they agree or disagree with the statement in order to identify a shared perspective using Q-methodology; a methodology that explores subjectivity. Thirty-six HCPs working in the clinical area in SSA participated in the study. Analysis was done using a Q-methodology dedicated software called the PQMethod 2.35. Four perspectives identifying the aspect(s) of the model the HCPs identify to influence their use of technology in their clinical practice. Keywords: Q-methodology, Technology-Acceptance-Model (TAM), Unified-Theory-of-Acceptance-and-Use-of-Technology (UTAUT), Healthcare professional

Semantic web, reusable learning objects, personal learning networks in health: key pieces for digital health literacy

The knowledge existing in the World Wide Web is exponentially expanding, while continuous advancements in health sciences contribute to the creation of new knowledge. There are a lot of efforts trying to identify how the social connectivity can endorse patients' empowerment, while other studies look at the identification and the quality of online materials. However, emphasis has not been put on the big picture of connecting the existing resources with the patients “new habits” of learning through their own Personal Learning Networks. In this paper we propose a framework for empowering patients' digital health literacy adjusted to patients' currents needs by utilizing the contemporary way of learning through Personal Learning Networks, existing high quality learning resources and semantics technologies for interconnecting knowledge pieces. The framework based on the concept of knowledge maps for health as defined in this paper. Health Digital Literacy needs definitely further enhancement and the use of the proposed concept might lead to useful tools which enable use of understandable health trusted resources tailored to each person need

Exploring healthcare professionals adoption and use of Information and Communication Technology using Q-methodology and Models of Technology Acceptance

Background: Information and communication technologies (ICTs) and more specifically e-health are viewed as important tools within healthcare. They are used to support clinical activities such as interactions between healthcare professionals and patients, clinical self-development, patient education, routine clinical activities, and also have the potential to address many challenges affecting healthcare sectors globally. However, there is still limited information on how technologies are adopted and used within clinical practice by health professionals particularly in countries in Sub Saharan Africa (SSA). Methodology: This study used Q-methodology and models of technology acceptance (TAM and UTUAT) to explore the factors that influence ICT adoption among nurses and physicians in clinical practice in SSA. Thirty six participants from a tertiary hospital in SSA conducted Q-sorts of 46 statements relating to their interaction with technologies in their clinical practice. Results: Four factors; the patient-driven adopters, the task-driven adopters, the pragmatists and the e-health champions emerged after Q-analysis representing the distinct views of this group of healthcare professionals. Conclusion: The findings suggest different viewpoints to the adoption and use of e-health resources in clinical practise. These views may help understand how these health professionals make their choices when it comes to ICT in health care