A case study evaluation of implementation of a care pathway to support normal birth in one English birth centre: anticipated benefits and unintended consequences

Background: The policy drive for the UK National Health Service (NHS) has focused on the need for high quality services informed by evidence of best practice. The introduction of care pathways and protocols to standardise care and support implementation of evidence into practice has taken place across the NHS with limited evaluation of their impact. A multi-site case study evaluation was undertaken to assess the impact of use of care pathways and protocols on clinicians, service users and service delivery. One of the five sites was a midwifery-led Birth Centre, where an adapted version of the All Wales Clinical Pathway for Normal Birth had been implemented. Methods: The overarching framework was realistic evaluation. A case study design enabled the capture of data on use of the pathway in the clinical setting, use of multiple methods of data collection and opportunity to study and understand the experiences of clinicians and service users whose care was informed by the pathway. Women attending the Birth Centre were recruited at their 36 week antenatal visit. Episodes of care during labour were observed, following which the woman and the midwife who cared for her were interviewed about use of the pathway. Interviews were also held with other key stakeholders from the study site. Qualitative data were content analysed. Results: Observations were undertaken of four women during labour. Eighteen interviews were conducted with clinicians and women, including the women whose care was observed and the midwives who cared for them, senior midwifery managers and obstetricians. The implementation of the pathway resulted in a number of anticipated benefits, including increased midwifery confidence in skills to support normal birth and promotion of team working. There were also unintended consequences, including concerns about a lack of documentation of labour care and negative impact on working relationships with obstetric and other midwifery colleagues. Women were unaware their care was informed by a care pathway. Conclusion: Care pathways are complex interventions which generate a number of consequences for practice. Those considering introduction of pathways need to ensure all relevant stakeholders are engaged with this and develop robust evaluation strategies to accompany implementation

Determinants of providing smoking cessation care in five groups of healthcare professionals: A cross-sectional comparison

Public Health and primary carePrevention, Population and Disease management (PrePoD

Patient-reported feedback in daily dental practice; Patient-reported feedback promotes delivery of smoking cessation advice by dental professionals

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Experienced barriers and facilitators for integrating smoking cessation advice and support into daily dental practice. A short report

Item does not contain fulltextIn a controlled study, primary care dental professionals in the intervention group were encouraged to provide smoking cessation advice and support for all smoking patients with the help of a stage-based motivational protocol. The barriers and facilitators reported by the dental professionals on two occasions for their efforts to incorporate smoking cessation advice and counselling into daily patient care are summarised here. Lack of practice time and anticipated resistance on the part of the patient were cited as barriers by over 50% of the dental professionals in the first interviews. Periodontal treatment and the presence of smoking-related diseases were mentioned as the most important stimuli. The experience-based interviews revealed key points for the implementation of smoking cessation advice and support in daily dental care. Education on the associations between smoking and oral health, vocational training on motivational interviewing and the offering of structured advice protocols were identified as promising components for an implementation strategy to promote the involvement of dental professionals in the primary and secondary prevention of tobacco addiction

Efficacy of a Web-Based Computer-Tailored Smoking Prevention Intervention for Dutch Adolescents: A Randomized Controlled Trial

BACKGROUND: Preventing smoking initiation among adolescents is crucial to reducing tobacco-caused death and disease. This study focuses on the effectiveness of a Web-based computer-tailored smoking prevention intervention aimed at adolescents. OBJECTIVE: The intent of the study was to describe the intervention characteristics and to show the effectiveness and results of a randomized controlled trial. We hypothesized that the intervention would prevent smoking initiation among Dutch secondary school students aged 10-20 years and would have the largest smoking prevention effect among the age cohort of 14-16 years, as smoking uptake in that period is highest. METHODS: The intervention consisted of a questionnaire and fully automated computer-tailored feedback on intention to start smoking and motivational determinants. A total of 89 secondary schools were recruited via postal mail and randomized into either the computer-tailored intervention condition or the control condition. Participants had to complete a Web-based questionnaire at baseline and at 6-month follow-up. Data on smoking initiation were collected from 897 students from these schools. To identify intervention effects, multilevel logistic regression analyses were conducted using multiple imputation. RESULTS: Smoking initiation among students aged 10-20 years was borderline significantly lower in the experimental condition as compared to the control condition 6 months after baseline (OR 0.25, 95% CI 0.05-1.21, P=.09). Additional analyses of the data for the 14-16 year age group showed a significant effect, with 11.5% (24/209) of the students in the control condition reporting initiation compared to 5.7% (10/176) in the experimental condition (OR 0.22, 95% CI 0.05-1.02, P=.05). No moderation effects were found regarding gender and educational level. CONCLUSIONS: The findings of this study suggest that computer-tailored smoking prevention programs are a promising way of preventing smoking initiation among adolescents for at least 6 months, in particular among the age cohort of 14-16 years. Further research is needed to focus on long-term effects. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 77864351; http://www.controlled-trials.com/ISRCTN77864351 (Archived by WebCite at http://www.webcitation.org/6BSLKSTm5)

Campagnes over schade van roken zijn absoluut noodzakelijk

Campaigns about the health damage of smoking are absolutely necessary Results from the International Tobacco Control Policy Evaluation (ITC) Project show that Dutch smokers have less knowledge and awareness of the health damage of smoking compared to many other countries. This lack of knowledge and awareness of the health damage of smoking suggests that educational campaigns about the harm of smoking are very much needed in the Netherlands. The Ministry of Health has decided to end all educational campaigns about lifestyle, including smoking, which is a big mistake for effective tobacco control

Roken tijdens de zwangerschap: Trends in de periode 2001-2010

Doel. Het vaststellen van trends in de rookprevalentie onder zwangeren in de periode 2001-2010 en deze prevalentie relateren aan verschillen naar opleidingsniveau. Opzet. Beschrijvend; landelijke peilingen. Methode. In 2001, 2002, 2003, 2005, 2007 en 2010 werden via organisaties voor jeugdgezondheidszorg tijdens het periodiek gezondheidsonderzoek 28.720 vragenlijsten uitgedeeld aan moeders van kinderen ≤ 6 maanden. In totaal vulden 16.358 moeders (57%) de vragenlijst in. Resultaten. In de periode 2001-2010 is het aantal zwangeren dat rookte tijdens de zwangerschap gehalveerd (p < 0,001). In 2010 rookte 6,3% (95%-BI: 5,0-7,6) van de zwangeren dagelijks gedurende de hele zwangerschap. De rookprevalentie was het hoogst onder laagopgeleide zwangeren (13,8% in 2010; 95%-BI: 9,3-18,4) en het laagst onder hoogopgeleiden (2,4% in 2010; 95%-BI: 1,2-3,6). Tijdens de zwangerschap stopte 4% van de rokende vrouwen. De mediaan van het aantal gedurende de zwangerschap gerookte sigaretten was 5 per dag, tegenover 10 in het laatste half jaar vóór de zwangerschap. In 2001 was de het verschil in rookprevalentie tussen laag- en hoogopgeleide zwangeren 18,9%, in 2010 was dat 11,4%. Het verschil tussen middelbaar- en hoogopgeleide zwangeren was 6,5 en 5,4% in respectievelijk 2001 en 2010. Conclusie. Het percentage vrouwen dat gedurende de gehele zwangerschap rookt is tussen 2001 en 2010 gehalveerd, maar in 2010 rookte nog steeds 6,3% van de zwangeren. De rookprevalentie verschilde sterk tussen de opleidingsniveaus; de absolute verschillen veranderden niet gedurende het onderzoek