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Estudio primario

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La adherencia a la medicación en sobrevivientes de accidentes cerebrovasculares: una comparación cualitativa de adherers bajas y altas.

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Revista British journal of health psychology
Año 2011
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OBJETIVOS: El objetivo de este estudio fue investigar los factores que pueden explicar la varianza en la adherencia a la medicación en pacientes con accidente cerebrovascular. Diseño. Una comparación cualitativa de adherers altas y bajas a la medicación. MÉTODOS: Trece participantes, seleccionados de entre una muestra de 180 sobrevivientes de accidentes cerebrovasculares, ya que auto-reportaron la menor adherencia a los regímenes de medicación, fueron comparados con 13 informes adherencia máxima. Todos participaron en entrevistas cualitativas semiestructuradas. RESULTADOS: El análisis temático revelaron que las personas con falta de adherencia a la medicación informaron tanto intencionales como no intencionales no adhesión. Dos temas principales: la importancia de la estabilidad de una rutina de medicamentos y las creencias sobre la medicación y el tratamiento. Altas adherers informaron recordar tomar su medicación y buscar el apoyo de profesionales de la salud tanto de la familia y. También tenían una comprensión realista de las consecuencias de la falta de adherencia, y creían que su medicina hizo que más bien que mal. Bajo adherers informaron olvidar su medicación, a veces intencionalmente no tomar su medicación y recibir poco apoyo por parte del personal médico. Ellos no le gustaba tomar su medicación, tenía un conocimiento limitado acerca de la razón de la medicación o las intenciones, a menudo cuestionado sus beneficios. CONCLUSIONES: Nuestros resultados sugieren que la medicación apropiada y creencias enfermedad junto con una rutina de medicamentos estables son útiles para lograr una óptima adherencia a la medicación en pacientes con accidente cerebrovascular. Las intervenciones diseñadas para centrarse tanto en la adherencia intencional y no intencional, pueden ayudar a maximizar la adherencia a la medicación en pacientes con accidente cerebrovascular.

Estudio primario

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What influences physical activity in people with heart failure?: a qualitative study.

Revista International journal of nursing studies
Año 2011
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BACKGROUND: Research has highlighted the benefits of physical activity for people with stable heart failure in improving morbidity and quality of life. However, adherence to exercise among this patient group is low. Barriers and enablers to sustained physical activity for individuals with heart failure have been little investigated. OBJECTIVES: To explore reasons why people with heart failure do and do not engage in regular physical activity. DESIGN: A qualitative, interview-based investigation. SETTINGS: Three heart failure clinics held at hospitals in the UK. PARTICIPANTS: Purposive sampling was adopted to provide maximum variation in terms of gender, age, heart failure duration and severity, and current activity levels. Twenty two patients (7=female) were interviewed, aged between 53 and 82 years. METHODS: Semi-structured interviews were conducted via telephone. These were recorded and transcribed verbatim. Framework analysis was applied to collected data. RESULTS: Interviewees' narratives suggested that adopting positive health behaviours was complex, affected by internal and external factors. This was reflected in the four themes identified during analysis: fluctuating health; mental outlook; others' expectations; environmental influences. Failure to exercise arose because of symptoms, co-morbidities, poor sense of self as active and/or lack of perceived benefit. Likewise, encouragement from others and inclement weather affected exercising. CONCLUSIONS: Areas identified during interviews as influencing activity levels relate to those commonly found in behavioural change theories, namely perceived costs and benefits, self-efficacy and social support. These are concepts that practitioners may consider when devising interventions to assist patients with heart failure in undertaking and maintaining regular exercise patterns.

Estudio primario

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Aphasia friendly written health information: content and design characteristics.

Revista International journal of speech-language pathology
Año 2011
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People with aphasia need communicatively accessible written health information. Healthcare providers require knowledge of how to develop printed education materials (PEMs) in formats that people with aphasia prefer and can read. This study aimed to explore formatting characteristics considered to be barriers and facilitators to reading PEMs. Semi-structured in-depth interviews were conducted with 40 adults with aphasia who were selected using maximum variation sampling across aphasia severity, reading ability, and time post-stroke. Participants were shown stroke and aphasia PEMs obtained from the recruiting stroke services, asked to rank them from most liked to least liked, and comment on factors that made the PEMs easier and harder to read. The majority of participants ranked the aphasia friendly stroke (56.4%, n = 22) and aphasia (87.2%, n = 34) PEMs as most liked. Forty-five facilitator and 46 barrier codes were identified using qualitative content analysis and grouped into two categories; (1) content characteristics and (2) design characteristics. Findings support many of the recommendations found within the literature for developing best practice PEMs and accessible information for other patient groups. Routine consideration of the facilitators and barriers identified will contribute to making written information more accessible to people with aphasia.

Estudio primario

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An exploration of lifestyle beliefs and lifestyle behaviour following stroke: findings from a focus group study of patients and family members.

Revista BMC family practice
Año 2010
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Este artículo está incluido en 1 Revisión sistemática Revisiones sistemáticas (1 referencia)

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BACKGROUND: Stroke is a major cause of disability and family disruption and carries a high risk of recurrence. Lifestyle factors that increase the risk of recurrence include smoking, unhealthy diet, excessive alcohol consumption and physical inactivity. Guidelines recommend that secondary prevention interventions, which include the active provision of lifestyle information, should be initiated in hospital, and continued by community-based healthcare professionals (HCPs) following discharge. However, stroke patients report receiving little/no lifestyle information.There is a limited evidence-base to guide the development and delivery of effective secondary prevention lifestyle interventions in the stroke field. This study, which was underpinned by the Theory of Planned Behaviour, sought to explore the beliefs and perceptions of patients and family members regarding the provision of lifestyle information following stroke. We also explored the influence of beliefs and attitudes on behaviour. We believe that an understanding of these issues is required to inform the content and delivery of effective secondary prevention lifestyle interventions. METHODS: We used purposive sampling to recruit participants through voluntary sector organizations (29 patients, including 7 with aphasia; 20 family members). Using focus group methods, data were collected in four regions of Scotland (8 group discussions) and were analysed thematically. RESULTS: Although many participants initially reported receiving no lifestyle information, further exploration revealed that most had received written information. However, it was often provided when people were not receptive, there was no verbal reinforcement, and family members were rarely involved, even when the patient had aphasia. Participants believed that information and advice regarding healthy lifestyle behaviour was often confusing and contradictory and that this influenced their behavioural intentions. Family members and peers exerted both positive and negative influences on behavioural patterns. The influence of HCPs was rarely mentioned. Participants' sense of control over lifestyle issues was influenced by the effects of stroke (e.g. depression, reduced mobility) and access to appropriate resources. CONCLUSIONS: For secondary prevention interventions to be effective, HCPs must understand psychological processes and influences, and use appropriate behaviour change theories to inform their content and delivery. Primary care professionals have a key role to play in the delivery of lifestyle interventions.

Estudio primario

No clasificado

Overcoming barriers to engaging socio-economically disadvantaged populations in CHD primary prevention: a qualitative study.

Revista BMC public health
Año 2010
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Este artículo está incluido en 1 Revisión sistemática Revisiones sistemáticas (1 referencia)

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BACKGROUND: Preventative medicine has become increasingly important in efforts to reduce the burden of chronic disease in industrialised countries. However, interventions that fail to recruit socio-economically representative samples may widen existing health inequalities. This paper explores the barriers and facilitators to engaging a socio-economically disadvantaged (SED) population in primary prevention for coronary heart disease (CHD). METHODS: The primary prevention element of Have a Heart Paisley (HaHP) offered risk screening to all eligible individuals. The programme employed two approaches to engaging with the community: a) a social marketing campaign and b) a community development project adopting primarily face-to-face canvassing. Individuals living in areas of SED were under-recruited via the social marketing approach, but successfully recruited via face-to-face canvassing. This paper reports on focus group discussions with participants, exploring their perceptions about and experiences of both approaches. RESULTS: Various reasons were identified for low uptake of risk screening amongst individuals living in areas of high SED in response to the social marketing campaign and a number of ways in which the face-to-face canvassing approach overcame these barriers were identified. These have been categorised into four main themes: (1) processes of engagement; (2) issues of understanding; (3) design of the screening service and (4) the priority accorded to screening. The most immediate barriers to recruitment were the invitation letter, which often failed to reach its target, and the general distrust of postal correspondence. In contrast, participants were positive about the face-to-face canvassing approach. Participants expressed a lack of knowledge and understanding about CHD and their risk of developing it and felt there was a lack of clarity in the information provided in the mailing in terms of the process and value of screening. In contrast, direct face-to-face contact meant that outreach workers could explain what to expect. Participants felt that the procedure for uptake of screening was demanding and inflexible, but that the drop-in sessions employed by the community development project had a major impact on recruitment and retention. CONCLUSION: Socio-economically disadvantaged individuals can be hard-to-reach; engagement requires strategies tailored to the needs of the target population rather than a population-wide approach.

Estudio primario

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Communication and self-management education at nurse-led COPD clinics in primary health care.

Revista Patient education and counseling
Año 2009
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OBJECTIVE: The aim of the study was to explore the structure, content in communication and self-management education in patients' first consultations at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary healthcare. METHOD: Thirty consultations performed by seven registered nurses were videotaped; structure and content in the consultation was analyzed using Pendleton's Consultation Map. Nurses' self-management education was assessed from the content of the conversation: whether important and relevant information and self-management education was given, and how investigations were performed. RESULTS: Each consultation lasted for a mean time of 37.53 min. Communication about reasons for consultations concerned mainly medical and physical problems and to a certain extent patients' perceptions. Teaching about self-management and smoking cessation was of an informative nature. Two consultations ended with shared understanding, and none of the patients received an individual treatment-plan. CONCLUSION: Nurses rarely planned the consultations on an individual basis and rarely used motivational dialogue in self-management education and in smoking cessation. PRACTICE IMPLICATIONS: The findings could be used to help nurses to reflect on how to improve the structure of the visit, self-management education, smoking cessation and patient communication.

Estudio primario

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Transition from specialist to primary diabetes care: a qualitative study of perspectives of primary care physicians.

Revista BMC family practice
Año 2009
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Este artículo está incluido en 1 Revisión sistemática Revisiones sistemáticas (1 referencia)

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BACKGROUND: The growing prevalence of diabetes and heightened awareness of the benefits of early and intensive disease management have increased service demands and expectations not only of primary care physicians but also of diabetes specialists. While research has addressed issues related to referral into specialist care, much less has been published about the transition from diabetes specialists back to primary care. Understanding the concerns of family physicians related to discharge of diabetes care from specialist centers can support the development of strategies that facilitate this transition and result in broader access to limited specialist services. This study was undertaken to explore primary care physician (PCP) perspectives and concerns related to reassuming responsibility for diabetes care after referral to a specialized diabetes center. METHODS: Qualitative data were collected through three focus groups. Sessions were audio-taped and transcribed verbatim. Data were coded and sorted with themes identified using a constant comparison method. The study was undertaken through the regional academic referral center for adult diabetes care in Ottawa, Canada. Participants included 22 primary care physicians representing a variety of referral frequencies, practice types and settings. RESULTS: Participants described facilitators and barriers to successful transition of diabetes care at the provider, patient and systems level. Major facilitators included clear communication of a detailed, structured plan of care, ongoing access to specialist services for advice or re-referral, continuing education and mentoring for PCPs. Identified provider barriers were gaps in PCP knowledge and confidence related to diabetes treatment, excessive workload and competing time demands. Systems deterrents included reimbursement policies for health professionals and inadequate funding for diabetes medications and supplies. At the PCP-patient interface, insufficient patient confidence or trust in PCP's ability to manage diabetes, poor motivation and "non-compliance" emerged as potential patient barriers to transition. Incongruence between PCP attitudes and expectations related to diabetes self-management and those of patients who had attended a multidisciplinary specialist center was also observed. CONCLUSION: This study underlines the breadth of PCP concerns related to transition of diabetes care and the importance of this topic to them. While tools that promote timely information flow and care planning are cornerstones to successful transition, and may be sufficient for some practitioners, appropriately resourced decision support and education strategies should also be available to enhance PCP capacity and readiness to resume diabetes care after referral to a specialist center. Characteristics of the patient-care provider relationship that impact discharge were identified and are worthy of further research.

Estudio primario

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Perceptions of a service redesign by adults living with type 2 diabetes.

Revista Journal of advanced nursing
Año 2009
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Este artículo está incluido en 3 Revisiones sistemáticas Revisiones sistemáticas (3 referencias)

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AIM: This article is a report of a study conducted to explore the perceptions of adults with type 2 diabetes towards the service redesign. BACKGROUND: Diabetes is reaching epidemic proportions and the management of this chronic illness is changing in response to this challenge. In the United Kingdom, there is ongoing restructuring of healthcare services for people with chronic illnesses to ensure that their general health and clinical needs are met predominantly in primary care. METHOD: An explorative qualitative approach was used. Eight focus groups were conducted with 35 people with type 2 diabetes in one urban location between 2003 and 2004. Five focus groups were conducted with people who had recently experienced the restructured service and three groups with people who had up to 2 years' experience of the new service. Concurrent data collection and thematic analysis were conducted by three researchers and credibility and verification sought by feedback to participants. FINDINGS: Five main themes were identified: impact of living with diabetes; understanding diabetes; drivers for organizational change; care in context and individual concerns. Participants identified issues for ongoing development of the service. CONCLUSION: People with type 2 diabetes appreciate their care management within the primary care setting where there has been investment in staff to deliver this care. Healthcare resources are required to support the development of staff and the necessary infrastructure to undertake management in primary care. Policy makers need to address the balance of resources between primary and secondary care.

Estudio primario

No clasificado

Factores que inhiben o promueven la utilización de la teleasistencia en la enfermedad pulmonar crónica comprensión.

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Autores Mair FS , Hiscock J , Beaton SC
Revista Chronic illness
Año 2008
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Este artículo está incluido en 4 Revisiones sistemáticas Revisiones sistemáticas (4 referencias)

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OBJETIVOS: Para llevar a cabo una evaluación del proceso de un ensayo controlado aleatorio (ECA) de teleasistencia domiciliaria para el tratamiento de las exacerbaciones agudas de la enfermedad pulmonar obstructiva crónica (EPOC), utilizando el modelo de proceso de normalización (NPM) como un marco explicativo. MÉTODOS: entrevistas semi-estructuradas se llevaron a cabo con los pacientes (n = 9) y enfermeros (n = 11) que participan en un ECA. Se utilizó un enfoque de marco al análisis de datos. RESULTADOS: El servicio de teleasistencia no proporcionó una ventaja de interacción para las enfermeras que prestan este servicio y no encajaba con las opiniones de las enfermeras de la utilización más adecuada o preferida de sus habilidades. Parecía poco probable que se normalizó en el marco de la prestación de la asistencia sanitaria ordinaria El servicio de teleasistencia, ya que el equipo de enfermería carecía de la confianza de que era una forma segura de proporcionar asistencia sanitaria en este contexto y que no fue percibida como la mejora de la eficiencia. DISCUSIÓN: La NGP asigna efectivamente a los hallazgos del estudio y explicó los factores que inhibieron la entrega de rutina de los servicios de la EPOC mediante la teleasistencia.

Estudio primario

No clasificado

Transforming clinical practice amongst community nurses: mentoring for COPD patient self-management.

Revista Journal of clinical nursing
Año 2008
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Este artículo está incluido en 1 Revisión sistemática Revisiones sistemáticas (1 referencia)

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AIMS AND OBJECTIVES: To report on the process of transforming clinical practice amongst community nurses through a mentoring programme implemented to support self-management amongst community-based sufferers of chronic obstructive pulmonary disease. BACKGROUND: The increasing incidence of and health burden from, chronic diseases has led to the emergence of more proactive, integrated chronic disease management approaches across the acute and primary care sectors. An important part of these approaches is the direct involvement of patients in their own care. Despite some difficulties with comparing the benefits of chronic disease self-management programmes, many evaluations report some benefit and all highlight the importance of health professionals in supporting self-management behaviours. In the primary care sector, community nurses are ideally situated to support these behaviours, but to do this effectively transformation of nursing practice must occur. DESIGN: Qualitative, longitudinal study informed by action research methods and involving monthly group discussions with community nurse mentors. METHODS: Community nurses from four community health centres in Tasmania were trained in motivational interviewing techniques to promote self-management amongst chronic obstructive pulmonary disease patients. Nurses' mentoring experiences were monitored during group discussions and subjected to thematic analysis. RESULTS: The paper reports the findings of the first 12 months of the project. In this phase, nurses experienced a transformation in their constructions of chronic obstructive pulmonary disease and their clinical practice. This involved a shift from a fatalistic, prescriptive, biomedical approach to a primary healthcare approach characterised by empathy, consultation, facilitation and a holistic focus. CONCLUSIONS: Community nurses face challenges in supporting chronic disease self-management. These challenges can be overcome and a transformation in clinical practice instilled. RELEVANCE TO CLINICAL PRACTICE: This study highlights that it is possible to support community nurses to take a lead role in the ongoing management of chronic disease in the community.