Background
Methods
Study design
Study population and recruitment
Data collection and processing
Interviews
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If yes, what strategies did you find helpful and why?
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If no, why not and what strategies would have been more helpful?
Survey
Data analysis
Interviews
Survey
Results
Participants
Trial | HCP completing the trial | HCP completing the survey | Response rate (%) | Profession % (n) | Mean age (years) | Female sex % (n) |
---|---|---|---|---|---|---|
Total (IG/CG) | Total (IG/CG)a | |||||
GE | 21 (10/11) | 21 (10/11) | 100 | GPs: 100 (21) | 54.9 (44–68) | 19.0 (4) |
NL | 33 (19/14) | 30 (17/13) | 90.9 | PNs: 83 (25) | 42.4 (22–61) | 96.7 (29) |
HCA: 17 (5) | ||||||
PL | 18 (9/9) | 13 (7/6) | 72.2 | GPs: 100 (13) | 47.6 (39–58) | 46.2 (6) |
4 missings | 4 missings | |||||
UK | 146 (16/130) | 61 (13/48) | 41.8 | GPs: 54 (33) | Not collected = 61 missings | Not collected = 61 missings |
PNs: 29 (18) | ||||||
HCA: 15 (9) | ||||||
Unknown: 2 (1) | ||||||
All | 218 (54/164) | 125 (47/78) | 57.3 | GPs: 54 (67) | 48.3 (22–68) | 31.2 (39) |
PNs: 34 (43) | 65 missings | 65 missings | ||||
HCA: 10 (14) | ||||||
Unknown: 1(1) |
Results related to determinants (research questions A1 and A2)
Determinants intended to be modified by the program | Relevance* | Modification** | |||
---|---|---|---|---|---|
Total | IG | CG | IG | ||
% (n) | % (n) | % (n) | % (n) | ||
GE | 1 Knowledge of HCP | 71.4 (15) | 80.0 (8) | 63.6 (7) | 100.0 (10) |
2 Routine | 52.3 (11) | 30.0 (3) | 72.7 (8) | 90.0 (9) | |
3 Availability of medication lists | 61.9 (13) | 40.0 (4) | 81.8 (9) | 80.0 (8) | |
4 Identification of the target group | 23.8 (5) | 40.0 (4) | 9.0 (1) | 90.0 (8) | |
5 Feasibility of checklists | 90.5 (19) | 90.0 (9) | 90.9 (10) | 80.0 (8) | |
6 Patients’ ability for self-management | 90.5 (19) | 90.0 (9) | 90.9 (10) | 80.0 (8) | |
7 Language barrier | 76.2 (16) | 70.0 (7) | 81.8 (9) | 70.0 (7) | |
8 Patients’ knowledge | 57.1 (12) | 60.0 (6) | 54.5 (6) | 90.0 (9) | |
9 Standardization of medication lists | 61.9 (13) | 60.0 (6) | 63.6 (7) | 70.0 (7) | |
Mean of all items GE | 65.1 (13.7) | 62.2 (6.2) | 67.6 (7.4) | 83.3 (8.2) | |
NL | 1 Apply motivational interviewing | 93.3 (28) | 100.0 (17) | 84.6 (11) | 100.0 (17) |
2 Giving good advice to patients | 96.7 (29) | 100.0 (17) | 92.3 (12) | 100.0 (17) | |
3 More attention for the motivation of the patient | 96.7 (29) | 100.0 (17) | 92.3 (12) | 100.0 (17) | |
4 PN gives lifestyle advice in an acceptable and feasible way | 93.3 (28) | 94.1 (16) | 92.3 (12) | 100.0 (17) | |
5 PN meets patients’ information needs | 93.3 (28) | 94.1 (16) | 92.3 (12) | 94.1 (16) | |
6 PN drafts feasible targets for patients | 96.7 (29) | 100.0 (17) | 92.3 (12) | 100.0 (17) | |
7 E-health support for self-management | 83.3 (25) | 94.1 (16) | 69.2 (9) | 88.2 (15) | |
Mean of all items NL | 93.3 (28) | 97.5 (16.6) | 87.9 (11.4) | 97.5 (16.6) | |
PL | 1 Availability of educational materials for recommendation 1 | 100.0 (13) | 100.0 (7) | 100.0 (6) | 28.6 (2) |
2 Availability of training for GPs | 69.2 (9) | 57.1 (4) | 83.3 (5) | 42.9 (3) | |
3 Labeling of medication records | 100.0 (13) | 100.0 (7) | 100.0 (6) | 100.0 (7) | |
4 Accessibility of mMRC scale | 100.0 (13) | 100.0 (7) | 100.0 (6) | 100.0 (7) | |
5 Accessibility of checklists for recommendation 2 | 92.3 (12) | 85.7 (6) | 100.0 (6) | 100.0 (7) | |
6 Availability of the recommendations | 100.0 (13) | 100.0 (7) | 100.0 (6) | 100.0 (7) | |
7 Availability of training for personnel on dyspnea assessment | 92.3 (12) | 85.7 (6) | 100.0 (6) | 71.4 (5) | |
8 Availability of educational materials for recommendation 3 | 100.0 (13) | 100.0 (7) | 100.0 (6) | 100.0 (7) | |
9 Availability of treatment plans | 92.3 (12) | 85.7 (6) | 100.0 (6) | 85.7 (6) | |
10 Accessibility of checklist for recommendation 3 | 92.3 (12) | 85.7 (6) | 100.0 (6) | 85.7 (6) | |
11 Availability of peak flow meters | 92.3 (12) | 85.7 (6) | 100.0 (6) | 85.7 (6) | |
12 Availability of demonstration inhalers | 100.0 (13) | 100.0 (7) | 100.0 (6) | 100.0 (7) | |
13 Availability of educational materials on use of inhaler devices | 100.0 (13) | 100.0 (7) | 100.0 (6) | 100.0 (7) | |
14 Training of GPs on inhaler devices | 100.0 (13) | 100.0 (7) | 100.0 (6) | 85.7 (6) | |
15 Presence of additional staff (educator) | 84.6 (11) | 71.4 (5) | 100.0 (6) | 71.4 (5) | |
Mean of all items PL | 94.4 (12.3) | 90.5 (6.3) | 98.9 (5.9) | 83.3 (5.9) | |
UK | 1 Skills of HCP to raise the issue of weight with patients | 45.9 (28) | 69.2 (9) | 39.6 (19) | 100.0 (13) |
2 Skills of HCP to measure waist circumference | 50.8 (31) | 53.8 (7) | 50.0 (24) | 92.3 (12) | |
3 Skills of HCP to assess patients’ willingness to change | 47.5 (29) | 61.5 (8) | 43.8 (21) | 84.6 (11) | |
4 Availability of resources to inform and motivate patients | 67.2 (41) | 84.6 (11) | 62.5 (30) | 100.0 (13) | |
5 Availability of prescriptive weight loss information | 83.6 (51) | 92.3 (12) | 81.3 (39) | 100.0 (13) | |
6 Work with HCP whom manage obese and overweight patients to improve their knowledge on diets | 66.7 (32) | 76.9 (10) | 45.8 (22) | 92.3 (12) | |
7 Availability of information about referral pathways | 59.0 (36) | 76.9 (10) | 54.2 (26) | 92.3 (12) | |
Mean of all items UK | 60.1 (35.4) | 73.6 (9.6) | 53.9 (25.9) | 94.5 (12.3) |
Number of determinants | GE | NL | PL | UK | All |
---|---|---|---|---|---|
Intended to be addressed | 9 | 7 | 15 | 7 | 38 |
Perceived as relevant % (n)a | 44 (4) | 100 (7) | 100 (15) | 43 (3) | 76 (29) |
Perceived as modified % (n)b | 100 (9) | 100 (7) | 87 (13) | 100 (7) | 95 (36) |
GE | PL | NW | UK | NL | All | |
---|---|---|---|---|---|---|
% (n) | % (n) | % (n) | % (n) | % (n) | % (n) | |
Number of determinants identified after program delivery | 32 | 8 | 24 | 10 | 15 | 89 |
Thereof identified before | 75 (24) | 75 (6) | 67 (16) | 100 (10) | 40 (6) | 70 (62) |
Thereof prioritized (i.e., judged to be relevant and potentially modifiable) | 69 (22) | 38 (3) | 29 (7) | 80 (8) | 0 | 45 (40) |
Thereof intended to be addressed by the program | 50 (16) | 38 (3) | 25 (6) | 80 (8) | 0 | 37 (33) |
Number of alternative strategies identified after program delivery | 15 | 11 | 5 | 22 | 12 | 65 |
Thereof identified before % (n) | 67 (10) | 18 (2) | 80 (4) | 46 (10) | 75 (9) | 54 (35) |
Thereof prioritized before (i.e., assessed as potentially effective and feasible, but not used in the final program) | 20 (3) | 18 (2) | 0 | 18 (4) | 33 (4) | 20 (13) |
Number and type of determinants not selected | ||||||
Patient factors | 4 | 1 | 3 | – | 1 | 9 |
Capacity for organizational change | 1 | – | 2 | – | 1 | 4 |
Incentives and resources | 4 | 2 | 2 | 2 | 4 | 13 |
Professional interactions | 1 | 1 | 1 | – | 3 | 6 |
Social, political, and legal factors | – | – | – | – | 2 | 2 |
Individual health care professional factors | 6 | 1 | 8 | – | 1 | 16 |
Not assigned to checklist | – | – | 2 | – | 3 | 5 |
Number and type of strategies not prioritized | ||||||
Intervention development and delivery | – | 6 | – | 3 | – | 9 |
Change service sites | 3 | – | 1 | 3 | 1 | 8 |
Provision of materials | 1 | – | 1 | 3 | 2 | 7 |
Share local knowledge | 2 | 1 | – | 2 | 1 | 6 |
Change record systems | 4 | – | – | 1 | – | 5 |
Training | 1 | – | 1 | 3 | – | 5 |
Ongoing support | 1 | 1 | – | 1 | 1 | 4 |
Adaptions on patient level | – | – | 2 | – | – | 2 |
Revise professional roles | – | – | – | 1 | 1 | 2 |
Funding | – | – | – | 1 | 1 | 2 |
Provision of evidence | – | – | – | – | 1 | 1 |
External feedback | – | 1 | – | – | – | 1 |
Results related to the use of strategies (research questions B1 and B2)
Country | Strategya (short term) | Use of the strategy in terms ofb | Adaptionc | Helpfulnessd | ||||
---|---|---|---|---|---|---|---|---|
Content | Frequency | Duration | Coverage | Total | ||||
GE (n = 10) | GE 1 | 100.0 | n.a. | n.a. | n.a. | 100.0 | n.a. | 60.0 |
GE 2 | 100.0 | n.a. | n.a. | n.a. | 100.0 | 0.0 | 60.0 | |
GE 3 | 30.0 | n.a. | n.a. | n.a. | 30.0 | 10.0 | 80.0 | |
GE 4 | 70.0 | n.a. | n.a. | n.a. | 70.0 | 10.0 | 60.0 | |
GE 5 | 40.0 | n.a. | n.a. | n.a. | 40.0 | 0.0 | 90.0 | |
GE 6 | 50.0 | n.a. | n.a. | n.a. | 50.0 | 10.0 | 50.0 | |
GE 7 | 50.0 | n.a. | n.a. | n.a. | 50.0 | 0.0 | 40.0 | |
GE 8 | 20.0 | n.a. | n.a. | n.a. | 20.0 | 10.0 | 50.0 | |
GE 9 | 50.0 | n.a. | n.a. | n.a. | 50.0 | 0.0 | 40.0 | |
Mean of all items GE | 56.7 | 5.0 | 58.9 | |||||
UK (n = 13) | UK 1 | 100.0 | n.a. | n.a. | n.a. | 100.0 | 23.1 | 84.6 |
UK 2 | 53.8 | 30.8 | n.a. | 30.8 | 38.4 | 0 | 53.8 | |
UK 3 | 84.6 | 69.2 | n.a. | 61.5 | 71.8 | 7.7 | 92.3 | |
UK 4 | 61.5 | n.a. | n.a. | 46.2 | 53.9 | 7.7 | 76.9 | |
UK 5 | 61.5 | 38.5 | n.a. | 61.5 | 53.8 | 7.7 | 84.6 | |
UK 6 | 69.2 | 15.4 | 0.0 | 38.5 | 41.0 | 7.7 | 76.9 | |
UK 7 | 30.8 | n.a. | n.a. | n.a. | 30.8 | 7.7 | 69.2 | |
Mean of all items UK | 55.7 | 8.8 | 76.9 | |||||
PL (n = 7) | PL1 | 71.4 | n.a. | n.a. | n.a. | 71.4 | n.a. | n.a. |
PL2 | n.a. | 57.1 | 28.6 | 14.3 | 33.3 | 0 | 28.6 | |
PL3 | n.a. | 28.6 | 14.3 | 14.3 | 19.0 | 28.6 | 28.6 | |
PL4 | n.a. | 28.6 | 42.9 | 71.4 | 47.6 | 28.6 | 42.9 | |
Mean of all items PL | 42.8 | 19.1 | 33.4 | |||||
NL (n = 17) | NL1 | 100.0 | n.a. | n.a. | n.a. | 100.0 | n.a. | 94.1 |
NL2 | 64.7 | n.a. | n.a. | n.a. | 64.7 | n.a. | 64.7 | |
NL3 | 17.6 | n.a. | n.a. | n.a. | 17.6 | n.a. | 17.6 | |
NL4 | 11.8 | n.a. | n.a. | 17.6 | 14.7 | 23.5 | 11.8 | |
NL5 | 5.9 | n.a. | n.a. | n.a. | 5.9 | 23.5 | 41.2 | |
NL6 | 5.9 | n.a. | n.a. | n.a. | 5.9 | n.a. | 0 | |
NL7 | 23.5 | n.a. | n.a. | n.a. | 23.5 | 47.1 | 23.5 | |
NL8 | 17.6 | n.a. | n.a. | n.a. | 17.6 | 35.3 | 11.8 | |
Mean of all items NL | 31.2 | 32.3 | 33.1 |