Contact Count Research Articles

Student nurses and midwives’ experiences of teaching and learning about ‘making every contact count’ health behaviour change programme: Descriptive qualitative study

Aim/objectiveTo explore nursing/midwifery students’ experiences of the teaching and learning of units one and two of a national undergraduate curriculum. BackgroundThe 'National Undergraduate Curriculum for Chronic Disease Prevention and Management: Making Every Contact Count’ (MECC) is part of Ireland’s national policy to support the prevention of chronic disease by promoting health behaviour change. This is being implemented as a programme within the Irish Health Service and is also being delivered, for the first time in undergraduate medical, allied health and nursing/midwifery education by tertiary education institutes. DesignQualitative descriptive research. MethodsPurposeful sampling was used to recruit participants (n = 17) from an undergraduate nursing/midwifery programme (n = 131) in one tertiary level Irish institution. Four focus groups were undertaken by two members of the research team, who were not part of the module teaching team. Each focus group was guided by a semi-structured interview guide, recorded and transcribed verbatim. Thematic data analysis was undertaken. ResultsThree main themes were identified, namely: Building foundations and making connections; Personal responsibility and the Ah factor: now I understand. ConclusionFindings indicate that students had a positive learning experience whilst also highlighting the students’ transition to lifelong learning encompassing adult learning and personal responsibility.

Behavioural change intervention for re-framing antenatal education to make “every contact count”

Abstract Issue A trusted source of information, the Baby Buddy webapp was co-created with parents and professionals to support the educational role of maternal healthcare providers. However, providers in Cyprus and elsewhere may not actively engage in antenatal education (AE) to make “every contact count”. Description of Problem The impact of Public Health digital interventions can be maximized when adopted in care pathways. To define barriers and enablers in behavioural terms complimentary methods were used guided by the COM-B model and related Theoretical Domains Framework: questionnaire survey (N = 49), focus group (N = 11) and round-table workshops (N = 40) among in-training and registered midwives. Results Beliefs about the benefits of AE are strong and viewed as a core function of the professional role, yet not supported nor prioritized by current practice. Many problematic areas relate to organizational context, such as weak interprofessional collaboration and lack of policy, protocols and resources. Medicalization of birth and socio-cultural norms are sustaining alienation of the midwife and conditions of power dynamics. AE was perceived as a means to enhance the autonomy of the profession but the phenomenon is complex and also pertains to perceptions and behaviours of service users. There are also issues with procedural knowledge and the need for skill development was identified. Lessons As a digital tool, Baby Buddy can enrich the user-provider exchange. However, AE beyond the formal setting of the antenatal class is perceived to be a ‘bad fit' with current practice. Training (e.g. skills strengthening), persuasion (e.g. reflection on professional identity), enablement (e.g. protocols) were identified as promising intervention functions. Modelling was identified as the most promising both in terms of “credible models” for the role itself as well as re-framing the concept of AE not as preparation for childbirth but in the context of shared decision-making. Key messages Barriers to being an effective antenatal educator are several, originating from an unsupportive system and wider socio-cultural norms of users and providers. In addition to designing a theory-driven research-informed intervention, the process functioned as a participatory learning experience through collective reflection.

HPRep: Quantifying Reproducibility in HiChIP and PLAC-Seq Datasets

HiChIP and PLAC-Seq are emerging technologies for studying genome-wide long-range chromatin interactions mediated by the protein of interest, enabling more sensitive and cost-efficient interrogation of protein-centric chromatin conformation. However, due to the unbalanced read distribution introduced by protein immunoprecipitation, existing reproducibility measures developed for Hi-C data are not appropriate for the analysis of HiChIP and PLAC-Seq data. Here, we present HPRep, a stratified and weighted correlation metric derived from normalized contact counts, to quantify reproducibility in HiChIP and PLAC-Seq data. We applied HPRep to multiple real datasets and demonstrate that HPRep outperforms existing reproducibility measures developed for Hi-C data. Specifically, we applied HPRep to H3K4me3 PLAC-Seq data from mouse embryonic stem cells and mouse brain tissues as well as H3K27ac HiChIP data from human lymphoblastoid cell line GM12878 and leukemia cell line K562, showing that HPRep can more clearly separate among pseudo-replicates, real replicates, and non-replicates. Furthermore, in an H3K4me3 PLAC-Seq dataset consisting of 11 samples from four human brain cell types, HPRep demonstrated the expected clustering of data that could not be achieved by existing methods developed for Hi-C data, highlighting the need for a reproducibility metric tailored to HiChIP and PLAC-Seq data.

Rare health conditions 50: ‘making every contact count’, myoclonus-dystonia, Eagle syndrome

The purpose of this series is to briefly highlight a range of rare health conditions. Rare health conditions are those that affect no more and usually fewer than 1 person in every 2000 and many healthcare assistants (HCAs) and nurses will encounter some of these conditions, given the high number of them. This 50th article will explore two of these conditions and the implications of ‘making every contact count’.

We are not out of the woods yet.

British Journal of Community NursingVol. 26, No. 9 While's WordsWe are not out of the woods yetAlison WhileAlison WhileEmeritus Professor of Community Nursing, King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care; Fellow, Queen's Nursing InstituteSearch for more papers by this authorAlison WhilePublished Online:2 Sep 2021https://doi.org/10.12968/bjcn.2021.26.9.466AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Academy of Medical Sciences. COVID-19: preparing for the future. Looking ahead to winter 2021/22 and beyond. 2021. https://tinyurl.com/yp83vf5a (accessed 5 August 2021) Google ScholarCoelho CM, Suttiwan P, Arato N, Zsido AN. On the nature of fear and anxiety triggered by COVID-19. Front Psychol. 2020; 11:581314. https://doi.org/10.3389/fpsyg.2020.581314 Crossref, Medline, Google ScholarLadds E, Rushforth A, Wieringa S et al. Persistent symptoms after Covid-19: qualitative study of 114 “long Covid” patients and draft quality principles for services. BMC Health Serv Res. 2020; 20:1144. https://doi.org/10.1186/s12913-020-06001-y Crossref, Medline, Google ScholarNational Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19. NG188. 2020. https://tinyurl.com/33dm7ddp (accessed 5 August 2021) Google ScholarPublic Health England. Making every contact count (MECC): consensus statement. 2016. https://tinyurl.com/jvhye6pc (accessed 5 August 2021) Google ScholarWhile A. Understanding vaccine hesitancy: the evidence. Br J Community Nurs. 2021a; 26(6):278–282. https://doi.org/10.12968/bjcn.2021.26.6.278 Link, Google ScholarWhile A. Evidence-based strategies to promote vaccine acceptance. Br J Community Nurs. 2021b; 26(7): 338–343. https://doi.org/10.12968/bjcn.2021.26.7.338 Google Scholar FiguresReferencesRelatedDetails 2 September 2021Volume 26Issue 9ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 2 September 2021 Published in print 2 September 2021 Information© MA Healthcare LimitedPDF download

The Impact of Financial Incentives on Service Engagement Among Adults Experiencing Homelessness and Mental Illness: A Pragmatic Trial Protocol

Background: People experiencing homelessness and mental illness have poorer service engagement and health-related outcomes compared to the general population. Financial incentives have been associated with increased service engagement, but evidence of effectiveness is limited. This protocol evaluates the acceptability and impact of financial incentives on service engagement among adults experiencing homelessness and mental illness in Toronto, Canada.Methods: This study protocol uses a pragmatic field trial design and mixed methods (ClinicalTrials.gov Identifier: NCT03770221). Study participants were recruited from a brief multidisciplinary case management program for adults experiencing homelessness and mental illness following hospital discharge, and were randomly assigned to usual care or a financial incentives arm offering $20 for each week they attended meetings with a program provider. The primary outcome of effectiveness is service engagement, measured by the count of participant-provider health-care contacts over the 6-month period post-randomization. Secondary health, health service use, quality of life, and housing outcomes were measured at baseline and at 6-month follow-up. Quantitative data will be analyzed using descriptive statistics and inferential modeling including Poisson regression and generalized estimating equations. A subset of study participants and other key informants participated in interviews, and program staff in focus groups, to explore experiences with and perspectives regarding financial incentives. Qualitative data will be rigorously coded and thematically analyzed.Conclusions: Findings from this study will contribute high quality evidence to an underdeveloped literature base on the effectiveness and acceptability of financial incentives to improve service engagement and health-related outcomes among adults experiencing homelessness and mental illness.

Evidence-based strategies to promote vaccine acceptance

Vaccine hesitancy can undermine a vaccination programme. Alison While looks at the strategies that can be used to promote vaccination uptake The success of a vaccination programme depends upon its coverage so that it provides herd immunity. Vaccine hesitancy has the potential to undermine a vaccine programme. Evidence suggests that some strategies are more effective in promoting vaccination uptake. Nurses should help in the promotion of vaccination uptake using evidence-based interventions and through ‘Making Every Contact Count’.

Evidence-based strategies to promote vaccine acceptance.

The success of a vaccination programme depends upon its coverage so that it provides herd immunity. Vaccine hesitancy has the potential to undermine a vaccine programme. Evidence suggests that some strategies are more effective in promoting vaccination uptake. Community nurses should help in the promotion of vaccination uptake using evidence-based interventions and through 'Making Every Contact Count'.

Complements or substitutes? Associations between volumes of care provided in the community and hospitals

Policymakers often suggest that expansion of care in community settings may ease increasing pressures on hospital services. Substitution may lower overall health system costs, but complementarity due to previously unidentified needs might raise them. We used new national data on community and primary medical care services in England to undertake system-level analyses of whether activity in the community acts as a complement or a substitute for activity provided in hospitals. We used two-way fixed effects regression to relate monthly counts of community care and primary medical care contacts to emergency department attendances, outpatient visits and admissions for 242 hospitals between November 2017 and September 2019. We then used national unit costs to estimate the effects of increasing community activity on overall system expenditure. The findings show community care contacts to be weak substitutes with all types of hospital activity and primary care contacts are weak substitutes for emergency hospital attendances and admissions. Our estimates ranged from 28 [95% CI 21, 45] to 517 [95% CI 291, 7265] community care contacts and from 34 [95% CI 17, 1283] to 1655 [95% CI − 1995, 70,145] GP appointments to reduce one hospital service visit. Primary care and planned hospital services are complements. Increases in community services and primary care activity are both associated with increased overall system expenditure of £34 [95% CI £156, £54] per visit for community care and £41 [95% CI £78, £74] per appointment in general practice. Expansion of community-based services may not generate reductions in hospital activity and expenditure.

GRiNCH: simultaneous smoothing and detection of topological units of genome organization from sparse chromatin contact count matrices with matrix factorization

High-throughput chromosome conformation capture assays, such as Hi-C, have shown that the genome is organized into organizational units such as topologically associating domains (TADs), which can impact gene regulatory processes. The sparsity of Hi-C matrices poses a challenge for reliable detection of these units. We present GRiNCH, a constrained matrix-factorization-based approach for simultaneous smoothing and discovery of TADs from sparse contact count matrices. GRiNCH shows superior performance against seven TAD-calling methods and three smoothing methods. GRiNCH is applicable to multiple platforms including SPRITE and HiChIP and can predict novel boundary factors with potential roles in genome organization.

Making every contact count: recognising obesity in paediatric and young adult cardiology.

With increased survival, children with CHD are reaching adulthood, however, obesity amongst this cohort is an emerging problem. Making every contact count encourages clinicians to utilise contact to elicit behaviour change. The aim of this work was to identify whether the body habitus of children classified as obese was addressed during a clinical review. A retrospective observational cohort study was completed using a cardiology outpatient dataset from 2010 to 2019. Inclusion criteria are all children with a body mass index z score classified as obese (≥ 2 z scores). Individual electronic patient records were reviewed to identify long-term anthropometric measures including (i) recognition of body habitus, (ii) prescription of physical activity or dietary intervention, and (iii) referral to a weight management programme or dietitian. From the cohort of 95 patients, 285 "obese clinical encounters" were identified, at the time of a cardiology clinic attendance. Of those, obesity was acknowledged in 25 clinic letters (8.65%), but only 8 used the correct terms "obese" or "obesity" (2.77%). Action to tackle obesity was recorded in 9.3% of cases with a direct referral to a dietitian being made on 3 occasions (1.04%). Body habitus is not being routinely addressed by cardiologists caring for paediatric and young adult cardiac patients. This study has recognised an alarmingly high incidence of missed opportunities to make every contact count, to manage those with obesity and associated risk factors.

Conversations of opportunity in diabetes care

Anne Phillips explores the ways in which diabetes consultations can be maximised to deliver the best effects for people living with diabetes and health professionals involved in their care Changes to diabetes care due to the COVID-19 pandemic have caused extra pressures for both people living with diabetes and the health professionals involved in their care. Virtual and remote consulting has caused many health professionals to experience stress and usual face-to-face conversations with people living with diabetes have changed in context, frequency and delivery. The nuances of non-verbal communication can be lost in virtual consultations, so it is vitally important that health professionals are aware of this and consider how to deliver consultation conversations to the best effect. It is imperative that every contact counts and every virtual and face-to-face consultation has meaning for the person living with diabetes to maximise the benefit for the individual and their circumstances.

Using Human-Centred Design to Develop Innovative Approaches to Improve Delivery of Brief Interventions in Primary Care: The HealthEir Project

IntroductionA priority action of the Healthy Ireland implementation plan is the Making Every Contact Count initiative (MECC) that aims to leverage the 30 million annual contacts with the healthcare system by asking every health worker to deliver brief interventions [1]. Benefits of brief interventions are well established, but GPs and pharmacists report challenges implementing them in practice including limited training, time, and poor fit with existing practices [2].AimThis government-funded Sláintecare project aimed to develop a novel method for brief interventions in pharmacy/GP settings using human-centred design.MethodsUser research was carried out with twelve users, including patients (3), GPs (4), and pharmacists (5) to identify their needs and priorities. Participants were recruited via email using a purposive sampling approach and completed semi-structured interviews with a design researcher. All participants invited agreed to participate. Next, a series of design sprints were completed with the research team. Design sprints allowed the team to integrate insights from user research with findings from a literature review/secondary research to understand pain points, identify stakeholder and user goals, and develop a list of initial design specifications. This list was used to develop and iterate a series of prototype solutions. Prototype service blueprints and wireframes (simple, two-dimensional schematic illustrations of the digital interface) were developed and tested with users before final versions were agreed.ResultsFindings from the interviews and literature review indicated (1) the main barrier to adoption was time, (2) patients and pharmacists were very positive about brief interventions with GPs more hesitant, (3) an approach blending technology with a consultation was preferred, and (4) having a specific list of local supports was important. Prototyping and evaluation processes identified that a simple interface with a clear indication of progress were preferred.A blended intervention combining a tablet-based digital tool and structured interaction was developed. The interface was designed to maximise use of patient and healthcare professional time, and mapped to the 5As approach (which is underpinned by principles of motivational interviewing, shared-decision making, and readiness to change frameworks). The HealthEir digital tool enables patients to self-complete the Ask, Advise, and Assess phases of a brief intervention using a tablet device while waiting to see their pharmacist/GP. The pharmacist or GP then review the patient’s responses, risk level, and importance confidence and readiness scores. They complete the Assist and Arrange elements during the consultation, supported by a directory of local/national patient support services before printing information tickets for the patient to keep. The HealthEir intervention has been successfully rolled out at eight pilot pharmacy sites nationally, with a mix of urban/rural sites, and independent/chain pharmacies.ConclusionsAdopting an interdisciplinary approach based on human-centred design principles led to the development of a blended brief intervention that has been successfully introduced in pilot sites across Ireland. While the implementation has been smooth despite COVID-19 challenges, and initial feedback has been very positive, the impact cannot yet be fully evaluated as research is ongoing. Future work will involve extending the intervention to include other healthcare professionals.

Patients' experiences of behaviour change interventions delivered by general practitioners during routine consultations: A nationally representative survey.

BackgroundConsistent with the ‘Making Every Contact Count’ UK public health policy, general practitioners (GPs) are expected to provide patients with behaviour change interventions opportunistically. However, there is a belief widely held among GPs that patients neither want or need such interventions. We aimed to understand the following: (a) the characteristics of people attending GP appointments, (b) patients' needs for health behaviour change, (c) perceptions of appropriateness and helpfulness of interventions, and (d) factors associated with recall of receipt of interventions.MethodsCross‐sectional nationally representative online survey of UK adults who had attended GP clinics in the preceding four weeks (n = 3028). Data were analysed using descriptive statistics and binary logistic regression.Results94.5% (n = 2862) of patients breached at least one health behaviour guideline, and 55.1% reported never having had a conversation with their GP about health behaviours. The majority of patients perceived intervention as appropriate (range 84.2%‐87.4% across behaviours) and helpful (range 82.8%‐85.9% across behaviours). Being male (OR = 1.412, 95% CI 1.217, 1.639), having a long‐term condition (OR = 1.514, 95% CI 1.287, 1.782) and a higher number of repeat GP visits (OR = 1.016, 95% CI 1.010, 1.023) were among factors associated with recall of receipt of interventions.ConclusionsPatients perceived behaviour change intervention during routine GP consultations as appropriate and helpful, yet there are variations in the likelihood of receiving interventions according to sociodemographic factors. GPs could adopt a more proactive approach to behaviour change in patient consultations with the broad approval of patients.Patient or public contributionThe questionnaire was piloted among a convenience sample prior to distribution.

Preoperative education: making every contact count.

Patient education is an important part of obtaining informed consent, but can also be used to educate patients about how to prepare for surgery and help them take responsibility for improving their own health to reduce their risk of perioperative complications.

The Social Antagonist Hypothesis: COVID-19 Case Growth Speed Increases With Number of Social Contacts with People Over 65 Years Old, but Decreases with Contact with Others. Evidence Against 'Senior Hours'.

To estimate the importance of social isolation for individuals of different ages to slowing the growth of the COVID-19 pandemic, we measured the speed of COVID-19 case growth as a function of the proclivity of social contacts, both in general and with older people. COVID-19 case growth speed increased with number of social contacts with people >65 years old, but decreased with average number of contacts across all ages. We introduce the Social Antagonist Hypothesis, suggesting that contacts of younger people with other younger people keep young people away from older people, offering relative protection to the older population more vulnerable to COVID-19 from contagion by younger people. To test this, we correlate the number of contacts of younger people to those of older people, and find a significant negative correlation, as predicted by the Social Antagonist Hypothesis. We then find this negative correlation is due to a negative correlation between young-to-young contact counts and young-to-old ones. We conclude that “Senior Hours” for older populations only may be counterproductive toward the goal of protecting the most vulnerable population.

Supplemental Material for Optimizing Making Every Contact Count (MECC) Interventions: A Strategic Behavioral Analysis

Supplemental Material for Optimizing Making Every Contact Count (MECC) Interventions: A Strategic Behavioral Analysis

Estimating tie strength in social networks using temporal communication data

Even though the concept of tie strength is central in social network analysis, it is difficult to quantify how strong social ties are. One typical way of estimating tie strength in data-driven studies has been to simply count the total number or duration of contacts between two people. This, however, disregards many features that can be extracted from the rich data sets used for social network reconstruction. Here, we focus on contact data with temporal information. We systematically study how features of the contact time series are related to topological features usually associated with tie strength. We focus on a large mobile-phone dataset and measure a number of properties of the contact time series for each tie and use these to predict the so-called neighbourhood overlap, a feature related to strong ties in the sociological literature. We observe a strong relationship between temporal features and the neighbourhood overlap, with many features outperforming simple contact counts. Features that stand out include the number of days with calls, number of bursty cascades, typical times of contacts, and temporal stability. These are also seen to correlate with the overlap in diverse smaller communication datasets studied for reference. Taken together, our results suggest that such temporal features could be useful for inferring social network structure from communication data.

Cochrane corner: digital contact tracing technologies in epidemics.

Contact tracing is a public health measure implemented to control the spread and break the chains of transmission of an infectious disease. It is done by identifying, assessing, and managing people who have been exposed to an infectious disease to prevent onward transmission. We summarize findings from a rapid Cochrane review that included cohort and modelling studies to assess the benefits and harms of digital solutions for identifying contacts of confirmed positive cases of an infectious disease. The review included 12 studies, which assessed digital contact tracing for the following infectious diseases: Ebola, tuberculosis, pertussis and coronavirus disease 2019 (COVID-19). This review revealed low-certainty evidence of a decrease in secondary cases of the targeted infectious disease, if digital contact tracing was used. However, it is uncertain from the currently available evidence whether digital contact tracing would produce more reliable counts of contacts and reduce the time taken to complete contact tracing. Therefore, implementation of digital contact tracing in the context of the ongoing coronavirus pandemic in African countries should be accompanied by a robust monitoring and evaluation framework. There should be an evaluation and documentation of the benefits, cost-effectiveness, acceptability, feasibility, equity impacts, and unintended consequences of the intervention.

Seasonal flu, vaccinations and COVID-19

Seasonal flu, vaccinations and COVID-19