Appointment Flexibility Research Articles

5099 Capturing the Patient Voice for Diabetes Eye Exams

Abstract Disclosure: S. Du: None. S. Lambrechts: None. M. Freeby: None. M. Han: None. Background: Diabetic retinopathy (DR) is a leading cause of blindness among adults 20-74 years old. Ophthalmic exams are recommended every 1-2 years for type 2 diabetes patients with minimal to no DR. The 50th percentile Integrated Healthcare Association benchmark for DR screening is 49%, but at our academic medical center, the completion rate is 30%. Potential barriers to screening noted in the literature include lower levels of education, lack of knowledge about DR, and financial barriers. Objective: To understand motivating factors and barriers to DR screening among patients in our health system. Methods: We utilized the Patient Voice qualitative research method to uncover themes and identify interventions to improve care delivery. The literature was synthesized to develop a structured interview guide. From our urban academic health system, 15 patients were randomly selected for interview, six of whom had completed the “Diabetes Eye Exam” care gap and nine that had not. Interviews were transcribed and coded for thematic analysis. Results: Six opportunity areas were identified. 1) There are currently only six retinal cameras located across primary and specialty care clinics serving more than 38,000 diabetes patients. 67% of patients felt the current clinic locations were inconvenient, with distant locations and long travel times. 2) 20% of patients expressed that they would like increased flexibility of appointments offered, such as evening, weekend, and same day appointments. 3) Patients were motivated by automated diabetes eye exam specific reminder messages and appreciated the ability to self-schedule within the patient portal. 47% of patients wanted yearly reminder messages, while 40% had no preference. 4) 53% of patients expressed that they did not fully understand DR or were confused about the difference between an optometrist exam and diabetes eye exam. 5) 40% of patients completed their eye exam with their local optometrist and found this to be a more convenient option. One patient expressed that she wished her doctor had informed her that she could complete her diabetes eye exam at a local optometry clinic. 6) If patients do choose to complete their exam with their local optometrist, they would like reminders to send their records to their primary care physician or endocrinologist. A more streamlined processes to upload outside records through the patient portal would decrease this barrier. Conclusion: It is important to engage patient stakeholders and understand their needs to improve overall experience and close care gaps. Through the Patient Voice, we learned that factors such as driving distance, traffic, scheduling, and issues with uploading records are major barriers to care gap completion. Convenient clinic locations, education, and reminder messages are motivating factors. Future work will focus on developing and implementing solutions in each opportunity area. Presentation: 6/1/2024

“How Do I Prepare for This?” Patient Perspectives on Providers’ Employment-related Support During Pregnancy

BackgroundHealth care providers can offer employment-related support to pregnant patients by providing information about occupational risks and benefits, discussing adjustments, and/or completing paperwork to help patients obtain accommodations or benefits, but little research has examined whether and how this support is provided. MethodsWe conducted interviews with 20 adults who had been employed while pregnant within the 5 years preceding data collection. Eligible participants had low incomes, were hourly wage earners, or were employed in service or retail occupations. Applied thematic analysis was used to identify emergent themes. ResultsPeople who had been employed while pregnant described a range of experiences during that time, including physical and psychological demands from work, lack of access to appropriate accommodations, difficulties combining breastfeeding with work, and work-related challenges accessing health care. Participants described four primary roles that health care providers played: 1) completing paperwork needed to apply for benefits or receive work modification; 2) providing information about how to mitigate employment-related risks; 3) providing referrals to social or medical services; and 4) advocating for patients to ensure receipt of accommodations, resources, and information. Strategies identified by patients that could be enacted within health care to help them better navigate the work-pregnancy interface include increasing appointment flexibility, providing information about work-related risks and benefits programs and referrals to legal support, and helping providers to understand and support their patients’ individual work-related concerns. ConclusionsHealth care providers have a critical role to play in supporting employed pregnant people to achieve flexibility in managing their work and to be active participants in discussions about recommended workplace accommodations.

İSTANBUL’DA UYGULANAN ENTEGRE VE TOPLUM TEMELLİ BİR PSİKOSOSYAL DESTEK HİZMETİNİN GÜÇLÜ YÖNLERİ: GÖÇMEN PERSPEKTİFİNDEN NİTEL BİR KEŞİF ÇALIŞMASI

Turkey hosts a large number of refugees and asylum seekers, mainly from the Middle East. Despite being exposed to several risk factors for developing mental health conditions, refugees have low contact rates with mental health services in Turkey. The aim of the current study was to explore refugee and service provider perspectives on the characteristics of an integrated community-based psychological counselling programme in Istanbul, which may help to mitigate the barriers to mental health services regularly experienced by refugees. Eight interviews were conducted with three service providers and five Syrian and Afghan refugees who had attended a psychological counselling service in Istanbul between June and July 2021. Data was analysed using framework analysis. Four themes were identified as potential service characteristics which could mitigate barriers to accessing mental health services: (1) reputation-based trust, (2) appointment flexibility, (3) child-friendly spaces and (4) social support. Implications for research and practice are discussed with an emphasis on service development. Patient champion networks, client-centred approaches, and active participation of refugees in the continued development of mental health services are recommended as strategies to increase refugees' engagement with mental health services.

Stigma, Secrecy and Masculine Norms: A Systematic Review of How Perinatal Mental Illness in Men and Their Partners Is Experienced by Males

AimsBackground: In recent years, fathers have become increasingly involved in pregnancy and childcare and the concept of paternal perinatal mental illness (PMI) has gained research interest. There has been increased recognition of the impact of parenthood on the mental health of males, particularly in first time fathers where feelings of helplessness and marginalisation are common. Prevalence of paternal PMI is thought to be 10–16%, with higher risk demonstrated when their partner too experiences PMI. The importance of this topic was highlighted in the NHS long term plan, which recognised the disparity in service provision between males and females and the need to address this. Aim: To conduct a systematic review to establish the knowledge, beliefs, and experiences of males with PMI and whose partners had PMI, and to understand the barriers associated with help-seeking for paternal PMI.MethodsFive databases including EMBASE, Web of Science, Ovid MEDLINE, Scopus and PsycINFO were searched for qualitative studies investigating the experiences of males affected by PMI personally or through their partner's illness. The research question and inclusion criteria were determined using the PICOSS (population, intervention, comparison, outcome, setting, study design) method. 11 studies met criteria for inclusion and were appraised for quality using the Critical Appraisal Skills Programme and Joanna Briggs Institute Qualitative checklists. Evidence was synthesised using thematic analysis and study quality and risk of bias were assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) checklist and Risk of Bias in Systematic Reviews (ROBIS) too.Results5 main themes and 17 sub-themes were identified, and demonstrated lack of knowledge and preparation for fatherhood, and distress and isolation experienced by males with PMI. Males were reluctant to seek help, and factors including stigma and lack of awareness regarding PMI and available support services were identified as barriers. The option to remain anonymous, flexibility of appointments and an emphasis on peer support were considered facilitators to engagement.ConclusionUnhelpful and potentially damaging stereotypes regarding masculinity and PMI still exist, prohibit help-seeking for PMI and promote the marginalisation of males in perinatal settings. Support for males with PMI is warranted but lacking, and effective communication and education regarding paternal PMI for both professionals and the public is needed to allow successful expansion of services to include males.

Dental diaspora: oral health care attitudes and experiences in culturally and linguistically diverse mothers in Australia

BackgroundGlobally oral health care is unequally accessible or utilised within culturally and linguistically diverse (CALD) migrant communities. Yet much remains unknown about CALD mothers and their oral healthcare experiences in Australia. Hence, this paper explores the oral health care attitudes and experiences of CALD mothers within the Australian context with the broader objective to reduce oral health inequalities.MethodsQualitative semi-structured interviews were conducted from a social constructivism paradigm. Participants were foreign country born, spoke language/s other than English and have a child. Purposive snowball sampling and recruitment was conducted through CALD organisations and social media. Participants were interviewed for their attitudes and experiences to dental care and frequency of utilisation in Australia and the home country. Interviews were transcribed verbatim and grounded analysis (Strauss and Corbin) performed. Researcher bias was reduced through reflexivity and triangulation.ResultsThe participants (n = 33) included 20 CALD mothers born in India and 13 from either China, Fiji, Nepal, Macedonia and Israel. The theme, experiences with health workforce personnel revealed positive attitudes toward CALD providers from similar cultural and/or linguistic backgrounds. We coin these CALD providers as the ‘dental diaspora’. The dental diaspora facilitated CALD mothers through culture and/or language factors, alleviating cost barriers and flexibility in appointments. Dental travel to the home country was affirmed, however family visitation was the foremost reason for travel.ConclusionThe findings suggest that the dental diaspora plays a significant role in promoting oral health care utilisation for first generation CALD mothers in Australia. This paper brings to light the phenomenon of the ‘dental diaspora’ as an essential health workforce that contributes to addressing inequities in oral healthcare utilisation within CALD migrant communities. Universal health coverage in oral health is further affirmed, as aligned to the WHO policy context.

Barriers and enablers to diabetic retinopathy screening: a cross-sectional survey of young adults with type 1 and type 2 diabetes in the UK

IntroductionDiabetic retinopathy screening (DRS) attendance in young adults (YAs) is consistently below recommended levels. The aim of this study was to identify barriers and enablers of DRS attendance among YAs...

Preference to Family Doctor Contracted Service of Patients with Chronic Disease in Urban China: A Discrete Choice Experiment.

ObjectiveShanghai is one of the pioneers proposing family doctor contract service (FDCS). However, there is no quantitative research focusing on the Shanghai experience from a demand-side perspective. This study investigated Shanghai chronic patients’ relative preferences for FDCS using a discrete choice experiment method.MethodsA face-to-face discrete choice experiment (DCE) was performed to elicit the preference with 300 samples. Attributes and levels were extracted from the literature review and focus group consultation with patients. Seven attributes, follow-up frequency, medicine accessibility, family doctor competency, health management, referral convenience, appointment flexibility, and shared decision-making, were decided. Three levels were attached to each attribute. A mixed logit model was used to evaluate the multiple-choice data.ResultsA total of 248 patients completed the survey. Patient valued FDCS medicine accessibility (β=0.57, P < 0.05), and high family doctor competency (β= 0.43, P < 0.05), regular health management activities (β=0.36, P < 0.05), high follow-up frequency (β=0.31, P < 0.05) the most. The good doctor-patient shared decision-making atmosphere (β=0.12, P < 0.05), high referral convenience (β=0.06, P < 0.05) and high appointment flexibility (β=0.04, P < 0.05) are valued as less important. No significant preference heterogeneity was identified for patients with different sociodemographic characteristics. Respondents reported other FDCS needs, including online health consultation, specialist services in local institutes, higher reimbursement rates, free rehabilitation guidance for the disabled and personal health management.ConclusionThis research is the first discrete choice experiment FDCS preference research targeting on Chinese urban population. The results suggested that to increase the quality of FDCS, policy-makers should prioritize follow-up frequency, medicine accessibility, family doctor competency and health management. The service package should consider a higher reimbursement rate and rehabilitation guidance for the disabled if extra health-care resources available. Future FDCS policy should consider stated societal preference and be congruent with it.

The Role of Clinical Leaders in Workforce Development and Retention in Post-Acute and Long-Term Care

The Role of Clinical Leaders in Workforce Development and Retention in Post-Acute and Long-Term Care

Preferences among young people between public and private sexual and reproductive health services

BackgroundSexual and reproductive health services aim at the promotion of sexual health and elimination of the risk of sexually transmitted infections (STI’s). Therefore, they constitute an important framework for the improvement of young people's quality of life. The aim of this study was to investigate the main reasons that young people visit these services and furthermore what drives the choice between public and private sector.&#x0D; MethodsThe study included participants aged 18-20 years, living in the capital city of Athens, Greece. The questionnaire was developed for the purposes of the current study, including questions about the reasons for visiting sexual and reproductive health services, preferences between public and private sector.&#x0D; FindingsFrom 162 participants who visited sexual and reproductive health services, the main reason was for a Pap test (Pap smear) followed by STI/HIV testing, vaccination for HPV and other gynecological tests (i.e. ultrasounds). The majority of the participants, though not significant, preferred the private compared to public sector (n=127 vs n=35, respectively). The main reasons for choosing the private sector was accessibility and flexibility of appointments (p=0.02) and privacy (p=0.008). Even though, most of the participants (61.1%) who visited the private sector were informed about the existence of public sexual and reproductive health services.&#x0D; ConclusionsConvenience and privacy seemed to be the most important reasons for visiting the private sector. Efforts should be made for public sexual and reproductive health services in order to be more accessible and flexible to young people. These efforts can be supported by community engagement initiatives.

The impact of the COVID-19 lockdown on services for substance use in Denmark: Implications for meeting users' needs and recommendations for the future.

Background: The aim of this study was to document employees’ experiences of changes in service provision for substance use disorders (SUDs) during the first COVID-19 lockdown in Denmark (spring 2020), as well as to examine their relation to challenges in meeting the service users’ needs. Methods: Employees (N = 373) working in SUD treatment and harm reduction services completed an online survey soon after the first national lockdown. The survey included questions about changes in service provision during the lockdown, perceived concerns of the service users, and challenges in meeting the users’ emerging needs. Results: Employees reported some positive changes in service provisions, such as increased flexibility in appointments, administering medication-assisted treatment (MAT), and use of telehealth. Negative changes were related to reduced contact with practitioners and harm reduction facilities. Approximately one third of employees reported significant challenges in meeting the users’ emerging needs. This was particularly so when users’ concerns were about physical and mental well-being, and substance use. In regression models, negative changes in the access to practitioners and MAT administration (but not other changes) predicted difficulties meeting the users’ needs. Conclusion: Employees in SUD treatment and harm reduction services in Denmark experienced both positive and negative changes as a result of the first lockdown. However, not all the provision changes were linked to challenges in meeting the users’ needs. We discuss practical and research implications of our findings with a focus on the users’ physical and mental health, use of telehealth, MAT, and overall service reorganisation.

Barriers and enablers to diabetic eye screening attendance: An interview study with young adults with type 1 diabetes.

AimThe aim of this study was to identify barriers and enablers of diabetic eye screening (DES) attendance amongst young adults with diabetes living in the United Kingdom.MethodsSemistructured qualitative interviews with adults aged 18–34 years with diabetes. Participants were purposively sampled to aim for representation across gender, geographical locations, diabetes type, years since diabetes diagnosis and patterns of attendance (i.e. regular attenders, occasional non‐attenders, regular non‐attenders). Data were collected and analysed using the Theoretical Domains Framework (TDF) to explore potential individual, sociocultural and environmental influences on attendance. Data were analysed using a combined deductive and inductive thematic analysis approach. Barriers/enablers were mapped to behaviour change techniques (BCTs) to identify potential strategies to increase attendance.ResultsKey barriers to attendance reported by the sample of 29 study participants with type 1 diabetes, fell within the TDF domains: [Knowledge] (e.g. not understanding reasons for attending DES or treatments available if diabetic retinopathy is detected), [Social Influences] (e.g. lack of support following DES results), [Social role and Identity] (e.g. not knowing other people their age with diabetes, feeling ‘isolated’ and being reluctant to disclose their diabetes) and [Environmental Context and Resources] (e.g. lack of appointment flexibility and options for rescheduling). Enablers included: [Social Influences] (e.g. support of family/diabetes team), [Goals] (e.g. DES regarded as ‘high priority’). Many of the reported barriers/enablers were consistent across groups. Potential BCTs to support attendance include Instructions on how to perform the behaviour; Information about health consequences; Social support (practical) and Social comparison.ConclusionsAttendance to diabetic eye screening in young adults is influenced by a complex set of interacting factors. Identification of potentially modifiable target behaviours provides a basis for designing more effective, tailored interventions to help young adults regularly attend eye screening and prevent avoidable vision loss.

The transition to independence and adult care for women with Turner syndrome: Current status and priorities of 1338 women and parents.

Transitioning to adult health care and functioning is crucial for youth and young adults with special health care needs, such as those with Turner syndrome (TS). The International Turner Syndrome Consensus Group developed clinical practice guidelines to improve this transition. This study sought to evaluate how effectively they have been implemented and whether they align with the priorities of women with TS and families of girls and women with TS. A web-based survey was offered to those affiliated with major TS support organizations, with 1338 successfully responding (n= 543 women [≥18 years]; n= 232 parents of a woman [≥18 years]; and n= 563 parents of a girl with TS [<18 years]). Findings demonstrated that while most women transitioned to adult primary care providers, follow-up with key specialists was lacking. Women and families prioritized flexibility in appointments and designating one provider to oversee all their TS-related care. They identified health care coverage as a barrier to receiving care. The transition process to adult care and independence commonly occurred after girls become legal adults. Together, these findings serve to inform strategies to improve the delivery of transitional care for girls and women with TS.

Accessing and engaging with antenatal care: an interview study of teenage women

BackgroundPregnant teenagers in rural and regional areas experience distinct disadvantages, that are not simply a function of their age, and these have a substantial impact on their health and that of their baby. Studies demonstrate that antenatal care improves pregnancy outcomes amongst pregnant women, especially adolescents. Understanding teenager’s views and experiences of pregnancy and motherhood is important to ensure antenatal care meets young women’s needs. This study explored teenage women’s experiences and perceptions of barriers and facilitators to engaging in pregnancy care in rural and regional Victoria, Australia.MethodsBetween February–October 2017, pregnant women aged ≤19 years were purposively recruited from one regional and two rural health services in Victoria. Semi-structured, face-to-face interviews guided by naturalistic inquiry were conducted and an inductive approach to analysis was applied.ResultsFour key themes emerged from the analysis of the transcripts of 16 interviews: Valuing pregnancy care, Interactions with Maternity Service, Woman-centred care, and Support systems. Teenage women primary motivation to attend care was to ensure their baby’s wellbeing and lack of engagement occurred when the relevance of antenatal care was not understood. Appointment flexibility and an accessible location was important; most participants were reliant on others for transport. Continuity of carer and respectful, non-judgement communication by staff was highly valued. Many young women had fractured families with pregnancy diminishing their social world, yet having a baby gave them purpose in their lives.ConclusionMaternity services and health professionals that provide flexible, adaptable women-centred care and support through pregnancy and early motherhood will assist young women’s engagement in antenatal care.

Societal preferences for the treatment of impulsive-violent offenders: a discrete choice experiment

ObjectivesThe aim of this study is to quantify societal preferences for, and assess trade-offs between characteristics of treatment programmes for impulsive-violent offenders.SettingThe study was conducted in New South Wales, Australia’s...

Adapting a home telemonitoring intervention for underserved Hispanic/Latino patients with type 2 diabetes: an acceptability and feasibility study

BackgroundHome telemonitoring is a promising approach to optimizing outcomes for patients with Type 2 Diabetes; however, this care strategy has not been adapted for use with understudied and underserved Hispanic/Latinos (H/L) patients with Type 2 Diabetes.MethodsA formative, Community-Based Participatory Research approach was used to adapt a home telemonitoring intervention to facilitate acceptability and feasibility for vulnerable H/L patients. Utilizing the ADAPT-ITT framework, key stakeholders were engaged over an 8-month iterative process using a combination of strategies, including focus groups and structured interviews. Nine Community Advisory Board, Patient Advisory, and Provider Panel Committee focus group discussions were conducted, in English and Spanish, to garner stakeholder input before intervention implementation.Focus groups and structured interviews were also conducted with 12 patients enrolled in a 1-month pilot study, to obtain feedback from patients in the home to further adapt the intervention. Focus groups and structured interviews were approximately 2 hours and 30 min, respectively. All focus groups and structured interviews were audio-recorded and professionally transcribed. Structural coding was used to mark responses to topical questions in the moderator and interview guides.ResultsTwo major themes emerged from qualitative analyses of Community Advisory Board/subcommittee focus group data. The first major theme involved intervention components to maximize acceptance/usability. Subthemes included tablet screens (e.g., privacy/identity concerns; enlarging font sizes; lighter tablet to facilitate portability); cultural incongruence (e.g., language translation/literacy, foods, actors “who look like me”); nursing staff (e.g., ensuring accessibility; appointment flexibility); and, educational videos (e.g., the importance of information repetition). A second major theme involved suggested changes to the randomized control trial study structure to maximize participation, including a major restructuring of the consenting process and changes designed to optimize recruitment strategies. Themes from pilot participant focus group/structured interviews were similar to those of the Community Advisory Board such as the need to address and simplify a burdensome consenting process, the importance of assuring privacy, and an accessible, culturally congruent nurse.ConclusionsThese findings identify important adaptation recommendations from the stakeholder and potential user perspective that should be considered when implementing home telemonitoring for underserved patients with Type 2 Diabetes.Trial registrationNCT03960424; ClinicalTrials.gov (US National Institutes of Health). Registered 23 May 2019. Registered prior to data collection. https://www.clinicaltrials.gov/ct2/show/NCT03960424?term=NCT03960424&draw=2&rank=1

Parental expectations before and after 12-month experience with video consultations combined with regular outpatient care for children with type 1 diabetes: a qualitative study.

To explore parents' expectations of the perceived barriers to and benefits of 1year of monthly video consultations combined with regular outpatient care of children with type 1 diabetes. The Virtual Diabetes Outpatient Clinic for Children and Youth (VIDIKI) study was a controlled, multicentre, perennial study with 240 participants from northern Germany. Fifty-four qualitative interviews with parents were analysed using qualitative content analysis. Before the intervention, 30 interviews were conducted to assess parents' expectations, and after 1year, 24 interviews evaluated the experienced benefits and barriers to video consultations. Four main topics were identified from parents' responses to the video consultation. The main advantages of the video consultation compared with standard care were a higher frequency of contact for optimized insulin dosing and saving time; difficulties with internet connections were identified as the main barrier. A feeling of increased confidence with respect to insulin dosing was directly associated with telemedicine. Digital prescriptions and meeting the same diabetologist in both outpatient and telemedical care were mentioned as important improvements. The majority of interviewees preferred intervals of 4-6weeks between video consultations. The higher frequency of contact with the diabetes team was considered a great relief by parents of children with type 1 diabetes. Apart from the time savings and flexibility in appointments, the most important advantages were the higher frequency of contact leading to short-term therapy adjustments and an increase in the ability to adjust therapy independently. (German Clinical Trials Registry No: DRKS00012645).

To tele- or not to telehealth? Ongoing COVID-19 challenges for private psychiatry in Australia

Objectives:Following a very rapid and significant uptake of metropolitan telepsychiatry in private practice in Australia during COVID-19, practical questions remain: How long should psychiatrists continue telepsychiatry? Are there benefits of continuing: reduced COVID-19 risks to patient and psychiatrist, and flexibility of appointments? Will the Medicare Benefits Schedule (MBS) telehealth items be retained? How does metropolitan telepsychiatry fit into the overall mix of public and private services? This is an important debate.Conclusions:Private psychiatrists may continue to offer the majority of care, where practical, via telepsychiatry to reduce COVID-19 exposure risks, as well as allow for the realities of practice management for pandemic public health measures. However, consideration has to be given to the potential drawbacks for patients with sight, hearing and illness-related disabilities or risks, when in-person consultation is required. There are also risks: some patients may not benefit from telepsychiatry due to the nature of their illness, and will patients feel rapport is lost? However, the retention of COVID-19 MBS telehealth items is needed for ongoing flexible and comprehensive private practice psychiatry.

Developing Attributes and Attribute-Levels for a Discrete-Choice Experiment: An Example for Interventions of Impulsive Violent Offenders.

Discrete-Choice Experiments (DCEs) are used to assess the strength of preferences and value of interventions, but researchers using the method have been criticised for failing to either undertake or publish the rigorous research for selecting the necessary attributes and levels. The aim of this study was to elicit attributes to inform a DCE to assess societal and offenders' preferences for, and value of, treatment of impulsive-violent offenders. In doing so, this paper thoroughly describes the process and methods used in developing the DCE attributes and levels. Four techniques were used to derive the final list of attributes and levels: (1) a narrative literature review to derive conceptual attributes; (2) seven focus group discussions (FGDs) comprising 25 participants including offenders and the general public and one in-depth interview with an offender's family member to generate contextual attributes; (3) priority-setting methods of voting and ranking to indicate participants' attributes of preference; (4) a Delphi method consensus exercise with 13 experts from the justice health space to generate the final list of attributes. Following the literature review and qualitative data collection, 23 attributes were refined to eight using the Delphi method. These were: treatment effectiveness, location and continuity of treatment, treatment type, treatment provider, voluntary participation, flexibility of appointments, treatment of co-morbidities and cost. Society and offenders identified similar characteristics of treatment programs as being important. The mixed methods approach described in this manuscript contributes to the existing limited methodological literature in DCE attribute development.

Improving primary care Access in Context and Theory (I-ACT trial): a theory-informed randomised cluster feasibility trial using a realist perspective

BackgroundPrimary care access can be challenging for older, rural, socio-economically disadvantaged populations. Here we report the I-ACT cluster feasibility trial which aims to assess the feasibility of trial design and context-sensitive intervention to improve primary care access for this group and so expand existing theory.MethodsFour general practices were recruited; three randomised to intervention and one to usual care. Intervention practices received £1500, a support manual and four meetings to develop local, innovative solutions to improve the booking system and transport.Patients aged over 64 years old and without household car access were recruited to complete questionnaires when booking an appointment or attending the surgery. Outcome measures at 6 months included: self-reported ease of booking an appointment and transport; health care use; patient activation; capability; and quality of life. A process evaluation involved observations and interviews with staff and participants.ResultsThirty-four patients were recruited (26 female, eight male, mean age 81.6 years for the intervention group and 79.4 for usual care) of 1143 invited (3% response rate). Most were ineligible because of car access. Twenty-nine participants belonged to intervention practices and five to usual care. Practice-level data was available for all participants, but participant self-reported data was unavailable for three. Fifty-six appointment questionnaires were received based on 150 appointments (37.3%).Practices successfully designed and implemented the following context-sensitive interventions: Practice A: a stacked telephone system and promoting community transport; Practice B: signposting to community transport, appointment flexibility, mobility scooter charging point and promoting the role of receptionists; and Practice C: local taxi firm partnership and training receptionists. Practices found the process acceptable because it gave freedom, time and resource to be innovative or provided an opportunity to implement existing ideas. Data collection methods were acceptable to participants, but some found it difficult remembering to complete booking and appointment questionnaires. Expanded theory highlighted important mechanisms, such as reassurance, confidence, trust and flexibility.ConclusionsRecruiting older participants without access to a car proved challenging. Retention of participants and practices was good but only about a third of appointment questionnaires were returned. This study design may facilitate a shift from one-size-fits-all interventions to more context-sensitive interventions.Trial registrationISRCTN18321951, Registered on 6 March 2017.

Feasibility and acceptability of a proposed trial of acupuncture as an adjunct to lifestyle interventions for weight loss in Polycystic Ovary Syndrome: a qualitative study

BackgroundPolycystic Ovary Syndrome (PCOS) is a common female reproductive disorder with multiple manifestations. Weight management is a key therapeutic goal. Acupuncture is a potential adjunctive weight loss treatment in non-PCOS populations. We aimed to engage patients in co-design and assess the feasibility and acceptability of methods for a randomised controlled trial (RCT) on acupuncture and telephone-based health coaching for weight management in overweight or obese women with PCOS using qualitative methods.MethodsWe recruited women who had PCOS and were aged 18–45 years and with a body mass index of 25 kg/m2 and over, using social media. Two face-to-face focus group meetings and three semi-structured telephone interviews were conducted (n = 10). We analysed data using thematic analysis and aimed to compare and contrast motivations for joining the trial between women who were actively trying to conceive (n = 7) and not trying to conceive (n = 3). Attitudes to, knowledge and experiences of acupuncture; perceptions and attitudes towards the interventions in the RCT (real acupuncture, sham acupuncture and telephone-based health coaching); the outcomes of importance; and barriers and facilitators to successful trial recruitment and retention were collected.ResultsWomen were both acupuncture-naive and acupuncture-experienced. Overall, attitudes towards acupuncture were positive, and the trial design was acceptable with appointment flexibility requested. Ideal enrolment time, if women were trying to conceive, was six months prior to conception. Women supported three-month intervention and the use of sham acupuncture as a control. Financial incentives were not believed to be necessary, and women spoke of altruistic intentions in enrolling for such a trial. Women who were trying to conceive voiced a need for support from their family, health coaches, and peers. The telephone-based health coaching offered welcome support and accountability, noted as possible facilitators of weight loss.ConclusionsOur findings show that acupuncture is a likely acceptable adjunct to lifestyle interventions for weight loss in PCOS, and that a sham-controlled trial is feasible and acceptable to PCOS women. Further research is required in order to evaluate the efficacy of acupuncture together with lifestyle for weight management in PCOS.