Practitioner Intervention Research Articles

General-practitioner-led alcohol and other drugs withdrawal: Supporting patient choice, safety and success

Alcohol or other drug (AOD) withdrawal is a common reason for patients to seek treatment. Ambulatory, or 'home-based', AOD withdrawal for patients who are low risk is a useful intervention for general practitioners (GPs) to help empower their patients to improve their health and make meaningful change to their AOD use.This article explores the themes of patient choice, safety and optimising success in GP-led withdrawal. The four-step framework of 'who', 'prepare', 'withdrawal' and 'follow-up' outlines how to best support patients in the general practice setting to undertake a withdrawal.There are many benefits to a GP-led, home-based AOD withdrawal. The strategies to facilitate choice and safety and to optimise withdrawal success described in the article include careful patient selection, preparing the patient using domains of whole-person care, clarifying the patient's goals and stage of change, support during withdrawal and fostering long-term treatment in general practice.

Occupational Therapy Practitioner Interventions for Individuals with Hoarding Tendencies: A Descriptive and Associational Survey

Hoarding Disorder is a condition often referred to occupational therapy for comprehensive assessment and intervention, however the strategies that occupational therapy professionals use in the clinical management of hoarding behaviors is poorly understood. The purpose of this mixed methods survey design research was to collect and analyze information on the beliefs, attitudes, and perceptions of common and effective intervention techniques currently used among occupational therapy professionals to address hoarding behaviors. A total of 18 (n = 18) responding occupational therapy professionals met inclusion criteria. Occupational therapy professionals universally indicated that environmental modification strategies were utilized as an intervention to manage hoarding behaviors, and the majority of participants also indicated the use of ADL training, IADL training, household mobility training, occupation-based therapeutic activity, personal safety training and self-management training as interventions for Hoarding Disorder. Regression analysis between the perceived effectiveness of a given intervention and the reported frequency of how often the intervention was used indicated that occupational therapy professionals found that the following interventions were generally most effective for the management of Hoarding Disorder: environmental modification, <i>rs</i>(18) =.550, <i>p</i> =.018, VS-MPR = 5.09; personal safety training, <i>rs</i>(18) =.543, <i>p</i> =.020, VS-MPR = 4.70; creative expression activities, <i>rs</i>(18) =.624, <i>p</i> =.006, VS-MPR = 11.98; ADL training, <i>rs</i>(18) =.412, <i>p</i> =.066, VS-MPR = 2.05; self management training, <i>rs</i>(18) =.443, <i>p</i> =.075, VS-MPR = 1.89; and occupation-based therapeutic activities, <i>rs</i>(18) =.444, <i>p</i> =.063, VS-MPR = 2.11. The results of this study affirm that occupational therapy professionals generally find complex systems of techniques as more effective than single techniques for treating those with hoarding disorders, however further research is needed to better understand which occupational therapy assessments and interventions work well together as effective treatment systems.

The Impact of Primary Care Practitioner Intervention as an Adjunct to a Diabetes Case Management System.

Objective The objective of this study was to assess whether additional primary care practitioner (PCP) contacts beyond the intake visit are associated with reduced hemoglobin A1c in patients with type 2 diabetes actively engaged in the Kaiser Permanente case management system. Methods This retrospective cohort study using the Kaiser Permanente electronic health record explored the effect of enhanced PCP contact among adult patients with type 2 diabetes actively working with diabetes case managers (defined as ≥ 4 case manager contacts during the study period). Results A total of 837 patients met the inclusion and exclusion criteria. On average, patients with the highest PCP contact, < 7 contacts, had Ac levels 0.53 lower than those in the lowest PCP contact quartile, < 3 contacts (p = 0.0007). A1c decreased an average of 0.20 when the PCP contact quartile was one quartile higher (p = 0.0004). Holding the baseline A1c constant, the A1c decreased an average of 0.15 when the PCP contact quartile was one quartile higher (p = 0.0024). A1c change was significantly correlated with baseline A1c; A1c decreased by 0.64 more as the baseline A1c level increased by 1 (p < 0.0001). Additionally, the A1c level decreased by 0.02 more when patient age increased by 1 (p < 0.0001). Metformin use was associated with a decrease of A1c by 0.40 (p = 0.0057), whereas insulin use was associated with an increase of A1c by 0.29 (p = 0.0280). Conclusion In summary, a significant reduction was observed in A1c in patients with increased PCP contacts. This effect was seen in patients already receiving recommended case manager support.

Walking in their shoes: How primary-care experiences of adults aged 50+ reveal the benefits of e-learning intervention for general practitioners.

Patient experiences and activation are increasingly researched. However, related data are limited in three areas: interventions for general practitioners (GPs) working with mature adults (50+), dedicated e-learning interventions for GPs, and assessments of e-learning for medical staff through patient experiences. We examined how e-learning intervention focused on improving GPs' skills in activating communication (understood as promoting engagement and active participation in healthcare) can enhance the experiences of mature patients. The intervention was designed for GPs, yet innovative assessment was based on patient experiences post-visit. Three research conditions for GPs (n = 165) were introduced: (1) e-learning or (2) pdf-article intervention and (3) control. Two independent waves of their patients participated before and after the intervention. Experience measures for patients (n = 1639) included the Patient Expectations Scale (post-visit), perceived GP's Communication Skills scale, and Patient Satisfaction with Visit scale. E-learning intervention compared with the control group had a favorable effect for 5 out of 8 dimensions of patient experience. Change in emotional support and quality of life was particularly visible. Mature patient experiences can be improved with the e-learning intervention for GPs. Measuring patient experience enriches the available knowledge and can help design future research and interventions.

The adaptation and fidelity tool to support social service practitioners in balancing fidelity and adaptations: Longitudinal, mixed-method evaluation study.

Evidence-based interventions (EBIs) seldom fit seamlessly into a setting and are often adapted. The literature identifies practitioners' management of fidelity and adaptations as problematic but offers little guidance. This study aimed to investigate practitioners' perceptions of the feasibility and usability of an intervention aimed to support them in fidelity and adaptation management when working with EBIs. The intervention, the adaptation and fidelity tool (A-FiT), was developed based on the literature, along with input from social service practitioners and social services' Research and Development units' personnel. The intervention consisted of two workshops where the participants were guided through a five-step process to manage fidelity and adaptations. It was tested in a longitudinal mixed-method intervention study with 103 practitioners from 19 social service units in Stockholm, Sweden. A multimethod data collection was employed, which included interviews at follow-up, questionnaires at baseline and follow-up (readiness for change and self-rated knowledge), workshop evaluation questionnaires (usability and feasibility) after each workshop, and documentation (participants' notes on worksheets). To analyze the data, qualitative content analysis, Kruskal-Wallis tests, and Wilcoxon rank-sum tests were performed. Overall, the practitioners had a positive perception of the intervention and perceived it as relevant for fidelity and adaptation management (mean ratings over 7.0 on usability and feasibility). The workshops also provided new knowledge and skills to manage fidelity and adaptations. Furthermore, the intervention provided insights into the practitioners' understanding about adaptation and fidelity through a more reflective approach. Practical tools are needed to guide professionals not only to adhere to intervention core elements but also to help them to manage fidelity and adaptation. The proposed A-FiT intervention for practitioners' management of both fidelity and adaptation is a novel contribution to the implementation literature. Potentially, the next step is an evaluation of the intervention's impact in an experimental design.

Developing effective workforce training to support the long-term care of older adults: A review of reviews.

This review of reviews aimed to identify and synthesise evidence to support the design of learning interventions for non-registered practitioners supporting older people in long-term care (people's own homes, hospices or residential/nursing care). Our objectives were to inform the analysis part of the Analysis, Design, Development Implementation and Evaluation framework by finding evidence on the following five components of learning: content, format (teaching strategies and resources/media), structure, contextual factors (barriers and enablers) and measures used when monitoring the effectives of learning. Databases searched included Pro-quest (ASSIA), Scopus, Ovid (PsycINFO, Medline, Embase and Social Policy and Practice), SCIE Online and Cochrane Reviews and reference searching, with the last search being conducted in April 2021. Fifteen papers were identified as eligible for inclusion. Most of the interventions aimed to improve dementia care (n= 10), with others exploring LGBT+ competency (n= 2), or other forms of professional development (n= 3). Common features of effective learning included a multifaceted approach, with in-practice learning being blended with additional implementation strategies (e.g. supervision) and didactic learning/worksheets. An important contextual factor was working within an organisational culture which supported shared learning and reflection. This may also help encourage engagement with training, where staff are unwilling to attend if it may compromise care delivery. Future research should focus on the characteristics of trainers and the structure of learning, with more research being needed in in mental and physical morbidities outside the remit of dementia to improve the overall quality of the social care workforce.

Stress Management in Pre- and Postoperative Care Amongst Practitioners and Patients in Cardiac Catheterization Laboratory: A Study Protocol.

BackgroundAs the number of cardiac diseases continuously increases within the last years in modern society, so does cardiac treatment, especially cardiac catheterization. The procedure of a cardiac catheterization is challenging for both patients and practitioners. Several potential stressors of psychological or physical nature can occur during the procedure. The objective of the study is to develop and implement a stress management intervention for both practitioners and patients that aims to reduce the psychological and physical strain of a cardiac catheterization.MethodsThe clinical study (DRKS00026624) includes two randomized controlled intervention trials with parallel groups, for patients with elective cardiac catheterization and practitioners at the catheterization lab, in two clinic sites of the Ernst-von-Bergmann clinic network in Brandenburg, Germany. Both groups received different interventions for stress management. The intervention for patients comprises a psychoeducational video with different stress management technics and additional a standardized medical information about the cardiac catheterization examination. The control condition includes the in hospitals practiced medical patient education before the examination (usual care). Primary and secondary outcomes are measured by physiological parameters and validated questionnaires, the day before (M1) and after (M2) the cardiac catheterization and at a postal follow-up 6 months later (M3). It is expected that people with standardized information and psychoeducation show reduced complications during cardiac catheterization procedures, better pre- and post-operative wellbeing, regeneration, mood and lower stress levels over time. The intervention for practitioners includes a Mindfulness-based stress reduction program (MBSR) over 8 weeks supervised by an experienced MBSR practitioner directly at the clinic site and an operative guideline. It is expected that practitioners with intervention show improved perceived and chronic stress, occupational health, physical and mental function, higher effort-reward balance, regeneration and quality of life. Primary and secondary outcomes are measured by physiological parameters (heart rate variability, saliva cortisol) and validated questionnaires and will be assessed before (M1) and after (M2) the MBSR intervention and at a postal follow-up 6 months later (M3). Physiological biomarkers in practitioners will be assessed before (M1) and after intervention (M2) on two work days and a two days off. Intervention effects in both groups (practitioners and patients) will be evaluated separately using multivariate variance analysis.DiscussionThis study evaluates the effectiveness of two stress management intervention programs for patients and practitioners within cardiac catheter laboratory. Study will disclose strains during a cardiac catheterization affecting both patients and practitioners. For practitioners it may contribute to improved working conditions and occupational safety, preservation of earning capacity, avoidance of participation restrictions and loss of performance. In both groups less anxiety, stress and complications before and during the procedures can be expected. The study may add knowledge how to eliminate stressful exposures and to contribute to more (psychological) security, less output losses and exhaustion during work. The evolved stress management guidelines, training manuals and the standardized patient education should be transferred into clinical routines.

‘What's the magic word?’: mapping oral language interventions implemented in prevention and early intervention programmes

ABSTRACT The nationally funded Prevention and Early Intervention (PEI) programme aimed to design, deliver and evaluate interventions to improve a range of outcomes for children growing up in areas of low socio-economic status (SES). A key focus for many PEI programmes was to improve the oral language abilities of children, recognising its important link to a range of literacy, learning, social, emotional and behavioural indicators. This paper reviewed the published reports of PEI and community programmes that implemented oral language interventions for children, parents and practitioners. This mapping exercise demonstrated that the oral language interventions implemented varied extensively and were predominantly evaluated through gathering the perspectives of those receiving the supports. A noticeable gap was the lack of a national evaluation framework of the oral language interventions provided, resulting in difficulties making comparisons, determining impact and contributing to the evidence base of the effectiveness of bespoke interventions designed and delivered. Implications of this mapping exercise are outlined for the future implementation and evaluation of universal and targeted oral language interventions.

Nurse driven outpatient wound center: Reducing readmission with wound care excellence

There is a growing need for new and innovative ways to care for patients in the ambulatory setting, including providing wound care for patients.A vascular surgery department in a large urban academic medical center noted there was an increasing number of patients with chronic wounds that needed weekly care. The number of patients, the time needed to provide wound care, and limited clinic space was creating a strain on traditional clinic hours.Collaboration between one of the vascular surgery advanced practice registered nurses (APRN) and vascular registered nurse (RN) led to the creation of a vascular wound clinic. Patients with chronic wounds were identified by vascular surgeons at one institution and referred to the wound clinic. A retrospective chart review was used to look at number of patients, number of visits per patient, surgical interventions, number of wounds closed, size of wounds, and complications.The ability to provide a single point of contact for the patient's vascular surgery and wound care needs allowed the clinic to provide comprehensive care for 29 patients and close more than 75% of wounds. The retrospective chart review found that patients receiving weekly wound care with clear communication from the multidisciplinary team, the nursing and nurse practitioner interventions kept most patients out of the hospital, with only two unplanned readmissions to the hospital, neither due to chronic wounds.This nursing led wound clinic was able to accommodate complex vascular surgery patients, heal chronic wounds, and decrease unplanned readmissions. Expanding the clinic to assist with limb salvage and more podiatric patients is providing a new patient base and improving the care for the community that it serves.

Evaluation of an education intervention for Australian health practitioners to support people with dementia with driving decisions: A pretest-posttest survey

Objective Drivers with dementia will at some stage need to stop driving. The timing of driving retirement is informed by the advice of health practitioners, however many find this task complex and challenging as they feel unprepared or lack confidence, having limited training and education on dementia and driving. Few opportunities exist for Australian health practitioners to advance learning about dementia and driving. This study evaluated the impact of a Dementia and Driving Education Module on practitioner self-perceived knowledge, confidence, and competence in supporting people living with dementia with decisions about driving. Methods A single group, pretest-posttest survey was conducted for this study. Health practitioners were recruited over 19 months via email and invited to attend a face-to-face dementia and driving workshop. The workshop comprised of a two-hour Dementia and Driving Education Module including seven learning activities incorporating six vignettes, five self-reflections, one case study and a paper copy of a dementia and driving decision aid. Participants completed a survey prior to, immediately after and six weeks post completion of the education module. Results A total of 240 health practitioners, from over six disciplines, took part in one of eleven workshops delivered via face-to-face and online across five states of Australia. Significant increases occurred in all outcome measures of perceived knowledge, confidence and competence between baseline and immediately post-education module survey responses and between baseline and six weeks post-survey responses. Conclusions The Dementia and Driving Education Module and accompanying decision aid demonstrate an efficacious solution for a diverse range of health practitioners to enhance their knowledge, confidence, and competence in supporting people living with dementia with driving retirement decisions.

Building Compassion Fatigue Resilience: Awareness, Prevention, and Intervention for Pre-Professionals and Current Practitioners.

Compassion fatigue (CF), or the extreme stress and burnout from helping others, is widely considered to be harmful to professional well-being. Due to a lack of awareness and education around CF in healthcare professionals, mental health clinicians may feel particularly unsure about how to treat these common symptoms. There is considerable symptom overlap between CF and several other presentations, including posttraumatic stress disorder, depression, insomnias, and substance abuse disorders. Evidenced-based assessments designed to measure symptoms of CF are discussed, as well as screening measures for overlapping presentations. Treating fellow clinicians and pre-professionals comes with unique ethical considerations, most notably privacy concerns that may impact professional development. The culture of training programs does not adequately prepare pre-professionals for psychological well-being. As psychologists, it is our ethical responsibility to advocate for changes in graduate education and at our training sites. By utilizing evidenced-based strategies, such as acceptance and commitment therapy, we can assist professionals and pre-professionals in building resilience as they navigate a career in the helping professions.

“If only he were blind”: Shame, trauma, and dissociation among women with body dysmorphic disorder in physically intimate relationships

ABSTRACT Background Body Dysmorphic Disorder (BDD) involves a debilitating preoccupation with one’s appearance and associated difficulties in social and interpersonal relationships, according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). Quantitative research has investigated the severity of relationship difficulties in BDD, while qualitative research has primarily focused on intrapersonal phenomena, although interpersonal difficulties, including with physical intimacy, have frequently emerged from these studies. Aims This study explores how women with BDD make sense of their lived experiences of physical intimacy in the context of current partner relationships. Method Six adult women participated in individual semi-structured interviews. The data was analysed using Interpretative Phenomenological Analysis. Results The analysis generated three superordinate themes: 1) The shame in being seen, 2) Disgust and detachment during intimacy, and 3) A flawed self, unworthy of relationships. Conclusions This study demonstrates how appearance-related concerns filter into the cognitive, behavioural, and emotional intersubjective spaces of physically intimate partnerships. Shame or trauma may be triggered and may be managed through disengagement or dissociation. Clinical implications These findings support calls for a full psychological assessment of the contextual and interpersonal components of BDD, and further suggest that psychological interventions for shame, trauma, and dissociation, such as compassion-focused therapy, imagery rescripting, or body-focused therapies, may be helpful additions to cognitive-behavioural or exposure and response prevention interventions for practitioners working with BDD.

A Study of Mental Illness Stigma Intervention for Mental Health Service Practitioners

心理健康服务从业者；心理疾病污名；心理疾病患者

A roadmap for the development and evaluation of the eHealthResp online course.

BackgroundInappropriate antibiotic use constitutes one of the most concerning public health issues, being one of the main causes of antibiotic resistance. Hence, to tackle this issue, it is important to encourage the development of educational interventions for health practitioners, namely by using digital health tools. This study focuses on the description of the development and validation process of the eHealthResp online course, a web platform directed to physicians and pharmacists, with the overall goal of improving antibiotic use for respiratory tract infections, along with the assessment of its usability.MethodsThe eHealthResp platform and the courses, developed with a user-centered design and based on Wordpress and MySQL, were based on a previously developed online course. A questionnaire to assess the usability was distributed among physicians (n = 6) and pharmacists (n = 6). Based on the obtained results, statistical analyses were conducted to calculate the usability score and appraise the design of the online course, as well as to compare the overall scores attributed by both groups. Further qualitative comments provided by the participants have also been analyzed.ResultsThe eHealthResp contains two online courses directed to physicians and pharmacists aiming to aid in the management of respiratory tract infections. The average usability score of the eHealthResp online courses for physicians and pharmacists was of 78.33 (±11.57, 95%CI), and 83.75 (±15.90, 95%CI), respectively. Qualitative feedback emphasized the usefulness of the course, including overall positive reviews regarding user-friendliness and consistency.ConclusionsThis study led us to conclude that the eHealthResp online course is not recognized as a complex web platform, as both qualitative and quantitative feedback obtained were globally positive.

When Work Conflicts With Personal Projects: The Association of Work-Life Conflict With Worker Wellbeing and the Mediating Role of Mindfulness.

The negative emotional and health effects of work-life conflict (WLC) have been demonstrated in numerous studies regarding organizational psychology and occupational health. However, little is known about WLC’s relationship with positive wellbeing outcomes, including emotional, psychological, and social aspects of workers’ thriving. Furthermore, the mediating processes underlying the effects of WLC remain mostly unknown. The current study investigated the associations of perceived time- and strain-based WLC with positive mental health and thriving at work, as well as the mediating role of mindfulness in these associations. It is argued that WLC causes reduced mindfulness capacities among workers, which is in turn associated with lower positive wellbeing given the importance of mindfulness in emotion regulation. A sample of 330 workers based in Québec, Canada, completed an online survey including a measure of strain- and time-based interference with personal projects (i.e., the goals and activities that define the daily life of an individual) and validated scales of wellbeing outcomes and mindfulness. Results of structural equation modeling revealed negative associations between time- and strain-based WLC with positive mental health and thriving at work. Work-life conflict was related to lower mindfulness, which played a mediating role in the associations between time-based WLC with positive mental health and thriving at work, as well as strain-based WLC with positive mental health. The mediation was complete for the time-based WLC and positive mental health association, but partial for the other mediated pathways, highlighting the need for more research to identify additional mediators. These results highlight that beyond resulting in negative emotional/health outcomes often studied in previous research, WLC may be associated with workers’ reduced potential to live a fulfilling life, in general and in the workplace. Recommendations (e.g., mindfulness intervention to promote emotional regulation, personal project intervention) for workplace policymakers and practitioners are identified.

Measuring the effects of nurse practitioner (NP)-led care on depression and anxiety levels in people with multiple sclerosis: a study protocol for a randomized controlled trial

BackgroundCanada has one of the highest rates of multiple sclerosis (MS) in the world. Treatments and supports for people with MS (PwMS) have become increasingly complex, requiring individualized and adaptive care. Specialized NPs provide advanced skills to those with complex medical conditions, with potential to enhance the health, functioning, and quality of life for PwMS. This study aims to determine the effect of a Nurse Practitioner (NP) on depression and anxiety levels in PwMS.MethodsWe will perform a parallel randomized controlled trial. PwMS who are followed by general private-practice neurologists will be randomly assigned to the intervention group (NP-led care) or the ‘usual care’ control group (general neurologist or family physician and registered nurse support). In the intervention group, the NP will assess and provide care to the MS patient and their caregiver at a baseline visit, with 3-month and 6-month follow-up visits. PwMS in the control group will receive usual care provided by their community neurologists or family physicians with the standard assistance provided by registered nurses experienced in MS care. The primary outcome will be the difference in change in the patient’s anxiety and depression scores as measured by the validated Hospital Anxiety and Depression Scale (HADS) questionnaire at 3 months. Secondary outcomes will include difference in change in HADS at 6 months; Modified Fatigue Impact Scale scores (MSIF) at 3 and 6 months; EQ-5D scores at 3 and 6 months; caregiver health-related quality of life in MS measures (CAREQOL-MS) at 3 and 6 months; number of visits and phone calls to healthcare professionals recorded by patient, and satisfaction with NP-led care vs usual care measured by the validated Consultant Satisfaction Questionnaire.DiscussionFindings from this study will contribute to exploring benefits of advanced nursing practitioner interventions for PwMS followed by general neurologists and family physicians in a community setting. It will provide evidence of the benefits of NP-led care for PwMS and offer an alternative healthcare resource for management of MS.Trial registrationClinicalTrials.govPro00069595. Retrospectively registered on June 26, 2020. Protocol version: January 2017, version 1.

TH24. INVESTIGATION OF THE CAUSAL RELATIONSHIP BETWEEN IRON ACCUMULATION IN THE BRAIN AND NEURODEGENERATIVE DISEASE

Advance care planning (ACP) is seldom initiated with people with dementia (PWD) and mainly focuses on medical end-of-life decisions. We studied the effects of an educational intervention for general practitioners (GPs) aimed at initiating and optimizing ACP, with a focus on discussing medical and nonmedical preferences of future care.A single-blinded cluster randomized controlled trial.In 2016, 38 Dutch GPs (all from different practices) completed the study. They recruited 140 PWD, aged ≥65 years at any stage and with any type of dementia, from their practice.Intervention group GPs were trained in ACP, including shared decision-making and role-playing exercises. Control group GPs provided usual care. The primary outcome was ACP initiation: the proportion of PWD that had at least 1 ACP conversation documented in their medical file. Key secondary outcomes were the number of medical (ie, resuscitation, hospital admission) and nonmedical (ie, activities, social contacts) preferences discussed. At the 6-month follow-up, subjects' medical records were analyzed using random effect logistics and linear models with correction for GP clustering.38 GP clusters (19 intervention; 19 control) included 140 PWD (intervention 73; control 67). Four PWD (2.9%) dropped out on the primary and key secondary outcomes. After 6 months, intervention group GPs initiated ACP with 35 PWD (49.3%), and control group GPs initiated ACP with 9 PWD (13.9%) [odds ratio (OR) 1.99; P = .002]. Intervention group GPs discussed 0.8 more medical [95% confidence interval (CI) 0.3, 1.3; P = .003] and 1.5 more nonmedical (95% CI 0.8, 2.3; P < .001) preferences per person with dementia than control group GPs.Our educational intervention increased ACP initiation, and the number of nonmedical and medical preferences discussed. This intervention has the potential to better align future care of PWD with their preferences but because of the short follow-up, the GPs' long-term adoption remains unknown.

Parenting styles and types: Breastfeeding attitudes in a large sample of mothers

ObjectiveThe importance of breastfeeding for both maternal and infant health is well established. However, it remains the case that only a small percentage of infants are breastfed after the first six months of life. Maternal negative breastfeeding attitudes are associated with a reduced likelihood of breastfeeding an infant, but they are a malleable target for practitioner interventions. By adjusting perceptions, and therefore behaviours within the population, maternal and infant health outcomes may be improved. As such, it is important to understand whether certain types of mother might feel more negatively about breastfeeding. Here. we investigated the relationships between parenting styles, personality traits, and breastfeeding attitudes. In addition, we aimed to address the interrelated nature of parenting styles by identifying ‘types’ of mother who may feel more negatively about breastfeeding. DesignA cross-sectional survey was used in order to measure parenting styles, personality traits, and attitudes to breastfeeding. ParticipantsA sample of 1,347 mothers (age M = 31.4 years, SD = 7.4 years) participated. Recruitment took place through online mother and baby groups based predominantly in the United Kingdom. ResultsMore permissive and less uninvolved mothers felt positively about breastfeeding, but limited associations between personality factors and breastfeeding attitudes were found. We applied a cluster analytical approach to investigate whether there were particular ‘types’ of mothers in our sample, and if these showed systematic differences. Our analyses revealed two profiles, best described as ‘high nurturance’ (high scoring on authoritative and permissive) and ‘low nurturance’ (low scoring on these dimensions). These two types of mother showed significant differences along all four parenting styles, and our ‘high nurturance’ type was more conscientious and emotionally stable, and felt more positively about breastfeeding. ConclusionsParenting styles were associated with breastfeeding attitudes. Through identifying an underlying nurturance dimension that best explains differences in parenting styles across mothers, we provide a potential avenue to improving breastfeeding attitudes. By focussing on ‘low nurturance’ mothers in particular, professionals may be able to provide interventions to improve breastfeeding attitudes and, as a result, address low rates of breastfeeding in the UK.

Practise till you drop: Trialing an online intervention for late-career medical practitioners to promote planning for retirement

Many medical practitioners in Australia work beyond the traditional retirement age. Transitioning to retirement is important, however, because the likelihood of poorer clinical outcomes increases with practitioner age. The objective of the present study was to develop and trial an online educational intervention to promote planning for a smoother transition to retirement using a non-randomized control group pre- and post-test design. Medical practitioners aged 55 or over (N = 262, Mage = 61.9) and working 30 or more hours per week were recruited to complete four online modules that addressed a range of topics (physical, health, financial, social, cognitive, and emotional well-being) and encouraged planning for retirement resources. Outcome measures included work centrality, mastery, and goal perceptions across the aforementioned resource domains. Eighty-one doctors completed post-training measures; a control group who completed only the measures (n = 23) and a training group (n = 58). Pre-post comparisons showed no significant changes for the control group. However, the training group at Time 2 showed lower work centrality t(57) = 2.12, (p = .036), and changes to social t(57) = 2.35, (p = .022), emotional t(57) = 3.18, (p = .002) and health goal perceptions t(57) = −2.02, (p = .049). Controlling for baseline scores and self-selection bias determinants, Generalized Linear Model (GLM) analyses indicated a training group increase in mastery scores (β = 0.87, p = .045) and decrease in negative perception of the consequence of not meeting emotional goals (β = −0.37, p = .043). Although not significant, GLM results also showed an increase in resources, three of four health goal domains and financial goals, indicating the potential for positive training effects in future applications of the program. The online retirement planning resource showed promise in promoting a sense of mastery and a reassessment of retirement plans, taking into consideration resource accumulation and goal setting across five specific goal domains. We discuss the theoretical and practical implications of our findings.

Clinical and healthcare improvement through My Health Record usage and education in general practice (CHIME-GP): a study protocol for a cluster-randomised controlled trial

BackgroundThere is an international interest in whether improved primary care can lead to a more rational use of health resources. There is evidence that educational interventions can lead to improvements in the quality of rational prescribing and test ordering. A new national platform for shared medical records in Australia, My Health Record (MHR), poses new opportunities and challenges for system-wide implementation. This trial (CHIME-GP) will investigate whether components of a multifaceted education intervention in an Australian general practice setting on rational prescribing and investigation ordering leads to reductions in health-service utilisation and costs in the context of the use of a national digital health record system.MethodsThe trial will be undertaken in Australian general practices. The aim of the research is to evaluate the effectiveness of components of a web-based educational intervention for general practitioners, regarding rational use of medicines, pathology and imaging in the context of the use of the MHR system. Our target is to recruit 120 general practitioners from urban and regional regions across Australia. We will use a mixed methods approach incorporating a three-arm pragmatic cluster randomised parallel trial and a prospective qualitative inquiry. The effect of each education component in each arm will be assessed, using the other two arms as controls. The evaluation will synthesise the results embedding qualitative pre/post interviews in the quantitative results to investigate implementation of the intervention, clinical behaviour change and mechanisms such as attitudes, that may influence change. The primary outcome will be an economic analysis of the cost per 100 consultations of selected prescriptions, pathology and radiology test ordering in the 6 months following the intervention compared with 6 months prior to the intervention. Secondary outcome measures include the rates per 100 consultations of selected prescriptions, pathology and radiology test ordering 6 months pre- and post-intervention, and comparison of knowledge assessment tests pre- and post-intervention.DiscussionThe trial will produce robust health economic analyses on the evidence on educational intervention in reducing unnecessary prescribing, pathology and imaging ordering, in the context of MHR. In addition, the study will contribute to the evidence-base concerning the implementation of interventions to improve the quality of care in primary care practice.Trial registrationClinicalTrials.gov ACTRN12620000010998. Registered on 09 January 2020 with the Australian New Zealand Clinical Trials Registry