Rehearsal Of Skills Research Articles

The development and study of the effectiveness of a novel uterine contraction learning aid: A two-phase research study

BackgroundNursing students lack clinical experience in assessing intrapartum uterine activity, rating their ability and level of understanding as low or fair despite receiving theoretical instruction prior to attending clinical placements. Teaching model/aids may facilitate learning, however, purchasing additional models could prove expensive within many organisations. Limited exposure to skills rehearsal in school may contribute to student anxiety, stress, and perceived low self-efficacy when in clinical practice. ObjectivesTo develop and assess the effectiveness of a novel Uterine Contraction Learning Aid as a training tool to expand the knowledge, attitude, and practice of nursing students. MethodsA two-phase study conducted at The Institute of Nursing in Thailand. Phase I was underpinned by research and development. After first being considered for its quality, by five experts comprising an obstetrician, two midwives and two nursing instructors, the novel Uterine Contraction Learning Aid was assessed by 30 fourth-year nursing students with experience in assessing uterine contractions for its educational suitability. Phase II - Sixty year-three nursing students were assigned via matched-pairs to either an experimental or control group to evaluate the effectiveness of the Uterine Contraction Learning Aid, completing three questionnaires underpinned by the knowledge, attitude, and practice concept. ResultsPhase I- Descriptive statistics applied to survey responses indicate participants rated the quality of the Uterine Contraction Learning Aid highly in every aspect of learning skills, and perceptions of confidence. The overall production was rated at a good level. Phase II - An independent sample t-test was used to compare knowledge, attitude, and practice values in assessing uterine contractions between control and experimental groups. Participants in the experiment group had significantly higher scores in knowledge and practice when assessing uterine contractions compared to the control group (t = 4.768, p < 0.000 vs. t = 3.630, p < 0.001, respectively). There was no statistically significant difference in attitudes in relation to assessing uterine contractions between the two groups (t = 0.188, p = 0.852). ConclusionsThe novel Uterine Contraction Learning Aid can be used effectively to prepare nursing students prior to practicing with women undergoing intrapartum care.

Boot camps and academia: odd bedfellows for a national collaborative approach to training non-medical cystoscopists

Scottish cystoscopy service provision faces significant challenges in the years ahead driven by COVID-19’s impact on diagnostic waiting times, the development of national treatment centres to expand infrastructure/service delivery, and limited short-term medical capacity to support recovery. These factors have greatly increased demand for the rapid development of a supportive non-medical cystoscopist workforce [1]. There is currently no agreed national approach to non-medical cystoscopy training in Scotland despite clear guidance on competencies from the British Association of Urology Nurses (BAUN). Our proposed solution has been to collaboratively develop and pilot an accelerated learning programme, including a simulation ‘bootcamp’, that pump primes adaptation to the role and clinical training requirements through technical and non-technical skill rehearsal. We invited experts from clinical practice, education, and simulation to form a national short life working group ( Diagram of the national short life working group A unified model for pilot was developed, integrating clinical simulation, theory, and work-based learning (WBL). It focuses on core cystoscopy skills initially, providing the necessary knowledge and ‘hands on’ ability required for independent practice. The process is primed by a two-day ‘cystoscopy bootcamp’ using simulation-based education (SBE). This comprises of a variety of methods including high volume cystoscopy skill rehearsal of increasing realism, progressing to cadaver. Non-technical skills are simulated through bespoke scenarios relevant to the role including obtaining informed consent, team communication, and delivering bad news. Expert discussion and debriefing is interwoven throughout. Formal evaluation is ongoing with early reports of increased preparedness and quicker adaptation to the clinical environment. In addition to the anticipated benefits, bootcamp also established early peer support mechanisms and, through the engagement and networking of diverse faculty, fostered integration with the wider community of practice, and a commitment to building a continually improving, user-informed simulation programme. The method provides a cost-effective collaborative way to explore research, educational models, and the challenges of implementation in real time, through a multi-professional lens. The approach has been crucial to ownership, commitment and acceptance of the programme while fostering integrated cross discipline delivery. 1. Scottish Government Endoscopy and urology diagnostic recovery and renewal plan. 30 Nov 2021 Endoscopy and urology diagnostic: recovery and renewal plan – gov.scot (

Virtual and Augmented Reality in Neurosurgery: The Evolution of its Application and Study Designs

As the art of neurosurgery evolves in the 21st century, more emphasis is placed on minimally invasive techniques, which require technical precision. Simultaneously, the reduction on training hours continues, and teachers of neurosurgery faces "double jeopardy"-with harder skills to teach and less time to teach them. Mixed reality appears as the neurosurgical educators' natural ally: Virtual reality facilitates the learning of spatial relationships and permits rehearsal of skills, while augmented reality can make procedures safer and more efficient. Little wonder then, that the body of literature on mixed reality in neurosurgery has grown exponentially. Publications involving virtual and augmented reality in neurosurgery were examined. A total of 414 papers were included, and they were categorized according to study design and analyzed. Half of the papers were published within the last 3 years alone. Whereas in the earlier half, most of the publications involved experiments in virtual reality simulation and the efficacy of skills acquisition, many of the more recent publication are proof-of-concept studies. This attests to the evolution of mixed reality in neurosurgery. As the technology advances, neurosurgeons are finding more applications, both in training and clinical practice. With parallel advancement in Internet speed and artificial intelligence, the utilization of mixed reality will permeate neurosurgery. From solving staff problems in global neurosurgery, to mitigating the deleterious effect of duty-hour reductions, to improving individual operations, mixed reality will have a positive effect in many aspects of neurosurgery.

144 Simulation Without the Bells and Whistles of Technology

Full-scale simulation (FSS) is one of the most effective and commonly used simulation modalities in healthcare education. It enables the rehearsal of skills in a safe and controlled environment without the risk of harming patients, which provides a strong argument for it being a useful educational approach. With technological developments and the widescale use of simulation technologies in many institutions, simulation has become an essential part of healthcare professional training and curricula. However, setting up a simulation laboratory can be very costly for institutions, as can training facilitators and ensuring equipment maintenance. Simulated patients (actors) are also not universally embraced because of the costs. This makes running an FSS challenging. Furthermore, technology fear, shortage of trained staff, scarcity of space and equipment, workload and applicability to the existing curriculum can be acknowledged as further barriers to the adoption of FSS. We assert that Visually-Enhanced Mental Simulation (VEMS), which includes a patient poster instead of a patient simulator or simulated patient This study aimed to explore nursing students’ evaluation of the VEMS sessions.VEMS is a mental form of simulation which includes basic representations of a patient, equipment and interventions. A laminated patient poster is used to represent the patient and laminated equipment cards are used for equipment. A whiteboard or flipchart are used to write interventions and patient parameters in real-time. Also, the simulation session includes ‘thinking aloud’ (participants verbalize their thinking process and actions). Before the scenario, pre-briefing takes place, and a debriefing follows after the scenario, as in FSS.As part of a wider project, we piloted the use of VEMS with 30 final-year adult nursing students who consented to participate in VEMS sessions. The main study relied on a quasi-experimental design to compare two simulation modalities, FSS and VEMS. The study was approved by the University of Hertfordshire Ethics Committee (protocol number: aHSK/PGR/UH/03692(2)). Final-year adult nursing students studying at the university were targeted for this study. Control (FSS) and experimental (VEMS) groups were exposed to the same scenarios which included two deteriorating postoperative patients. Students were asked to evaluate the effectiveness of the simulation session with the Simulation Effectiveness Tool-Modified (SET-M) The students found VEMS to be effective for their learning and confidence as they marked it 43.70 (SD: 9.11) out of 57. The pre-briefing part scored 2.41 (SD: 0.61), the learning scored 2.19 (SD: 0.50), the confidence subscale scored 2.25 (SD: 0.57), and the debriefing part scored 2.51 (SD: 0.53), all out of three points.This may suggest that students found the VEMS session a useful learning activity which also contributed to developing their confidence. Based on the pilot study questionnaire data, it could be argued that VEMS can be a valuable simulation approach in nursing education as it does not rely on technology and is easy to facilitate anywhere.

Training Residents in Advance Care Planning: A Task-Based Needs Assessment Using the 4-Component Instructional Design.

Residents may learn how to perform advance care planning (ACP) through informal curriculum. Task-based instructional designs and recent international consensus statements for ACP provide opportunities to explicitly train residents, but residents' needs are poorly understood. We assessed residents' training needs in ACP at the Geneva University Hospitals in Geneva, Switzerland. Qualitative data were collected and analyzed iteratively between December 2017 and September 2019. Transcripts were coded using both a deductive content analysis based on the 4-Component Instructional Design (4C/ID) model and an inductive thematic analysis. Out of 55 individuals contacted by email, 49 (89%) participated in 7 focus groups and 10 individual interviews, including 19 residents, 18 fellows and attending physicians, 4 nurses, 1 psychologist, 1 medical ethics consultant, 3 researchers, and 3 patients. Participants identified 3 tasks expected of residents (preparing, discussing, and documenting ACP) and discussed why training residents in ACP is complex. Participants described knowledge (eg, prognosis), skills (eg, clinical and ethical reasoning), and attitudes (eg, reflexivity) that residents need to become competent in ACP and identified needs for future training. In terms of the 4C/ID, these needs revolved around: (1) learning tasks (eg, workplace practice, simulated scenarios); (2) supportive information (eg, videotaped worked examples, cognitive feedback); (3) procedural information (eg, ACP pocket-sized information sheet, corrective feedback); and (4) part-task practice (eg, rehearsal of communication skills, simulation). This study provides a comprehensive description of tasks and competencies to train residents in ACP.

Translation and Validation of the Spanish Movement Imagery Questionnaire Revised Second Version (MIQ-RS).

Motor imagery, which emphasizes mental rehearsal of motor skills to improve function, is frequently used in clinical practice. Because of its increasing use, reliable and valid tools are necessary to evaluate motor imagery abilities. However, there are few questionnaires translated and validated into Spanish language. To translate, transculturally adapt, and validate the Spanish version of the Movement Imagery Questionnaire-Revised Second Version (MIQ-RS). A single-center observational study. University community. One hundred fifty-five healthy participants were recruited. Not applicable. Spanish translation of the MIQ-RS and psychometric performances of the questionnaire were tested using concurrent-criterion and content validity, construct validity, internal consistency, and test-rest reliability. Internal consistency, concurrent-criterion validity, construct validity, and test-rest reliability were assessed with Cronbach´s alpha, Spearman´s correlation coefficient, confirmatory factor analysis, and intraclass correlation coefficient (ICC), respectively. Results showed satisfactory internal consistency (Cronbach α = 0.90), test-retest reliability (ICC for visual items = 0.844 and for kinesthetic items = 0.70) and content and criterion-concurrent validity (Spearman´s correlation coefficient for visual items, 0.60 and for kinesthetic items, 0.81) of the MIQ-RS Spanish version. The two-factor structure was supported by confirmatory factor analysis. Statistically significant gender differences were observed in mean kinesthetic motor imagery scores and in mean visual motor imagery scores according to sports practice. No significant differences for gender, age, and sports, musical, and dance practice were reported. The Spanish version of the MIQ-RS is a valid and reliable tool to assess motor imagery abilities in healthy young people.

PROTOCOL: A systematic review and meta-analysis of randomised controlled trials evaluating the impact of parenting programmes for parents of adolescents (10-18 years) on adolescent mental health outcomes, positive development and the parent-adolescent relationship.

PROTOCOL: A systematic review and meta-analysis of randomised controlled trials evaluating the impact of parenting programmes for parents of adolescents (10-18 years) on adolescent mental health outcomes, positive development and the parent-adolescent relationship.

Wesley LifeForce Suicide Prevention Gatekeeper Training in Australia: 6 Month Follow-Up Evaluation of Full and Half Day Community Programs.

Background and Objective: Wesley Mission LifeForce training is an Australian suicide prevention gatekeeper program which has not been formally evaluated. The aims of this evaluation were to (1) determine the short- and medium- term impacts of the training on worker capabilities (perceived and declarative knowledge), attitudes, and reluctance to intervene measures; and (2) compare the impact of the half and full day workshops on these measures.Method: 1,079 Australian community workers of diverse professional backgrounds completed a pre-workshop questionnaire as part of registration for the Wesley LifeForce suicide prevention training between 2017 and 2019. Of these, 299 participants also completed the post workshop questionnaires (matched sample). They attended either half day (n = 97) or full day workshops (n = 202) and completed also a 3- and 6- month follow-up questionnaire. We used linear mixed-effect modeling for repeated measures to analyze data.Results: LifeForce training participants experienced an increase in perceived capability, declarative knowledge, more positive attitudes and reduced reluctance to intervene, at least in the short term. The program is particularly well targeted for community gatekeepers with no prior training, albeit those with prior training in this study also experienced positive and significant gains on most measured constructs.Conclusions: We found evidence of effectiveness of the Wesley LifeForce training over time, without difference between the short (half day) and longer (full day) formats of delivery. Nevertheless, the latter format offers skills-based and skills rehearsal opportunities, the impacts of which we were unable to measure in this evaluation and should be estimated in the future.

What got in the way? Caregiver-reported challenges to home practice of assigned intervention skills.

Evidence-based intervention (EBI) effectiveness is hindered by low rates of caregiver home practice, or caregiver rehearsal of intervention skills at home. Although home practice is essential to intervention success, we know little about what makes home practice difficult to complete. We sought to identify the challenges caregivers face when attempting home practice assignments within the context of community implementation of a family-based preventative EBI. We also aimed to identify barriers, perceived need, and implementation-related factors that may contribute to frequency of home practice challenges. The family-based preventative intervention Bridges was delivered to caregivers and adolescents in three public middle schools in North America within a randomized efficacy-effectiveness hybrid trial. Caregivers (N = 233) completed worksheets in which they reported challenges to home practice of intervention skills. Caregiver-endorsed challenges were coded for emergent themes and categorized into higher-order home practice challenge domains. Additional data was gathered through multiple methods. In addition to descriptive analyses, multilevel linear regressions were conducted to identify factors associated with frequency of home practice challenge domains. Over 85% of caregivers reported one or more home practice challenges. Challenges fell into six domains: daily stresses, cognitions/beliefs about the intervention/practice, caregiver wellness/regulation, adolescent responsiveness, relevance/acceptability of intervention or assignment, and external barriers to practice. Adolescent externalizing symptoms, academic performance, and caregiver participation in the English-language intervention group (compared to Spanish-language delivery) were associated with greater frequency of reported challenges. Among caregivers already attending intervention sessions, specific support to overcome challenges in daily stresses and beliefs about the intervention/practice can support greater home practice compliance, which in turn may impact overall intervention effectiveness. Findings suggest that providing services in caregivers' preferred language may avert potential challenges. Further research into home practice challenges is necessary to identify appropriate home practice implementation supports. Low rates and poor quality of caregiver home practice of intervention skills hampers intervention effectiveness, but no prior studies have identified the difficulties caregivers face when attempting home practice of intervention skills and their rates of occurrence. Within a community implementation of a family-based preventative intervention, we found that difficulties were common and largely fell in the domains theorized to impact engagement, such as daily stresses and beliefs about the intervention/practice. Findings also suggest that providing services and materials in caregivers' preferred language may avert potential home practice challenges. By identifying common home practice challenges and correlates of different challenges, our findings point to a need to develop appropriate and effective home practice implementation support.

Task Sharing or Task Dumping: Counsellors Experiences of Delivering a Psychosocial Intervention for Mental Health Problems in South Africa

Given task-sharing mental health counselling to non-specialist providers is a recognised strategy to increase service capacity, ensuring that their training, supervision, and support needs are met is necessary to facilitate the sustainable delivery of a high-quality service. Using in-depth interviews, we qualitatively explored the experiences of 18 facility-based counsellors (FBCs) tasked with delivering a counselling intervention within chronic disease services offered within primary care facilities participating in the project MIND cluster randomised controlled trial. Findings show that project MIND training with a strong emphasis on role playing and skills rehearsal improved FBCs’ confidence and competence, complemented by highly structured supervision and debriefing provided by a registered counsellor, were key strategies for supporting the implementation of task-shared mental health counselling. FBCs perceived many benefits to providing mental health counselling in primary healthcare but systemic interventions are needed for sustained implementation.

Targeting affect leads to reduced paranoia in people with psychosis: a single case series

Current psychological interventions for psychosis focus primarily on cognitive and behavioural management of delusions and hallucinations, with modest outcomes. Emotions are not usually targeted directly, despite evidence that people with psychosis have difficulty identifying, accepting and modifying affective states. This study assessed the impact of emotion regulation skills practice on affect and paranoia in seven people who met criteria for a diagnosis of schizophrenia or schizoaffective disorder. The study utilised a single case ABA design and measured emotion regulation skills, affect and paranoia over baseline, intervention and withdrawal of intervention phases. We predicted that eight sessions of skills rehearsal would lead to improved emotion regulation, reduced negative affect, increased positive affect, and reduced paranoia. Most participants were able to learn to regulate their emotions, and reported reduced negative affect and paranoia. There was no clear pattern of change for positive affect. These findings suggest that emotion can be targeted in psychosis, and is associated with reduced paranoia. Emotion regulation may constitute a key treatment target in cognitive behavioural therapy for psychosis.

Virtual Standardized Patients vs Academic Training for Learning Motivational Interviewing Skills in the US Department of Veterans Affairs and the US Military

Despite the need for effective and scalable training in motivational interviewing (MI) that includes posttraining coaching and feedback, limited evidence exists regarding the effectiveness of using virtual (computerized) standardized patients (VSPs) in such training. To evaluate the efficacy of training with a VSP on the acquisition and maintenance of MI skills compared with traditional academic study. This study was a 2-group, parallel-training randomized trial of 120 volunteer health care professionals recruited from a Department of Veterans Affairs and Department of Defense medical facility. Motivational interviewing skill was coded by external experts blinded to training group and skill assessment time points. Data were collected from October 17, 2016, to August 12, 2019. After a computer course on MI, participants trained during two 45-minute sessions separated by 3 months. The 2 randomized training conditions included a branching storyline VSP, which provided MI skill rehearsal with immediate and summative feedback, and a control condition, which included academic study of content from the computerized MI course. Measurement of MI skill was based on recorded conversations with human standardized patients, assessed using the Motivational Interviewing Treatment Integrity 4.2.1 coding system, measured at baseline, after training, and after additional training in the randomized condition 3 months later. A total of 120 volunteers (83 [69%] women), with a mean (SD) of 13.6 (10.3) years of health care experience, participated in the study; 61 were randomized to receive the intervention, and 59 were randomized to the control group. Those assigned to VSP training had significantly greater posttraining improvement in technical global scores (0.23; 95% CI, 0.03-0.44; P = .02), relational global scores (0.57; 95% CI, 0.33-0.81; P = .001), and the reflection-to-question ratio (0.23; 95% CI, 0.15-0.31; P = .001). Differences were maintained after the 3-month additional training session, with more improvements achieved after the 3-month training for the VSP trainees on the reflection-to- question ratio (0.15; 95% CI, 0.07-0.24; P = .001). This randomized trial demonstrated a successful transfer of training from a VSP to human standardized patients. The VSP MI skill outcomes were better than those achieved with academic study and were maintained over time. Virtual standardized patients have the potential to facilitate dissemination of MI and may be useful for training in other evidence-based skills and treatments. ClinicalTrials.gov Identifier: NCT04558060.

Adolescent experiences of app-integrated therapy

Smartphone ownership estimates indicate the vast majority of young people are engaging with smartphone devices. The medium offers a promising opportunity for psychologists to connect with young people seeking help to traverse challenges with mental health, behaviour, learning and wellbeing. However, the views of young people using apps alongside face-to-face therapy remain largely unexplored. Given that clients make the single strongest contribution to therapeutic outcomes it is important to consider the perspectives of adolescents in clinical settings. Using semistructured qualitative interviews, the experiences of seven Australian secondary school-aged adolescents (12–18 years) involved in app-integrated therapy were explored. Thematic analysis resulted in the identification of eight key themes: Between-sessions, Introduction, Responsive, Age, Mindfulness-Meditation, Connection, Knowledge, and App features. Recommending apps appears to encourage young people to take ownership of their therapy, affording opportunities for self-reflection and rehearsal of valuable skills. Further research focused on understanding the views of young people utilising apps with therapy is needed to maximise potential therapeutic benefits. Preliminary practice recommendations and future research directions are proposed.

When resuscitation doesn’t work: A qualitative study examining ambulance personnel preparation and support for termination of resuscitation and patient death

BackgroundMany ambulance personnel can withhold or terminate resuscitation on-scene, but these decisions are emotionally, ethically and cognitively challenging. Although there is a wealth of research examining training and performance of life-saving resuscitation efforts, there is little published research examining how ambulance personnel are prepared and supported for situations where resuscitation is unsuccessful, unwanted or unwarranted. AimTo identify and describe existing preparation and support mechanisms for ambulance personnel enacting decisions to terminate resuscitation and manage patient death in the field. MethodFocus groups were held with senior ambulance personnel working in clinical education and peer support roles. ResultsParticipants believed professional and personal exposure to death and dying and positive social modelling by mentors were essential preparation for ambulance personnel terminating resuscitation and managing patient death. Ambulance personnel responded to patient death idiosyncratically. Key supports included on-scene or phone back-up during the event and informal peer and managerial support after the event. ConclusionClinical and life experience is highly-valued by ambulance personnel who provide training and support. However, novice ambulance personnel may benefit from greater awareness and rehearsal of skills associated with terminating resuscitation and managing the scene of a patient death. Organisations need to acknowledge idiosyncratic staff needs and offer a variety of support mechanisms both during and after the event.

Optimus BONUS: open access simulation-based education packages on paediatric resuscitation using spaced repetition and deliberate practice

Open access paediatric healthcare simulations are relatively scarce.1 2 In addition, freely available scenarios are packaged as isolated educational experiences separate from the broader educational needs of individuals and institutions....

Housing structure and occupant behaviour to increase the environmental and health co-benefits of housing: Insights from expert interviews in New Zealand

Both housing structure and occupant use of homes influence health outcomes and carbon emissions. However, it remains unclear how these elements interact. We conducted semi-structured interviews with 13 technical experts in the New Zealand housing and health sectors. We applied the general inductive method for qualitative data analysis and generated frameworks for ‘housing structure’ and ‘occupant behaviour’ including: (i) issues or barriers, (ii) solutions or facilitators and (iii) potential interventions. Addressing the location, aspect and design of the house were seen to offer the greatest gains in energy efficiency, indoor temperature and air quality. Insulation, heating and ventilation were the most critical technologies for promoting health. Raising consumer expectations of housing standards was thought to be critical to boost demand and drive supply for better quality housing. Participants proposed that sharing personal stories, combining information with active strategies (demonstration, skill rehearsal) and providing incentives were promising strategies to realise the full potential of health-enhancing home design. Schools and the local community were identified as suitable settings. We conclude that public health interventions should not only aim to build homes that maximise health and environmental outcomes but must also pay attention to how occupants behave and interface with their houses.

Preparing Social Work Graduates for Digital Practice: Ethical Pedagogies for Effective Learning

ABSTRACTDebate has arisen in social work about the value of online education, with proponents providing examples of innovative approaches to online teaching and those against it citing the need for face-to-face interactions to suitably teach and assess social work skills. At the same time, social workers are increasingly making use of social media, websites, online databases, email, and text messaging services for work with clients. Consequently, social workers must be adequately prepared to make use of online technologies in their practice. Drawing on examples of online interactive activities used at two regional universities and informed by Chi’s conceptual framework of cognitive processes of learning, this article argues that learning via information and communications technology (ICT) helps prepare graduates for emerging digital practice and should be an integral part of social work education. Further, ICT enables educators to monitor the levels and quality of student rehearsal of practice skills and knowledge in interactive learning experiences helping promote competent practice, grounded in social work values.

NON-CONTACT INJURY INCIDENCE AND WARM UP OBSERVATION IN HOCKEY IN SCOTLAND

Noncontact injuries occur during manoeuvres such as landing, accelerating and the side-cut. This investigation has assessed the prevalence and manoeuvres associated with noncontact injuries and the current warm up practice....

Enhancing Stress Management Coping Skills Using Induced Affect and Collaborative Daily Assessment

The purpose of this paper is to highlight the use of induced affect (IA) and collaborative (therapeutic) assessment (CA) as components of Cognitive-Affective Stress Management Training (CASMT). IA is a technique for rehearsing cognitive and physical relaxation coping skills under conditions of high affective arousal, which has been shown to result in high levels of coping self-efficacy. CA provides diary-based feedback to clients about the processes underlying their stress experiences and helps identify affect-arousing experiences to be targeted by IA. We include descriptions of the IA technique and an online stress and coping daily diary, as well as sample transcripts illustrating how CA is integrated into CASMT and how IA evokes high affective arousal and skills rehearsal. To illustrate idiographic assessment, we also describe three treatment cases involving female clients between the ages of 20 and 35 with anxiety symptoms who participated in 6 weeks of CASMT and reported their daily stress and coping experiences (before, during, and following the intervention) for a total of 10 weeks. The resulting time series data, analyzed using Simulation Modeling Analysis (SMA), revealed that all clients reported improved negative affect regulation over the course of treatment, yet they exhibited idiographic patterns of change on other outcome and coping skills variables. These results illustrate how IA and CA may be used to enhance emotional self-regulation and how time-series analyses can identify idiographic aspects of treatment response that would not be evident in group data.

Development of a behaviour change intervention: a case study on the practical application of theory

BackgroundUse of theory in implementation of complex interventions is widely recommended. A complex trial intervention, to enhance self-management support for people with osteoarthritis (OA) in primary care, needed to be implemented in the Managing Osteoarthritis in Consultations (MOSAICS) trial. One component of the trial intervention was delivery by general practitioners (GPs) of an enhanced consultation for patients with OA. The aim of our case study is to describe the systematic selection and use of theory to develop a behaviour change intervention to implement GP delivery of the enhanced consultation.MethodsThe development of the behaviour change intervention was guided by four theoretical models/frameworks: i) an implementation of change model to guide overall approach, ii) the Theoretical Domains Framework (TDF) to identify relevant determinants of change, iii) a model for the selection of behaviour change techniques to address identified determinants of behaviour change, and iv) the principles of adult learning. Methods and measures to evaluate impact of the behaviour change intervention were identified.ResultsThe behaviour change intervention presented the GPs with a well-defined proposal for change; addressed seven of the TDF domains (e.g., knowledge, skills, motivation and goals); incorporated ten behaviour change techniques (e.g., information provision, skills rehearsal, persuasive communication); and was delivered in workshops that valued the expertise and professional values of GPs. The workshops used a mixture of interactive and didactic sessions, were facilitated by opinion leaders, and utilised ‘context-bound communication skills training.’ Methods and measures selected to evaluate the behaviour change intervention included: appraisal of satisfaction with workshops, GP report of intention to practise and an assessment of video-recorded consultations of GPs with patients with OA.ConclusionsA stepped approach to the development of a behaviour change intervention, with the utilisation of theoretical frameworks to identify determinants of change matched with behaviour change techniques, has enabled a systematic and theory-driven development of an intervention designed to enhance consultations by GPs for patients with OA. The success of the behaviour change intervention in practice will be evaluated in the context of the MOSAICS trial as a whole, and will inform understanding of practice level and patient outcomes in the trial.