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Andersson, E. K., Müssener, U., Linderoth, C., Karlsson, N., Bendtsen, P. & Bendtsen, M. (2018). Effectiveness of a Text Messaging-Based Intervention Targeting Alcohol Consumption Among University Students: Randomized Controlled Trial. JMIR mhealth and uhealth, 6(6), Article ID e146.
Open this publication in new window or tab >>Effectiveness of a Text Messaging-Based Intervention Targeting Alcohol Consumption Among University Students: Randomized Controlled Trial
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2018 (English)In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 6, no 6, article id e146Article in journal (Refereed) Published
Abstract [en]

Background: Excessive drinking among university students is a global challenge, leading to significant health risks. However, heavy drinking among students is widely accepted and socially normalized. Mobile phone interventions have attempted to reach students who engage in excessive drinking. A growing number of studies suggest that text message-based interventions could potentially reach many students and, if effective, such an intervention might help reduce heavy drinking in the student community. Objective: The objective of this study was to test the effectiveness of a behavior change theory-based 6-week text message intervention among university students. Methods: This study was a two-arm, randomized controlled trial with an intervention group receiving a 6-week text message intervention and a control group that was referred to treatment as usual at the local student health care center. Outcome measures were collected at baseline and at 3 months after the initial invitation to participate in the intervention. The primary outcome was total weekly alcohol consumption. Secondary outcomes were frequency of heavy episodic drinking, highest estimated blood alcohol concentration, and number of negative consequences attributable to excessive drinking. Results: A total of 896 students were randomized to either the intervention or control group. The primary outcome analysis included 92.0% of the participants in the intervention group and 90.1% of the control group. At follow-up, total weekly alcohol consumption decreased in both groups, but no significant between-group difference was seen. Data on the secondary outcomes included 49.1% of the participants in the intervention group and 41.3% of the control group. No significant between-group difference was seen for any of the secondary outcomes. Conclusions: The present study was under-powered, which could partly explain the lack of significance. However, the intervention, although theory-based, needs to be re-assessed and refined to better support the target group. Apart from establishing which content forms an effective intervention, the optimal length of an alcohol intervention targeting students also needs to be addressed in future studies.

Place, publisher, year, edition, pages
JMIR PUBLICATIONS, INC, 2018
Keywords
alcohol consumption intervention; text message-based intervention; university students; brief intervention
National Category
Substance Abuse
Identifiers
urn:nbn:se:liu:diva-149731 (URN)10.2196/mhealth.9642 (DOI)000436207100005 ()29941417 (PubMedID)
Note

Funding Agencies|Public Health Agency in Sweden [05670-2014-6.2]

Available from: 2018-07-24 Created: 2018-07-24 Last updated: 2018-08-14
Johansson Capusan, A., Kuja-Halkola, R., Bendtsen, P., Viding, E., McCrory, E., Marteinsdottir, I. & Larsson, H. (2016). Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study. Psychological Medicine, 46(12), 2637-2646
Open this publication in new window or tab >>Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study
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2016 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 12, p. 2637-2646Article in journal (Refereed) Published
Abstract [en]

Background

Childhood maltreatment (CM) has been associated with increased risk of attention deficit hyperactivity disorder (ADHD) in children and adults. It is, however, unclear whether this association is causal or due to familial confounding.

Method

Data from 18 168 adult twins, aged 20–46 years, were drawn from the population-based Swedish twin registry. Retrospective self-ratings of CM (emotional and physical neglect, physical and sexual abuse and witnessing family violence), and self-ratings for DSM-IV ADHD symptoms in adulthood were analysed. Possible familial confounding was investigated using a within twin-pair design based on monozygotic (MZ) and dizygotic (DZ) twins.

esults

CM was significantly associated with increased levels of ADHD symptom scores in adults [regression coefficient: 0.40 standard deviations, 95% confidence interval (CI) 0.37–0.43]. Within twin-pair analyses showed attenuated but significant estimates within DZ (0.29, 95% CI 0.21–0.36) and MZ (0.18, 95% CI 0.10–0.25) twin pairs. Similar results emerged for hyperactive/impulsive and inattentive ADHD symptom scores separately in association with CM. We conducted sensitivity analyses for early maltreatment, before age 7, and for abuse and neglect separately, and found similarly reduced estimates in DZ and MZ pairs. Re-traumatization after age 7 did not significantly influence results.

Conclusions

CM was significantly associated with increased ADHD symptoms in adults. Associations were partly due to familial confounding, but also consistent with a causal interpretation. Our findings support cognitive neuroscience studies investigating neural pathways through which exposure to CM may influence ADHD. Clinicians treating adults with ADHD should be aware of the association with maltreatment.

Place, publisher, year, edition, pages
Cambridge: Cambridge University Press, 2016
Keywords
Adult ADHD; childhood maltreatment; environmental risk; familial confounding; twins
National Category
Public Health, Global Health, Social Medicine and Epidemiology Psychiatry Occupational Health and Environmental Health Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-130714 (URN)10.1017/S0033291716001021 (DOI)000382567600016 ()27376862 (PubMedID)
Note

Funding agencies: Swedish Research Council [2014-3831, LIO-440851]

Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2018-01-10Bibliographically approved
Johansson Capusan, A., Bendtsen, P., Marteinsdottir, I. & Larsson, H. (2016). Comorbidity of Adult ADHD and Its Subtypes With Substance Use Disorder in a Large Population-Based Epidemiological Study.. Journal of Attention Disorders
Open this publication in new window or tab >>Comorbidity of Adult ADHD and Its Subtypes With Substance Use Disorder in a Large Population-Based Epidemiological Study.
2016 (English)In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: The objective of the study is to explore the role and possible substance preference in ADHD and subtypes in substance use disorder (SUD).

METHOD: Using self-report data on ADHD Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) symptoms and SUD (alcohol, illicit drugs, and nicotine) in 18,167 Swedish twins, aged 20 to 45 years, we obtained odds ratios (OR) from mixed effect logistic regression, controlling for age, sex, education, and nonindependence of twin data.

RESULTS: Increased ADHD symptoms were significantly associated with increased odds for all SUD. ORs ranged between 1.33 for regular nicotine (95% confidence interval [CI] = [1.12, 1.59]); 2.54 for multiple drug use (95% CI = [2.00, 3.23]), and 3.58 for alcohol dependence (95% CI = [2.86, 4.49]).

CONCLUSION: ADHD symptoms and subtypes in the population are associated with increased risks for all SUD outcomes, with no difference between ADHD subtypes, no substance preference, and no sex differences for the comorbidity. Clinicians need to consider ADHD evaluation and treatment as part of management of SUD in adults.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
ADHD subtypes; adult ADHD; alcohol; comorbidity; substance-related disorders
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-126285 (URN)10.1177/1087054715626511 (DOI)26838558 (PubMedID)
Available from: 2016-03-21 Created: 2016-03-21 Last updated: 2017-11-30
Müssener, U., Bendtsen, M., Karlsson, N., White, I. R., Mccambridge, J. & Bendtsen, P. (2016). Effectiveness of Short Message Service Text-Based Smoking Cessation Intervention Among University Students A Randomized Clinical Trial. JAMA Internal Medicine, 176(3), 321-328
Open this publication in new window or tab >>Effectiveness of Short Message Service Text-Based Smoking Cessation Intervention Among University Students A Randomized Clinical Trial
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2016 (English)In: JAMA Internal Medicine, ISSN 2168-6106, E-ISSN 2168-6114, Vol. 176, no 3, p. 321-328Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Smoking is globally the most important preventable cause of ill health and death. Mobile telephone interventions and, in particular, short message service (SMS) text messaging, have the potential to overcome access barriers to traditional health services, not least among young people. OBJECTIVE To determine the effectiveness of a text-based smoking cessation intervention among young people. DESIGN, SETTING, AND PARTICIPANTS A single-blind, 2-arm, randomized clinical trial (Nicotine Exit [NEXit]) was conducted from October 23, 2014, to April 17, 2015; data analysis was performed from April 23, 2014, to May 22, 2015. Participants included daily or weekly smokers willing to set a quit date within 1 month of enrollment. The study used email to invite all college and university students throughout Sweden to participate. INTERVENTIONS The NEXit core program is initiated with a 1- to 4-week motivational phase during which participants can choose to set a stop date. The intervention group then received 157 text messages based on components of effective smoking cessation interventions for 12 weeks. The control group received 1 text every 2 weeks thanking them for participating in the study, with delayed access to the intervention. MAIN OUTCOMES AND MEASURES The primary outcomes were self-reported prolonged abstinence (not having smoked >5 cigarettes over the past 8 weeks) and 4-week point prevalence of complete smoking cessation shortly after the completion of the intervention (approximately 4 months after the quit date). RESULTS A total of 1590 participants, mainly between 21 and 30 years of age, were randomized into the study; 827 (573 [69.3%] women) were allocated to the intervention group and 763 (522 [68.4%] women) were included in the control group. Primary outcome data were available for 783 (94.7%) of the intervention group and 719 (94.2%) of the control group. At baseline, participants were smoking a median (range) of 63 (1-238) and 70 (2-280) cigarettes per week, respectively. Eight-week prolonged abstinence was reported by 203 participants (25.9%) in the intervention group and 105 (14.6%) in the control group; 4-week point prevalence of complete cessation was reported by 161 (20.6%) and 102 (14.2%) participants, respectively, a mean (SD) of 3.9 (0.37) months after the quit date. The adjusted odds ratios (95% CIs) for these findings were 2.05 (1.57-2.67) and 1.56 (1.19-2.05), respectively. CONCLUSIONS AND RELEVANCE With the limitation of assessing only the short-term effect of the intervention, the effects observed in this trial are comparable with those for traditional smoking cessation interventions. The simple NEXit intervention has the potential to improve the uptake of effective smoking cessation interventions.

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC, 2016
National Category
Basic Medicine Computer and Information Sciences
Identifiers
urn:nbn:se:liu:diva-127282 (URN)10.1001/jamainternmed.2015.8260 (DOI)000372302500008 ()26903176 (PubMedID)
Note

Funding Agencies|Swedish Research Council [521-2012-2865]; Swedish Medical Research Council [U105260558]

Available from: 2016-04-20 Created: 2016-04-19 Last updated: 2018-01-10
Johansson Capusan, A., Bendtsen, P., Marteinsdottir, I., Kuja-Halkola, R. & Larsson, H. (2015). Genetic and environmental contributions to the association between attention deficit hyperactivity disorder and alcohol dependence in adulthood: A large population-based twin study.. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 168(6), 414-422
Open this publication in new window or tab >>Genetic and environmental contributions to the association between attention deficit hyperactivity disorder and alcohol dependence in adulthood: A large population-based twin study.
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2015 (English)In: American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, ISSN 1552-4841, E-ISSN 1552-485X, Vol. 168, no 6, p. 414-422Article in journal (Refereed) Published
Abstract [en]

Previous research indicates that attention deficit hyperactivity disorder (ADHD) frequently co-occurs with alcohol dependence; however, the extent to which shared genetic risk factors underpin this association remains unclear. The aim of this study is to investigate the relative importance of genetic, shared, and nonshared environmental factors for the overlap between ADHD and alcohol dependence in adults. Almost 18,000 adult twins aged 20-45 years, from more than 12,000 twin pairs (5,420 complete pairs), from the population-representative Swedish Twin Registry, were included. Self-ratings were used to assess symptoms of ADHD and alcohol dependence. Twin analysis was used to determine the role of additive genetic (A), shared (C), and nonshared environmental (E) factors. As a result, we found a significant association between ADHD and alcohol dependence (odds ratio 3.58; 95% confidence interval, 2.85-4.49). Twin analysis suggested that shared genetic risk factors explained 64% of the overlap between ADHD and alcohol dependence. Nonshared environmental factors accounted for the remaining 36%, whereas the contribution of shared environmental factors was minimal. We found no support for statistically significant sex differences in the overlap between ADHD and alcohol dependence. In conclusion the overlap between ADHD and alcohol dependence in adulthood was largely explained by shared genetic risk factors. This is an important step toward understanding the underlying nature of the risk of alcohol dependence in patients with ADHD and suggests that individuals with ADHD and their family members are important targets for alcohol prevention and treatment.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
National Category
Substance Abuse
Identifiers
urn:nbn:se:liu:diva-116624 (URN)10.1002/ajmg.b.32300 (DOI)000360052200003 ()25711682 (PubMedID)
Available from: 2015-03-27 Created: 2015-03-27 Last updated: 2017-12-04
Andersson, K., Krevers, B. & Bendtsen, P. (2015). Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative. BMC Health Services Research, 15(31)
Open this publication in new window or tab >>Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative
2015 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, no 31Article in journal (Refereed) Published
Abstract [en]

Background:

Non-communicable diseases are a leading cause of death and can largely be prevented by healthy lifestyles. Health care organizations are encouraged to integrate healthy lifestyle promotion in routine care. This study evaluates the impact of a team initiative on healthy lifestyle promotion in primary care.

Methods: A quasi-experimental, cross-sectional design compared three intervention centres that had implemented lifestyle teams with three control centres that used a traditional model of care. Outcomes were defined using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting regular practice of lifestyle promotion; implementation, fidelity to the original lifestyle team protocol. Data collection methods included a patient questionnaire (n = 888), a staff questionnaire (n = 120) and structured interviews with all practice managers and, where applicable, team managers (n = 8). The chi square test and problem-driven content analysis was used to analyse the questionnaire and interview data, respectively.

Results:Reach: patients at control centres (48%, n = 211) received lifestyle promotion significantly more often compared with patients at intervention centres (41%, n = 169). Effectiveness: intervention staff was significantly more positive towards the effectiveness of lifestyle promotion, shared competency and how lifestyle promotion was prioritized at their centre. Adoption: 47% of staff at intervention centres and 58% at control centres reported that they asked patients about their lifestyle on a daily basis. Implementation: all intervention centres had implemented multi-professional teams and team managers and held regular meetings but struggled to implement in-house referral structures for lifestyle promotion, which was used consistently among staff.

Conclusions:Intervention centres did not show higher rates than control centres on reach of patients or adoption among staff at this stage. All intervention centres struggled to implement working referral structures for lifestyle promotion. Intervention centres were more positive on effectiveness outcomes, attitudes and competency among staff, however. Thus, lifestyle teams may facilitate lifestyle promotion practice in terms of increased responsiveness among staff, illustrated by positive attitudes and perceptions of shared competency. More research is needed on lifestyle promotion referral structures in primary care regarding their configuration and implementation.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
Healthy lifestyle promotion; Primary care; Implementation fidelity; Coordination of care; RE-AIM framework
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-114581 (URN)10.1186/s12913-015-0688-4 (DOI)000348819200002 ()25608734 (PubMedID)
Note

Funding Agencies|Ostergotland County Council; Linkoping University

Available from: 2015-02-27 Created: 2015-02-26 Last updated: 2018-08-14
Bendtsen, P., Bendtsen, M., Karlsson, N., White, I. R. & McCambridge, J. (2015). Online Alcohol Assessment and Feedback for Hazardous and Harmful Drinkers: Findings From the AMADEUS-2 Randomized Controlled Trial of Routine Practice in Swedish Universities. Journal of Medical Internet Research, 17(7), e170
Open this publication in new window or tab >>Online Alcohol Assessment and Feedback for Hazardous and Harmful Drinkers: Findings From the AMADEUS-2 Randomized Controlled Trial of Routine Practice in Swedish Universities
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2015 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 17, no 7, p. e170-Article in journal (Refereed) Published
Abstract [en]

Background: Previous research on the effectiveness of online alcohol interventions for college students has shown mixed results. Small benefits have been found in some studies and because online interventions are inexpensive and possible to implement on a large scale, there is a need for further study. Objective: This study evaluated the effectiveness of national provision of a brief online alcohol intervention for students in Sweden. Methods: Risky drinkers at 9 colleges and universities in Sweden were invited by mail and identified using a single screening question. These students (N=1605) gave consent and were randomized into a 2-arm parallel group randomized controlled trial consisting of immediate or delayed access to a fully automated online assessment and intervention with personalized feedback. Results: After 2 months, there was no strong evidence of effectiveness with no statistically significant differences in the planned analyses, although there were some indication of possible benefit in sensitivity analyses suggesting an intervention effect of a 10% reduction (95% CI -30% to 10%) in total weekly alcohol consumption. Also, differences in effect sizes between universities were seen with participants from a major university (n=365) reducing their weekly alcohol consumption by 14% (95% CI -23% to -4%). However, lower recruitment than planned and differential attrition in the intervention and control group (49% vs 68%) complicated interpretation of the outcome data. Conclusions: Any effects of current national provision are likely to be small and further research and development work is

Place, publisher, year, edition, pages
Journal of Medical Internet Research / JMIR Publications, 2015
Keywords
alcohol drinking; behavior therapy; students; Internet; electronic mail; feedback
National Category
Basic Medicine Computer and Information Sciences
Identifiers
urn:nbn:se:liu:diva-120461 (URN)10.2196/jmir.4020 (DOI)000358010200001 ()26159179 (PubMedID)
Note

Funding Agencies|Swedish Council for Working Life and Social Research (FAS, in Swedish) [2010-0024]; Wellcome Trust Research Career Development fellowship in Basic Biomedical Science [WT086516MA]; Medical Research Council [U105260558]

Available from: 2015-08-12 Created: 2015-08-11 Last updated: 2018-01-11
Bendtsen, P., Anderson, P., Wojnar, M., Newbury-Birch, D., Müssener, U., Colom, J., . . . Gual, A. (2015). Professionals Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study. Alcohol and Alcoholism, 50(4), 430-437
Open this publication in new window or tab >>Professionals Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study
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2015 (English)In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 50, no 4, p. 430-437Article in journal (Refereed) Published
Abstract [en]

To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals. Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%. The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.

Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy B - Oxford Open Option D, 2015
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-120454 (URN)10.1093/alcalc/agv020 (DOI)000357867100009 ()25787012 (PubMedID)
Note

Funding Agencies|Netherlands Organization for Health Research and Development (ZonMW) [200310017]

Available from: 2015-08-12 Created: 2015-08-11 Last updated: 2018-01-11
Müssener, U., Bendtsen, M., Karlsson, N., White, I. R., McCambridge, J. & Bendtsen, P. (2015). SMS-based smoking cessation intervention among university students: study protocol for a randomised controlled trial (NEXit trial). Trials, 16, Article ID 140.
Open this publication in new window or tab >>SMS-based smoking cessation intervention among university students: study protocol for a randomised controlled trial (NEXit trial)
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2015 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 16, article id 140Article in journal (Refereed) Published
Abstract [en]

Background: Most smoking efforts targeting young people have so far been focused on prevention of initiation, whereas smoking cessation interventions have largely been targeted towards adult populations. Thus, there is limited evidence for effective smoking cessation interventions in young people, even though many young people want to quit smoking. Mobile communication technology has the potential to reach large numbers of young people and recent text-based smoking cessation interventions using phones have shown promising results. Methods/design: The study aims to evaluate a newly developed text-based smoking cessation intervention for students in colleges and universities in Sweden. The design is a randomised controlled trial (RCT) with a delayed/waiting list intervention control condition. The trial will be performed simultaneously in all colleges and universities served by 25 student health care centres in Sweden. Outcomes will be evaluated after 4 months, with 2 cessation primary outcomes and 4 secondary outcomes. After outcome evaluation the control group will be given access to the intervention. Discussion: The study will examine the effectiveness of a stand-alone SMS text-based intervention. The intervention starts with a motivational phase in which the participants are given an opportunity to set a quit date within 4 weeks of randomisation. This first phase and the subsequent core intervention phase of 12 weeks are totally automated in order to easily integrate the intervention into the daily routines of student and other health care settings. As well as providing data for the effectiveness of the intervention, the study will also provide data for methodological analyses addressing a number issues commonly challenging in Internet-based RCTs. For example, an extensive follow-up strategy will be used in order to evaluate the use of repeated attempts in the analysis, and in particular to explore the validity of a possible missing not at random assumption that the odds ratio between the primary outcome and response is the same at every attempt.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
: Tobacco, Smoking cessation, Students, Text messages, Mobile phones, SMS
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-117550 (URN)10.1186/s13063-015-0640-2 (DOI)000353116200001 ()25872503 (PubMedID)
Available from: 2015-05-04 Created: 2015-05-04 Last updated: 2017-12-04
Thomas, K., Bendtsen, P. & Krevers, B. (2015). Towards implementing coordinated healthy lifestyle promotion in primary care: a mixed method study. International Journal of Integrated Care, 15, Article ID e030.
Open this publication in new window or tab >>Towards implementing coordinated healthy lifestyle promotion in primary care: a mixed method study
2015 (English)In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 15, article id e030Article in journal (Refereed) Published
Abstract [en]

Background: Primary care is increasingly being encouraged to integrate healthy lifestyle promotion in routine care. However, implementation has been suboptimal. Coordinated care could facilitate lifestyle promotion practice but more empirical knowledge is needed about the implementation process of coordinated care initiatives. This study aimed to evaluate the implementation of a coordinated healthy lifestyle promotion initiative in a primary care setting.

Methods: A mixed method, convergent, parallel design was used. Three primary care centres took part in a two-year research project. Data collection methods included individual interviews, document data and questionnaires. The General Theory of Implementation was used as a framework in the analysis to integrate the data sources.

Results: Multi-disciplinary teams were implemented in the centres although the role of the teams as a resource for coordinated lifestyle promotion was not fully embedded at the centres. Embedding of the teams was challenged by differences among the staff, patients and team members on resources, commitment, social norms and roles.

Conclusions: The study highlights the importance of identifying and engaging key stakeholders early in an implementation process. The findings showed how the development phase influenced the implementation and embedding processes, which add aspects to the General Theory of Implementation.

Place, publisher, year, edition, pages
Utrecht, Netherlands: Utrecht University Library Open Access Journals, 2015
Keywords
Healthy lifestyle promotion; primary care; process evaluation; implementation; General Theory of Implementation; mixed methods
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-121491 (URN)000366093800003 ()26312058 (PubMedID)
Note

Funding agencies: Ostergotland County Council; Linkoping University

Available from: 2015-09-22 Created: 2015-09-22 Last updated: 2018-08-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5913-2903

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