16 results on '"Hardeman, Wendy"'
Search Results
2. Patient and practitioner views on a combined face-to-face and digital intervention to support medication adherence in hypertension: a qualitative study within primary care
- Author
-
Van Emmenis, Miranda, Jamison, James, Kassavou, Aikaterini, Hardeman, Wendy, Naughton, Felix, A'Court, Charlotte, Sutton, Stephen, Eborall, Helen, Van Emmenis, Miranda [0000-0002-4717-6746], Kassavou, Aikaterini [0000-0002-6562-4143], Naughton, Felix [0000-0001-9790-2796], Eborall, Helen [0000-0002-6023-3661], Apollo - University of Cambridge Repository, and Sutton, Stephen [0000-0003-1610-0404]
- Subjects
primary care ,hypertension ,Primary Health Care ,Hypertension/drug therapy ,public health ,Humans ,General Medicine ,Mobile Applications ,Qualitative Research ,Medication Adherence - Abstract
ObjectivesTo explore patients’ and healthcare practitioners’ (HCPs) views about non-adherence to hypertension medication and potential content of a combined very brief face-to-face discussion (VBI) and digital intervention (DI).MethodsA qualitative study (N=31): interviews with patients with hypertension (n=6) and HCPs (n=11) and four focus groups with patients with hypertension (n=14). Participants were recruited through general practices in Eastern England and London. Topic guides explored reasons for medication non-adherence and attitudes towards a potential intervention to support adherence. Stimuli to facilitate discussion included example SMS messages and smartphone app features, including mobile sensing. Analysis was informed methodologically by the constant comparative approach and theoretically by perceptions and practicalities approach.ResultsParticipants’ overarching explanations for non-adherence were non-intentional (forgetting) and intentional (concerns about side effects, reluctance to medicate). These underpinned their views on intervention components: messages that targeted forgetting medication or obtaining prescriptions were considered more useful than messages providing information on consequences of non-adherence. Tailoring the DI to the individuals’ needs, regarding timing and number of messages, was considered important for user engagement. Patients wanted control over the DI and information about data use associated with any location sensing. While the DI was considered limited in its potential to address intentional non-adherence, HCPs saw the potential for a VBI in addressing this gap, if conducted in a non-judgemental manner. Incorporating a VBI into routine primary care was considered feasible, provided it complemented existing GP practice software and HCPs received sufficient training.ConclusionsA combined VBI-DI can potentially address intentional and non-intentional reasons for non-adherence to hypertension medication. For optimal engagement, recommendations from this work include a VBI conducted in a non-judgmental manner and focusing on non-intentional factors, followed by a DI that is easy-to-use, highly tailored and with provision of data privacy details about any sensing technology used.
- Published
- 2022
3. Cost-Effectiveness and Value of Information Analysis of Brief Interventions to Promote Physical Activity in Primary Care
- Author
-
Gc, Vijay Singh, Suhrcke, Marc, Hardeman, Wendy, Sutton, Stephen, Wilson, Edward CF, Very Brief Interventions Programme Team, Sutton, Stephen [0000-0003-1610-0404], Wilson, Ed [0000-0002-8369-1577], and Apollo - University of Cambridge Repository
- Subjects
Adult ,Counseling ,Male ,Cost-Benefit Analysis ,Health Behavior ,physical activity ,Health Promotion ,brief intervention ,Patient Care Planning ,State Medicine ,Health Check ,primary care ,Patient Education as Topic ,Humans ,cost-effectiveness ,Exercise ,Aged ,Primary Health Care ,Uncertainty ,Middle Aged ,Actigraphy ,value of information ,Primary Prevention ,Self Care ,Treatment Outcome ,England ,Female ,Quality-Adjusted Life Years ,Risk Reduction Behavior - Abstract
BACKGROUND: Brief interventions (BIs) delivered in primary care have shown potential to increase physical activity levels and may be cost-effective, at least in the short-term, when compared with usual care. Nevertheless, there is limited evidence on their longer term costs and health benefits. OBJECTIVES: To estimate the cost-effectiveness of BIs to promote physical activity in primary care and to guide future research priorities using value of information analysis. METHODS: A decision model was used to compare the cost-effectiveness of three classes of BIs that have been used, or could be used, to promote physical activity in primary care: 1) pedometer interventions, 2) advice/counseling on physical activity, and (3) action planning interventions. Published risk equations and data from the available literature or routine data sources were used to inform model parameters. Uncertainty was investigated with probabilistic sensitivity analysis, and value of information analysis was conducted to estimate the value of undertaking further research. RESULTS: In the base-case, pedometer interventions yielded the highest expected net benefit at a willingness to pay of £20,000 per quality-adjusted life-year. There was, however, a great deal of decision uncertainty: the expected value of perfect information surrounding the decision problem for the National Health Service Health Check population was estimated at £1.85 billion. CONCLUSIONS: Our analysis suggests that the use of pedometer BIs is the most cost-effective strategy to promote physical activity in primary care, and that there is potential value in further research into the cost-effectiveness of brief (i.e.
- Published
- 2018
4. The feasibility of the PAM intervention to support treatment-adherence in people with hypertension in primary care: a randomised clinical controlled trial.
- Author
-
Kassavou, Aikaterini, Mirzaei, Venus, Shpendi, Sonia, Brimicombe, James, Chauhan, Jagmohan, Bhattacharya, Debi, Naughton, Felix, Hardeman, Wendy, Eborall, Helen, Van Emmenis, Miranda, De Simoni, Anna, Takhar, Amrit, Gupta, Pankaj, Patel, Prashanth, Mascolo, Cecilia, Prevost, Andrew Toby, Morris, Stephen, Griffin, Simon, McManus, Richard J., and Mant, Jonathan
- Subjects
PRIMARY care ,HYPERTENSION ,BLOOD pressure ,HEMOGLOBINS ,LIPIDS - Abstract
The PAM intervention is a behavioural intervention to support adherence to anti-hypertensive medications and therefore to lower blood pressure. This feasibility trial recruited 101 nonadherent patients (54% male, mean age 65.8 years) with hypertension and high blood pressure from nine general practices in the UK. The trial had 15.5% uptake and 7.9% attrition rate. Patients were randomly allocated to two groups: the intervention group (n = 61) received the PAM intervention as an adjunct to usual care; the control group (n = 40) received usual care only. At 3 months, biochemically validated medication adherence was improved by 20% (95% CI 3–36%) in the intervention than control, and systolic blood pressure was reduced by 9.16 mmHg (95% CI 5.69–12.64) in intervention than control. Improvements in medication adherence and reductions in blood pressure suggested potential intervention effectiveness. For a subsample of patients, improvements in medication adherence and reductions in full lipid profile (cholesterol 1.39 mmol/mol 95% CI 0.64–1.40) and in glycated haemoglobin (3.08 mmol/mol, 95% CI 0.42–5.73) favoured the intervention. A larger trial will obtain rigorous evidence about the potential clinical effectiveness and cost-effectiveness of the intervention. Trial registration Trial date of first registration 28/01/2019. ISRCTN74504989. https://doi.org/10.1186/ISRCTN74504989. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
5. Evaluation of a very brief pedometer-based physical activity intervention delivered in NHS Health Checks in England: The VBI randomised controlled trial.
- Author
-
Hardeman, Wendy, Mitchell, Joanna, Pears, Sally, Van Emmenis, Miranda, Theil, Florence, Gc, Vijay S., Vasconcelos, Joana C., Westgate, Kate, Brage, Søren, Suhrcke, Marc, Griffin, Simon J., Kinmonth, Ann Louise, Wilson, Edward C. F., Prevost, A. Toby, Sutton, Stephen, and VBI Research Team
- Subjects
- *
PHYSICAL activity , *MEDICAL screening , *NATIONAL health services , *PRIMARY care , *RANDOMIZED controlled trials , *NURSES' aides - Abstract
Background: The majority of people do not achieve recommended levels of physical activity. There is a need for effective, scalable interventions to promote activity. Self-monitoring by pedometer is a potentially suitable strategy. We assessed the effectiveness and cost-effectiveness of a very brief (5-minute) pedometer-based intervention ('Step It Up') delivered as part of National Health Service (NHS) Health Checks in primary care.Methods and Findings: The Very Brief Intervention (VBI) Trial was a two parallel-group, randomised controlled trial (RCT) with 3-month follow-up, conducted in 23 primary care practices in the East of England. Participants were 1,007 healthy adults aged 40 to 74 years eligible for an NHS Health Check. They were randomly allocated (1:1) using a web-based tool between October 1, 2014, and December 31, 2015, to either intervention (505) or control group (502), stratified by primary care practice. Participants were aware of study group allocation. Control participants received the NHS Health Check only. Intervention participants additionally received Step It Up: a 5-minute face-to-face discussion, written materials, pedometer, and step chart. The primary outcome was accelerometer-based physical activity volume at 3-month follow-up adjusted for sex, 5-year age group, and general practice. Secondary outcomes included time spent in different intensities of physical activity, self-reported physical activity, and economic measures. We conducted an in-depth fidelity assessment on a subsample of Health Check consultations. Participants' mean age was 56 years, two-thirds were female, they were predominantly white, and two-thirds were in paid employment. The primary outcome was available in 859 (85.3%) participants. There was no significant between-group difference in activity volume at 3 months (adjusted intervention effect 8.8 counts per minute [cpm]; 95% CI -18.7 to 36.3; p = 0.53). We found no significant between-group differences in the secondary outcomes of step counts per day, time spent in moderate or vigorous activity, time spent in vigorous activity, and time spent in moderate-intensity activity (accelerometer-derived variables); as well as in total physical activity, home-based activity, work-based activity, leisure-based activity, commuting physical activity, and screen or TV time (self-reported physical activity variables). Of the 505 intervention participants, 491 (97%) received the Step it Up intervention. Analysis of 37 intervention consultations showed that 60% of Step it Up components were delivered faithfully. The intervention cost £18.04 per participant. Incremental cost to the NHS per 1,000-step increase per day was £96 and to society was £239. Adverse events were reported by 5 intervention participants (of which 2 were serious) and 5 control participants (of which 2 were serious). The study's limitations include a participation rate of 16% and low return of audiotapes by practices for fidelity assessment.Conclusions: In this large well-conducted trial, we found no evidence of effect of a plausible very brief pedometer intervention embedded in NHS Health Checks on objectively measured activity at 3-month follow-up.Trial Registration: Current Controlled Trials (ISRCTN72691150). [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
6. Differences in objectively measured physical activity and sedentary behaviour between white Europeans and south Asians recruited from primary care: cross-sectional analysis of the PROPELS trial.
- Author
-
Biddle, Gregory J. H., Edwardson, Charlotte L., Rowlands, Alex V., Davies, Melanie J., Bodicoat, Danielle H., Hardeman, Wendy, Eborall, Helen, Sutton, Stephen, Griffin, Simon, Khunti, Kamlesh, and Yates, Thomas
- Subjects
LIGHT intensity ,CROSS-sectional method ,TYPE 2 diabetes ,PHYSICAL activity ,PRIMARY care - Abstract
Background: Self-reported data have consistently shown South Asians (SAs) to be less physically active than White Europeans (WEs) in developed countries, however objective data is lacking. Differences in sedentary time have not been elucidated in this population. This study aimed to quantify differences in objectively measured physical activity and sedentary behaviour between WEs and SAs recruited from primary care and to investigate differences in demographic and lifestyle correlates of these behaviours.Methodology: Baseline data were utilised from a randomised control trial recruiting individuals identified at high risk of type 2 diabetes from primary care. Light intensity physical activity, moderate-to-vigorous intensity physical activity (MVPA) and steps were measured using the Actigraph GT3X+, while sitting, standing and stepping time were measured using the activPAL3™. Devices were worn concurrently for seven days. Demographic (employment, sex, age, education, postcode) and behavioural (fruit and vegetable consumption, alcohol consumption, smoking status) characteristics were measured via self and interview administered questionnaires.Results: A total of 963 WE (age = 62 ± 8, female 51%) and 289 SA (age = 55 ± 11, female 43%) were included. Compared to WEs, SAs did less MVPA (24 vs 33 min/day, p = 0.001) and fewer steps (6404 vs 7405 per day, p ≤ 0.001), but sat less (516 vs 552 min/day, p ≤ 0.001) and stood more (328 vs 283 min/day, p ≤ 0.001). Ethnicity also modified the extent to which demographic and behavioural factors act as correlates of physical activity and sedentary behaviour. Differences between sex in levels of MVPA and sitting time were greater in SAs compared to WEs, with SA women undertaking the least amount of MVPA (19 min/day), the least sitting time (475 min/day) and most standing time (377 min/day) than any other group. Smoking and alcohol status also acted as stronger correlates of sitting time in SAs compared to WEs. In contrast, education level acted as a stronger correlate of physical activity in WEs compared to SAs.Conclusion: SAs were less active yet less sedentary than WEs, which demonstrates the need to tailor the behavioural targets of interventions in multi-ethnic communities. Common correlates of physical activity and sedentary behaviour also differed between ethnicities.Trial Registration: ISRCTN83465245 Trial registration date: 14/06/2012. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
7. A systematic review of the physical activity assessment tools used in primary care.
- Author
-
Smith, Toby O., McKenna, Máire C., Salter, Charlotte, Hardeman, Wendy, Richardson, Kathryn, Hillsdon, Melvyn, Hughes, Carly A., Steel, Nicholas, and Jones, Andy P.
- Subjects
PHYSICAL activity ,PRIMARY care ,MEDICAL personnel ,PHYSICAL therapy ,SYSTEMATIC reviews ,EXERCISE ,PRIMARY health care ,PSYCHOMETRICS ,RESEARCH evaluation ,RESEARCH funding - Abstract
Background: Primary care is an ideal setting for physical activity interventions to prevent and manage common long-term conditions. To identify those who can benefit from such interventions and to deliver tailored support, primary care professionals (e.g. GPs, practice nurses, physiotherapists, health care assistants) need reliable and valid tools to assess physical activity. However, there is uncertainty about the best-performing tool.Objective: To identify the tools used in the literature to assess the physical activity in primary care and describe their psychometric properties.Method: A systematic review of published and unpublished literature was undertaken up to 1 December 2016). Papers detailing physical activity measures, tools or approaches used in primary care consultations were included. A synthesis of the frequency and context of their use, and their psychometric properties, was undertaken. Studies were appraised using the Downs and Black critical appraisal tool and the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) initiative checklist.Results: Fourteen papers reported 10 physical activity assessment tools. The General Practice Physical Activity Questionnaire (GPPAQ) was most frequently reported. None of the assessment tools identified showed high reliability and validity. Intra-rater reliability ranged from kappa: 0.53 [Brief Physical Activity Assessment Tool (BPAAT)] to 0.67 (GPPAQ). Criterion validity ranged from Pearson's rho: 0.26 (GPPAQ) to 0.52 (Physical Activity Vital Sign). Concurrent validity ranged from kappa: 0.24 (GPPAQ) to 0.64 (BPAAT).Conclusion: The evidence base about physical activity assessment in primary care is insufficient to inform current practice. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
8. A randomised controlled trial of three very brief interventions for physical activity in primary care.
- Author
-
Pears, Sally, Bijker, Maaike, Morton, Katie, Vasconcelos, Joana, Parker, Richard A., Westgate, Kate, Brage, Soren, Wilson, Ed, Prevost, A. Toby, Kinmonth, Ann-Louise, Griffin, Simon, Sutton, Stephen, and Hardeman, Wendy
- Subjects
PRIMARY care ,PHYSICAL activity ,MEDICAL care costs ,HEALTH outcome assessment ,RANDOMIZED controlled trials - Abstract
Background: Very brief interventions (VBIs) for physical activity are promising, but there is uncertainty about their potential effectiveness and cost. We assessed potential efficacy, feasibility, acceptability, and cost of three VBIs in primary care, in order to select the most promising intervention for evaluation in a subsequent large-scale RCT. Methods: Three hundred and ninety four adults aged 40-74 years were randomised to a Motivational (n = 83), Pedometer (n = 74), or Combined (n = 80) intervention, delivered immediately after a preventative health check in primary care, or control (Health Check only; n = 157). Potential efficacy was measured as the probability of a positive difference between an intervention arm and the control arm in mean physical activity, measured by accelerometry at 4 weeks. Results: For the primary outcome the estimated effect sizes (95% CI) relative to the Control arm for the Motivational, Pedometer and Combined arms were respectively: +20.3 (-45.0, +85.7), +23.5 (-51.3, +98.3), and -3.1 (-69.3, +63.1) counts per minute. There was a73% probability of a positive effect on physical activity for each of the Motivational and Pedometer VBIs relative to control, but only 46% for the Combined VBI. Only the Pedometer VBI was deliverable within 5 min. All VBIs were acceptable and low cost. Conclusions: Based on the four criteria, the Pedometer VBI was selected for evaluation in a large-scale trial. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
9. PRomotion Of Physical activity through structured Education with differing Levels of ongoing Support for people at high risk of type 2 diabetes (PROPELS): study protocol for a randomized controlled trial.
- Author
-
Yates, Tom, Griffin, Simon, Bodicoat, Danielle H., Brierly, Gwen, Dallosso, Helen, Davies, Melanie J., Eborall, Helen, Edwardson, Charlotte, Gillett, Mike, Gray, Laura, Hardeman, Wendy, Hill, Sian, Morton, Katie, Sutton, Stephen, Troughton, Jacqui, and Khunti, Kamlesh
- Subjects
ROBOTICS in education ,MENTAL discipline ,EDUCATIONAL literature ,DIFFERENTIAL psychology ,MEDICAL care accountability ,TYPE 2 diabetes diagnosis ,TYPE 2 diabetes prevention ,ASIANS ,BEHAVIOR ,COMPARATIVE studies ,EXERCISE ,EXPERIMENTAL design ,HEALTH attitudes ,HEALTH promotion ,RESEARCH methodology ,MEDICAL cooperation ,MOTOR ability ,TYPE 2 diabetes ,PAMPHLETS ,PATIENT education ,PROBABILITY theory ,RESEARCH ,RESEARCH funding ,RISK assessment ,TELEPHONES ,TIME ,WHITE people ,TEXT messages ,EVALUATION research ,RANDOMIZED controlled trials ,SEDENTARY lifestyles ,EVALUATION of human services programs - Abstract
Background: The prevention of type 2 diabetes is recognised as a health care priority. Lifestyle change has proven effective at reducing the risk of type 2 diabetes, but limitations in the current evidence have been identified in: the promotion of physical activity; availability of interventions that are suitable for commissioning and implementation; availability of evidence-based interventions using new technologies; and physical activity promotion among ethnic minorities. We aim to investigate whether a structured education programme with differing levels of ongoing support, including text-messaging, can increase physical activity over a 4 year period in a multi-ethnic population at high risk of diabetes.Methods/design: A multi-centre randomised controlled trial, with follow-up at 12 and 48 months. The primary outcome is change in ambulatory activity at 48 months. Secondary outcomes include changes to markers of metabolic, cardiovascular, anthropometric and psychological health along with cost-effectiveness. Participants aged 40-74 years for White European, or 25-74 years for South Asians, with an HbA1c value of between 6.0 and < 6.4% (42 and 47 mmol/mol) or with a previously recorded plasma glucose level or HbA1c value within the high risk (prediabetes) range within the last five years, are invited to take part in the trial. Participants are identified through primary care, using an automated diabetes risk score within their practice database, or from a database of previous research participants. Participants are randomly assigned to either: 1) the control group who receive a detailed advice leaflet; 2) the Walking Away group, who receive the same leaflet and attend a 3 hour structured education programme with annual maintenance sessions delivered in groups; or 3) the Walking Away Plus group, who receive the leaflet, attend the structured education programme with annual maintenance sessions, plus receive follow-on support through highly-tailored text-messaging and telephone calls to help to aid pedometer use and behaviour change.Discussion: This study will provide new evidence for the long-term effectiveness of a structured education programme focused on physical activity, conducted within routine care in a multi-ethnic population in the UK. It will also investigate the impact of different levels of ongoing support and the cost-effectiveness of each intervention.Trial Registration: ISRCTN83465245 Trial registration date: 14/06/2012. [ABSTRACT FROM AUTHOR]- Published
- 2015
- Full Text
- View/download PDF
10. Development and feasibility study of very brief interventions for physical activity in primary care.
- Author
-
Pears, Sally, Morton, Katie, Bijker, Maaike, Sutton, Stephen, and Hardeman, Wendy
- Subjects
HEALTH care intervention (Social services) ,PHYSICAL activity ,PRIMARY care ,PUBLIC health ,BEHAVIOR modification ,HEALTH promotion ,BOOKLET Category Test - Abstract
Background: There is increasing interest in brief and very brief behaviour change interventions for physical activity as they are potentially scalable to the population level. However, few very brief interventions (VBIs) have been published, and evidence is lacking about their feasibility, acceptability and which 'active ingredients' (behaviour change techniques) would maximise their effectiveness. The aim of this research was to identify and develop promising VBIs for physical activity and test their feasibility and acceptability in the context of preventive health checks in primary care. Methods: The process included two stages, guided by four criteria: effectiveness, feasibility, acceptability, and cost. In Stage 1, we used an iterative approach informed by systematic reviews, a scoping review of BCTs, team discussion, stakeholder consultation, a qualitative study, and cost estimation to guide the development of promising VBIs. In Stage 2, a feasibility study assessed the feasibility and acceptability of the short-listed VBIs, using tape-recordings and interviews with practitioners (n = 4) and patients (n = 68), to decide which VBIs merited further evaluation in a pilot trial. Results: Four VBIs were short-listed: Motivational intervention; Action Planning intervention; Pedometer intervention; and Physical Activity Diary intervention. All were deliverable in around five minutes and were feasible and acceptable to participants and practitioners. Based on the results of interviews with practitioners and patients, techniques from the VBIs were combined into three new VBIs for further evaluation in a pilot trial. Conclusions: Using a two-stage approach, in which we considered the practicability of VBIs (acceptability, feasibility and cost) alongside potential efficacy from the outset, we developed a short-list of four promising VBIs for physical activity and demonstrated that they were acceptable and feasible as part of a preventive health check in primary care. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
11. Protocol for the ADDITION-Plus study: a randomised controlled trial of an individuallytailored behaviour change intervention among people with recently diagnosed type 2 diabetes under intensive UK general practice care.
- Author
-
Griffin, Simon J., Simmons, Rebecca K., Williams, Kate M., Prevost, A. Toby, Hardeman, Wendy, Grant, Julie, Whittle, Fiona, Boase, Sue, Hobbis, Imogen, Brage, Soren, Westgate, Kate, Fanshawe, Tom, Sutton, Stephen, Wareham, Nicholas J., and Kinmonth, Ann Louise
- Subjects
PEOPLE with diabetes ,PRIMARY care ,SMOKING ,PHYSICAL activity - Abstract
Background: The increasing prevalence of type 2 diabetes poses both clinical and public health challenges. Costeffective approaches to prevent progression of the disease in primary care are needed. Evidence suggests that intensive multifactorial interventions including medication and behaviour change can significantly reduce cardiovascular morbidity and mortality among patients with established type 2 diabetes, and that patient education in selfmanagement can improve short-term outcomes. However, existing studies cannot isolate the effects of behavioural interventions promoting self-care from other aspects of intensive primary care management. The ADDITION-Plus trial was designed to address these issues among recently diagnosed patients in primary care over one year. Methods/Design: ADDITION-Plus is an explanatory randomised controlled trial of a facilitator-led, theory-based behaviour change intervention tailored to individuals with recently diagnosed type 2 diabetes. 34 practices in the East Anglia region participated. 478 patients with diabetes were individually randomised to receive (i) intensive treatment alone (n = 239), or (ii) intensive treatment plus the facilitator-led individual behaviour change intervention (n = 239). Facilitators taught patients key skills to facilitate change and maintenance of key behaviours (physical activity, dietary change, medication adherence and smoking), including goal setting, action planning, self-monitoring and building habits. The intervention was delivered over one year at the participant's surgery and included a one-hour introductory meeting followed by six 30-minute meetings and four brief telephone calls. Primary endpoints are physical activity energy expenditure (assessed by individually calibrated heart rate monitoring and movement sensing), change in objectively measured dietary intake (plasma vitamin C), medication adherence (plasma drug levels), and smoking status (plasma cotinine levels) at one year. We will undertake an intention-to-treat analysis of the effect of the intervention on these measures, an assessment of cost-effectiveness, and analyse predictors of behaviour change in the cohort. Discussion: The ADDITION-Plus trial will establish the medium-term effectiveness and cost-effectiveness of adding an externally facilitated intervention tailored to support change in multiple behaviours among intensively-treated individuals with recently diagnosed type 2 diabetes in primary care. Results will inform policy recommendations concerning the management of patients early in the course of diabetes. Findings will also improve understanding of the factors influencing change in multiple behaviours, and their association with health outcomes. Trial registration: ISRCTN: ISRCTN99175498 [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
12. Protocol for SAMS (Support and Advice for Medication Study): A randomised controlled trial of an intervention to support patients with type 2 diabetes with adherence to medication.
- Author
-
Farmer, Andrew J., Prevost, A. Toby, Hardeman, Wendy, Craven, Anthea, Sutton, Stephen, Griffin, Simon J., and Kinmonth, Ann-Louise
- Subjects
TREATMENT of diabetes ,DRUGS ,PATIENT compliance ,PRIMARY care ,OPERANT behavior - Abstract
Background: Although some interventions have been shown to improve adherence to medication for diabetes, results are not consistent. We have developed a theory-based intervention which we will evaluate in a well characterised population to test efficacy and guide future intervention development and trial design. Methods and Design: The SAMS (Supported Adherence to Medication Study) trial is a primary care based multi-centre randomised controlled trial among 200 patients with type 2 diabetes and an HbA1c of 7.5% or above. It is designed to evaluate the efficacy of a two-component motivational intervention based on the Theory of Planned Behaviour and volitional action planning to support medication adherence compared with standard care. The intervention is delivered by practice nurses. Nurses were trained using a workshop approach with role play and supervised using assessment of tape-recorded consultations. The trial has a two parallel groups design with an unbalanced three-to-two individual randomisation eight weeks after recruitment with twelve week follow-up. The primary outcome is medication adherence measured using an electronic medication monitor over 12 weeks and expressed as the difference between intervention and control in mean percentage of days on which the correct number of medication doses is taken. Subgroup analyses will explore impact of number of medications taken, age, HbA1c, and self-reported adherence at baseline on outcomes. The study also measures the effect of dispensing medication to trial participants packaged in the electronic medication-monitoring device compared with conventional medication packaging. This will be achieved through one-to-one randomisation at recruitment to these conditions with assessment of the difference between groups in self-report of medication adherence and change in mean HbA1c from baseline to eight weeks. Anonymised demographic data are collected on non-respondents. Central randomisation is carried out independently of trial coordination and practices using minimisation to adjust for selected confounders. Discussion: The SAMS intervention and trial design address weaknesses of previous research by recruitment from a well-characterised population, definition of a feasible theory based intervention to support medication taking and careful measurement to estimate and interpret efficacy. The results will inform practice and the design of a cost-effectiveness trial [ISRCTN30522359]. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
13. What do we know about brief interventions for physical activity that could be delivered in primary care consultations? A systematic review of reviews.
- Author
-
Lamming, Laura, Pears, Sally, Mason, Dan, Morton, Katie, Bijker, Maaike, Sutton, Stephen, Hardeman, Wendy, and VBI Programme Team
- Subjects
- *
PHYSICAL activity , *MEDICAL databases , *MEDLINE , *GUIDELINES , *MEDICAL consultation , *EXERCISE , *HEALTH behavior , *MEDICAL care , *MEDICAL referrals , *PATIENTS , *PRIMARY health care , *SYSTEMATIC reviews - Abstract
This systematic review of reviews aims to investigate how brief interventions (BIs) are defined, whether they increase physical activity, which factors influence their effectiveness, who they are effective for, and whether they are feasible and acceptable. We searched CINAHL, Cochrane database of systematic reviews, DARE, HTA database, EMBASE, MEDLINE, PsycINFO, Science Citation Index-Expanded and Social Sciences Citation Index, and Scottish Intercollegiate Guidelines Network from their inception until May 2015 to identify systematic reviews of the effectiveness of BIs aimed at promoting physical activity in adults, reporting a physical activity outcome and at least one BI that could be delivered in a primary care setting. A narrative synthesis was conducted. We identified three specific BI reviews and thirteen general reviews of physical activity interventions that met the inclusion criteria. The BI reviews reported varying definitions of BIs, only one of which specified a maximum duration of 30min. BIs can increase self-reported physical activity in the short term, but there is insufficient evidence about their long-term impact, their impact on objectively measured physical activity, and about the factors that influence their effectiveness, feasibility and acceptability. Current definitions include BIs that are too long for primary care consultations. Practitioners, commissioners and policy makers should be aware of this when interpreting evidence about BIs, and future research should develop and evaluate very brief interventions (of 5min or less) that could be delivered in a primary care consultation. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
14. Behavioural interventions to promote physical activity in a multiethnic population at high risk of diabetes: PROPELS three-arm RCT
- Author
-
Kamlesh Khunti, Simon Griffin, Alan Brennan, Helen Dallosso, Melanie Davies, Helen Eborall, Charlotte Edwardson, Laura Gray, Wendy Hardeman, Laura Heathcote, Joseph Henson, Katie Morton, Daniel Pollard, Stephen Sharp, Stephen Sutton, Jacqui Troughton, Thomas Yates, Khunti, Kamlesh [0000-0003-2343-7099], Griffin, Simon [0000-0002-2157-4797], Brennan, Alan [0000-0002-1025-312X], Dallosso, Helen [0000-0002-6732-0864], Davies, Melanie [0000-0002-9987-9371], Eborall, Helen [0000-0002-6023-3661], Edwardson, Charlotte [0000-0001-6485-9330], Gray, Laura [0000-0002-9284-9321], Hardeman, Wendy [0000-0002-6498-9407], Heathcote, Laura [0000-0001-8063-7447], Henson, Joseph [0000-0002-3898-7053], Morton, Katie [0000-0002-9961-6491], Pollard, Daniel [0000-0001-5630-0115], Sharp, Stephen [0000-0003-2375-1440], Sutton, Stephen [0000-0003-1610-0404], Troughton, Jacqui [0000-0003-3690-9534], Yates, Thomas [0000-0002-5724-5178], and Apollo - University of Cambridge Repository
- Subjects
Adult ,MULTIETHNIC ,Cost-Benefit Analysis ,Walking ,BEHAVIOUR CHANGE ,TYPE 2 DIABETES ,PRIMARY CARE ,Diabetes Mellitus, Type 2/prevention & control ,Medical technology ,PREDIABETES ,Humans ,MHEALTH ,R855-855.5 ,PEDOMETER ,Exercise ,Health Policy ,Middle Aged ,PREVENTION ,Actigraphy ,ETHNICITY ,Diabetes Mellitus, Type 2 ,IMPAIRED GLUCOSE REGULATION ,NON-DIABETIC HYPERGLYCAEMIA ,Quality of Life ,Female ,PHYSICAL ACTIVITY ,STRUCTURED EDUCATION ,Quality-Adjusted Life Years ,RANDOMISED CONTROLLED TRIAL - Abstract
Background Type 2 diabetes is a leading cause of mortality globally and accounts for significant health resource expenditure. Increased physical activity can reduce the risk of diabetes. However, the longer-term clinical effectiveness and cost-effectiveness of physical activity interventions in those at high risk of type 2 diabetes is unknown. Objectives To investigate whether or not Walking Away from Diabetes (Walking Away) – a low-resource, 3-hour group-based behavioural intervention designed to promote physical activity through pedometer use in those with prediabetes – leads to sustained increases in physical activity when delivered with and without an integrated mobile health intervention compared with control. Design Three-arm, parallel-group, pragmatic, superiority randomised controlled trial with follow-up conducted at 12 and 48 months. Setting Primary care and the community. Participants Adults whose primary care record included a prediabetic blood glucose measurement recorded within the past 5 years [HbA1c ≥ 42 mmol/mol (6.0%), Interventions Participants were randomised (1 : 1 : 1) using a web-based tool to (1) control (information leaflet), (2) Walking Away with annual group-based support or (3) Walking Away Plus (comprising Walking Away, annual group-based support and a mobile health intervention that provided automated, individually tailored text messages to prompt pedometer use and goal-setting and provide feedback, in addition to biannual telephone calls). Participants and data collectors were not blinded; however, the staff who processed the accelerometer data were blinded to allocation. Main outcome measures The primary outcome was accelerometer-measured ambulatory activity (steps per day) at 48 months. Other objective and self-reported measures of physical activity were also assessed. Results A total of 1366 individuals were randomised (median age 61 years, median body mass index 28.4 kg/m2, median ambulatory activity 6638 steps per day, women 49%, black and minority ethnicity 28%). Accelerometer data were available for 1017 (74%) and 993 (73%) individuals at 12 and 48 months, respectively. The primary outcome assessment at 48 months found no differences in ambulatory activity compared with control in either group (Walking Away Plus: 121 steps per day, 97.5% confidence interval –290 to 532 steps per day; Walking Away: 91 steps per day, 97.5% confidence interval –282 to 463). This was consistent across ethnic groups. At the intermediate 12-month assessment, the Walking Away Plus group had increased their ambulatory activity by 547 (97.5% confidence interval 211 to 882) steps per day compared with control and were 1.61 (97.5% confidence interval 1.05 to 2.45) times more likely to achieve 150 minutes per week of objectively assessed unbouted moderate to vigorous physical activity. In the Walking Away group, there were no differences compared with control at 12 months. Secondary anthropometric, biomechanical and mental health outcomes were unaltered in either intervention study arm compared with control at 12 or 48 months, with the exception of small, but sustained, reductions in body weight in the Walking Away study arm (≈ 1 kg) at the 12- and 48-month follow-ups. Lifetime cost-effectiveness modelling suggested that usual care had the highest probability of being cost-effective at a threshold of £20,000 per quality-adjusted life-year. Of 50 serious adverse events, only one (myocardial infarction) was deemed possibly related to the intervention and led to the withdrawal of the participant from the study. Limitations Loss to follow-up, although the results were unaltered when missing data were replaced using multiple imputation. Conclusions Combining a physical activity intervention with text messaging and telephone support resulted in modest, but clinically meaningful, changes in physical activity at 12 months, but the changes were not sustained at 48 months. Future work Future research is needed to investigate which intervention types, components and features can help to maintain physical activity behaviour change over the longer term. Trial registration Current Controlled Trials ISRCTN83465245. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 77. See the NIHR Journals Library website for further project information.
- Published
- 2022
15. Evaluation of a very brief pedometer-based physical activity intervention delivered in NHS Health Checks in England: The VBI randomised controlled trial
- Author
-
A Toby Prevost, Stephen Sutton, Soren Brage, Joana C. Vasconcelos, Ann Louise Kinmonth, Simon J. Griffin, Florence Theil, Wendy Hardeman, Joanna Mitchell, Kate Westgate, Miranda Van Emmenis, Edward C. F. Wilson, Marc Suhrcke, Sally Pears, Vijay Gc, Hardeman, Wendy [0000-0002-6498-9407], Mitchell, Joanna [0000-0003-2138-3402], Pears, Sally [0000-0002-6417-1402], Gc, Vijay S [0000-0003-0365-2605], Vasconcelos, Joana C [0000-0001-7709-4058], Westgate, Kate [0000-0002-0283-3562], Brage, Søren [0000-0002-1265-7355], Suhrcke, Marc [0000-0001-7263-8626], Griffin, Simon J [0000-0002-2157-4797], Wilson, Edward CF [0000-0002-8369-1577], Prevost, A Toby [0000-0003-1723-0796], Apollo - University of Cambridge Repository, Gc, Vijay S. [0000-0003-0365-2605], Vasconcelos, Joana C. [0000-0001-7709-4058], Griffin, Simon J. [0000-0002-2157-4797], Wilson, Edward C. F. [0000-0002-8369-1577], Prevost, A. Toby [0000-0003-1723-0796], and Wilson, Edward C F [0000-0002-8369-1577]
- Subjects
Male ,Time Factors ,Economics ,Health Care Providers ,Cost-Benefit Analysis ,Psychological intervention ,Fitness Trackers/economics ,Nurses ,Social Sciences ,030204 cardiovascular system & hematology ,Cardiovascular Medicine ,Primary Health Care/economics ,State Medicine ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,law ,Medicine and Health Sciences ,Public and Occupational Health ,030212 general & internal medicine ,Medical Personnel ,Cost–benefit analysis ,General Medicine ,Cost-effectiveness analysis ,Health Care Costs ,Middle Aged ,Healthy Volunteers ,3. Good health ,Actigraphy/economics ,Professions ,England ,Cardiovascular Diseases ,Medicine ,Engineering and Technology ,State Medicine/economics ,Female ,Behavioral and Social Aspects of Health ,Research Article ,Adult ,medicine.medical_specialty ,Drug Research and Development ,Cost-Effectiveness Analysis ,Fitness Trackers ,Research and Analysis Methods ,03 medical and health sciences ,Intervention (counseling) ,medicine ,Humans ,Clinical Trials ,Healthy Lifestyle ,Exercise ,Primary Care ,Aged ,NHS health check ,Pharmacology ,Primary Health Care ,business.industry ,Physical Activity ,Actigraphy ,Randomized Controlled Trials ,Economic Analysis ,Health Care ,Pedometer ,People and Places ,Physical therapy ,Population Groupings ,Brief intervention ,Electronics ,Accelerometers ,Clinical Medicine ,business - Abstract
Background The majority of people do not achieve recommended levels of physical activity. There is a need for effective, scalable interventions to promote activity. Self-monitoring by pedometer is a potentially suitable strategy. We assessed the effectiveness and cost-effectiveness of a very brief (5-minute) pedometer-based intervention (‘Step It Up’) delivered as part of National Health Service (NHS) Health Checks in primary care. Methods and findings The Very Brief Intervention (VBI) Trial was a two parallel-group, randomised controlled trial (RCT) with 3-month follow-up, conducted in 23 primary care practices in the East of England. Participants were 1,007 healthy adults aged 40 to 74 years eligible for an NHS Health Check. They were randomly allocated (1:1) using a web-based tool between October 1, 2014, and December 31, 2015, to either intervention (505) or control group (502), stratified by primary care practice. Participants were aware of study group allocation. Control participants received the NHS Health Check only. Intervention participants additionally received Step It Up: a 5-minute face-to-face discussion, written materials, pedometer, and step chart. The primary outcome was accelerometer-based physical activity volume at 3-month follow-up adjusted for sex, 5-year age group, and general practice. Secondary outcomes included time spent in different intensities of physical activity, self-reported physical activity, and economic measures. We conducted an in-depth fidelity assessment on a subsample of Health Check consultations. Participants’ mean age was 56 years, two-thirds were female, they were predominantly white, and two-thirds were in paid employment. The primary outcome was available in 859 (85.3%) participants. There was no significant between-group difference in activity volume at 3 months (adjusted intervention effect 8.8 counts per minute [cpm]; 95% CI −18.7 to 36.3; p = 0.53). We found no significant between-group differences in the secondary outcomes of step counts per day, time spent in moderate or vigorous activity, time spent in vigorous activity, and time spent in moderate-intensity activity (accelerometer-derived variables); as well as in total physical activity, home-based activity, work-based activity, leisure-based activity, commuting physical activity, and screen or TV time (self-reported physical activity variables). Of the 505 intervention participants, 491 (97%) received the Step it Up intervention. Analysis of 37 intervention consultations showed that 60% of Step it Up components were delivered faithfully. The intervention cost £18.04 per participant. Incremental cost to the NHS per 1,000-step increase per day was £96 and to society was £239. Adverse events were reported by 5 intervention participants (of which 2 were serious) and 5 control participants (of which 2 were serious). The study’s limitations include a participation rate of 16% and low return of audiotapes by practices for fidelity assessment. Conclusions In this large well-conducted trial, we found no evidence of effect of a plausible very brief pedometer intervention embedded in NHS Health Checks on objectively measured activity at 3-month follow-up. Trial registration Current Controlled Trials (ISRCTN72691150)., Wendy Hardeman and colleagues investigate a short physical activity intervention in a randomized controlled trial., Author summary Why was this study done? Systematic reviews support the effectiveness and cost-effectiveness of brief (up to 30 minutes) physical activity interventions in primary care and the effectiveness of intensive pedometer interventions. There is a need for briefer interventions in primary care, where time is limited but potential reach is large. However, the reviews show uncertainty about the effectiveness and cost-effectiveness of very brief (up to 5 minutes) interventions in primary care. Until now, there have been no randomised controlled trials (RCTs) of a very brief pedometer-based intervention to increase physical activity in primary care. What did the researchers do and find? We randomly assigned participants who attended preventive health checks in primary care (National Health Service [NHS] Health Checks) to the health check alone or additionally a very brief pedometer-based physical activity intervention delivered by practice nurses or healthcare assistants. We measured physical activity objectively at 3 months after the intervention. Our large trial found no benefit of a very brief physical activity intervention in the context of preventive health checks in primary care. Despite the intervention being apparently simple and very brief, fidelity of delivery was suboptimal. Trial participants were more active than might have been expected. The economic evaluation shows a small added cost for a small and uncertain benefit. What do these findings mean? The absence of a positive effect of a very brief physical activity intervention challenges the commissioning of such interventions in this context. Primary care practitioners should continue to opportunistically provide very brief advice about physical activity.
- Published
- 2020
16. A randomised controlled trial of three very brief interventions for physical activity in primary care
- Author
-
Simon J. Griffin, Richard A Parker, Stephen Sutton, Joana C. Vasconcelos, A T Prevost, Sally Pears, Wendy Hardeman, Ann Louise Kinmonth, Maaike Bijker, Katie L. Morton, Kate Westgate, Edward C. F. Wilson, Soren Brage, Hardeman, Wendy [0000-0002-6498-9407], Apollo - University of Cambridge Repository, Westgate, Kathryn Louise [0000-0002-0283-3562], Brage, Soren [0000-0002-1265-7355], Wilson, Edward Charles [0000-0002-8369-1577], and Griffin, Simon James [0000-0002-2157-4797]
- Subjects
Adult ,Male ,VBI Programme Team ,medicine.medical_specialty ,Health Behavior ,Psychological intervention ,Physical activity ,Primary care ,Public Health And Health Services ,Health check ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Environmental health ,Behaviour change techniques ,Epidemiology ,medicine ,Humans ,Very brief interventions ,030212 general & internal medicine ,Exercise ,Public, Environmental & Occupational Health ,Motivation ,Public health ,Science & Technology ,Primary Health Care ,business.industry ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,030229 sport sciences ,Middle Aged ,Actigraphy ,Treatment Outcome ,Pedometer ,Physical therapy ,Feasibility Studies ,Health promotion ,Female ,Biostatistics ,business ,Life Sciences & Biomedicine ,Research Article - Abstract
$\textbf{Background}$ Very brief interventions (VBIs) for physical activity are promising, but there is uncertainty about their potential effectiveness and cost. We assessed potential efficacy, feasibility, acceptability, and cost of three VBIs in primary care, in order to select the most promising intervention for evaluation in a subsequent large-scale RCT. $\textbf{Methods}$ Three hundred and ninety four adults aged 40–74 years were randomised to a Motivational ($\textit{n}$ = 83), Pedometer ($\textit{n}$ = 74), or Combined ($\textit{n}$ = 80) intervention, delivered immediately after a preventative health check in primary care, or control (Health Check only; $\textit{n}$ = 157). Potential efficacy was measured as the probability of a positive difference between an intervention arm and the control arm in mean physical activity, measured by accelerometry at 4 weeks. $\textbf{Results}$ For the primary outcome the estimated effect sizes (95 % CI) relative to the Control arm for the Motivational, Pedometer and Combined arms were respectively: +20.3 (−45.0, +85.7), +23.5 (−51.3, +98.3), and −3.1 (−69.3, +63.1) counts per minute. There was a73% probability of a positive effect on physical activity for each of the Motivational and Pedometer VBIs relative to control, but only 46 % for the Combined VBI. Only the Pedometer VBI was deliverable within 5 min. All VBIs were acceptable and low cost. $\textbf{Conclusions}$ Based on the four criteria, the Pedometer VBI was selected for evaluation in a large-scale trial. $\textbf{Trial registration}$ Current Controlled Trials ISRCTN02863077. Retrospectively registered 05/10/2012., This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0608-10079). ATP and JV were supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funder had no role in study design, data collection, data analysis, data interpretation, the writing of the manuscript, and decision to submit the manuscript for publication., This is the final version of the article. It first appeared from BioMed Central via https://doi.org/10.1186/s12889-016-3684-7
- Published
- 2016
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.