Search

Aim: To explore educators' perspectives on the implementation of goal‐setting and action‐planning strategies within a structured diabetes self‐management education programme. Methods: Ten semi‐structured interviews were conducted with diabetes self‐management education providers delivering the 'Dose Adjustment for Normal Eating' (DAFNE) programme to people with Type 1 diabetes throughout Ireland. A pre‐designed topic guide, focused on exploring educators' experiences of delivery and application and views on usefulness of goal‐setting strategies, was used in all interviews. The interviews were recorded, transcribed and analysed using thematic analysis. Results: Five main themes were identified: 'people need a plan', discussing perspectives on goal‐setting's value; 'the power of the group', highlighting the impact a group format has on goal‐setting practices; 'diversity and individuality', discussing differences in DAFNE participants' and educators' engagement with goal‐setting; 'goal‐setting's fit', exploring perspectives on how well goal‐setting fits within diabetes self‐management education and follow‐up care; and 'feelings of inadequate psychological knowledge', addressing challenges experienced in the delivery of goal‐setting components. Conclusion: While educators saw benefits in the implementation of goal‐setting and planning strategies within diabetes self‐management education, concerns about how well goal‐setting currently fits within diabetes self‐management education and follow‐up care were evident. Additionally, many educators experienced the delivery of goal‐setting and action‐planning strategies as challenging and would value additional training opportunities. What's new?: This study is the first to explore diabetes self‐management education (DSME) providers' perspectives on the implementation of goal‐setting and action‐planning components within a DSME programme.Educators in such programmes are encouraged to embrace these behaviour change strategies to promote patient‐centred DSME; however, the present study shows that, although educators see value in goal‐setting, many experience its delivery as challenging and would value additional training.Many educators questioned how well goal‐setting currently fits within the Dose Adjustment for Normal Eating (DAFNE) DSME programme and are concerned about a lack of follow‐up after DSME.Issues highlighted in this study should be addressed in DSME research, and could be targeted within DSME providers' training. [ABSTRACT FROM AUTHOR]

Abstract: Background: While a healthy sexual life is regarded as an important aspect of quality of life, sexual counselling from healthcare providers for cardiac patients has received little attention in the literature. Aim: To document current practice and assess the needs of cardiac rehabilitation service providers in Ireland with regard to sexual assessment and management for patients. Methods: Cardiac rehabilitation staff in all relevant centres in Ireland responded to a postal questionnaire. Sexual health management was assessed by a series of questions on current practice, staff attitudes, beliefs and perceived barriers to discussing sexual problems. Results: Staff (N =60; 61% response rate) reported a lack of assessment and counselling protocols for addressing sexual health problems, with little or no onward referral system available. Results also suggest staff believe that patients do not expect them to ask about their sexual concerns. Barriers reported included an overall lack of confidence (45%), knowledge (58%) and training (85%). Conclusion: Development of guidelines, assessment protocols and training for cardiac rehabilitation staff are essential in the area of sexual health problems in order to improve the quality of services for patients with coronary heart disease. [ABSTRACT FROM AUTHOR]

Background and Aims While a ‘Family-Centered’ approach to care is accepted as best practice in the context of childhood disability, it may lead to increased demands on family members by requiring them to be active participants in their child's care. This may impact upon the physical and mental health of the caregiver and therefore needs to be investigated. This study aimed to assess the health status of caregivers of children with cerebral palsy (CP) in Ireland and to identify vulnerable subgroups. Methods A cross-sectional postal survey was conducted using a questionnaire incorporating the SF-36v2.0. The sample consisted of male and female caregivers of children with CP, representing all levels of ability. Two questionnaires were sent to each child's home; a total of 312 questionnaires were sent to the homes of 156 children. Results Completed questionnaires were returned by 161 caregivers (100 women, 61 men) of 101 children, giving a response rate of 65%. Caregivers of children with CP were found to have poorer health than the Irish general population, for whom normative data exist. Female caregivers had poorer health than male caregivers in both the physical ( P < 0.05) and mental health ( P < 0.001) domains of the SF-36. Caregivers spending more time caring had significantly poorer mental health than those spending less time caring ( P < 0.05). There was no difference in the health of caregivers of ‘more independent’ versus ‘more dependent’ children, apart from the latter group reporting higher levels of bodily pain ( P < 0.05). Conclusion This study provides evidence of the inferior health status of caregivers of children with CP in Ireland, particularly that of women. [ABSTRACT FROM AUTHOR]

Aims: Maternally inherited diabetes and deafness (MIDD) is a rare form of adult‐onset diabetes that can be difficult to diagnose due to its variable clinical phenotype. Transfer RNA‐derived small fragments are a novel, emerging class of small non‐coding RNAs (sncRNAs) that have significant potential as serum biomarkers due to their stress‐induced generation, abundance, stability and ease of detection. Methods: We investigated the levels of tiRNA 5'ValCAC (alone and in combination with miR‐23b‐3p) identified from small RNA sequencing studies in serum samples from healthy controls, type 1 diabetes, type 2 diabetes and MIDD subjects. Results: Serum levels of 5'ValCAC were reduced in MIDD and type 2 diabetes subjects compared to controls. Type 2 diabetes subjects had higher serum levels of miR‐23b‐3p compared to all other subjects. Receiver Operating Characteristic analysis showed the potential of 5'ValCAC and miR‐23b‐3p as MIDD biomarkers, with the combination showing excellent separation from type 2 diabetes subjects. Conclusions: This is the first report showing altered serum levels of tiRNAs in diabetes subjects. The combined use of 5'ValCAC and miR‐23b‐3p as serum biomarkers could potentially differentiate between MIDD subjects and type 2 diabetes subjects. [ABSTRACT FROM AUTHOR]

Aims: Attendance at structured diabetes education has been recommended internationally for all people with Type 2 diabetes. However, attendance rates are consistently low. This qualitative study aimed to explore experiences of attending and delivering Type 2 diabetes structured education programmes in Ireland and barriers and facilitators to attendance. Methods: People with Type 2 diabetes who had attended one of the three programmes delivered in Ireland and educators from the three programmes took part in semi‐structured telephone interviews. Interviews were audio‐taped, transcribed and analysed using inductive thematic analysis. Results: Twelve attendees and 14 educators were interviewed. Two themes were identified in relation to experiences of programme attendance and delivery: 'Structured education: addressing an unmet need' and 'The problem of non‐attendance'. The third theme 'Barriers to attendance: can't go, won't go, don't know and poor system flow' outlined how practicalities of attending, lack of knowledge of the existence and benefits, and limited resources and support for education within the diabetes care pathway impacts on attendance. The final theme 'Supporting attendance: healthcare professionals and the diabetes care pathway' describes facilitators to participants' attendance and the strategies educators perceived to be important in increasing attendance. Conclusions: Healthcare professionals have an important role in improving attendance at structured diabetes education programmes. Improving attendance may require promotion by healthcare professionals and for education to be better embedded and supported within the diabetes care pathway. What's new?: This is the first time that experiences, and barriers and facilitators to attendance at Type 2 diabetes structured education programmes have been explored among educators and attendees.Similar to a previous review, we identified 'Can't go' and 'Won't go' reasons for non‐attendance.We also identified two new categories: 'Don't know' – lack of knowledge of the existence and benefits of programmes and 'Poor system flow' – issues with healthcare system resources and lack of importance placed on education.Healthcare professionals have an important role in promoting attendance.Improving attendance may require education to be better embedded and supported within the diabetes care pathway. [ABSTRACT FROM AUTHOR]

Background: Decreased sexual activity and sexual problems are common among people with cardiovascular disease, negatively impacting relationship satisfaction and quality of life. International guidelines recommend routine delivery of sexual counselling to cardiac patients. The Cardiac Health and Relationship Management and Sexuality (CHARMS) baseline study in Ireland found, similar to international findings, limited implementation of sexual counselling guidelines in practice. The aim of the current study was to develop the CHARMS multi-level intervention to increase delivery of sexual counselling by healthcare professionals. We describe the methods used to develop the CHARMS intervention following the three phases of the Behaviour Change Wheel approach: understand the behaviour, identify intervention options, and identify content and implementation options. Survey (n = 60) and focus group (n = 14) data from two previous studies exploring why sexual counselling is not currently being delivered were coded by two members of the research team to understand staff's capability, opportunity, and motivation to engage in the behaviour. All potentially relevant intervention functions to change behaviour were identified and the APEASE (affordability, practicability, effectiveness, acceptability, side effects and equity) criteria were used to select the most appropriate. The APEASE criteria were then used to choose between all behaviour change techniques (BCTs) potentially relevant to the identified functions, and these BCTs were translated into intervention content. The Template for Intervention Description and Replication (TIDieR) checklist was used to specify details of the intervention including the who, what, how and where of proposed intervention delivery.Results: Providing sexual counselling group sessions by cardiac rehabilitation staff to patients during phase III cardiac rehabilitation was identified as the target behaviour. Education, enablement, modelling, persuasion and training were selected as appropriate intervention functions. Twelve BCTs, linked to intervention functions, were identified for inclusion and translated into CHARMS intervention content.Conclusions: This paper details the use of Behaviour Change Wheel approach to develop an implementation intervention in an under-researched area of healthcare provision. The systematic and transparent development of the CHARMS intervention will facilitate the evaluation of intervention effectiveness and future replication and contribute to the advancement of a cumulative science of implementation intervention design. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the Irish smoking ban has had an impact on secondhand smoke (SHS) exposures for hospitality workers. Design, setting, and participants: Before and after the smoking ban a cohort of workers (n = 35) from a sample of city hotels (n = 15) were tested for saliva cotinine concentrations and completed questionnaires. Additionally, a random sample (n = 20) of city centre bars stratified by size (range 400–5000 square feet), were tested for air nicotine concentrations using passive samplers before and after the ban. Main outcome measures: Salivary cotinine concentrations (ng/ml), duration of self reported exposures to secondhand smoke, air nicotine (μg/cubic metre). Results: Cotinine concentrations reduced by 69%, from 1.6 ng/ml to 0.5 ng/ml median (SD 1.29; p « 0.005). Overall 74% of subjects experienced decreases (range 16–99%), with 60% showing a halving of exposure levels at follow up. Self reported exposure to SHS at work showed a significant reduction from a median 30 hours a week to zero (p «0.001). There was an 83% reduction in air nicotine concentrations from median 35.5 μg/m3 to 5.95 μg/m3 (p « 0.001). At baseline, three bars (16%) were below the 6.8 μg/m3 air nicotine significant risk level for lung cancer alone; at follow up this increased to 10 (53%). Conclusions: Passive smoking and associated risks were significantly reduced but not totally eliminated. Exposure to SHS is still possible for those working where smokin9 is still allowed and those working where smoke may migrate from outdoor areas. Further research is required to assess the true extent and magnitude of these exposures. [ABSTRACT FROM AUTHOR]