Background Adoption of low back pain guidelines is a well-documented problem. Information to guide the development of behaviour change interventions is needed. The review is the first to synthesise the evidence regarding physicians’ barriers to providing evidence-based care for LBP using the Theoretical Domains Framework (TDF). Using the TDF allowed us to map specific physician-reported barriers to individual guideline recommendations. Therefore, the results can provide direction to future interventions to increase physician compliance with evidence-based care for LBP. Methods We searched the literature for qualitative studies from inception to July 2018. Two authors independently screened titles, abstracts, and full texts for eligibility and extracted data on study characteristics, reporting quality, and methodological rigour. Guided by a TDF coding manual, two reviewers independently coded the individual study themes using NVivo. After coding, we assessed confidence in the findings using the GRADE-CERQual approach. Results Fourteen studies ( n = 318 physicians) from 9 countries reported barriers to adopting one of the 5 guideline-recommended behaviours regarding in-clinic diagnostic assessments (9 studies, n = 198), advice on activity (7 studies, n = 194), medication prescription (2 studies, n = 39), imaging referrals (11 studies, n = 270), and treatment/specialist referrals (8 studies, n = 193). Imaging behaviour is influenced by (1) social influence — fr om patients requesting an image or wanting a diagnosis ( n = 252, 9 studies), (2) beliefs about consequence— physicians believe that providing a scan will reassure patients ( n = 175, 6 studies), and (3) environmental context and resources— physicians report a lack of time to have a conversation with patients about diagnosis and why a scan is not needed ( n = 179, 6 studies). Referrals to conservative care is influenced by environmental context and resources —long wait-times or a complete lack of access to adjunct services prevented physicians from referring to these services ( n = 82, 5 studies). Conclusions Physicians face numerous barriers to providing evidence-based LBP care which we have mapped onto 7 TDF domains. Two to five TDF domains are involved in determining physician behaviour, confirming the complexity of this problem. This is important as interventions often target a single domain where multiple domains are involved. Interventions designed to address all the domains involved while considerin...

Lifestyle issues including physical activity, diet, smoking, alcohol consumption, and self-reported stress have all been shown to predispose people to higher risk of cardiovascular disease. This study provides further psychometrics on the Simple Lifestyle Indicator Questionnaire (SLIQ), a short, easy-to-use instrument which measures all these lifestyle characteristics as a single construct. One hundred and ninety-three individuals from St. John's, Newfoundland, and Labrador, Canada completed the SLIQ and reference standards for diet, exercise, stress, and alcohol consumption. The reference standards were a detailed Diet History Questionnaire (DHQ), the Social Readjustment Rating Scale (SRRS), the SF36 Health Status Questionnaire, and a survey of eight questions from a cardiovascular risk questionnaire. Physical activity score was compared with number of steps on a pedometer. Correlations between scores on the SLIQ and the reference standards were the SLIQ versus DHQ (r = 0.679, P = 0.001), SLIQ versus pedometer (r = 0.455, P = 0.002), SLIQ versus alcohol consumption (r = 0.665, P = 0.001), SLIQ versus SRRS (r = −0.264, P = 0.001), SLIQ versus eight-question risk score (r = 0.475, P = 0.001), and SLIQ versus Question 1 on SF36 (r = 0.303, P = 0.001). The SLIQ is sufficiently valid when compared to reference standards to be useful as a brief assessment of an individual's cardiovascular lifestyle in research and clinical settings.

This study examined the effects of 4 subtypes of social support (tangible, affective, positive social interaction, and emotional/informational) and gender on the severity and duration of depressive symptoms within the general adult Canadian population. Data were collected from the Canadian Community Health Survey (CCHS; Statistics Canada, 2002). Upon meeting predetermined criteria, 6,316 participants were included in the study. The findings suggest that, overall, positive social interaction was significantly associated with decreases in depression severity; while emotional/informational support was significantly associated with increases in depression severity. Positive social interaction and emotional/informational support appeared to significantly decrease the duration of depression. Interesting gender differences also emerged among the 4 subtypes of social support. Implications of the findings are discussed.

BackgroundCervical cancer is highly preventable and treatable if detected early through regular screening. Women in the Canadian province of Newfoundland & Labrador have relatively low rates of cervical cancer screening, with rates of around 40 % between 2007 and 2009. Persistent infection with oncogenic human papillomavirus (HPV) is a necessary cause for the development of cervical cancer, and HPV testing, including self-sampling, has been suggested as an alternative method of cervical cancer screening that may alleviate some barriers to screening. Our objective was to determine whether offering self-collected HPV testing screening increased cervical cancer screening rates in rural communities.MethodsDuring the 2-year study, three community-based cohorts were assigned to receive either i) a cervical cancer education campaign with the option of HPV testing; ii) an educational campaign alone; iii) or no intervention. Self-collection kits were offered to eligible women at family medicine clinics and community centres, and participants were surveyed to determine their acceptance of the HPV self-collection kit. Paired proportions testing for before-after studies was used to determine differences in screening rates from baseline, and Chi Square analysis of three dimensional 2 × 2 × 2 tables compared the change between communities.ResultsCervical cancer screening increased by 15.2 % (p < 0.001) to 67.4 % in the community where self-collection was available, versus a 2.9 % increase (p = 0.07) in the community that received educational campaigns and 8.5 % in the community with no intervention (p = 0.193). The difference in change in rates was statistically significant between communities A and B (p < 0.001) but not between communities A and C (p = 0.193). The response rate was low, with only 9.5 % (168/1760) of eligible women opting to self-collect for HPV testing. Of the women who completed self-collection, 15.5 % (26) had not had a Pap smear in the last 3 years, and 88.7 % reported that they were somewhat or very satisfied with self-collection.ConclusionsOffering self-collected HPV testing increased the cervical cancer screening rate in a rural NL community. Women who completed self-collection had generally positive feelings about the experience. Offering HPV self-collection may increase screening compliance, particularly among women who do not present for routine Pap smears.

The intensive, home-delivered, program of care for the well old elderly did not have an impact on the outcomes measured.