Components of complex interventions for healthcare: A narrative synthesis of qualitative studies

Ma, Si-Si; Yu, He; Liang, Ning; Zhu, Sijia; Li, Xun; Robinson, Nicola; Liu, Jianping

doi:10.1016/j.jtcms.2020.04.003

Cited by 4 publications

(3 citation statements)

References 42 publications

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“…The intervention focuses on strengthening participants capabilities and intrinsic motivation for change, which is in line with findings of a recent review on conceptualisations of person-centred care that concludes that "personcentred healthcare must value the social network of each patient, promote quality of life and personal goals, not only health status improvement" [55, p.2]. A recent study on complex interventions recommends that elements of biological, psychological, social, cognitive behavioural, and environmental support should be considered when constructing such interventions [56]. These domains are all reflected in the intervention BigMove.…”

Section: Discussionsupporting

confidence: 71%

BigMove: A Group Intervention for People with Physical and Mental Health Conditions

Veen

Evans

Aalders³

et al. 2022

International Journal of Integrated Care

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Introduction:This article describes an innovative, integrated care intervention, called BigMove, which aims to improve the functioning, capabilities and quality of life of people with a combination of physical and mental health conditions. Description: Theoretical frameworks reflected in the intervention are the Capability Approach (CA) and Self-Determination Theory (SDT). Essential elements of the intervention included to expand participants' behavioural repertoire are motivational interviewing; functional goal setting (using the International Classification of Functioning, Disability and Health (ICF); cognitive behavioural therapy; enjoyment; support of the group; and physical activity. The design combines individual sessions and group sessions.Discussion: By integrating the CA and the SDT, the intervention enables participants to make self-directed and value-driven choices in life and change their behaviour accordingly to strengthen their functioning and capabilities. To foster person-centred, integrated care, it is crucial to reform the interaction between professionals and patients and to re-structure the organisation and financing of care to enable the provision of complex integrated care interventions. Conclusion:For people with physical and mental health conditions, the intervention BigMove provides an innovative integrated care approach that addresses aspirations people have regarding their functioning and focuses on individual goal setting and behaviour change. 2

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Section: Discussionsupporting

confidence: 71%

BigMove: A Group Intervention for People with Physical and Mental Health Conditions

Veen

Evans

Aalders³

et al. 2022

International Journal of Integrated Care

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“…By identifying systematic barriers and facilitators for the adoption of evidence-based interventions in LTC units, we will contribute to the active management of obstacles and the use of positive approaches to facilitate the adoption of evidence-based practices related to the prevention of PUs [ 41 , 42 , 43 ].…”

Section: Introductionmentioning

confidence: 99%

The Relationship between Nursing Practice Environment and Pressure Ulcer Care Quality in Portugal’s Long-Term Care Units

Furtado

Voorham²,

Infante

et al. 2023

Healthcare

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Background: The morbidity associated with ageing has contributed to an increase in the prevalence of Pressure Ulcers (PUs) in all care settings. The impact of these on people’s quality of life and the extent of the associated economic and social burden constitutes today, by their importance, a serious public health problem. This study aims to describe the nursing work environment in Portuguese long-term care (LTC) units and to assess how this environment relates to the quality of PU care. Methods: A longitudinal study among inpatients with PUs was conducted in LTC units. The Nursing Work Index-Revised Scale (NWI-R) was sent to all nurses in these units. Cox proportional hazard models were used to relate the satisfaction degree with the service (measured by the NWI-R-PT items) to the healing time of the PUs, adjusting for confounders. Results: A total of 165 of 451 invited nurses completed the NWI-R-PT. Most were women (74.6%) and had 1 to 5 years of professional experience. Less than half (38.4%) had education in wound care. Of the 88 patients identified with PUs, only 63 had their PU documented, highlighting the difficulties in updating electronic records. The results showed that the level of concordance with Q28 “Floating so that staffing is equalised among units” is strongly associated with a shorter PU healing time. Conclusion: A good distribution of nursing staff over the units will likely improve the quality of wound care. We found no evidence for possible associations with the questions on participation in policy decisions, salary level, or staffing educational development and their relationship with PUs healing times.

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“…The intervention focuses on strengthening participants capabilities and intrinsic motivation for change, which is in line with findings of a recent review on conceptualisations of person-centred care that concludes that 'person-centred healthcare must value the social network of each patient, promote quality of life and personal goals, not only health status improvement' (Giusti et al, 2020, p. 2). A recent study on complex interventions recommends that elements of biological, psychological, social, cognitive behavioural, and environmental support should be considered when constructing such interventions (Ma et al, 2020). These domains are all reflected in the intervention BigMove.…”

Section: Discussionmentioning

confidence: 99%

Toward a paradigm shift in healthcare

van der Veen

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This thesis examines the foundations and effects of the BigMove intervention, an innovative approach to person-centred, integrated, and community-based care for people with physical and mental health conditions. The intervention aims to improve participants’ functioning, capabilities, and quality of life while fostering behaviour change. As the number of adults living with multimorbidity continues to grow, healthcare systems face increasing challenges in providing adequate care. Current interventions, often targeting specific diseases and their associated health-related risk behaviours, frequently fail to meet the needs of people with multimorbidity. A person-centred, integrated, community-based intervention that goes beyond isolated, disease-oriented approaches may improve outcomes beyond narrow disease-specific aspects. Over the past decades, two frameworks have significantly contributed to the transition towards more integrated and person-centred care: the International Classification of Functioning, Disability, and Health (ICF) and the Capability Approach (CA). The joint use of these frameworks has three advantages; (1) it provides the opportunity to increase patients’ influence and choice regarding their functioning and to give them a more equal position in the delivery of care, (2) it enables an evaluation of functionings and capabilities from the perspective of patients; and (3) it provides a basis for recording self-perceived functioning and evaluation of goals suitable for use in research and quality improvement. A practical example is presented through a unique e-health application used in the intervention that allows a person to self-assess, record, and evaluate their self-perceived functioning, as well as formulate related goals and action plans. The theoretical frameworks reflected in the intervention are the Capability Approach (CA) and Self-Determination Theory. Essential elements of the intervention are motivational interviewing, functional goal setting using the ICF, cognitive behavioural therapy, enjoyment, group support and physical activity. The design combines individual sessions and group sessions. Furthermore, the intervention incorporates collaboration between healthcare professionals. Examining data on participants' self-perceived functioning, goals, and action plans before and after experiencing at least 120 days demonstrated that the application can be used to record self-perceived functioning, goals, and action plans and capture changes over time. The evaluation of outcomes on self-perceived health, quality of life, coping behaviour, and social and mental functioning after 120 days in the intervention, indicated significant improvements. The observed changes can be considered clinically relevant improvements. Based on the theoretical perspectives and the findings of this thesis, a novel model to capture the process of behaviour change in the intervention is presented: the Model of Complex Dynamic Behaviour Change. Finally, recommendations for policy, practice, education, and future research are made. More emphasis should be placed on integrating relational autonomy and freedom of choice into care pathways. The use of the ICF to assess self-perceived functioning, goals, and action plans could provide a novel method of evaluating person-centred care as well as provide information for policymakers to shape future policies. This thesis offers valuable insights for future development and evaluation of interventions for individuals with multimorbidity.

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Components of complex interventions for healthcare: A narrative synthesis of qualitative studies

Cited by 4 publications

References 42 publications

BigMove: A Group Intervention for People with Physical and Mental Health Conditions

BigMove: A Group Intervention for People with Physical and Mental Health Conditions

The Relationship between Nursing Practice Environment and Pressure Ulcer Care Quality in Portugal’s Long-Term Care Units

Toward a paradigm shift in healthcare

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