Illness beliefs, treatment beliefs and information needs as starting points for patient information—Evaluation of an intervention for patients with chronic back pain

Glattacker, Manuela; Heyduck, Katja; Meffert, Cornelia

doi:10.1016/j.pec.2011.05.028

Cited by 71 publications

(68 citation statements)

References 39 publications

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“…[28][29][30] In the current study, patients wanted a clear explanation of their pain which provided not only a diagnostic label but, more importantly, an individualised causal understanding; that is, they were striving to develop a realistic illness representation. This was an essential prerequisite for engaging with treatment decisions: uncertain and poorly elaborated understandings of LBP appeared to have a dramatic impact, driving reluctance to engage with decision making and/or recommended treatments.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Identifying patients’ beliefs about treatments for chronic low back pain in primary care: a focus group study

Dima¹,

Lewith²,

Little³

et al. 2013

Br J Gen Pract

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BackgroundCurrent evidence-based guidelines for low back pain (LBP) recommend multiple diverse approaches to treatment and suggest considering patient preferences when formulating a treatment plan. AimTo explore patient preferences and to identify patients' beliefs about LBP treatments. Design and settingQualitative study using focus groups in primary care in South-West England. MethodThirteen focus groups were organised with a purposive sample of 75 adults with LBP. Group discussions of LBP treatments were facilitated, audiorecorded, and the verbatim transcripts thematically analysed. ResultsEight themes were identified, four related to treatment beliefs and four to seeking treatment. Treatment beliefs comprised participants' expectations and appraisals of specific treatments, which were underpinned by four distinct dimensions: credibility, effectiveness, concerns and individual fit. Treatment beliefs were expressed in the broader context of treatment seeking: participants' primary concern was to obtain a clear explanation of their LBP which went beyond a diagnostic label and provided an understanding of the cause(s) of their LBP. They described engaging in self-management activities and claimed they were willing to try anything if it might help them. Participants wanted an empathic and expert practitioner who could deliver a suitable treatment (or refer them on to someone else) and help them to negotiate the challenges of the healthcare system. ConclusionThese findings highlight the importance of helping patients develop coherent illness representations about their LBP before trying to engage them in treatment-decisions, uptake, or adherence. Addressing patients' illness and treatment perceptions in clinical practice could improve shared decision making and patient outcomes.Keywords back pain; health knowledge, attitudes, practice; illness behaviour; patient preference; primary health care; qualitative research.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Identifying patients’ beliefs about treatments for chronic low back pain in primary care: a focus group study

Dima¹,

Lewith²,

Little³

et al. 2013

Br J Gen Pract

View full text Add to dashboard Cite

show abstract

“…However, with respect to functioning, the intervention was not effective. The results of the intervention study are reported elsewhere (18).…”

Section: From the Department Of Quality Management And Social Medicinmentioning

confidence: 99%

Illness beliefs and treatment beliefs as predictors of short-term and medium-term outcome in chronic back pain

Glattacker

Heyduck²,

Meffert³

2013

J Rehabil Med

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Objective: Patients' illness beliefs were shown to be more relevant than other psychosocial factors of influence for predicting outcome in back pain in primary care. The aim of this study was to determine whether illness beliefs and beliefs about rehabilitation are predictors of functioning, pain intensity, and coping with pain after rehabilitation in a population with longstanding chronic back pain. Design and patients: The study included 110 patients with longstanding chronic back pain in a longitudinal study design with 3 measurement points (before rehabilitation, end of rehabilitation, and 6 months follow-up). Methods: Hierarchical multiple regression analyses were conducted to test the relative contribution of illness beliefs and beliefs about rehabilitation to the rehabilitation outcomes while adjusting for baseline values of outcome measures, mental health, sociodemographic, and illness-related variables. Results: Illness beliefs and beliefs about rehabilitation made a significant contribution to the prediction of rehabilitation outcomes. In the short and medium term, incremental variance for coping with pain was as much as 13%, for functioning up to 14%, and for pain intensity between 6% and 9%. Conclusion: Further studies should be conducted as a confirmatory test of our preliminary results and to test the relative relevance of these constructs compared with other yellow flags for chronic patient samples.

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“…Assuming that the population SD of SIMS scores is 5 points, [49][50][51] in a sample of 40 pharmacies, 30 patients per pharmacy would be required to detect such a difference with 80% power, at the 5% level of statistical significance. Furthermore, assuming a non-response rate of 50% and an intrapharmacy correlation coefficient of 0.05, 1200 patients in receipt of dispensing services and 1200 patients undergoing a MUR would need to be surveyed (n = 2400 in total).…”

Section: Subjects (Patient Survey)mentioning

confidence: 99%

“…The SIMS, MARS and BMQ are of proven reliability and validity, and have been widely used in research studies in a number of settings (including pharmacy) across a range of conditions and in several countries. [49][50][51]55,[59][60][61][62] The patient satisfaction scale lists 15 statements that respondents are asked to rate on a five-point Likert scale, from 1 (strongly disagree) to 5 (strongly agree) according to how they felt about their visit to a pharmacy. In addition, following cognitive interview piloting, a 'not applicable' option was provided, which was scored 3 (equivalent to 'neither agree nor disagree').…”

Section: Patient Surveymentioning

confidence: 99%

Investigating the organisational factors associated with variation in clinical productivity in community pharmacies: a mixed-methods study

Jacobs

Bradley

Elvey

et al. 2017

Health Serv Deliv Res

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Background Community pharmacies play a key role in health-care systems, dispensing prescriptions and providing medicine-related services. Service provision varies across community pharmacy organisations and may depend on organisational characteristics, such as ownership, staffing and skill mix. Objectives To inform the commissioning of community pharmacy services by (1) exploring variation in clinical productivity (levels of service delivery and service quality) in pharmacies, (2) identifying the organisational factors associated with this variation and (3) developing a toolkit for commissioners. Design Mixed-methods study: community pharmacy survey, administrative data analysis, patient survey, stakeholder interviews and toolkit development. Setting Nine socioeconomically diverse geographical areas of England. Participants Stage 1: community pharmacies in nine study areas. Stage 2: in 39 pharmacies, two consecutive samples of approximately 30 patients each following receipt of (1) dispensing and (2) medicines use review (MUR) services. Pharmacy and commissioning representatives from across all types of pharmacy and study sites. Main outcome measures Stage 1: dispensing, MUR, new medicines service volume and safety climate. Stage 2: patient satisfaction, Satisfaction with Information about Medicines Scale (SIMS) and Medication Adherence Report Scale (MARS). Data sources Stage 1: (i) community pharmacy activity data; (ii) socioeconomic and health needs data; and (iii) community pharmacy questionnaire (ownership type, organisational culture, staffing and skill mix, working patterns, management structure, safety climate, pharmacy–general practice integration), all linked by pharmacy postcode and organisational ‘F’ code. Stage 2: (i) patient questionnaire (background, patient satisfaction, SIMS, MARS); (ii) semistructured stakeholder interviews (variation in quantity and quality of service provision, opportunities and barriers to clinical productivity, mechanisms by which different organisational characteristics may help or hinder clinical productivity). Quantitative data were analysed by fitting a series of fixed-effects linear, logistic and multilevel logistic regression models in Stata® (version 13; StataCorp LP, College Station, TX, USA). Qualitative data were analysed thematically using a framework approach in NVivo10 (QSR International, Warrington, UK). Results In stage 1, 285 out of 817 pharmacy questionnaires were returned [valid response rate 34.6% (277/800)]. In stage 2, 1008 out of 2124 patient questionnaires were returned [valid response rate 46.5% (971/2087)]. Thirty pharmacy and 10 commissioning representatives were interviewed face to face or by telephone. Following integration of stage 1 and 2 findings, clinical productivity was associated with pharmacy ownership type, organisational culture, staffing and skill mix, and pharmacy–general practice relationships. Extra-organisational associations included local area deprivation, age profile and health needs, pharmacy location, public perceptions and expectations, supply chain problems, commissioning structures/processes, levels of remuneration and legal/regulatory constraints. Existing arrangements for monitoring clinical productivity focused primarily on quantity. Limitations Non-random selection of study sites and non-participation by four major pharmacy chains limited generalisability. Investigation of the full scope of pharmacy service provision was prevented by a lack of available activity data for locally commissioned services. Quantitative exploration of service quality was limited by available validated measures. Conclusions These findings have important implications for community pharmacies and service commissioners, highlighting the importance of ownership type, organisational culture, staffing and skill mix for maximising the delivery of high-quality pharmacy services and informing the development of a commissioners’ toolkit. Future work Future studies should (1) develop tools to measure community pharmacy service quality; (2) describe and evaluate different models of skill mix; and (3) explore how services are commissioned locally from community pharmacies and the extent to which local needs are met. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Illness beliefs, treatment beliefs and information needs as starting points for patient information—Evaluation of an intervention for patients with chronic back pain

Cited by 71 publications

References 39 publications

Identifying patients’ beliefs about treatments for chronic low back pain in primary care: a focus group study

Identifying patients’ beliefs about treatments for chronic low back pain in primary care: a focus group study

Illness beliefs and treatment beliefs as predictors of short-term and medium-term outcome in chronic back pain

Investigating the organisational factors associated with variation in clinical productivity in community pharmacies: a mixed-methods study

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