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Providing routine chronic disease preventive care in community substance use services: a pilot study of a multistrategic clinical practice change intervention.

ABSTRACT: OBJECTIVES:To evaluate the potential effectiveness of a practice change intervention in increasing preventive care provision in community-based substance use treatment services. In addition, client and clinician acceptability of care were examined. DESIGN:A pre-post trial conducted from May 2012 to May 2014. SETTING:Public community-based substance use treatment services (n=15) in one health district in New South Wales (NSW), Australia. PARTICIPANTS:Surveys were completed by 226 clients and 54 clinicians at baseline and 189 clients and 46 clinicians at follow-up. INTERVENTIONS:A 12-month multistrategic clinician practice change intervention that aimed to increase the provision of preventive care for smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. PRIMARY AND SECONDARY OUTCOME MEASURES:Client and clinician reported provision of assessment, brief advice and referral for three modifiable health risk behaviours: smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. Clinician-reported optimal care was defined as providing care to 80% of clients or more. Client acceptability and clinician attitudes towards preventive care were assessed at follow-up. RESULTS:Increases in client reported care were observed for insufficient fruit and/or vegetable consumption including: assessment (24%?vs 54%, p<0.001), brief advice (26%?vs 46%, p<0.001), and clinicians speaking about (10%?vs 31%, p<0.001) and arranging a referral (1%?vs 8%, p=0.006) to telephone helplines. Clinician reported optimal care delivery increased for: assessment of insufficient fruit and/or vegetable consumption (22%?vs 63%, p<0.001) and speaking about telephone helplines for each of the three health risk behaviours. Overall, clients and clinicians held favourable views regarding preventive care. CONCLUSION:This study reported increases in preventive care for insufficient fruit and/or vegetable consumption; however, minimal increases were observed for smoking or insufficient physical activity. Further investigation of the barriers to preventive care delivery in community substance use settings is needed. TRIALREGISTRATION NUMBER:ACTRN12614000469617.

SUBMITTER: Tremain D

PROVIDER: S-EPMC6104796 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe effects of dietary intervention in managing sarcopenic obesity are controversial, and behavior change techniques are lacking in previous studies which are important for the success of dietary intervention. This study aimed to evaluate the feasibility and preliminary effects of a dietary behaviour change (DBC) intervention on managing sarcopenic obesity among community-dwelling older people in the community.MethodsA two-armed, RCT was conducted. Sixty community-dwelling older adults (≥ 60 years old) with sarcopenic obesity were randomised into either the experimental group (n = 30), receiving a 15-week dietary intervention combined with behaviour change techniques guided by the Health Action Process Approach model, or the control group (n = 30), receiving regular health talks. Individual semi-structured interviews were conducted with 21 experimental group participants to determine the barriers and facilitators of dietary behaviour changes after the intervention.ResultsThe feasibility of the DBC intervention was confirmed by an acceptable recruitment rate (57.14%) and a good retention rate (83.33%). Compared with the control group, the experimental group significantly reduced their body weight (p = 0.027, d = 1.22) and improved their dietary quality (p < 0.001, d = 1.31). A positive improvement in handgrip strength (from 15.37 ± 1.08 kg to 18.21 ± 1.68 kg), waist circumference (from 99.28 ± 1.32 cm to 98.42 ± 1.39 cm), and gait speed (from 0.91 ± 0.02 m/s to 0.99 ± 0.03 m/s) was observed only in the experimental group. However, the skeletal muscle mass index in the experimental group decreased. The interview indicated that behaviour change techniques enhanced the partcipants' compliance with their dietary regimen, while cultural contextual factors (e.g., family dining style) led to some barriers.ConclusionThe DBC intervention could reduce body weight, and has positive trends in managing handgrip strength, gait speed, and waist circumference. Interestingly, the subtle difference between the two groups in the change of muscle mass index warrants futures investigation. This study demonstrated the potential for employing dietary behaviour change interventions in community healthcare.Trial registrationRegistered retrospectively on ClinicalTrailas.gov (31/12/2020, NCT04690985).

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Providing routine chronic disease preventive care in community substance use services: a pilot study of a multistrategic clinical practice change intervention.

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