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Supporting health care professionals to improve the processes of shared decision making and self-management in a web-based intervention: randomized controlled trial.

Sassen B, Kok G, Schepers J, Vanhees L - J. Med. Internet Res. (2014)

Bottom Line: Research to assess the effect of interventions to improve the processes of shared decision making and self-management directed at health care professionals is limited.In the intervention group, no differences in social-cognitive determinants, intention and behavior were found for health care professionals, compared with the control group.We narrowed the intervention group and no significant differences were found in intention and behavior, except for barriers.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Health Care, Innovation in Health Care, University of Applied Sciences, Utrecht, Netherlands. Barbara.sassen@hu.nl.

ABSTRACT

Background: Research to assess the effect of interventions to improve the processes of shared decision making and self-management directed at health care professionals is limited. Using the protocol of Intervention Mapping, a Web-based intervention directed at health care professionals was developed to complement and optimize health services in patient-centered care.

Objective: The objective of the Web-based intervention was to increase health care professionals' intention and encouraging behavior toward patient self-management, following cardiovascular risk management guidelines.

Methods: A randomized controlled trial was used to assess the effect of a theory-based intervention, using a pre-test and post-test design. The intervention website consisted of a module to help improve professionals' behavior, a module to increase patients' intention and risk-reduction behavior toward cardiovascular risk, and a parallel module with a support system for the health care professionals. Health care professionals (n=69) were recruited online and randomly allocated to the intervention group (n=26) or (waiting list) control group (n=43), and invited their patients to participate. The outcome was improved professional behavior toward health education, and was self-assessed through questionnaires based on the Theory of Planned Behavior. Social-cognitive determinants, intention and behavior were measured pre-intervention and at 1-year follow-up.

Results: The module to improve professionals' behavior was used by 45% (19/42) of the health care professionals in the intervention group. The module to support the health professional in encouraging behavior toward patients was used by 48% (20/42). The module to improve patients' risk-reduction behavior was provided to 44% (24/54) of patients. In 1 of every 5 patients, the guideline for cardiovascular risk management was used. The Web-based intervention was poorly used. In the intervention group, no differences in social-cognitive determinants, intention and behavior were found for health care professionals, compared with the control group. We narrowed the intervention group and no significant differences were found in intention and behavior, except for barriers. Results showed a significant overall difference in barriers between the intervention and the control group (F1=4.128, P=.02).

Conclusions: The intervention was used by less than half of the participants and did not improve health care professionals' and patients' cardiovascular risk-reduction behavior. The website was not used intensively because of time and organizational constraints. Professionals in the intervention group experienced higher levels of barriers to encouraging patients, than professionals in the control group. No improvements were detected in the processes of shared decision making and patient self-management. Although participant education level was relatively high and the intervention was pre-tested, it is possible that the way the information was presented could be the reason for low participation and high dropout. Further research embedded in professionals' regular consultations with patients is required with specific emphasis on the processes of dissemination and implementation of innovations in patient-centered care.

Trial registration: Netherlands Trial Register Number (NTR): NTR2584; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2584 (Archived by WebCite at http://www.webcitation.org/6STirC66r).

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figure3: Intervention screenshot.

Mentions: Participants had access to the website [32], which offered several modules. The development and content of the intervention is described in detail elsewhere [7,30]. Modules and a forum were directed at the health care professional to increase professionals’ awareness of their thoughts, and learn skills and strategies to support patients in their own self-management, this to improve their intention and behavior toward patient-centered health education. The first module enclosed a set of seven screens to help the professional to improve his or her professional behavior (Figure 2). The screens contained self-complete forms and were designed and pre-tested to educate the health care professional, with a personal feedback system in a “coaching spider chart”. The screens started with “risk” communication to support thinking about encouraging patients. This was followed by listing the pros and cons of encouraging patients in the short- and long-term. Hereafter, the health professional was encouraged to seek support and look at the sub-skills needed to be an encouraging health professional. Next, there was a screen for planning the encouraging behavior change, making a plan, and putting the behavior change into practice. The identification of high-risk situations and the practice of coping responses were encouraged. To enhance effective patient-centered health education, the website also included a second module with a support system for the health professional, parallel to the module for encouraging the patient (Figure 3). The third module consisted of a maximum of seven consultations to encourage the patient with cardiovascular risk factors, easily adaptable to the needs and individual characteristics of the patients (Figure 4). This module started with risk perception to encourage the patient to think about individual cardiovascular risk and personal vulnerability, followed by encouraging the patient to describe what the personal pros and cons are (not) to becoming physically active in the short- and long-term. With the support of the professional, the patient was encouraged to recognize social pressure, seek social support, and practice sub-skills. The patient was supported in planning the behavior and putting it into practice, detecting high-risk situations, and practicing coping responses. The third module started with the assessment following cardiovascular risk management guidelines. The screens contained the patient’s profile with a feedback system on the progression in behavior change in a spider chart, physical activity levels in bar graphs, and cardiovascular risk factors in a pie chart. The website helped the patient to look back at the plans made in conjunction with the health care professional. The website provided a fourth module with specific information on physical activity devices, planning physical activity, and cardiovascular risk factors. The website also included a link to a forum directed at health care professionals to share experiences with other professionals in the intervention group. The intervention was extensively tested, but not piloted. The website underwent no changes during implementation. Institutional affiliations were displayed on the website. The study was approved by the Research Ethics Board at Maastricht University and was registered in the Dutch Trial Register (Trial ID: ECP-92, NTR2584).


Supporting health care professionals to improve the processes of shared decision making and self-management in a web-based intervention: randomized controlled trial.

Sassen B, Kok G, Schepers J, Vanhees L - J. Med. Internet Res. (2014)

Intervention screenshot.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4259881&req=5

figure3: Intervention screenshot.
Mentions: Participants had access to the website [32], which offered several modules. The development and content of the intervention is described in detail elsewhere [7,30]. Modules and a forum were directed at the health care professional to increase professionals’ awareness of their thoughts, and learn skills and strategies to support patients in their own self-management, this to improve their intention and behavior toward patient-centered health education. The first module enclosed a set of seven screens to help the professional to improve his or her professional behavior (Figure 2). The screens contained self-complete forms and were designed and pre-tested to educate the health care professional, with a personal feedback system in a “coaching spider chart”. The screens started with “risk” communication to support thinking about encouraging patients. This was followed by listing the pros and cons of encouraging patients in the short- and long-term. Hereafter, the health professional was encouraged to seek support and look at the sub-skills needed to be an encouraging health professional. Next, there was a screen for planning the encouraging behavior change, making a plan, and putting the behavior change into practice. The identification of high-risk situations and the practice of coping responses were encouraged. To enhance effective patient-centered health education, the website also included a second module with a support system for the health professional, parallel to the module for encouraging the patient (Figure 3). The third module consisted of a maximum of seven consultations to encourage the patient with cardiovascular risk factors, easily adaptable to the needs and individual characteristics of the patients (Figure 4). This module started with risk perception to encourage the patient to think about individual cardiovascular risk and personal vulnerability, followed by encouraging the patient to describe what the personal pros and cons are (not) to becoming physically active in the short- and long-term. With the support of the professional, the patient was encouraged to recognize social pressure, seek social support, and practice sub-skills. The patient was supported in planning the behavior and putting it into practice, detecting high-risk situations, and practicing coping responses. The third module started with the assessment following cardiovascular risk management guidelines. The screens contained the patient’s profile with a feedback system on the progression in behavior change in a spider chart, physical activity levels in bar graphs, and cardiovascular risk factors in a pie chart. The website helped the patient to look back at the plans made in conjunction with the health care professional. The website provided a fourth module with specific information on physical activity devices, planning physical activity, and cardiovascular risk factors. The website also included a link to a forum directed at health care professionals to share experiences with other professionals in the intervention group. The intervention was extensively tested, but not piloted. The website underwent no changes during implementation. Institutional affiliations were displayed on the website. The study was approved by the Research Ethics Board at Maastricht University and was registered in the Dutch Trial Register (Trial ID: ECP-92, NTR2584).

Bottom Line: Research to assess the effect of interventions to improve the processes of shared decision making and self-management directed at health care professionals is limited.In the intervention group, no differences in social-cognitive determinants, intention and behavior were found for health care professionals, compared with the control group.We narrowed the intervention group and no significant differences were found in intention and behavior, except for barriers.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Health Care, Innovation in Health Care, University of Applied Sciences, Utrecht, Netherlands. Barbara.sassen@hu.nl.

ABSTRACT

Background: Research to assess the effect of interventions to improve the processes of shared decision making and self-management directed at health care professionals is limited. Using the protocol of Intervention Mapping, a Web-based intervention directed at health care professionals was developed to complement and optimize health services in patient-centered care.

Objective: The objective of the Web-based intervention was to increase health care professionals' intention and encouraging behavior toward patient self-management, following cardiovascular risk management guidelines.

Methods: A randomized controlled trial was used to assess the effect of a theory-based intervention, using a pre-test and post-test design. The intervention website consisted of a module to help improve professionals' behavior, a module to increase patients' intention and risk-reduction behavior toward cardiovascular risk, and a parallel module with a support system for the health care professionals. Health care professionals (n=69) were recruited online and randomly allocated to the intervention group (n=26) or (waiting list) control group (n=43), and invited their patients to participate. The outcome was improved professional behavior toward health education, and was self-assessed through questionnaires based on the Theory of Planned Behavior. Social-cognitive determinants, intention and behavior were measured pre-intervention and at 1-year follow-up.

Results: The module to improve professionals' behavior was used by 45% (19/42) of the health care professionals in the intervention group. The module to support the health professional in encouraging behavior toward patients was used by 48% (20/42). The module to improve patients' risk-reduction behavior was provided to 44% (24/54) of patients. In 1 of every 5 patients, the guideline for cardiovascular risk management was used. The Web-based intervention was poorly used. In the intervention group, no differences in social-cognitive determinants, intention and behavior were found for health care professionals, compared with the control group. We narrowed the intervention group and no significant differences were found in intention and behavior, except for barriers. Results showed a significant overall difference in barriers between the intervention and the control group (F1=4.128, P=.02).

Conclusions: The intervention was used by less than half of the participants and did not improve health care professionals' and patients' cardiovascular risk-reduction behavior. The website was not used intensively because of time and organizational constraints. Professionals in the intervention group experienced higher levels of barriers to encouraging patients, than professionals in the control group. No improvements were detected in the processes of shared decision making and patient self-management. Although participant education level was relatively high and the intervention was pre-tested, it is possible that the way the information was presented could be the reason for low participation and high dropout. Further research embedded in professionals' regular consultations with patients is required with specific emphasis on the processes of dissemination and implementation of innovations in patient-centered care.

Trial registration: Netherlands Trial Register Number (NTR): NTR2584; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2584 (Archived by WebCite at http://www.webcitation.org/6STirC66r).

Show MeSH