Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce reulceration risk among patients with a history of diabetic foot ulcers.
Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce reulceration risk among patients with a history of diabetic foot ulcers.
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DOI：
10.1136/bmjopen-2017-019865
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发表时间：
2018-05-18
期刊：
影响因子：
2.9
通讯作者：
Bradbury K
中科院分区：
文献类型：
--
作者：
Greenwell K;Sivyer K;Vedhara K;Yardley L;Game F;Chalder T;Richards G;Drake N;Gray K;Weinman J;Bradbury K
制定 REDUCE 维持干预的综合干预计划，以支持糖尿病足溃疡 (DFU) 患者维持降低溃疡复发风险的行为。采用基于理论、基于证据和以人为本的干预措施制定方法。在干预计划的第一阶段，通过文献范围审查和对 DFU 患者 (n=20) 的定性访谈来整理证据。这被用来确定该人群的社会心理需求和挑战，以及干预目标行为的障碍和促进因素：定期足部检查、足部健康发生变化时的快速自我转介、分级和定期的身体活动以及情绪管理。在第二阶段，这些证据与专家咨询相结合来制定干预计划。制定了指导干预措施发展的简短“指导原则”。利用“行为分析”和“逻辑建模”将干预内容映射到行为改变理论，全面描述干预及其假设机制。干预目标行为面临的主要挑战包括患者对何时自我参考的不确定性、影响足部检查和身体活动的身体限制，以及对某些人来说，管理负面情绪的困难。干预设计的重要考虑因素包括需要提高患者进行自我转诊和使用维持干预的信心，以及需要承认某些干预内容可能仅与某些患者相关（情绪管理、身体活动）。行为分析确定了以下假设促进长期行为维持的过程，包括提高患者的技能、自我效能、知识、积极结果预期、个人控制感、社会支持和身体机会。这项研究为 REDUCE 维护干预措施的干预计划提供了透明的描述。它提供了对目标行为的潜在障碍和促进因素的见解，以及在临床实践中使用的潜在有用的行为改变技术。
To develop a comprehensive intervention plan for the REDUCE maintenance intervention to support people who have had diabetic foot ulcers (DFUs) to sustain behaviours that reduce reulceration risk. Theory-based, evidence-based and person-based approaches to intervention development were used. In phase I of intervention planning, evidence was collated from a scoping review of the literature and qualitative interviews with patients who have had DFUs (n=20). This was used to identify the psychosocial needs and challenges of this population and barriers and facilitators to the intervention’s target behaviours: regular foot checking, rapid self-referral in the event of changes in foot health, graded and regular physical activity and emotional management. In phase II, this evidence was combined with expert consultation to develop the intervention plan. Brief ‘guiding principles’ for shaping intervention development were created. ‘Behavioural analysis’ and ‘logic modelling’ were used to map intervention content onto behaviour change theory to comprehensively describe the intervention and its hypothesised mechanisms. Key challenges to the intervention’s target behaviours included patients’ uncertainty regarding when to self-refer, physical limitations affecting foot checking and physical activity and, for some, difficulties managing negative emotions. Important considerations for the intervention design included a need to increase patients’ confidence in making a self-referral and in using the maintenance intervention and a need to acknowledge that some intervention content might be relevant to only some patients (emotional management, physical activity). The behavioural analysis identified the following processes hypothesised to facilitate long-term behaviour maintenance including increasing patients’ skills, self-efficacy, knowledge, positive outcome expectancies, sense of personal control, social support and physical opportunity. This research provides a transparent description of the intervention planning for the REDUCE maintenance intervention. It provides insights into potential barriers and facilitators to the target behaviours and potentially useful behaviour change techniques to use in clinical practice.
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DOI：
10.1136/bmj.h1258
发表时间：
2015-03-19
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moore GF;Audrey S;Barker M;Bond L;Bonell C;Hardeman W;Moore L;O'Cathain A;Tinati T;Wight D;Baird J
通讯作者：
Baird J
影响因子：
0.7
作者：
Monami, Matteo;Longo, Rosella;Mannucci, Edoardo
通讯作者：
Mannucci, Edoardo
影响因子：
4
作者：
Baxter SK;Blank L;Woods HB;Payne N;Rimmer M;Goyder E
通讯作者：
Goyder E
影响因子：
16.2
作者：
Margolis, DJ;Kantor, J;Berlin, JA
通讯作者：
Berlin, JA
影响因子：
8
作者：
Boulton, Andrew J. M.
通讯作者：
Boulton, Andrew J. M.