Communication in Smoking Cessation and Self-management : a study at Nurse-led COPD-clinics in Primary Health Care

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care

Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes. Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care. Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations. Results: Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communicationwasmainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation. Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking. Practice implications: To make patients more active, the nurses need more education and continuous training in motivational communication.

Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and survival in Vietnam : a qualitative study

Background In the Neonatal health – Knowledge into Practice (NeoKIP) trial in Vietnam, local stakeholder groups, supported by trained laywomen acting as facilitators, promoted knowledge translation (KT) resulting in decreased neonatal mortality. In general, as well as in the community-based NeoKIP trial, there is a need to further understand how context influences KT interventions in low- and middle-income countries (LMICs). Thus, the objective of this study was to explore the influence of context on the facilitation process in the NeoKIP intervention. Methods A secondary content analysis was performed on 16 Focus Group Discussions with facilitators and participants of the stakeholder groups, applying an inductive approach to the content on context through naïve understanding and structured analysis. Results The three main-categories of context found to influence the facilitation process in the NeoKIP intervention were: (1) Support and collaboration of local authorities and other communal stakeholders; (2) Incentives to, and motivation of, participants; and (3) Low health care coverage and utilization. In particular, the role of local authorities in a KT intervention was recognized as important. Also, while project participants expected financial incentives, non-financial benefits such as individual learning were considered to balance the lack of reimbursement in the NeoKIP intervention. Further, project participants recognized the need to acknowledge the needs of disadvantaged groups. Conclusions This study provides insight for further understanding of the influence of contextual aspects to improve effects of a KT intervention in Vietnam. We suggest that future KT interventions should apply strategies to improve local authorities’ engagement, to identify and communicate non-financial incentives, and to make disadvantaged groups a priority. Further studies to evaluate the contextual aspects in KT interventions in LMICs are also needed.

Oförändrad prestation, men varierande motivation under menstruationscykeln : Ett examensarbete som undersöker om maximalstyrka och explosivitet förändras under menstruationscykeln samt om motivationen korrelerar med prestationen

Syfte - Studien avser att undersöka om prestation gällande maximalstyrka och explosivitet varierar under menstruationscykeln. Dessutom undersöks om den psykologiska motivationen eller känslan korrelerar med prestationen. Studiens syfte är att skapa en utgångspunkt för att se om periodisering av styrketräning i relation till menstruationscykeln faser är aktuell för kvinnor inom prestationsidrotter. Metod - Testerna genomfördes under en menstruationscykel, fyra veckor. Ett test genomfördes varje vecka för att täcka in fyra faser under menstruationscykeln och för att erhålla ett konsekvent veckomönster. Menstruationscykelns faser räknades ut i efterhand för att inte i förhand påverka testdeltagarnas motivation och prestation i förhållande till menstruationscykeln. Fas 1 menstruationsfas, fas 2 intermenstruation, fas 3 intermenstruation/ägglossning och fas 4 premenstruation. I testgruppen ingick fyra kvinnor, 32 år (± 10), längd 162,8 cm (± 7,32), vikt 57,4 kg (± 5,79). I kontrollgruppen ingick en man och två kvinnor utan menstruation, 26,67 år (± 9,02), längd 168,3 cm (± 8,96), vikt 71,7 kg (± 11,02). Fysiska tester, längdhopp och knäböj. En standardiserad uppvärmning genomfördes inför varje test, följdes av tre stycken jämfota längdhopp utan ansats med två minuter vila mellan hoppen. Bästa hoppet av tre dokumenterades. Längdhopp (CV 1,8 %) (Hopkins, Schabort & Hawley, 2001), knäböj, en repetition max [1RM] (CV 1,57 %) (Urquhart, Moir, Graham & Connaboy, 2015). En specifik uppvärmning genomfördes även inför 1RM knäböj därefter försök på en repetition på 1RM. Frågeformulär gällande hälsotillstånd och motivation “Snabbkollen” (Cross & Lyle, 1999) besvarades inför varje testtillfälle. Vid sista testtillfället fick alla testdeltagare fylla i ett frågeformulär om upplevda symptom och tillstånd under den gångna menstruationscykeln. Resultat och slutsats - Det är ur denna studie svårt att tyda om menstruationscykelns olika faser skulle ha någon relevant effekt värd att ta hänsyn till när det gäller prestationen hos idrottande kvinnor. Dock visar resultaten att menstruationscykeln påverkar motivationen.