5 - All research
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Item Which experiences of health care delivery matter to service users and why? : A critical interpretive synthesis and conceptual map(2012-04) Entwistle, Vikki Ann; Firnigl, Danielle; Ryan, Mandy; Francis, Jillian Joy; Kinghorn, Philip; University of Aberdeen.Aberdeen Centre for Evaluation; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Aberdeen Health Psychology GroupItem Developing theory-informed behaviour change interventions to implement evidence into practice : a systematic approach using the Theoretical Domains Framework(2012) French, Simon D; Green, Sally E; O'Connor, Denise A; McKenzie, Joanne E; Francis, Jillian Joy; Michie, Susan; Buchbinder, Rachelle; Schattner, Peter; Spike, Neil; Grimshaw, Jeremy M; University of Aberdeen.Aberdeen Health Psychology Group; University of Aberdeen.Other Applied Health SciencesItem E-mail invitations to general practitioners were as effective as postal invitations and were more efficient(2012-07) Treweek, Shaun; Barnett, Karen; Maclennan, Graeme; Bonetti, Debbie; Eccles, Martin P; Francis, Jillian Joy; Jones, Claire; Pitts, Nigel B; Ricketts, Ian W; Weal, Mark; Sullivan, Frank; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Aberdeen Health Psychology Group; University of Aberdeen.Institute of Applied Health SciencesItem Specifying content and mechanisms of change in interventions to change professionals’ practice : an illustration from the Good Goals study in occupational therapy(2012) Kolehmainen, Niina; Francis, Jillian Joy; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Aberdeen Health Psychology GroupItem Management of people with acute low-back pain : a survey of Australian chiropractors(2011-12-15) Walker, Bruce F; French, Simon D; Page, Matthew J; O'Connor, Denise A; McKenzie, Joanne E; Beringer, Katherine; Murphy, Kerry; Keating, Jenny L; Michie, Susan; Francis, Jillian Joy; Green, Sally E; University of Aberdeen.Aberdeen Health Psychology Group; University of Aberdeen.Other Applied Health SciencesItem Strengthening evaluation and implementation by specifying components of behaviour change interventions: a study protocol Implementation Science : a study protocol(2011) Michie, Susan; Abraham, Charles; Eccles, Martin; Francis, Jillian Joy; Hardeman, Wendy; Johnston, Marie; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Medicine, Medical Sciences & NutritionItem From Theory to Intervention: Mapping Theoretically Derived Behavioural Determinants to Behaviour Change Techniques(Wiley-Blackwell, 2008) Michie, Susan; Johnston, Marie; Francis, Jillian Joy; Hardeman, Wendy; Eccles, Martin P.Theory provides a helpful basis for designing interventions to change behaviour but offers little guidance on how to do this. This paper aims to illustrate methods for developing an extensive list of behaviour change techniques (with definitions) and for linking techniques to theoretical constructs. A list of techniques and definitions was generated from techniques published in two systematic reviews, supplemented by "brainstorming" and a systematic search of nine textbooks used in training applied psychologists. Inter-rater reliability of extracting the techniques and definitions from the textbooks was assessed. Four experts judged which techniques would be effective in changing 11 theoretical constructs associated with behaviour change. Thirty-five techniques identified in the reviews were extended to 53 by brainstorming and to 137 by consulting textbooks. Agreement for the 53 definitions was 74.7 per cent (15.4% cells completed and 59.3% cells empty for both raters). Agreement about the link between the 35 techniques and theoretical constructs was 71.7 per cent of 385 judgments (12.2% agreement that effective and 59.5% agreement that not effective). This preliminary work demonstrates the possibility of developing a comprehensive, reliable taxonomy of techniques linked to theory. Further refinement is needed to eliminate redundancies, resolve uncertainties, and complete technique definitions.Item Attitudes of advanced Australian medical oncology trainees to rural practice(Blackwell Publishing, 2008-03) Francis, Heather Marion; Clarke, Kerrie A.; Steer, Christopher B.; Francis, Jillian Joy; Underhill, Craig R.Aim: To identify the views of medical oncology trainees regarding rural training posts and rural practice overall, and to identify factors that may improve recruitment. Methods: A questionnaire was posted to all advanced oncology trainees in Australia in June 2006. The trainees were questioned on the perceived advantages and disadvantages of rural practice, their experience during previous rural rotations and potential incentives and barriers in recruiting trainees and specialist oncologists to regional and rural centers. Results: There was a 60% response rate. Of all participants 58% had considered rural practice. Those with a rural family background were more likely to have considered rural practice. Attitudes based on responses to listed disadvantages and advantages of rural practice were heterogenous. Lifestyle factors seemed to be of particular importance. Although there were perceived deficiencies in opportunities for professional education in rural oncology rotations, 94% felt their rotation had been a positive experience overall and 62% were more likely to consider a rural career following their rural rotation. Improving locum cover for leave was seen as a potential incentive by 97% trainees. Conclusion: Despite positive attitudes towards rural practice, many barriers exist preventing recruitment of medical oncology trainees to rural areas, in particular lifestyle factors that are difficult to modify. Factors that can be improved include improving access to clinical trials, enabling access to locum cover. Educational opportunities for current rural trainees need to be improved. Further study into potential incentives to enhance rural recruitment is required.Item Personal project analysis : opportunities and implications for multiple goal assessment, theoretical integration, and behaviour change(EHPS, 2008-06) Presseau, Justin; Sniehotta, Falko F.; Francis, Jillian Joy; Little, Brian R.Much of our behaviour acts in service of pursuing our goals (Carver & Scheier, 1998). However, research into goal pursuit has mostly focused upon the study of single isolated health goals and behaviours. As Gebhardt (this issue) discusses, life is more complex; people pursue multiple goals via numerous behaviours (health related and not), which all potentially compete for limited resources. Further investigation is needed using multiple goal approaches that account for this complexity. This thought piece describes a comprehensive unit of analysis and an associated methodological framework for conducting research on multiple goals, and provides suggestions for its potential application in health psychology.Item The effectiveness and cost-effectiveness of minimal access surgery amongst people with gastro-oesophageal reflux disease – a UK collaborative study(National Institute for Health Research, 2008-09) Grant, Adrian Maxwell; Wileman, Samantha Mary; Ramsay, Craig R; Bojke, Laura; Sculpher, Mark J.; Kilonzo, Mary Mueni; Vale, Luke David; Francis, Jillian Joy; Mowat, Ashley G.; Krukowski, Zygmunt H.; Campbell, Marion Kay; Epstein, David; Macran, Sue; Heading, Robert; Thursz, Mark; Russell, Ian; REFLUX Trial Group; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences*Corresponding author randomised arm of the trial (178 allocated to surgical management,179 allocated to continued, but optimised,medical management) and 453 recruited to the parallel non-randomised preference arm (261 chose surgical management, 192 chose to continue with best medical management). The type of fundoplication was left to the discretion of the surgeon. Main outcome measures: Participants completed a baseline reflux questionnaire, developed specifically for this study, containing a disease-specific outcome measure, the Short Form with 36 Items (SF-36), the EuroQol-5 Dimensions (EQ-5D) and the Beliefs about Medicines and Surgery questionnaires (BMQ/BSQ).Postal questionnaires were completed at participant specific time intervals after joining the trial (equivalent to approximately 3 and 12 months after surgery).Intraoperative data were recorded by the surgeons and all other in-hospital data were collected by the research nurse. At the end of the study period, participants completed a discrete choice experiment questionnaire. Results: The randomised groups were well balanced at entry. Participants had been taking GORD medication for a median of 32 months; the mean age of participants was 46 years and 66% were men. Of 178 randomised to surgery, 111 (62%) actually had fundoplication.There was a mixture of clinical and personal reasons why some patients did not have surgery, sometimes Objectives: To evaluate the clinical effectiveness, costeffectiveness and safety of a policy of relatively early laparoscopic surgery compared with continued medical management amongst people with gastro-oesophageal reflux disease (GORD) judged suitable for both policies. Design: Relative clinical effectiveness was assessed by a randomised trial (with parallel non-randomised preference groups) comparing a laparoscopic surgerybased policy with a continued medical management policy. The economic evaluation compared the costeffectiveness of the two management policies in order to identify the most efficient provision of future care and describe the resource impact that various policies for fundoplication would have on the NHS.Setting: A total of 21 hospitals throughout the UK with a local partnership between surgeon(s) and gastroenterologist(s) who shared the secondary care of patients with GORD.Participants: The 810 participants, who were identified retrospectively or prospectively via their participating clinicians, had both documented evidence of GORD (endoscopy and/or manometry/24-hour pH monitoring) and symptoms for longer than 12 months. In addition,the recruiting clinician(s) was clinically uncertain about which management policy was best.Intervention: Of the 810 eligible patients who consented to participate, 357 were recruited to the related to long waiting times. A total or partial wrap procedure was performed depending on surgeon preference. Complications were uncommon and there were no deaths associated with surgery. By the equivalent of 12 months after surgery, 38% in the randomised surgical group (14% amongst those who had surgery) were taking reflux medication compared with 90% in the randomised medical group. There were substantial differences (one-third to one-half standard deviation) favouring the randomised surgical group across the health status measures, the size depending on assumptions about the proportion that actually had fundoplication. These differences were the same or somewhat smaller than differences observed at 3 months. The lower the reflux score, the worse the symptoms at trial entry and the larger the benefit observed after surgery. The preference surgical group had the lowest reflux scores at baseline. These scores improved substantially after surgery, and by 12 months they were better than those in the preference medical group. The BMQ/BSQ and discrete choice experiment did distinguish the preference groups from each other and from the randomised groups. The latter indicated that the risk of serious complications was the most important single attribute of a treatment option. A within trial cost-effectiveness analysis suggested that the surgery policy was more costly (mean £2049) but also more effective [+0.088 quality-adjusted life-years (QALYs)]. The estimated incremental cost per QALY was £19,000–£23,000, with a probability between 46% (when 62% received surgery) and 19% (when all received surgery) of cost-effectiveness at a threshold of £20,000 per QALY. Modelling plausible longer-term scenarios (such as lifetime benefit after surgery) indicated a greater likelihood (74%) of costeffectiveness at a threshold of £20,000, but applying a range of alternative scenarios indicated wide uncertainty.The expected value of perfect information was greatest for longer-term quality of life and proportions of surgical patients requiring medication.Conclusions: Amongst patients requiring long-term medication to control symptoms of GORD, surgical management significantly increases general and refluxspecific health-related quality of life measures, at least up to 12 months after surgery. Complications of surgery were rare. A surgical policy is, however, more costly than continued medical management. At a threshold of £20,000 per QALY it may well be cost-effective, especially when putative longer-term benefits are taken into account, but this is uncertain.The more troublesome the symptoms, the greater the potential benefit from surgery. Uncertainty about cost-effectiveness would be greatly reduced by more reliable information about relative longer-term costs and benefits of surgical and medical policies. This could be through extended follow-up of the reflux trial cohorts or of other cohorts of fundoplication patients.
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