Gemma Pearce

Implementing supported self-management for asthma: a systematic review and suggested hierarchy of evidence of implementation studies

BackgroundAsthma self-management remains poorly implemented in clinical practice despite overwhelming evidence of improved healthcare outcomes, reflected in guideline recommendations over three decades. To inform delivery in routine care, we synthesised evidence from implementation studies of self-management support interventions.MethodsWe systematically searched eight electronic databases (1980 to 2012) and research registers, and performed snowball and manual searches for studies evaluating implementation of asthma self-management in routine practice. We included, and adapted systematic review methodology to reflect, a broad range of implementation study designs. We extracted data on study characteristics, process measures (for example, action plan ownership), asthma control (for example, patient reported control questionnaires, days off school/work, symptom-free days) and use of health services (for example, admissions, emergency department attendances, unscheduled consultations). We assessed quality using the validated Downs and Black checklist, and conducted a narrative synthesis informed by Kennedy’s whole systems theoretical approach (considering patient, practitioner and organisational components and the interaction between these).ResultsWe included 18 studies (6 randomised trials, 2 quasi-experimental studies, 8 with historical controls and 3 with retrospective comparators) from primary, secondary, community and managed care settings serving a total estimated asthma population of 800,000 people in six countries. In these studies, targeting professionals (n = 2) improved process, but had no clinically significant effect on clinical outcomes. Targeting patients (n = 6) improved some process measures, but had an inconsistent impact on clinical outcomes. Targeting the organisation (n = 3) improved process measures, but had little/no effect on clinical outcomes. Interventions that explicitly addressed patient, professional and organisational factors (n = 7) showed the most consistent improvement in both process and clinical outcomes. Authors highlighted the importance of health system commitment, skills training for professionals, patient education programmes supported by regular reviews, and on-going evaluation of implementation effectiveness.ConclusionsOur methodology offers an exemplar of reviews synthesising the heterogeneous implementation literature. Effective interventions combined active engagement of patients, with training and motivation of professionals embedded within an organisation in which self-management is valued. Healthcare managers should consider how they can promote a culture of actively supporting self-management as a normal, expected, monitored and remunerated aspect of the provision of care.Systematic review registrationPROSPERO (registration number: CRD42012002898) Accessed 24 May 2015

Three Worlds: new directions in participant development in sport and physical activity

The twin challenges of inactivity and the 2012 Olympics have tightened the focus in UK sport promotion. However, the twin track approach which treats these challenges as distinct concerns may limit the efficacy of interventions in either area. We propose that a continuum between participation, performance sport and elite achievement represents the most efficacious and logical focus for practitioners and researchers alike. We explore the genesis of this, and other problematic features through critical consideration of key theories. Finally, we propose a multidimensional approach to lifelong sport and activity participation as a theoretically justified basis for research and intervention design.

Promoting lifelong physical activity and high level performance: realising an achievable aim for physical education

Background: Even though all school-aged children in most countries experience some form of curricular physical education many do not maintain a lifelong involvement in sport or physical activity. From a theoretical perspective, the development models that dominate sport are limited by their staged and linear approaches to development (e.g. Côtés Developmental Model of Sport Participation) and their focus on a ‘distinct’ pathway to elite sport. R.P. Bailey and colleagues in 2010 advocated a new approach to understanding development in sport that enables a lifelong flow between different, but interrelated, motives for participation in sport (e.g. Participation, Personal Excellence, Elite Excellence). It is suggested that a common set of skills facilitate participation for these related but distinct motives across the lifespan. However, we argue that many curricular models in PE do not equip individuals with the skills necessary to maintain their involvement in sport and progress back and forth between different types of activities. Purpose: The purpose of this paper is to explore the psycho-motor and psycho-behavioural factors that underpin prolonged engagement in sport and physical activity, against a consideration of the extent to which these factors are promoted within PE. Key findings: Offering an operationalisation of this purpose, the Developing the Potential of Young People in Sport (DPYPS) model was used as an illustration of a developmental and educationally-oriented framework that recognised the interrelated importance of developing key developmental skills, namely psychomotor and psycho-behavioural skills, in a PE context. Essentially the skills offered within the DPYPS program are those psychological and psychomotor fundamentals that underpin learning, development, and performance and act as the foundation of lifelong engagement in sport and physical activity.

The PRISMS taxonomy of self-management support: derivation of a novel taxonomy and initial testing of its utility

Background Supporting self-management is a core response of health care systems globally to the increasing prevalence of long-term conditions. Lack of a comprehensive taxonomy (or classification) of self-management support components hinders characterization and, ultimately, understanding of these frequently complex, multi-component interventions. Objective To develop a comprehensive, descriptive taxonomy of self-management support components. Methods Components were derived from the 969 unique randomized controlled trials described in the 102 systematic reviews and 61 implementation trials, examining 14 diverse long-term conditions included in the Practical Reviews in Self-Management Support (PRISMS) project followed by discussion at an expert stakeholder workshop. The utility of the taxonomy was then tested using a self-management support intervention for cancer survivors. Results The PRISMS taxonomy comprises 14 components that might be used to support self-management (e.g. information about condition/management, provision of equipment, social support), when delivered to someone with a long-term condition or their carer. Overarching dimensions are delivery mode; personnel delivering the support; intervention targeting; and intensity, frequency and duration of the intervention. The taxonomy does not consider the effectiveness or otherwise of the different components or the overarching dimensions. Conclusions The PRISMS taxonomy offers a framework to researchers describing self-management support interventions, to reviewers synthesizing evidence and to developers of health services for people with long-term conditions.

Systematic meta-review of supported self-management for asthma: A healthcare perspective

BackgroundSupported self-management has been recommended by asthma guidelines for three decades; improving current suboptimal implementation will require commitment from professionals, patients and healthcare organisations. The Practical Systematic Review of Self-Management Support (PRISMS) meta-review and Reducing Care Utilisation through Self-management Interventions (RECURSIVE) health economic review were commissioned to provide a systematic overview of supported self-management to inform implementation. We sought to investigate if supported asthma self-management reduces use of healthcare resources and improves asthma control; for which target groups it works; and which components and contextual factors contribute to effectiveness. Finally, we investigated the costs to healthcare services of providing supported self-management.MethodsWe undertook a meta-review (systematic overview) of systematic reviews updated with randomised controlled trials (RCTs) published since the review search dates, and health economic meta-analysis of RCTs. Twelve electronic databases were searched in 2012 (updated in 2015; pre-publication update January 2017) for systematic reviews reporting RCTs (and update RCTs) evaluating supported asthma self-management. We assessed the quality of included studies and undertook a meta-analysis and narrative synthesis.ResultsA total of 27 systematic reviews (n = 244 RCTs) and 13 update RCTs revealed that supported self-management can reduce hospitalisations, accident and emergency attendances and unscheduled consultations, and improve markers of control and quality of life for people with asthma across a range of cultural, demographic and healthcare settings. Core components are patient education, provision of an action plan and regular professional review. Self-management is most effective when delivered in the context of proactive long-term condition management. The total cost (n = 24 RCTs) of providing self-management support is offset by a reduction in hospitalisations and accident and emergency visits (standard mean difference 0.13, 95% confidence interval −0.09 to 0.34).ConclusionsEvidence from a total of 270 RCTs confirms that supported self-management for asthma can reduce unscheduled care and improve asthma control, can be delivered effectively for diverse demographic and cultural groups, is applicable in a broad range of clinical settings, and does not significantly increase total healthcare costs. Informed by this comprehensive synthesis of the literature, clinicians, patient-interest groups, policy-makers and providers of healthcare services should prioritise provision of supported self-management for people with asthma as a core component of routine care.Systematic review registrationRECURSIVE: PROSPERO CRD42012002694; PRISMS: PROSPERO does not register meta-reviews

Participant development in sport and physical activity: The impact of biological maturation

Abstract Recent literature sees participation in sport and physical activity as a lifelong continuum. As a consequence, youth sport must be seen as more than just about young athletes achieving elite performance. Accordingly, there is a need to improve our understanding of development in order to help grow and maintain involvement in sport and physical activity since the spectrum of participation is linked on a bio-psycho-social perspective throughout life. Reflecting this need, the paper reviews the evidence underpinning various ‘accepted constructs’ of development such as non-linear biological growth, specialised physical development periods, and the associated acute and chronic training prescription implications. Based on such, the paper identifies a need for academics and practitioners to work more closely to establish an evidence-base related to accelerated and decelerated periods of athletic development during maturation using controlled longitudinal investigations in order to help nurture athletic development and participation pathways from a lifelong perspective to a greater extent.

Football pitches and Barbie dolls: young children’s perceptions of their school playground

Playgrounds and play times offer valuable contexts for children to explore and learn about themselves and their social lives. This study sought to gather evidence of children’s perceptions of their playgrounds and play times, specifically whether the playgrounds were seen positively or negatively and the types of activities in which they engaged. Child-oriented methods were adopted inspired by the Mosaic approach. The main themes from the focus group interviews were social play (friendship, loneliness/solitude and fair play); physical activity play (activities and rationale); risk (injuries and bullying); and gender (action/stillness and gendered roles). Research suggests that segregation declines when adult supervision supports shared play, and our experiences suggest that such intervention is the most likely solution to the ‘problem’ of gender play in this setting.

Experiences of Self-Management Support Following a Stroke: A Meta-Review of Qualitative Systematic Reviews

Background Supporting self-management in stroke patients improves psychological and functional outcomes but evidence on how to achieve this is sparse. We aimed to synthesise evidence from systematic reviews of qualitative studies in an overarching meta-review to inform the delivery and development of self-management support interventions. Methods We systematically searched eight electronic databases including MEDLINE, EMBASE and CINAHL for qualitative systematic reviews (published January 1993 to June 2012). We included studies exploring patients’, carers’ or health care professionals’ experiences relevant to self-management support following a stroke, including studies describing the lived experience of surviving a stroke. We meta-synthesised the included review findings using a meta-ethnographic framework. Results Seven reviews, reporting 130 unique studies, were included. Themes emerging from the reviews were pertinent, consistent and showed data saturation; though explicit mention of self-management support was rare. Our meta-review highlighted the devastating impact of stroke on patients’ self-image; the varying needs for self-management support across the trajectory of recovery; the need for psychological and emotional support throughout recovery particularly when physical recovery plateaus; the considerable information needs of patients and carers which also vary across the trajectory of recovery; the importance of good patient-professional communication; the potential benefits of goal-setting and action-planning; and the need for social support which might be met by groups for stroke survivors. Conclusions The observed data saturation suggests that, currently, no further qualitative research simply describing the lived experience of stroke is needed; we propose that it would be more useful to focus on qualitative research informing self-management support interventions and their implementation. Our findings demonstrate both the on-going importance of self-management support and the evolving priorities throughout the stages of recovery following a stroke. The challenge now is to ensure these findings inform routine practice and the development of interventions to support self-management amongst stroke survivors.

The development of synchronous text-based instant messaging as an online interviewing tool

The article reports the development of a synchronous text-based online interviewing tool with a continuity of private discussion that is not achieved in open-ended questionnaires, email interviews and online discussion boards. The participants were women who had undergone a surgical or natural menopause, who in a pilot interview highlighted the potential sensitivity of this subject and inspired the implementation of this method. The overall feedback was positive with the main advantages centred on feelings of anonymity, convenience and a more comfortable interview environment. Disadvantages included lack of body language and technical issues with computers. This technique ensures a degree of confidentiality while still obtaining depth of enquiry, where other qualitative methods potentially risk invading a participant’s privacy. It can be offered both alongside other interviewing techniques to allow participant choice and on its own when exploring sensitive and personal topics or when extra participant anonymity is appropriate.

Body image during the menopausal transition: a systematic scoping review

This scoping review aimed to examine womens body image during the menopausal transition systematically. A systematic search strategy and exclusion criteria were applied to ensure that only relevant research was included in the review. A total of 15 studies in 17 papers were included highlighting an equivocal relationship between body image and the menopausal transition. The menopausal transition is complex and individual, and should not be examined as a simple positive or negative transition. There is a sense of confusion for women experiencing the menopausal transition due to contradicting medical advice and societal expectations of body image. Currently, the research consists of exploratory-based studies that highlight the importance of researching this field further to aid adaptive coping and self-management across this transition.