ReviewEnhancing delivery of health behaviour change interventions in primary care: A meta-synthesis of views and experiences of primary care nurses
Introduction
Behaviours related to health, especially smoking, diet and physical activity are central to public health [1], [2]. The use of health care services to support health behaviour change (HBC) activities should be optimised [3]. Treatment fidelity describes the extent to which HBC interventions are delivered as planned; whether they remain true to the theoretical frameworks from which they were developed, or to manuals or similar resources specifying intervention techniques. If interventions are not delivered as intended then it is difficult to determine whether outcomes can be attributed to the intervention itself [4], [5], [6]. As a result effective interventions may be discarded and ineffective interventions may be adopted. Lack of attention to fidelity may also result in studies that cannot be adequately replicated across different research contexts or from research to practice [6]. This clearly has implications for the development of evidence based practice, the importance of which has gained momentum in recent years [3].
Methods for enhancing treatment fidelity in HBC interventions have received greater attention in the last few years, due at least partly to the publication of the work in the United States of the National Institutes of Health Behavior Change Consortium (NIH-BCC) Treatment Fidelity Workgroup [6]. Primary care has been identified as a key setting for delivery of HBC interventions due to the opportunities available for undertaking HBC as part of routine care or to support the management of chronic diseases [3], [7], [8]. In many countries, HBC interventions are increasingly being delivered by primary care nurses, as part of their developing role in the management of long term conditions and helping people lead healthier lives. This trend is particularly evident in UK health policy [7], [8]. Even so, there is little known about which strategies are most appropriate to enhance fidelity of delivery to a structured approach by nurses in primary care, despite this being the setting in which advice is commonly provided about HBC.
A number of qualitative studies have explored the views and experiences of nurses who have delivered HBC interventions in primary care [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. The synthesis of such studies can develop understanding of factors that could enhance delivery of and adherence to such interventions.
Hence, the aims of the current study are to systematically find and synthesise qualitative studies that elicited the views and experiences of nurses involved in the delivery of HBC interventions in primary care, with a focus on how this can enhance delivery and adherence to structured HBC interventions.
Section snippets
Methods
The review comprised three elements.
Systematic identification of literature
The search of electronic databases yielded 882 unique references. Nine studies were included in the synthesis [9], [10], [11], [12], [13], [14], [15], [16], [17], [18] (see Fig. 1).
Critical appraisal of studies
All nine studies were deemed to be of good quality in relation to the appropriateness of the research design, recruitment, researcher–participant relationship and ethical considerations. However, there was variation in the quality of studies concerning sufficient description of the data collection and analysis
Discussion
The synthesis resulted in the development of four inter-linking third order themes that were not explicit in all the primary studies, suggesting factors that need to be actively considered in order to support delivery of HBC interventions by primary care nurses. These are (a) engagement of nurses; (b) clarification of roles and responsibilities; (c) engagement of the primary care practices; and (d) communication of aims and outcomes.
In line with previous reviews, searching for qualitative
Acknowledgements
The authors wish to acknowledge Christopher Bark, Subject Librarian, Coventry University who supported the development of the literature search, the authors of the included studies for their assistance in identifying potential studies and sending associated study papers and Warwick and Coventry Primary Care Research for funding the first author's PhD studentship.
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