Enhancing Self-care Through Opportunistic Motivational Techniques, Used by Community Nurses, While Caring for Housebound Patients With Long-term Conditions: a Mixed Methods Feasibility Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 62
- 试验地点
- 2
- 主要终点
- Recruitment and retention to the study
研究概览
简要总结
The prevalence of people living with problems due to a long-term condition (LTC) such as heart disease, diabetes or arthritis in England exceeds 15 million, and the number of those with more than one LTC continues to grow (LTCs). This population consumes a large proportion of health service resources. Advancing age and LTCs increase the likelihood of becoming housebound, this has a detrimental effect on health and quality of life. Health policy advocates a health service model of empowerment and self-care. People who live with LTCs are often very knowledgeable about how to look after their health but find it difficult to adjust their.
Motivational techniques have been demonstrated to facilitate behaviour change through changing the style of communication from directive to collaborative. The use of patient-centred conversational style of communication has been shown to elicit more willingness to change than professional-led directive consultations. Community nurses are in a unique position to influence housebound patients to play a greater part in caring for themselves, preventing complications in their long-term conditions and further ill health.
This study intends to test the feasibility and acceptability of training community nurses in Understanding Behaviour Change, a communication technique which uses motivational interviewing to guide patients to change their behaviour. The opportunistic use of motivational techniques to create participatory relationships between patients, community nurses potentially represents an effective intervention to enable patients with LTCs to optimise the way they care for themselves.
Motivational interviewing techniques have been widely demonstrated to bring about behaviour change but have not been studied in the context of changing the style of communication between housebound patients and the professionals caring for them.
详细描述
Study Design and Methods This study has a pragmatic mixed methods explanatory design, consisting of a clinical trial and a qualitative study. The results of the trial will be used to inform the interview protocol for the qualitative study, the data from which will be analysed to explore and elaborate on the results from the trial.
Phase one: Clinical Trial Design This is a parallel controlled, single blinded trial. The outcomes of the patients cared for by nurses who have undergone UBC will be compared with the outcomes from patients who have received usual care.
Population: All patients referred to the caseload of the community nursing teams will be considered for inclusion in this trial. If the patients are on the community caseload they will be considered housebound at the time of treatment as this is the criteria for acceptance onto the caseload. The criteria of infrequent absences from home which are short in duration and require taxing effort is used in line with the Medicare definition of homebound (U.S. Department of Health and Human Services 2010).
Blinding: The patients will not be told whether or not they are being cared for by nurses who have received UBC training.
Randomisation: It is intended that a trial resulting from this study would have a random controlled cluster design to overcome this. All eligible patients in one locality will be exposed to the intervention and all eligible patients in the other locality will not be exposed. Randomising at community nursing team level in a cluster trial could lead to contamination, as within the locality nurses may cover for other teams at weekends and during periods of staff absence. If this feasibility study leads to a larger trial, it would be possible to randomise at locality level to reduce bias. Non-randomised feasibility studies do not have reduced validity (Craig et al 2008).
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients who give informed consent
- •Patients on the community nurses caseload
- •Patients with long-term conditions
排除标准
- •Any inclusion criteria not met
- •Patients who are not expected to be seen more than three times
- •Less than 18 years old.
- •Patients who are unable to complete the questionnaire in English.
- •Patients who through physical or psychological conditions do not have the potential to contribute to their own care, as decided by the community nurse.
- •Patients who are unable to give informed consent.
- •Those who hold their own health budget or are part of the proactive care programme
- •Patients who are at the end of life.
研究组 & 干预措施
Intervention
participants will receive their usual treatment from nurses who have had some training in behaviour change and motivational interviewing.
干预措施: Behaviour change and motivational interviewing (Behavioral)
Control
The participants will receive their usual treatment from nurses who have had no additional training in behaviour change and motivational interviewing.
结局指标
主要结局
Recruitment and retention to the study
时间窗: 12 months
To test the feasibility of recruiting people who are housebound to a behaviour change intervention (ESC) The number of housebound patients who meet the inclusion criteria of those who is recruited to the study. The number of participants who complete the study. The reasons for not completing the study.
次要结局
- General self-efficacy scale(12 months)
- Measurement of patient enablement(12 months)
- Quality of life(12 months)
- The appropriateness of the preliminary primary outcome(12 months)