National Primary Care Research and Development Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
Implement Sci. 2010 Jan 29;5:7. doi: 10.1186/1748-5908-5-7.
The WISE (Whole System Informing Self-management Engagement) approach encompasses creating, finding, and implementing appropriate self-care support for people with long-term conditions. A training package for primary care to introduce the approach was developed and underwent formative evaluation. This entailed exploring the acceptability of the WISE approach and its effectiveness in changing communication within consultations. The study aimed to refine the patient, practitioner, and patient level components of the WISE approach and translate the principles of WISE into an operational intervention deliverable through National Health Service training methods.
Normalisation Process Theory provided a framework for development of the intervention. Practices were recruited from an inner city Primary Care Trust in NW England. All practice staff were expected to attend two afternoon training sessions. The training sessions were observed by members of the training team. Post-training audio recordings of consultations from each general practitioner and nurse in the practices were transcribed and read to provide a narrative overview of the incorporation of WISE skills and tools into consultations. Face-to-face semi-structured interviews were conducted with staff post-training.
Two practices out of 14 deemed eligible agreed to take part. Each practice attended two sessions, although a third session on consultation skills training was needed for one practice. Fifty-four post-training consultations were recorded from 15 clinicians. Two members of staff were interviewed at each practice. Significant elements of the training form and methods of delivery fitted contemporary practice. There were logistical problems in getting a whole practice to attend both sessions, and administrative staff founds some sections irrelevant. Clinicians reported problems incorporating some of the tools developed for WISE, and this was confirmed in the overview of consultations, with limited overt use of WISE tools and missed opportunities to address patients' self-management needs.
The formative evaluation approach and attention to normalisation process theory allowed the training team to make adjustments to content and delivery and ensure appropriate staff attended each session. The content of the course was simplified and focussed more clearly on operationalising the WISE approach. The patient arm of the approach was strengthened by raising expectations of a change in approach to self-care support by their practice.
WISE（全面系统促进自我管理参与）方法包括为患有长期疾病的人创建、寻找和实施适当的自我护理支持。为向初级保健引入该方法开发了一个培训包，并进行了形成性评估。这需要探索 WISE 方法的可接受性及其在改变咨询中的沟通方面的有效性。该研究旨在完善 WISE 方法的患者、从业者和患者层面的内容，并将 WISE 的原则转化为通过国民保健制度培训方法提供的可操作干预措施。
正常化进程理论为干预措施的制定提供了框架。从英格兰西北部一个内城的初级保健信托中招募了实践。所有实践工作人员都预计要参加两个下午的培训课程。培训课程由培训团队的成员进行观察。对实践中每位全科医生和护士的咨询后的音频记录进行转录并阅读，以提供将 WISE 技能和工具纳入咨询的叙述性概述。培训后，对工作人员进行了面对面的半结构化访谈。
14 个实践中有 2 个符合条件并同意参加。每个实践都参加了两个课程，但有一个实践需要进行第三次关于咨询技巧培训的课程。从 15 名临床医生那里记录了 54 次培训后的咨询。在每个实践中采访了两名工作人员。培训形式和交付方法的重要内容符合当代实践。让整个实践参加两个课程存在后勤问题，行政人员发现有些部分不相关。临床医生报告说，在整合为 WISE 开发的一些工具时遇到了问题，这在咨询概述中得到了证实，WISE 工具的明显使用有限，错过了解决患者自我管理需求的机会。
形成性评估方法和对正常化进程理论的关注使培训团队能够调整内容和交付方式，并确保适当的工作人员参加每个课程。课程内容简化了，更加明确地侧重于实施 WISE 方法。通过提高他们的实践对自我护理支持方法改变的期望，加强了方法的患者方面。
