Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
BMC Health Serv Res. 2013 Feb 9;13:54. doi: 10.1186/1472-6963-13-54.
Lifestyle risk factors like smoking, nutrition, alcohol consumption, and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care is an appropriate setting to address these risk factors in individuals. Generalist community health nurses (GCHNs) are uniquely placed to provide lifestyle interventions as they see clients in their homes over a period of time. The aim of the paper is to examine the impact of a service-level intervention on the risk factor management practices of GCHNs.
The trial used a quasi-experimental design involving four generalist community nursing services in NSW, Australia. The services were randomly allocated to either an intervention group or control group. Nurses in the intervention group were provided with training and support in the provision of brief lifestyle assessments and interventions. The control group provided usual care. A sample of 129 GCHNs completed surveys at baseline, 6 and 12 months to examine changes in their practices and levels of confidence related to the management of SNAP risk factors. Six semi-structured interviews and four focus groups were conducted among the intervention group to explore the feasibility of incorporating the intervention into everyday practice.
Nurses in the intervention group became more confident in assessment and intervention over the three time points compared to their control group peers. Nurses in the intervention group reported assessing physical activity, weight and nutrition more frequently, as well as providing more brief interventions for physical activity, weight management and smoking cessation. There was little change in referral rates except for an improvement in weight management related referrals. Nurses' perception of the importance of 'client and system-related' barriers to risk factor management diminished over time.
This study shows that the intervention was associated with positive changes in self-reported lifestyle risk factor management practices of GCHNs. Barriers to referral remained. The service model needs to be adapted to sustain these changes and enhance referral.
ACTRN12609001081202.
生活方式风险因素，如吸烟、营养、饮酒和缺乏身体活动（SNAP），是慢性病的主要行为风险因素。初级卫生保健是在个人层面解决这些风险因素的适当场所。全科社区保健护士（GCHN）由于在一段时间内能够在患者家中看到患者，因此能够提供生活方式干预，处于独特的位置。为了检验服务层面干预对 GCHN 管理风险因素做法的影响，本文旨在研究这一干预措施。
该试验采用准实验设计，涉及澳大利亚新南威尔士州的四个全科社区护理服务。这些服务被随机分配到干预组或对照组。干预组的护士接受了提供简短生活方式评估和干预的培训和支持。对照组提供常规护理。129 名全科社区保健护士完成了基线、6 个月和 12 个月的调查，以检查他们在管理 SNAP 风险因素方面的做法和信心水平的变化。对干预组的六名半结构化访谈和四名焦点小组进行了访谈，以探讨将干预措施纳入日常实践的可行性。
与对照组相比，干预组的护士在三个时间点对评估和干预的信心都有所增强。干预组的护士报告称，更频繁地评估身体活动、体重和营养状况，并更频繁地提供身体活动、体重管理和戒烟方面的简短干预。除了体重管理相关转诊的改善外，转诊率几乎没有变化。护士对管理风险因素的“患者和系统相关”障碍的重要性的看法随着时间的推移而减弱。
本研究表明，该干预措施与 GCHN 自我报告的生活方式风险因素管理做法的积极变化相关。转诊障碍仍然存在。需要调整服务模式，以维持这些变化并加强转诊。
ACTRN12609001081202。
