Implementing psychological interventions delivered by respiratory professionals for people with COPD. A stakeholder interview study.

Implementing psychological interventions in healthcare services requires an understanding of the organisational context. We conducted an interview study with UK National Health Service stakeholders to understand the barriers and facilitators for implementing psychological interventions for people with chronic obstructive pulmonary disorder (COPD). We used TANDEM as an exemplar intervention; a psychological intervention recently evaluated in a randomised controlled trial. Twenty participants providing care and/or services to people with COPD were purposively sampled from NHS primary/secondary care, and commissioning organisations. Participants were recruited via professional networks and referrals. Verbatim transcripts of semi-structured interviews were analysed using thematic analysis. Four themes were identified: (1) Living with COPD and emotional distress affects engagement with physical and psychological services; (2) Resource limitations affects service provision in COPD; (3) Provision of integrated care is important for patient well-being; and (4) Healthcare communication can be an enabler or a barrier to patient engagement. People need support with physical and psychological symptoms inherent with COPD and healthcare should be provided holistically. Respiratory healthcare professionals are considered able to provide psychologically informed approaches, but resources must be available for training, staff supervision and service integration. Communication between professionals is vital for clear understanding of an intervention's aims and content, to facilitate referrals and uptake. There was widespread commitment to integrating psychological and physical care, and support of respiratory healthcare professionals' role in delivering psychological interventions but significant barriers to implementation due to concerns around resources and cost efficiency. The current study informs future intervention development and implementation.

Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps.

OBJECTIVE: Smartphone games that aim to alter health behaviours are common, but there is uncertainty about how to achieve this. We systematically reviewed health apps containing gaming elements analysing their embedded behaviour change techniques. METHODS: Two trained researchers independently coded apps for behaviour change techniques using a standard taxonomy. We explored associations with user ratings and price. DATA SOURCES: We screened the National Health Service (NHS) Health Apps Library and all top-rated medical, health and wellness and health and fitness apps (defined by Apple and Google Play stores based on revenue and downloads). We included free and paid English language apps using 'gamification' (rewards, prizes, avatars, badges, leaderboards, competitions, levelling-up or health-related challenges). We excluded apps targeting health professionals. RESULTS: 64 of 1680 (4%) health apps included gamification and met inclusion criteria; only 3 of these were in the NHS Library. Behaviour change categories used were: feedback and monitoring (n=60, 94% of apps), reward and threat (n=52, 81%), and goals and planning (n=52, 81%). Individual techniques were: self-monitoring of behaviour (n=55, 86%), non-specific reward (n=49, 82%), social support unspecified (n=48, 75%), non-specific incentive (n=49, 82%) and focus on past success (n=47, 73%). Median number of techniques per app was 14 (range: 5-22). Common combinations were: goal setting, self-monitoring, non-specific reward and non-specific incentive (n=35, 55%); goal setting, self-monitoring and focus on past success (n=33, 52%). There was no correlation between number of techniques and user ratings (p=0.07; rs=0.23) or price (p=0.45; rs=0.10). CONCLUSIONS: Few health apps currently employ gamification and there is a wide variation in the use of behaviour change techniques, which may limit potential to improve health outcomes. We found no correlation between user rating (a possible proxy for health benefits) and game content or price. Further research is required to evaluate effective behaviour change techniques and to assess clinical outcomes. TRIAL REGISTRATION NUMBER: CRD42015029841.

Patients' perceptions of early supported discharge for chronic obstructive pulmonary disease: a qualitative study.

OBJECTIVE: To explore patients' views of an early supported discharge service for chronic obstructive pulmonary disease (COPD). INTERVENTION: Early supported discharge service (EDS) with discharge at 3.5 days (average length of stay for COPD at the time was 9.5 days). After discharge, patients were visited at home daily for 3 days by a nurse from the early discharge service and then, as required, up to 2 weeks. PARTICIPANTS: Purposive, maximum variation sample of 23 mainly older, retired patients admitted to hospital with an acute exacerbation of COPD in 2005. 14 patients listed as receiving EDS, and 9 listed as refusing EDS. DESIGN: Qualitative analysis of audiotaped, semistructured, face-to-face interviews. Setting Economically deprived inner-city borough in England. Results (1) Negotiation and consent. Patients had little recall of being approached to join the scheme. They often felt they had been discharged from hospital before they were ready. They were often unable or unwilling to negotiate timing of discharge with hospital staff. (2) Process of discharge from hospital. Patients experienced difficulties with transport home and supplies of medication. (3) Life at home after a hospital admission. Resuming life at home after an admission for an acute exacerbation for COPD was difficult. Not all patients found the home nursing component of the service helpful. CONCLUSIONS: Early supported discharge with domiciliary care is a model that ought to promote a more equal partnership between patient and healthcare, but this did not appear to be the case in practice.

Evaluating hospital at home and early discharge schemes for patients with an acute exacerbation of COPD.

Hospital at home and early discharge schemes for patients experiencing an acute exacerbation of their chronic obstructive pulmonary disease, appear to be an effective and safe option for selected patients and these services have become increasingly common. Here we discuss the evaluation of such schemes including: the rationale for evaluation; aspects of quality which might be considered for evaluation; the role of evaluation frameworks, quantitative and qualitative evaluation and steps in planning an evaluation.

Emotional intelligence and stress coping in dental undergraduates--a qualitative study.

OBJECTIVE: To explore how dental undergraduates with different levels of emotional intelligence (EI) cope with stress. DESIGN: Qualitative unstructured depth interviews. SETTING: A dental teaching hospital in the UK, 2002. SUBJECTS AND METHODS: Subjects selected from the undergraduate population of a 5-year dental degree course. A questionnaire survey was carried out to determine the EI scores of the subjects. In each year of study, subjects were divided into low and high EI groups at the median score. From each EI group in each year, one male and one female subject were recruited. DATA COLLECTION: Unstructured face-to-face interviews. DATA ANALYSIS: Transcribing, sifting, indexing and charting data according to key themes. RESULTS: 10 males and 10 females with low and high EI, representing all 5 years of study were interviewed. The experience of stress, expressed in emotional terms, ranged from anger and frustration to hatred. Four sets of coping strategies, adopted at varying degrees according to EI, were identified. High EI students were more likely to adopt reflection and appraisal, social and interpersonal, and organisation and time-management skills. Low EI students were more likely to engage in health-damaging behaviours. CONCLUSIONS: Future research needs to establish whether the enhancement of EI in dental students would lead to improved stress-coping, and better physical and psychological health.