Evaluating the impact of continuing professional development courses on physician behavioral intention: a pre-post study with follow-up at six months.

BACKGROUND: Continuing professional development (CPD) for health professionals includes educational activities to maintain or improve skills. We evaluated the impact of a series of CPD courses by identifying factors influencing physicians' intention to adopt targeted behaviors and assessing self-reported behavior adoption six months later. METHODS: In this pre-post study, eligible participants attended at least one in-person course at the Fédération des Médecins Spécialistes du Québec annual meeting in November 2019. Before and afterwards, participants completed CPD-REACTION, a validated questionnaire based on Godin's integrated model for health professional behavior change that measures intention and psychosocial factors influencing intention. We used Wilcoxon signed-rank test to compare pre- and post-course intention scores and linear regression analyses to identify factors influencing intention. We also compared the post-course intention scores of participants reporting a behavior change six months later with the scores of those reporting no behavior change six months later. Qualitative data was collected only six months after courses and responses to open-ended questions were analyzed using the Theoretical Domains Framework. RESULTS: A total of 205/329 course attendees completed CPD-REACTION (response rate 62.3%). Among these participants, 158/329 (48%) completed the questionnaire before CPD courses, 129/329 (39.2%) only after courses and 47/329 (14.3%) at 6 months. Study population included 192 physicians of whom 78/192(40.6%) were female; 59/192(30.7%) were between 50 and 59 years old; and 72/192 (37.5%) were surgical specialist physicians. Mean intention scores before (n = 158) and after (n = 129) courses were 5.74(SD = 1.52) and 6.35(SD = 0.93) respectively. Differences in mean (DM) intention before and afterwards ranged from - 0.31(p = 0.17) to 2.25(p = 0.50). Multivariate analysis showed that beliefs about capabilities (ß = 0.15, p = 0.001), moral norm (ß = 0.75, p < 0.0001), and beliefs about consequences (ß = 0.11, p = 0.04) influenced post-course intention. Post-course intention was correlated with behavior six months later (DM = 0.63; p = 0.02). Qualitative analysis showed that facilitators to behavior adoption after six months were most often related to the TDF domains of beliefs about capabilities. Most frequent barriers to adoption related to lack of resources. CONCLUSIONS: Overall, scores for intention to adopt targeted behaviors increased after the courses. CPD providers could increase participants' intention by including interventions that emphasize beliefs about capabilities, moral norm and beliefs about consequences.

Cyberbullying involvement, parental support, and cannabis use among adolescents.

BACKGROUND: Cyberbullying victimization has been associated with cannabis use among adolescents. However, it is unclear if this relationship also holds for cyberbullying perpetrators. OBJECTIVE: This cross-sectional study examined the association between cyberbullying involvement and cannabis use among adolescents and tested if parental support was associated with cyberbullying involvement and cannabis use. PARTICIPANTS AND SETTING: Data from 7229 students aged 11-20 years were obtained from the 2019 Ontario Student Drug Use and Health Survey, a province-wide survey of middle and high school students across Ontario, Canada. METHODS: Participants self-reported their cannabis use frequency, their involvement in cyberbullying, and their perception of parental support. Cyberbullying involvement was operationalized as an action taking place at least two times. Multivariable logistic regression models were adjusted for age, sex, ethnoracial background, and subjective socioeconomic status. RESULTS: Overall, 8.6 % of students were cyberbullying victims only, 2 % were cyberbullying perpetrators only, and 2.8 % were both cyberbullying victims and perpetrators. Results showed that experience of cyberbullying victimization only (OR: 2.17; 95 % CI: 1.64-2.88), perpetration only (OR: 2.64; 95 % CI: 1.51-4.63), or both (OR: 3.34; 95 % CI: 2.12-5.28) was associated with greater odds of cannabis use. Results further indicated that higher parental support was associated with lower odds of cannabis use in a dose-response fashion. Higher parental support was also associated with a lower risk of cyberbullying involvement. CONCLUSIONS: These findings suggest that involvement in cyberbullying in any role is associated with greater cannabis use among adolescents and that parental support is associated with less cannabis use and cyberbullying involvement.

Use of the CPD-REACTION Questionnaire to Evaluate Continuing Professional Development Activities for Health Professionals: Systematic Review.

BACKGROUND: Continuing professional development (CPD) is essential for physicians to maintain and enhance their knowledge, competence, skills, and performance. Web-based CPD plays an essential role. However, validated theory-informed measures of their impact are lacking. The CPD-REACTION questionnaire is a validated theory-informed tool that evaluates the impact of CPD activities on clinicians' behavioral intentions. OBJECTIVE: We aimed to review the use of the CPD-REACTION questionnaire, which measures the impact of CPD activities on health professionals' intentions to change clinical behavior. We examined CPD activity characteristics, ranges of intention, mean scores, score distributions, and psychometric properties. METHODS: We conducted a systematic review informed by the Cochrane review methodology. We searched 8 databases from January 1, 2014, to April 20, 2021. Gray literature was identified using Google Scholar and Research Gate. Eligibility criteria included all health care professionals, any study design, and participants' completion of the CPD-REACTION questionnaire either before, after, or before and after a CPD activity. Study selection, data extraction, and study quality evaluation were independently performed by 2 reviewers. We extracted data on characteristics of studies, the CPD activity (eg, targeted clinical behavior and format), and CPD-REACTION use. We used the Mixed Methods Appraisal Tool to evaluate the methodological quality of the studies. Data extracted were analyzed using descriptive statistics and the Student t test (2-tailed) for bivariate analysis. The results are presented as a narrative synthesis reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS: Overall, 65 citations were eligible and referred to 52 primary studies. The number of primary studies reporting the use of CPD-REACTION has increased continuously since 2014 from 1 to 16 publications per year (2021). It is available in English, French, Spanish, and Dutch. Most of the studies were conducted in Canada (30/52, 58%). Furthermore, 40 different clinical behaviors were identified. The most common CPD format was e-learning (34/52, 65%). The original version of the CPD-REACTION questionnaire was used in 31 of 52 studies, and an adapted version in 18 of 52 studies. In addition, 31% (16/52) of the studies measured both the pre- and postintervention scores. In 22 studies, CPD providers were university-based. Most studies targeted interprofessional groups of health professionals (31/52, 60%). CONCLUSIONS: The use of CPD-REACTION has increased rapidly and across a wide range of clinical behaviors and formats, including a web-based format. Further research should investigate the most effective way to adapt the CPD-REACTION questionnaire to a variety of clinical behaviors and contexts. TRIAL REGISTRATION: PROSPERO CRD42018116492; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=116492.

Nonmedical use of prescription opioids, psychological distress, and suicidality among adolescents.

PURPOSE: The present study examined associations between nonmedical use of prescription opioids and serious psychological distress, suicidal ideation, and suicide attempts, and tested whether age and sex moderate these relationships. METHODS: Data on 5582 adolescents were obtained from a representative province-wide survey of students in grades 7 through 12 (mean age: 15.3 years) across Ontario, Canada. Nonmedical use of prescribed opioids in the last 12 months was categorized in "no use", "infrequent use (1-2 times)", and "regular use (3 times or more)". Logistic regression analysis was adjusted for age, sex, ethnicity, subjective socioeconomic status, and other substance use (i.e., tobacco cigarette, alcohol, cannabis). RESULTS: Overall, regular nonmedical use of prescription opioids was strongly associated with greater odds of serious psychological distress (OR: 3.47; 95% CI 1.42-8.45), suicidal ideation (OR: 2.73; 95% CI 1.84-4.05), and suicide attempts (OR: 3.21; 95% CI 1.40-7.37). However, infrequent nonmedical use of prescription opioids was associated with greater odds of serious psychological distress (OR: 1.79; 95% CI 1.08-2.98) and suicidal ideation (OR: 1.63; 95% CI 1.20-2.21), but not suicide attempts (OR: 1.84; 95% CI 0.76-4.45). Age-stratified analyses showed that both infrequent (OR: 1.61; 95% CI 1.01-2.58) and regular (OR: 3.40; 95% CI 2.11-5.46) nonmedical use of prescription opioids was strongly associated with greater odds of suicidal ideation among 15- to 20-year-olds, but not 11- to 14-year-olds. CONCLUSION: These findings suggest that nonmedical use of prescription opioids is strongly associated with mental health problems among adolescents. Future research using a longitudinal design is needed to confirm age differences and temporality.

Adolescent pregnancy: Maternal and fetal outcomes in patients with and without preeclampsia.

OBJECTIVE: To determine the prevalence of preeclampsia (PE) in adolescents and to evaluate its association with risk factors for, and the occurrence of, adverse maternal and fetal outcomes. RESULTS: Of 3006 deliveries, 533 (17.7%) were from teenage mothers, with twenty-eight (5.3%) presenting PE; 17.8% of these cases were classed as severe. Vitamin and mineral supplementation was associated with the occurrence of PE (p=0.034). Puerperal complications and prematurity were more frequent in the PE group. CONCLUSIONS: Prevalence of PE among adolescents was similar to the literature data and was associated with high rates of preterm birth and puerperal complications.