A group intervention for pregnant multiparas with fear of childbirth: A protocol of a feasibility study of the MOTIVE trial.

BACKGROUND: Although research interest in fear of childbirth has increased, interventions targeting especially multiparas with fear of childbirth have been overlooked, although untreated fear can cause serious adverse effects on the mother and the whole family. Thus MOTIVE (Multiparas overcoming Childbirth Fear Through Intervention and Empowerment), an intervention for pregnant multiparas with fear of childbirth, was designed. METHODS: This is a protocol of a single-arm non-randomized feasibility study of the MOTIVE trial with a mixed-methods design. The primary aim of the intervention is to assist pregnant multiparas with fear of childbirth, with the desired outcome to alleviate fear. MOTIVE consists of four group sessions (2 h each); three during pregnancy and one after giving birth and in addition of a phone call after birth. The intervention is provided by a midwife and a psychiatric nurse at the maternity hospital. Quantitative data will be gathered via self-report questionnaires at three time points, at baseline, at 4 weeks post-baseline and post-intervention. Qualitative data will be gathered by diaries, open-ended questions from post-intervention questionnaires, and individual interviews. The target is to assemble four groups of four multiparas over a 12-month period. DISCUSSION: The findings will provide insights into the feasibility and acceptability of the intervention and will inform revisions to it. The results will guide the development of a definitive, larger-scale trial evaluation to further examine the efficacy of the refined intervention.

Developing an Instrument to Measure Public Health Nurses' Competence Related to Breastfeeding Beyond 12 Months.

BACKGROUND: Health professionals need adequate competence to support breastfeeding beyond infancy. There is no established instrument to measure health professionals' competence regarding long-term breastfeeding. To respond to this shortcoming, the Long-Term Breastfeeding Competence Scale (LBCS) was developed. RESEARCH AIM: To develop and pilot an instrument that measures public health nurses' competence related to breastfeeding beyond 12 months in order to provide adequate breastfeeding counseling for families. METHODS: This study was conducted as a cross-sectional online survey on public health nurses working in maternity and/or child health clinics. The relevance and clarity of the LBCS were assessed by an expert panel (N = 6). Public health nurses (N = 197) completed the LBCS, which consisted of a knowledge and skills dimension and an attitude dimension. Descriptive statistics were used to describe the characteristics of the study sample. The conceptual validity of the knowledge and skills dimension was assessed using the dichotomous Rasch analysis, and attitude dimension using the exploratory factor analysis. Internal consistency was evaluated using Cronbach's alpha. The distribution of the items was summarized by descriptive statistics. RESULTS: According to expert panel evaluations, the LBCS was found to meet the requirements for relevance and clarity (S-CVI 0.90). The internal consistency of the instrument was at a good level (α = 0.796) and met the requirements set for a new instrument. CONCLUSION: The LBCS is appropriate to determine public health nurses' competence related to breastfeeding beyond 12 months. The LBCS can be used to identify the need for education concerning breastfeeding beyond 12 months.

Perception of inherited risk in type 2 diabetes: a systematic review.

Introduction: A family history is impacting the individual's risk perception. The objective of this systematic review was to describe inherited risk perceptions of type 2 diabetes from the citizen's viewpoint. The aim was to summarize and increase understanding so that the increased knowledge could be used effectively in type 2 diabetes risk communication in health care. Methods: We conducted a systematic review using CINAHL, Medline, and Scopus databases for hereditary, risk, perception, and diabetes related concepts, within the date range of 1.1.2017 to 2.8.2022. Eligible articles were English, peer-reviewed, and addressed the research question: how is hereditary risk of type 2 diabetes perceived? Returns were viewed independently by two authors, and evaluated using the appraisal criteria of the Joanna Briggs Institute. A thematic analysis was used for the synthesis of the data, yielding three themes describing perceptions of inherited risk in type 2 diabetes. Results: A total of 32 articles were included, of which 23 were quantitative, 5 qualitative, and 4 were mixed-methods studies. The extracted themes were (1) Identifying heredity as a risk factor, (2) Diversity of hereditary risk, and (3) Perception of the magnitude of personal risk. Discussion: The perception towards hereditary risk can vary from a desire to actively make a lifestyle change, to the view that diabetes is inevitable regardless of lifestyle. A positive family history increases the risk perception of type 2 diabetes, but the perceived magnitude of the risk may vary from person to person. The findings have the potential to be applied in healthcare's risk communication.

Health professionals' competencies regarding breastfeeding beyond 12 months: a systematic review.

BACKGROUND: Breastfeeding up to two years and beyond supports the health and neurobiological development of a child. Nevertheless, mothers experience criticism from health professionals towards breastfeeding beyond 12 months. Competence related to breastfeeding counselling is defined as minimum knowledge, skills and attitudes that all health professionals should have to protect, promote and support breastfeeding. Professionals' education related to breastfeeding beyond 12 months is insufficient worldwide which challenges the competent and evidence-based support mothers wish for. METHODS: This systematic review aimed to synthesize the existing literature on health professionals' competencies regarding breastfeeding beyond 12 months. The search was limited to peer-reviewed scientific papers published between 2000 and 2022 that focused on the competencies of health professionals regarding breastfeeding beyond 12 months. Seven databases were searched, and of the 884 studies retrieved, seven were included in the review. The studies were subjected to the Joanna Briggs Institute (JBI) critical appraisal checklists. The data were analyzed using deductive thematic analysis, driven by the concept of competence. RESULTS: All the dimensions of competence could be found in the data. Health professionals' knowledge or skills related to breastfeeding beyond 12 months were explored in all seven studies, and attitudes towards breastfeeding beyond 12 months were explored in four studies. The main themes identified were Knowledge Combined with Skills, and Attitudes. The main theme, Knowledge Combined with Skills, was formed out of eight themes: perceptions regarding nutritional value, perceptions regarding economic value, perceptions regarding family interaction, perceptions regarding impacts on the mother's wellbeing, perceptions regarding impacts on the child's wellbeing, perceptions regarding suitable duration, perceptions regarding recommendations, and counseling skills. The attitudes varied and therefore the Attitudes main theme consisted of three themes: promotive attitudes, hostile attitudes, and passive attitudes towards breastfeeding beyond 12 months. CONCLUSIONS: Health professionals' knowledge and skills include several dimensions and vary substantially. Health professionals' attitudes vary between hostile and supportive and influence professionals' advice regarding breastfeeding beyond 12 months. The results suggested that there is considerable variation in health professionals' competencies, which emphasizes the importance of education regarding breastfeeding beyond 12 months.

Experiences of Help from the Perspective of Parents Whose Adolescent Is Harming Themselves or Has Died by Suicide.

Adolescent self-harm or suicide are emotionally difficult for parents, thus also parents need help. This qualitative descriptive study aimed to produce knowledge on the experiences of help received by Finnish parents (n = 23) whose adolescent is harming themselves or has died by suicide. The parents received diverse help for themselves, and for their self-harming adolescent or the deceased adolescent's sibling. Parents described negative experiences, but also factors that promoted their experience of help. There are many barriers to help related to the parents themselves, the adolescent, or to the social support system. Professional help should be easier to obtain and be based on the parents' individual expectations.

Shattered childhood: Experiences of polio survivors in Finland 1950s and 1960s.

AIM: To describe the childhood experiences of patients with polio from the acute phase of the disease during post-war Finland in the 1950s and 1960s. DESIGN: Qualitative empirical study based on self-reported history of nursing rooted in the past, a history of experiences. METHODOLOGY: Interview materials were gathered in the form of themes (45) and written interviews (4) (29 September 2018 to 30 June 2019). Data were analysed by reflexive thematic analysis to highlight hidden and latent experiences. This approach generated the study's main theme, themes and subthemes. RESULTS: The main theme, 'shattered childhood', generated from the study results and was then divided into two themes, both of which were influenced in part by the loss of a familiar childhood, the changed environment, the breakdown of the body and the absence of control. Through their childhood memories, polio survivors described their broken childhoods using the following themes: 'betrayal by their bodies' and 'isolation'. In the narratives, the theme 'betrayal by one's own body' was generated by the following subthemes: 'suddenness of the affliction', 'paralysis' and 'being moved to the hospital'. The 'isolation' theme developed from the subthemes 'isolation from the body and surroundings' and 'emotional and social loneliness'. CONCLUSION: Polio survivors' experiences during the acute stage of the disease were traumatic and demonstrated children's inferior nursing position in Finland in the 1950s and 1960s. IMPACT: The study increases our understanding of the history of caring for children and families who were affected and disabled by polio and the importance of their experiences in society and healthcare settings. PATIENT OR PUBLIC CONTRIBUTION: The authors collaborated with the Finnish Polio Association to recruit study participants and plan the study. Patients with polio during childhood underwent interviews, and their experiences formulated the data, which were analysed and the basis of the results. REPORTING METHOD: Consolidated criteria for reporting qualitative research (COREQ), a 32-item checklist for interviews and focus groups, have been used as a reporting and checklist tool. All authors have agreed on the final version and the use of the COREQ criteria, relationship with participants, theoretical framework, setting, data collection and data analysis and report.

Factors helping pregnant multiparas cope with fear of birth: A qualitative study.

OBJECTIVE: This study describes factors helping pregnant multiparas cope with their fear of birth and aims to contribute insight into measures that could be taken to support and develop care for multiparas with fear of birth. METHODS: Purposive sampling was used for collecting data from closed discussion forums. An electronic questionnaire included structured background questions and qualitative open-ended questions related to the factors multiparas had found helped them cope with their fear of birth. After excluding respondents in early pregnancy (n = 20), the data consisted of answers from 78 pregnant multiparas from Finland. The data were analysed using inductive content analysis. RESULTS: The factors helping pregnant multiparas to cope with their fear of birth included obtaining information, planning ahead, receiving empathic support, dealing with emotions in different ways, and focusing on the positive. CONCLUSIONS: The support multiparas receive for their fear of birth from healthcare providers is insufficient and the quality and content of care varies widely. As a result, multiparas have been left to personally take responsibility for coping with their fear. IMPLICATIONS FOR PRACTICE: The care for treating fear of birth in multiparas needs to be improved. This requires a critical evaluation of the maternity system, policies, and competence of healthcare professionals who work with pregnant people.

Learning from fall-related interventions for older people at home: A scoping review.

This scoping review aims to provide a better understanding about the fall-related interventions, and the conditions which stand out as effective in decreasing fall risks of older people at home. A total of 28 peer-reviewed papers were included when they reported interventions with an incidence of falls or fall-risk as a primary outcome for older people, focusing on the home environment, from 8 databases. Qualitative examination was complemented by quantitative risk ratio analysis where it was feasible. The interventions regarding incidence of falls had a mean risk rate of 0.75; moreover, interventions using multiple strategies were found relatively successful. The interventions regarding fall risk had a mean hazard rate of 0.66. A considerable number of no-effect ratios were evident. Combining education, home assessment or improvement, and use of technology with implementation by health service experts appears to be the most promising intervention strategy to reduce falls.

Exploring digital interventions to facilitate coping and discomfort for nurses experiencing the menopause in the workplace: An international qualitative study.

INTRODUCTION: The global nursing workforce is predominantly female, with a large proportion working in the 45-55 age group. Menopause is a transition for all women, and; therefore needs recognition as it can impact work performance and consequently staff turnover. BACKGROUND: Women will go through the menopause, but not all women are affected. The menopause transition presents a range of signs and symptoms both physical and psychological which can impact the quality of life and individuals' work/life balance. The nursing workforce is predominantly women that will work through the menopause transition. OBJECTIVES: The study explored perspectives on digital health interventions as strategies to support menopausal women and to understand the requirements for designing health interventions for support in the workplace. DESIGN: A qualitative explorative design. SETTINGS: Nurses working in a range of clinical settings in England, Finland, Denmark, New Zealand, Australia and USA. METHODS: Nurses (n = 48) participated in focus groups from six different countries from February 2020-June 2022 during the pandemic from a range of acute, primary care and education settings. Nurses were invited to participate to share their experiences. Thematic analysis was used. RESULTS: All participants were able to describe the physical symptoms of menopause, with some cultural and possible hemisphere differences; more noticeable was the psychological burden of menopause and fatigue that is not always recognized. Four themes were identified: Managing symptoms in the workplace; Recognition in the workplace; Menopause interventions; and Expectation versus the invisible reality. These themes revealed information that can be translated for implementation into digital health interventions. CONCLUSIONS: Managers of nursing female staff in the menopausal age range need greater awareness, and menopause education should involve everyone. Finally, our results demonstrate design attributes suitable for inclusion in digital health strategies that are aligned with likely alleviation of some of the discomforts of menopause. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Structural and Psychological Empowerment of Learners Enrolled in Continuing Nursing Leadership Education in Finland: A Quasi-Experimental Longitudinal Study.

BACKGROUND: This study was conducted to assess structural and psychological empowerment among learners enrolled in a continuing leadership education program. Although the number of nurse leadership development interventions has increased, there is little evidence on how they influence leaders' empowerment. METHOD: A longitudinal study was employed, with learners (N = 85) enrolled in a continuing leadership education program as the participants. Data were collected in the beginning, at the end, and 8 months after the completion of the program using internationally validated instruments. Data were analyzed statistically. RESULTS: A total of 25 learners (29%) responded to the questionnaire at all three data collection points. The education significantly increased psychological and structural empowerment across all dimensions except formal power. These increased levels of empowerment were partially sustained at the 8-month follow-up time point. CONCLUSION: Continuing education seems to benefit nurse leaders, and the continuing nursing leadership education program was positively associated with learners' perceived empowerment. [J Contin Educ Nurs. 2023;54(10):462-471.].

Nursing managers' experiences of facing the COVID-19 pandemic in their work: A systematic review.

AIM: There is far little evidence available on nursing managers' experiences during this global crisis. This systematic review aimed to provide the first comprehensive summary of the findings of published studies describing data concerning nursing managers' experiences of the COVID-19 outbreak. DESIGN: Studies published between January 2019 and the end of December 2021 were retrieved from CINAHL, Medline and PubMed databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to guide the search methodology. METHODS: In total, 14 relevant articles were assessed using the Joanna Briggs Institute Critical Appraisal Tools and subjected to thematic content analysis. RESULTS: Our findings revealed five main themes describing nursing managers' experiences: an expanding and changing role, ensuring the well-being of staff, communication, support received, development and learning. Nursing managers found the task of operational management confusing, as objectives have been constantly changing as the pandemic has progressed. The results should be used in preparation for future crises similar to the COVID-19 pandemic.

In-hospital supplementation and subsequent breastfeeding practices in Finland: A cross-sectional population-level study.

BACKGROUND: The Baby-Friendly Hospital Initiative suggests that in-hospital supplementation should be avoided unless medically indicated. The supporting evidence is contradictory, as nonexperimental studies have shown an association between supplementation and decreased breastfeeding rates, whereas trials have failed to do so. The aim of this study was to investigate whether in-hospital supplementation is associated with exclusive breastfeeding to the age of 5 months and any breastfeeding to the age of 12 months in full-term, normal-weight singleton infants. METHODS: This is a secondary analysis of national-level, cross-sectional survey data. The data were collected in child health clinics in Finland. Families attending a regular health examination with a child aged 2 weeks to 12 months were eligible to participate. Full-term, normal-weight, singleton infants (n = 3025) were included in this study. Multivariate logistic regression was performed using in-hospital supplementation and socioeconomic characteristics as covariates and exclusive and any breastfeeding as outcomes. RESULTS: In total, 55.3% (n = 1631) of the infants received in-hospital supplementation. After controlling for socioeconomic factors, in-hospital supplementation was associated with decreased exclusive breastfeeding to the age of 5 months and with a decrease in any breastfeeding to the age of 7 months. CONCLUSIONS: Our findings suggest that noncontrolled supplementation, without a trial's rigorous procedures of care, is associated with decreased breastfeeding postdischarge. Both donor milk and infant formula use were associated with lower breastfeeding rates, although the association was stronger with formula use. In clinical settings, liberal, nonmedically indicated supplementation should be avoided.

Parent and carer experiences of health care professionals' communication about childhood obesity: a qualitative systematic review protocol.

OBJECTIVE: The objective of the systematic review is to identify, critically appraise, and synthesize the best available qualitative evidence on parent and carer experiences of health care professionals' communication about childhood obesity. INTRODUCTION: Parents and carers play a key role in a child's environment and healthy development, which is why they can find it confronting to discuss their child's weight. This review will provide an insight into the experiences of parents and carers with health care professionals' communication about their child's overweight or obesity. INCLUSION CRITERIA: This qualitative review will consider participants who are parents and carers with a child with overweight or obesity (birth to 12 years). The phenomenon of interest is parents' and carers' lived experiences of childhood obesity communication from a health care professional, and the context is health care settings. Communication includes verbal or written communication about a child's obesity from health care professionals received by a parent or carer. METHODS: The proposed review will systematically search the following databases: MEDLINE (EBSCO), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, LILACS, and the Finnish health sciences database MEDIC. ProQuest Dissertations and Theses (ProQuest) will be searched for unpublished articles. A manual search will supplement the database searches. The quality of included studies will be assessed independently by 2 reviewers, and the qualitative data will be extracted from papers by 2 independent reviewers using the standardized JBI data extraction tool. The recommended JBI approach to critical appraisal, study selection, data extraction, and data synthesis meta-aggregation will be used. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022297709.

New graduate registered nurses' professional competence and the impact of preceptors' education intervention: a quasi-experimental longitudinal intervention study.

AIMS AND OBJECTIVES: The aim of this quasi-experimental longitudinal intervention study was to investigate new graduate nurses' professional competence development after preceptors' participation in an education intervention. BACKGROUND: New graduate registered nurses are expected to be competent in many areas of nursing. Expectations that are sometimes unrealistic may cause a sense of inadequacy and stress, and this may in turn prevent them from fully deploying their competencies. Competence development is related to practice environment, occupational commitment, empowerment, and work experience. Orientation or transition programs have been designed to ensure new graduate nurses' competence, and preceptors and preceptorship could also have significant influence on their competence development. DESIGN: A quasi-experimental longitudinal intervention study. METHODS: The data was collected from October 2015 to November 2017. Participating wards were randomized into intervention and control groups. The intervention group preceptors had an eight-hour education intervention that focused on new employees' orientation, particularly from new graduates' point of view. Wards in the control group continued to precept as before. The Nurse Competence Scale was used for new graduates' self-assessment at baseline and at three-month and nine-month follow-up. This study is reported in accordance with the TREND Statement Checklist. RESULTS: The education intervention aimed at preceptors did not have impact on the intervention group NGRNs' competence development. There were no statistically significant differences between the groups and effect size remained small. CONCLUSIONS: The preceptors' education intervention was not effective enough to develop new graduates' professional competence so that it would have differed from that of the graduates receiving conventional orientation at the university hospital. This study confirmed that competence development is a complex and multidimensional phenomenon and organizations should invest in new graduate registered nurses' competence development during their early career. Preceptors' education and development of preceptorship and transition programs are an important part of overall competence development in complex health care environments. TRIAL REGISTRATION: Retrospectively registered.

Family Needs Checklist: Development of a Mobile Application for Parents with Children to Assess the Risk for Child Maltreatment.

Child maltreatment (CM) has been enormously studied. However, a preventive practice still requires comprehensive and effective instruments to assess the risks for CM in a family context. The aim of this study is to describe the development process of an evidence-based CM risk assessment instrument (Family Needs Checklist, FNC) for primary prevention online utilization. This article reports the development process of the checklist and its mobile application, consisting of a systematic literature review, identification of known risk factors using the content analysis method, and generation of the checklist, including a multidisciplinary group in the design and feedback. As a result, a comprehensive and compact checklist was developed to be used by parents or caregivers as a self-referral instrument with an option to be used with professionals as a basis for joint conversations. The FNC consists of parental, family-, and child-related risk factors. Based on the international evidence, the online application consists of knowledge about different CM types, information about risk factors and protective factors as well as recommendations and guidance to support services. The FNC is based on robust evidence on known risk factors causing CM in families. It can be used for primary prevention utilization in the general population.

The marital relationship and health-related quality of life of prostate cancer patients and their spouses: A prospective, longitudinal study.

AIMS: This study aims to measure any changes in the marital relationship during the first year after a diagnosis of prostate cancer, identify the demographic characteristics that influenced such changes, and measure changes related to health-related quality of life (HRQoL). BACKGROUND: Knowledge is limited on the impact of a diagnosis of prostate cancer on the marital relationship and HRQoL of patients and their spouses. DESIGN: A 1-year longitudinal study. METHODS: Data were collected from five Finnish hospitals between October 2013 and January 2017. Of the 350 recruited couples (N = 700), 179 patients and 166 spouses completed the Marital Questionnaire and the RAND 36-Item Health Survey 1 year after diagnosis. RESULTS: No major changes were found in the marital relationship during the follow-up period. The spouses reported statistically significant changes in their marital relationships, but the patients did not. Furthermore, changes in the marital relationship were not associated with the patients' HRQoL. Among spouses, emotional well-being was associated with changes in the marital relationship. CONCLUSION: The marital relationship was relevant in terms of the spouses' HRQoL during the first year after a diagnosis of prostate cancer. Nurses and other healthcare providers should assess counselling and support provided to spouses individually.

Structural and psychological empowerment of students obtaining continuing leadership education in Finland-a national survey.

BACKGROUND: In nursing, empowerment may be deemed one's potential to gain power, achieve goals and promote one's skills to advance positive changes in the working environment, or decentralization of authority. Empowerment is associated with nurses' and nurse leaders' satisfaction, performance and organizational commitment, as well as burnout, emotional exhaustion and intentions to leave the profession. Research on nurse empowerment in relation to continuing education is sparse. OBJECTIVES: This study describes the structural and psychological empowerment levels of students beginning a collaboratively implemented continuing leadership education program. DESIGN: Cross-sectional electronic survey. SETTINGS: National, continuing nursing leadership education program (37 ECT) organized by five universities that provide masters level education to nurse leaders in Finland. PARTICIPANTS: Students (N = 85) working at nine healthcare organizations across the service system as current or prospective nurse leaders and enrolled in the continuing leadership education program. METHODS: The Conditions of Work Effectiveness Questionnaire and the Work Empowerment Questionnaire were each used to measure structural and psychological empowerment, respectively. The data were collected between October 2019 and February 2020. RESULTS: A total of 69 students participated (response rate 81 %). Moderate levels of both structural and psychological empowerment were observed. In structural empowerment, the strongest dimension was access to opportunity (4.1, SD 0.7), whereas access to support was the weakest (2.7, SD 0.7). The strongest psychological empowerment dimension was verbal empowerment (8.5, SD 1.9) and the weakest was outcome empowerment (7.0, SD 1.6). CONCLUSIONS: Nurses and nurse leaders seem to lack the status and power required to impact their organizations, possibly causing them to apply for nursing leadership education. Nurse leaders should be given opportunities for continuing leadership education to improve empowerment and, as a result, staff outcomes.

The importance of management in promoting hospital staff's mental well-being during the COVID-19 pandemic-A survey.

AIM: To describe hospital staff's experiences of management actions to promote their mental well-being during the COVID-19 pandemic. Mental well-being was examined on the basis of four entities: level of anxiety, support and encouragement from the manager, and the opportunity to discuss concerns about COVID-19 with the manager. BACKGROUND: The workload of COVID-19 affects the mental well-being of staff. However, there is limited data on managers' actions to promote their mental well-being during the pandemic. METHODS: A cross-sectional study was used to collect survey data (n = 1995) among staff working in two specialized medical care hospitals. To gain deeper understanding related issues, the survey included open questions, which were answered by 178 participants. RESULTS: The results indicate that those staff who felt they had received support, encouragement, and the opportunity to discuss of COVID-19 worries with a manager experienced less anxiety. CONCLUSIONS: The study provides an insight into managers' actions to promote staff's mental well-being during the COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: The manager's actions have a significant effect on the anxiety levels of staff. During the pandemic, the well-being of staff is a priority that should be visible to both hospital administrators and policymakers.

Effects of intervention on lifestyle changes among coronary artery disease patients: A 6-month follow-up study.

AIM: The main aim of the study was to investigate the effects of a nurse-led lifestyle-related risk factor modification intervention on multiple lifestyle behaviours among coronary artery disease patients over six months. DESIGN: A pre-test post-test control group design was conducted in a single clinical centre in Nepal. METHODS: A total of 224 eligible patients were randomly assigned to either the usual care group or the intervention group at baseline. The lifestyle intervention consisted of a brief counselling session supplemented with informational leaflets. Standard questionnaires were used to collect self-reported data from patients on multiple lifestyle behaviours: diet, physical activity, adherence to medication, stress, body mass index, smoking and alcohol consumption. General linear model repeated measure analysis was used to estimate the effect of intervention. RESULTS: A statistically significant effect of study group-by-time interaction for diet, adherence to medication, physical activity, and perceived stress was found at 6-month follow-up. Overall, greater improvement in lifestyle habits was found in the intervention group compared with the control group at 6-month follow-up.