The impact of a brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial)

BMC Public Health

on behalf of the CN SNAP Project Team¹  Andrew Milat¹  Neil Orr¹  Mahnaz Fanaian¹  Upali W Jayasinghe¹  Gawaine Powell Davies¹  Anna M Williams¹  Rachel A Laws¹  Bibiana C Chan¹  Mark F Harris¹ 

[1] Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia

关键词: Community nursing;    Physical activity;    Alcohol;    Nutrition;    Smoking;    Lifestyle behaviours;    Primary health care;   

Others  :  1162306
DOI  :  10.1186/1471-2458-13-375

 received in 2012-09-12, accepted in 2013-04-16,  发布年份 2013

【 摘 要 】

Background

The risk factors for chronic disease, smoking, poor nutrition, hazardous alcohol consumption, physical inactivity and weight (SNAPW) are common in primary health care (PHC) affording opportunity for preventive interventions. Community nurses are an important component of PHC in Australia. However there has been little research evaluating the effectiveness of lifestyle interventions in routine community nursing practice. This study aimed to address this gap in our knowledge.

Methods

The study was a quasi-experimental trial involving four generalist community nursing (CN) services in New South Wales, Australia. Two services were randomly allocated to an ‘early intervention’ and two to a ‘late intervention’ group. Nurses in the early intervention group received training and support in identifying risk factors and offering brief lifestyle intervention for clients. Those in the late intervention group provided usual care for the first 6 months and then received training. Clients aged 30–80 years who were referred to the services between September 2009 and September 2010 were recruited prior to being seen by the nurse and baseline self-reported data collected. Data on their SNAPW risk factors, readiness to change these behaviours and advice and referral received about their risk factors in the previous 3 months were collected at baseline, 3 and 6 months. Analysis compared changes using univariate and multilevel regression techniques.

Results

804 participants were recruited from 2361 (34.1%) eligible clients. The proportion of clients who recalled receiving dietary or physical activity advice increased between baseline and 3 months in the early intervention group (from 12.9 to 23.3% and 12.3 to 19.1% respectively) as did the proportion who recalled being referred for dietary or physical activity interventions (from 9.5 to 15.6% and 5.8 to 21.0% respectively). There was no change in the late intervention group. There a shift towards greater readiness to change in those who were physically inactive in the early but not the comparison group. Clients in both groups reported being more physically active and eating more fruit and vegetables but there were no significant differences between groups at 6 months.

Conclusion

The study demonstrated that although the intervention was associated with increases in advice and referral for diet or physical activity and readiness for change in physical activity, this did not translate into significant changes in lifestyle behaviours or weight. This suggests a need to facilitate referral to more intensive long-term interventions for clients with risk factors identified by primary health care nurses.

Trial registration

ACTRN12609001081202

【 授权许可】

   
2013 Harris et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]AIHW: Chronic Disease and Associated Risk Factors in Australia. Canberra: Australian Institute of Health and Welfare; 2006.
• [2]ABS: National Health Survey: Summary of Results, 2007–08. Canberra: Australian Bureau of Statistics; 2009.
• [3]Whitlock E, Orleans T, Pender N, Allan J: Evaluating primary care behavioural counseling interventions: an evidence-based approach. Am J Prev Med 2002, 22(4):267-284.
• [4]Duaso MJ, Cheung P: Health promotion and lifestyle advice in a general practice: what do patients think? J Adv Nurs 2002, 39(5):472-479.
• [5]Rice V, Stead L: Nursing interventions for smoking cessation (review). Cochrane Database Syst Rev 2008, Art.No.(1):CD001188.
• [6]Kaner E, Beyer F, Dickinson H, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B: Effectiveness of brief alcohol interventions in primary care. Cochrane Database Syst Rev 2007, 18(2):CD004148.
• [7]Pignone M, Ammerman A, Fernandez L, Orleans T, Pender N, Woolf S, Lohr K, Sutton S: Counseling to promote a healthy diet in adults. A summary of the evidnece for the U.S Preventive Services Task Force. Am J Prev Med 2003, 24(1):75-90.
• [8]Team CP: Evaluation of the counterweight programme for obesity management in primary care: a starting point for continuous improvement. Br J Gen Pract 2008, 58(553):548.
• [9]Lawton B, Rose S, Elley R, Dowell A, Fenton A, Moyes S: Exercise on prescription for women aged 40–74 recruited through primary care: two year randomised controlled trial. BMJ 2008, 337:a2509.
• [10]Elley C, Kerse N, Arroll B, Robinson E: Effectiveness of counselling patients on physical activity in general practice: a cluster randomised controlled trial. Br Med J 2003, 326:793-798.
• [11]Eriksson MK, Franks PW, Eliasson M: A 3-year randomized trial of lifestyle intervention for cardiovascular risk reduction in the primary care setting: the Swedish Björknäs study. PLoS One 2009, 4(4):e5195.
• [12]Sargeant GM, Forrest LE, Parker RM: Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: a systematic review. Obes Rev 2012, 13:1148-1171.
• [13]Dosh SA, Holtrap JS, Torres T, Arnold AK, Bauman J, White LL: Changing organizational constructs into fucntion tools: an assessment of the 5A’s in primary care practices. Ann Fam Med 2005, 3:s50-s52.
• [14]Hung DY, Shelley DR: Multilevel analysis of the chronic care model and the 5A services for treating tobacco use in urban primary care clinics. Health Serv Res 2009, 44(1):103-127.
• [15]Brookes K, Davidson J, Daly P, Hancock K: Community health nursing in Australia: a critical literature review and implications for professional development. Contemp Nurse 2004, 16:195-207.
• [16]Kemp LA, Harris E, Comino EJ: Changes in community nursing in Australia: 1995–2000. J Adv Nurs 2005, 49(3):307-314.
• [17]Laws R, Williams A, Powell Davies G, Eames-Brown R, Amoroso C, Harris M: A square peg in a round hole? Approaches to incorporating lifestyle counselling into routine primary health care. Aust J Prim Health 2008, 14(3):101-111.
• [18]Runciman P, Watson H, McIntosh J, Tolson D: Community nurses’ health promotion work with older people. J Adv Nurs 2006, 55(1):46-57.
• [19]Ward B, Verinder G: Young people and alcohol misuse: how can nurses use the Ottawa Charter for Health Promotion? Australian Journal of Adcanced Nursing 2008, 25(4):114-119.
• [20]Smith K, Bazini-Barakat N: A public health nursing practice model: melding public health principles with the nursing process. Public Health Nurs 2003, 20(1):42-48.
• [21]Sourtzi P, Nolan P, Andrews R: Evaluation of health promotion activities in community nursing practice. J Adv Nurs 1996, 24:1214-1223.
• [22]Laws RA, Chan BC, Williams AM, Davies GP, Jayasinghe UW, Fanaian M, Harris MF: An efficacy trial of brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial). BMC Nurs 2010, 9(1):4. BioMed Central Full Text
• [23]RACGP: Guidelines for Preventive Activities in General Practice. 7th edition. Melbourne: RACGP; 2009.
• [24]Smith B, Marshall A, Huang N: Screening for physical activity in family practice: evaluation of two brief assessment tools. Am J Prev Med 2005, 29(4):256-264.
• [25]Bush K, Kivlahan D, McDonell M, Fihn S, Bradley K: The AUDIT alcohol consumption questions (AUDIT-C). Arch Intern Med 1998, 158:1789-1795.
• [26]CfEa R: Summary Report on Adult Health from the New South Wales Population Health Survey. Sydney: NSW Department of Health; 2008:2009.
• [27]Marshall AL, Smith BJ, Bauman AE, Kaur S, Bull F: Reliability and validity of a brief physical activity assessment for use by family doctors. British J Sports Medicine 2005, 39(5):294-297.
• [28]Prochaska J, Velicer W, Rossi J, Goldstein M, Marcus B, Rakowski W, Fiore C, Harlow L, Redding C, Rosenbloom D: Stages of change and decisiona balance for 12 problem behaviors. Health Psychol 1994, 13(1):39-46.
• [29]Fanaian M, Laws RA, Passey M, McKenzie S, Wan Q, Powell Davies G, Lyle D, Harris MF: Health improvement and prevention study (HIPS) - evaluation of an intervention to prevent vascular disease in general practice. BMC Family Pracice 2010, 11:57. BioMed Central Full Text
• [30]Kerr C, Tayler R, Heard G: Handbook of public health methods. Sydney: McGraw-Hill; 1998.
• [31]Happ MB, Sereika S, Garrett K, Tate J: Use of the quasi-experimental sequential cohort design in the Study of Patient-Nurse Effectiveness with Assisted Communication Strategies (SPEACS). Contemp Clin Trials 2008, 29(5):801-808.
• [32]Rashbash J, Steele F, Browne W, Prosser B: Multilevel analysis with MLwiN Software: A user’s guide to MLwiN version 2.0.. Bristol: Centre for multilevel modelling, University of Bristol; 2005.
• [33]Chan BC, Laws RA, Williams AM, Davies GP, Fanaian M, Harris MF: Is there scope for community health nurses to address lifestyle risk factors? The community nursing SNAP trial. BMC Nurs 2012, 11(1):4. BioMed Central Full Text
• [34]Christl B, Chan B, Laws R, Williams A, Davies GP, Harris MF: Clients’ experience of brief lifestyle interventions by community nurses. Aust J Prim Health 2012, 18(4):321-326.
• [35]Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI, Kumanyika S, Schmitz KH, Diewald LK, Barg R, Chittams J, Moore RH: A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med 2011, 365(21):1969-1979.
• [36]Wood D, on behalf of the EUROACTION Study Group: Nurse-coordinated multidisciplinary family based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease & asymptomatic individuals at high risk of cardiovascular disease: a paired cluster-randomised controlled trial. Lancet 2008, 371:1999-2012.
• [37]Thompson KA, Parahoo AK, Blair N: A nurse-led smoking cessation clinic -- quit rate results and views of participants. Health Educ J 2007, 66:307.
• [38]Borelli BNS, Hecht J, Edmonds K, Papandonatos G, Abrams D: Home health care nurses as a new channel for smoking cessation treatment: outcomes from project CARES (Community-nurse Assisted Research and Education on Smoking). Prev Med 2005, 41:815-821.
• [39]Appel LJ, Clark JM, Yeh H-C, Wang N-Y, Coughlin JW, Daumit GD, Miller ER, Dalcin A, Jerome GJ, Geller S, Noronha G, Pozefsky T, Charleston J, Reynolds JB, Durkin N, Rubin RR, Louis TA, Brancati FL: Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 2010, 365:1959-1968.
• [40]Hung DY, Rundall TG, Tallia AF, Cohen DJ, Halpin HA, Crabtree BF: Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors. Milbank Q 2007, 85(1):69-91.
• [41]Passey ME, Laws RA, Jayasinghe UW, Fanaian M, McKenzie S, Powell-Davies G, Lyle D, Harris MF: Predictors of primary care referrals to a vascular disease prevention lifestyle program among participants in a cluster randomised trial. BMC Health Serv Res 2012, 12:234. BioMed Central Full Text
• [42]Leonard K: Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect. J Health Econ 2008, 27:444-459.