摘要:

PurposeThe purpose of this study was to identify the behaviour change techniques (BCTs) that are associated with greater effectiveness in smoking cessation interventions for people with chronic obstructive pulmonary disease (COPD).MethodsA systematic review and meta‐analysis was conducted. Web ofKnowledge,CINAHL,EMBASE,PsycINFO, andMEDLINEwere searched from the earliest date available toDecember 2012. Data were extracted and weighted average effect sizes calculated;BCTs used were coded according to an existing smoking cessation‐specificBCTtaxonomy.ResultsSeventeen randomized controlled trials (RCTs) were identified that involved a total sample of 7446 people withCOPD. The sample‐weighted mean quit rate for allRCTs was 13.19%, and the overall sample‐weighted effect size wasd+ = 0.33. Thirty‐sevenBCTs were each used in at least three interventions. Four techniques were associated with significantly larger effect sizes:Facilitate action planning/develop treatment plan,Prompt self‐recording,Advise on methods of weight control, andAdvise on/facilitate use of social support. Three newCOPD‐specificBCTs were identified, andLinkingCOPDand smokingwas found to result in significantly larger effect sizes.ConclusionsSmoking cessation interventions aimed at people withCOPDappear to benefit from using techniques focussed on forming detailed plans and self‐monitoring. AdditionalRCTs that use standardized reporting of intervention components andBCTs would be valuable to corroborate findings from the present meta‐analysis.Statement of contributionWhat is already known on this subject?Chronic obstructive pulmonary disease (COPD) is responsible for considerable health and economic burden worldwide, and smoking cessation (SC) is the only known treatment that can slow the decline in lung function experienced. Previous reviews of smoking cessation interventions for this population have established that a combination of pharmacological support and behavioural counselling is most effective. While pharmacological support has been detailed, and effectiveness ranked, the content of behavioural counselling varies between interventions, and it is not clear what the most effective components are.What does this study add?Detailed description of ‘behavioural counselling’ component ofSCinterventions for people withCOPD.Meta‐analysis to identify effective behaviour change techniques tailored for this population.Discussion of these findings in the context of designin

ISSN:1359-107X    

DOI:10.1111/bjhp.12071

年代:2014

数据来源: WILEY

摘要:

ObjectivesHealth care reform in Bulgaria has been ongoing for two decades. Since 1990, it has been transforming from a socialized system of medical care with free access, to one which is decentralized, includes private health care services, the general practitioner model and a National Health Insurance Fund. In this context, we are conducting an internationalECFramework 7 project: ‘Improving quality and safety in the hospital: The link between organizational culture, burnout, and quality of care’.We focus on health professionals’ perceptions of organizational hierarchies in Bulgarian hospitals and how doctors and nurses connect these to organizational justice.MethodsWe conducted seven focus groups and four interviews, with a total of 42 participants (27 nurses, 15 physicians and medical residents) in three hospitals. Data were analysed through thematic analysis and discourse analysis with Atlas.ti.ResultsFrom the perspective of health professionals, health reform has intensified traditional hierarchies and inequalities and has created new ones in Bulgarian hospitals. These hierarchies are continuously (re)constructed through language and practices and also destabilized through resistance. The health professionals protest fact that these hierarchies are permeated with unfairness and silence voices. All health professions (nurses, doctors, residents) in our study experience being unjustly positioned and disempowered in various hierarchies. They connect these experiences to stress and anxiety.ConclusionsParticipatory action research needs to address multiple dimensions of organizational relationships in Bulgarian hospitals, including hierarchical relationships and ways of promoting organizational justice.Statement of ContributionWhat is already known on this subject?Health care organizations are hierarchically organized. Organizational injustice can contribute to burnout in health professionals. There is a high level of stress and burnout for health professionals in Bulgaria.What does this study add?This study adds understanding of changing hierarchies in hospitals during health care reform in the post‐socialist period. Illuminates how health professionals' discourse sustains and resists hierarchical relationships in Bulgarian hospitals. Adds understanding of health professionals' perspectives on implications of injustice for their wel

ISSN:1359-107X    

DOI:10.1111/bjhp.12008

年代:2014

数据来源: WILEY

摘要:

ObjectivesBased on health care professionals' (HPs) and patients' interviews about work demands and quality of care in hospitals, the study explores the way that patients andHPs constructed their identities to describe and construct the health care system inGreece.DesignThis is a qualitative study using a focus group (FG) design.MethodsSevenFGs discussions were conducted: threeFGs discussions were conducted for the assessment of job stressors (1 for doctors, 1 for nurses and 1 for residents) and fourFGs discussions for the assessment of quality of care (1 for doctors, 1 for nurses, 1 for residents and 1 for patients). The sample consisted of health care professionals working in a teaching hospital in the region ofThessaloniki,Greece, and patients who had at least one experience of any kind in the same hospital. Transcripts of theFGs discussions underwent discourse analysis.ResultsThe results showed that bothHPs and patients construct the health care system based on bipolar constructions of responsibility and powerlessness. In particular, participants use these constructions to allocate the responsibility to different levels of the health care system hierarchy or to the system per se constructing, at the same time, themselves as the ‘viewers’ of this system.ConclusionsThe study allowed a deeper understanding of issues related to quality of care in hospitals providing context‐specific information. Identity in health care organizations was inextricably linked to power and responsibility. The need to deconstruct this responsibility/powerlessness ideology is discussed.Statement of contributionWhat is already known on the subject?Relatively little is known about how both patients and health care professionals construct quality of care. Organizational cultures in health care settings are symbiotically linked with quality of care and medical errors.What does this study add?The constructions of health care professionals and patients create and recreate the organizational culture organically. The present study illuminates how health care professionals and patients negotiate their identities based on passivity and rejection of accountability, which contribute to medical errors and pass

ISSN:1359-107X    

DOI:10.1111/bjhp.12028

年代:2014

数据来源: WILEY

ISSN:1359-107X    

DOI:10.1111/bjhp.12079

年代:2014

数据来源: WILEY

ISSN:1359-107X    

DOI:10.1111/bjhp.12087

年代:2014

数据来源: WILEY