Alexandra Lelia Dima

Background People from deprived backgrounds and people with disability have generally limited access to health screening. This study aimed to identify the factors influencing access to recommended screenings for these disadvantaged groups, to inform development of tailored screening support. Methods Thirty semi-structured interviews were conducted with 18 participants from deprived backgrounds and 12 participants with disability. A content analysis using an analytical framework was performed. Barriers and facilitators to screening participation were categorized into four domains: individual, social, healthcare system/healthcare professional, and screening procedure. Results Most barriers and facilitators pertained to the individual or healthcare system/healthcare professional domains. In the individual domain, fear could have a negative influence on screening participation in both groups. In the social domain, social influences (i.e. having children, knowing people suffering from the disease) were reported as facilitating screening. People with disability reported to be more influenced by factors related to the healthcare domain (i.e. perceived risk; recommendation from a healthcare professional or an educator). Conclusion Our results highlight the need to better consider the environmental factors of individuals, in particular the potential influence of relatives and healthcare professionals, to improve their participation in screening.

Background: Medication non-adherence in mental health is a serious issue. A key challenge is identifying person-specific determinants to tailor support. However, comprehensive, theory and evidence-based tools for this purpose are lacking. To address this gap, we developed the 15-item ‘Collaborative Medication Adherence in Bipolar disorder Questionnaire (C-MABQ15)’ underpinned by the Theoretical Domains Framework.Aim: To validate CMAB-Q15 to identify non-adherence and person-specific determinants requiring intervention. Objectives were to: (1) retain items meeting Mokken Scale double monotonicity criteria from initial 50-item C-MABQ (2) evaluate the resulting scale’s psychometric properties.Methods: A cross-section of patients (>18years) in a community mental health setting in England prescribed lithium were invited to complete the initial 50-items C-MABQ; a subsample provided test-retest data. Mokken scale analysis was performed to select unidimensional, locally independent, monotonous and non-intersecting items. Criterion validity was evaluated against the Medication Adherence Report Scale-5 (MARS-5) and blood lithium levels. We assessed readability, model fit, internal consistency (Cronbach’s alpha, α), and test-retest reliability (intra-class correlation coefficient, ICC).Results: Of 835 patients invited, 363 (43.5%) responded; 325 provided complete data. Fifteen items (C-MABQ15) fulfilled Mokken scale criteria demonstrating construct validity. C-MABQ15 showed criterion validity with MARS-5 (r=0.32, p<0.001). C-MABQ15 scores trended as expected with lithium levels; however, between-group difference was non-significant (mean difference -0.45; p=0.75). C-MABQ15 demonstrated excellent internal consistency (α =0.91, 95% CI=0.89 to 0.93) and good readability, model fit (CFI=0.997, TLI=0.996, RMSEA=0.059), and test-retest reliability (ICC=0.74, 95% CI=0.61 to 0.82, p<0.001).Conclusion: C-MABQ15 identifies non-adherence and person-specific determinants, providing foundation for personalised support.

Background People from deprived backgrounds and people with disability have generally limited access to health screening. This study aimed to identify the factors influencing access to recommended screenings for these disadvantaged groups, to inform development of tailored screening support. Methods Thirty semi-structured interviews were conducted with 18 participants from deprived backgrounds and 12 participants with disability. A content analysis using an analytical framework was performed. Barriers and facilitators to screening participation were categorized in four domains: individual, social, healthcare system/healthcare professional, and screening procedure. Results Most barriers and facilitators pertained to the individual and healthcare system/healthcare professional domains. In the individual domain, fear could have a negative influence on screening participation in both groups. In the social domain, social influences (i.e. having children, knowing people suffering from the disease) were reported as facilitating screening. People with disability reported to be more influenced by factors related to the healthcare domain. Conclusion Our results highlight the need to better consider the environmental factors of individuals, in particular the potential influence of relatives and healthcare professionals, to improve their participation in screening.

Background People from deprived backgrounds and people with disability have generally limited access to health screening. This study aimed to identify the factors influencing access to recommended screenings for these disadvantaged groups, to inform development of tailored screening support. Methods Thirty semi-structured interviews were conducted with 18 participants from deprived backgrounds and 12 participants with disability. A content analysis using an analytical framework was performed. Barriers and facilitators to screening participation were categorized in four domains: individual, social, healthcare system/healthcare professional, and screening procedure. Results Most barriers and facilitators pertained to the individual and healthcare system/healthcare professional domains. In the individual domain, fear could have a negative influence on screening participation in both groups. In the social domain, social influences (i.e. having children, knowing people suffering from the disease) were reported as facilitating screening. People with disability reported to be more influenced by factors related to the healthcare domain. Conclusion Our results highlight the need to better consider the environmental factors of individuals, in particular the potential influence of relatives and healthcare professionals, to improve their participation in screening.

Introduction: Long-term use of benzodiazepines (BZD) triggers health problems. Although Spain leads European use of BZD, the number of long-term users (LTUs) remains unknown. Objective: The aim of the study is to estimate the proportion of primary care (PC) patients who initiate a BDZ prescription that subsequently become LTU and to identify its associated factors. Design: Retrospective real-world data cohort. Setting and participant: It included the population over 15 years with a new prescription of BZD in PC in Catalonia. Users were considered LTU if they had been dispensed at least three prescriptions within 3 months. Sociodemographic characteristics of patients and prescribers, pathologies, previous BZD use, number and type of visits, and prescription quality standard were considered. We estimated the proportion of LTU among patients with a new prescription, stratified by age and sex, and estimated risk factors by multivariate generalised linear models. Result: 100 638 users with a new BZD prescription were included. 27.1% were LTU at 3 months and 14.5% at 6 months. LTU increases with age and is higher in women. Predictors of LTU are Spanish nationality, living in rural areas, having a mental illness, having used BZD, having virtual visits or not meeting pharmacy-therapeutic quality standards. Conclusion: The number of patients who develop LTU is high, especially in the elderly. Exploring the causes of this phenomenon could contribute to the development of future interventions.

Tools that can be used to collect behavioural data during pandemics are needed to inform policy and practice. The objective of this project was to develop the Your COVID-19 Risk tool in response to the global spread of COVID-19, aiming to promote health behaviour change. We developed an online resource based on key behavioural evidence-based risk factors related to contracting and spreading COVID-19. This tool allows for assessing risk and provides instant support to protect individuals from infection. The Risk Estimation Questions assessed users’ location, age, gender, work environment, day-to-day behaviours currently performed, and conditions under which these behaviours would change. Users were also asked to estimate how often they keep their distance from others in public and regularly wash their hands, and the procedures they follow to do so. A multidisciplinary research team of more than 150 international experts developed the tool. Over 60,000 users in more than 150 countries have assessed their risk and provided data. The majority of respondents reported that they almost always keep their distance from others in public places, and most participants reported washing their hands after touching public or shared surfaces or when entering buildings. The tool, data, and results were openly shared to support government and health agencies developing behaviour change interventions. This tool creates a blueprint for similar digital infrastructure that can be replicated and used in future pandemics.

Background: Technology-mediated medication adherence interventions have proven useful, yet implementation in clinical practice is low. The European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE) European Cooperation in Science and Technology Action (CA19132) online repository of medication adherence technologies (MATechs) aims to provide an open access, searchable knowledge management platform to facilitate innovation and support medication adherence management across health systems. To provide a solid foundation for optimal use and collaboration, the repository requires a shared interdisciplinary terminology. Objective: We consulted stakeholders on their views and level of agreement with the terminology proposed to inform the ENABLE repository structure. Methods: A real-time web-based Delphi study was conducted with stakeholders from 39 countries active in research, clinical practice, patient representation, policy making, and technology development. Participants rated terms and definitions of MATech and of 21 attribute clusters on product and provider information, medication adherence descriptors, and evaluation and implementation. Relevance, clarity, and completeness criteria were rated on 9-point scales, and free-text comments were provided interactively. Participants could reconsider their ratings based on real-time aggregated feedback and revisit the survey throughout the study period. We quantified agreement and process indicators for the complete sample and per stakeholder group and performed content analysis on comments. Consensus was considered reached for ratings with a disagreement index of <1. Median ratings guided decisions on whether attributes were considered mandatory, optional, or not relevant. We used the results to improve the terminology and repository structure. Results: Of 250 stakeholders invited, 117 (46.8%) rated the MATech definition, of whom 83 (70.9%) rated all attributes. Consensus was reached for all items. The definition was considered appropriate and clear (median ratings 7.02, IPR 6.10-7.69, and 7.26, IPR 6.73-7.90, respectively). Most attributes were considered relevant, mandatory, and sufficiently clear to remain unchanged except for ISO certification (considered optional; median relevance rating 6.34, IPR 5.50-7.24) and medication adherence phase, medication adherence measurement, and medication adherence intervention (candidates for optional changes; median clarity ratings 6.07, IPR 4.86-7.17; 6.37, IPR 4.80-6.67; and 5.67, IPR 4.66-6.61, respectively). Subgroup analyses found several attribute clusters considered moderately clear by some stakeholder groups. Results were consistent across stakeholder groups and time, yet response variation was found within some stakeholder groups for selected clusters, suggesting targets for further discussion. Comments highlighted issues for further debate and provided suggestions informing modifications to improve comprehensiveness, relevance, and clarity. Conclusions: By reaching agreement on a comprehensive MATech terminology developed following state-of-the-art methodology, this study represents a key step in the ENABLE initiative to develop an information architecture capable of structuring and facilitating the development and implementation of MATech across Europe. The debates and challenges highlighted in stakeholders’ comments outline a potential road map for further development of the terminology and the ENABLE repository. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-059674