Browsing by Author "Edwards, Alun"
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- ItemOpen AccessEnvironmental Scan of Weight Bias Exposure in Primary Health Care Training Programs(Society for Teaching and Learning in Higher Education, 2016-12-11) Russell-Mayhew, Shelly; Nutter, Sarah; Alberga, Angela S.; Jelinski, Susan; Ball, Geoff D. C.; Edwards, Alun; Oddie, Scott; Sharma, Arya M.; Pickering, Barbara; Forhan, MaryNegative attitudes and beliefs about individuals with obesity (also known as weight bias) have negative consequences for physical and mental health for individuals with obesity and impact the quality of care provided by health professionals. A preliminary environmental scan of college and university training programs was conducted consisting of 67 degree and diploma granting programs from 22 institutions in Alberta, targeting programs training future health professionals. Publicly available online course descriptions were examined for weight-related keywords. Keyword frequency was used to determine the extent that coursework addressed weight-related issues. The results suggested that courses are structured to include learning about general health promotion as well as lifestyle factors that may contribute to obesity but may not systematically include learning about weight bias or its potential impact. Our findings highlight the need for further in-depth investigations as well as the need to enhance current curricula in higher education by including information related to weight, obesity and weight bias. Les attitudes et les croyances négatives concernant les personnes obèses (également connues comme partialité contre les obèses) ont des conséquences négatives sur la santé physique et mentale des personnes obèses et affectent la qualité des soins qui leur sont prodigués par les professionnels de la santé. Nous avons mené une étude environnementale préliminaire des programmes de formation universitaires et collégiaux qui a porté sur67 programmes menant à un certificat ou à un diplôme dans 22 établissements d’Alberta, et nous avons principalement visé les programmes de formation de futurs professionnels de la santé. Les descriptions de cours en ligne accessibles au grand public ont été examinées et les mots clés faisant référence aux problèmes de poids ont été identifiés. Les résultats suggèrent que les cours sont structurés de manière à inclure l’apprentissage de la promotion de la santé en général ainsi que les facteurs relatifs au style de vie qui peuvent contribuer à l’obésité mais ils n’incluent pas l’apprentissage systématique de la partialité contre les obèses ou ses effets potentiels. Nos résultats illustrent le besoin de mener des enquêtes approfondies ainsi que celui de renforcer les programmes de cours actuels en enseignement supérieur pour y inclure des informations relatives au poids, à l’obésité et à la partialité contre les obèses.
- ItemOpen AccessInformal Learning Using Tablet Computers and Apps: A Multi-Method Study of Older Adults Self-Managing Diabetes(2016-01-07) Seabrook, Heather Jane; Lockyer, Jocelyn; Edwards, Alun; Kopp, GailBackground: Mobile software applications (apps) and online health information are a growing resource for diabetes self-management. Apps and online resources may confer benefits, yet a lack of relevant guidance continues to impede the design and implementation of effective interventions that use them. Alternative learning designs that align with older adults’ preference for informal learning and diverse needs could facilitate the continued learning and self-management essential to maintaining their well-being. Methods: Guided by the technology acceptance theory of Venkatesh and colleagues, Phase 1 of this study adapted a systematic review methodology to identify apps for self-management of diabetes and used principles to assess them. Phase 2 used a multi-case study approach in which older adults were provided personalized instruction to help them use the tablet computer and apps. Transcripts were analyzed to identify themes within and across cases. Results: In Phase 1, two apps were selected from 1,936 search results. Critical quality issues varied depending on an app’s purpose. Apps with self-management information neglected to reference their source (attribution). Apps that supported other self-management activities had safety and usability problems. In Phase 2, a conceptual model was developed in which participants’ self-perceived needs and preferences influenced use of the intervention and consequently their outcomes. Personalized training facilitated use. Participants benefitted from convenient, easy access to appropriate resources. They experienced challenges ranging from app-level usability issues to the system-level problems. Outcomes included review, problem-solving, data visualization, showing information face-to-face, and technology adoption. Conclusions: Few of the apps currently available are appropriate for use by older adults for diabetes self-management. Some means of ensuring access to a pool of vetted apps is recommended and there is a need for a decision-matrix for screening apps to ensure they are optimally selected for patient use. Detailed criteria and an approach are provided to further this work. The study also provides a new understanding of older adults’ use of tablet computers and apps to facilitate learning and self-management. The conceptual model and framework of design and implementation considerations could guide learning designers in developing effective interventions for older adults.
- ItemOpen AccessThe Association Between Income and Patient-Reported Diabetes Care: Results of a Cross-Sectional Survey(2016) Saad, Nathalie; Hemmelgarn, Brenda; McBrien, Kerry; Edwards, Alun; Zhang, JianguoThe main objective of this study was to evaluate the association between income and indicators of access to care as well as indicators of guideline-concordant recommended care in patients with diabetes and poor glycemic control. We used data from a cross-sectional telephone survey of outpatients with diabetes and linked this data with administrative and laboratory data. The study population included adult outpatients living in Calgary, Alberta with diabetes. The exposure was the total household income in the prior 12 months, as reported by survey respondents. We conducted a poisson regression analysis to determine the association between income and each of the outcome variables. We found that participants with an annual household income of < $20,000 were less likely to report taking recommended aspirin as well as statin therapy compared to those with an annual household income > $50,000. Further research is required to delineate the underlying reasons for these results.
- ItemOpen AccessThe evaluating self-management and educational support in severely obese patients awaiting multidisciplinary bariatric care (EVOLUTION) trial: principal results(2017-03-02) Padwal, Raj S; Klarenbach, Scott; Sharma, Arya M; Fradette, Miriam; Jelinski, Susan E; Edwards, Alun; Majumdar, Sumit RAbstract Background In Canada, demand for multidisciplinary bariatric (obesity) care far outstrips capacity. Consequently, prolonged wait times exist that contribute to substantial health impairments. A supportive, educational, self-management intervention (with in-person and web-based versions) for patients wait-listed for bariatric care has already been implemented in Northern and Central Alberta, Canada, but its effectiveness is unknown. The objective of this trial is to evaluate the clinical and economic outcomes of two self-management programs of varying intensity that are currently in use. Methods We conducted a pragmatic, prospective, parallel-arm, randomized controlled trial of 651 wait-listed patients from two regional bariatric programs. Patients were randomized to (1) an in-person, group-based intervention (13 sessions; n = 215) or (2) a web-based intervention (13 modules; n = 225) or (3) control group (printed educational materials; n = 211). After randomization, subjects had 3 months to review the content assigned to them (the intervention period) prior to bariatric clinic entry. The primary outcome was the proportion of patients achieving 5% weight loss at 9 months. Intention-to-treat two-way comparisons were performed and adjusted for baseline age, sex, site and body mass index. Results At baseline, mean age was 40.4 ± 9.8 years, mean weight was 134.7 ± 25.2 kg, mean body mass index was 47.7 ± 7.0 kg/m2 and 83% of participants were female. A total of 463 patients (71%) completed 9 months follow-up. At least 5% weight loss was achieved by 24.2% of those in the in-person strategy, 24.9% for the web-based strategy and 21.3% for controls (adjusted p value = 0.26 for in-person vs. controls, 0.28 for web-based vs. controls, 0.96 for in-person vs. web-based). Absolute and relative (% of baseline) mean weight reductions were 3.7 ± 7.1 kg (2.7 ± 5.4%) for in-person strategy, 2.8 ± 6.7 kg (2.0 ± 4.8%) for web-based and 2.9 ± 8.8 kg (1.9 ± 5.9%) for controls (p > 0.05 for all comparisons). No between-group differences were apparent for any clinical or humanistic secondary outcomes. Total annual costs in Canadian dollars were estimated at $477,000.00 for the in-person strategy, $9456.78 for the web-based strategy and $2270.31 for provision of printed materials. Discussion Two different self-management interventions were no more effective and were more costly than providing printed education materials to severely obese patients. Our findings underscore the need to develop more potent interventions and the importance of comprehensively evaluating self-management strategies before widespread implementation. Trial registration ClinicalTrials.gov, NCT01860131 . Registered 17 May 2013.