Gwyneth Rees

Bio: Gwyneth Rees is an academic researcher from University of Melbourne. The author has contributed to research in topics: Population & Diabetic retinopathy. The author has an hindex of 25, co-authored 70 publications receiving 1984 citations. Previous affiliations of Gwyneth Rees include Johns Hopkins University & Western General Hospital.

Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study

Abstract: Background: The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose: This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods: Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results: Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion: The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF.

The psychometric validity of the NEI VFQ-25 for use in a low-vision population

Abstract: PURPOSE. To determine the psychometric validity of the National Eye Institute-Visual Function Questionnaire (NEI VFQ25) and its subscale structure for use in people with low vision. METHODS. Two hundred thirty-two participants completed the NEI VFQ-25. Rasch analysis was used to test the psychometric performance of the questionnaire and each subscale. Factor models were hypothesized and tested with confirmatory factor analysis (CFA) and subsequently validated with Rasch analysis. RESULTS. For the overall scale, two rating scales had to be dichotomized and three misfitting items removed to improve fit to the Rasch model. There was evidence of multidimensionality, indicating that the scale would benefit from scale splitting. For the NEI VFQ-25 subscale structure, six of the original 12 subscales could not fit the Rasch model because of item insufficiency (fewer than two items) and the remaining six displayed poor item fit characteristics indicating that the NEI VFQ-25 does not have a viable subscale structure. CFA supported a two-factor model with visual functioning (10 items) and socioemotional (9 items) scales. Most goodness-of-fit statistics were within the recommended range of values. The factor loadings of items on their respective scales were statistically significant (P 0.001) and ranged between 0.59 and 0.84. The two scales individually fitted the Rasch model and were found to be unidimensional with adequate psychometric characteristics. CONCLUSIONS. The native NEI VFQ-25 is a better performing instrument when split into visual functioning and socioemotional scales. These scales possess valid parameters for assessment of the impact of low vision in this population. (Invest Ophthalmol Vis Sci. 2010;51:2878‐2884) DOI:10.1167/iovs.09-4494

Are obesity and anthropometry risk factors for diabetic retinopathy? The diabetes management project.

Abstract: PURPOSE. To investigate the relationship between anthropometric parameters and diabetic retinopathy (DR) in adults with diabetes. METHODS. Five hundred participants with diabetes were recruited prospectively from ophthalmology clinics in Melbourne, Australia. Each underwent an eye examination, anthropometric measurements, and standardized interview-administered questionnaires, and fasting blood glucose and serum lipids were analyzed. Two-field fundus photographs were taken and graded for DR. Height; weight; body mass index (BMI); waist, hip, neck, and head circumferences; and skinfold measurements were recorded. RESULTS. A total of 492 patients (325 men, 66.1%) aged between 26 and 90 years (median, 65) were included in the analysis: 171 (34.8%), 187 (38.0%), and 134 (27.2%) with no DR, nonproliferative DR (NPDR), and proliferative DR (PDR), respectively. After multiple adjustments, higher BMI (odds ratio [OR], 1.06; 95% confidence interval [CI],1.01‐1.11; P 0.02) was significantly associated with any DR. Obese people were 6.5 times more likely to have PDR than were those with normal weight (OR, 6.52; 95% CI, 1.49‐28.6; P 0.013). Neck circumference (OR, 1.05; 95% CI, 1.00‐1.10; P 0.03) and waist circumference (OR, 1.12; 95% CI, 1.03‐1.22; P 0.01) were significantly associated with any DR. BMI (OR, 1.04; 95% CI, 1.00‐1.08; P 0.04) and neck circumference (OR, 1.04 95% CI, 1.01‐1.08; P 0.04) were also positively associated with increasing severity levels of DR. CONCLUSIONS. Persons with diabetes with higher BMI and larger neck circumference are more likely to have DR and more severe stages of DR. These data suggest that obesity is an independent risk factor for DR. (Invest Ophthalmol Vis Sci. 2011;52:4416‐4421) DOI:10.1167/iovs.11-7208

Supporting informality: team working and integrated care records

Abstract: This paper reports findings from an ethnographic study of the work of Adult and Care of the Elderly Community Mental Health Teams in the context of the deployment of an Electronic Medical Record. Our findings highlight the importance of informal discussions and provisional judgments as part of the process by which teams achieve consensual clinical management decisions over time. We show how paper-based documentation supports this collaborative work by affording both the revision of preliminary clinical management options and the accretion of contributions by team members with different clinical perspectives and expertise. Finally, we consider the implications both for teamwork and the Integrated Care Record (ICR) as clinical documentation becomes increasingly held and distributed electronically.

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Making sense of implementation theories, models and frameworks

Abstract: Implementation science has progressed towards increased use of theoretical approaches to provide better understanding and explanation of how and why implementation succeeds or fails. The aim of this article is to propose a taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science, to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers. Theoretical approaches used in implementation science have three overarching aims: describing and/or guiding the process of translating research into practice (process models); understanding and/or explaining what influences implementation outcomes (determinant frameworks, classic theories, implementation theories); and evaluating implementation (evaluation frameworks). This article proposes five categories of theoretical approaches to achieve three overarching aims. These categories are not always recognized as separate types of approaches in the literature. While there is overlap between some of the theories, models and frameworks, awareness of the differences is important to facilitate the selection of relevant approaches. Most determinant frameworks provide limited “how-to” support for carrying out implementation endeavours since the determinants usually are too generic to provide sufficient detail for guiding an implementation process. And while the relevance of addressing barriers and enablers to translating research into practice is mentioned in many process models, these models do not identify or systematically structure specific determinants associated with implementation success. Furthermore, process models recognize a temporal sequence of implementation endeavours, whereas determinant frameworks do not explicitly take a process perspective of implementation.

A Meta-Analytic Review of the Common-Sense Model of Illness Representations

Abstract: A meta-analysis of empirical studies (N ¼ 45) adopting Leventhal, Meyer and Nerenz’s (1980) Common Sense Model (CSM) of illness representations is presented. The average corrected intercorrelation matrix for the sample of studies showed that the CSM illness cognition dimensions of consequences, control/cure, identity and timeline followed a logical pattern supporting their construct and discriminant validity across illness types. A content analysis classified coping strategies into seven distinctive categories and health outcomes into six categories. Examining the average corrected correlation coefficients across the studies revealed that perceptions of a strong illness identity were significantly and positively related to the use of coping strategies of avoidance and emotion expression. In addition, perceived controllability of the illness was significantly associated with cognitive reappraisal, expressing emotions and problem-focused coping strategies. Perceptions of the illness as highly symptomatic, having a chronic timeline and serious consequences was significantly correlated with avoidance and expressing emotions coping strategies. Further, perceptions that the illness was curable/controllable was significantly and positively related to the adaptive outcomes of psychological well-being, social functioning and vitality and negatively related to psychological distress and disease state. Conversely, illness consequences, timeline and identity exhibited significant, negative relationships with psychological well being, role and social functioning and vitality. The analyses provide evidence for theoretically predictable relations between illness cognitions, coping and outcomes across studies.

A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems

Abstract: Implementing new practices requires changes in the behaviour of relevant actors, and this is facilitated by understanding of the determinants of current and desired behaviours. The Theoretical Domains Framework (TDF) was developed by a collaboration of behavioural scientists and implementation researchers who identified theories relevant to implementation and grouped constructs from these theories into domains. The collaboration aimed to provide a comprehensive, theory-informed approach to identify determinants of behaviour. The first version was published in 2005, and a subsequent version following a validation exercise was published in 2012. This guide offers practical guidance for those who wish to apply the TDF to assess implementation problems and support intervention design. It presents a brief rationale for using a theoretical approach to investigate and address implementation problems, summarises the TDF and its development, and describes how to apply the TDF to achieve implementation objectives. Examples from the implementation research literature are presented to illustrate relevant methods and practical considerations. Researchers from Canada, the UK and Australia attended a 3-day meeting in December 2012 to build an international collaboration among researchers and decision-makers interested in the advancing use of the TDF. The participants were experienced in using the TDF to assess implementation problems, design interventions, and/or understand change processes. This guide is an output of the meeting and also draws on the authors’ collective experience. Examples from the implementation research literature judged by authors to be representative of specific applications of the TDF are included in this guide. We explain and illustrate methods, with a focus on qualitative approaches, for selecting and specifying target behaviours key to implementation, selecting the study design, deciding the sampling strategy, developing study materials, collecting and analysing data, and reporting findings of TDF-based studies. Areas for development include methods for triangulating data, e.g. from interviews, questionnaires and observation and methods for designing interventions based on TDF-based problem analysis. We offer this guide to the implementation community to assist in the application of the TDF to achieve implementation objectives. Benefits of using the TDF include the provision of a theoretical basis for implementation studies, good coverage of potential reasons for slow diffusion of evidence into practice and a method for progressing from theory-based investigation to intervention.