HPE 100 – March 2022 | Page 18

REVIEW

Improving competencies in behaviour change support in chronic disease : the case of medication adherence

An interprofessional European competency framework , linked with behaviour change techniques from an established taxonomy , can be used to optimise medication adherence in persons living with chronic disease
Isa Brito Félix MSc Nursing Research , Innovation and Development Centre of Lisbon ( CIDNUR ), Nursing School of Lisbon , Lisbon , Portugal Marta Moreira Marques PhD Comprehensive Health Research Centre ( CHRC ), NOVA Medical School , Lisbon , Portugal Afonso Miguel Cavaco PhD Faculty of Pharmacy , University of Lisbon , Lisbon , Portugal . Mara Pereira Guerreiro PhD Nursing Research , Innovation and Development Centre of Lisbon ( CIDNUR ), Nursing School of Lisbon , Lisbon , Portugal ; Centro de Investigação Interdisciplinar Egas Moniz ( CiiEM ), Instituto Universitário Egas Moniz , Monte de Caparica , Portugal
Hospital pharmacists contribute to inpatient and outpatient medications and care through a unique expertise by , for example , medication reconciliation , management of drug-related problems and patient education . In this setting , pharmacists improve medication management at the hospital-to-home interface , supporting the patients routinely taking medication and their adherence , and contributing to better outcomes . 1
This paper presents an overview of a European competency framework for health and other professions to support behaviour change for the self-management of chronic disease , 2 and its application to medication adherence , a key behaviour in self-management . * *
The article comprises three key sections . First , it sets the scene for the need and relevance of the competency framework as a tool to create standards of practice and guide training . Second , it describes the development of the competency framework to support behaviour change in persons living with chronic disease . 2 Then , it turns to the case of supporting medication adherence , by providing examples of the application of behaviour change techniques ( BCTs ) from an established taxonomy . Using BCTs in medication adherence consultations facilitates the provision of tailored interventions by hospital pharmacists , while fostering comprehensiveness and consistency . Moreover , it renders hospital pharmacists ’ interventions more explicit .
Background Chronic diseases are a global epidemic , responsible for 40.5 million deaths in 2016 , corresponding to 71 % of deaths worldwide . 3 Changing and sustaining desirable lifestyle behaviours is key in preventing and managing chronic diseases .
Self-management is defined as tasks performed by an individual to minimise the impact of one ’ s disease , with or without the support of health professionals . 4 Tasks can holistically be categorised under medical management ( for example , taking medication , adhering to a diet , engaging in physical activity ), role management ( for example , redefining life roles in light of a chronic disease ) and emotional management ( for example , dealing with anger and frustration ), and are related to a set of skills . 4 This definition captures the idea that self-management encompasses a variety of health behaviours in which individuals should engage .
Healthcare and other professionals are expected to support behaviour change for the self-management of chronic disease , including , for example , interventions to improve medication adherence or increase physical activity . However , effective interventions targeting a range of health behaviours are still not the norm routinely . Evidence shows that health professionals perceive a lack of confidence in their own skill set and ability to deliver behaviour change interventions , focusing seldom this aspect on consultations . 5 , 6 It appears that perceived knowledge and skills relating to the implementation of behaviour change interventions is a global workforce problem , which is imperative to address .
A BCT is “ an observable , replicable , and irreducible component of an intervention designed to alter or redirect causal processes that regulate behaviour ”. 7 BCTs include setting goals , self-monitoring of behaviour , social support etc . A seminal British guidance on individual-level health behaviour change interventions recommended detailing the BCTs by using standardised classification systems , so that interventions can be replicated and include techniques shown to be effective at changing behaviour . 8 This guideline from the National Institute for Health and Care Excellence ( NICE ) has recommended that behaviour change practitioners recognise BCTs in the interventions they are delivering and have the relevant skills to deliver them . 8 The BCT Taxonomy ( version 1 - BCTTv . 1 ) is the most well-known classification of BCTs . It has gained international acceptance as a valid tool for specifying the content of behaviour change interventions . 7 , 9 Notably , a recent scoping review found that BCTs remain underused in self-management interventions . 10 One reason that might explain this shortcoming is the poor permeation of behavioural science and BCTs , in particular , into the education and training of health and other professionals .
Train4Health ( www . train4health . eu ) is a strategic partnership involving seven European institutions across five countries , which seeks to improve behaviour change support competencies for the self-management of chronic disease . The Train4Health consortium comprises higher education institutions ( nursing , pharmacy and sports sciences ), an IT partner and the European Students ’ Union . Hallmarks of the Train4Health project ( 2019 - ) include drawing on
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