A continuing educational intervention in primary health care using the ConPrim model

Sammanfattning: Background and aim: The overall aim of this thesis was to evaluate an intervention about “Nutritional care for patients cared for at home” developed using an interprofessional continuing educational model adapted for primary health care (ConPrim®). Material and method: This thesis includes four studies, three quantitative and one qualitative. The source of the data for all studies was the subject-specific intervention developed using the three-part ConPrim® model (web-based program, practical exercise, case seminar). Each part is adapted to primary health care, interprofessional, and grounded in pedagogical theory. Participants were district nurses (DNs) and general practitioners (GPs). An intervention group (IG) and a control group (CG) was used. Study I evaluated the IG’s perceptions (n=67) of ConPrim® (as used in the subject-specific intervention) using a computer based questionnaire. Studies II and III evaluated the effectiveness of the intervention using a 32-statement, study-specific questionnaire about three topic areas. Study II evaluated effectiveness for both professions together (IG=87, CG=53) and presented the results for each topic area by statement. Study III evaluated effectiveness by profession (IG: DNs=48, GPs=39; CG: DNs=36, GPs=17), and presented the results by topic area. Study IV used grounded theory method to explore interactions between DNs and GPs during case-seminar discussions about nutritional care for patients cared for at home. Results: In Study I, the professionals agreed that the ConPrim® model as applied in the intervention was suitable, the designs of the web-based program and case seminar were attractive, and they could use what they had learned in everyday clinical work. They found the time spent acceptable, with the exception of the practical exercise. In Study II, statistically significant effects were found in the inter-group analyses in 20 of the 32 statements: in all statements that assessed familiarity with important concepts and all statements about collaboration with other caregivers (except 2 of the 14 concerning level of knowledge). In Study III, the effectiveness of the intervention was measured by profession. It was significant for both professions in areas 1 and 2, but in area 3, it was significant for GPs but not DNs. Nevertheless, the total intervention effect (p = 0.000 – p = 0.004) was significant in all three areas. In Study IV, a theoretical model was constructed that describes how DNs and GPs negotiate the issue of responsibility for nutritional care via a uniprofessional dialogue (which does not lead to interprofessional learning) or an ongoing interprofessional dialogue (which under certain circumstances can lead to interprofessional learning). Conclusions: The intervention developed using the ConPrim®model is promising. However, the instructions for the practical exercise should be clarified and the intervention adjusted to increase both professions’ level of knowledge about important aspects of nutritional care. The grounded theory model illuminates importance of the distinction between uni- and interprofessional dialogue; only the latter can lead to interprofessional learning.