The development and evaluation of the cardiovascular assessment screening program

Bruneau, Jill E. E. (2020) The development and evaluation of the cardiovascular assessment screening program. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

BACKGROUND: An exploratory mixed methods study, with the philosophical basis of pragmatism and interpretive description, was used to develop, implement, and evaluate an intervention called the Cardiovascular Assessment Screening Program (CASP) to address the underutilization of clinical practice guidelines for cardiovascular screening. The Knowledge-to-Action (KTA) Framework with guideline adaptation was used to guide the study. METHODS: In phase 1, the qualitative study, ten interviews and five focus groups were conducted with healthcare providers (HCPs), managers, and the public to gain different perspectives to inform the development of CASP. In phase 2, the quantitative study, CASP was tested in a randomized controlled trial (RCT) with eight nurse practitioners (NPs) and 167 patients aged 40-74 years without previously diagnosed cardiovascular disease (CVD). The intervention group implemented CASP while the control group provided usual care. Phase 3 integration examined the results from phases 1 and 2. RESULTS: From the focus groups and interviews conducted in the qualitative phase, themes emerged related to the barriers to, facilitators of, and strategies for CVD screening in the local context. The Theoretical Domains Framework (TDF) was applied to the themes to identify relevant behaviour change techniques and modes of delivery, from which specific intervention components for CASP were developed. Findings from Phase 2, the RCT, showed a statistically and clinically significant difference between the NP intervention group compared to the control group in terms of comprehensiveness of screening, RR = 43.9, 95% CI [13.4, 144.2], p < .0001. The NPs in the intervention group were able to identify multiple risk factors; determine their patients’ level of CVD risk; identify NPs’ and patients’ priorities for action; and encourage individualized goal-setting with patients for heart health. In Phase 3, the integration of results from phases 1 and 2 confirmed and refined strategies for knowledge translation. The mixed methods study results are reported in Manuscript 1, while Manuscript 2 focuses primarily on Phase 2, the results from the RCT. Manuscript 3 discusses strategies to address recruitment issues of HCPs such as nurses and NPs, as participants in research studies. CONCLUSION: CASP was effective and can be used by HCPs and patients for CVD screening and management utilizing current guidelines to identify risk factors and promote relevant actions to reduce CVD risk and promote healthy aging.

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