title: The impact of a team-based intervention on the lifestyle risk factor management practices of community nurses: outcomes of the community nursing SNAP trial.
abstract: BACKGROUND
  Lifestyle risk factors like smoking, nutrition, alcohol consumption, and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care is an appropriate setting to address these risk factors in individuals. Generalist community health nurses (GCHNs) are uniquely placed to provide lifestyle interventions as they see clients in their homes over a period of time. The aim of the paper is to examine the impact of a service-level intervention on the risk factor management practices of GCHNs.
  
  
  METHODS
  The trial used a quasi-experimental design involving four generalist community nursing services in NSW, Australia. The services were randomly allocated to either an intervention group or control group. Nurses in the intervention group were provided with training and support in the provision of brief lifestyle assessments and interventions. The control group provided usual care. A sample of 129 GCHNs completed surveys at baseline, 6 and 12 months to examine changes in their practices and levels of confidence related to the management of SNAP risk factors. Six semi-structured interviews and four focus groups were conducted among the intervention group to explore the feasibility of incorporating the intervention into everyday practice.
  
  
  RESULTS
  Nurses in the intervention group became more confident in assessment and intervention over the three time points compared to their control group peers. Nurses in the intervention group reported assessing physical activity, weight and nutrition more frequently, as well as providing more brief interventions for physical activity, weight management and smoking cessation. There was little change in referral rates except for an improvement in weight management related referrals. Nurses' perception of the importance of 'client and system-related' barriers to risk factor management diminished over time.
  
  
  CONCLUSIONS
  This study shows that the intervention was associated with positive changes in self-reported lifestyle risk factor management practices of GCHNs. Barriers to referral remained. The service model needs to be adapted to sustain these changes and enhance referral.
  
  
  BACKGROUND
  ACTRN12609001081202.
authors: Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
authors: Bibiana C
authors: BC
authors: Chan
authors: Upali W
authors: UW
authors: Jayasinghe
authors: Bettina
authors: B
authors: Christl
authors: Rachel A
authors: RA
authors: Laws
authors: Neil
authors: N
authors: Orr
authors: Anna
authors: A
authors: Williams
authors: Kate
authors: K
authors: Partington
authors: Mark F
authors: MF
authors: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D003152:Community Health Nursing; D005260:Female; D017144:Focus Groups; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D009726:Nurses; D017063:Outcome Assessment, Health Care; D011361:Professional Competence; D036301:Qualitative Research; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D055815:Young Adult
references: J Am Pharm Assoc (2003). 2006 May-Jun;46(3):364-9
references: 16739758
references: J Health Econ. 2008 Mar;27(2):444-59
references: 18192043
references: Aust J Prim Health. 2012;18(2):123-8
references: 22551834
references: Fam Med. 2005 Jun;37(6):415-21
references: 15933914
references: Prev Med. 2008 Mar;46(3):252-9
references: 18234324
references: Prev Med. 2006 Dec;43(6):472-6
references: 16920185
references: N Engl J Med. 2011 Nov 24;365(21):1969-79
references: 22082239
references: Contemp Nurse. 2004 Apr-Jun;16(3):195-207
references: 15125102
references: BMJ. 2008 Dec 11;337:a2509
references: 19074218
references: Prev Med. 2006 Aug;43(2):86-91
references: 16687167
references: BMC Nurs. 2010 Feb 23;9:4
references: 20175932
references: Am J Prev Med. 2006 Sep;31(3):233-9
references: 16905034
references: Am J Prev Med. 2002 May;22(4):267-84
references: 11988383
references: J Adv Nurs. 2005 Feb;49(3):307-14
references: 15660555
references: BMC Nurs. 2012 Mar 15;11:4
references: 22420868
references: Cochrane Database Syst Rev. 2004;(1):CD001188
references: 14973964
references: Am J Prev Med. 2003 Jan;24(1):75-92
references: 12554027
references: Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004148
references: 17443541
references: Implement Sci. 2009 Oct 13;4:66
references: 19825189
references: Prev Med. 2000 Aug;31(2 Pt 1):167-76
references: 10938218