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Original article

Vol. 154 No. 10 (2024)

Theory-driven assessment of intentions and behaviours related to mobility of older inpatients: a survey of patients and healthcare professionals

DOI
https://doi.org/10.57187/s.3385
Cite this as:
Swiss Med Wkly. 2024;154:3385
Published
01.10.2024

Summary

BACKGROUND: Low mobility of patients during hospitalisation is associated with adverse outcomes. To successfully change behaviours related to mobility of older hospitalised patients, we need to better understand the mechanisms underlying patient and healthcare professional behaviours. In this study, we thus assessed patient- and healthcare professional-reported intentions and behaviours related to mobility of older patients hospitalised on an acute medical ward, based on a theoretical framework – the Health Action Process Approach (HAPA) model – and on additional barriers and facilitators to mobility.

METHODS: We conducted a cross-sectional survey in April 2022 among patients aged ≥60 years recently hospitalised on an an acute medical ward of one of three hospitals of different language/cultural regions of Switzerland, and healthcare professionals (physicians, nurses/nursing assistants, physiotherapists) working on those wards. The survey assessed the HAPA model and additional barriers and facilitators to patient mobility at hospital, as previously identified in the literature. The target behaviour studied was “to move as much as possible during hospitalisation” for patients and “to ensure my patients move as much as possible during hospitalisation” for healthcare professionals. We conducted hierarchical linear regressions to determine factors associated with the self-reported intention to perform the behaviour and with the self-reported behaviour itself.

RESULTS: A total of 142 healthcare professionals (61 physicians, 59 nurses, 22 physiotherapists) and 200 patients (mean age 74 years) completed the survey. Patients with higher intention to move as much as possible during hospitalisation scored significantly higher on factual knowledge, outcome expectancies and risk perception. Healthcare professionals with higher intention to ensure that their patients move as much as possible during hospitalisation scored higher on action knowledge, outcome expectancies and risk perception. The more the patients reported that they moved as much as possible during hospitalisation, the higher their action knowledge and action control. The more healthcare professionals reported that they ensure that patients move as much as possible during hospitalisation, the higher they scored on factual knowledge, role perception, planning and action control.

CONCLUSIONS: factual and action knowledge, self-efficacy, outcome expectancies, risk perception, planning and action control were identified as important drivers of patient- and healthcare professional-reported intentions and behaviours related to inpatient mobility. These parameters can be addressed through behaviour-change interventions and should be considered in future interventions to successfully implement practice changes, with the goal of improving mobility of older patients during hospitalisation, and thus the outcomes of this particularly vulnerable population.

References

  1. Brown CJ, Friedkin RJ, Inouye SK. Prevalence and outcomes of low mobility in hospitalized older patients. J Am Geriatr Soc. 2004 Aug;52(8):1263–70. doi: https://doi.org/10.1111/j.1532-5415.2004.52354.x DOI: https://doi.org/10.1111/j.1532-5415.2004.52354.x
  2. Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc. 2009 Sep;57(9):1660–5. doi: https://doi.org/10.1111/j.1532-5415.2009.02393.x DOI: https://doi.org/10.1111/j.1532-5415.2009.02393.x
  3. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993 Feb;118(3):219–23. doi: https://doi.org/10.7326/0003-4819-118-3-199302010-00011 DOI: https://doi.org/10.7326/0003-4819-118-3-199302010-00011
  4. Markey DW, Brown RJ. An interdisciplinary approach to addressing patient activity and mobility in the medical-surgical patient. J Nurs Care Qual. 2002 Jul;16(4):1–12. doi: https://doi.org/10.1097/00001786-200207000-00002 DOI: https://doi.org/10.1097/00001786-200207000-00002
  5. Kalisch BJ, Lee S, Dabney BW. Outcomes of inpatient mobilization: a literature review. J Clin Nurs. 2014 Jun;23(11-12):1486–501. doi: https://doi.org/10.1111/jocn.12315 DOI: https://doi.org/10.1111/jocn.12315
  6. Boyd CM, Landefeld CS, Counsell SR, Palmer RM, Fortinsky RH, Kresevic D, et al. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc. 2008 Dec;56(12):2171–9. doi: https://doi.org/10.1111/j.1532-5415.2008.02023.x DOI: https://doi.org/10.1111/j.1532-5415.2008.02023.x
  7. Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003 Apr;51(4):451–8. doi: https://doi.org/10.1046/j.1532-5415.2003.51152.x DOI: https://doi.org/10.1046/j.1532-5415.2003.51152.x
  8. D’Onofrio A, Büla C, Rubli E, Butrogno F, Morin D. Functional trajectories of older patients admitted to an Acute Care Unit for Elders. Int J Older People Nurs. 2018 Mar;13(1):e12164. doi: https://doi.org/10.1111/opn.12164 DOI: https://doi.org/10.1111/opn.12164
  9. Hamilton AC, Lee N, Stilphen M, Hu B, Schramm S, Frost F, et al. Increasing Mobility via In-hospital Ambulation Protocol Delivered by Mobility Technicians: A Pilot Randomized Controlled Trial. J Hosp Med. 2019 May;14(5):272–7. doi: https://doi.org/10.12788/jhm.3153 DOI: https://doi.org/10.12788/jhm.3153
  10. Hastings SN, Sloane R, Morey MC, Pavon JM, Hoenig H. Assisted early mobility for hospitalized older veterans: preliminary data from the STRIDE program. J Am Geriatr Soc. 2014 Nov;62(11):2180–4. doi: https://doi.org/10.1111/jgs.13095 DOI: https://doi.org/10.1111/jgs.13095
  11. Brown CJ, Foley KT, Lowman JD Jr, MacLennan PA, Razjouyan J, Najafi B, et al. Comparison of Posthospitalization Function and Community Mobility in Hospital Mobility Program and Usual Care Patients: A Randomized Clinical Trial. JAMA Intern Med. 2016 Jul;176(7):921–7. doi: https://doi.org/10.1001/jamainternmed.2016.1870 DOI: https://doi.org/10.1001/jamainternmed.2016.1870
  12. Raymond MJ, Jeffs KJ, Winter A, Soh SE, Hunter P, Holland AE. The effects of a high-intensity functional exercise group on clinical outcomes in hospitalised older adults: an assessor-blinded, randomised-controlled trial. Age Ageing. 2017 Mar;46(2):208–13. doi: https://doi.org/10.1093/ageing/afw215 DOI: https://doi.org/10.1093/ageing/afw215
  13. Teodoro CR, Breault K, Garvey C, Klick C, O’Brien J, Purdue T, et al. STEP-UP: Study of the Effectiveness of a Patient Ambulation Protocol. Medsurg Nurs. 2016;25(2):111–6.
  14. Wood W, Tschannen D, Trotsky A, Grunawalt J, Adams D, Chang R, et al. A mobility program for an inpatient acute care medical unit. Am J Nurs. 2014 Oct;114(10):34–40. doi: https://doi.org/10.1097/01.NAJ.0000454850.14395.eb DOI: https://doi.org/10.1097/01.NAJ.0000454850.14395.eb
  15. Taylor NF, Harding KE, Dennett AM, Febrey S, Warmoth K, Hall AJ, et al. Behaviour change interventions to increase physical activity in hospitalised patients: a systematic review, meta-analysis and meta-regression. Age Ageing. 2022 Jan;51(1):afab154. doi: https://doi.org/10.1093/ageing/afab154 DOI: https://doi.org/10.1093/ageing/afab154
  16. Hoyer EH, Brotman DJ, Chan KS, Needham DM. Barriers to early mobility of hospitalized general medicine patients: survey development and results. Am J Phys Med Rehabil. 2015 Apr;94(4):304–12. doi: https://doi.org/10.1097/PHM.0000000000000185 DOI: https://doi.org/10.1097/PHM.0000000000000185
  17. So C, Pierluissi E. Attitudes and expectations regarding exercise in the hospital of hospitalized older adults: a qualitative study. J Am Geriatr Soc. 2012 Apr;60(4):713–8. doi: https://doi.org/10.1111/j.1532-5415.2012.03900.x DOI: https://doi.org/10.1111/j.1532-5415.2012.03900.x
  18. Mani H, Möri C, Mattmann M, Liechti F, Inauen J, Aujesky D, et al. Barriers and facilitators to mobility of patients hospitalised on an acute medical ward: a systematic review. Age Ageing. 2022 Jul;51(7):afac159. doi: https://doi.org/10.1093/ageing/afac159 DOI: https://doi.org/10.1093/ageing/afac159
  19. van Dijk-Huisman HC, Raeven-Eijkenboom PH, Magdelijns FJ, Sieben JM, de Bie RA, Lenssen AF. Barriers and enablers to physical activity behaviour in older adults during hospital stay: a qualitative study guided by the theoretical domains framework. BMC Geriatr. 2022 Apr;22(1):314. doi: https://doi.org/10.1186/s12877-022-02887-x DOI: https://doi.org/10.1186/s12877-022-02887-x
  20. King B, Bodden J, Steege L, Brown CJ. Older adults experiences with ambulation during a hospital stay: A qualitative study. Geriatr Nurs. 2021;42(1):225–32. doi: https://doi.org/10.1016/j.gerinurse.2020.08.005 DOI: https://doi.org/10.1016/j.gerinurse.2020.08.005
  21. Schwarzer R. Modeling health behavior change: how to predict and modify the adoption and maintenance of health behaviors. Appl Psychol. 2008;57(1):1–29. doi: https://doi.org/10.1111/j.1464-0597.2007.00325.x DOI: https://doi.org/10.1111/j.1464-0597.2007.00325.x
  22. Schwarzer R. Health action process approach (HAPA) as a theoretical framework to understand behavior change. Actual Psicol. 2016;30(121):119–30. doi: https://doi.org/10.15517/ap.v30i121.23458 DOI: https://doi.org/10.15517/ap.v30i121.23458
  23. Bierbauer W, Inauen J, Schaefer S, Kleemeyer MM, Lüscher J, König C, et al. Health Behavior Change in Older Adults: Testing the Health Action Process Approach at the Inter- and Intraindividual Level. Appl Psychol Health Well-Being. 2017 Nov;9(3):324–48. doi: https://doi.org/10.1111/aphw.12094 DOI: https://doi.org/10.1111/aphw.12094
  24. Caudroit J, Stephan Y, Le Scanff C. Social cognitive determinants of physical activity among retired older individuals: an application of the health action process approach. Br J Health Psychol. 2011 May;16(Pt 2):404–17. doi: https://doi.org/10.1348/135910710X518324 DOI: https://doi.org/10.1348/135910710X518324
  25. Renner B, Spivak Y, Kwon S, Schwarzer R. Does age make a difference? Predicting physical activity of South Koreans. Psychol Aging. 2007 Sep;22(3):482–93. doi: https://doi.org/10.1037/0882-7974.22.3.482 DOI: https://doi.org/10.1037/0882-7974.22.3.482
  26. Derksen C, Keller FM, Lippke S. Obstetric Healthcare Workers’ Adherence to Hand Hygiene Recommendations during the COVID-19 Pandemic: Observations and Social-Cognitive Determinants. Appl Psychol Health Well-Being. 2020 Dec;12(4):1286–305. doi: https://doi.org/10.1111/aphw.12240 DOI: https://doi.org/10.1111/aphw.12240
  27. Lutze B, Chaberny IF, Graf K, Krauth C, Lange K, Schwadtke L, et al. Intensive care physicians’ and nurses’ perception that hand hygiene prevents pathogen transmission: belief strength and associations with other cognitive factors. J Health Psychol. 2017 Jan;22(1):89–100. doi: https://doi.org/10.1177/1359105315595123 DOI: https://doi.org/10.1177/1359105315595123
  28. Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth. 2017 May;11(5 Suppl 1):S80–9. doi: https://doi.org/10.4103/sja.SJA_203_17 DOI: https://doi.org/10.4103/sja.SJA_203_17
  29. Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993 Dec;46(12):1417–32. doi: https://doi.org/10.1016/0895-4356(93)90142-N DOI: https://doi.org/10.1016/0895-4356(93)90142-N
  30. Baker PS, Bodner EV, Allman RM. Measuring life-space mobility in community-dwelling older adults. J Am Geriatr Soc. 2003 Nov;51(11):1610–4. doi: https://doi.org/10.1046/j.1532-5415.2003.51512.x DOI: https://doi.org/10.1046/j.1532-5415.2003.51512.x
  31. Ericsson KA, Simon HA. Thinking-Aloud Processes. Protocol Analysis: Verbal Reports as Data. Cambridge (MA): MIT Press; 1993. doi: https://doi.org/10.7551/mitpress/5657.001.0001 DOI: https://doi.org/10.7551/mitpress/5657.001.0001
  32. Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age Ageing. 1997 May;26(3):189–93. doi: https://doi.org/10.1093/ageing/26.3.189 DOI: https://doi.org/10.1093/ageing/26.3.189
  33. Austin N, Devine A, Dick I, Prince R, Bruce D. Fear of falling in older women: a longitudinal study of incidence, persistence, and predictors. J Am Geriatr Soc. 2007 Oct;55(10):1598–603. doi: https://doi.org/10.1111/j.1532-5415.2007.01317.x DOI: https://doi.org/10.1111/j.1532-5415.2007.01317.x
  34. Veenstra GL, Dabekaussen KF, Molleman E, Heineman E, Welker GA. Health care professionals’ motivation, their behaviors, and the quality of hospital care: A mixed-methods systematic review. Health Care Manage Rev. 2022 Apr-Jun;47(2):155–67. doi: https://doi.org/10.1097/HMR.0000000000000284 DOI: https://doi.org/10.1097/HMR.0000000000000284
  35. Andah E, Essang B, Friend C, Greenley S, Harvey K, Spears M, et al. Understanding the impact of professional motivation on the workforce crisis in medicine: a rapid review. BJGP Open. 2021 Apr;5(2):BJGPO.2021.0005. doi: https://doi.org/10.3399/BJGPO.2021.0005 DOI: https://doi.org/10.3399/BJGPO.2021.0005
  36. Moreno NA, de Aquino BG, Garcia IF, Tavares LS, Costa LF, Giacomassi IW, et al. Physiotherapist advice to older inpatients about the importance of staying physically active during hospitalisation reduces sedentary time, increases daily steps and preserves mobility: a randomised trial. J Physiother. 2019 Oct;65(4):208–14. doi: https://doi.org/10.1016/j.jphys.2019.08.006 DOI: https://doi.org/10.1016/j.jphys.2019.08.006
  37. Liu B, Moore JE, Almaawiy U, Chan WH, Khan S, Ewusie J, et al.; MOVE ON Collaboration. Outcomes of Mobilisation of Vulnerable Elders in Ontario (MOVE ON): a multisite interrupted time series evaluation of an implementation intervention to increase patient mobilisation. Age Ageing. 2018 Jan;47(1):112–9. doi: https://doi.org/10.1093/ageing/afx128 DOI: https://doi.org/10.1093/ageing/afx128