Developing a framework for the implementation of recommendations for lifestyle factors for people with RMDs across Europe: assessment of current materials and implementation needs

Abstract

Lifestyle factors (such as diet, physical activity or smoking habits, among others) are known to influence the progression of rheumatic and musculoskeletal diseases (RMDs). Despite contemporary improvements in RMD care, the management of lifestyle factors is suboptimal. In the context of a recent European Alliance of Associations for Rheumatology (EULAR) task force, existing informative materials regarding lifestyle factors for people with RMDs were collected from national organisations across European countries. Current materials show important limitations in terms of coverage, literature support and access, which may make the implementation of successful interventions difficult. In the present viewpoint, a roadmap to cover these gaps at the European level with the recent EULAR recommendations on lifestyle factors is discussed from an implementation perspective. This analysis may pave the ground for future implementation endeavours at the European level related to non-pharmacological interventions that may also be applicable beyond rheumatology.

Keywords: arthritis, rheumatoid; health services research; nursing; patient care team; qualitative research.

Figure 1

Roadmap for the implementation of materials focused on lifestyle factors for people with rheumatic and musculoskeletal diseases. This figure covers all the steps from generating evidence to end product implementation. Yellow blocks summarise the steps already achieved. According to general implementation science and the analysis of unmet needs in existing materials, several factors judged to be essential to allow successful implementation and to promote change were selected and grouped into related to implementation object, context or organisational variables. The roadmap was conceived as a general scheme that could serve as a guide for a spectrum of implementation projects based on lifestyle factors. Specific adaptations may be considered for each element). For each item, the responsible actor and the level of action is indicated. Macro-level refers to supranational or international structures (international research teams/task forces, international associations, etc); meso-level refers to regional and institutional structures or actors (national societies/associations, national patient associations, policymakers, health systems, etc); whereas micro-level refers to front-line individuals (clinicians, health professionals, patients, etc).