Alexander M Clark

Alexander M Clark
University of Alberta | UAlberta · Faculty of Nursing

BA(Hons) PhD

About

142
Publications
26,429
Reads
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5,997
Citations
Introduction
Professor & Associate Dean (Research) Interests: Prevention and management of heart disease, complexity theory, realism, qualitative research, systematic review.
Additional affiliations
April 2003 - present
University of Alberta
Position
  • Professor (Full) Associate Dean (Research)

Publications

Publications (142)
Article
Purpose of review: To review the application of intersectionality to heart failure. Intersectionality refers to the complex ways in which disenfranchisement and privilege intersect to reproduce and influence health and social outcomes. Recent findings: Intersectionality challenges approaches that focus on a single or small number of socio-demogr...
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This study explores factors that affect the people of low socioeconomic status regarding food choices after diagnosis with cardiovascular disease. Qualitative approach was used to identify the important factors associated with dietary changes as a result of their disease. Twenty-four participants were interviewed from two cardiac facilities in Kara...
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Background: Coronary heart disease (CHD) is a major cause of death worldwide. Cardiac rehabilitation, an evidence-based CHD secondary prevention programme, remains underutilized. Telehealth may offer an innovative solution to overcome barriers to cardiac rehabilitation attendance. We aimed to determine whether contemporary telehealth interventions...
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Background: Coronary heart disease (CHD) is the single most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people live with CHD and may need support to manage their symptoms and improve prognosis. Cardiac rehabilitation is a complex multifaceted intervention which aims to improve the health outco...
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Predatory journals are out to get you and your work. Awareness of predatory publishers and their practices is now much higher than even three years ago: predatory being defined by the Oxford English Dictionary as 'preying naturally on' and 'seeking to exploit' others. This article is protected by copyright. All rights reserved.
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Cardiovascular disease exerts an enormous burden on women's health. The intake of a healthy diet may reduce this burden. However, social norms and economic constraints are often factors that restrain women from paying attention to their diet. Underpinned by critical realism, this study explores how gender/sex influences decision-making regarding fo...
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Abstract Background Values are central to ethical and effective nursing and health care. However, in relation to heart failure, an extremely common and burdensome syndrome, the role that patients’ values have in influencing self-care is poorly understood. Methods A mixed methods systematic review was conducted using a critical meta-narrative synth...
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Cognitive impairment is prevalent in heart failure (HF) with severe consequences, including increased risk of mortality and reduced ability to self-manage HF symptoms. Identifying cognitive impairment through screening would assist clinicians in managing HF and comorbid cognitive impairment. However, the accuracy of cognitive screening instruments...
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This systematic review aimed to generate patient-focussed recommendations to enhance support of heart failure self-care by examining patients' experiences, perspectives and self-care behaviours. Despite increased recognition of the importance of heart failure self-care, patients' knowledge and practices around this self-care and interventions to im...
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To discuss issues in the theorization and study of gender observed during a qualitative meta-synthesis of influences on uptake of secondary prevention and cardiac rehabilitation services. Women and men can equally benefit from secondary prevention/cardiac rehabilitation and there is a need to understand gender barriers to uptake. Meta-method analys...
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Background: Effective heart failure (HF) self-care can improve clinical outcomes but is dependent on patients' undertaking a number of complex self-care behaviors. Research into the effectiveness of HF management programs demonstrates mixed results. There is a need to improve understanding of patient perspectives' of self-care need in order to enha...
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There is a growing focus on interdisciplinary team approaches in science and public health research, including cardiology. This trend is apparent in a large body of team publications and the strong interest from the funding agencies to support interdisciplinary research. Despite this increased emphasis on the importance and roles of teams, schools...
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Purpose: To explore the effects of targeted physical activity (PA) print material on PA and quality of life (QOL) in young adult cancer survivors (YACS) aged 18-39 either on or off treatment. Methods: YACS (N=212) recruited from a cancer registry were randomly assigned to a Targeted Physical Activity Guidebook (TPAG) or the Canadian Physical Activi...
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To identify the main contextual factors and processes that influence patients' self-care of heart failure (HF). A systematic review was conducted using qualitative meta-synthesis. Ten databases were searched until March 19, 2012. Of the 1421 papers identified by the systematic search, 45 studies were included in this meta-synthesis. To be included...
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Background: To identify the main contextual factors and processes that influence patients’ self-care of heart failure (HF). Methods and Results: A systematic review was conducted using qualitative meta-synthesis. Ten databases were searched until March 19, 2012. Of the 1421 papers identified by the systematic search, 45 studies were included in th...
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Taking debates about the roles of structure and agency in health as a lens, this essay asks how Critical Realist and Feminist Intersectional approaches might inform health interventions research. Despite recognition of multiple determinants of health, health problems are often thought of as individual and interventions, in turn, target risky indivi...
Article
To examine the personal and structural facilitators and barriers for home-dialysis decision-making for older adults with chronic kidney disease. Chronic illness is a global problem. Older adults with chronic kidney disease form a large and growing segment of the dialysis population in many high-income countries but are less likely to uptake home-di...
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Self-care is at the foundation for living with a chronic condition such as heart failure (HF). Patients with HF express difficulty with translating self-care knowledge into understanding "how" to engage in these activities and behaviors. Understanding the strategies that patients develop to engage in self-care will help healthcare providers (HCPs)...
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Disease management interventions for heart failure (HF) are inconsistent and very seldom incorporate the views and needs of patients and their caregivers into intervention design. To improve intervention effectiveness and consistency, a systematic review identified 49 studies which examined the views and needs of patients with HF and their caregive...
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There is a misconception that cardiovascular disease (CVD) is the burden of wealthy nations, but, in fact, it is the leading cause of death and disability-adjusted life worldwide. Healthy diets are an essential factor in the prevention of CVD. However, promoting healthy diet is challenging, particularly for people with low-socioeconomic status (SES...
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Referral to cardiac rehabilitation and secondary prevention programs remains very low, despite evidence suggesting strong clinical efficacy. To develop evidence-based interventions to promote referral, the complex factors and processes influencing referral need to be better understood. We performed a systematic review using qualitative meta-synthes...
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International studies suggest almost half of all major coronary episodes annually occur in survivors of acute coronary syndrome (ACS). A greater focus on medium- and long-term ACS management and adherence to proven therapies is essential if out-of-hospital reductions in mortality and morbidity are to be optimized. A national panel of clinical and r...
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This editorial refers to ‘Cost-of-illness study of patients subjected to cardiac rhythm management devices implantation: results from a single tertiary centre’ by J. Fanourgiakis et al. , 15: 366–375. Costs worthy of consideration often do not make it to the picture in cost-of-illness studies. Thus, there is cause for concern when Fanourgiakis et...
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The accessibility and effectiveness of health services for people with coronary heart disease (CHD) have never been more important: more people are living longer with symptomatic CHD in high-income, middle-income and low-income countries.1 Healthy behaviours can reduce likelihood of premature death in people with CHD by threefold.2 Yet, despite the...
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Background: Greater participation in cardiac rehabilitation improves morbidity and mortality in people with coronary heart disease, but little is understood of patients' decisions to participate. Methods: To develop interventions aimed at increasing completion of programmes, we conducted a qualitative systematic review and meta-synthesis to expl...
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BackgroundThis paper presents critical realism (CR) as an innovative system for research in tobacco prevention and control. CR argues that underlying mechanisms are considered and explored to ensure effective implementation of any program/policy or intervention. Any intervention or program/policy that is transposed from one country to another or on...
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: Anxiety is common among patients with coronary artery disease (CAD). Despite the benefits of home-based CAD prevention interventions on quality of life and atherosclerotic risk factors, the efficacy of home-based programs in reducing patient anxiety is unknown. : We performed a systematic review and meta-analysis of all randomized trials that exa...
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Young adult cancer survivors (YACS) face unique challenges from their disease and treatments that may influence their sport participation choices as well as their psychosocial response.Objectives To examine the prevalence, correlates, and psychosocial outcomes of sport participation in YACS.DesignA provincial, population-based mailed survey of 588...
Article
It is unknown if vigorous to maximal aerobic interval training (INT) is more effective than traditionally prescribed moderate-intensity continuous aerobic training (MCT) for improving peak oxygen uptake (Vo(2)) and the left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction. MEDLINE, PubMed, Scopus, a...
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To understand hypertensive patients' perspectives regarding blood pressure and hypertension treatment, this qualitative study applied semistructured interviews of hypertensive patients. Participants were recruited from two hypertension clinics at the University of Alberta in Edmonton, Canada. To be eligible for inclusion, patients had to be aged 18...
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Cardiovascular disease is among the leading causes of mortality and morbidity in Canada. Cardiac rehabilitation (CR) has a long robust history here, and there are established clinical practice guidelines. While the effectiveness of CR in the Canadian context is clear, only 34% of eligible patients participate, and strategies to increase access for...
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Football and healthcare are both complex adaptive systems. Alex Clark and colleagues wonder how and why football scores more highly when it comes to introducing interventions Who would you rather have as a player on your football team: Messi or Clark⇓? Both players share numerous characteristics, such as they both have brown hair, have the same s...
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Cardiac rehabilitation and secondary prevention programs can prevent heart disease in high-risk populations. However, up to half of all patients referred to these programs do not subsequently participate. Although age, sex, and social factors are common predictors of attendance, to increase attendance rates after referral, the complex range of fact...
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To analyse available research on the effectiveness of prewarming to prevent perioperative hypothermia and identify knowledge gaps for future research. Perioperative hypothermia is common and causes complications, such as coagulation and platelet function abnormalities; increased cardiac morbidity, surgical site infection, and pressure ulcer inciden...
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Objective: We hypothesized that an open-minded investigation towards facilitation and barriers could lead to the identification of major themes in personal knowledge and attitudes to hypertension by patients. Design and Methods: A qualitative study of 26 adult hypertensive patients using semi-structured interviewing was conducted. Participants were...
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“ The transition from a paradigm in crisis to a new one … changes some of the field's most elementary theoretical generalizations as well as many of its paradigm methods and applications. ” Thomas S Kuhn.1 Few areas of non-pharmacological research have had as much study or success as heart failure disease management programmes (HFDMPs). The first...
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To examine the determinants of physical activity (PA) in young adult cancer survivors (YACS). A survey of 588 YACS in Alberta, Canada, assessed PA, medical and demographical factors, and theory of planned behavior variables. Path analysis explained 38% (P<.001) of the variance in PA with significant contributions from intention, planning, affective...
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OBJECTIVE: To understand the process of help-seeking among heart failure patients from the perspectives of patients, caregivers and health professionals. DESIGN: Systematic review using qualitative meta-synthesis. METHODS: A systematic search (20th May 2011) was conducted to identify studies published in English as full papers ≥1995 reporting prima...
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Participation in cardiac rehabilitation (CR) benefits patients with coronary heart disease (CHD), yet worldwide only some 15–30% of those eligible attend. To improve understanding of the reasons for poor participation we undertook a systematic review and meta-synthesis of the qualitative literature. Qualitative studies identifying patient barriers...
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Effective communication is a prerequisite for any successful encounter between patient and provider. Nevertheless, it is unclear how/where communication can impact/affect adherence to antihypertensive medication, and maintenance of lifestyle changes to control blood pressure targets. Poor physician communication is correlated with a higher risk of...
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Background: To assess the effects of patient education on mortality, morbidity, health-related quality of life (HRQoL), and healthcare costs in people with coronary heart disease (CHD).Design: Systematic review and meta-analysis.Methods: Data sources were Cochrane Library, Medline, Embase, PsycINFO, CINAHL, and ongoing trial registries until August...
Article
This systematic review examined how people with chronic kidney disease make decisions about the type of dialysis modality to use. In particular, meta-synthesis was used to understand the process of patient decision-making and how aspects of context influenced these decisions. This topic is important because home-dialysis has economic and quality of...
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The components of complex interventions are frequently discussed, invoked and examined in theory and research but seldom defined. This leads to theoretical and ontological ambiguities, lack of methodological transparency, and potentially, resistance to the wider movement towards complex intervention. This paper is the first to compare and contrast...
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HARWOOD L and CLARK AM. Nursing Inquiry 2012; 19: 29–38 Understanding health decisions using critical realism: home-dialysis decision-making during chronic kidney disease This paper examines home-dialysis decision making in people with Chronic Kidney Disease (CKD) from the perspective of critical realism. CKD programmes focus on patient education f...
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SWORD W, CLARK AM, HEGADOREN K, BROOKS S and KINGSTON D. Nursing Inquiry 2012; 19: 51–62 The complexity of postpartum mental health and illness: a critical realist study Postpartum depression (PPD) is a major public health issue that profoundly impacts the woman, her infant and family. Although it may be linked to hormone changes, no direct hormona...
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Aim: This article is a report of a study examining the relationships between chronic kidney disease stressors and coping strategies with dialysis modality. Background: People with chronic kidney disease are given information to enable dialysis modality choice. This education increases awareness and may alleviate concerns and stress. Disease-rela...
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Although the Internet has been shown to be an effective tool for supporting behavioural change in other chronic diseases, less in known about the efficacy of, or need for, Internet-based interventions in the prevention of coronary heart disease (CHD). We investigated computer literacy, consumer need and perceived usefulness of the Internet as a sec...
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Coronary heart disease (CHD) includes chest pain, heart attacks, and the need for heart surgery and is a major cause of premature death and disability. Education is a common element of care for people with CHD aiming to decrease mortality and morbidity as well as improving quality of life. This review shows that there is not enough information avai...
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More data, better data or improved evidence translation: what will improve cardiovascular outcomes? As countries must focus more on the value of and access to health services over effectiveness alone, we argue that data on key aspects of interventions are predominantly missing from the current evidence-base. We examine this need in relation to seco...
Data
Full-text available
AMSTAR Quality Ranking of Included Studies. Quality assessment ratings for each item on the AMSTAR tool for each review.
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Full-text available
Despite favourable results from past meta-analyses, some recent large trials have not found heart failure (HF) disease management programs to be beneficial. To explore reasons for this, we evaluated evidence from existing meta-analyses. Systematic review incorporating meta-review was used. We selected meta-analyses of randomized controlled trials p...