A National Network of Public Health and Faith-Based Organizations to Increase Influenza Prevention Among Hard-to-Reach Populations

We studied a national collaboration to prevent the spread of 2009 H1N1 and seasonal influenza, and highlighted how a partnership among the Interfaith Health Program (IHP) at Emory University, the Department of Health and Human Services Partnership Center, the Centers for Disease Control and Prevention, and the Association of State and Territorial Health Officials (ASTHO) leveraged the distinctive capabilities of local public health, health care, and faith-based organizations in 10 communities around the country. From 2009 to 2016, IHP, ASTHO, and the Partnership Center worked as intermediaries with these partnerships, aligning and amplifying their capacity to extend influenza prevention services for hard-to-reach vulnerable populations. We suggested that intermediary organizations enabled information sharing, co-learning, and dissemination of best practices through horizontal and vertical channels. We recommended practices for these partnerships to engage local networks that share commitments to eliminate health disparities, to use a frame of strengths and assets, and to provide a supportive multilocal, multilevel learning community.

Enhancing the National Dialogue on the Prevention of Intimate Partner Violence

Little systematic information exists about how community-based prevention efforts at the state and local levels contribute to our knowledge of intimate partner violence (IPV) prevention. The Centers for Disease Control and Prevention's (CDC) DELTA FOCUS program funds ten state domestic violence coalitions to engage in IPV primary prevention through approaches addressing the outer layers of the social ecology. This paper explored the ways in which DELTA FOCUS recipients have contributed to a national-level dialogue on IPV prevention. Previously undefined, the authors define national-level dialogue and retrospectively apply the CDC Science Impact Framework (SIF) to describe contributions DELTA FOCUS recipients made to it. Authors conducted document review and qualitative content analysis of recipient semi-annual progress reports from 2014 to 2016 (N = 40) using NVivo. A semi-structured coding scheme was applied across the five SIF domains: Creating Awareness, Catalyzing Action, Effecting Change, Disseminating Science, and Shaping the Future. All recipients sought to promote IPV prevention by communicating and sharing with non-CDC-funded state coalitions, national partners, and other IPV stakeholders information and resources accumulated through practice-based prevention efforts. Through implementing and disseminating their prevention work in myriad ways, DELTA FOCUS recipients are building practice-based evidence on community-based IPV prevention.

Professionals' preferences and experiences with inter-organizational consultation to assess suspicions of child abuse and neglect

This study addresses the following questions in cases of suspected child abuse and neglect (CAN) in children up to four years of age: 1) How many professionals intend to seek inter-organizational consultation? 2) What types of organizations do professionals prefer to consult? and 3) What factors can be identified as facilitator(s) or barrier(s) regarding inter-organizational consultation, based on professionals' experiences? Professionals working with children in 101 organizations in a medium-sized Dutch city were invited to fill in an online questionnaire. The questionnaire included a vignette about a suspected case. Quantitative, qualitative, and social network analysis approaches were used to analyze the data. Seventy-eight questionnaires were available for analysis. Fifty-five respondents (71%) intended to seek inter-organizational consultation. Ten different organization types were mentioned. The most frequently mentioned organization was preventive child healthcare. In total, 82 text fragments from 39 participants were available to analyze barriers and facilitators to inter-organizational consultation, 60 fragments that entailed a facilitator and 22 fragments that entailed a barrier. The text fragments were subdivided into twelve factors. The three factors that were most often identified as a facilitator were 'support', 'undertaking action', and 'regard'. Barriers were found in relation to all twelve factors. No specific barrier(s) stood out. This study demonstrated that most professionals are inclined to seek inter-organizational consultation when they suspect CAN. They are especially likely to seek consultation from preventive child health care organizations. Their experiences mainly revealed facilitators and few barriers. The implications for research and practice are also discussed.

NCRP Vision for the Future and Program Area Committee Activities in 2018

The National Council on Radiation Protection and Measurements' (NCRP) congressional charter aligns with our vision for the future: to improve radiation protection for the public and workers. This vision is embodied within NCRP's ongoing initiatives: preparedness for nuclear terrorism, increasing the number of radiation professionals critically needed for the nation, providing new guidance for comprehensive radiation protection in the United States, addressing the protection issues surrounding the ever-increasing use of ionizing radiation in medicine (the focus of this year's annual meeting), assessing radiation doses to aircrew related to higher altitude and longer flights, providing guidance on emerging radiation issues such as the radioactive waste from hydraulic fracturing, focusing on difficult issues such as high-level waste management, and providing better estimates of radiation risks at low doses within the framework of the Million Person Study of Low-Dose Radiation Health Effects. Cutting-edge initiatives included a reevaluation of the science behind recommendations for lens of the eye dose, recommendations for emergency responders on dosimetry after a major radiological incident, guidance to the National Aeronautics and Space Administration with regard to possible central nervous system effects from galactic cosmic rays (the high-energy, high-mass ions bounding through space), reevaluating the population exposure to medical radiation, and addressing whether the linear no-threshold model is still the best available for purposes of radiation protection (not for risk assessment). To address these initiatives and goals, NCRP has seven program area committees on biology and epidemiology, operational concerns, emergency response and preparedness, medicine, environmental issues and waste management, dosimetry, and communications. The NCRP vision for the future will continue and increase under the leadership of President-Elect Dr. Kathryn D. Held (Massachusetts General Hospital and Harvard Medical School, and current NCRP executive director and chief science officer). The NCRP quest to improve radiation protection for the public is hindered only by limited resources, both human capital and financial.

Realist evaluation of the role of the Universal Health Coverage Partnership in strengthening policy dialogue for health planning and financing: a protocol

INTRODUCTION

In 2011, WHO, the European Union and Luxembourg entered into a collaborative agreement to support policy dialogue for health planning and financing; these were acknowledged as core areas in need of targeted support in countries' quest towards universal health coverage (UHC). Entitled 'Universal Health Coverage Partnership', this intervention is intended to strengthen countries' capacity to develop, negotiate, implement, monitor and evaluate robust and integrated national health policies oriented towards UHC. It is a complex intervention involving a multitude of actors working on a significant number of remarkably diverse activities in different countries.

METHODS AND ANALYSIS

The researchers will conduct a realist evaluation to answer the following question: How, in what contexts, and triggering what mechanisms, does the Partnership support policy dialogue for health planning and financing towards UHC? A qualitative multiple case study will be undertaken in Togo, Liberia, Democratic Republic of Congo, Cape Verde, Burkina Faso and Niger. Three steps will be implemented: (1) formulating context-mechanism-outcome explanatory propositions to guide data collection, based on expert knowledge and theoretical literature; (2) collecting empirical data through semistructured interviews with key informants and observations of key events, and analysing data; (3) specifying the intervention theory.

ETHICS AND DISSEMINATION

The primary target audiences are WHO and its partner countries; international and national stakeholders involved in or supporting policy dialogues in the health sector, especially in low-income countries; and researchers with interest in UHC, policy dialogue, evaluation research and/or realist evaluation.

When more isn't merrier: pharmaceutical alliance networks and breakthrough innovation

Strategic alliances, in particular strategic alliances with universities, are widely thought to be beneficial to the drug discovery process. However, the discussion of alliances and their effect has tended to focus on single alliances and has ignored the fact that firms tend to participate in multiple alliances simultaneously. Here, we show the importance of adopting a portfolio perspective of strategic alliances. We build a model of the U.S. pharmaceutical industry, and show how 2298 alliances, announced over a 15-year period, impact the alliance portfolios of 324 pharmaceutical firms, and how that, in turn, impacts the breakthrough innovations that these firms produce. In doing so, we show the stengths and benifits of strategic alliances, but we also show the dangers of adopting a more the merrier approach to strategic alliance making.

A Qualitative Study of an Employment Scheme for Mentors with Lived Experience of Offending Within a Multi-Agency Mental Health Project for Excluded Young People

The use of peer intervention schemes is increasingly popular within services for offending groups and there is growing evidence of their benefit for peers delivering the interventions. The current study explores staff and peer experiences of an employment scheme for peer mentors within a community project for young people involved in offending. Semi-structured interviews were conducted with full time staff (n=4) and peer mentors employed on the scheme (n=2). Thematic analysis revealed three themes of "Opportunity and Empowerment", "Supportive Processes" and "Role Definition and Structure". The results suggest that meaningful employment opportunities, with holistic support and processes for reflection and mentalisation of self and others, contribute to the personal and professional development of ex-offenders in peer mentoring roles.

Improving Health Care Career Pipeline Programs for Underrepresented Students: Program Design that Makes a Difference

BACKGROUND

Health care career pipeline training programs are one solution to increasing the number of minority and underrepresented health care providers. The Chicago Cancer Health Equity Collaborative (ChicagoCHEC) Research Fellows Program, a tri-institutional effort between the University of Illinois at Chicago (UIC), Northeastern Illinois University (NEIU), and Northwestern University (NU), provides a holistic, 8-week summer research fellowship that facilitates self-reflection, professional development, and exposes and guides the novice undergraduate and postbaccalaureate student toward a health care career inclusive of research and scientific discovery.

OBJECTIVES

The number of underrepresented students achieving health care careers is minimal. We outline curriculum development, innovation, lessons learned, and selected outcomes from the first three cohorts of the ChicagoCHEC Research Fellows program.

METHODS

A tri-institutional, collaborative curricular team was formed consisting of research faculty and staff at NEIU, UIC and NU. Once accepted, fellows experience a cohort model curriculum with particular emphasis to mindful inclusion of nontraditional students. The ChicagoCHEC Research Fellows Program uses evidence-based mentorship models, group reflection, and extensive program evaluation to continuously improve its program model.

CONCLUSIONS

The 48 fellow alumni from the first 3 years reported high satisfaction with the program and will continued to be tracked for academic success. The ChicagoCHEC Research Fellows program will continue to provide academic and professional tools, sponsorship, and mentorship opportunities to underrepresented students as they progress toward health care careers. A program such as the ChicagoCHEC Fellows Program can serve as a useful model for increasing the number of minority researchers in health care careers.

Uppsala Biobank-the development of a biobank organization in a local, regional, and national setting

A biobank is generally in an international setting considered as a sample collection with linked data. In Sweden we have a lot of sample collections, but the definition of a biobank has changed, and it has become an organization that administrates many sample collections as well as an infrastructure to support research. Uppsala Biobank was started in September 2008 as a joint biobank organization between Uppsala County Council and Uppsala University. At the start there were 138 registered biobanks in Uppsala for these two principals. The decision was to have only one biobank, where all previous biobanks would be transformed to be sample collections. Uppsala Biobank has gone from the wish to centralize biobanking administration to be a research infrastructure, a national model for hospital-integrated biobanking, a support structure for biobanking activities in the health care region, and the local competence center for all biobank issues in Uppsala.

A learning health systems approach to improving the quality of care for patients in South Asia

Poor quality of care is a leading cause of excess morbidity and mortality in low- and middle- income countries (LMICs). Improving the quality of healthcare is complex, and requires an interdisciplinary team equipped with the skills to design, implement and analyse setting-relevant improvement interventions. Such capacity is limited in many LMICs. However, training for healthcare workers in quality improvement (QI) methodology without buy-in from multidisciplinary stakeholders and without identifying setting-specific priorities is unlikely to be successful. The Care Quality Improvement Network (CQIN) was established between Network for Improving Critical care Systems and Training (NICST) and University College London Centre for Perioperative Medicine, with the aim of building capacity for research and QI. A two-day international workshop, in collaboration with the College of Surgeons of Sri Lanka, was conducted to address the above deficits. Innovatively, the CQIN adopts a learning health systems (LHS) approach to improving care by leveraging information captured through the NICST electronic multi-centre acute and critical care surveillance platform. Fifty-two delegates from across the CQIN representing clinical, civic and academic healthcare stakeholders from six countries attended the workshop. Mapping of care processes enabled identification of barriers and drivers to the delivery of care and facilitated the selection of feasible QI methods and matrices. Six projects, reflecting key priorities for improving the delivery of acute care in Asia, were collaboratively developed: improving assessment of postoperative pain; optimising sedation in critical care; refining referral of deteriorating patients; reducing surgical site infection after caesarean section; reducing surgical site infection after elective general surgery; and improving provision of timely electrocardiogram recording for patients presenting with signs of acute myocardial infarction. Future project implementation and evaluation will be supported with resources and expertise from the CQIN partners. This LHS approach to building capacity for QI may be of interest to others seeing to improve care in LMICs.

Hospital adoption of interoperability functions

BACKGROUND

The seamless transmission of patient health information across health care settings, commonly referred to as interoperability, is a focal point of federal electronic health record (EHR) incentive programs. The objective of this study was to examine the extent to which interoperability functions outlined in Promoting Interoperability Stage 3 (PI3) requirements have been adopted by US hospitals, and barriers to interoperability.

METHODS

We conducted a cross-sectional analysis of 2781 non-federal, acute-care hospitals responding to the 2015 American Hospital Association Information Technology (IT) Supplement survey. We described the percentage of hospitals that adopted PI3 functionalities, identified hospital characteristics associated with adoption, and compared barriers to interoperability between hospitals that have and have not adopted PI3 functionalities.

RESULTS

Only 16.7% of hospitals had adopted all six core functionalities required to meet PI3 objectives. Over 70% of hospitals had implemented at least four of six functionalities, while 1.8% implemented none. Major teaching (adjusted odds ratio [aOR]=1.66), system affiliated (aOR=1.63), and regional health information exchange participating hospitals (aOR=1.86) were more likely to adopt PI3 functionalities, while for-profit hospitals (OR=0.11) were less likely. Hospitals that adopted PI3 functionalities more frequently reported experiencing barriers to interoperability, including the receiving provider's ability and interest to send/receive data.

CONCLUSIONS

While only a small proportion of hospitals had implemented all six PI3 functionalities at the time the requirements were finalized, the vast majority had already implemented most of the required functionalities. Still, several barriers stand in the way of achieving seamless interoperability, many of which lie outside hospitals' control.

The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale

BACKGROUND

Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. We present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research.

METHODS/DESIGN

Participants are patients at a Federally Qualified Health Center in Portland, Oregon that serves patients experiencing homelessness or who have substance use disorders. Participants meet at least one of the following criteria: > 1 hospitalization over past 6 months; at least one medical co-morbidity including uncontrolled diabetes, heart failure, chronic obstructive pulmonary disease, liver disease, soft-tissue infection; and 1 mental health diagnosis or substance use disorder. We exclude patients if they have < 6 months to live, have cognitive impairment preventing consent, or are non-English speaking. Following consent and baseline assessment, we randomize participants to immediate SUMMIT intervention or wait-list control group. Participants receiving the SUMMIT intervention transfer care to a clinic-based team of physician, complex care nurse, care coordinator, social worker, and pharmacist with reduced panel size and flexible scheduling with emphasis on motivational interviewing, patient goal setting and advanced care planning. Wait-listed participants continue usual care plus engagement with community health worker intervention for 6 months prior to joining SUMMIT. The primary outcome is hospital utilization at 6 months; secondary outcomes include emergency department utilization, patient activation, and patient experience measures. We follow participants for 12 months after intervention initiation.

DISCUSSION

The SUMMIT A-ICU is an intensive primary care intervention for high-utilizers impacted by homelessness. Use of a wait-list control design balances community and staff stakeholder needs, who felt all participants should have access to the intervention, while addressing research needs to include control populations. Design limitations include prolonged follow-up period that increases risk for attrition, and conflict between practice and research; including partner stakeholders and embedded researchers familiar with the population in study planning can mitigate these barriers. Trial registration ClinicalTrials.gov NCT03224858, Registered 7/21/17 retrospectively registered https://clinicaltrials.gov/ct2/show/NCT03224858.

Outcomes of a Critical Care Hospital-Based Fellowship for Senior Nursing Students

BACKGROUND

A partnership between four academic sites and one practice site was created to address a gap in baccalaureate nursing education resulting from the lack of pediatric and critical clinical experience. Four schools of nursing (SONs) were invited to recruit senior-level nursing students to participate in a critical care fellowship opportunity during their senior synthesis courses.

METHOD

In a mixed-method evaluation, data were collected through three questionnaires.

RESULTS

The findings indicated that the students increased their knowledge and ability in caring for critical pediatric patients. The difference in clinical hours by the SONs did not reveal significant mean differences across measures of self-efficacy, clinical knowledge, or clinical confidence.

CONCLUSION

The critical care hospital-based fellowship can be used as a partnership between a hospital and SONs to expose prelicensure students to clinical experiences and education related to pediatric critical care to decrease nursing shortages in these specialty areas. [J Nurs Educ. 2018;57(8):469-475.].

Veterans Health Information Exchange: Successes and Challenges of Nationwide Interoperability

Health Information Exchange (HIE) between organizations is necessary to have more complete information and coordinate care. Given its nationwide footprint, the Department of Veterans Affairs (VA) connects and exchanges health information with a large number of organizations and consequently has a unique opportunity to experience most issues affecting clinical interoperability. The Veterans HIE Program manages these exchanges by focusing on patient engagement, provider adoption, partner relationship, technology platform, and performance. This paper analyzes the success and challenges of this program over the last five years, and offers valuable metrics and insights. Although significant progress has been made, nationwide interoperability remains fragmented and laborious, requiring multiple agreements and exchange methods. A future nationwide interoperability would embrace a single "on-ramp" to connect to everyone.

National Heart, Lung, and Blood Institute and American Association for Thoracic Surgery Workshop Report: Identifying collaborative clinical research priorities in lung transplantation

This report summarizes the discussion and recommendations from the June 2017 NHLBI-AATS Workshop on Identifying Collaborative Clinical Research Priorities in Lung Transplantation.

Connected, attracted, and concerned: A Q study on medical crossborder curriculum partnerships

INTRODUCTION

A new form of internationalization has been trending upward in the medical education realm: crossborder medical curriculum partnerships established to deliver the same, or adapted, curriculum to groups of geographically separated students. This study aims to investigate crossborder medical curriculum partnerships by exploring the experiences of teachers at the recipient institution who have a key role in delivering the program.

METHODS

From four pioneering recipient medical schools, 24 teachers participated in a Q-sort study. Each participant rank-ordered 42 statements about teaching in a crossborder medical curriculum on a scale from -5 (indicating strong disagreement) to +5 (indicating strong agreement). The authors conducted a "by-person" factor analysis to uncover distinct patterns in the ranking of statements, using the statistical results and participants' comments about their Q sorts to interpret these patterns and translate them into distinct viewpoints.

RESULTS

Three viewpoints emerged, reflecting: (1) a feeling of connectedness with the partner institution, trust in the quality of the curriculum, and appreciation of interinstitutional relationships; (2) the partnership's attractiveness because of the career opportunities it offers; and (3) concerns over the quality of graduates because of doubts about the appropriateness of the didactic model and insufficient attention to local healthcare needs, and over the practical feasibility of such partnerships.

CONCLUSIONS

The three viewpoints identified revealed a pallet of views on how host teachers might experience their work. It shows the heterogeneous features of this group and seems to counterbalance reports that they are feeling "deprived" from their role as teacher. Two viewpoints featured an appreciation of interinstitutional relationships and of the partnership, especially when perceiving a degree of autonomy. Partners can capitalize on all different viewpoints by deploying procedure and policies to raise the quality of education delivery.

Challenges and opportunities for implementation of substance misuse interventions in conflict-affected populations

Alcohol and other drug misuse are significant but neglected public health issues in conflict-affected populations. In this article, we review the literature on the challenges and strategies for implementing substance misuse treatment and prevention services in conflict and post-conflict settings in low- and middle-income countries. We identified nine studies describing interventions in conflict-affected populations residing in Afghanistan, Croatia, India, Kenya, Kosovo, Pakistan, and Thailand. Six of these nine studies focused on refugee populations. Reports revealed challenges to intervention implementation, as well as promising practices and recommendations for future implementation that we characterized as existing in the inner and outer contexts of an implementing organization. Challenges existing in the outer context included low political prioritization, lack of coordination and integration, and limited advocacy for access to substance misuse services. Challenges within the inner context related to competing priorities and a shortage of providers. Resource limitations existed in both the inner and outer contexts. Stigma was a challenge that threatened implementation and utilization of substance use services in situations when substance use interventions were not congruent with the roles, structure, values, and authority of the system or implementing organization. Future research should focus on developing, applying, and evaluating strategies for overcoming these challenges in order to make progress toward meeting the need for substance misuse services in conflict-affected populations.

Trends in interorganizational transactions in personalized medicine development

Personalized medicine is an innovative concept that allows patients with a validated companion diagnosis (CoDx) to receive treatment using the most suitable drug. Currently, a major movement in the pharmaceutical industry involves the integrated use of multiple resources from external sources. To ascertain preferable interorganizational collaborations and their suitable exits, we compared the related transactions in personalized and nonpersonalized cancer drugs. We found that there were significantly more of some alliance deals in personalized medicine, and that market licenses, one of the exits, were well correlated with other alliances only in personalized medicine. Furthermore, four types of collaboration mode were identified, and more active collaborations with external partners were found to lead to more successful outcomes in personalized medicine development.

Research priorities in fragility fractures of the lower limb and pelvis: a UK priority setting partnership with the James Lind Alliance

OBJECTIVE

To determine research priorities in fragility fractures of the lower limb and pelvis which represent the shared priorities of patients, their friends and families, carers and healthcare professionals.

DESIGN/SETTING

A national (UK) research priority setting partnership.

PARTICIPANTS

Patients over 60 years of age who have experienced a fragility fracture of the lower limb or pelvis; carers involved in their care (both in and out of hospital); family and friends of patients; healthcare professionals involved in the treatment of these patients including but not limited to surgeons, anaesthetists, paramedics, nurses, general practitioners, physicians, physiotherapists and occupational therapists.

METHODS

Using a multiphase methodology in partnership with the James Lind Alliance over 18 months (August 2016-January 2018), a national scoping survey asked respondents to submit their research uncertainties. These were amalgamated into a smaller number of research questions. The existing evidence was searched to ensure that the questions had not been answered. A second national survey asked respondents to prioritise the research questions. A final shortlist of 25 questions was taken to a multistakeholder workshop where a consensus was reached on the top 10 priorities.

RESULTS

There were 963 original uncertainties submitted by 365 respondents to the first survey. These original uncertainties were refined into 88 research questions of which 76 were judged to be true uncertainties following a review of the research evidence. Healthcare professionals and other stakeholders (patients, carers, friends and families) were represented equally in the responses. The top 10 represent uncertainties in rehabilitation, pain management, anaesthesia and surgery.

CONCLUSIONS

We report the top 10 UK research priorities in patients with fragility fractures of the lower limb and pelvis. The priorities highlight uncertainties in rehabilitation, postoperative physiotherapy, pain, weight-bearing, infection and thromboprophylaxis. The challenge now is to refine and deliver answers to these research priorities.

Coordination in theory, coordination in practice: the case of the Clusters

The atomised nature of the humanitarian system has led to frequent and repeated attempts to coordinate humanitarian activity. Since 2005, some of the best resourced, and arguably most successful, coordination mechanisms have been the humanitarian Clusters, groups of UN (United Nations) and non-UN actors that engage in sectoral coordination of humanitarian response (such as the provision of healthcare and water) at the global and country level. Nevertheless, it is not clear exactly what 'coordination' means in the context of a Cluster. Formal guidance suggests that they should be aiming to create a single, joint strategy to guide the activities of members. Actual experience of the Clusters, however, indicates that looser forms of coordination are more effective. This finding resonates with organisational theory, and with the experience of emergency management professionals beyond the international humanitarian sector. To capitalise fully on the success of the Clusters, policymakers may need to rethink their attitudes to, and expectations of, coordination.

Cross-Sector Collaboration in the High-Poverty Setting: Qualitative Results from a Community-Based Diabetes Intervention

OBJECTIVE

To characterize the motivations of stakeholders from diverse sectors who engaged in cross-sector collaboration with an academic medical center.

DATA SOURCE

Primary qualitative data (2014-2015) were collected from 22 organizations involved in a cross-sector diabetes intervention on the South Side of Chicago.

STUDY DESIGN

In-depth, semistructured interviews; participants included leaders from all stakeholder organization types (e.g., businesses, community development, faith-based) involved in the intervention.

DATA COLLECTION METHODS

Data were transcribed verbatim from audio and video recordings. Analysis was conducted using the constant comparison method, derived from grounded theory.

PRINCIPAL FINDINGS

All stakeholders described collaboration as an opportunity to promote community health in vulnerable populations. Among diverse motivations across organization types, stakeholders described collaboration as an opportunity for: financial support, brand enhancement, access to specialized skills or knowledge, professional networking, and health care system involvement in community-based efforts. Based on our findings, we propose a framework for implementing a working knowledge of stakeholder motivations to facilitate effective cross-sector collaboration.

CONCLUSIONS

We identified several factors that motivated collaboration across diverse sectors with health care systems to promote health in a high-poverty, urban setting. Understanding these motivations will be foundational to optimizing meaningful cross-sector collaboration and improving diabetes outcomes in the nation's most vulnerable communities.

Implementation of triple the time spent on physical education in pre-school to 6th grade: A qualitative study from the programme managers' perspective

Schools constitute an important arena for promoting physical activity. However, school-based programmes often face implementation challenges, and the identification of factors influencing the implementation process is considered important in order to secure the effectiveness of future interventions. The aim of this study was to identify factors influencing the various implementation stages during the initial years of a programme tripling the amount of physical education at the primary school level. Document analysis of publicly available programme descriptions and meeting minutes, were conducted. Document analysis was complemented by two semi-structured group interviews with main programme managers to gather in-depth programme experiences and perspectives. Results show that early involvement of schools may ensure the best possible match between programmes and the needs and resources of schools, and that an ongoing shared partnership may help programme managers address program challenges in early stages. It seems that predetermined core elements in programmes are essential. At the same time programmes must be flexible enough for adaptation to individual school contexts. Finally, the implementation of triple the amount of physical education, is supported by teachers receiving a professional development course focusing on how to organise outdoor physical education in different seasons and weather conditions.