Selecting and Improving Quasi-Experimental Designs in Effectiveness and Implementation Research

Promoting respectful maternal and newborn care using the Dignity game: A quasi-experimental study

AIM

This study assessed a) the impact of playing the Dignity board game on participants' understanding of respectful maternal and newborn care and b) participants' perceptions of how the game influenced their subsequent practice in Malawi and Zambia.

BACKGROUND

Nurse-midwives' poor understanding of respectful maternal and newborn care can lead to substandard practice; thus, effective education is pivotal. Used in several disciplines, game-based learning can facilitate skills acquisition and retention of knowledge.

DESIGN

a quasi-experimental study, using mixed-methods of data collection.

METHODS

Data were collected between January and November 2020. Nurse-midwives (N = 122) and students (N = 115) were recruited from public hospitals and nursing schools. Completion of paper-based questionnaires, before and after game-playing, assessed knowledge of respectful care principles and perceptions around behaviours and practice. Face-to-face interviews (n = 18) explored perceived impact of engaging with the game in clinical practice. Paired and unpaired t-test were used to compare scores. Qualitative data were analysed and reported thematically.

RESULTS

The study was completed by 215 (90.7 %) participants. Post-test scores improved significantly for both groups combined; from 25.91 (SD 3.73) pre-test to 28.07 (SD 3.46) post-test (paired t = 8.67, 95 % confidence interval 1.67-2.65), indicating an increased knowledge of respectful care principles. Nurse-midwives performed better than students, both before and after. In Malawi, the COVID pandemic prevented a third of nurse-midwives' from completing post-game questionnaires. Qualitative findings indicate the game functioned as a refresher course and helped nurse-midwives to translate principles of respectful care into practice. It was also useful for self-reflection.

CONCLUSIONS

The Dignity board game has the potential to enhance understanding and practice of respectful maternal and newborn care principles in low-resource settings. Integration into nursing and midwifery curricula and in-service training for students and healthcare workers should be considered.

Impact of a link worker social prescribing intervention on non-elective admitted patient care costs: A quasi-experimental study

Healthcare systems in many countries are enthusiastically adopting link worker social prescribing interventions that aim to tackle the social determinants of health by linking patients to voluntary and community sector activities and sources of support to address their social needs and improve condition management. Social prescribing interventions aim to improve health and reduce healthcare spending. However, despite the diversion of healthcare budgets to fund social prescribing, we still lack robust evidence for its effectiveness. In this study we evaluate whether participation in a social prescribing intervention reduced non-elective admitted patient care use and costs for 8283 patients aged between 40 and 74 years, with a diagnosis of type 2 diabetes and living in an area of high socioeconomic deprivation in north-east England. Patients were followed for a total of 6 years: 2 years pre-intervention and 4 years post intervention. Exploiting a natural experiment, we used a two-part difference-in-differences regression model to estimate costs conditional on healthcare use. We also estimated intervention effects across several intervention and control groups and sample subgroups. Participation in the intervention resulted in reductions of up to -£77.57 [95% CI: -152.30, -2.84] (for high engagement patients) per patient, per year, in non-elective care costs. Reductions were greater for patients with higher levels of engagement with the intervention. Sub-group analyses showed greater cost reductions for non-White patients, older patients, and patients without additional co-morbidities. Our findings suggest that engagement with a link worker social prescribing intervention may reduce non-elective healthcare spending, perhaps through enabling better condition management that results in fewer avoidable health crises.

A generalized interrupted time series model for assessing complex health care interventions

Assessing the impact of complex interventions on measurable health outcomes is a growing concern in health care and health policy. Interrupted time series (ITS) designs borrow from traditional case-crossover designs and function as quasi-experimental methodology able to retrospectively analyze the impact of an intervention. Statistical models used to analyze ITS designs primarily focus on continuous-valued outcomes. We propose the "Generalized Robust ITS" (GRITS) model appropriate for outcomes whose underlying distribution belongs to the exponential family of distributions, thereby expanding the available methodology to adequately model binary and count responses. GRITS formally implements a test for the existence of a change point in discrete ITS. The methodology proposed is able to test for the existence of and estimate the change point, borrow information across units in multi-unit settings, and test for differences in the mean function and correlation pre- and post-intervention. The methodology is illustrated by analyzing patient falls from a hospital that implemented and evaluated a new care delivery model in multiple units.

Posttraumatic Stress Disorder (PTSD) as a Risk Factor for Cardiovascular Disease: Implications for Future Research and Clinical Care

PURPOSE OF REVIEW

Posttraumatic stress disorder (PTSD) may be an important risk factor for cardiovascular disease (CVD). We explore the literature linking PTSD to CVD, potential mechanisms, interventions, and clinical implications. We outline gaps in current literature and highlight necessary future research.

RECENT FINDINGS

PTSD has been independently associated with deleterious effects on cardiovascular health through biological, behavioral, and societal pathways. There are evidence-based psychotherapeutic interventions and pharmacotherapies for PTSD that may mitigate its impact on CVD. However, there are limited studies that rigorously analyze the impact of treating PTSD on cardiovascular outcomes. Trauma-informed CVD risk stratification, education, and treatment offer opportunities to improve patient care. These approaches can include a brief validated screening tool for PTSD identification and treatment. Pragmatic trials are needed to test PTSD interventions among people with CVD and evaluate for improved outcomes.

Structural interventions that affect racial inequities and their impact on population health outcomes: a systematic review

Structural racism is the historical and ongoing reinforcement of racism within society due to discriminatory systems and inequitable distribution of key resources. Racism, embedded within institutional structures, processes and values, perpetuates historical injustices and restricts access to structural factors that directly impact health, such as housing, education and employment. Due to the complex and pervasive nature of structural racism, interventions that act at the structural level, rather than the individual level, are necessary to improve racial health equity. This systematic review was conducted to evaluate the effects of structural-level interventions on determinants of health and health outcomes for racialized populations. A total of 29 articles are included in this review, analyzing interventions such as supplemental income programs, minimum wage policies, nutrition safeguard programs, immigration-related policies, and reproductive and family-based policies. Most studies were quasi-experimental or natural experiments. Findings of studies were largely mixed, although there were clear benefits to policies that improve socioeconomic status and opportunities, and demonstrable harms from policies that restrict access to abortion or immigration. Overall, research on the effects of structural-level interventions to address health inequities is lacking, and the evidence base would benefit from well-designed studies on upstream policy interventions that affect the structural determinants of health and health inequities and improve daily living conditions.

Neonatal outcomes from a quasi-experimental clinical trial of Family Integrated Care versus Family-Centered Care for preterm infants in U.S. NICUs

BACKGROUND

Family Integrated Care (FICare) benefits preterm infants compared with Family-Centered Care (FCC), but research is lacking in United States (US) Neonatal Intensive Care Units (NICUs). The outcomes for infants of implementing FICare in the US are unknown given differences in parental leave benefits and health care delivery between the US and other countries where FICare is used. We compared preterm weight and discharge outcomes between FCC and mobile-enhanced FICare (mFICare) in the US.

METHODS

In this quasi-experimental study, we enrolled preterm infant (≤ 33 weeks)/parent dyads from 3 NICUs into sequential cohorts: FCC or mFICare. Our primary outcome was 21-day change in weight z-scores. Our secondary outcomes were nosocomial infection, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and human milk feeding (HMF) at discharge. We used intention-to-treat analyses to examine the effect of the FCC and mFICare models overall and per protocol analyses to examine the effects of the mFICare intervention components.

FINDINGS

253 infant/parent dyads participated (141 FCC; 112 mFICare). There were no parent-related adverse events in either group. In intention-to-treat analyses, we found no group differences in weight, ROP, BPD or HMF. The FCC cohort had 2.6-times (95% CI: 1.0, 6.7) higher odds of nosocomial infection than the mFICare cohort. In per-protocol analyses, we found that infants whose parents did not receive parent mentoring or participate in rounds lost more weight relative to age-based norms (group-difference=-0.128, CI: -0.227, -0.030; group-difference=-0.084, CI: -0.154, -0.015, respectively). Infants whose parents did not participate in rounds or group education had 2.9-times (CI: 1.0, 9.1) and 3.8-times (CI: 1.2, 14.3) higher odds of nosocomial infection, respectively.

CONCLUSION

We found indications that mFICare may have direct benefits on infant outcomes such as weight gain and nosocomial infection. Future studies using implementation science designs are needed to optimize intervention delivery and determine acute and long-term infant and family outcomes.

CLINICAL TRIAL REGISTRATION

NCT03418870 01/02/2018.

Service redesign interventions to reduce waiting time for paediatric rehabilitation and therapy services: A systematic review of the literature

Despite well-documented benefits of rehabilitation and therapy services for children with disabilities, long waiting lists to access these services are common. There is a growing body of evidence, primarily from mixed or adult services, demonstrating that waiting times can be reduced through strategies that target wasteful processes and support services to keep up with demand. However, providers of rehabilitation and therapy services for children face additional complexities related to the long-term nature of many developmental conditions and the need to consider timing of interventions with developmental milestones and education transition points. This review aimed to synthesise available evidence on service redesign strategies in reducing waiting time for paediatric therapy services. We conducted a systematic review of studies conducted in outpatient paediatric rehabilitation or therapy settings, including physical and mental health services, evaluating a service redesign intervention and presenting comparative data on time to access care. Two reviewers independently applied inclusion criteria, assessed risk of bias and extracted data. Findings were analysed descriptively and the certainty of evidence was synthesised according to criteria for health service research. From 1934 studies identified, 33 met the criteria for inclusion. Interventions were categorised as rapid response strategies, process efficiency interventions or substitution strategies (using alternative providers in place of medical specialists). Reductions in waiting time were reported in 30 studies. Evidence is limited by study designs with high risk of bias, but this is mitigated by consistency of findings and large effect sizes. There is moderate-certainty evidence that service redesign strategies similar to those used in adult populations can be applied in paediatric rehabilitation and therapy settings to reduce waiting time.

Training Intervention and Program of Support for Fostering the Adoption of Family-Centered Telehealth in Pediatric Rehabilitation: Protocol for a Multimethod, Prospective, Hybrid Type 3 Implementation-Effectiveness Study

BACKGROUND

Children with disability face long wait times for rehabilitation services. Before the COVID-19 pandemic, telehealth adoption was low across pediatric rehabilitation. Owing to the COVID-19 pandemic restrictions, pediatric therapists were asked to rapidly shift to telehealth, often with minimal training. To facilitate the behavior changes necessary for telehealth adoption, provision of appropriate evidence-based training and support is required. However, evidence to support the effective implementation of such training is lacking. The successful real-world implementation of a training intervention and program of support (TIPS) targeting pediatric therapists to enhance the adoption of family-centered telerehabilitation (FCT) requires the evaluation of both implementation and effectiveness.

OBJECTIVE

This study aimed to evaluate TIPS implementation in different pediatric rehabilitation settings and assess TIPS effectiveness, as it relates to therapists' adoption, service wait times, families' perception of service quality, and costs.

METHODS

This 4-year, pan-Canadian study involves managers, pediatric occupational therapists, physiotherapists, speech-language pathologists, and families from 20 sites in 8 provincial jurisdictions. It will use a multimethod, prospective, hybrid type 3 implementation-effectiveness design. An interrupted time series will assess TIPS implementation. TIPS will comprise a 1-month training intervention with self-paced learning modules and a webinar, followed by an 11-month support program, including monthly site meetings and access to a virtual community of practice. Longitudinal mixed modeling will be used to analyze indicators of therapists' adoption of and fidelity to FCT collected at 10 time points. To identify barriers and facilitators to adoption and fidelity, qualitative data will be collected during implementation and analyzed using a deductive-inductive thematic approach. To evaluate effectiveness, a quasi-experimental pretest-posttest design will use questionnaires to evaluate TIPS effectiveness at service, therapist, and family levels. Generalized linear mixed effects models will be used in data analysis. Manager, therapist, and family interviews will be conducted after implementation and analyzed using reflective thematic analysis. Finally, cost data will be gathered to calculate public system and societal costs.

RESULTS

Ethics approval has been obtained from 2 jurisdictions (February 2022 and July 2022); approval is pending in the others. In total, 20 sites have been recruited, and data collection is anticipated to start in September 2022 and is projected to be completed by September 2024. Data analysis will occur concurrently with data collection, with results disseminated throughout the study period.

CONCLUSIONS

This study will generate knowledge about the effectiveness of TIPS targeting pediatric therapists to enhance FCT adoption in pediatric rehabilitation settings, identify facilitators for and barriers to adoption, and document the impact of telehealth adoption on therapists, services, and families. The study knowledge gained will refine the training intervention, enhance intervention uptake, and support the integration of telehealth as a consistent pediatric rehabilitation service option for families of children with disabilities.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05312827; https://clinicaltrials.gov/ct2/show/NCT05312827.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/40218.

Effects of combined aerobic and resistance training on gut microbiota and cardiovascular risk factors in physically active elderly women: A randomized controlled trial

Background: Exercise can modulate gut microbiota and lower the risk of cardiovascular disease (CVD). However, the association between exercise-induced changes in gut microbiota and CVD risk have not been investigated.

Objective: This study determined the effects of exercise training on CVD risk and gut microbiota in physically active elderly women and whether exercise-induced gut microbiota changes were associated with CVD risk.

Methods: An 8-week randomized controlled trial was conducted with 14 elderly women assigned to exercise group (n = 8) or control group (n = 6). Physical function, sarcopenic obesity, and metabolic syndrome were evaluated as components of CVD risk. Gut microbiota composition was determined using 16S rRNA gene sequencing. Repeated-measures analysis of variance was used to examine intra-group and inter-group differences.

Results: A significant group × time interaction was observed for chair sit-and-reach (F = 8.262, p = 0.014), single-leg standing with eyes closed (F = 7.340, p = 0.019), waist circumference (F = 6.254, p = 0.028), and body fat mass (F = 12.263, p = 0.004), for which the exercise group showed improved trends. The exercise group exhibited significant improvements in skeletal muscle mass (p = 0.041) and fasting blood glucose (p = 0.017). Regarding gut microbiota, a significant interaction was observed for the class Betaproteobacteria (F = 6.822, p = 0.023) and genus Holdemania (F = 4.852, p = 0.048).

Conclusion: The 8-week exercise training improved physical function, lowered CVD risk, and modulated relative abundance of gut microbiota associated with CVD in physically active elderly women.

The WISDOM self-management intervention: A cost-effectiveness analysis to support the transformation of type 2 diabetes care in England

OBJECTIVES

To assess the cost-effectiveness of the WISDOM self-management intervention for type 2 diabetes compared with care as usual.

DESIGN

We performed a difference-in-differences analysis to estimate differences in risk factors for diabetes complications between people in the WISDOM group (n = 25, 276) and a control group (n = 15, 272) using GP records. A decision analytic model was then used to extrapolate differences in risk factors into costs and outcomes in the long term.

SETTING

Participating GP practices in West Hampshire and Southampton, UK.

PARTICIPANTS

All people diagnosed with type 2 diabetes between January 1990 and March 2020 (n = 40,548).

OUTCOMES

Diabetes-related complications, quality-adjusted life years (QALYs) and costs to the English National Health Service at 5 years and lifetime.

INTERVENTIONS

The WISDOM intervention included risk stratification, self-management education programme to professionals and people with type 2 diabetes, and monitoring of key treatment targets.

RESULTS

WISDOM was associated with less atrial fibrillation [p = 0.001], albuminuria [p = 0.002] and blood pressure [p = 0.098]. Among all people in the intervention group, WISDOM led to 51 [95%CI: 25; 76] QALYs gained and saved £278,036 [95%CI: -631,900; 176,392] in the first 5 years after its implementation compared with care as usual. During those people' lifetime, WISDOM led to 253 [95%CI: 75; 404] QALYs gained and cost saving of £126,380 [95%CI: -1,466,008; 1,339,628]. The gains in QALYs were a result of reduced diabetes-related complications through improved management of the associated risk factors.

CONCLUSIONS

The WISDOM risk-stratification and education intervention for type 2 diabetes appear to be cost-effective compared to usual care by reducing diabetes complications.

Method of Nursing Interventions to Reduce the Incidence of Bullying and Its Impact on Students in School: A Scoping Review

The bullying of students in schools can have a negative impact on students. The impact of bullying can take the form of anxiety, low psychological well-being, low social adjustment, psychological distress, and risk of suicide. Incidents of bullying are still considered normal, and there has not been a focus on reducing their incidence and impact. The purpose of this study is to describe nursing interventions to reduce the incidence of bullying and its impact on students at school. This study used the scoping review method and literature reviews via CINAHL, PubMed, and ProQuest databases. The keywords used in English were "bullying OR cyberbullying OR aggression" AND "students OR school students" AND "school OR schools" AND "nursing intervention". The criteria for articles in this study were: full texts, student populations and samples, randomized control trials or quasi-experiment research designs, use of the English language, and the publication period of the last 10 years (2013-2022). We found 11 articles discussing nursing interventions to reduce the incidence of bullying and its impact on students in schools. There are four types of interventions that can be provided to students, namely, prevention programs, activities programs, peer group programs, and resilience programs. Most of the articles used randomized control trials and quasi-experiment designs. The samples in the articles analyzed were in the range of 50-7121 students. These four types of interventions can reduce the incidence of bullying and its impact on students at school, and in addition, they can improve the social skills and mental health of students, for example, by increasing their self-efficacy, resilience, and adaptive coping. There are four nursing interventions to reduce the incidence of bullying and its impact on students in schools, namely, the prevention program, activities program, peer group program, and resilience program.

Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design

BACKGROUND

Mental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based on small-scale randomised trials with relatively short follow-ups. We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety-related work disability.

METHODS

We drew a nationally representative sample of the working-age population (aged 18-55 in 2010). The study group comprised all those who started rehabilitative psychotherapy in 2011-2014. A total of 10 436 participants who were followed from 3 years prior to 4 years after the onset of rehabilitative psychotherapy. This resulted in 83 488 observations. The annual total number of mental health-related work disability months (0 to 12) was calculated from the total number of annual compensated sickness absence and disability pension days. A quasi-experimental interrupted time series analysis was applied.

RESULTS

The onset of rehabilitative psychotherapy marked a decline in work disability in comparison to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76 to 0.85) and a 48% decrease in the slope (IRR 0.52; 95% CI 0.50 to 0.54) of work disability were detected in comparison to the counterfactual scenario. No significant gender differences were observed. The decline in work disability was the steepest in the oldest age group.

CONCLUSIONS

This study suggests that statutory psychotherapy may decrease work disability at the population level. However, further evidence of causal inference and the potential heterogeneity of the association is required.

What does it mean for an autism intervention to be evidence-based?

Although there is consensus in the field that individuals on the autism spectrum should receive interventions that are evidence-based, the concept of "evidence-based" is multifaceted and subject to ongoing development and debate. In this commentary, we review historical developments, methodological approaches, as well as areas of controversies and research directions in the establishment of an evidence base for autism intervention. LAY SUMMARY: What does it mean for an autism intervention to be evidence-based? In this commentary, we address this complex issue by examining historical developments, methodological approaches, as well as areas of ongoing debate in the establishment of evidence-based interventions for autism.

Young people's choice and voice concerning sex and relationships: effects of the multicomponent Get Up Speak Out! Programme in Iganga, Uganda

BACKGROUND

Young people in Uganda face challenges in achieving their sexual and reproductive health and rights (SRHR), such as lack of information, limited access to services, teenage pregnancy and sexually transmitted infections. To address this, their empowerment - including their ability to express themselves and make decisions, is a key strategy. This study assessed how young people's voice and choice concerning sex and relationships changed over the period of 3 years of implementation of the Get Up Speak Out! programme.

METHODS

Data were collected through a household survey with young people (15-24 years) and through focus group discussions, in-depth interviews and key informant interviews with youth and community stakeholders in 2017 for the baseline and 2020 for the end-line. Using the difference-in-difference technique and thematic analysis, changes in key outcomes were assessed over time between intervention and control area.

RESULTS

There were limited changes over time in the intervention area, which did not differ from changes in the control area. Young people were able to express themselves and expand their decision-making space on sex and relationships, in particular if they were older, male and in a relationship. Young women negotiated their agency, often by engaging in transactional sex. However, youth were still restricted in their self-expression and their choices as speaking about sexuality was taboo, particularly with adults. This was influenced by the political and religious climate around SRHR in Uganda, which emphasised abstinence as the best option for young people to prevent SRHR-related problems.

CONCLUSIONS

Young people's SRHR remains a challenge in Uganda in the context of a conservative political and religious environment that reinforces social and gender norms around youth and young women's sexuality. The limited effect of the programme on increasing young people's voice and choice concerning relationships in Uganda can be understood in the context of a ban on comprehensive sexuality education (CSE) and the COVID-19 pandemic. These structural and emerging contextual factors enforce the taboo around youth sexuality and hinder their access to SRHR information and services. Multi-component and targeted programmes are needed to influence changes at the structural, community and individual level.

Food Insecurity among Low-Income Households with Children Participating in a School-Based Fruit and Vegetable Co-Op

The purpose of this study was to evaluate the impact of a nutrition intervention on food insecurity among low-income households with children. Data were collected from 371 parent−child dyads in a quasi-experimental evaluation study of a 1-year intervention (n = 6 intervention schools receiving Brighter Bites, n = 6 wait-list control schools), and longitudinal follow-up of the intervention group 2 years post-intervention in Houston, Texas. Data were collected at three timepoints: at baseline and 1 year for all participants, and at 2 year follow-up for the intervention group (the wait-list control group received the intervention during that time). At baseline, most parents reported food insecurity (60.6%; 70% intervention group, 53.6% control). Food insecurity decreased significantly from 81.3% to 61.7% [(−0.32, −0.07) p = 0.002] among intervention participants immediately post-intervention. After adjusting for ethnicity, 2 years post-intervention the predicted percentage of participants reporting food insecurity decreased significantly by roughly 35.4% from 76.4% at baseline to 41.0% [(−0.49, −0.22), p < 0.001]. Between-group changes were not significant. The re-sults of this study demonstrated a significant positive impact of Brighter Bites on food security in the short and long-term among low-income households with children, albeit results should be in-terpreted with caution.

Implementation of a Health Promotion Practice Using Individually Targeted Lifestyle Interventions in Primary Health Care: Protocol for the "Act in Time" Mixed Methods Process Evaluation Study

Background

There is growing evidence that noncommunicable diseases (NCDs) can be attributable to unhealthy lifestyle habits. However, there has been little application of this knowledge in primary health care (PHC).

Objective

This study aims to evaluate the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a PHC setting. This practice is based on national guidelines targeting unhealthy lifestyle habits with a potential risk for NCDs.

Methods

A pre-post implementation study design with a control group is used in a PHC setting in central Sweden. The Medical Research Council guidelines for process evaluation of complex interventions will be applied. The implementation process and outcomes will be assessed using a mix of qualitative and quantitative methods. A strategic sample of up to 6 PHC centers will be included as intervention centers, which will receive a 12-month multifaceted implementation strategy. Up to 6 matched PHC centers will serve as controls. Core components in the implementation strategy are external and internal facilitators in line with the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and the Astrakan change leadership model. Data will be collected at baseline, during the implementation phase, and 4-6 months after the implementation strategy. Questionnaires will be sent to roughly 500 patients in every PHC center and 200 health care professionals (HCPs) before and after implementation. In addition, purposeful sampling will be used for interviews and focus group discussions with managers, HCPs, patient representatives, and internal and external facilitators. Use of data from medical records and activity logs will be an additional data source.

Results

Recruitment of PHC centers began in March 2021 and ended in Spring 2022. Based on the planned timeline with the 12-month implementation strategy and 4-6-month follow-up, we expect to collect the final data in Summer 2023.

Conclusions

This study will explain implementation process and outcomes using a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a real-world PHC context. The study is expected to provide new knowledge about the role of facilitators and their contribution to implementation outcomes. These findings can guide policy makers, managers, and PHC staff to integrate health promotion and disease prevention in PHC and provide methodological support to facilitators.

Trial Registration

ClinicalTrials.gov NCT04799860; https://clinicaltrials.gov/ct2/show/NCT04799860

International Registered Report Identifier (IRRID)

DERR1-10.2196/37634

Retrofitting home insulation reduces incidence and severity of chronic respiratory disease

To assess whether retrofitting home insulation can reduce the risk of respiratory disease incidence and exacerbation, a retrospective cohort study was undertaken using linked data from a national intervention program. The study population was made up of 1 004 795 residents from 205 001 New Zealand houses that received an insulation subsidy though a national Energy Efficiency and Conservation Authority program. A difference-in-difference model compared changes in the number of prescriptions dispensed for respiratory illness post- insulation to a control population over the same timeframe. New prescribing of chronic respiratory disease medication at follow-up was used to compare incidence risk ratios between intervention and control groups. Chronic respiratory disease incidence was significantly lower in the intervention group at follow-up: odds ratio 0.90 (95% CI: 0.86-0.94). There was also a 4% reduction in medication dispensed for treating exacerbations of chronic respiratory disease symptoms in the intervention group compared with the control group: relative rate ratio (RRR) 0.96 (95% CI: 0.96-0.97). There was no change in medication dispensed to prevent symptoms of chronic respiratory disease RRR: 1,00 (95% CI: 0.99-1.00). These findings support home insulation interventions as a means of improving respiratory health outcomes.

Retrofitting home insulation reduces incidence and severity of chronic respiratory disease

To assess whether retrofitting home insulation can reduce the risk of respiratory disease incidence and exacerbation, a retrospective cohort study was undertaken using linked data from a national intervention program. The study population was made up of 1 004 795 residents from 205 001 New Zealand houses that received an insulation subsidy though a national Energy Efficiency and Conservation Authority program. A difference-in-difference model compared changes in the number of prescriptions dispensed for respiratory illness post- insulation to a control population over the same timeframe. New prescribing of chronic respiratory disease medication at follow-up was used to compare incidence risk ratios between intervention and control groups. Chronic respiratory disease incidence was significantly lower in the intervention group at follow-up: odds ratio 0.90 (95% CI: 0.86-0.94). There was also a 4% reduction in medication dispensed for treating exacerbations of chronic respiratory disease symptoms in the intervention group compared with the control group: relative rate ratio (RRR) 0.96 (95% CI: 0.96-0.97). There was no change in medication dispensed to prevent symptoms of chronic respiratory disease RRR: 1,00 (95% CI: 0.99-1.00). These findings support home insulation interventions as a means of improving respiratory health outcomes.

Influential methods reports for group-randomized trials and related designs

BACKGROUND

This article identifies the most influential methods reports for group-randomized trials and related designs published through 2020. Many interventions are delivered to participants in real or virtual groups or in groups defined by a shared interventionist so that there is an expectation for positive correlation among observations taken on participants in the same group. These interventions are typically evaluated using a group- or cluster-randomized trial, an individually randomized group treatment trial, or a stepped wedge group- or cluster-randomized trial. These trials face methodological issues beyond those encountered in the more familiar individually randomized controlled trial.

METHODS

PubMed was searched to identify candidate methods reports; that search was supplemented by reports known to the author. Candidate reports were reviewed by the author to include only those focused on the designs of interest. Citation counts and the relative citation ratio, a new bibliometric tool developed at the National Institutes of Health, were used to identify influential reports. The relative citation ratio measures influence at the article level by comparing the citation rate of the reference article to the citation rates of the articles cited by other articles that also cite the reference article.

RESULTS

In total, 1043 reports were identified that were published through 2020. However, 55 were deemed to be the most influential based on their relative citation ratio or their citation count using criteria specific to each of the three designs, with 32 group-randomized trial reports, 7 individually randomized group treatment trial reports, and 16 stepped wedge group-randomized trial reports. Many of the influential reports were early publications that drew attention to the issues that distinguish these designs from the more familiar individually randomized controlled trial. Others were textbooks that covered a wide range of issues for these designs. Others were "first reports" on analytic methods appropriate for a specific type of data (e.g. binary data, ordinal data), for features commonly encountered in these studies (e.g. unequal cluster size, attrition), or for important variations in study design (e.g. repeated measures, cohort versus cross-section). Many presented methods for sample size calculations. Others described how these designs could be applied to a new area (e.g. dissemination and implementation research). Among the reports with the highest relative citation ratios were the CONSORT statements for each design.

CONCLUSIONS

Collectively, the influential reports address topics of great interest to investigators who might consider using one of these designs and need guidance on selecting the most appropriate design for their research question and on the best methods for design, analysis, and sample size.

Methods to improve the translation of evidence-based interventions: A primer on dissemination and implementation science for occupational safety and health researchers and practitioners

Objective

A limited focus on dissemination and implementation (D&I) science has hindered the uptake of evidence-based interventions (EBIs) that reduce workplace morbidity and mortality. D&I science methods can be used in the occupational safety and health (OSH) field to advance the adoption, implementation, and sustainment of EBIs for complex workplaces. These approaches should be responsive to contextual factors, including the needs of partners and beneficiaries (such as employers, employees, and intermediaries).

Methods

By synthesizing seminal literature and texts and leveraging our collective knowledge as D&I science and/or OSH researchers, we developed a D&I science primer for OSH. First, we provide an overview of common D&I terminology and concepts. Second, we describe several key and evolving issues in D&I science: balancing adaptation with intervention fidelity and specifying implementation outcomes and strategies. Next, we review D&I theories, models, and frameworks and offer examples for applying these to OSH research. We also discuss widely used D&I research designs, methods, and measures. Finally, we discuss future directions for D&I science application to OSH and provide resources for further exploration.

Results

We compiled a D&I science primer for OSH appropriate for practitioners and evaluators, especially those newer to the field.

Conclusion

This article fills a gap in the OSH research by providing an overview of D&I science to enhance understanding of key concepts, issues, models, designs, methods and measures for the translation into practice of effective OSH interventions to advance the safety, health and well-being of workers.

The role of electronic medical records in improving health care quality: A quasi-experimental study

The Teleprimary Care-Oral Health Clinical Information System (TPC-OHCIS) is an updated electronic medical record (EMR) that has been applied in Malaysian primary healthcare. Recognizing the level of patient satisfaction following EMR implementation is crucial for assessing the performance of health care services. Hence, the main objective of this study was to compare the level of patient satisfaction between EMR-based clinics and paper-based clinics. The study was a quasi-experimental design that used a control group and was conducted among patients in 14 public primary healthcare facilities in the Seremban district of Malaysia from May 10, to June 30, 2021. Patient satisfaction was assessed using the validated Short-Form Patient Satisfaction Questionnaire, which consisted of 7 subscales. All data were analyzed using the IBM Statistical Package for Social Sciences version 21. A total of 321 patients consented to participate in this study, and 48.9% of them were from EMR clinics. The mean score for the communication subscale was the highest at 4.08 and 3.96 at EMR-adopted clinics and paper-based record clinics. There were significant differences in general satisfaction and communication subscales, with higher patient satisfaction found in clinics using EMR. With the utilization of EMR, patient satisfaction and communication in delivering healthcare services have improved.

Investigating feasibility of 2021 WHO protocol for cervical cancer screening in underscreened populations: PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC)

Background

High-risk human papillomavirus (hrHPV) testing has been recommended by the World Health Organization as the primary screening test in cervical screening programs. The option of self-sampling for this screening method can potentially increase women’s participation. Designing screening programs to implement this method among underscreened populations will require contextualized evidence.

Methods

PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC) will use a multi-method approach to investigate the feasibility of implementing a cervical cancer screening strategy with hrHPV self-testing as the primary screening test in Bangladesh, India, Slovak Republic and Uganda. The primary outcomes of study include uptake and coverage of the screening program and adherence to follow-up. These outcomes will be evaluated through a pre-post quasi-experimental study design. Secondary objectives of the study include the analysis of client-related factors and health system factors related to cervical cancer screening, a validation study of an artificial intelligence decision support system and an economic evaluation of the screening strategy.

Discussion

PRESCRIP-TEC aims to provide evidence regarding hrHPV self-testing and the World Health Organization’s recommendations for cervical cancer screening in a variety of settings, targeting vulnerable groups. The main quantitative findings of the project related to the impact on uptake and coverage of screening will be complemented by qualitative analyses of various determinants of successful implementation of screening. The study will also provide decision-makers with insights into economic aspects of implementing hrHPV self-testing, as well as evaluate the feasibility of using artificial intelligence for task-shifting in visual inspection with acetic acid.

Trial registration

ClinicalTrials.gov, NCT05234112. Registered 10 February 2022

Supplementary Information

The online version contains supplementary material available at (10.1186/s12889-022-13488-z).

Data Velocity in HIV-Related Implementation Research: Estimating Time From Funding to Publication

BACKGROUND

Given available effective biomedical and behavioral prevention and treatment interventions, HIV-related implementation research (IR) is expanding. The rapid generation and dissemination of IR to inform guidelines and practice has the potential to optimize the impact of the Ending the Epidemic Initiative and the HIV pandemic response more broadly.

METHODS

We leveraged a prior mapping review of NIH-funded awards in HIV and IR from January 2013 to March 2018 and identified all publications linked to those grants in NIH RePORTER through January 1, 2021 (n = 1509). Deduplication and screening of nonoriginal research reduced the count to 1032 articles, of which 952 were eligible and included in this review. Publication volume and timing were summarized; Kaplan-Meier plots estimated time to publication.

RESULTS

Among the 215 NIH-funded IR-related awards, 127 of 215 (59%) published original research directly related to the grant, averaging 2.0 articles (SD: 3.3) per award, largely in the early IR phases. Many articles (521 of 952, 55%) attributed to grants did not report grant-related data. Time from article submission to publication averaged 205 days (SD: 107). The median time-to-first publication from funding start was 4 years. Data dissemination velocity varied by award type, trending toward faster publication in recent years. Delays in data velocity included (1) time from funding to enrollment, (2) enrollment length, and (3) time from data collection completion to publication.

CONCLUSION

Research publication was high overall, and time-to-publication is accelerating; however, over 40% of grants have yet to publish findings from grant-related data. Addressing bottlenecks in the production and dissemination of HIV-related IR would reinforce its programmatic and policy relevance in the HIV response.

Interaction training – an enabler for improvement measures within the psychosocial risk assessment process

Purpose

The study objectives were to (1) identify if providing solution-focused interaction training enables managers and employees to develop and implement actions to improve their psychosocial work environment and (2) test a recontextualization of the psychosocial work environment as social structures affecting members of the workplace and verify if social interactions effectively change the local psychosocial work environment.

Design/methodology/approach

The intervention involved training managers, supervisors and employees in solution-focused interaction. This study used a controlled interrupted time-series design, with an intervention and control group (CG) and pre- and post-measurements.

Findings

The psychosocial work environment improved, indicating that the training led to better social interactions, contributing to changes in the social structures within the intervention group (IG). Collective reflection between participants in the take action phase was the key to success. The recontextualization uncovered these mechanisms.

Research limitations/implications

The present study supports a recontextualization of the psychosocial work environment as primarily decided by social structures that emerge in recurrent interactions within work teams. The same social structures also seem to be important for other features of the production system, like job performance.

Practical implications

Training designed to enable high-quality social interactions, like dialogue and collective reflection, has proven to be effective in changing social structures. Moreover, managers may need training in facilitating the collective reflection between participants. Increased focus on social interactions within work teams is suggested for future study of organizational change processes, psychosocial work environment and practical psychosocial work environment management.

Originality/value

The intervention was delivered in the preparation phase to enable an effective take action phase. Both phases are less studied in psychosocial risk assessments research. The recontextualization has never been fully used in psychosocial research.

Interventions in hypertension: systematic review and meta-analysis of natural and quasi-experiments

BACKGROUND

Hypertension is an urgent public health problem. Consistent summary from natural and quasi-experiments employed to evaluate interventions that aim at preventing or controlling hypertension is lacking in the current literature. This study aims to summarize the evidence from natural and quasi-experiments that evaluated interventions used to prevent or control hypertension.

METHODS

We searched PubMed, Embase and Web of Science for natural and quasi-experiments evaluating interventions used to prevent hypertension, improve blood pressure control or reduce blood pressure levels from January 2008 to November 2018. Descriptions of studies and interventions were systematically summarized, and a meta-analysis was conducted.

RESULTS

Thirty studies were identified, and all used quasi-experimental designs including a difference-in-difference, a pre-post with a control group or a propensity score matching design. Education and counseling on lifestyle modifications such as promoting physical activity (PA), promoting a healthy diet and smoking cessation consultations could help prevent hypertension in healthy people. The use of computerized clinical practice guidelines by general practitioners, education and management of hypertension, the screening for cardiovascular disease (CVD) goals and referral could help improve hypertension control in patients with hypertension. The educating and counseling on PA and diet, the monitoring of patients' metabolic factors and chronic diseases, the combination of education on lifestyles with management of hypertension, the screening for economic risk factors, medical needs, and CVD risk factors and referral all could help reduce blood pressure. In the meta-analysis, the largest reduction in blood pressure was seen for interventions which combined education, counseling and management strategies: weighted mean difference in systolic blood pressure was - 5.34 mmHg (95% confidence interval [CI], - 7.35 to - 3.33) and in diastolic blood pressure was - 3.23 mmHg (95% CI, - 5.51 to - 0.96).

CONCLUSIONS

Interventions that used education and counseling strategies; those that used management strategies; those that used combined education, counseling and management strategies and those that used screening and referral strategies were beneficial in preventing, controlling hypertension and reducing blood pressure levels. The combination of education, counseling and management strategies appeared to be the most beneficial intervention to reduce blood pressure levels.

Association between vaccine preventable diseases in children and improved sanitation following a nationwide sanitation campaign in India: an ecological analysis

OBJECTIVE

Persistent exposure to faecal pathogens due to open defecation may cause environmental enteropathy that, in turn, may lead to undernutrition and vaccine failure in under 5-year-old (u5) children. The Swachh Bharat Mission (SBM) programme in India, launched in 2014, aimed to construct toilets for every household nationwide and reduce open defecation. This programme, if successful, had the potential to reduce the burden of four vaccine preventable diseases (VPDs): diphtheria, pertussis, tetanus and measles. We examine whether increased household toilet availability in Indian districts following SBM corresponds with a reduction in diphtheria, pertussis, tetanus and measles in u5 children.

DESIGN

Observational, ecological study.

SETTING

532 districts in 28 Indian states, from 2013 to 2016.

PRIMARY OUTCOME AND EXPOSURE

We retrieved data on district-level change in the annual incidence (per 1000 u5 children) of four VPDs, from 2013 (pre-SBM) to 2016 (post-SBM). We obtained data on our exposure, the change in the percentage of households with toilets (per district), from three large national surveys conducted in 2013 and 2016. We used linear regression analysis, which controlled for change over time in socioeconomic factors, health system-related covariates and pre-SBM annual incidence of VPDs.

RESULTS

A one percentage point increase in households with toilets corresponds with 0.33 fewer measle cases per 1000 u5 children in a district (coefficient: -0.33, 95% CI -0.0641 to -0.014; p<0.05). About 12% of this association is mediated by a reduction in u5 stunting. We observe no relation of the exposure with diphtheria, pertussis or tetanus. Findings remain robust to sensitivity analyses.

CONCLUSION

Rapid improvements in ambient sanitation through increased toilet availability correspond with a reduction in the annual incidence of measles in u5 children. We encourage replication of findings and further research to identify potential pathways by which SBM may reduce measle burden in u5 children.

How Can Education for Sustainable Development (ESD) Be Effectively Implemented in Teaching and Learning? An Analysis of Educational Science Recommendations of Methods and Procedures to Promote ESD Goals

Education for sustainable development (ESD) has been a task assigned to schools and universities since the mid-1990s. This global movement spawned ESD research in numerous fields, including, among others, didactics and educational sciences, as well as sustainability sciences. In this article, we analyze the state of research on reliable recommendations of means (more precisely, teaching and learning methods and procedures) to promote the ESD goals. Within the framework of systematic literature analysis, we compared and evaluated 17 scientific publications from the field of ESD. Using qualitative content analysis, we scanned the 17 articles for recommendations of means of ESD and the cited evidence for their effectiveness. The findings show two groups of recommended means, differing particularly in the degree of learner autonomy and the quality of evidence for their effectiveness. We discuss possible tasks that can be derived from these findings for didactic research on ESD, and we make a suggestion for further teaching action.

Evaluating the heterogeneous effect of a modifiable risk factor on suicide: The case of vitamin D deficiency

OBJECTIVES

To illustrate the use of machine learning methods to search for heterogeneous effects of a target modifiable risk factor on suicide in observational studies. The illustration focuses on secondary analysis of a matched case-control study of vitamin D deficiency predicting subsequent suicide.

METHODS

We describe a variety of machine learning methods to search for prescriptive predictors; that is, predictors of significant variation in the association between a target risk factor and subsequent suicide. In each case, the purpose is to evaluate the potential value of selective intervention on the target risk factor to prevent the outcome based on the provisional assumption that the target risk factor is causal. The approaches illustrated include risk modeling based on the super learner ensemble machine learning method, Least Absolute Shrinkage and Selection Operator (Lasso) penalized regression, and the causal forest algorithm.

RESULTS

The logic of estimating heterogeneous intervention effects is exposited along with the illustration of some widely used methods for implementing this logic.

CONCLUSIONS

In addition to describing best practices in using the machine learning methods considered here, we close with a discussion of broader design and analysis issues in planning an observational study to investigate heterogeneous effects of a modifiable risk factor.

Interrupted time-series analysis of active case-finding for tuberculosis during the COVID-19 pandemic, Zambia

Objective

To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic and the subsequent implementation of tuberculosis response measures on tuberculosis notifications in Zambia.

Methods

We used an interrupted time-series design to compare monthly tuberculosis notifications in Zambia before the pandemic (January 2019 to February 2020), after implementation of national pandemic mitigation measures (April 2020 to June 2020) and after response measures to improve tuberculosis detection (August 2020 to September 2021). The tuberculosis response included enhanced data surveillance, facility-based active case-finding and activities to generate demand for services. We used nationally aggregated, facility-level tuberculosis notification data for the analysis.

Findings

Pre-pandemic tuberculosis case notifications rose steadily from 2890 in January 2019 to 3337 in February 2020. After the start of the pandemic and mitigation measures, there was a −22% (95% confidence interval, CI: −24 to −19) immediate decline in notifications in April 2020. Larger immediate declines in notifications were seen among human immunodeficiency virus (HIV)-positive compared with HIV-negative individuals (−36%; 95% CI: −38 to −35; versus −12%; 95% CI: −17 to −6). Following roll-out of tuberculosis response measures in July 2020, notifications immediately increased by 45% (95% CI: 38 to 51) nationally and across all subgroups and provinces. The trend in notifications remained stable through September 2021, with similar numbers to the predicted number had the pandemic not occurred.

Conclusion

Implementation of a coordinated public health response including active tuberculosis case-finding was associated with reversal of the adverse impact of the pandemic and mitigation measures. The gains were sustained throughout subsequent waves of the pandemic.

Feasibility of Post-hospitalization Telemedicine Video Visits for Children With Medical Complexity

OBJECTIVES

To evaluate feasibility and acceptability of post-hospitalization telemedicine video visits (TMVV) during hospital-to-home transitions for children with medical complexity (CMC); and explore associations with hospital utilization, caregiver self-efficacy (CSE), and family self-management (FSM).

METHOD

This non-randomized pilot study assigned CMC (n=28) to weekly TMVV for four weeks post-hospitalization; control CMC (n=20) received usual care without telemedicine. Feasibility was measured by time to connection and proportion of TMVV completed; acceptability was measured by parent-reported surveys. Pre/post-discharge changes in CSE, FSM, and hospital utilization were assessed.

RESULTS

64 TMVV were completed; 82 % of patients completed 1 TMVV; 54 % completed four TMVV. Median time to TMVV connection was 1 minute (IQR=2.5). Parents reported high acceptability of TMVV (mean 6.42; 1 -7 scale). CSE and FSM pre/post-discharge were similar for both groups; utilization declined in both groups post-discharge.

DISCUSSION

Post-hospitalization TMVV for CMC were feasible and acceptable during hospital-to-home transitions.

Child Health, Vulnerability, and Complexity: Use of Telehealth to Enhance Care for Children and Youth With Special Health Care Needs

Telehealth, or the use of telecommunications technology and infrastructure to deliver health-related services and information that support patient care, has the potential to improve the quality of care, particularly deficiencies related to access and patient experience of care. Telehealth may also reduce disparities for children and youth with special health care needs (CYSHCN) with barriers to accessing in-person care, for example, those residing in rural areas and children with medical complexity who are particularly fragile. While important foundational work has been done to study telehealth's effectiveness and implementation, key gaps remain regarding its use for CYSHCN. The CYSHCNet national research agenda development process, described in a companion article, identified as key priority areas for future research telehealth as an innovative care delivery model for all CYSHCN and as a mechanism to address rural-urban disparities in health care access. Here, we review the current knowledge around telehealth, identify populations for whom telehealth could be especially beneficial, discuss the important gaps identified, and make recommendations for specific studies that will move the field forward. There are ample opportunities for telehealth to improve health and patient/family experience of care and quality of life for CYSHCN while requiring less time and resources from families accessing this care. Innovative research to inform best practices around incorporation and implementation of telehealth will improve its efficiency and effectiveness and achieve optimal outcomes.

Blended Therapies and Mobile Phones for Improving the Health of Female Victims of Gender Violence

We carried out a case study with a group of female victims of gender violence (n = 39) with the objective of evaluating a blended psychotherapeutic intervention. The results show that blended therapies with mobile text messages combined with face-to-face group therapies significantly improved the health of these women. Mood states and the symptoms of depression were measured with a PHQ-9 personal health questionnaire and evolved positively. In the group of women (n = 39) the scores improved from an initial 13.5 (SD = 7.2, range 3-34) to 6.0 at the end of the period of messages (SD = 5.2, range 0-18), which was a significant difference (t (39) = 2.02; p = 0.000). Most of the women stated that the messages had helped them improve their mood (91.6%) and their general health (83.3%), which made them feel more connected to their social environment (80.6%). We observed that adherence to medication for each woman improved. With mixed therapies and mobile phones, social service professionals can incorporate technology into daily practices and offer personalized attention and daily counseling to victims of gender-based violence.

The Peterborough Exemplar: a protocol to evaluate the impact and implementation of a new patient-centred, system-wide community mental healthcare model in England

BACKGROUND

Community mental healthcare has significantly grown since de-institutionalization. Despite progress, service fragmentation and gaps in service provision remain key barriers to effective community care in England. Recent mental healthcare policies highlighted the need to transform service provision by developing patient-centred, joined-up community mental healthcare. In response to policy guidance, a system-wide community mental healthcare model was developed in Peterborough (England). The "Peterborough Exemplar" is based on two main pillars: (1) the creation of knowledge exchange pathways to strengthen interorganizational relationships, and (2) the development of new, accessible community services addressing existing service gaps. This paper presents the protocol developed to evaluate the Peterborough Exemplar.

METHODS

A quasi-experimental design with an intervention group and a nonequivalent comparator group has been developed to compare service provision provided in Peterborough pre- and post-intervention with services provided in Fenland, a neighbouring area where service users access usual care. Two evaluation methods will be employed to compare service provision between the two groups: (1) outcome measures completed by service users and carers will be analysed to assess quality of life and service satisfaction, and (2) service activity data will be analysed to assess service usage. In addition, qualitative interviews will be conducted with staff members of participating organizations to explore the implementation of the Exemplar in Peterborough and evaluate knowledge exchange processes among local service providers. A matched control approach will be used to compare outcome measures between the two areas. Descriptive and inferential statistics, including chi-square tests, will be used to analyse service activity data and examine differences between the two areas. A thematic analysis will be adopted to analyse qualitative data.

DISCUSSION

Outcomes of the evaluation will contribute to understanding the contribution of the Peterborough Exemplar on mental health service provision locally. Evaluation findings and intermediate reporting will be shared with organizations involved in the implementation of the Peterborough Exemplar and with local decision-makers to inform the Exemplar delivery. As the Peterborough Exemplar is an Early Implementer (EI) site funded by NHS England, findings will be shared with policy-makers to inform national policy on community mental healthcare and integrated care.

The Effect of Managerial and Leadership Training and Simulation on Senior Nursing Students’ Career Planning and Self-Efficacy

Introduction

Enhancing nursing students’ professional knowledge and integrating simulation and clinical training into students’ education may affect their career planning and development.

Objectives

This study aimed to explore how managerial and leadership training and simulation affect career planning knowledge, career choice, and self-efficacy among senior nursing students. Additionally, it explored how students perceived the training they received.

Methods

This study employed a mixed methods design for collecting quantitative and qualitative data about the training. A quasi-experimental design using a pretest and posttest with a convenience sample of senior nursing students ( N = 80) at a Saudi nursing college guided the quantitative part. Nursing students were introduced to a managerial and leadership training and simulation intervention focused on career knowledge. The career planning questionnaire and a self-efficacy scale were used to collect quantitative data before and after the intervention, and the open-ended questions were used for qualitative data about the training they received. For the quantitative data, we used descriptive and inferential statistics, and for the qualitative data, we used content analysis.

Results

After the training sessions, nursing students’ career planning knowledge and self-efficacy scores were considerably enhanced, with a significant difference and positive associations ( p < .001). Four themes were driven from the qualitative analysis: student engagement, experiential learning and reflection, the teacher's role as facilitator, and teamwork.

Conclusions

Knowledge and preparedness are essential elements for career planning and development. Nursing curricula should provide students with ongoing educational opportunities to help them enhance their career planning and self-efficacy. As well, nurse managers play an important role in shaping the career paths of senior undergraduates and internship nurses. Career counseling sessions and career activities can be scheduled frequently before graduation and during the internship year, which is essential for prelicensure and orientation.

Efficacy of an Enhanced Implementation Strategy to Increase Parent Engagement with a Health Promotion Program in Childcare

Previous efforts to involve parents in implementation of childcare-based health promotion interventions have yielded limited success, suggesting a need for different implementation strategies. This study evaluated the efficacy of an enhanced implementation strategy to increase parent engagement with Healthy Me, Healthy We. This quasi-experimental study included childcare centers from the second of two waves of a cluster-randomized trial. The standard approach (giving parents intervention materials, prompting participation at home, inviting participation with classroom events) was delivered in 2016-2017 (29 centers, 116 providers, and 199 parents). The enhanced approach (standard plus seeking feedback, identifying and addressing barriers to parent participation) was delivered in 2017-2018 (13 centers, 57 providers, and 114 parents). Parent engagement was evaluated at two levels. For the center-level, structured interview questions with providers throughout the intervention were systematically scored. For the parent-level, parents completed surveys following the intervention. Differences in parent engagement were evaluated using linear regression (center-level) and mixed effects (parent-level) models. Statistical significance was set at p < 0.025 for two primary outcomes. There was no difference in parent engagement between approaches at the center-level, β = -1.45 (95% confidence interval, -4.76 to 1.87), p = 0.38l. However, the enhanced approach had higher parent-level scores, β = 3.60, (95% confidence interval, 1.49 to 5.75), p < 0.001. In the enhanced approach group, providers consistently reported greater satisfaction with the intervention than parents (p < 0.001), yet their fidelity of implementing the enhanced approach was low (less than 20%). Results show promise that parent engagement with childcare-based health promotion innovations can positively respond to appropriately designed and executed implementation strategies, but strategies need to be feasible and acceptable for all stakeholders.

Methods to evaluate COVID-19 vaccine effectiveness, with an emphasis on quasi-experimental approaches

The evaluation of vaccine effectiveness is conducted with real-world data. They are essential to monitor the performance of vaccination programmes over time, and in the context of the emergence of new variants. Until now, the effectiveness of COVID-19 vaccines has been assessed based on classic methods, such as cohort and test-negative case-control studies, which may often not allow for adequate control of inherent biases in the assignment of vaccination campaigns. The aim of this review was to discuss the study designs available to evaluate vaccine effectiveness, highlighting quasi-experimental studies, which seek to mimic randomized trials, by introducing an exogenous component to allocate to treatment, in addition to the advantages, limitations, and applicability in the context of Brazilian data. The use of quasi-experimental approaches, such as interrupted time series, difference-in-differences, propensity scores, instrumental variables, and regression discontinuity design, are relevant due to the possibility of providing more accurate estimates of COVID-19 vaccine effectiveness. This is especially important in scenarios such as the Brazilian, which characterized by the use of various vaccines, with the respective numbers and intervals between doses, applied to different age groups, and introduced at different times during the pandemic.

Evaluating a social marketing campaign on healthy nutrition and lifestyle among primary-school children: A mixed-method research design

Italy has one of the highest levels of childhood overweight and obesity in Europe. Therefore, preventing children from becoming overweight is a major public health challenge. Here, we used a mixed-method research approach - including a quasi-experimental design and three surveys - to create a formative evaluation of a social marketing campaign on healthy nutrition and lifestyle in Italian primary school children. The social marketing campaign was organized around the 4 Ps of the marketing mix (product: the educational activities; place: the involved schools and supermarkets; promotion: the in-person and technology-based communication; and price: hours spent by the targeted children in fulfilling the educational activities). The campaign involved primary-school children across four Italian cities. The findings suggest that social marketing education campaigns can be effective tools to improve children's knowledge about healthy food and lifestyle, reduce their sedentary behavior, and increase their consumption of healthy food. Also, increasing children's acceptance of healthful nourishment is a valuable tool to improve the dietary habits of the entire family. With relation to the educational program assessment method, this study can inform societal interventions especially those involving children through the integration of different qualitative and quantitative research methods, which collect data from different subjects and perspectives.

Standardized, Coordinated Care in Nursing Homes Lowers Rehospitalization After Hip Fracture

OBJECTIVES

To assess the effect of enhanced standardized interdisciplinary cooperation between the orthogeriatric ward, municipality, and nursing home facility (NHF) on readmission rates in patients with hip fracture.

DESIGN

Quasi-experimental design with a nonequivalent control group.

SETTING AND PARTICIPANTS

From January 2018 to July 2020, patients with hip fracture who were admitted to the department of orthopedic surgery and traumatology at Lillebaelt Hospital, and later discharged to NHF were included.

INTERVENTION

The intervention consisted of a safety program to the NHF for the first 14 days postdischarge and included assessment of vital signs, weight, pain, signs of constipation, hours of mobilization, and daily intake of fluids and high-protein beverages. Acute team nurses undertook visits (planned and unplanned) and could take blood samples and administer intravenous fluids or antibiotics at the NHF. Control participants received usual care.

METHODS

The intervention was performed in 2 municipalities with an acute team; the remaining 3 municipalities comprised the control group. The primary outcome was 30-day readmission, and secondary outcomes were mortality, mobility, and quality of life.

RESULTS

There were 100 patients in the intervention group and 152 in the control group. The median age was 86 years, 68% were female, and more than 60% had a low mental score; there were no statistical differences between groups in baseline variables. The 30-day readmission rate was 14% in the intervention group and 30% in the control group (P = .004). The 30-day mortality rate was 6% in the intervention group and 13% in the control group (P = .07). There was no statistically significant difference in mobility between the 2 groups but there was a higher health-related quality of life score in the intervention group (P = .045).

CONCLUSIONS AND IMPLICATIONS

Enhanced standardized interdisciplinary cooperation between hospital, NHF teams, and visiting acute team nurses can lower readmissions and potentially mortality.

Increased Depression Screening and Treatment Recommendations After Implementation of a Perinatal Collaborative Care Program

OBJECTIVE

The study evaluated whether implementation of perinatal collaborative care is associated with improvements in screening and treatment recommendations for perinatal depression by obstetric clinicians.

METHODS

This cohort study, conducted from January 2015 to January 2019, included all women who received prenatal care in five obstetric clinics and delivered at a single quaternary care hospital in Chicago. In January 2017, a perinatal collaborative care program (COMPASS) was implemented. Completion of depression screening and recommendations for treatment following a positive depression screen were compared before and after COMPASS implementation. Adjusted analyses included inverse probability weighting by using propensity scores to impose control over imbalance between exposure groups with respect to prespecified covariates.

RESULTS

A total of 7,028 women were included in these analyses: 3,227 (46%) before and 3,801 (54%) after COMPASS implementation. Women who received obstetric care after implementation were significantly more likely than those who received care before implementation to receive antenatal screening for depression (81% versus 33%; adjusted odds ratio [aOR]=8.5, 95% confidence interval [CI]=7.6-9.5). After implementation, women with a positive antenatal screen for depression were more likely to receive a treatment recommendation (61% versus 44%; aOR=2.1, 95% CI=1.2-3.7). After implementation of perinatal collaborative care, combined psychotherapy and pharmacotherapy were more frequently recommended, compared with before implementation.

CONCLUSIONS

Implementation of a perinatal collaborative care program was associated with improvements in perinatal depression screening and recommendations for treatment by obstetric clinicians.

Toward a Healthy and Environmentally Sustainable Campus Food Environment: A Scoping Review of Postsecondary Food Interventions

Interventions are urgently needed to transform the food system and shift population eating patterns toward those consistent with human health and environmental sustainability. Postsecondary campuses offer a naturalistic setting to trial interventions to improve the health of students and provide insight into interventions that could be scaled up in other settings. However, the current state of the evidence on interventions to support healthy and environmentally sustainable eating within postsecondary settings is not well understood. A scoping review of food- and nutrition-related interventions implemented and evaluated on postsecondary campuses was conducted to determine the extent to which they integrate considerations related to human health and/or environmental sustainability, as well as to synthesize the nature and effectiveness of interventions and to identify knowledge gaps in the literature. MEDLINE (via PubMed), CINAHL, Scopus, and ERIC were searched to identify articles describing naturalistic campus food interventions published in English from January 2015 to December 2019. Data were extracted from 38 peer-reviewed articles, representing 37 unique interventions, and synthesized according to policy domains within the World Cancer Research Foundation's NOURISHING framework. Most interventions were focused on supporting human health, whereas considerations related to environmental sustainability were minimal. Interventions to support human health primarily sought to increase nutrition knowledge or to make complementary shifts in food environments, such as through nutrition labeling at point of purchase. Interventions to support environmental sustainability often focused on reducing food waste and few emphasized consumption patterns with lower environmental impacts. The implementation of integrated approaches considering the complexity and interconnectivity of human and planetary health is needed. Such approaches must go beyond the individual to alter the structural determinants that shape our food system and eating patterns.

MacKillop Family Services' Family Preservation and Reunification Response for Vulnerable Families-Protocol for an Effectiveness-Implementation Study

International evidence supports the effect of intensive family preservation and reunification services in preventing children's placement in out-of-home care (OOHC). Evidence within Australia is scarce. This protocol paper describes a hybrid effectiveness-implementation evaluation of the Victorian Family Preservation and Reunification (FPR) Response implemented by MacKillop Family Services. Participants include families engaged in the program and staff involved in program delivery. A pre-post study design will be used to assess the effectiveness of the FPR in improving family outcomes from intake to closure, including: (i) parenting knowledge, skills, and capability; (ii) family safety and home environment; (iii) child development, adolescent behaviour, education attendance and attachment; (iv) connection to services; and (v) prevention of children from entering or re-entering OOHC. Interviews and focus groups will be conducted with staff to evaluate the program's fidelity, reach, feasibility, acceptability, and enablers and barriers to implementation. Quantitative data will be analysed using descriptive statistics and a series of paired-samples t-tests and F tests to examine changes in outcomes over time; thematic analysis will be used for qualitative data. If the FPR can yield significant improvements in families' outcomes, this would provide strong support for its scale-up across Australia, to better support vulnerable families.

Pharmacist-led intervention in treatment non-adherence and associated direct costs of management among ambulatory patients with type 2 diabetes in southwestern Nigeria

BACKGROUND

Non-adherence to recommended therapy remains a challenge to achieving optimal clinical outcome with resultant economic implications.

OBJECTIVE

To evaluate the effect of a pharmacist-led intervention on treatment non-adherence and direct costs of management among patients with type 2 diabetes (T2D).

METHOD

A quasi-experimental study among 201-patients with T2D recruited from two-tertiary healthcare facilities in southwestern Nigeria using semi-structured interview. Patients were assigned into control (HbA1c < 7%, n = 95) and intervention (HbA1c ≥ 7%, n = 106) groups. Baseline questionnaire comprised modified 4-item Medication Adherence Questions (MAQ), Perceived Dietary Adherence Questionnaire (PDAQ) and International Physical Activity Questionnaire, to assess participants' adherence to medications, diet and physical activity, respectively. Post-baseline, participants were followed-up for 6-month with patient-specific educational intervention provided to resolve adherence discrepancies in the intervention group only, while control group continued to receive usual care. Subsequently, direct costs of management for 6-month pre-baseline and 6-month post-baseline were estimated for both groups. Data were summarized using descriptive statistics. Chi-square, McNemar and paired t-test were used to evaluate categorical and continuous variables at p < 0.05.

RESULTS

Mean age was 62.9 ± 11.6 years, and 160(79.6%) were females. Glycated haemoglobin (HbA1c) was 6.1 ± 0.6% (baseline) and 6.1 ± 0.8% at 6-month post-baseline (p = 0.094) for control group, and 8.7 ± 1.5% (baseline) versus 7.8 ± 2.0% (6-month), p < 0.001, for the intervention. Post-baseline, response to MAQ items 1 (p = 0.017) and 2 (p < 0.001) improved significantly for the intervention. PDAQ score increased significantly from 51.8 ± 8.8 at baseline to 56.5 ± 3.9 at 6-month (p < 0.001) for intervention, and from 56.3 ± 4.0 to 56.5 ± 3.9 (p = 0.094) for the control group. Physical activity increased from 775.2 ± 700.5 Metabolic Equivalent Task (MET) to 829.3 ± 695.5MET(p < 0.001) and from 901.4 ± 743.5MET to 911.7 ± 752.6MET (p = 0.327) for intervention and control groups, respectively. Direct costs of management per patient increased from USD 327.3 ± 114.4 to USD 333.0 ± 118.4 (p = 0.449) for the intervention, while it decreased from USD 290.1 ± 116.97 to USD289.1 ± 120.0 (p = 0.89) for control group, at baseline and 6-month post-baseline, respectively.

CONCLUSION

Pharmacist-led intervention enhanced adherence to recommended medications, diet and physical activity among the intervention patients, with a corresponding significant improvement in glycaemic outcome and an insignificant increase in direct costs of management. There is a need for active engagement of pharmacists in management of patients with diabetes in clinical practice.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04712916 . Retrospectively-registered.

NICE shared decision making guidelines and mental health: challenges for research, practice and implementation

The National Institute for Health and Care Excellence (NICE) initiated an ambitious effort to develop the first shared decision making guidelines. The purpose of this commentary is to identify three main concerns pertaining to the new published guidelines for shared decision making research, practice, implementation and cultural differences in mental health.

A Quasi-Experimental Evaluation of a School-Based Prescription Opioid Misuse Education Program

The use of prescription opioids is a matter of concern among academics and practitioners, but there remains a lack of programming to target this issue. One program, This Is (Not) About Drugs (TINAD), is intended to address part of this need by altering youth perceptions of the risks associated prescription opioid misuse as well as heroin. This study presents results from a quasi-experimental evaluation of TINAD. Propensity score matching techniques were used to account for selection effects across treatment and comparison groups. Program participants demonstrated increases in understanding of the similarities between prescription opioids and heroin and the risks associated with prescription opioid misuse. While these results are promising, TINAD requires a more rigorous evaluation of its effectiveness.

Maternal and Child Health Benefits of the Mamata Conditional Cash Transfer Program in Odisha, India

BACKGROUND

Conditional cash transfers (CCTs) are demand-side interventions that link cash receipt to fulfilment of health-promoting conditions such as regular health check-ups and investment in human capital. In 2011, the Indian state of Odisha, implemented a statewide CCT program-the Mamata Scheme-towards improving maternal/child health outcomes and promoting health-seeking behavior. Mamata targets pregnant and lactating women aged ≥19 y, and provides a sizable financial incentive relative to household income levels.

OBJECTIVES

We aimed to longitudinally examine whether, and to what extent, initiation of the Mamata scheme corresponded with changes in health and nutrition outcomes in Odisha, relative to comparison states in India.

METHODS

Outcomes included maternal health service utilization [antenatal care (ANC), iron-folic acid supplementation, breastfeeding counseling, full child immunization, tetanus vaccination, vitamin A supplementation] and nutrition [anemia during pregnancy and stunting, anemia in children <5 y old (U5)]. Data on outcomes and covariates were obtained from 3 waves of India's National Family Health Surveys corresponding to the years 1999, 2006, and 2016. We used difference-in-differences (DID) estimation strategy to estimate the impact of the program.

RESULTS

The pooled sampled size comprised >200,000 mother-child dyads. Tests of parallel trends indicated that preintervention trends were similar across all outcomes in Odisha with the exception of anemia. When comparing Odisha with other states for health services, DID models indicated that exposure to Mamata corresponded with increased odds of counseling for breastfeeding (OR: 2.74; 95% CI: 1.97, 3.80), ANC receipt (OR: 1.51; 95% CI: 1.15, 1.99), and full immunization (OR: 1.69; 95% CI: 1.37, 2.08). DID models also indicated decline in stunting (OR: 0.92; 95% CI: 0.84, 1.02) and anemia (OR: 0.62; 95% CI: 0.54, 0.71) among U5 children in Odisha following Mamata, relative to comparison states. Models comparing poor with nonpoor groups indicated the presence of heterogeneous effects.

CONCLUSIONS

This study provides proof-of-concept for potential improvements in maternal and child nutrition outcomes following CCTs that incentivize health care utilization in India.

Child Undernutrition following the Introduction of a Large-Scale Toilet Construction Campaign in India

BACKGROUND

Lack of toilets and the widespread practice of open defecation may contribute to India's large burden of child undernutrition.

OBJECTIVES

We examine whether a large national sanitation campaign launched in 2014, the Swachh Bharat Mission (SBM), precedes a reduction in stunting and wasting among under 5-y-old (u5) children in India.

METHODS

In this observational study, we used district-level data from before (2013-2014) and after (2015-2016) SBM from 3 national surveys to derive, as our outcomes, the percentage of u5 children per district who are stunted and wasted. We defined our exposures as 1) binary indicator of SBM and 2) percentage of households with toilets per district. Our analytic sample comprised nearly all 640 Indian districts (with ∼1200 rural/urban divisions per district per time point). Linear regression analyses controlled for baseline differences in districts, linear time trends by state, and relevant covariates.

RESULTS

Relative to pre-SBM, u5 stunting declines by 0.06% (95% CI: -0.10, -0.01; P = 0.009) with every percentage increase in households with toilets post-SBM. Rural regions and districts with higher pre-SBM toilet availability show greater decline in u5 stunting post-SBM.

CONCLUSIONS

An increase in toilet availability on a national scale, precipitated by the SBM sanitation campaign, is associated with a reduction in undernutrition among u5 children in India over the early phase of the campaign.

Does behavioral intervention affect intention to quit? : A quasi-experimental study from primary healthcare settings in India

INTRODUCTION

Tobacco is the leading cause of death and disease in India. This study examines the effect of training intervention in behavioral counseling on intention to quit tobacco in primary healthcare settings in India. The intervention included training to improve behavioral counseling practices of primary care physicians (PCPs) based on the 5As approach to increase patients' motivation to quit tobacco.

METHODS

A quasi-experimental design was used for the study. The intervention consists of training of primary care physicians in the behavioral intervention in tobacco cessation. The intervention was conducted in twelve districts of two states in India (Rajasthan and Odisha) in 2016-2017. Four districts were randomly sampled for the study. A total of 1314 participants (intervention and control) were recruited for the study in the baseline and end-line surveys, respectively. Intention to quit in 30 days was the primary outcome measure. Difference-in-difference (DiD) logistic regression models were used separately for smokers and smokeless tobacco users to estimate the odds of intention to quit. Analysis was done in STATA Version 14.

RESULTS

The intervention and time variable had a significantly positive influence on the intention to quit tobacco among smokers. Smokers in the intervention districts had higher odds of intention to quit (OR=9.82; 95% CI: 1.67-57.72) compared to smokers in the control districts. Smokeless tobacco (SLT) users had higher odds of intention to quit (OR=3.06; 95% CI: 1.35-6.98) in the end-line survey compared to baseline survey.

CONCLUSIONS

Our findings indicate that building capacity in behavioral intervention in primary care settings can help increase the intention to quit among smokers. The observed difference in intention to quit between smokers and SLT users suggests the need of tailored counseling interventions for SLT users. There is a need for further research to design and evaluate training and behavioral interventions for SLT and dual (smoking and SLT) users in primary care settings in low- and middle-income countries.

Enhancing Recruitment and Retention of Minority Populations for Clinical Research in Pulmonary, Critical Care, and Sleep Medicine: An Official American Thoracic Society Research Statement

Background: Well-designed clinical research needs to obtain information that is applicable to the general population. However, most current studies fail to include substantial cohorts of racial/ethnic minority populations. Such underrepresentation may lead to delayed diagnosis or misdiagnosis of disease, wide application of approved interventions without appropriate knowledge of their usefulness in certain populations, and development of recommendations that are not broadly applicable.Goals: To develop best practices for recruitment and retention of racial/ethnic minorities for clinical research in pulmonary, critical care, and sleep medicine.Methods: The American Thoracic Society convened a workshop in May of 2019. This included an international interprofessional group from academia, industry, the NIH, and the U.S. Food and Drug Administration, with expertise ranging from clinical and biomedical research to community-based participatory research methods and patient advocacy. Workshop participants addressed historical and current mistrust of scientific research, systemic bias, and social and structural barriers to minority participation in clinical research. A literature search of PubMed and Google Scholar was performed to support conclusions. The search was not a systematic review of the literature.Results: Barriers at the individual, interpersonal, institutional, and federal/policy levels were identified as limiting to minority participation in clinical research. Through the use of a multilevel framework, workshop participants proposed evidence-based solutions to the identified barriers.Conclusions: To date, minority participation in clinical research is not representative of the U.S. and global populations. This American Thoracic Society research statement identifies potential evidence-based solutions by applying a multilevel framework that is anchored in community engagement methods and patient advocacy.