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Mucheru D, McAuliffe E, Kesale A, Gilmore B. A rapid realist review on leadership and career advancement interventions for women in healthcare. BMC Health Serv Res 2024; 24:856. [PMID: 39069605 DOI: 10.1186/s12913-024-11348-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024] Open
Abstract
Women represent 70% of the global health workforce but only occupy 25% of health and social care leadership positions. Gender-based stereotypes, discrimination, family responsibilities, and self-perceived deficiencies in efficacy and confidence inhibit the seniority and leadership of women. The leadership inequality is often compounded by the intersection of race and socio-economic identities. Resolving gender inequalities in healthcare leadership brings women's expertise to healthcare decision making, which can lead to equity of healthcare access and improve healthcare services. With the aim of enhancing women's advancement to leadership positions, a rapid realist review (RRR) was conducted to identify the leadership and career advancement interventions that work for women in healthcare, why these interventions are effective, for whom they are effective, and within which contexts these interventions work. A RRR ultimately articulates this knowledge through a theory describing an intervention's generative causation. The Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) for conducting a realist synthesis guided the methodology. Preliminary theories on leadership and career advancement interventions for women in healthcare were constructed based on an appraisal of key reviews and consultation with an expert panel, which guided the systematic searching and initial theory refinement. Following the literature search, 22 studies met inclusion criteria and underwent data extraction. The review process and consultation with the expert panel yielded nine final programme theories. Theories on programmes which enhanced leadership outcomes among women in health services or professional associations centred on organisational and management involvement; mentorship of women; delivering leadership education; and development of key leadership skills. The success of these strategies was facilitated by accommodating programme environments, adequacy and relevance of support provided and programme accessibility. The relationship between underlying intervention entities, stakeholder responses, contexts and leadership outcomes, provides a basis for underpinning the design for leadership and career advancement interventions for women in healthcare.
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Affiliation(s)
- Doreen Mucheru
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - Eilish McAuliffe
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Brynne Gilmore
- UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Fitzgerald I, Sahm LJ, Howe J, Maidment I, Wallace E, Crowley EK. Shared decision-making interventions in the choice of antipsychotic prescription in people living with psychosis (SHAPE): Protocol for a realist review. PLoS One 2024; 19:e0304626. [PMID: 39052681 PMCID: PMC11271866 DOI: 10.1371/journal.pone.0304626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/14/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Shared decision-making (SDM) has yet to be successfully adopted into routine use in psychiatric settings amongst people living with severe mental illnesses. Suboptimal rates of SDM are particularly prominent amongst patients with psychotic illnesses during antipsychotic treatment choices. Many interventions have been assessed for their efficacy in improving SDM within this context, although results have been variable and inconsistent. AIMS To generate an in-depth understanding of how, why, for whom, and to what extent interventions facilitating the application of SDM during antipsychotic treatment choices work and the impact of contextual factors on intervention effectiveness. METHODS This review will use realist review methodology to provide a causal understanding of how and why interventions work when implementing SDM during antipsychotic treatment choices. The cohort of interest will be those experiencing psychosis where ongoing treatment with an antipsychotic is clinically indicated. The review will take place over five stages; (1) Locating existing theories, (2) Searching for evidence, (3) Selecting articles, (4) Extracting and organising data and (5) Synthesizing evidence and drawing conclusions. An understanding of how and why interventions work will be achieved by developing realist programme theories on intervention effectiveness through iterative literature reviews and engaging with various stakeholder groups, including patient, clinician and carer representatives. DISCUSSION This is the first realist review aiming to identify generative mechanisms explaining how and why successful interventions aimed at improving SDM within the parameters outlined work and in which contexts desired outcomes are most likely to be achieved. Review findings will include suggestions for clinicians, policy and decision-makers about the most promising interventions to pursue and their ideal attributes.
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Affiliation(s)
- Ita Fitzgerald
- Pharmacy Department, St Patrick’s Mental Health Services, Dublin, Ireland
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Laura J. Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
- Pharmacy Department, Mercy University Hospital, Cork, Ireland
| | - Jo Howe
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Ian Maidment
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Emma Wallace
- Department of General Practice, School of Medicine, University College Cork, Cork, Ireland
| | - Erin K. Crowley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Mead ES, Teeling SP, McNamara M. A Realist Review Protocol into the Contexts and Mechanisms That Enable the Inclusion of Environmental Sustainability Outcomes in the Design of Lean Healthcare Improvement Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:868. [PMID: 39063445 PMCID: PMC11276605 DOI: 10.3390/ijerph21070868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024]
Abstract
Healthcare makes a significant contribution to the social, economic and environmental benefits of communities. It is correspondingly a significant employer and consumer of both energy and consumables, often at high costs. Lean, a quality improvement methodology focuses on the elimination of non-value add (NVA) activities (steps that do not add value from the perspective of the customer) to improve the flow of people, information or goods. Increasingly, Lean thinking is evolving from its initial focus on eliminating NVA to a more holistic approach that encompasses sustainability. However, little work has been undertaken intentionally, including environmental sustainability outcomes in Lean healthcare interventions. Realist review methodology facilitates an understanding of the extent to which an intervention works, for whom, in what context, why and how, and has proven useful in research relating to Lean interventions in healthcare settings. This protocol provides details for a realist review that will enable an understanding of the specific contexts in which certain mechanisms are activated that enable the inclusion of environmental sustainability outcomes in the design of Lean healthcare improvement interventions.
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Affiliation(s)
- Elaine Shelford Mead
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
| | - Seán Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
- Centre for Person-Centered Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland
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Chouliara N, Cameron T, Ballard-Ridley S, Fisher RJ, Kettlewell J, Kidd L, Luxton L, Pomeroy V, Stockley RC, Thomas S, Gordon AL. Investigating the Implementation of Community-Based Stroke Telerehabilitation in England; A Realist Synthesis Study Protocol. Healthcare (Basel) 2024; 12:1027. [PMID: 38786437 PMCID: PMC11120767 DOI: 10.3390/healthcare12101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high-quality, equitable community-based stroke rehabilitation, and under what conditions. Using a realist approach, we will synthesise information from (1) an evidence review, (2) qualitative interviews with clinicians (n ≤ 30), and patient-family carer dyads (n ≤ 60) from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service-users and policy-makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice, and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of a realist methodology and co-production to inform evidence-based recommendations that consider the needs and priorities of clinicians and people affected by stroke.
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Affiliation(s)
- Niki Chouliara
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham NG7 2TU, UK
| | - Trudi Cameron
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham NG7 2TU, UK
| | | | | | - Jade Kettlewell
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
| | - Lisa Kidd
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow G4 0BA, UK;
| | - Leanna Luxton
- Northampton General Hospital NHS Trust, Northampton NN1 5BD, UK;
| | - Valerie Pomeroy
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK;
| | - Rachel C. Stockley
- School of Nursing and Midwifery, University of Central Lancashire, Lancashire PR1 2HE, UK;
| | - Shirley Thomas
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
| | - Adam L. Gordon
- School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK; (T.C.); (J.K.); (S.T.); (A.L.G.)
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham NG7 2TU, UK
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Ali A, Groot G, April M, MacPhee M, Witham S, Alimezelli H, Carr T. Understanding the impact of a residential housing program for people living with HIV/AIDS: results from a realist evaluation. BMJ Open 2024; 14:e075194. [PMID: 38740498 PMCID: PMC11097874 DOI: 10.1136/bmjopen-2023-075194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND In Canada, the Public Health Agency surveillance of new HIV cases has demonstrated annual increasing rates since 2020. The rates of new HIV cases are highest in the province of Saskatchewan. OBJECTIVES The aim of the project was to conduct a resident-oriented realist evaluation of an innovative supportive housing programme, Sanctum, for people living with HIV/AIDS who also face social care issues, such as homelessness. This project took place in Saskatchewan, a province that is seeking innovative approaches to improve quality of life and HIV/AIDS management for its citizens. Our evaluation addressed how and why participants were successful (or not) within the Sanctum programme. DESIGN AND SETTING Sanctum is a housing programme located in an inner-city location within the province of Saskatchewan. A unique component of this evaluation was the inclusion of an individual with lived experience, a resident partner, as a member of the research team. PARTICIPANTS 11 recent Sanctum graduates, seven men and four women, were recruited for client partner-led in-depth, semistructured interviews. INTERVENTIONS Prior to the evaluation, we developed a realist programme theory with potential causal explanations, known as context-mechanism-outcomes (CMO) configurations. Interview data from the evaluation and ongoing discussions with Sanctum board members and our resident partner were used to test, refine and validate the final programme theory and CMO configurations. RESULTS CMO configurations at the micro (individual), meso (interpersonal) and macro (community) levels complement the over-arching programme theory. Key findings were the importance of Sanctum's harm reduction philosophy, accompanied by a non-judgmental and patient-oriented approach. Participants were supported to reduce risky behaviour, improve self-care management and develop healthier relationships within a 'safe' home-like setting. Underlying mechanisms that contributed to participants' success in the programme included: intrinsic motivation, self-worth, belongingness, empowerment and self-efficacy. Evidence-informed recommendations are offered to support Sanctum-like programme development for individuals with holistic health needs related to HIV/AIDS diagnoses and lack of access to necessary social determinants of health. CONCLUSIONS Stigma associated with HIV/AIDS and living circumstances, such as homelessness, were successfully addressed using harm reduction principles and judgement-free approaches within a family-like environment.
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Affiliation(s)
- Anum Ali
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Gary Groot
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Melissa April
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Maura MacPhee
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Hubert Alimezelli
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Tracey Carr
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Marshall P, Booth M, Coole M, Fothergill L, Glossop Z, Haines J, Harding A, Johnston R, Jones S, Lodge C, Machin K, Meacock R, Nielson K, Puddephatt JA, Rakic T, Rayson P, Robinson H, Rycroft-Malone J, Shryane N, Swithenbank Z, Wise S, Lobban F. Understanding the Impacts of Online Mental Health Peer Support Forums: Realist Synthesis. JMIR Ment Health 2024; 11:e55750. [PMID: 38722680 PMCID: PMC11117133 DOI: 10.2196/55750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation. OBJECTIVE This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users. METHODS We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff. RESULTS Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users' perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety. CONCLUSIONS This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability. TRIAL REGISTRATION PROSPERO CRD42022352528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=352528.
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Affiliation(s)
- Paul Marshall
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Millissa Booth
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Matthew Coole
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Lauren Fothergill
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Zoe Glossop
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Jade Haines
- IT Corporate Services, Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Andrew Harding
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Rose Johnston
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Christopher Lodge
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Karen Machin
- Survivor Research Network, London, United Kingdom
| | - Rachel Meacock
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Kristi Nielson
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Jo-Anne Puddephatt
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Tamara Rakic
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Paul Rayson
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Heather Robinson
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Jo Rycroft-Malone
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Nick Shryane
- Social Statistics, University of Manchester, Manchester, United Kingdom
| | - Zoe Swithenbank
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Sara Wise
- IT Corporate Services, Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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Tate K, Penconek T, Booth A, Harvey G, Flynn R, Lalleman P, Wolbers I, Hoben M, Estabrooks CA, Cummings GG. Contextually appropriate nurse staffing models: a realist review protocol. BMJ Open 2024; 14:e082883. [PMID: 38719308 PMCID: PMC11086385 DOI: 10.1136/bmjopen-2023-082883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Decisions about nurse staffing models are a concern for health systems globally due to workforce retention and well-being challenges. Nurse staffing models range from all Registered Nurse workforce to a mix of differentially educated nurses and aides (regulated and unregulated), such as Licensed Practical or Vocational Nurses and Health Care Aides. Systematic reviews have examined relationships between specific nurse staffing models and client, staff and health system outcomes (eg, mortality, adverse events, retention, healthcare costs), with inconclusive or contradictory results. No evidence has been synthesised and consolidated on how, why and under what contexts certain staffing models produce different outcomes. We aim to describe how we will (1) conduct a realist review to determine how nurse staffing models produce different client, staff and health system outcomes, in which contexts and through what mechanisms and (2) coproduce recommendations with decision-makers to guide future research and implementation of nurse staffing models. METHODS AND ANALYSIS Using an integrated knowledge translation approach with researchers and decision-makers as partners, we are conducting a three-phase realist review. In this protocol, we report on the final two phases of this realist review. We will use Citation tracking, tracing Lead authors, identifying Unpublished materials, Google Scholar searching, Theory tracking, ancestry searching for Early examples, and follow-up of Related projects (CLUSTER) searching, specifically designed for realist searches as the review progresses. We will search empirical evidence to test identified programme theories and engage stakeholders to contextualise findings, finalise programme theories document our search processes as per established realist review methods. ETHICS AND DISSEMINATION Ethical approval for this study was provided by the Health Research Ethics Board of the University of Alberta (Study ID Pro00100425). We will disseminate the findings through peer-reviewed publications, national and international conference presentations, regional briefing sessions, webinars and lay summary.
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Affiliation(s)
- Kaitlyn Tate
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Tatiana Penconek
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew Booth
- School of Medicine and Population Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Flynn
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Inge Wolbers
- University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Matthias Hoben
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Carole A Estabrooks
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Greta G Cummings
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Fitzmaurice Y, Beeke S, Isaksen J, Cunningham U, Jagoe C, Shé ÉN, McMenamin R. Communication partner training for student health and social care professionals engaging with people with stroke acquired communication difficulties: A protocol for a realist review. HRB Open Res 2024; 6:60. [PMID: 38384971 PMCID: PMC10879762 DOI: 10.12688/hrbopenres.13783.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 02/23/2024] Open
Abstract
Background Stroke acquired communication impairments impede effective communication. Consequently, in stroke care, communicative interactions can be challenging for both patients and staff and can predispose patients to increased risk of preventable adverse events. Communication partner training (CPT) can mitigate such negative outcomes by optimising communicative interactions. Providing CPT to student health and social care professionals (SH&SCPs) has the potential to enhance their clinical expertise and experiences and enhance the future clinical care of patients with stroke acquired communication impairments. This research aims to expand our understanding of how CPT is operationalised for SH&SCPs in higher education institutions and determine: what works; for whom; in what contexts; how and why? Methods This review is Phase 1 of a research project employing a realist approach with public and patient involvement (PPI). It incorporates five iterative steps: 1.) Clarifying the scope; 2.) Searching for evidence; 3.) Selecting and appraising evidence; 4.) Data extraction; 5.) Synthesising data and developing a middle range theory explaining how CPT is expected to work for SH&SCPs. An advisory panel, including PPI advisors, content advisors, student advisors, realist advisors and educationalist advisor has been set up to consult throughout the review and collaboratively agree the middle range theory. Discussion While there is an evolving evidence base for CPT, including stroke specific CPT for SH&SCPs, it is acknowledged that there are challenges to its implementation in complex real-world settings. In combining empirical evidence with theoretical understanding, realist review permits synthesis of data from diverse sources and goes beyond determining efficacy to explore generative causation and solutions for real world practice. A middle range realist programme theory that coherently explains how CPT is expected to work when teaching SH&SCPs to communicate with people with stroke acquired communication impairments will provide educators with new insights into CPT development and implementation in their higher education institutions.
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Affiliation(s)
- Yvonne Fitzmaurice
- School of Health Sciences, University of Galway, Galway, H91 TK33, Ireland
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, England, WC1E 6BT, UK
| | - Jytte Isaksen
- Department of Language, Culture, History and Communication, University of Souhern Denmark, Odense, Denmark
| | - Una Cunningham
- Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
| | - Caroline Jagoe
- School of Linguistics, Speech and Communication Sciences, The University of Dublin Trinity College, Dublin, Leinster, D02 PN40, Ireland
- Speech Pathology and Audiology, School of Human and Communication Development, University of Witwatersrand, Johannesburg, South Africa
| | - Éidín Ní Shé
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, D02 YN77, Ireland
| | - Ruth McMenamin
- School of Health Sciences, University of Galway, Galway, H91 TK33, Ireland
- PPI Ignite Network @ University of Galway, University of Galway, Galway, H91 TK33, Ireland
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Duprez V, Dhont L, van der Cingel M, Hafsteinsdóttir TB, Malfait S. Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review. J Adv Nurs 2024; 80:1248-1261. [PMID: 37849078 DOI: 10.1111/jan.15902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
AIM To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies. DESIGN Realist review according to the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). DATA SOURCES PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022. REVIEW METHODS Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group. RESULTS Multiple context-mechanism-outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only. CONCLUSIONS A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies. IMPACT Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated. NO PATIENT OR PUBLIC CONTRIBUTION Prospero ID CRD42021292290.
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Affiliation(s)
- Veerle Duprez
- Department of Nursing, Ghent University Hospital, Ghent, Belgium
| | - Laure Dhont
- Department of Nursing, Ghent University Hospital, Ghent, Belgium
| | - Margreet van der Cingel
- Professorship Nursing Leadership and Research, NHL-Stenden University of Applied Sciences and Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Thóra B Hafsteinsdóttir
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Simon Malfait
- Department of Nursing, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and health sciences, Ghent University, Ghent, Belgium
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Shukla S, Abejirinde IOO, Meyer SR, Shenderovich Y, Steinert JI. Mechanisms behind gender transformative approaches targeting adolescent pregnancy in low- and middle-income countries: a realist synthesis protocol. Syst Rev 2024; 13:95. [PMID: 38521961 PMCID: PMC10960499 DOI: 10.1186/s13643-024-02513-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/13/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Adolescent pregnancy is defined as pregnancy at the age of 19 or below. Pregnancy and childbirth complications are the most significant cause of death among 15-19-year-old girls. Several studies have indicated that inequitable gender norms can increase the vulnerability of adolescent girls, including violence exposure, early marriage, and adolescent pregnancy. To address these disparities, gender transformative approaches aim to challenge and transform restrictive gender norms, roles, and relations through targeted interventions, promoting progressive changes. This realist review aims to synthesise existing evidence from a broad range of data sources to understand how, why, for whom, and in what contexts gender transformative approaches succeed in reducing adolescent pregnancy in low- and middle-income countries. METHOD AND ANALYSIS We employ a five-step realist synthesis approach: (1) clarify the scope of review and assessment of published literature, (2) development of initial programme theories, (3) systematic search for evidence, (4) development of refined programme theories, and (5) expert feedback and dissemination of results. This protocol presents the results of the first three steps and provides details of the next steps. We extracted data from 18 studies and outlined eight initial programme theories on how gender transformative approaches targeting adolescent pregnancy work in the first three steps. These steps were guided by experts in the field of sexual and reproductive health, implementation science, and realist methodology. As a next step, we will systematically search evidence from electronic databases and grey literature to identify additional studies eligible to refine the initial programme theories. Finally, we will propose refined programme theories that explain how gender transformative approaches work, why, for whom, and under which circumstances. ETHICS AND DISSEMINATION Ethics approval is not required because the included studies are published articles and other policy and intervention reports. Key results will be shared with the broader audience via academic papers in open-access journals, conferences, and policy recommendations. The protocol for this realist review is registered in PROSPERO (CRD42023398293).
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Affiliation(s)
- Shruti Shukla
- TUM School of Social Sciences and Technology, Technical University of Munich, München, 80333, Germany.
| | - Ibukun-Oluwa Omolade Abejirinde
- Division of Social and Behavioural Health Sciences, University of Toronto Dalla Lana School of Public Health and Women's College Hospital Research Institute, Toronto, Ontario, Canada
| | - Sarah R Meyer
- Institute for Medical Information Processing, Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Biometry, and Epidemiology, Munich, Germany
| | - Yulia Shenderovich
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Janina Isabel Steinert
- TUM School of Social Sciences and Technology, Technical University of Munich, München, 80333, Germany
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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McCormack Z, Kerr A, Simpson A, Keating D, Strawbridge J. What works for whom, how and why in mental health education for undergraduate health profession students? A realist synthesis protocol. BMJ Open 2024; 14:e078130. [PMID: 38471690 PMCID: PMC10936517 DOI: 10.1136/bmjopen-2023-078130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION It has been shown that mental health education can support positive attitudes of health profession students towards people with mental health challenges, which supports them to provide optimal healthcare to this group. There are many different approaches to designing and delivering mental health education to health profession students. Each has their own advantages and disadvantages, and often mental health education programmes incorporate a multimodal approach in order to reap the benefits of a variety of teaching and learning approaches. The aim of this study is to understand the current landscape of teaching and learning approaches to mental health education for undergraduate health profession students. We will examine the features of successful outcomes for health profession students for:Learning environment.Knowledge development and retention.Confidence. MOTIVATION Preparedness for professional practice. METHODS For this, a realist synthesis has been chosen in order to review the literature. Realist synthesis lends itself to the review of complex interventions such as mental health education for undergraduate health profession curricula because it seeks to uncover the range of different mechanisms and context configurations that produce different outcomes. Health profession education and education practice, in general, is complex. A patient and public involvement (PPI) group is involved throughout this study and includes undergraduate health profession students, and members of the St John of Gods Hospital Consumers and Carers Council who are involved at every stage of the research. This study will engage with a stakeholder group who will support the refining of the programme theory. ETHICS AND DISSEMINATION Ethical approval has been sought and approved by Royal College of Surgeons, Ireland Ethical Committee (REC number: 212622783). We will aim to write up and publish the full synthesis as a journal article. We will also discuss ways of dissemination outside of academia with our PPI group.
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Affiliation(s)
- Zoe McCormack
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aisling Kerr
- School of Pharmacy Practice, Robert Gordon University, Aberdeen, UK
| | - Andrew Simpson
- Library Services, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dolores Keating
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- Pharmacy Department, Saint John of God Hospitaller Services, Dublin, Ireland
| | - Judith Strawbridge
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Bosongo S, Belrhiti Z, Chenge F, Criel B, Coppieters Y, Marchal B. The role of provincial health administration in supporting district health management teams in the Democratic Republic of Congo: eliciting an initial programme theory of a realist evaluation. Health Res Policy Syst 2024; 22:29. [PMID: 38378688 PMCID: PMC10880215 DOI: 10.1186/s12961-024-01115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND In 2006, the Ministry of Health in the Democratic Republic of Congo designed a strategy to strengthen the health system by developing health districts. This strategy included a reform of the provincial health administration to provide effective technical support to district health management teams in terms of leadership and management. The provincial health teams were set up in 2014, but few studies have been done on how, for whom, and under what circumstances their support to the districts works. We report on the development of an initial programme theory that is the first step of a realist evaluation seeking to address this knowledge gap. METHODS To inform the initial programme theory, we collected data through a scoping review of primary studies on leadership or management capacity building of district health managers in sub-Saharan Africa, a review of policy documents and interviews with the programme designers. We then conducted a two-step data analysis: first, identification of intervention features, context, actors, mechanisms and outcomes through thematic content analysis, and second, formulation of intervention-context-actor-mechanism-outcome (ICAMO) configurations using a retroductive approach. RESULTS We identified six ICAMO configurations explaining how effective technical support (i.e. personalised, problem-solving centred and reflection-stimulating) may improve the competencies of the members of district health management teams by activating a series of mechanisms (including positive perceived relevance of the support, positive perceived credibility of provincial health administration staff, trust in provincial health administration staff, psychological safety, reflexivity, self-efficacy and perceived autonomy) under specific contextual conditions (including enabling learning environment, integration of vertical programmes, competent public health administration staff, optimal decision space, supportive work conditions, availability of resources and absence of negative political influences). CONCLUSIONS We identified initial ICAMO configurations that explain how provincial health administration technical support for district health management teams is expected to work, for whom and under what conditions. These ICAMO configurations will be tested in subsequent empirical studies.
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Affiliation(s)
- Samuel Bosongo
- Faculté de Médecine et Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of Congo.
- École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
- Institute of Tropical Medicine, Antwerp, Belgium.
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Democratic Republic of Congo.
| | - Zakaria Belrhiti
- Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco
- Centre Mohammed VI de la Recherche et Innovation (CM6), Rabat, Morocco
| | - Faustin Chenge
- Faculté de Médecine et Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of Congo
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Democratic Republic of Congo
- Ecole de Santé Publique, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Bart Criel
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Yves Coppieters
- École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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Knight L, Neiva Ganga R, Tucker M. Integrated care system leadership: a rapid realist review. Leadersh Health Serv (Bradf Engl) 2024; ahead-of-print. [PMID: 38345072 DOI: 10.1108/lhs-12-2023-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
PURPOSE Given the complex nature of integrated care systems (ICSs), the geographical spread and the large number of organisations involved in partnership delivery, the importance of leadership cannot be overstated. This paper aims to present novel findings from a rapid realist review of ICS leadership in England. The overall review question was: how does leadership in ICSs work, for whom and in what circumstances? DESIGN/METHODOLOGY/APPROACH Development of initial programme theories and associated context-mechanism-outcome configurations (CMOCs) were supported by the theory-gleaning activities of a review of ICS strategies and guidance documents, a scoping review of the literature and interviews with key informants. A refined programme theory was then developed by testing these CMOCs against empirical data published in academic literature. Following screening and testing, six CMOCs were extracted from 18 documents. The study design, conduct and reporting were informed by the Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) training materials (Wong et al., 2013). FINDINGS The review informed four programme theories explaining that leadership in ICSs works when ICS leaders hold themselves and others to account for improving population health, a sense of purpose is fostered through a clear vision, partners across the system are engaged in problem ownership and relationships are built at all levels of the system. RESEARCH LIMITATIONS/IMPLICATIONS Despite being a rigorous and comprehensive investigation, stakeholder input was limited to one ICS, potentially restricting insights from varied geographical contexts. In addition, the recent establishment of ICSs meant limited literature availability, with few empirical studies conducted. Although this emphasises the importance and originality of the research, this scarcity posed challenges in extracting and applying certain programme theory elements, particularly context. ORIGINALITY/VALUE This review will be of relevance to academics and health-care leaders within ICSs in England, offering critical insights into ICS leadership, integrating diverse evidence to develop new evidence-based recommendations, filling a gap in the current literature and informing leadership practice and health-care systems.
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Affiliation(s)
- Lisa Knight
- Liverpool Business School, Liverpool John Moores University, Liverpool, UK
| | | | - Matthew Tucker
- Liverpool Business School, Liverpool John Moores University, Liverpool, UK
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Klingberg S, Adhikari B, Draper CE, Bosire E, Nyirenda D, Tiigah P, Mukumbang FC. Enhanced or hindered research benefits? A realist review of community engagement and participatory research practices for non-communicable disease prevention in low- and middle-income countries. BMJ Glob Health 2024; 9:e013712. [PMID: 38341191 PMCID: PMC10862340 DOI: 10.1136/bmjgh-2023-013712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Community engagement and participatory research are widely used and considered important for ethical health research and interventions. Based on calls to unpack their complexity and observed biases in their favour, we conducted a realist review with a focus on non-communicable disease prevention. The aim was to generate an understanding of how and why engagement or participatory practices enhance or hinder the benefits of non-communicable disease research and interventions in low- and middle-income countries. METHODS We retroductively formulated theories based on existing literature and realist interviews. After initial searches, preliminary theories and a search strategy were developed. We searched three databases and screened records with a focus on theoretical and empirical relevance. Insights about contexts, strategies, mechanisms and outcomes were extracted and synthesised into six theories. Five realist interviews were conducted to complement literature-based theorising. The final synthesis included 17 quality-appraised articles describing 15 studies. RESULTS We developed six theories explaining how community engagement or participatory research practices either enhance or hinder the benefits of non-communicable disease research or interventions. Benefit-enhancing mechanisms include community members' agency being realised, a shared understanding of the benefits of health promotion, communities feeling empowered, and community members feeling solidarity and unity. Benefit-hindering mechanisms include community members' agency remaining unrealised and participation being driven by financial motives or reputational expectations. CONCLUSION Our review challenges assumptions about community engagement and participatory research being solely beneficial in the context of non-communicable disease prevention in low- and middle-income countries. We present both helpful and harmful pathways through which health and research outcomes are affected. Our practical recommendations relate to maximising benefits and minimising harm by addressing institutional inflexibility and researcher capabilities, managing expectations on research, promoting solidarity in solving public health challenges and sharing decision-making power.
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Affiliation(s)
- Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Edna Bosire
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Deborah Nyirenda
- Community Engagement & Bioethics, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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Wood L, Foster NE, Dean SG, Booth V, Hayden JA, Booth A. Contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain: a realist review. Br J Sports Med 2024; 58:222-230. [PMID: 38176852 DOI: 10.1136/bjsports-2023-107598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Therapeutic exercises are a core treatment for low back pain (LBP), but it is uncertain how rehabilitative exercise facilitates change in outcomes. Realist reviews explore how the context (C) of certain settings or populations and underlying mechanisms (M) create intended or unintended outcomes (O). Our objective was to explore and understand the behavioural mechanisms by which therapeutic exercise creates change in outcomes of adherence, engagement and clinical outcomes for patients with LBP. METHODS This was a realist review reported following the Realist and Meta-narrative Evidence Syntheses: Evolving Standards guidance. We developed initial programme theories, modified with input from a steering group (experts, n=5), stakeholder group (patients and clinicians, n=10) and a scoping search of the published literature (n=37). Subsequently, an information specialist designed and undertook an iterative search strategy, and we refined and tested CMO configurations. RESULTS Of 522 initial papers identified, 75 papers were included to modify and test CMO configurations. We found that the patient-clinician therapeutic consultation builds a foundation of trust and was associated with improved adherence, engagement and clinical outcomes, and that individualised exercise prescription increases motivation to adhere to exercise and thus also impacts clinical outcomes. Provision of support such as timely follow-up and supervision can further facilitate motivation and confidence to improve adherence to therapeutic exercises for LBP. CONCLUSIONS Engagement in and adherence to therapeutic exercises for LBP, as well as clinical outcomes, may be optimised using mechanisms of trust, motivation and confidence. These CMO configurations provide a deeper understanding of ways to optimise exercise prescription for patients with LBP.
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Affiliation(s)
- Lianne Wood
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Queensland, Australia
| | | | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Booth
- Information Resources Group, University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
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Wood L, Booth V, Dean S, Foster NE, Hayden JA, Booth A. Understanding how therapeutic exercise prescription changes outcomes important to patients with persistent non-specific low back pain: a realist review protocol. Syst Rev 2024; 13:63. [PMID: 38331838 PMCID: PMC10854159 DOI: 10.1186/s13643-024-02466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/20/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Persistent low back pain (LBP) is the leading cause of disability worldwide, and therapeutic exercise is recommended as a first-line treatment in international guidelines. The effects of exercise on clinical outcomes of pain and physical function are small to moderate, despite broader impacts on cardiovascular systems, biological health, mood, and emotional well-being. Therapeutic exercise prescription is defined as exercise that is prescribed by a clinician for a health-related treatment. It is unknown how therapeutic exercise prescription creates effects on outcomes of importance. Realist reviews explore how underlying mechanisms (M) may be active in the context (C) of certain situations, settings, or populations to create an intended or unintended outcome (O). Our objective is to explore and understand the mechanisms by which therapeutic exercise prescription changes outcomes for people with persistent LBP. METHODS We will develop initial programme theories based on preliminary data from a previous systematic review and consensus workshop. These theories will be modified with input from a steering group (experts), a stakeholder group (people with lived experience of exercise for persistent LBP and clinicians), and a scoping search of the published literature. An information specialist will design and undertake an iterative search strategy. These will be used to create CMO configurations, which will be refined and tested using the literature. The realist review will be reported following RAMESES guidance. DISCUSSION Realist reviews are uncommon in LBP research to date, yet those offer an opportunity to contrast with traditional methods of randomised controlled trials and systematic reviews and provide additional information regarding the contexts and mechanisms that may trigger certain outcomes. This can aid our understanding of the contextual features that may influence exercise prescription, such as for whom they are most effective, in what setting, how they are implemented and why. This realist synthesis will enhance our understanding of therapeutic exercise prescription to improve adherence and engagement and ultimately will provide clinically relevant recommendations regarding exercise prescription for those with persistent LBP. SYSTEMATIC REVIEW REGISTRATION The review has been registered with PROSPERO (CRD42017072023).
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Affiliation(s)
- Lianne Wood
- Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences University of Exeter, Exeter, UK.
- Faculty of Medicine, University of Keele, Newcastle Under Lyme, UK.
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Sarah Dean
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Nadine E Foster
- Faculty of Medicine, University of Keele, Newcastle Under Lyme, UK
- Surgical, Treatment And Rehabilitation Service (STARS) Education and Research Alliance, Metro North Health and The University of Queensland, Brisbane, QLD, Australia
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Abbott P, Nixon G, Stanley I, D’Ambruoso L. A protocol for a critical realist synthesis of school mindfulness interventions designed to promote pupils' mental wellbeing. Front Public Health 2024; 11:1309649. [PMID: 38264247 PMCID: PMC10803664 DOI: 10.3389/fpubh.2023.1309649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction The review described in this protocol will be the first critical realist review of the literature reporting on the impact of school-based mindfulness interventions on the mental wellbeing of pupils. Mindfulness interventions are increasingly being introduced into schools to promote children's (and teachers') wellbeing. Findings from impact evaluations, including systematic reviews and metanalysis, suggest that school-based mindfulness interventions promote pupils' wellbeing. However, there is a need for further evidence on the underlying causal mechanisms and contexts that explain program outcomes, to provide insight into how mindfulness programs can be successfully implemented in other contexts. Methods and analysis A critical realist review methodology will be used to provide a causal interdisciplinary understanding of how school-based mindfulness interventions promote the mental wellbeing of pupils. This will be done through a systematic literature review and extrapolating context, agency, intervention, mechanisms, and outcome configurations. This will enable an understanding of how, in certain contexts, pupils can use the resources offered by a mindfulness intervention knowingly or unknowingly to trigger mechanisms that promote their mental wellbeing and what mechanisms in the context support, restrict or prevent change. We will then use retrodiction and retroduction to develop the most plausible interdisciplinary middle-range theory to explain the findings. Discussion The review findings will inform a critical realist evaluation of a mindfulness intervention in schools. The findings from the review will also enable us to inform policymakers and other stakeholders about what conditions need to be in place for mindfulness interventions to promote pupils' mental wellbeing. We will publish the findings from the review in academic and professional publications, policy briefs, workshops, conferences, and social media.PROSPERO registration number: CRD42023410484.
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Affiliation(s)
- Pamela Abbott
- Centre for Global Development, University of Aberdeen, Aberdeen, United Kingdom
- School of Education, University of Aberdeen, Aberdeen, United Kingdom
| | - Graeme Nixon
- Centre for Global Development, University of Aberdeen, Aberdeen, United Kingdom
- School of Education, University of Aberdeen, Aberdeen, United Kingdom
| | - Isabel Stanley
- Centre for Global Development, University of Aberdeen, Aberdeen, United Kingdom
- School of Education, University of Aberdeen, Aberdeen, United Kingdom
| | - Lucia D’Ambruoso
- Centre for Global Development, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, United Kingdom
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Tatton C, Lloyd J. Understanding for whom, under what conditions and how smoking cessation services for pregnant women in the United Kingdom work-a rapid realist review. BMC Public Health 2023; 23:2488. [PMID: 38087281 PMCID: PMC10717267 DOI: 10.1186/s12889-023-17378-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Maternal smoking in pregnancy is associated with several adverse maternal and infant health outcomes including increased risk of miscarriage, stillbirth, low birth weight, preterm birth, and asthma. Progress to reduce rates of smoking at time of delivery in England have been slow and over the last decade, less than half of pregnant women who accessed services went onto report having quit. This realist review was undertaken to improve the understanding of how smoking cessation services in pregnancy work and to understand the heterogeneity of outcomes observed. METHODS The initial programme theory was developed using the National Centre for Smoking Cession and Training Standard Treatment Programme for Pregnant Women and the National Institute for Health and Care Excellence guidance on treating tobacco dependency. A search strategy and inclusion criteria were developed. Four databases were searched to identify published papers and four websites were hand searched to identify any unpublished literature that could contribute to theory building. Realist logic was applied to the analysis of papers to identify the contexts in which the intended behaviour change mechanism(s) were triggered, or not, and towards what outcomes to develop context mechanism outcome configurations. RESULTS The review included 33 papers. The analysis produced 19 context mechanism outcome configurations structured under five closely interconnected domains (i) articulating harm, (ii) promoting support, (iii) managing cravings, (iv) maintaining commitment and (v) building self-efficacy. This review identifies two key processes involved in how services achieve their effects: how material resources are implemented and relationships. Of the two key processes identified, more existing literature was available evidencing how material resources are implemented. However, the review provides some evidence that non-judgemental and supportive relationships with healthcare workers where regular contact is provided can play an important role in interrupting the social cues and social practice of smoking, even where those around women continue to smoke. CONCLUSIONS This review clarifies the range of interconnected and bi-directional relationships between services and the personal and social factors in women's lives. It underscores the importance of aligning efforts across the models five domains to strengthen services' ability to achieve smoking cessation.
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Affiliation(s)
- Claire Tatton
- Faculty of Health and Life Sciences, Department of Health and Community Sciences, University of Exeter, Exeter, UK.
| | - Jenny Lloyd
- Faculty of Health and Life Sciences, Department of Health and Community Sciences, University of Exeter, Exeter, UK
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Aunger JA, Maben J, Abrams R, Wright JM, Mannion R, Pearson M, Jones A, Westbrook JI. Drivers of unprofessional behaviour between staff in acute care hospitals: a realist review. BMC Health Serv Res 2023; 23:1326. [PMID: 38037093 PMCID: PMC10687856 DOI: 10.1186/s12913-023-10291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Unprofessional behaviours (UB) between healthcare staff are rife in global healthcare systems, negatively impacting staff wellbeing, patient safety and care quality. Drivers of UBs include organisational, situational, team, and leadership issues which interact in complex ways. An improved understanding of these factors and their interactions would enable future interventions to better target these drivers of UB. METHODS A realist review following RAMESES guidelines was undertaken with stakeholder input. Initial theories were formulated drawing on reports known to the study team and scoping searches. A systematic search of databases including Embase, CINAHL, MEDLINE and HMIC was performed to identify literature for theory refinement. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories. RESULTS We included 81 reports (papers) from 2,977 deduplicated records of grey and academic reports, and 28 via Google, stakeholders, and team members, yielding a total of 109 reports. Five categories of contributor were formulated: (1) workplace disempowerment; (2) harmful workplace processes and cultures; (3) inhibited social cohesion; (4) reduced ability to speak up; and (5) lack of manager awareness and urgency. These resulted in direct increases to UB, reduced ability of staff to cope, and reduced ability to report, challenge or address UB. Twenty-three theories were developed to explain how these contributors work and interact, and how their outcomes differ across diverse staff groups. Staff most at risk of UB include women, new staff, staff with disabilities, and staff from minoritised groups. UB negatively impacted patient safety by impairing concentration, communication, ability to learn, confidence, and interpersonal trust. CONCLUSION Existing research has focused primarily on individual characteristics, but these are inconsistent, difficult to address, and can be used to deflect organisational responsibility. We present a comprehensive programme theory furthering understanding of contributors to UB, how they work and why, how they interact, whom they affect, and how patient safety is impacted. More research is needed to understand how and why minoritised staff are disproportionately affected by UB. STUDY REGISTRATION This study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490 .
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Affiliation(s)
- Justin Avery Aunger
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- NIHR Midlands Patient Safety Research Collaboration, University of Birmingham, Birmingham, UK.
| | - Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ruth Abrams
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Judy M Wright
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Aled Jones
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Govindaraj R, Agar M, Currow D, Luckett T. Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes. J Med Internet Res 2023; 25:e48483. [PMID: 38015606 PMCID: PMC10716761 DOI: 10.2196/48483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/13/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. OBJECTIVE This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes. METHODS A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool. RESULTS Overall, 61 studies were included in the realist synthesis: 15 (25%) mixed methods studies, 9 (15%) qualitative studies, 13 (21%) descriptive studies, 21 (34%) randomized controlled trials, and 3 (5%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions-remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload. CONCLUSIONS The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters.
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Affiliation(s)
- Ramkumar Govindaraj
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Meera Agar
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - David Currow
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Tim Luckett
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Fletcher K, Wydera S, Thorpe N, Radford K, das Nair R, Booth V. A rapid realist review of clinical neuropsychology rehabilitation programmes to improve psychological wellbeing and quality of life for people with acquired brain injuries. Neuropsychol Rehabil 2023:1-36. [PMID: 37975854 DOI: 10.1080/09602011.2023.2273580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 10/03/2023] [Indexed: 11/19/2023]
Abstract
Approximately 20% of acquired brain injury (ABI) survivors experience reduced psychological wellbeing (PWB). Neuropsychological rehabilitation (NPR) is one approach supporting people with ABI to participate meaningfully in activities despite challenges. Although literature supports NPR effectiveness, little is known about change mechanisms. This systematic realist review identifies what NPR programmes have been designed, delivered, and evaluated for people with ABI to improve PWB and/or quality of life (QOL), as well as providing a context-relevant understanding of what NPR includes and how NPR might lead to positive outcomes. A rapid realist review was conducted in three phases: (1) structured retrieval and evidence extraction; (2) stakeholder consultation; (3) analysis and synthesis. Searches were completed, and findings from 35 publications and one stakeholder consultation were synthesized into a refined logic model. Six context-mechanism-outcome chains (CMOCs) were identified. Participants' relationships to internal experiences, and feelings of self-worth, mastery, and connection appeared to be mechanisms that led to improved PWB and QOL. Adaptation and individualized programmes were also key mechanisms to explain successful NPR. Embedding CMOCs into NPR could improve PWB and/or QOL for people with ABI. The logic model will inform ongoing development of a new online, group-based, NPR programme.
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Affiliation(s)
- K Fletcher
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | | | - N Thorpe
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - K Radford
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - R das Nair
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- SINTEF, Trondheim, Norway
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - V Booth
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
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Maben J, Aunger JA, Abrams R, Wright JM, Pearson M, Westbrook JI, Jones A, Mannion R. Interventions to address unprofessional behaviours between staff in acute care: what works for whom and why? A realist review. BMC Med 2023; 21:403. [PMID: 37904186 PMCID: PMC10617100 DOI: 10.1186/s12916-023-03102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Unprofessional behaviour (UB) between staff encompasses various behaviours, including incivility, microaggressions, harassment, and bullying. UB is pervasive in acute healthcare settings and disproportionately impacts minoritised staff. UB has detrimental effects on staff wellbeing, patient safety and organisational resources. While interventions have been implemented to mitigate UB, there is limited understanding of how and why they may work and for whom. METHODS This study utilised a realist review methodology with stakeholder input to improve understanding of these complex context-dependent interventions. Initial programme theories were formulated drawing upon scoping searches and reports known to the study team. Purposive systematic searches were conducted to gather grey and published global literature from databases. Documents were selected if relevant to UB in acute care settings while considering rigour and relevance. Data were extracted from these reports, synthesised, and initial theories tested, to produce refined programme theories. RESULTS Of 2977 deduplicated records, 148 full text reports were included with 42 reports describing interventions to address UB in acute healthcare settings. Interventions drew on 13 types of behaviour change strategies and were categorised into five types of intervention (1) single session (i.e. one off); (2) multiple session; (3) single or multiple sessions combined with other actions (e.g. training sessions plus a code of conduct); (4) professional accountability and reporting programmes and; (5) structured culture change interventions. We formulated 55 context-mechanism-outcome configurations to explain how, why, and when these interventions work. We identified twelve key dynamics to consider in intervention design, including importance of addressing systemic contributors, rebuilding trust in managers, and promoting a psychologically safe culture; fifteen implementation principles were identified to address these dynamics. CONCLUSIONS Interventions to address UB are still at an early stage of development, and their effectiveness to reduce UB and improve patient safety is unclear. Future interventions should incorporate knowledge from behavioural and implementation science to affect behaviour change; draw on multiple concurrent strategies to address systemic contributors to UB; and consider the undue burden of UB on minoritised groups. STUDY REGISTRATION This study was registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO): https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490 .
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Affiliation(s)
- Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Justin Avery Aunger
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
- NIHR Midlands Patient Safety Research Collaboration, University of Birmingham, Birmingham, UK.
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Ruth Abrams
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Judy M Wright
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Aled Jones
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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Dugle G, Antwi J, Quentin W. Peer support interventions in maternal and child healthcare delivery in sub-Saharan Africa: protocol for a realist review. Syst Rev 2023; 12:199. [PMID: 37880778 PMCID: PMC10598906 DOI: 10.1186/s13643-023-02366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Peer support has been proposed as a promising policy intervention for addressing adverse maternal and child healthcare (MCH) outcomes in sub-Saharan Africa (SSA). Existing reviews on peer support largely draw on evidence from high-income countries or focus on single services like breastfeeding, nutrition or postnatal care. In contrast, this review aims to provide a comprehensive overview of the empirical literature on peer support interventions across various MCH services in sub-Saharan Africa. Specifically, we aim to understand how, why, for whom, and in what circumstances different forms of MCH peer support interventions contribute to improving healthcare outcomes in sub-Saharan Africa. METHODS This review follows five iterative steps for undertaking realist reviews (1) defining the review scope; (2) developing initial programme theories; (3) searching for evidence; (4) selecting and appraising evidence; and (5) extracting, analysing and synthesising evidence. Four databases-Cochrane Library, PubMed, CINAHL, and EMBASE-were repeatedly searched between March and June 2021. From a large volume of records retrieved from the database and citation search, 61 papers have been selected for review. We will conduct a second search of the same database covering June 2021 to the present before the final extraction and synthesis. The final list of selected papers will be imported into NVivo 12 software and organised, extracted, analysed and synthesised iteratively to examine and illustrate the causal links between contexts, mechanisms and outcomes of MCH peer support interventions in SSA. We have drawn on the existing literature on peer support in healthcare generally to develop initial programme theories. We will then use the empirical literature on MCH peer support interventions in SSA, inputs from a stakeholders' workshop in Ghana and a conference presentation to refine the initial programme theory. DISCUSSION The review will develop an explicit theory of peer support intervention in healthcare delivery and provide insights for developing evidence-informed policy on the intervention. Drawing lessons from the different national contexts and diverse areas of MCH in SSA, the review will provide an analytically generalizable programme theory that can guide intervention design and implementation. While focusing on MCH peer support interventions in SSA, the review contributes to evolving conversations on the use of theory for health policy planning and complex intervention design and implementation globally. TRIAL REGISTRATION PROSPERO registration ID: CRD42023427751 .
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Affiliation(s)
- Gordon Dugle
- School of Business, SD Dombo University of Business and Integrated Development Studies, Box UY 36, Wa, Ghana
| | - John Antwi
- School of Business, University for Development Studies, Post Office BOX 1350, Tamale, Ghana
| | - Wilm Quentin
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany.
- German West-African Centre of Global Health and Pandemic Prevention (G-WAC), Kwame Nkrumah University of Science and Technologies, Kumasi, Ghana.
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Dada S, Aivalli P, De Brún A, Barreix M, Chelwa N, Mutunga Z, Vwalika B, Gilmore B. Understanding communication in community engagement for maternal and newborn health programmes in low- and middle-income countries: a realist review. Health Policy Plan 2023; 38:1079-1098. [PMID: 37650702 PMCID: PMC10566325 DOI: 10.1093/heapol/czad078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
As community engagement (CE) is implemented for sustainable maternal and newborn health (MNH) programming, it is important to determine how these approaches work. Low- and middle-income countries (LMICs) have become a particular focus for MNH CE activities due to their high burden of maternal and neonatal deaths. MNH messaging and communication to engage communities are likely to differ by context, but how these approaches are actually developed and implemented within CE is not well understood. Understanding how communications in CE actually work is vital in the translation of learnings across programmes and to inform future projects. The purpose of this realist review is to describe how, why, to what extent and for whom communications in CE contribute to MNH programming in LMICs. After searching academic databases, grey literature and literature suggested by the expert advisory committee, documents were included if they described the CE communication processes/activities used for MNH programming in an LMIC. Relevant documents were assessed for richness (depth of insight) and rigor (trustworthiness and coherence of data/theories). Data were extracted as context-mechanism-outcome configurations (CMOCs) and synthesized into demi-regularities to contribute to theory refinement. After screening 416 records, 45 CMOCs were extracted from 11 documents. This informed five programme theories explaining that communications in CE for an MNH programme work when: communities are actively involved throughout the programme, the messaging and programme are acceptable, communication sources are trusted, the community has a reciprocal relationship with the programme and the community sees value in the programme. While these findings reflect what is often anecdotally known in CE or acknowledged in communications theory, they have implications for policy, practice and research by highlighting the importance of centring the community's needs and priorities throughout the stages of developing and implementing communications for CE in MNH.
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Affiliation(s)
- Sara Dada
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland
| | | | | | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
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Bird M, Côté-Boileau É, Wodchis WP, Jeffs L, MacPhee M, Shaw J, Austin T, Bruno F, Bhalla M, Gray CS. Exploring the impact of evaluation on learning and health innovation sustainability: protocol for a realist synthesis. Syst Rev 2023; 12:188. [PMID: 37803445 PMCID: PMC10557319 DOI: 10.1186/s13643-023-02348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Within the Learning Health System (LHS) model, learning routines, including evaluation, allow for continuous incremental change to take place. Within these learning routines, evaluation assists in problem identification, data collection, and data transformation into contextualized information, which is then re-applied to the LHS environment. Evaluation that catalyzes learning and improvement may also contribute to health innovation sustainability. However, there is little consensus as to why certain evaluations seem to support learning and sustainability, while others impede it. This realist synthesis seeks to understand the contextual factors and underlying mechanisms or drivers that best support health systems learning and sustainable innovation. METHODS This synthesis will be guided by Pawson and colleagues' 2005 and Emmel and colleagues' 2018 guidelines for conducting realist syntheses. The review process will encompass five steps: (1) scoping the review, (2) building theories, (3) identifying the evidence, (4) evidence selection and appraisal, and (5) data extraction and synthesis. An Expert Committee comprised of leaders in evaluation, innovation, sustainability, and realist methodology will guide this synthesis. Review findings will be reported using the RAMESES guidelines. DISCUSSION The use of a realist review will allow for exploration and theorizing about the contextual factors and underlying mechanisms that make evaluations 'work' (or 'not work') to support learning and sustainability. Depending on results, we will attempt to synthesize findings into a series of recommendations for evaluations with the intention to support health systems learning and sustainability. Finalized results will be presented at national and international conferences, as well as disseminated via a peer-reviewed publication. SYSTEMATIC REVIEW REGISTRATION This realist synthesis protocol has been registered with PROSPERO ( https://www.crd.york.ac.uk/prospero/ ID 382690).
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Affiliation(s)
- Marissa Bird
- Institute for Better Health, 100 Queensway West-Clinical, Administrative Building, 6Th Floor, Mississauga, ON, L5B 1B8, Canada.
- Institute of Health Policy Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Suite 425-155 College Street, Toronto, ON, M5T 3M6, Canada.
| | - Élizabeth Côté-Boileau
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, 7101 Av du Parc, Montréal, QC, H3N 1X9, Canada
| | - Walter P Wodchis
- Institute for Better Health, 100 Queensway West-Clinical, Administrative Building, 6Th Floor, Mississauga, ON, L5B 1B8, Canada
- Institute of Health Policy Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Suite 425-155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Lianne Jeffs
- Science of Care Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada
| | - Maura MacPhee
- Nursing-Applied Sciences, University of British Columbia, 239-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada
| | - James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Tujuanna Austin
- Institute of Health Policy Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Suite 425-155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Frances Bruno
- Institute of Health Policy Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Suite 425-155 College Street, Toronto, ON, M5T 3M6, Canada
- Science of Care Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada
| | - Megan Bhalla
- OPTI-Hex Lab, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada
| | - Carolyn Steele Gray
- Institute of Health Policy Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Suite 425-155 College Street, Toronto, ON, M5T 3M6, Canada
- Science of Care Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada
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Vaidya A, Simkhada P, Lee A, Jones S, Mukumbang FC. Implementing a package of essential non-communicable diseases interventions in low- and middle-income countries: a realist review protocol. BMJ Open 2023; 13:e074336. [PMID: 37775288 PMCID: PMC10546118 DOI: 10.1136/bmjopen-2023-074336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/20/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION The burden of non-communicable diseases (NCDs) is increasing rapidly, particularly in low- and middle-income countries (LMIC), accounting for 85% of premature deaths in the region. LMICs have been facing an increasing trend of a double burden of disease (infectious diseases and NCDs) that has led to multiple challenges in prioritising strategies for NCDs control amidst limited resources. Evidence indicates that measures such as the WHO's package of essential non-communicable (PEN) diseases interventions can prevent and control NCDs. However, because of the complexity of such health interventions, there is limited evidence that explains how the intervention works, for whom and in what context. We aim to unpack the causal mechanisms explaining how, why, for whom and in what context PEN prevents and controls NCDs. METHODS AND ANALYSIS We propose a realist review to understand how, why, for whom and under what circumstances PEN works or does not work. The review process includes five steps applied iteratively throughout the study: clarification of review scope, searching for evidence, appraising and extracting data, synthesising evidence and drawing conclusions, and disseminating the findings. Programme theories will be developed using the realist logic for theory formulation-Retroductive Theorising. The context-mechanism-outcome (CMO) heuristic tool will be used to develop the programme theories. Portions of the reviewed documents describing constructs of context, mechanism and outcomes will be coded inductively and extracted. These extracted constructs will then be linked abductively to formulate CMO configurations. ETHICS AND DISSEMINATION Formal ethical approval is not required for this review. Study findings will be disseminated through publications in peer-reviewed journals, conference presentations and formal and informal reports.
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Affiliation(s)
- Anju Vaidya
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Padam Simkhada
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Andrew Lee
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Susan Jones
- Health Sciences, University of Liverpool, Liverpool, UK
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