1
|
Mukherjee A, Yatirajula SK, Kallakuri S, Paslawar S, Lempp H, Raman U, Kumar A, Essue BM, Sagar R, Singh R, Peiris D, Norton R, Thornicroft G, Maulik PK. Protocol for process evaluation of ARTEMIS cluster randomised controlled trial: an intervention for management of depression and suicide among adolescents living in slums in India. BMJ Open 2024; 14:e081844. [PMID: 38772584 PMCID: PMC11110603 DOI: 10.1136/bmjopen-2023-081844] [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: 11/08/2023] [Accepted: 04/12/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION There are around 250 million adolescents (10-19 years) in India. The prevalence of mental health-related morbidity among adolescents in India is approximately 7.3%. Vulnerable subpopulations among adolescents such as those living in slum communities are particularly at risk due to poor living conditions, financial difficulty and limited access to support services. Adolescents' Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) is a cluster randomised controlled trial of an intervention that intends to improve the mental health of adolescents living in slum communities in India. The aim of this paper is to describe the process evaluation protocol for ARTEMIS trial. The process evaluation will help to explain the intervention outcomes and understand how and why the intervention worked or did not work. It will identify contextual factors, intervention barriers and facilitators and the adaptations required for optimising implementation. METHODS Case study method will be used and the data will include a mix of quantitative metrics and qualitative data. The UK Medical Research Council's guidance on evaluating complex interventions, the Reach, Efficacy, Adoption, Implementation and Maintenance Framework and the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Safety/Side Effects and, Equity criteria will be used to develop a conceptual framework and a priori codes for qualitative data analysis. Quantitative data will be analysed using descriptive statistics. Implementation fidelity will also be measured. DISCUSSION The process evaluation will provide an understanding of outcomes and causal mechanisms that influenced any change in trial outcomes. ETHICS AND DISSEMINATION Ethics Committee of the George Institute for Global Health India (project number 17/2020) and the Research Governance and Integrity Team, Imperial College, London (ICREC reference number: 22IC7718) have provided ethics approval. The Health Ministry's Screening Committee has approved to the study (ID 2020-9770). TRIAL REGISTRATION NUMBER CTRI/2022/02/040307.
Collapse
Affiliation(s)
| | | | | | | | - Heidi Lempp
- Inflammation Biology, King's College London, London, UK
| | - Usha Raman
- Department of Communication, University of Hyderabad, Hyderabad, India
| | - Ashok Kumar
- Dr.A.V. Baliga Memorial Trust, New Delhi, India
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | - David Peiris
- The George Institute for Global Health, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Norton
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Imperial College London, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pallab Kumar Maulik
- The George Institute for Global Health India, New Delhi, India
- University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Thienpondt A, Van Cauwenberg J, Van Damme J, Deforche B. Process evaluation of the Belgian one-month-without alcohol campaign 'Tournée Minérale': a mixed method approach. BMC Public Health 2024; 24:383. [PMID: 38317089 PMCID: PMC10840226 DOI: 10.1186/s12889-024-17941-z] [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: 06/12/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The Tournée Minérale campaign [TMC] is a mass media prevention campaign challenging Belgian adults to refrain from alcohol during one month. A process evaluation may help us better understand the effect of TMC and to formulate recommendations for future editions. The current study aimed to examine reach, experiences, perceived effectiveness and maintenance of TMC. METHODS A mixed method design was used to assess the process, using pre- and post-questionnaires (n = 49.022, 44.5 ± 13.1 years old, 37.0% men) and focus groups (n = 31, 47.3 ± 14.3 years old, 33.3% men). RESULTS Most campaign materials were considered useful and/or motivating. Facilitators for taking part in TMC were connectedness with other participants, stimulus control (e.g. removing alcohol at home) and a supportive social environment. Most difficulties were encountered with abstaining during social occasions as participants had to change a habit or find alternative non-alcoholic beverages. Participants reported both beneficial (e.g. sleeping better) and adverse effects (e.g. drinking more soft drinks). CONCLUSIONS Future editions of TMC should try to decrease perceived adverse effects (e.g. by providing attractive non-alcoholic beverages) and can benefit from having a forum where people can share experiences.
Collapse
Affiliation(s)
- Annelies Thienpondt
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, B- 9000, Belgium.
| | - Jelle Van Cauwenberg
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, B- 9000, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Joris Van Damme
- Flemish expertise centre on alcohol and other drugs, Vanderlindestraat 15, Schaarbeek, 1030, Belgium
| | - Benedicte Deforche
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, B- 9000, Belgium
- Movement and Nutrition for Health and Performance Research Unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, B-1050, Belgium
| |
Collapse
|
3
|
Jordan J, Tume L, Clarke M, McAuley D, McDowell C, McIlmurray L, Morris K, Peters M, Walsh T, Blackwood B. Delivery of a novel intervention to facilitate liberation from mechanical ventilation in paediatric intensive care: A process evaluation. PLoS One 2023; 18:e0293063. [PMID: 38011103 PMCID: PMC10681213 DOI: 10.1371/journal.pone.0293063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/04/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Prolonged mechanical ventilation increases the risk of mortality and morbidity. Optimising sedation and early testing for possible liberation from invasive mechanical ventilation (IMV) has been shown to reduce time on the ventilator. Alongside a multicentre trial of sedation and ventilation weaning, we conducted a mixed method process evaluation to understand how the intervention content and delivery was linked to trial outcomes. METHODS 10,495 children admitted to 18 paediatric intensive care units (ICUs) in the United Kingdom participated in a stepped-wedge, cluster randomised controlled trial, with 1955 clinical staff trained to deliver the intervention. The intervention comprised assessment and optimisation of sedation levels, and bedside screening of respiratory parameters to indicate readiness for a spontaneous breathing trial prior to liberation from ventilation. 193 clinical staff were interviewed towards the end of the trial. Interview data were thematically analysed, and quantitative adherence data were analysed using descriptive statistics. RESULTS The intervention led to a reduced duration of IMV (adjusted median difference- 7.1 hours, 95% CI -9.6 to -5.3, p = 0.01). Overall intervention adherence was 75% (range 59-85%). Ease and flexibility of the intervention promoted it use; designated responsibilities, explicit pathways of decision-making and a shared language for communication fostered proactivity and consistency towards extubation. Delivery of the intervention was hindered by established hospital and unit organisational and patient care routines, clinician preference and absence of clinical leadership. CONCLUSIONS The SANDWICH trial showed a significant, although small, reduction in duration of IMV. Findings suggest that greater direction in decision-making pathways, robust embedment of new practice in unit routine, and capitalising on the skills of Advanced Nurse Practitioners and physiotherapists would have contributed to greater intervention effect. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN16998143.
Collapse
Affiliation(s)
- Joanne Jordan
- School of Health, Wellbeing and Social Care, Open University, Milton Keynes, England
| | - Lyvonne Tume
- Faculty of Heath, Social Care & Medicine, Edge Hill University, Ormskirk, England
- PICU, Alder Hey Children’s NHS Trust, Liverpool, England
| | - Mike Clarke
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland
| | - Danny McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - Cliona McDowell
- Northern Ireland Clinical Trials Unit, Royal Hospitals, Belfast, Northern Ireland
| | - Lisa McIlmurray
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - Kevin Morris
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, England
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Mark Peters
- Great Ormond Street Institute of Child Health, NIHR Biomedical Research Centre, University College London, London, England
- Great Ormond Street Hospital, London, England
| | - Timothy Walsh
- Institute of Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| |
Collapse
|
4
|
Williams A, Lennox L, Harris M, Antonacci G. Supporting translation of research evidence into practice-the use of Normalisation Process Theory to assess and inform implementation within randomised controlled trials: a systematic review. Implement Sci 2023; 18:55. [PMID: 37891671 PMCID: PMC10612208 DOI: 10.1186/s13012-023-01311-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The status of randomised controlled trials (RCTs) as the 'gold standard' for evaluating efficacy in healthcare interventions is increasingly debated among the research community, due to often insufficient consideration for implementation. Normalisation Process Theory (NPT), which focuses on the work required to embed processes into practice, offers a potentially useful framework for addressing these concerns. While the theory has been deployed in numerous RCTs to date, more work is needed to consolidate understanding of if, and how, NPT may aid implementation planning and processes within RCTs. Therefore, this review seeks to understand how NPT contributes to understanding the dynamics of implementation processes within RCTs. Specifically, this review will identify and characterise NPT operationalisation, benefits and reported challenges and limitations in RCTs. METHODS A qualitative systematic review with narrative synthesis of peer-reviewed journal articles from eight databases was conducted. Studies were eligible for inclusion if they reported sufficient detail on the use of NPT within RCTs in a healthcare domain. A pre-specified data extraction template was developed based on the research questions of this review. A narrative synthesis was performed to identify recurrent findings. RESULTS Searches identified 48 articles reporting 42 studies eligible for inclusion. Findings suggest that NPT is primarily operationalised prospectively during the data collection stage, with limited sub-construct utilisation overall. NPT is beneficial in understanding implementation processes by aiding the identification and analysis of key factors, such as understanding intervention fidelity in real-world settings. Nearly three-quarters of studies failed to report the challenges and limitations of utilising NPT, though coding difficulties and data falling outside the NPT framework are most common. CONCLUSIONS NPT appears to be a consistent and generalisable framework for explaining the dynamics of implementation processes within RCTs. However, operationalisation of the theory to its full extent is necessary to improve its use in practice, as it is currently deployed in varying capacities. Recommendations for future research include investigation of NPT alongside other frameworks, as well as earlier operationalisation and greater use of NPT sub-constructs. TRIAL REGISTRATION The protocol for this systematic review was accepted for public registration on PROSPERO (registration number: CRD42022345427) on 26 July 2022.
Collapse
Affiliation(s)
- Allison Williams
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK.
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, Chelsea and Westminster Campus, London, SW10 9N, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, Chelsea and Westminster Campus, London, SW10 9N, UK
| |
Collapse
|
5
|
Walker RM, Chaboyer W, Cooke M, Whitty JA, Thalib L, Lockwood I, Latimer S, Campbell J, Probert R, Gillespie BM. EffEctiveness of Prophylactic fOam dressings in the prevention of saCral pressure injuries in at-risk hospitalised patients: the EEPOC trial. Trials 2023; 24:70. [PMID: 36721259 PMCID: PMC9887548 DOI: 10.1186/s13063-022-06999-y] [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: 11/01/2022] [Accepted: 12/08/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prophylactic dressings are increasingly used to prevent pressure injuries in hospitalised patients. However, evidence regarding the effectiveness of these dressings is still emerging. This trial aims to determine the clinical and cost-effectiveness of a prophylactic silicone foam border dressing in preventing sacral pressure injuries in medical-surgical patients. METHODS This is a multicentre, pragmatic, parallel group, randomised controlled trial. A sample size of 1320 was calculated to have >90% power to detect a 5% difference in the primary outcome at an alpha of 0.05. Adult patients admitted to participating medical-surgical wards are screened for eligibility: ≥18 years, admitted to hospital within the previous 36 h, expected length of stay of ≥24 h, and assessed high risk for hospital-acquired pressure injury. Consenting participants are randomly allocated to either prophylactic silicone foam dressing intervention or usual care without any dressing as the control group via a web-based randomisation service independent of the trial. Patients are enrolled across three Australian hospitals. The primary outcome is the cumulative incidence of patients who develop a sacral pressure injury. Secondary outcomes include the time to sacral pressure injury, incidence of severity (stage) of sacral pressure injury, cost-effectiveness of dressings, and process evaluation. Participant outcomes are assessed daily for up to 14 days by blinded independent outcome assessors using de-identified, digitally modified sacral photographs. Those who develop a sacral pressure injury are followed for an additional 14 days to estimate costs of pressure injury treatment. Analysis of clinical outcomes will be based on intention-to-treat, per-protocol, and sensitivity analyses. DISCUSSION This trial aims to provide definitive evidence on the effect prophylactic dressings have on the development of hospital-acquired sacral pressure injuries in medical-surgical patients. A parallel economic evaluation of pressure injury prevention and treatment will enable evidence-informed decisions and policy. The inclusion of a process evaluation will help to explain the contextual factors that may have a bearing on trial results including the acceptability of the dressings to patients and staff. The trial commenced 5 March 2020 and has been significantly delayed due to COVID-19. TRIAL REGISTRATION ANZCTR ACTRN12619000763145. Prospectively registered on 22 May 2019.
Collapse
Affiliation(s)
- R. M. Walker
- grid.412744.00000 0004 0380 2017NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia , Brisbane, Australia
| | - W. Chaboyer
- grid.1022.10000 0004 0437 5432NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - M. Cooke
- grid.1022.10000 0004 0437 5432School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - J. A. Whitty
- grid.8273.e0000 0001 1092 7967Health Economics Group, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - L. Thalib
- grid.449300.a0000 0004 0403 6369Department of Biostatistics, Faculty of Medicine, Istanbul Aydın University, Istanbul, Turkey
| | - I. Lockwood
- grid.1022.10000 0004 0437 5432Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - S. Latimer
- grid.1022.10000 0004 0437 5432School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University & Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia
| | - J. Campbell
- grid.1022.10000 0004 0437 5432NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - R. Probert
- grid.412744.00000 0004 0380 2017Stomal Therapy and Wound Management Department in the Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - B. M. Gillespie
- grid.1022.10000 0004 0437 5432NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| |
Collapse
|