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Bell AD, MacCallum C, Margolese S, Walsh Z, Wright P, Daeninck PJ, Mandarino E, Lacasse G, Kaur Deol J, de Freitas L, St. Pierre M, Belle-Isle L, Gagnon M, Bevan S, Sanchez T, Arlt S, Monahan-Ellison M, O'Hara J, Boivin M, Costiniuk C. Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions. Cannabis Cannabinoid Res 2024; 9:669-687. [PMID: 36971587 PMCID: PMC10998028 DOI: 10.1089/can.2021.0156] [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: 03/29/2023] Open
Abstract
Background: One in five individuals live with chronic pain globally, which often co-occurs with sleep problems, anxiety, depression, and substance use disorders. Although these conditions are commonly managed with cannabinoid-based medicines (CBM), health care providers report lack of information on the risks, benefits, and appropriate use of CBM for therapeutic purposes. Aims: We present these clinical practice guidelines to help clinicians and patients navigate appropriate CBM use in the management of chronic pain and co-occurring conditions. Materials and Methods: We conducted a systematic review of studies investigating the use of CBM for the treatment of chronic pain. Articles were dually reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical recommendations were developed based on available evidence from the review. Values and preferences and practical tips have also been provided to support clinical application. The GRADE system was used to rate the strength of recommendations and quality of evidence. Results: From our literature search, 70 articles met inclusion criteria and were utilized in guideline development, including 19 systematic reviews and 51 original research studies. Research typically demonstrates moderate benefit of CBM in chronic pain management. There is also evidence for efficacy of CBM in the management of comorbidities, including sleep problems, anxiety, appetite suppression, and for managing symptoms in some chronic conditions associated with pain including HIV, multiple sclerosis, fibromyalgia, and arthritis. Conclusions: All patients considering CBM should be educated on risks and adverse events. Patients and clinicians should work collaboratively to identify appropriate dosing, titration, and administration routes for each individual. Systematic Review Registration: PROSPERO no. 135886.
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Affiliation(s)
- Alan D. Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Caroline MacCallum
- Faculty of Medicine, Department of Internal Medicine, University of British Columbia, Vancouver, Canada
| | - Shari Margolese
- Canadian HIV Trials Network, University of British Columbia, Vancouver, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, Canada
| | | | - Paul J. Daeninck
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- CancerCare Manitoba, Winnipeg, Canada
| | - Enrico Mandarino
- Canadian HIV Trials Network, University of British Columbia, Vancouver, Canada
- MJardin Group Canada, Toronto, Canada
| | | | - Jagpaul Kaur Deol
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Lauren de Freitas
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
| | | | | | - Marilou Gagnon
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | | | - Tatiana Sanchez
- Department of Psychology, University of British Columbia, Kelowna, Canada
| | - Stephanie Arlt
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
| | | | | | | | - Cecilia Costiniuk
- Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
- McGill Cannabis Research Centre, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
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Rahtz E, Bell SL, Nurse A, Wheeler BW, Guell C, Elliott LR, Thompson CW, McDougall CW, Lovell R. What is known about what works in community-involved decision-making relating to urban green and blue spaces? A realist review protocol. Syst Rev 2023; 12:169. [PMID: 37730620 PMCID: PMC10512649 DOI: 10.1186/s13643-023-02333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND There is now a relatively well-established evidence base suggesting that greener living environments and time spent in urban green and blue spaces (UGBS) can be beneficial for human health and wellbeing. However, benefits are not universal and there remain widespread social inequalities in access to such resources and experiences, particularly along axes of class, race, ethnicity, age and disability, and in relation to efforts to increase the availability and accessibility of such spaces. These injustices often relate to distributive, procedural and recognition-based processes. There is growing interest in how to ensure that efforts to increase access to or use of UGBS (whether through infrastructural or social programmes) result in equitable outcomes whilst minimising potential for exacerbating existing inequalities and injustices. Community engagement is considered an important step towards more inclusive UGBS decision-making, from planning and design to management and maintenance processes. It is thought to contribute to better and more widely trusted decisions, enhanced democracy, community satisfaction, civic interest and feelings of green space ownership, and greater longevity of UGBS projects. However, uneven representation and barriers to participation can create imbalances and undermine these benefits. METHODS An iterative, multi-stage realist-inspired review will be conducted to ask what works, in what context and in what ways relating to the meaningful involvement of communities in UGBS decision-making, focusing on the skills, capacities and capabilities of different stakeholders and the role of contexts and processes. 'Effectiveness' (or what works) will be understood as a multifaceted outcome, encompassing both the processes and results of community engagement efforts. Following a scoping stage to identify initial programme theory, inclusion/exclusion criteria and derive search terms, relevant databases and grey literature will be searched to identify interdisciplinary literature in two phases. The first phase will be used to further develop programme theories, which will be articulated as 'if then' statements. The second phase searches will be used to identify sources to further explore and evidence the programme and formal theory. We will assess all includable evidence for conceptual richness, prioritising more conceptually rich sources if needed. DISCUSSION The realist synthesis will explore the key context, mechanism and outcome configurations that appear to explain if and how different approaches to community-involved UGBS decision-making are or are not effective. We will consider factors such as different conceptualisations of community, and if and how they have been involved in UGBS decision-making; the types of tools and approaches used; and the socio-cultural and political or governance structures within which decision-making takes place.
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Affiliation(s)
- Emmylou Rahtz
- European Centre for Environment and Human Health, University of Exeter Medical School, Peter Lanyon Building 12, Penryn, Cornwall, TR10 9FE, UK.
| | - Sarah L Bell
- European Centre for Environment and Human Health, University of Exeter Medical School, Peter Lanyon Building 12, Penryn, Cornwall, TR10 9FE, UK
| | - Alexander Nurse
- Department of Geography and Planning, Roxby Building, University of Liverpool, Liverpool, L69 7ZT, UK
| | - Benedict W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Peter Lanyon Building 12, Penryn, Cornwall, TR10 9FE, UK
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, Peter Lanyon Building 12, Penryn, Cornwall, TR10 9FE, UK
| | - Lewis R Elliott
- European Centre for Environment and Human Health, University of Exeter Medical School, Peter Lanyon Building 12, Penryn, Cornwall, TR10 9FE, UK
| | - Catharine Ward Thompson
- OPENspace Research Centre, University of Edinburgh, 74 Lauriston Place, Edinburgh, EH3 9DF, UK
| | - Craig W McDougall
- European Centre for Environment and Human Health, University of Exeter Medical School, Peter Lanyon Building 12, Penryn, Cornwall, TR10 9FE, UK
| | - Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, Peter Lanyon Building 12, Penryn, Cornwall, TR10 9FE, UK
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Duncan A, Stergiopoulos V, Dainty KN, Wodchis WP, Kirst M. Community mental health funding, stakeholder engagement and outcomes: a realist synthesis. BMJ Open 2023; 13:e063994. [PMID: 36725092 PMCID: PMC9896207 DOI: 10.1136/bmjopen-2022-063994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED Mental health services continues to be a high priority for healthcare and social service systems. Funding structures within community mental health settings have shown to impact service providers' behaviour and practices. Additionally, stakeholder engagement is suggested as an important mechanism to achieving the intended goals. However, the literature on community mental health funding reform and associated outcomes is inconsistent and there are no consistent best practices for stakeholder engagement in such efforts. OBJECTIVES This study sought to understand how stakeholder engagement impacts outcomes when there is a change in public funding within community mental health settings. DESIGN A realist synthesis approach was used to address the research question to fully understand the role of stakeholder engagement as a mechanism in achieving outcomes (system and service user) in the context of community mental health service reform. An iterative process was used to identify programme theories and context-mechanism-outcome configurations within the literature. RESULTS Findings highlight that in the absence of stakeholder engagement, funding changes may lead to negative outcomes. When stakeholders were engaged in some form, funding changes were more often associated with positive outcomes. Stakeholder engagement is multifaceted and requires considerable time and investment to support achieving intended outcomes when funding changes are implemented. CONCLUSIONS To support successful transformation of community mental health programmes, it is important that stakeholders are meaningfully engaged during funding allocation changes. Stakeholder engagement may entail connecting around a shared purpose, individual participation and meaningful interactions and dialogue.
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Affiliation(s)
- Andrea Duncan
- Department of Occupational Sciences & Occupational Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Leadership Team, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Katie N Dainty
- Patient Centred Outcomes, North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Maritt Kirst
- Community Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Burnette JL, Knouse LE, Billingsley J, Earl S, Pollack JM, Hoyt CL. A systematic review of growth mindset intervention implementation strategies. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2022. [DOI: 10.1111/spc3.12723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jeni L. Burnette
- College of Humanities and Social Sciences North Carolina State University Raleigh North Carolina USA
| | - Laura E. Knouse
- School of Arts and Sciences University of Richmond Richmond Virginia USA
| | - Joseph Billingsley
- School of Science and Engineering Tulane University New Orleans Louisiana USA
| | - Sydney Earl
- College of Humanities and Social Sciences North Carolina State University Raleigh North Carolina USA
| | - Jeffrey M. Pollack
- Poole College of Management North Carolina State University Raleigh North Carolina USA
| | - Crystal L. Hoyt
- Jepson School of Leadership Studies University of Richmond Richmond Virginia USA
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Deftereos I, Hitch D, Butzkueven S, Carter V, Arslan J, Fetterplace K, Fox K, Ottaway A, Pierce K, Steer B, Varghese J, Kiss N, Yeung J. Implementation of a standardised perioperative nutrition care pathway in upper gastrointestinal cancer surgery: a multi-site pilot study. J Hum Nutr Diet 2022; 36:479-492. [PMID: 35441757 DOI: 10.1111/jhn.13018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Perioperative nutrition support is recommended for patients undergoing upper gastrointestinal (UGI) cancer surgery; however, limited evidence exists regarding implementation of a nutrition care pathway in clinical practice. The aims of this pilot study were to determine if implementation of a standardised perioperative nutrition pathway for patients undergoing UGI cancer surgery improves access to dietetics care, and to evaluate study feasibility, fidelity, resource requirements and effect on clinical outcomes. METHODS Patients with newly diagnosed UGI cancer from four major metropolitan hospitals in Melbourne, planned for curative intent surgery, were included in the prospective pilot study (n=35), with historical controls (n=35) as standard care. Outcomes were dietetics care (dietetics contacts) nutritional status; hand grip strength; weight change; preoperative hospital admissions; complications and length of stay; recruitment feasibility; fidelity and adherence; and, resource requirements. Continuous data were analysed using independent samples t-test accounting for unequal variances or Mann-Whitney U test. Dichotomous data were analysed using Fisher's exact test. RESULTS The percentage of participants receiving preoperative dietetic intervention increased from 55% to 100% (p<0.001). Mean and standard deviation (SD) dietetics contacts increased from 2.2 (3.7) to 5.9 (3.9) (p<0.001). Non-statistically significant decreases in preoperative nutrition-related hospital admissions, and surgical complications were demonstrated in patients who underwent neoadjuvant therapy. Recruitment rate was 81%, and adherence to the nutrition pathway was high (>70% for all stages of the pathway). The mean estimated resource requirement for the preoperative period was 3.7 (2.8) hours per patient. CONCLUSION Implementation of this standardised nutrition pathway resulted in improved access to dietetics care. Recruitment feasibility and high fidelity to the intervention suggest that a larger study would be viable. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Irene Deftereos
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Danielle Hitch
- Allied Health, Western Health, Melbourne, Australia.,Occupational Therapy, Western Health, Melbourne, Australia
| | - Sally Butzkueven
- Department of Cancer Services, Western Health, Melbourne, Australia
| | - Vanessa Carter
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Janan Arslan
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine and Radiology, Melbourne Medical School, The University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Kate Fox
- Department of Nutrition and Dietetics, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Aurora Ottaway
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Kathryn Pierce
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Belinda Steer
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jessie Varghese
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Justin Yeung
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Western Health Chronic Disease Alliance, Western Health, Melbourne, Australia.,Department of Colorectal Surgery, Western Health, Melbourne, Australia
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Clinical guidelines for managing hearing loss as a complication of drug-resistant tuberculosis treatment: an evaluation of implementation fidelity in Kano, Nigeria. BMC Health Serv Res 2022; 22:142. [PMID: 35115002 PMCID: PMC8812187 DOI: 10.1186/s12913-022-07536-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Nigeria has a high burden of Tuberculosis (TB) including Drug-resistant Tuberculosis (DR-TB) and hearing loss. Despite several efforts directed toward its control, many patients fail to respond to treatment, having developed DR-TB. Lack of adherence to the DR-TB guidelines/improper implementation of the guideline has been identified as one of the factors impeding on effective treatment. This study sought to measure the implementation fidelity of health workers to management guidelines for hearing loss resulting from DR-TB treatment and to identify its determinants. Method A questionnaire-based cross-sectional study was conducted at the Infectious Disease Hospital, Kano. Implementation fidelity of the Programmatic Management guidelines for the treatment of Drug-resistant Tuberculosis was measured under the four domains of content, coverage, duration and frequency. The determinants examined are intervention complexity, facilitation strategies, quality of delivery and participant responsiveness as proposed by the Carroll et al. framework. Other determinants used are age, sex, professional cadre and work experience of healthcare providers. Results The Implementation fidelity score ranged from 40 to 64% with a mean of 47.6%. Quality of delivery, intervention complexity, participants’ responsiveness, and being a medical doctor exerted a positive effect on implementation fidelity while facilitation strategy, age and work experience exerted a negative effect on implementation fidelity. Conclusion The implementation fidelity of management guidelines for hearing loss resulting from DR-TB treatment was low. Implementation fidelity should be assessed early and at intervals in the course of implementing the Programmatic Management of Drug-resistant Tuberculosis guideline and indeed, in the implementation of any intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07536-y.
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OUP accepted manuscript. Health Promot Int 2022:6576076. [DOI: 10.1093/heapro/daac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Belizario JA, Lopes LG, Pires RH. Fungi in the indoor air of critical hospital areas: a review. AEROBIOLOGIA 2021; 37:379-394. [PMID: 34007098 PMCID: PMC8119621 DOI: 10.1007/s10453-021-09706-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/17/2021] [Indexed: 05/31/2023]
Abstract
Invasive fungal infection is an important cause of mortality and morbidity in neonates, especially in low-birthweight neonates. The contribution of fungi in the indoor air to the incidence of mucocutaneous colonization and to the risk of invasive fungal infection in this population is uncertain. This review aimed to identify and to summarize the best available evidence on the fungal contamination in the indoor air of critical hospital areas with an emphasis on pediatric/neonatal ICUs. Publications from 2005 to 2019 were searched in the databases Scientific Electronic Library Online (SciELO), US National Library of Medicine National Institutes of Health Search (PubMed), and Latin American Caribbean Health Sciences (LILACS). Descriptors in Health Sciences (DeCS) were used. Research papers published in Portuguese, English, and Spanish were included. Twenty-nine papers on all continents except Australia were selected. The results showed that the air mycobiota contained several fungal species, notably Aspergillus, Penicillium, Cladosporium, Fusarium, and yeast (Candida) species. The selected papers point out the risks that fungi pose to neonates, who have immature immune system, and describe simultaneous external factors (air humidity, seasonality, air and people flow, use of particulate filters, and health professionals' hand hygiene) that contribute to indoor air contamination with fungi. Improving communication among health professionals is a great concern because this can prevent major health complications in neonates, especially in low-birthweight neonates. The results reinforced the need to monitor environmental fungi more frequently and efficiently in hospitals, especially in neonatal ICUs.
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Affiliation(s)
- Jenyffie A. Belizario
- Universidade de Franca, Av. Dr. Armando Salles de Oliveira, 201, Parque Universitário, Franca, São Paulo 14404-600 Brazil
| | - Leonardo G. Lopes
- Universidade de Franca, Av. Dr. Armando Salles de Oliveira, 201, Parque Universitário, Franca, São Paulo 14404-600 Brazil
| | - Regina H. Pires
- Universidade de Franca, Av. Dr. Armando Salles de Oliveira, 201, Parque Universitário, Franca, São Paulo 14404-600 Brazil
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Abstract
The current standard in healthcare research is to maintain scientific fidelity of any intervention being tested. Fidelity is defined as the consistent delivery of interventions that ensures that all participants are provided the same information, guidance, and/or materials. Notably, the methods for ensuring fidelity of intervention delivery must also be consistent. This article describes our Intervention and Technology Delivery Fidelity Checklists used to ensure consistency. These checklists were completed by trained nurse observers who rated the intervention implementation and the technology delivery. Across our clinical trials and pilot studies, the fidelity scores were tabulated and compared. Intervention information and materials were delivered by a variety of devices including telehealth monitors, videophones, and/or iPads. Each of the devices allows audiovisual connections between health professionals from their offices and patients and participants in their homes. Our checklists guide the monitoring of fidelity of technology delivery. Overall checklist ratings across our studies demonstrate consistent intervention, implementation, and technology delivery approaches. Uniquely, the fidelity checklist verifies the interventionist's correct use of the technology devices to ensure consistent audiovisual delivery. Checklist methods to ensure intervention fidelity and technology delivery are essential research procedures, which can be adapted for use by researchers across multiple disciplines.
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Wright P, Walsh Z, Margolese S, Sanchez T, Arlt S, Belle-Isle L, St Pierre M, Bell A, Daeninck P, Gagnon M, Lacasse G, MacCallum C, Mandarino E, Yale J, O'Hara J, Costiniuk C. Canadian clinical practice guidelines for the use of plant-based cannabis and cannabinoid-based products in the management of chronic non-cancer pain and co-occurring conditions: protocol for a systematic literature review. BMJ Open 2020; 10:e036114. [PMID: 32448797 PMCID: PMC7253000 DOI: 10.1136/bmjopen-2019-036114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Chronic pain and co-occurring disorders, such as sleep disorders, anxiety, depression, post-traumatic stress disorder and substance use disorders, are among the most common conditions for which cannabis and cannabinoid-based products derived from the cannabis plant (CBP) are used for therapeutic purposes. However, healthcare providers report that they lack sufficient information on the risks, benefits and appropriate use of cannabis and CBP derived from the cannabis plant for therapeutic purposes. METHODS AND ANALYSIS We will conduct a systematic review of studies investigating the use of cannabis and CBP derived from the cannabis plant for the treatment of chronic pain and co-occurring conditions. Randomised controlled trials, meta-analyses and observational studies will be prioritised. We will exclude reviews of cannabinoid mechanisms of actions, commentary articles and narrative reviews. The primary outcome of interest will be efficacy in relieving chronic pain. Secondary outcomes will be efficacy in ameliorating conditions such as sleep disorders, anxiety, depression, post-traumatic stress disorder and substance use disorders. We will search electronic bibliographic databases including Academic Search Complete, Cochrane Database of Systematic Reviews, Evidence based Medicine Reviewes, OVID Medline, PsychINFO, PubMed, CINAHL and Web of Science. Two reviewers will conduct screening and data collection independently. Study level of bias will be assessed using the Cochrane Risk of Bias Assessment Tool for randomised controlled trials and non-randomised studies. Narrative analysis will be utilised to interpret the data. ETHICS AND DISSEMINATION The results of this systematic review will inform guideline development for the use of cannabis and CBP derived from the cannabis plant in the management of chronic pain and co-occurring conditions. Areas requiring further study will also be highlighted. PROSPERO REGISTRATION NUMBER CRD42020135886.
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Affiliation(s)
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
| | - Shari Margolese
- Canadian HIV Trials Network Community Advisory Board, Vancouver, British Columbia, Canada
| | - Tatiana Sanchez
- Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
| | - Stephanie Arlt
- Canadian Institute for Substance Use Research,University of Victoria, Victoria, British Columbia, Canada
| | | | - Michelle St Pierre
- Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
| | - Alan Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Daeninck
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marilou Gagnon
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | | | - Caroline MacCallum
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Enrico Mandarino
- Community Advisory, Canadian Institutes of Health Research Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- MJardin Canada, Toronto, Ontario, Canada
| | - Janet Yale
- Arthritis Society of Canada, Toronto, Ontario, Canada
| | - James O'Hara
- Canadians for Fair Access to Medical Marijuana, Toronto, Ontario, Canada
| | - Cecilia Costiniuk
- Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
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Title: Can changing the physical environment promote walking and cycling? A systematic review of what works and how. Health Place 2019; 58:102161. [PMID: 31301599 PMCID: PMC6737987 DOI: 10.1016/j.healthplace.2019.102161] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/14/2019] [Accepted: 07/02/2019] [Indexed: 02/02/2023]
Abstract
Environmental changes aimed at encouraging walking or cycling may promote activity and improve health, but evidence suggests small or inconsistent effects in practice. Understanding how an intervention works might help explain the effects observed and provide guidance about generalisability. We therefore aimed to review the literature on the effects of this type of intervention and to understand how and why these may or may not be effective. We searched eight electronic databases for existing systematic reviews and mined these for evaluative studies of physical environmental changes and assessed changes in walking, cycling or physical activity. We then searched for related sources including quantitative or qualitative studies, policy documents or reports. We extracted information on the evidence for effects ('estimation'), contexts and mechanisms ('explanation') and assessed credibility, and synthesised material narratively. We identified 13 evaluations of interventions specifically targeting walking and cycling and used 46 related sources. 70% (n = 9 evaluations) scored 3 or less on the credibility criteria for effectiveness. 6 reported significant positive effects, but higher quality evaluations were more likely to report positive effects. Only two studies provided rich evidence of mechanisms. We identified three common resources that interventions provide to promote walking and cycling: (i) improving accessibility and connectivity; (ii) improving traffic and personal safety; and (iii) improving the experience of walking and cycling. The most effective interventions appeared to target accessibility and safety in both supportive and unsupportive contexts. Although the evidence base was relatively limited, we were able to understand the role of context in the success of interventions. Researchers and policy makers should consider the context and mechanisms which might operate before evaluating and implementing interventions.
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Rivas C, Vigurs C, Cameron J, Yeo L. A realist review of which advocacy interventions work for which abused women under what circumstances. Cochrane Database Syst Rev 2019; 6:CD013135. [PMID: 31254283 PMCID: PMC6598804 DOI: 10.1002/14651858.cd013135.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Intimate partner abuse (including coercive control, physical, sexual, economic, emotional and economic abuse) is common worldwide. Advocacy may help women who are in, or have left, an abusive intimate relationship, to stop or reduce repeat victimisation and overcome consequences of the abuse. Advocacy primarily involves education, safety planning support and increasing access to different services. It may be stand-alone or part of other services and interventions, and may be provided within healthcare, criminal justice, social, government or specialist domestic violence services. We focus on the abuse of women, as interventions for abused men require different considerations. OBJECTIVES To assess advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances. SEARCH METHODS In January 2019 we searched CENTRAL, MEDLINE, 12 other databases, two trials registers and two relevant websites. The search had three phases: scoping of articles to identify candidate theories; iterative recursive search for studies to explore and fill gaps in these theories; and systematic search for studies to test, confirm or refute our explanatory theory. SELECTION CRITERIA Empirical studies of any advocacy or multi-component intervention including advocacy, intended for women aged 15 years and over who were experiencing or had experienced any form of intimate partner abuse, or of advocates delivering such interventions, or experiences of women who were receiving or had received such an intervention. Partner abuse encompasses coercive control in the absence of physical abuse. For theory development, we included studies that did not strictly fit our original criteria but provided information useful for theory development. DATA COLLECTION AND ANALYSIS Four review authors independently extracted data, with double assessment of 10% of the data, and assessed risk of bias and quality of the evidence. We adopted RAMESES (Realist and meta-narrative evidence syntheses: evolving standards) standards for reporting results. We applied a realist approach to the analysis. MAIN RESULTS We included 98 studies (147 articles). There were 88 core studies: 37 focused on advocates (4 survey-based, 3 instrument development, 30 qualitative focus) and seven on abused women (6 qualitative studies, 1 survey); 44 were experimental intervention studies (some including qualitative evaluations). Ten further studies (3 randomised controlled trials (RCTs), 1 intervention process evaluation, 1 qualitative study, 2 mixed methods studies, 2 surveys of women, and 1 mixed methods study of women and staff) did not fit the original criteria but added useful information, as befitting a realist approach. Two studies are awaiting classification and three are ongoing.Advocacy interventions varied considerably in contact hours, profession delivering and setting.We constructed a conceptual model from six essential principles based on context-mechanism-outcome (CMO) patterns.We have moderate and high confidence in evidence for the importance of considering both women's vulnerabilities and intersectionalities and the trade-offs of abuse-related decisions in the contexts of individual women's lives. Decisions should consider the risks to the woman's safety from the abuse. Whether actions resulting from advocacy increase or decrease abuse depends on contextual factors (e.g. severity and type of abuse), and the outcomes the particular advocacy intervention is designed to address (e.g. increasing successful court orders versus decreasing depression).We have low confidence in evidence regarding the significance of physical dependencies, being pregnant or having children. There were links between setting (high confidence), and potentially also theoretical underpinnings of interventions, type, duration and intensity of advocacy, advocate discipline and outcomes (moderate and low confidence). A good therapeutic alliance was important (high confidence); this alliance might be improved when advocates are matched with abused women on ethnicity or abuse experience, exercise cultural humility, and remove structural barriers to resource access by marginalised women. We identified significant challenges for advocates in inter-organisational working, vicarious traumatisation, and lack of clarity on how much support to give a woman (moderate and high confidence). To work effectively, advocates need ongoing training, role clarity, access to resources, and peer and institutional support.Our provisional model highlights the complex way that factors combine and interact for effective advocacy. We confirmed the core ingredients of advocacy according to both women and advocates, supported by studies and theoretical considerations: education and information on abuse; rights and resources; active referral and liaising with other services; risk assessment and safety planning. We were unable to confirm the impact of complexity of the intervention (low confidence). Our low confidence in the evidence was driven mostly by a lack of relevant studies, rather than poor-quality studies, despite the size of the review. AUTHORS' CONCLUSIONS Results confirm the core ingredients of advocacy and suggest its use rests on sound theoretical underpinnings. We determined the elements of a good therapeutic alliance and how it might be improved, with a need for particular considerations of the factors affecting marginalised women. Women's goals from advocacy should be considered in the contexts of their personal lives. Women's safety was not necessarily at greatest risk from staying with the abuser. Potentially, if undertaken for long enough, advocacy should benefit an abused woman in terms of at least one outcome providing the goals are matched to each woman's needs. Some outcomes may take months to be determined. Where abuse is severe, some interventions may increase abuse. Advocates have a challenging role and must be supported emotionally, through provision of resources and through professional training, by organisations and peers.Future research should consider the different principles identified in this review, and study outcomes should be considered in relation to the mechanisms and contexts elucidated. More longitudinal evidence is needed. Single-subject research designs may help determine exactly when effect no longer increases, to determine the duration of longitudinal work, which will likely differ for vulnerable and marginalised women. Further work is needed to ascertain how to tailor advocacy interventions to cultural variations and rural and resource-poor settings. The methods used in the included studies may, in some cases, limit the applicability and completeness of the data reported. Economic analyses are required to ascertain if resources devoted to advocacy interventions are cost-effective in healthcare and community settings.
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Affiliation(s)
- Carol Rivas
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Carol Vigurs
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Jacqui Cameron
- The University of MelbourneDepartment of Social Work, Melbourne School of Health SciencesMelbourneVICAustralia
- Finders UniversityNational Centre for Education and Training on Addiction (NCETA)AdelaideSouth AustraliaAustralia
| | - Lucia Yeo
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
- KK Women's and Children's HospitalDepartment of Child DevelopmentSingaporeSingapore229899
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Pérez D, Van der Stuyft P, Ridde V, Lefèvre P. To the bone: Comment on "I wanted a skeleton … they brought a prince": A qualitative investigation of factors mediating the implementation of a Performance Based Incentive program in Malawi. SSM Popul Health 2019; 7:100305. [PMID: 31297432 PMCID: PMC6598832 DOI: 10.1016/j.ssmph.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/01/2018] [Accepted: 10/07/2018] [Indexed: 11/15/2022] Open
Abstract
Recently, McMahon and colleagues set out to build on a widely-used fidelity framework, assessing the role of moderating factors during the implementation of performance-based financing programs in Malawi. Their attempt draws again the attention to the importance of approaching real word implementation issues from a theoretical perspective. It also highlights the importance of fidelity assessment within process evaluation of health programs. In this comment we argue that theoretical developments in the field of implementation science in global health would benefit from an accurate understanding of existing conceptual frameworks as well as from taking into account all contemporary contributions.
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Affiliation(s)
- Dennis Pérez
- Department of Epidemiology, Tropical Medicine Institute “Pedro Kouri”, Havana City, Cuba
- Public Health Research Institute, Montreal University, Montreal, Canada
| | | | - Valéry Ridde
- Public Health Research Institute, Montreal University, Montreal, Canada
- Centre Population et Développement, Institute de Recherche pour de Développement, Université Paris Descartes, Paris, France
| | - Pierre Lefèvre
- Freelance Consultant in Global Health, Brussels, Belgium
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Rivas C, Vigurs C. A realist review of which advocacy interventions work for which abused women under what circumstances: an exemplar. Cochrane Database Syst Rev 2018. [PMID: 31254283 DOI: 10.1002/14651858.cd013135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carol Rivas
- University College London; Department of Social Science, UCL Institute of Education; 18 Woburn Square London UK WC1H 0NR
| | - Carol Vigurs
- University College London; Department of Social Science, UCL Institute of Education; 18 Woburn Square London UK WC1H 0NR
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Radin Umar RZ, Sommerich CM, Lavender SA, Sanders E, Evans KD. Conceptual frameworks for the workplace change adoption process: elements integration from decision making and learning cycle process. ERGONOMICS 2018; 61:1173-1186. [PMID: 29757713 DOI: 10.1080/00140139.2018.1475016] [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: 06/20/2017] [Accepted: 04/11/2018] [Indexed: 06/08/2023]
Abstract
UNLABELLED Sound workplace ergonomics and safety-related interventions may be resisted by employees, and this may be detrimental to multiple stakeholders. Understanding fundamental aspects of decision-making, behavioural change, and learning cycles may provide insights into pathways influencing employees' acceptance of interventions. This manuscript reviews published literature on thinking processes and other topics relevant to decision making and incorporates the findings into two new conceptual frameworks of the workplace change adoption process. Such frameworks are useful for thinking about adoption in different ways and testing changes to traditional intervention implementation processes. Moving forward, it is recommended that future research focuses on systematic exploration of implementation process activities that integrate principles from the research literature on sense-making, decision-making, and learning processes. Such exploration may provide the groundwork for development of specific implementation strategies that are theoretically grounded and provide a revised understanding of how successful intervention adoption processes work. Practitioner summary: Adoption and acceptance of workplace changes may be facilitated through sound implementation strategies. This manuscript explores several principles of sense-making and decision-making processes that can potentially be used by industrial practitioners to inform the design and development of implementation strategies for interventions that improve workplace ergonomics and safety. ABBREVIATIONS Musculoskeletal Disorders (MSDs); National Institute for Occupational Safety and Health (NIOSH); National Occupational Research Agenda (NORA); Health and Safety Executive (HSE).
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Affiliation(s)
- Radin Zaid Radin Umar
- a Faculty of Manufacturing Engineering , Universiti Teknikal Malaysia Melaka, Hang Tuah Jaya , Durian Tunggal , Melaka , Malaysia
| | - Carolyn M Sommerich
- a Faculty of Manufacturing Engineering , Universiti Teknikal Malaysia Melaka, Hang Tuah Jaya , Durian Tunggal , Melaka , Malaysia
- b Department of Design , The Ohio State University , Columbus , OH , USA
| | - Steve A Lavender
- b Department of Design , The Ohio State University , Columbus , OH , USA
- c Department of Integrated Systems Engineering , The Ohio State University , Columbus , OH , USA
| | - Elizabeth Sanders
- d Division of Radiologic Sciences and Therapy, School of Health and Rehabilitation Sciences , The Ohio State University , Columbus , OH , USA
| | - Kevin D Evans
- b Department of Design , The Ohio State University , Columbus , OH , USA
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Abayneh S, Lempp H, Manthorpe J, Hanlon C. Development of programme theory for integration of service user and caregiver involvement in mental health system strengthening: protocol for realist systematic review. Int J Ment Health Syst 2018; 12:41. [PMID: 30061922 PMCID: PMC6057009 DOI: 10.1186/s13033-018-0220-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is international recognition of the need for service user and caregiver involvement in mental health system strengthening. However, little is known about how best to integrate this approach into the mental healthcare system; what works to advance involvement, under what conditions, how and when does involvement bring added value, and how can it work in resource-poor settings in low and middle-income countries. Objective To describe the methodology for a realist systematic review protocol to synthesise the evidence to explain the contexts, outcomes, and underlying mechanisms for involvement of service users with severe mental health problems and their caregivers in mental healthcare policy-making and planning, advocacy, service development, monitoring and improvement. Methods/designs The proposed realist systematic review will involve five steps: (i) clarifying the review scope, (ii) a systematic search for evidence, (iii) evidence appraisal and data extraction, (iv) data analysis, (v) synthesis of evidence and formation of revised programme theory. Inputs from a formative qualitative study, consultative Theory of Change meetings with key stakeholder groups, and scoping reviews will be used to identify candidate theory/theories that will guide the selection, appraisal and analysis of studies, and refine the Theory of Change model that will be piloted and evaluated. Synthesis of data will be undertaken using realist logic, constant comparison and thematic analysis. In a consultative meeting with stakeholders the Theory of Change model will then be situated with respect to relevant programme theories and adapted to incorporate the synthesized evidence of relevance to the local context. The finalized Theory of Change model will be piloted and evaluated in a primary health care setting in rural Ethiopia. Discussion Realist review methodology has not been applied to the area of mental health service user involvement in low- and middle-income country settings. In this protocol, we describe how this contextualized approach will be applied to identify and refine a theory-driven and transferable model of involvement of service users, embedded in ongoing work in Ethiopia.Systematic review registration PROSPERO CRD42018084595.
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Affiliation(s)
- Sisay Abayneh
- 1Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- 2Department of Inflammation Biology, Faculty of Life Sciences & Medicine, King's College London, Weston Education Centre, 10, Cutcombe Road, London, SE5 9RJ UK
| | - Jill Manthorpe
- 3Health &Social Care Workforce Research Unit, King's College London, Strand, London, WC2 4LL UK
| | - Charlotte Hanlon
- 1Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,4Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciencem, King's College London, 16 De Crespigny Park, London, SE5 8AF UK
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Williams NH, Roberts JL, Din NU, Charles JM, Totton N, Williams M, Mawdesley K, Hawkes CA, Morrison V, Lemmey A, Edwards RT, Hoare Z, Pritchard AW, Woods RT, Alexander S, Sackley C, Logan P, Wilkinson C, Rycroft-Malone J. Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR). Health Technol Assess 2018; 21:1-528. [PMID: 28836493 DOI: 10.3310/hta21440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Proximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking. OBJECTIVES To develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation. DESIGN Phase I - realist review, survey and focus groups to develop the rehabilitation package. Phase II - parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study. SETTING Recruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge. PARTICIPANTS Older adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area. INTERVENTIONS Participants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients' self-efficacy and increasing the amount and quality of patients' practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions. MAIN OUTCOME MEASURES The primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale - International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers. RESULTS Sixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control, n = 32; intervention, n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen's d = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen's d = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen's d = 0.31) and 1.3 (Cohen's d = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported. CONCLUSIONS Trial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure. TRIAL REGISTRATION Current Controlled Trials ISRCTN22464643. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.
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Affiliation(s)
- Nefyn H Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK.,Betsi Cadwaladr University Health Board, St Asaph, UK
| | | | - Nafees Ud Din
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Nicola Totton
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Kevin Mawdesley
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Claire A Hawkes
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew Lemmey
- School of Sports, Health and Exercise Science, Bangor University, Bangor, UK
| | | | - Zoe Hoare
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Robert T Woods
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Catherine Sackley
- School of Health and Social Care Research, King's College London, London, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Wilkinson
- School of Healthcare Sciences, Bangor University, Bangor, UK
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Roberts JL, Din NU, Williams M, Hawkes CA, Charles JM, Hoare Z, Morrison V, Alexander S, Lemmey A, Sackley C, Logan P, Wilkinson C, Rycroft-Malone J, Williams NH. Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups. BMJ Open 2017; 7:e014362. [PMID: 29025824 PMCID: PMC5652569 DOI: 10.1136/bmjopen-2016-014362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To develop an evidence and theory-based complex intervention for improving outcomes in elderly patients following hip fracture. DESIGN Complex-intervention development (Medical Research Council (MRC) framework phase I) using realist literature review, surveys and focus groups of patients and rehabilitation teams. SETTING North Wales. PARTICIPANTS Surveys of therapy managers (n=13), community and hospital-based physiotherapists (n=129) and occupational therapists (n=68) throughout the UK. Focus groups with patients (n=13), their carers (n=4) and members of the multidisciplinary rehabilitation teams in North Wales (n=13). RESULTS The realist review provided understanding of how rehabilitation interventions work in the real-world context and three programme theories were developed: improving patient engagement by tailoring the intervention to individual needs; reducing fear of falling and improving self-efficacy to exercise and perform activities of daily living; and coordination of rehabilitation delivery. The survey provided context about usual rehabilitation practice; focus groups provided data on the experience, acceptability and feasibility of rehabilitation interventions. An intervention to enhance usual rehabilitation was developed to target these theory areas comprising: a physical component consisting of six additional therapy sessions; and a psychological component consisting of a workbook to enhance self-efficacy and a patient-held goal-setting diary for self-monitoring. CONCLUSIONS A realist approach may have advantages in the development of evidence-based interventions and can be used in conjunction with other established methods to contribute to the development of potentially more effective interventions. A rehabilitation intervention was developed which can be tested in a future randomised controlled trial (MRC framework phases II and III). TRIAL REGISTRATION NUMBER ISRCTN22464643, Pre-results.
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Affiliation(s)
| | - Nafees Ud Din
- School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Michelle Williams
- School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Claire A Hawkes
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Joanna M Charles
- School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Zoe Hoare
- School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, Gwynedd, UK
| | | | - Andrew Lemmey
- School of Sports, Health and Exercise Science, Bangor University, Bangor, Gwynedd, UK
| | - Catherine Sackley
- Division of Health and Social Care Research, King's College, London, UK
| | - Phillipa Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Wilkinson
- School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Jo Rycroft-Malone
- School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Nefyn H Williams
- School of Healthcare Sciences, Bangor University, Bangor, Gwynedd, UK
- Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
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Brennan N, Bryce M, Pearson M, Wong G, Cooper C, Archer J. Towards an understanding of how appraisal of doctors produces its effects: a realist review. MEDICAL EDUCATION 2017; 51:1002-1013. [PMID: 28758237 DOI: 10.1111/medu.13348] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/13/2017] [Accepted: 03/20/2017] [Indexed: 05/09/2023]
Abstract
CONTEXT Revalidation was launched in the UK to provide assurances to the public that doctors are up to date and fit to practice. Appraisal is a fundamental component of revalidation. Approximately 150 000 doctors are appraised annually, costing an estimated £97 million over 10 years. There is little understanding of the theory of how and why appraisal is supposed to produce its effects. A realist review of the literature was utilised to explore these issues, as they generate context-mechanism-outcome (CMO) configurations, resulting in the creation of theories of how and why appraisal of doctors produces its effects. METHODS A programme theory of appraisal was created by convening stakeholders in appraisal and searching a database of research on appraisal of doctors. Supplementary searches provided literature on theories identified in the programme theory. Relevant sections of texts relating to the programme theory were extracted from included articles, coded in NVivo and synthesised using realist logic of analysis. A classification tool categorised the included articles' contributions to programme theory. RESULTS One hundred and twenty-five articles were included. Three mechanisms were identified: dissonance, denial and self-affirmation. The dissonance mechanism is most likely to cause outcomes of reflection and insight. Important contexts for the dissonance mechanism include the appraiser being highly skilled, the appraisee's working environment being supportive and the appraisee having the right attitude. The denial mechanism is more likely to be enacted if the opposite of these contexts occurs and could lead to game-playing behaviour. A skilled appraiser was also important in triggering the self-affirmation mechanism, resulting in reflection and insight. The contexts, mechanisms and outcomes identified were, however, limited by a lack of evidence that could enable further refining of the CMO configurations. CONCLUSION This review makes a significant contribution to our understanding of appraisal by identifying different ways that appraisal of doctors produces its effects. Further research will focus on testing the CMO configurations.
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Affiliation(s)
- Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Mark Pearson
- NIHR CLAHRC South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Julian Archer
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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Haegerich TM, David-Ferdon C, Noonan RK, Manns BJ, Billie HC. Technical Packages in Injury and Violence Prevention to Move Evidence Into Practice: Systematic Reviews and Beyond. EVALUATION REVIEW 2017; 41:78-108. [PMID: 27604301 PMCID: PMC5340632 DOI: 10.1177/0193841x16667214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Injury and violence prevention strategies have greater potential for impact when they are based on scientific evidence. Systematic reviews of the scientific evidence can contribute key information about which policies and programs might have the greatest impact when implemented. However, systematic reviews have limitations, such as lack of implementation guidance and contextual information, that can limit the application of knowledge. "Technical packages," developed by knowledge brokers such as the federal government, nonprofit agencies, and academic institutions, have the potential to be an efficient mechanism for making information from systematic reviews actionable. Technical packages provide information about specific evidence-based prevention strategies, along with the estimated costs and impacts, and include accompanying implementation and evaluation guidance to facilitate adoption, implementation, and performance measurement. We describe how systematic reviews can inform the development of technical packages for practitioners, provide examples of technical packages in injury and violence prevention, and explain how enhancing review methods and reporting could facilitate the use and applicability of scientific evidence.
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Affiliation(s)
- Tamara M Haegerich
- 1 Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Corinne David-Ferdon
- 2 Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rita K Noonan
- 1 Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian J Manns
- 3 Office of the Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Holly C Billie
- 1 Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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van der Kleij RMJJ, Crone MR, Reis R, Paulussen TGWM. Critical stakeholder determinants to the implementation of intersectoral community approaches targeting childhood obesity. HEALTH EDUCATION RESEARCH 2016; 31:697-715. [PMID: 27923861 DOI: 10.1093/her/cyw047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
Several intersectoral community approaches targeting childhood obesity (IACOs) have been launched in the Netherlands. Translation of these approaches into practice is however arduous and implementation. We therefore studied the implementation of five IACOs in the Netherlands for one-and-a-half years. IACO implementation was evaluated via an adapted version of the MIDI questionnaire, consisting of 18 theory-based constructs. A response rate of 62% was obtained. A hierarchical multivariate linear regression model was used to analyse our data; the final regression model predicted 65% of the variance in adherence. Higher levels of self-efficacy, being an implementer embedded in community B, and having more than 1 year of experience with IACO implementation were associated with higher degrees of adherence. Formal ratification of implementation by management and being prescribed a higher number of activities were related to lower degrees of adherence. We advise that, when designing implementation strategies, emphasis should be placed on the enhancement of professionals' self-efficacy, limitation of the number of activities prescribed and allocation of sufficient time to get acquainted and experienced with IACO implementation. Longitudinal studies are needed to further evaluate interaction between and change within critical determinants while progressing through the innovation process.
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Affiliation(s)
- R M J J van der Kleij
- Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - M R Crone
- Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - R Reis
- Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, The Netherlands
- The Children s Institute, School of Child and Adolescent Health, University of Cape Town, South Africa
| | - T G W M Paulussen
- Research Group Lifestyle, Netherlands Organisation for Applied Scientific Research, ZL, 2316 Leiden, The Netherlands
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Gilson L, Schneider H, Orgill M. Practice and power: a review and interpretive synthesis focused on the exercise of discretionary power in policy implementation by front-line providers and managers. Health Policy Plan 2016; 29 Suppl 3:iii51-69. [PMID: 25435536 DOI: 10.1093/heapol/czu098] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tackling the implementation gap is a health policy concern in low- and middle-income countries (LMICs). Limited attention has so far been paid to the influence of power relations over this gap. This article presents, therefore, an interpretive synthesis of qualitative health policy articles addressing the question: how do actors at the front line of health policy implementation exercise discretionary power, with what consequences and why? The article also demonstrates the particular approach of thematic synthesis and contributes to discussion of how such work can inform future health policy research. The synthesis drew from a broader review of published research on any aspect of policy implementation in LMICs for the period 1994-2009. From an initial set of 50 articles identified as relevant to the specific review question, a sample of 16 articles were included in this review. Nine report experience around decentralization, a system-level change, and seven present experience of implementing a range of reproductive health (RH) policies (new forms of service delivery). Three reviewers were involved in a systematic process of data extraction, coding, analysis, synthesis and article writing. The review findings identify: the practices of power exercised by front-line health workers and their managers; their consequences for policy implementation and health system performance; the sources of this power and health workers' reasons for exercising power. These findings also provide the basis for an overarching synthesis of experience, highlighting the importance of actors, power relations and multiple, embedded contextual elements as dimensions of health system complexity. The significance of this synthesis lies in its insights about: the micropractices of power exercised by front-line providers; how to manage this power through local level strategies both to influence and empower providers to act in support of policy goals; and the focus and nature of future research on these issues.
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Affiliation(s)
- Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa, Department for Global Health and Development, London School of Hygiene and Tropical Medicine, School of Public Health, University of the Western Cape, Cape Town, South Africa and Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa, Department for Global Health and Development, London School of Hygiene and Tropical Medicine, School of Public Health, University of the Western Cape, Cape Town, South Africa and Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town
| | - Helen Schneider
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa, Department for Global Health and Development, London School of Hygiene and Tropical Medicine, School of Public Health, University of the Western Cape, Cape Town, South Africa and Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town
| | - Marsha Orgill
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa, Department for Global Health and Development, London School of Hygiene and Tropical Medicine, School of Public Health, University of the Western Cape, Cape Town, South Africa and Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town
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Pérez D, Van der Stuyft P, Zabala MC, Castro M, Lefèvre P. A modified theoretical framework to assess implementation fidelity of adaptive public health interventions. Implement Sci 2016; 11:91. [PMID: 27391959 PMCID: PMC4939032 DOI: 10.1186/s13012-016-0457-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 05/14/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND One of the major debates in implementation research turns around fidelity and adaptation. Fidelity is the degree to which an intervention is implemented as intended by its developers. It is meant to ensure that the intervention maintains its intended effects. Adaptation is the process of implementers or users bringing changes to the original design of an intervention. Depending on the nature of the modifications brought, adaptation could either be potentially positive or could carry the risk of threatening the theoretical basis of the intervention, resulting in a negative effect on expected outcomes. Adaptive interventions are those for which adaptation is allowed or even encouraged. Classical fidelity dimensions and conceptual frameworks do not address the issue of how to adapt an intervention while still maintaining its effectiveness. DISCUSSION We support the idea that fidelity and adaptation co-exist and that adaptations can impact either positively or negatively on the intervention's effectiveness. For adaptive interventions, research should answer the question how an adequate fidelity-adaptation balance can be reached. One way to address this issue is by looking systematically at the aspects of an intervention that are being adapted. We conducted fidelity research on the implementation of an empowerment strategy for dengue prevention in Cuba. In view of the adaptive nature of the strategy, we anticipated that the classical fidelity dimensions would be of limited use for assessing adaptations. The typology we used in the assessment-implemented, not-implemented, modified, or added components of the strategy-also had limitations. It did not allow us to answer the question which of the modifications introduced in the strategy contributed to or distracted from outcomes. We confronted our empirical research with existing literature on fidelity, and as a result, considered that the framework for implementation fidelity proposed by Carroll et al. in 2007 could potentially meet our concerns. We propose modifications to the framework to assess both fidelity and adaptation. The modified Carroll et al.'s framework we propose may permit a comprehensive assessment of the implementation fidelity-adaptation balance required when implementing adaptive interventions, but more empirical research is needed to validate it.
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Affiliation(s)
- Dennis Pérez
- Epidemiology Division, Tropical Medicine Institute “Pedro Kouri”, Autopista Novia del Mediodía, Km. 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Patrick Van der Stuyft
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | | | - Marta Castro
- Epidemiology Division, Tropical Medicine Institute “Pedro Kouri”, Autopista Novia del Mediodía, Km. 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Pierre Lefèvre
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Morgan T, Williams LA, Gott M. A Feminist Quality Appraisal Tool: exposing gender bias and gender inequities in health research. CRITICAL PUBLIC HEALTH 2016. [DOI: 10.1080/09581596.2016.1205182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tessa Morgan
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Lisa Ann Williams
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
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25
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Waltman SH, Creed TA, Beck AT. Are the effects of cognitive behavior therapy for depression falling? Review and critique of the evidence. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Freshwater D, Cahill J. Development of research discourses: a conceptual map. J Adv Nurs 2016; 72:2030-41. [DOI: 10.1111/jan.13019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Dawn Freshwater
- University of Western Australia; Perth Western Australia Australia
| | - Jane Cahill
- School of Healthcare; University of Leeds; UK
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Augustsson H, von Thiele Schwarz U, Stenfors-Hayes T, Hasson H. Investigating variations in implementation fidelity of an organizational-level occupational health intervention. Int J Behav Med 2015; 22:345-55. [PMID: 24866259 DOI: 10.1007/s12529-014-9420-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The workplace has been suggested as an important arena for health promotion, but little is known about how the organizational setting influences the implementation of interventions. PURPOSE The aims of this study are to evaluate implementation fidelity in an organizational-level occupational health intervention and to investigate possible explanations for variations in fidelity between intervention units. METHOD The intervention consisted of an integration of health promotion, occupational health and safety, and a system for continuous improvements (Kaizen) and was conducted in a quasi-experimental design at a Swedish hospital. Implementation fidelity was evaluated with the Conceptual Framework for Implementation Fidelity and implementation factors used to investigate variations in fidelity with the Framework for Evaluating Organizational-level Interventions. A multi-method approach including interviews, Kaizen notes, and questionnaires was applied. RESULTS Implementation fidelity differed between units even though the intervention was introduced and supported in the same way. Important differences in all elements proposed in the model for evaluating organizational-level interventions, i.e., context, intervention, and mental models, were found to explain the differences in fidelity. CONCLUSION Implementation strategies may need to be adapted depending on the local context. Implementation fidelity, as well as pre-intervention implementation elements, is likely to affect the implementation success and needs to be assessed in intervention research. The high variation in fidelity across the units indicates the need for adjustments to the type of designs used to assess the effects of interventions. Thus, rather than using designs that aim to control variation, it may be necessary to use those that aim at exploring and explaining variation, such as adapted study designs.
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Affiliation(s)
- Hanna Augustsson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden,
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Pitzul KB, Lane NE, Voruganti T, Khan AI, Innis J, Wodchis WP, Baker GR. Role of context in care transition interventions for medically complex older adults: a realist synthesis protocol. BMJ Open 2015; 5:e008686. [PMID: 26586323 PMCID: PMC4654392 DOI: 10.1136/bmjopen-2015-008686] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/21/2015] [Accepted: 09/21/2015] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Approximately 30-50% of older adults have two or more conditions and are referred to as multimorbid or complex patients. These patients often require visits to various healthcare providers in a number of settings and are therefore susceptible to fragmented healthcare delivery while transitioning to receive care. Care transition interventions have been implemented to improve continuity of care, however, current evidence suggests that some interventions or components of interventions are only effective within certain contexts. There is therefore a need to unpack the mechanisms of how and within which contexts care transition interventions and their components are effective. Realist review is a synthesis method that explains how complex programmes work within various contexts. The purpose of this study is to explain the effect of context on the activities and mechanisms of care transition interventions in medically complex older adults using a realist review approach. METHODS AND ANALYSIS This synthesis will be guided by Pawson and colleagues' 2004 and 2005 protocols for conducting realist reviews. The underlying theories of care transition interventions were determined based on an initial literature search using relevant databases. English language peer-reviewed studies published after 1993 will be included. Several relevant databases will be searched using medical subject headings and text terms. A screening form will be piloted and titles, abstracts and full text of potentially relevant articles will be screened in duplicate. Abstracted data will include study characteristics, intervention type, contextual factors, intervention activities and underlying mechanisms. Patterns in Context-Activity-Mechanism-Outcome (CAMO) configurations will be reported. ETHICS AND DISSEMINATION Internal knowledge translation activities will occur throughout the review and existing partnerships will be leveraged to disseminate findings to frontline staff, hospital administrators and policymakers. Finalised results will be presented at local, national and international conferences, and disseminated via peer-reviewed publications in relevant journals.
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Affiliation(s)
- Kristen B Pitzul
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Natasha E Lane
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Teja Voruganti
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Anum I Khan
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Jennifer Innis
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - G Ross Baker
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
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29
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Pearson M, Hunt H, Cooper C, Shepperd S, Pawson R, Anderson R. Providing effective and preferred care closer to home: a realist review of intermediate care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2015; 23:577-593. [PMID: 25684035 DOI: 10.1111/hsc.12183] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 06/04/2023]
Abstract
Intermediate care is one of the number of service delivery models intended to integrate care and provide enhanced health and social care services closer to home, especially to reduce reliance on acute care hospital beds. In order for health and social care practitioners, service managers and commissioners to make informed decisions, it is vital to understand how to implement the admission avoidance and early supported discharge components of intermediate care within the context of local care systems. This paper reports the findings of a theory-driven (realist) review conducted in 2011-2012. A broad range of evidence contained in 193 sources was used to construct a conceptual framework for intermediate care. This framework forms the basis for exploring factors at service user, professional and organisational levels that should be considered when designing and delivering intermediate care services within a particular local context. Our synthesis found that involving service users and their carers in collaborative decision-making about the objectives of care and the place of care is central to achieving the aims of intermediate care. This pivotal involvement of the service user relies on practitioners, service managers and commissioners being aware of the impact that organisational structures at the local level can have on enabling or inhibiting collaborative decision-making and care co-ordination. Through all interactions with service users and their care networks, health and social care professionals should establish the meaning which alternative care environments have for different service users. Doing so means decisions about the best place of care will be better informed and gives service users choice. This in turn is likely to support psychological and social stability, and the attainment of functional goals. At an organisational level, integrated working can facilitate the delivery of intermediate care, but there is not a straightforward relationship between integrated organisational processes and integrated professional practice.
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Affiliation(s)
- Mark Pearson
- Peninsula Technology Assessment Group (PenTAG), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Harriet Hunt
- Peninsula Technology Assessment Group (PenTAG), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Sasha Shepperd
- Department of Public Health, University of Oxford, Oxford, UK
| | - Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Rob Anderson
- Peninsula Technology Assessment Group (PenTAG), Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Pearson M, Chilton R, Wyatt K, Abraham C, Ford T, Woods HB, Anderson R. Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom. Implement Sci 2015; 10:149. [PMID: 26510493 PMCID: PMC4625879 DOI: 10.1186/s13012-015-0338-6] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022] Open
Abstract
Background Schools have long been viewed as a good setting in which to encourage healthy lifestyles amongst children, and schools in many countries aspire to more comprehensive, integrated approaches to health promotion. Recent reviews have identified evidence of the effects of school health promotion on children’s and young people’s health. However, understanding of how such programmes can be implemented in schools is more limited. Methods We conducted a realist review to identify the conditions and actions which lead to the successful implementation of health promotion programmes in schools. We used the international literature to develop programme theories which were then tested using evaluations of school health promotion programmes conducted in the United Kingdom (UK). Iterative searching and screening was conducted to identify sources and clear criteria applied for appraisal of included sources. A review advisory group comprising educational and public health practitioners, commissioners, and academics was established at the outset. Results In consultation with the review advisory group, we developed four programme theories (preparing for implementation, initial implementation, embedding into routine practice, adaptation and evolution); these were then refined using the UK evaluations in the review. This enabled us to identify transferable mechanisms and enabling and constraining contexts and investigate how the operation of mechanisms differed in different contexts. We also identified steps that should be taken at a senior level in relation to preparing for implementation (which revolved around negotiation about programme delivery) and initial implementation (which centred on facilitation, support, and reciprocity—the latter for both programme deliverers and pupils). However, the depth and rigour of evidence concerning embedding into routine practice and adaptation and evolution was limited. Conclusions Our findings provide guidance for the design, implementation, and evaluation of health promotion in schools and identify the areas where further research is needed. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0338-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Pearson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - R Chilton
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - K Wyatt
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - C Abraham
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - T Ford
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - H B Woods
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - R Anderson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
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Pearson M, Chilton R, Wyatt K, Abraham C, Ford T, Woods HB, Anderson R. Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom. Implement Sci 2015. [PMID: 26510493 DOI: 10.1186/s13012–015–0338–6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schools have long been viewed as a good setting in which to encourage healthy lifestyles amongst children, and schools in many countries aspire to more comprehensive, integrated approaches to health promotion. Recent reviews have identified evidence of the effects of school health promotion on children's and young people's health. However, understanding of how such programmes can be implemented in schools is more limited. METHODS We conducted a realist review to identify the conditions and actions which lead to the successful implementation of health promotion programmes in schools. We used the international literature to develop programme theories which were then tested using evaluations of school health promotion programmes conducted in the United Kingdom (UK). Iterative searching and screening was conducted to identify sources and clear criteria applied for appraisal of included sources. A review advisory group comprising educational and public health practitioners, commissioners, and academics was established at the outset. RESULTS In consultation with the review advisory group, we developed four programme theories (preparing for implementation, initial implementation, embedding into routine practice, adaptation and evolution); these were then refined using the UK evaluations in the review. This enabled us to identify transferable mechanisms and enabling and constraining contexts and investigate how the operation of mechanisms differed in different contexts. We also identified steps that should be taken at a senior level in relation to preparing for implementation (which revolved around negotiation about programme delivery) and initial implementation (which centred on facilitation, support, and reciprocity-the latter for both programme deliverers and pupils). However, the depth and rigour of evidence concerning embedding into routine practice and adaptation and evolution was limited. CONCLUSIONS Our findings provide guidance for the design, implementation, and evaluation of health promotion in schools and identify the areas where further research is needed.
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Affiliation(s)
- M Pearson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - R Chilton
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - K Wyatt
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - C Abraham
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - T Ford
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - H B Woods
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - R Anderson
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
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Kågesten A, Tunçalp Ӧ, Ali M, Chandra-Mouli V, Tran N, Gülmezoglu AM. A Systematic Review of Reporting Tools Applicable to Sexual and Reproductive Health Programmes: Step 1 in Developing Programme Reporting Standards. PLoS One 2015; 10:e0138647. [PMID: 26418859 PMCID: PMC4852887 DOI: 10.1371/journal.pone.0138647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/01/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Complete and accurate reporting of programme preparation, implementation and evaluation processes in the field of sexual and reproductive health (SRH) is essential to understand the impact of SRH programmes, as well as to guide their replication and scale-up. OBJECTIVES To provide an overview of existing reporting tools and identify core items used in programme reporting with a focus on programme preparation, implementation and evaluation processes. METHODS A systematic review was completed for the period 2000-2014. Reporting guidelines, checklists and tools, irrespective of study design, applicable for reporting on programmes targeting SRH outcomes, were included. Two independent reviewers screened the title and abstract of all records. Full texts were assessed in duplicate, followed by data extraction on the focus, content area, year of publication, validation and description of reporting items. Data was synthesized using an iterative thematic approach, where items related to programme preparation, implementation and evaluation in each tool were extracted and aggregated into a consolidated list. RESULTS Out of the 3,656 records screened for title and abstracts, full texts were retrieved for 182 articles, out of which 108 were excluded. Seventy-four full text articles corresponding to 45 reporting tools were retained for synthesis. The majority of tools were developed for reporting on intervention research (n = 15), randomized controlled trials (n = 8) and systematic reviews (n = 7). We identified a total of 50 reporting items, across three main domains and corresponding sub-domains: programme preparation (objective/focus, design, piloting); programme implementation (content, timing/duration/location, providers/staff, participants, delivery, implementation outcomes), and programme evaluation (process evaluation, implementation barriers/facilitators, outcome/impact evaluation). CONCLUSIONS Over the past decade a wide range of tools have been developed to improve the reporting of health research. Development of Programme Reporting Standards (PRS) for SRH can fill a significant gap in existing reporting tools. This systematic review is the first step in the development of such standards. In the next steps, we will draft a preliminary version of the PRS based on the aggregate list of identified items, and finalize the tool using a consensus process among experts and user-testing.
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Affiliation(s)
- Anna Kågesten
- Department of Population, Family and Reproductive Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Ӧzge Tunçalp
- WHO Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Moazzam Ali
- WHO Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Venkatraman Chandra-Mouli
- WHO Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Nhan Tran
- Implementation Research Platform, Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - A. Metin Gülmezoglu
- WHO Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
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Lovell R, Husk K, Cooper C, Stahl-Timmins W, Garside R. Understanding how environmental enhancement and conservation activities may benefit health and wellbeing: a systematic review. BMC Public Health 2015; 15:864. [PMID: 26346542 PMCID: PMC4561424 DOI: 10.1186/s12889-015-2214-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Action taken to enhance or conserve outdoor environments may benefit health and wellbeing through the process of participation but also through improving the environment. There is interest, amongst both health and environmental organisations, in using such activities as health promotion interventions. The objective of this systematic review was to investigate the health and wellbeing impacts of participation in environmental enhancement and conservation activities and to understand how these activities may be beneficial, to whom and in what circumstances or contexts. METHODS A theory-led mixed-method systematic review was used to assess evidence of effect and to identify pathways to change (protocol: http://onlinelibrary.wiley.com/doi/ 10.1002/14651858.CD010351/full ). Due to the multi-disciplinary, dispersed and disparate body of evidence an extensive multi-stage search strategy was devised and undertaken. Twenty-seven databases and multiple sources of grey literature were searched and over 200 relevant organisations were contacted. The heterogenous evidence was synthesised using a narrative approach and a conceptual model was developed to illustrate the mechanisms of effect. Due to the limited nature of the evidence additional higher order evidence was sought to assess the plausibility of the proposed mechanisms of effect through which health and wellbeing may accrue. RESULTS The majority of the quantitative evidence (13 studies; all poor quality and lower-order study designs) was inconclusive, though a small number of positive and negative associations were observed. The qualitative evidence (13 studies; 10 poor quality, 3 good) indicated that the activities were perceived to have value to health and wellbeing through a number of key mechanisms; including exposure to natural environments, achievement, enjoyment and social contact. Additional high level evidence indicated that these pathways were plausible. CONCLUSIONS Despite interest in the use of environmental enhancement activities as a health intervention there is currently little direct evidence of effect, this is primarily due to a lack of robust study designs. Further rigorous research is needed to understand the potential of the activities to benefit health and environment.
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Affiliation(s)
- Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, RCHT, Truro, TR1 3HD, UK.
| | - Kerryn Husk
- European Centre for Environment and Human Health, University of Exeter Medical School, RCHT, Truro, TR1 3HD, UK.,NIHR CLAHRC South West Peninsula (PenCLAHRC), Plymouth University Peninsula Schools of Medicine and Dentistry, ITTC Building, Tamar Science Park, Plymouth, PL6 8BX, UK
| | - Chris Cooper
- University of Exeter Medical School, Peninsula Technology Assessment Group, Veysey Building, Exeter, EX2 4SG, UK
| | - Will Stahl-Timmins
- European Centre for Environment and Human Health, University of Exeter Medical School, RCHT, Truro, TR1 3HD, UK.,BMJ, BMA House, Tavistock Square, London, WC1H, 9JR, UK
| | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter Medical School, RCHT, Truro, TR1 3HD, UK
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Cargo M, Stankov I, Thomas J, Saini M, Rogers P, Mayo-Wilson E, Hannes K. Development, inter-rater reliability and feasibility of a checklist to assess implementation (Ch-IMP) in systematic reviews: the case of provider-based prevention and treatment programs targeting children and youth. BMC Med Res Methodol 2015; 15:73. [PMID: 26346461 PMCID: PMC4562191 DOI: 10.1186/s12874-015-0037-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several papers report deficiencies in the reporting of information about the implementation of interventions in clinical trials. Information about implementation is also required in systematic reviews of complex interventions to facilitate the translation and uptake of evidence of provider-based prevention and treatment programs. To capture whether and how implementation is assessed within systematic effectiveness reviews, we developed a checklist for implementation (Ch-IMP) and piloted it in a cohort of reviews on provider-based prevention and treatment interventions for children and young people. This paper reports on the inter-rater reliability, feasibility and reasons for discrepant ratings. METHODS Checklist domains were informed by a framework for program theory; items within domains were generated from a literature review. The checklist was pilot-tested on a cohort of 27 effectiveness reviews targeting children and youth. Two raters independently extracted information on 47 items. Inter-rater reliability was evaluated using percentage agreement and unweighted kappa coefficients. Reasons for discrepant ratings were content analysed. RESULTS Kappa coefficients ranged from 0.37 to 1.00 and were not influenced by one-sided bias. Most kappa values were classified as excellent (n = 20) or good (n = 17) with a few items categorised as fair (n = 7) or poor (n = 1). Prevalence-adjusted kappa coefficients indicate good or excellent agreement for all but one item. Four areas contributed to scoring discrepancies: 1) clarity or sufficiency of information provided in the review; 2) information missed in the review; 3) issues encountered with the tool; and 4) issues encountered at the review level. Use of the tool demands time investment and it requires adjustment to improve its feasibility for wider use. CONCLUSIONS The case of provider-based prevention and treatment interventions showed relevancy in developing and piloting the Ch-IMP as a useful tool for assessing the extent to which systematic reviews assess the quality of implementation. The checklist could be used by authors and editors to improve the quality of systematic reviews, and shows promise as a pedagogical tool to facilitate the extraction and reporting of implementation characteristics.
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Affiliation(s)
- Margaret Cargo
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, University of South Australia, Adelaide, Australia.
| | - Ivana Stankov
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, University of South Australia, Adelaide, Australia.
| | - James Thomas
- Evidence for Policy and Practice Information and Co-ordinating (EPPI) Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK.
| | - Michael Saini
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
| | - Patricia Rogers
- Centre for Applied Social Research, RMIT University (Royal Melbourne Institute of Technology), Melbourne, Australia.
| | - Evan Mayo-Wilson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Karin Hannes
- Methodology of Educational Sciences Research Group, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
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van der Kleij R, Coster N, Verbiest M, van Assema P, Paulussen T, Reis R, Crone M. Implementation of intersectoral community approaches targeting childhood obesity: a systematic review. Obes Rev 2015; 16:454-72. [PMID: 25824957 DOI: 10.1111/obr.12273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/19/2015] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
Abstract
The implementation of intersectoral community approaches targeting childhood obesity (IACO) is considered challenging. To help overcome these challenges, an overview of the evidence to date is needed. We searched four databases to identify papers that reported on the determinants of successful implementation of IACOs, resulting in the inclusion of 25 studies. We appraised study quality with the Crowe Critical Appraisal Tool and the Quality Framework; reported implementation outcome indicators were reviewed via narrative synthesis. Quality of included studies varied. The most frequently reported indicators of implementation success were fidelity and coverage. Determinants related to the social-political context and the organization were most often cited as influencing implementation, in particular, 'collaboration between community partners', 'the availability of (human) resources' and 'time available for implementation'. The association between determinants and implementation variability was never explicated. We conclude that although some insights into the effective implementation of IACOs are present, more research is needed. Emphasis should be placed on elucidating the relationship between determinants and implementation success. Research should further focus on developing a 'golden standard' for evaluating and reporting on implementation research. These actions will improve the comparison of study outcomes and may constitute the cumulative development of knowledge about the conditions for designing evidence-based implementation strategies.
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Affiliation(s)
- R van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands
| | - N Coster
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - M Verbiest
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - P van Assema
- Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - T Paulussen
- Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.,TNO Leiden, Leiden, The Netherlands
| | - R Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.,Amsterdam Institute for Social Science Research, University of Amsterdam, The Netherlands
| | - M Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands
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Higginbottom GMA, Morgan M, Alexandre M, Chiu Y, Forgeron J, Kocay D, Barolia R. Immigrant women's experiences of maternity-care services in Canada: a systematic review using a narrative synthesis. Syst Rev 2015; 4:13. [PMID: 26187687 PMCID: PMC4506414 DOI: 10.1186/2046-4053-4-13] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Canada's diverse society and its statutory commitment to multiculturalism means that a synthesis of knowledge related to the healthcare experiences of immigrants is essential to realise the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for the tailoring of services to user needs. We therefore assessed the experiences of immigrant women accessing maternity-care services in Canada. In particular, we investigated the experiences of immigrant women in Canada in accessing and navigating maternity and related healthcare services from conception to 6 months postpartum in Canada. Our focus was on (a) the accessibility and acceptability of maternity-care services for immigrant women and (b) the effects of the perceptions and experiences of these women on their birth and postnatal outcomes. METHODS We conducted a systematic review using a systematic search and narrative synthesis of peer-reviewed and non-peer-reviewed reports of empirical research, with the aim of providing stakeholders with perspectives on maternity-care services as experienced by immigrant women. We partnered with key stakeholders ('integrated knowledge users') to ensure the relevancy of topics and to tailor recommendations for effective translation into future policy, practice and programming. Two search phases and a three-stage selection process for published and grey literature were conducted prior to appraisal of literature quality and narrative synthesis of the findings. RESULTS Our knowledge synthesis of maternity care among immigrants to Canada provided a coherent evidence base for (a) eliciting a better understanding of the factors that generate disparities in accessibility, acceptability and outcomes during maternity care; and (b) improving culturally based competency in maternity care. Our synthesis also identified pertinent issues in multiple sectors that should be addressed to configure maternity services and programs appropriately. CONCLUSIONS Although immigrant women in Canada are generally given the opportunity to obtain necessary services, they face many barriers in accessing and utilising these services. These barriers include lack of information about or awareness of the services, insufficient supports to access these services and discordant expectations between the women and their service providers. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42012002185 .
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Affiliation(s)
- Gina M A Higginbottom
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada.
| | - Myfanwy Morgan
- King's College London, Primary Care and Public Health Sciences London, London, SE1 3QD, UK.
| | - Mirande Alexandre
- Citizenship and Immigration Canada, New Multiculturalism Grants and Contributions Program, Canada Place, Edmonton, AB, T5J 4C3, Canada.
| | - Yvonne Chiu
- Multicultural Health Brokers Co-operative, Edmonton, AB, T5H 2M6, Canada.
| | - Joan Forgeron
- Lois Hole Hospital, Alberta Health Services, Edmonton, AB, T5H 3V9, Canada.
| | - Deb Kocay
- Health Canada, Public Health Agency of Canada, Calgary, AB, T2G 4X3, Canada.
| | - Rubina Barolia
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada.
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Gilson L. Qualitative research synthesis for health policy analysis: what does it entail and what does it offer? Health Policy Plan 2014; 29 Suppl 3:iii1-5. [PMID: 25392133 DOI: 10.1093/heapol/czu121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa and Health Economics and Systems Analysis Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa and Health Economics and Systems Analysis Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Brennan N, Bryce M, Pearson M, Wong G, Cooper C, Archer J. Understanding how appraisal of doctors produces its effects: a realist review protocol. BMJ Open 2014; 4:e005466. [PMID: 24958211 PMCID: PMC4067866 DOI: 10.1136/bmjopen-2014-005466] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION UK doctors are now required to participate in revalidation to maintain their licence to practise. Appraisal is a fundamental component of revalidation. However, objective evidence of appraisal changing doctors' behaviour and directly resulting in improved patient care is limited. In particular, it is not clear how the process of appraisal is supposed to change doctors' behaviour and improve clinical performance. The aim of this research is to understand how and why appraisal of doctors is supposed to produce its effect. METHODS AND ANALYSIS Realist review is a theory-driven interpretive approach to evidence synthesis. It applies realist logic of inquiry to produce an explanatory analysis of an intervention that is, what works, for whom, in what circumstances, in what respects. Using a realist review approach, an initial programme theory of appraisal will be developed by consulting with key stakeholders in doctors' appraisal in expert panels (ethical approval is not required), and by searching the literature to identify relevant existing theories. The search strategy will have a number of phases including a combination of: (1) electronic database searching, for example, EMBASE, MEDLINE, the Cochrane Library, ASSIA, (2) 'cited by' articles search, (3) citation searching, (4) contacting authors and (5) grey literature searching. The search for evidence will be iteratively extended and refocused as the review progresses. Studies will be included based on their ability to provide data that enable testing of the programme theory. Data extraction will be conducted, for example, by note taking and annotation at different review stages as is consistent with the realist approach. The evidence will be synthesised using realist logic to interrogate the final programme theory of the impact of appraisal on doctors' performance. The synthesis results will be written up according to RAMESES guidelines and disseminated through peer-reviewed publication and presentations. TRIAL REGISTRATION NUMBER The protocol is registered with PROSPERO 2014:CRD42014007092.
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Affiliation(s)
- Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment, CAMERA, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment, CAMERA, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Mark Pearson
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Geoff Wong
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Julian Archer
- Collaboration for the Advancement of Medical Education Research and Assessment, CAMERA, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
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Hasson H, Brisson C, Guérin S, Gilbert-Ouimet M, Baril-Gingras G, Vézina M, Bourbonnais R. An organizational-level occupational health intervention: Employee perceptions of exposure to changes, and psychosocial outcomes. WORK AND STRESS 2014. [DOI: 10.1080/02678373.2014.907370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Rehfuess EA, Bartram J. Beyond direct impact: Evidence synthesis towards a better understanding of effectiveness of environmental health interventions. Int J Hyg Environ Health 2014; 217:155-9. [DOI: 10.1016/j.ijheh.2013.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 07/17/2013] [Accepted: 07/20/2013] [Indexed: 10/26/2022]
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Crawford G, Leavy J, Portsmouth L, Jancey J, Leaversuch F, Nimmo L, Reid-Dornbusch L, Hills E. Development of a Systematic Review of Public Health Interventions to Prevent Children Drowning. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojpm.2014.43014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Duggan A, Minkovitz CS, Chaffin M, Korfmacher J, Brooks-Gunn J, Crowne S, Filene J, Gonsalves K, Landsverk J, Harwood R. Creating a national home visiting research network. Pediatrics 2013; 132 Suppl 2:S82-9. [PMID: 24187127 DOI: 10.1542/peds.2013-1021f] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Home visiting can play a key role in the early childhood system of services. For home visiting to achieve its potential, decision-makers must make informed choices regarding adoption, adaptation, coordination, scale-up, and sustainment. We need a coordinated, focused, and theory-based home visiting research infrastructure to inform such decisions. The transdisciplinary Home Visiting Research Network (HVRN) was established in July 2012 with funding from the Health Resources and Services Administration. Its goal is to promote the translation of research findings into policy and practice. Its objectives are to (1) develop a national home visiting research agenda, (2) advance the use of innovative research methods; and (3) provide a research environment that is supportive of the professional development of emerging researchers interested in home visiting. A Management Team designs and directs activities to achieve these objectives through Work Teams. A Steering Committee of national leaders representing stakeholder groups oversees progress. HVRN's Coordinating Center supports the Work Teams and HVRN's Home visiting Applied Research Collaborative, a practice-based research network of home visiting programs. This article describes HVRN's rationale, approach, and anticipated products. We use home visiting-primary care coordination as an illustration, noting potential roles for pediatric practices and pediatric researchers and research educators in HVRN activities. HVRN creates the infrastructure for a rigorous program of research to inform policy and practice on home visiting as part of the system of services to improve family functioning, parenting, and child outcomes.
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Affiliation(s)
- Anne Duggan
- 615 N. Wolfe St, Room E4136; Johns Hopkins University, Baltimore, MD 21205.
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Nielsen K, Randall R. Opening the black box: Presenting a model for evaluating organizational-level interventions. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2013. [DOI: 10.1080/1359432x.2012.690556] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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44
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Higginbottom GMA, Morgan M, O'Mahony J, Chiu Y, Kocay D, Alexandre M, Forgeron J, Young M. Immigrant women's experiences of postpartum depression in Canada: a protocol for systematic review using a narrative synthesis. Syst Rev 2013; 2:65. [PMID: 23965183 PMCID: PMC3765819 DOI: 10.1186/2046-4053-2-65] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Literature documents that immigrant women in Canada have a higher prevalence of postpartum depression symptomatology than Canadian-born women. There exists a need to synthesize information on the contextual factors and social determinants of health that influence immigrant women's reception of and behavior in accessing existing mental health services. Our research question is: what are the ethnoculturally defined patterns of help-seeking behaviors and decision-making and other predictive factors for therapeutic mental health care access and outcomes with respect to postpartum depression for immigrant women in Canada? METHODS/DESIGN Our synthesis incorporates a systematic review using narrative synthesis of reports (peer- and non-peer reviewed) of empirical research and aims to provide stakeholders with perspectives on postpartum mental health care services as experienced by immigrant women. To reach this goal we are using integrated knowledge translation, thus partnering with key stakeholders throughout the planning, implementation and dissemination stages to ensure topic relevancy and impact on future practice and policy. The search and selection strategies draw upon established systematic review methodologies as outlined by the Centre for Reviews and Dissemination and also incorporate guidelines for selection and appraisal of gray literature. Two search phases (a database and a gray literature phase) will identify literature for screening and final selection based on an inclusion/exclusion checklist. Quality appraisal will be performed using the tools produced by the Centre for Evidence Based Management. The narrative synthesis will be informed by Popay et al. (2006) framework using identified tools for each of its four elements. The integrated knowledge translation plan will ensure key messages are delivered in an audience-specific manner to optimize their impact on policy and practice change throughout health service, public health, immigration and community sectors. DISCUSSION The narrative synthesis methodology will facilitate understandings and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socio-economic status, pre-migration history and geographical location. Our review aims to have a substantive and sustainable impact on health outcomes, practice, programs and/or policy in the context of postpartum mental health of immigrant women. PROSPERO registration number CRD42012003020.
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Affiliation(s)
- Gina M A Higginbottom
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton AB T6G 1C9, Canada.
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A health equity critique of social marketing: Where interventions have impact but insufficient reach. Soc Sci Med 2013; 83:133-41. [DOI: 10.1016/j.socscimed.2013.01.036] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/25/2013] [Accepted: 01/29/2013] [Indexed: 11/19/2022]
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Pearson M, Chilton R, Woods HB, Wyatt K, Ford T, Abraham C, Anderson R. Implementing health promotion in schools: protocol for a realist systematic review of research and experience in the United Kingdom (UK). Syst Rev 2012; 1:48. [PMID: 23083508 PMCID: PMC3488465 DOI: 10.1186/2046-4053-1-48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/05/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND School-based interventions and campaigns are used to promote health and address a wide variety of public health problems. Schools are considered to be key sites for the implementation of health promotion programmes for their potential to reach the whole population in particular age-groups and instil healthy patterns of behavior early in life. However, evidence for the effectiveness of school-based health promotion interventions is highly variable. Systematic reviews of the evidence of school-based interventions tend to be highly problem- or intervention- specific, thereby missing potential generic insights into implementation and effectiveness of such programmes across problems. METHODS/DESIGN A realist systematic review will be undertaken to explain how, why and in what circumstances schools can provide feasible settings for effective health promotion programmes in the United Kingdom (UK). The review will be conducted in two phases. Phase 1 will identify programme theories about implementation (ideas about what enables or inhibits effective health promotion to be delivered in a school setting). Phase 2 will test the programme theories so that they can be challenged, endorsed and/or refined. A Review Advisory Group of education and health professionals will be convened to help identify and choose potential programme theories, provide a 'reality check' on the clarity and explanatory strength of the mechanisms to be tested, and help shape the presentation of findings to be usable by practitioners and decision-makers. Review findings will be disseminated through liaison with decision-makers, and voluntary and professional groups in the fields of education and health.
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Affiliation(s)
- Mark Pearson
- PenTAG, Institute of Health Services Research, University of Exeter Medical School, University of Exeter, Exeter, EX2 4SG, UK.
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Using documents to investigate links between implementation and sustainability in a complex community intervention: the PRISM study. Soc Sci Med 2012; 75:1222-9. [PMID: 22749443 DOI: 10.1016/j.socscimed.2012.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 05/01/2012] [Accepted: 05/18/2012] [Indexed: 11/20/2022]
Abstract
The increasing imperative to find what works in health services has meant a rise in research trialing interventions deemed 'complex'. While the strength of these interventions comes from taking a 'whole of problem' approach using multiple and inter-linking strategies, ways of examining implementation are under-explored. Building sustainability is an important part of implementing complex intervention research, but this too has received little exploration in the implementation literature. This paper explores issues of implementation and sustainability by examining the case of PRISM (Program of Resources, Information and Support for Mothers), a community randomised trial in Victoria, Australia aimed at improving maternal health and wellbeing. It examines documents placed on the project website. Three groups of documents relating to implementation of the intervention were examined - implementation reports, media reports and community newsletters. Analysing these documents allowed a focus on the 'work' of the intervention - who does the work and what activities comprise the work - in order to examine implementation as it relates to sustainability. Document analysis provides a useful way of considering implementation and sustainability of complex intervention research. It can 'value add' to findings from process evaluation and extend our understanding of an intervention beyond outcome measures. Analysis of the documents in this case provides insights into why sustainability of an intervention may be difficult to achieve during implementation.
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Higginbottom GMA, Morgan M, Dassanayake J, Eyford H, Alexandre M, Chiu Y, Forgeron J, Kocay D. Immigrant women's experiences of maternity-care services in Canada: a protocol for systematic review using a narrative synthesis. Syst Rev 2012; 1:27. [PMID: 22651573 PMCID: PMC3433387 DOI: 10.1186/2046-4053-1-27] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 05/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Canada's diverse society and statutory commitment to multiculturalism means that the synthesis of knowledge related to the health care experiences of immigrants is essential to realize the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for tailoring of services to user needs. We are therefore assessing the experiences of immigrant women in Canada accessing maternity-care services. We are focusing on: 1) accessibility and acceptability (as an important dimension of access) to maternity-care services as perceived and experienced by immigrant women, and 2) the birth and postnatal outcomes of these women. METHODS The aim of this study is to use a narrative synthesis, incorporating both a systematic review using narrative synthesis of reports of empirical research (qualitative, quantitative, and mixed-method designs), and a literature review of non-empirically based reports, both of which include 'grey' literature. The study aims to provide stakeholders with perspectives on maternity-care services as experienced by immigrant women. To achieve this, we are using integrated knowledge translation, partnering with key stakeholders to ensure topic relevancy and to tailor recommendations for effective translation into future policy and practice/programming. Two search phases and a three-stage selection process are being conducted (database search retrieved 1487 hits excluding duplicates) to provide evidence to contribute jointly to both the narrative synthesis and the non-empirical literature review. The narrative synthesis will be informed by the previous framework published in 2006 by Popay et al., using identified tools for each of its four elements. The non-empirical literature review will build upon the narrative-synthesis findings and/or identify omissions or gaps in the empirical research literature. The integrated knowledge translation plan will ensure that key messages are delivered in an audience-specific manner to optimize their effect on policy and practice change throughout the health service, and the public health, immigration and community sectors. DISCUSSION Narrative-synthesis methods of systematic review facilitate understanding and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socioeconomic status, and geographical location. They also enable understanding of the shaping of differences between reported outcomes and study designs related to childbearing populations, and the development and implementation of maternity services and health interventions across diverse settings. PROSPERO REGISTRATION Number 2185.
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Affiliation(s)
- Gina M A Higginbottom
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Myfanwy Morgan
- King’s College London, Primary Care & Public Health Sciences London, London, SE1 3QD, UK
| | | | - Helgi Eyford
- Lois Hole Hospital, Alberta Health Services, Edmonton, AB, T5H 3V9, Canada
| | - Mirande Alexandre
- Citizenship and Immigration Canada, New Multiculturalism Grants and Contributions Program, Canada Place, Edmonton, AB, T5J 4C3, Canada
| | - Yvonne Chiu
- Multicultural Health Brokers Co-operative, Edmonton, AB, T5H 2M6, Canada
| | - Joan Forgeron
- Lois Hole Hospital, Alberta Health Services, Edmonton, AB, T5H 3V9, Canada
| | - Deb Kocay
- Health Canada, Public Health Agency of Canada, Calgary, AB, T2G 4X3, Canada
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Lorenc T, Pearson M, Jamal F, Cooper C, Garside R. The role of systematic reviews of qualitative evidence in evaluating interventions: a case study. Res Synth Methods 2012; 3:1-10. [PMID: 26061997 DOI: 10.1002/jrsm.1036] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/05/2012] [Accepted: 03/12/2012] [Indexed: 11/07/2022]
Abstract
Systematic reviews of qualitative evidence have been widely used to provide information on the context and implementation of interventions, and their potential barriers and facilitators. However, such reviews face a number of methodological challenges, and there are ongoing debates as to how qualitative evidence can best be used to inform our understanding of interventions. In this paper, we use a case study of two systematic reviews of qualitative evidence on the prevention of skin cancer to explore these issues. We find that qualitative evidence not directly related to interventions is likely to be of value for such reviews, that it is often not possible to construct fully comprehensive search strategies, and that there are diminishing returns to the synthesis, in terms of added value or insight, from the inclusion of large numbers of primary studies. We conclude that there are a number of ways in which systematic reviews of qualitative evidence can be utilised in conjunction with evidence on intervention effectiveness, without compromising the rigour of the review process. In particular, the use of theory to inform frameworks for synthesis is a promising way to integrate a broader range of qualitative evidence. Copyright © 2012 John Wiley & Sons, Ltd.
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Affiliation(s)
- Theo Lorenc
- Department of Social and Environmental Health, London School of Hygiene & Tropical Medicine, UK.
| | - Mark Pearson
- Peninsula Technology Assessment Group (PenTAG), Peninsula College of Medicine & Dentistry, University of Exeter, UK
| | - Farah Jamal
- Institute for Health & Human Development, University of East London, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), Peninsula College of Medicine & Dentistry, University of Exeter, UK
| | - Ruth Garside
- Peninsula Technology Assessment Group (PenTAG), Peninsula College of Medicine & Dentistry, University of Exeter, UK
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Ingram JC, Deave T, Towner E, Errington G, Kay B, Kendrick D. Identifying facilitators and barriers for home injury prevention interventions for pre-school children: a systematic review of the quantitative literature. HEALTH EDUCATION RESEARCH 2012; 27:258-68. [PMID: 21873613 PMCID: PMC3529629 DOI: 10.1093/her/cyr066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 07/06/2011] [Indexed: 05/21/2023]
Abstract
Injuries are the leading cause of childhood death internationally; steep social gradients exist in mortality and morbidity. The majority of pre-school injuries occur in the home, but implementing research into practice for injury prevention has received little attention. This systematic review describes key facilitators and barriers when implementing injury prevention interventions. The review used articles included in a Cochrane systematic review of the effectiveness of home safety education, with or without the provision of safety equipment. Each paper was screened to ensure that children under 5 years, intervention details and process measures and/or barriers and facilitators were included. Two authors independently reviewed each paper and extracted data. Themes were identified and framework analysis used in an iterative process. Ninety-nine papers were identified, 42 excluded and 57 included in the analysis. Seven facilitators and six barriers were identified. Facilitators related to the approach used, focused messages, minimal changes, deliverer characteristics, equipment accessibility, behaviour change and including incentives. The barriers included complex interventions, cultural, socio-economic, physical and behavioural barriers and deliverer constraints. Barriers and facilitators should be addressed when implementing injury prevention interventions and studies should explicitly explore factors that help or hinder the process.
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Affiliation(s)
- Jenny C. Ingram
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
- Correspondence to: Jenny C. Ingram. E-mail:
| | - Toity Deave
- Centre for Child and Adolescent Health, Faculty of Health and Applied Social Sciences, University of the West of England, Bristol BS8 2BN, UK
| | - Elizabeth Towner
- Centre for Child and Adolescent Health, Faculty of Health and Applied Social Sciences, University of the West of England, Bristol BS8 2BN, UK
| | - Gail Errington
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, NG7 2HA, UK
| | - Bryony Kay
- Bristol Royal Hospital for Children, University Hospitals Bristol NHSFT, Bristol BS2 8BJ, UK
| | - Denise Kendrick
- Division of Primary Care Research, University of Nottingham, Nottingham, NG7 2RD, UK
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