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McInnes E, Dale S, Bagot K, Coughlan K, Grimshaw J, Pfeilschifter W, Cadilhac DA, Fischer T, van der Merwe J, Middleton S. The Quality in Acute Stroke Care (QASC) global scale-up using a cascading facilitation framework: a qualitative process evaluation. BMC Health Serv Res 2024; 24:144. [PMID: 38287332 PMCID: PMC10823736 DOI: 10.1186/s12913-024-10617-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Variation in hospital stroke care is problematic. The Quality in Acute Stroke (QASC) Australia trial demonstrated reductions in death and disability through supported implementation of nurse-led, evidence-based protocols to manage fever, hyperglycaemia (sugar) and swallowing (FeSS Protocols) following stroke. Subsequently, a pre-test/post-test study was conducted in acute stroke wards in 64 hospitals in 17 European countries to evaluate upscale of the FeSS Protocols. Implementation across countries was underpinned by a cascading facilitation framework of multi-stakeholder support involving academic partners and a not-for-profit health organisation, the Angels Initiative (the industry partner), that operates to promote evidence-based treatments in stroke centres. .We report here an a priori qualitative process evaluation undertaken to identify factors that influenced international implementation of the FeSS Protocols using a cascading facilitation framework. METHODS The sampling frame for interviews was: (1) Executives/Steering Committee members, consisting of academics, the Angels Initiative and senior project team, (2) Angel Team leaders (managers of Angel Consultants), (3) Angel Consultants (responsible for assisting facilitation of FeSS Protocols into multiple hospitals) and (4) Country Co-ordinators (senior stroke nurses with country and hospital-level responsibilities for facilitating the introduction of the FeSS Protocols). A semi-structured interview elicited participant views on the factorsthat influenced engagement of stakeholders with the project and preparation for and implementation of the FeSS Protocol upscale. Interviews were recorded, transcribed verbatim and analysed inductively within NVivo. RESULTS Individual (n = 13) and three group interviews (3 participants in each group) were undertaken. Three main themes with sub-themes were identified that represented key factors influencing upscale: (1) readiness for change (sub-themes: negotiating expectations; intervention feasible and acceptable; shared goal of evidence-based stroke management); (2) roles and relationships (sub-themes: defining and establishing roles; harnessing nurse champions) and (3) managing multiple changes (sub-themes: accommodating and responding to variation; more than clinical change; multi-layered communication framework). CONCLUSION A cascading facilitation model involving a partnership between evidence producers (academic partners), knowledge brokers (industry partner, Angels Initiative) and evidence adopters (stroke clinicians) overcame multiple challenges involved in international evidence translation. Capacity to manage, negotiate and adapt to multi-level changes and strategic engagement of different stakeholders supported adoption of nurse-initiated stroke protocols within Europe. This model has promise for other large-scale evidence translation programs.
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Affiliation(s)
- Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne; and Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne; and Australian Catholic University, Sydney, Australia.
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia.
| | - Kathleen Bagot
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne; and Australian Catholic University, Sydney, Australia
| | - Kelly Coughlan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne; and Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Jeremy Grimshaw
- Centre for Practice-Changing Research (CPCR), Ottawa Health Research Institute, Ottawa Hospital - General Campus; and University of Ottawa, Ottawa, ON, Canada
| | - Waltraud Pfeilschifter
- Department of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany
- Department of Neurology, Germany Centre of Neurology and Neurosurgery, Goethe University, Frankfurt am Main, University Hospital Frankfurt, Frankfurt, Germany
| | - Dominique A Cadilhac
- Translational Public Health Division, Stroke and Ageing Research, School of Clinical Sciences, Monash University, Melbourne, Australia
- Public Health, Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | | | | | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne; and Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
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Abraham O, Slonac E, Paulsen Z. Pharmacists' perspectives on MedSMA℞T: A serious game to educate youth about opioid safety. J Am Pharm Assoc (2003) 2023; 63:1087-1094.e1. [PMID: 37116795 PMCID: PMC10942740 DOI: 10.1016/j.japh.2023.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Adolescent opioid misuse has been recognized as a dire public health issue. Despite efforts to address the opioid epidemic in the United States, opioid-related morbidity and mortality have continued to rise. Few interventions have been tailored to prevent adolescent opioid misuse. MedSMA℞T: Adventures in PharmaCity (MedSMA℞T), is a serious game that educates the end-user by challenging them to make applicable decisions in a low-stakes environment. OBJECTIVE The study aimed to characterize pharmacists' perspectives on using MedSMA℞T to educate adolescents and families about opioid medication safety. METHODS Pharmacists were recruited from the Pharmacy Practice Enhancement and Action Research Link (PearlRx) and the Pharmacy Society of Wisconsin. Consented pharmacists played the MedSMA℞T game for 30 minutes while a research team member observed via Zoom. Virtual semi-structured interviews (45 minutes) were recorded and transcribed verbatim. Two members of the research team independently coded each transcript using NVivo software to conduct inductive thematic analyses. Bi-weekly meetings were held to discuss and refine codes as well as the master codebook, and identify prevalent themes (intercoder reliability, kappa = 0.91). RESULTS Twenty-two pharmacists were interviewed between August and November 2021. Four themes were identified: game content and design, patient education, implementation barriers, and implementation facilitators. Most pharmacists perceived MedSMA℞T to be an effective resource for opioid safety education. Pharmacists reported that age-appropriate language was used in combination with realistic scenarios and relatable characters. Pharmacists also highlighted the value of interactive gameplay to engage the player to actively learn and recall educational content. CONCLUSIONS Pharmacists play an integral role as medication experts and contributed valuable insights into using and incorporating the MedSMA℞T game into various pharmacy practice settings. Future work is necessary to understand parents' and adolescents' perceptions of using MedSMA℞T as an opioid safety education tool in pharmacies.
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Affiliation(s)
- Olufunmilola Abraham
- University of Wisconsin School of Pharmacy, Social and Administrative Sciences Division, Madison, WI
| | - Evan Slonac
- University of Wisconsin School of Pharmacy, Social and Administrative Sciences Division, Madison, WI
| | - Zachary Paulsen
- University of Wisconsin School of Pharmacy, Social and Administrative Sciences Division, Madison, WI
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Zechmeister-Koss I, Aufhammer S, Bachler H, Bauer A, Bechter P, Buchheim A, Christiansen H, Fischer M, Franz M, Fuchs M, Goodyear M, Gruber N, Hofer A, Hölzle L, Juen E, Papanthimou F, Prokop M, Paul JL. Practices to support co-design processes: A case-study of co-designing a program for children with parents with a mental health problem in the Austrian region of Tyrol. Int J Ment Health Nurs 2023; 32:223-235. [PMID: 36226745 DOI: 10.1111/inm.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 01/14/2023]
Abstract
Forms of collaborative knowledge production, such as community-academic partnerships (CAP), have been increasingly used in health care. However, instructions on how to deliver such processes are lacking. We aim to identify practice ingredients for one element within a CAP, a 6-month co-design process, during which 26 community- and 13 research-partners collaboratively designed an intervention programme for children whose parent have a mental illness. Using 22 published facilitating and hindering factors for CAP as the analytical framework, eight community-partners reflected on the activities which took place during the co-design process. From a qualitative content analysis of the data, we distilled essential practices for each CAP factor. Ten community- and eight research-partners revised the results and co-authored this article. We identified 36 practices across the 22 CAP facilitating or hindering factors. Most practices address more than one factor. Many practices relate to workshop design, facilitation methods, and relationship building. Most practices were identified for facilitating 'trust among partners', 'shared visions, goals and/or missions', 'effective/frequent communication', and 'well-structured meetings'. Fewer practices were observed for 'effective conflict resolution', 'positive community impact' and for avoiding 'excessive funding pressure/control struggles' and 'high burden of activities'. Co-designing a programme for mental healthcare is a challenging process that requires skills in process management and communication. We provide practice steps for delivering co-design activities. However, practitioners may have to adapt them to different cultural contexts. Further research is needed to analyse whether co-writing with community-partners results in a better research output and benefits for participants.
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Affiliation(s)
| | | | | | - Annette Bauer
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Hanna Christiansen
- Institut für Klinische Kinder- und Jugendpsychologie, Philipps-University, Marburg, Germany
| | - Maria Fischer
- Hilfe für Angehörige Psychisch Erkrankter Menschen in Tirol, Innsbruck, Austria
| | - Marianne Franz
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Fuchs
- Medical University Innsbruck, Innsbruck, Austria.,Abteilung für Kinder- und Jugendpsychiatrie, Tirol Kliniken GmbH, Hall in Tirol, Austria
| | - Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, Victoria, Australia.,Emerging Minds, Hilton, South Australia, Australia
| | - Nadja Gruber
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Laura Hölzle
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Evi Juen
- Kinder- und Jugendhilfe, Landeck, Austria
| | | | - Mathias Prokop
- Univ. Klinik für Psychiatrie, Landeskrankenhaus-Universitätskliniken Innsbruck Tirol Kliniken GmbH, Innsbruck, Austria
| | - Jean Lillian Paul
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
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Ernstmann N, Kuske S, Holmberg C, Wensing M, Reuschenbach B, Büscher A, Neugebauer E, Karbach U, Bethge M, Ansmann L, Pfaff H. [Recommendations for a Core Curriculum for Master's Degree Programs in Health Services Research]. DAS GESUNDHEITSWESEN 2023; 85:133-138. [PMID: 36543257 PMCID: PMC9931451 DOI: 10.1055/a-1981-1643] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The aim of the present study was to develop recommendations for a core curriculum for master's degree programs in health services research. For this purpose, a standardized online survey of university lecturers was conducted in the first step. In the second step, the curricula of the existing study programs were analyzed. In the third step, a literature search was conducted. In the last step, the resulting recommendations were discussed in a panel of experts. The final recommendations comprise 13 topics on five guiding questions with 26 subtopics. The main topics come from the areas of basic sciences in the context of health services research, the health care system and health policy, the (empirical) health services research process, and knowledge transfer. The present recommendations will serve as a basis for discussion and as a starting point. The development of recommendations should be seen as an ongoing process, as the core competencies of health services researchers will have to be continuously adapted to new research topics, new research methods and regulations.
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Affiliation(s)
- Nicole Ernstmann
- Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Germany
- Lehrstuhl für Versorgungsforschung, Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Universität zu Köln, Köln, Germany
| | - Silke Kuske
- Pflegewissenschaft und Versorgungsforschung, Fliedner Fachhochschule Düsseldorf, Düsseldorf, Germany
| | - Christine Holmberg
- Institut für Sozialmedizin und Epidemiologie, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg an der Havel, Germany
| | - Michel Wensing
- Abteilung Allgemeinmedizin und Versorgungsforschung, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Bernd Reuschenbach
- Fakultät für Gesundheit und Pflege, Katholische Stiftungshochschule München, München, Germany
| | - Andreas Büscher
- Fakultät Wirtschafts- und Sozialwissenschaftten, Deutsches Netzwerk für Qualitätssicherung in der Pflege (DNQP), Hochschule Osnabruck, Osnabruck, Germany
| | - Edmund Neugebauer
- Campus Neuruppin, Medizinische Hochschule Brandenburg (MHB), Neuruppin, Germany
| | - Ute Karbach
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Universität zu Köln, Köln, Germany
| | - Matthias Bethge
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Lena Ansmann
- Department für Versorgungsforschung, Abteilung Organisationsbezogene Versorgungsforschung, Carl von Ossietzky Universitat Oldenburg, Oldenburg, Germany
| | - Holger Pfaff
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Universität zu Köln, Köln, Germany
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Yoong SL, Bolsewicz K, Reilly K, Williams C, Wolfenden L, Grady A, Kingsland M, Finch M, Wiggers J. Describing the evidence-base for research engagement by health care providers and health care organisations: a scoping review. BMC Health Serv Res 2023; 23:75. [PMID: 36694193 PMCID: PMC9872336 DOI: 10.1186/s12913-022-08887-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/24/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Having a research-engaged health and medical workforce is associated with improvements in clinical outcomes for patients. As such, there has been significant government investment internationally to support health care organisations and services to increase staff engagement with research. OBJECTIVES This scoping review sought to provide an overview of the literature describing strategies employed to increase research engagement by health care providers and organisations, and to undertake a qualitative analysis to generate a list of research engagement strategies. METHODS A scoping review using systematic search strategies was undertaken to locate peer-review publications and grey literature related to research engagement by health care providers and organisations. Research engagement was defined as a 'deliberate set of intellectual and practical activities undertaken by health care staff and organisations to conduct research'. A database search of electronic records was performed with no limit on publication date. Publications were included regardless of study type (excluding systematic reviews) and categorised as either databased (presenting data or new analysis of existing data) and non-databased (no new data or analyses). Databased publications were further classified according to study type, study design and setting. A qualitative synthesis using a Framework Approach was undertaken with all studies that described a strategy to improve research engagement. RESULTS A total of 152 publications were included in this study with 54% categorised as non-databased. Of the databased articles, the majority (72%) were descriptive studies describing prevalence of correlates of research engagement, 17 (25%) described intervention studies where only two were controlled studies. The following research engagement strategies were identified: i) dual skilled team/staff, ii) resources or physical infrastructure, iii) incentives, iv) leadership support of research, v) education/training, vi) networks, vii) forming partnerships or collaborations and viii) overall leadership structure of entity. CONCLUSIONS The literature on research engagement is primarily opinion-based and descriptive in nature. To provide the evidence needed to inform strategies, this needs to progress beyond descriptive to more rigorous well-designed intervention research.
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Affiliation(s)
- Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Burwood, VIC 3125 Australia ,Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Katarzyna Bolsewicz
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.493834.1National Centre for Immunisation Research and Surveillance, Sydney Children’s Hospital Network, Sydney, NSW 2145 Australia
| | - Kathryn Reilly
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Christopher Williams
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Alice Grady
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Meghan Finch
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
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Barnes LAJ, Longman J, Adams C, Paul C, Atkins L, Bonevski B, Cashmore A, Twyman L, Bailie R, Pearce A, Barker D, Milat AJ, Dorling J, Nicholl M, Passey M. The MOHMQuit (Midwives and Obstetricians Helping Mothers to Quit Smoking) Trial: protocol for a stepped-wedge implementation trial to improve best practice smoking cessation support in public antenatal care services. Implement Sci 2022; 17:79. [PMID: 36494723 PMCID: PMC9734467 DOI: 10.1186/s13012-022-01250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Smoking during pregnancy is the most important preventable cause of adverse pregnancy outcomes, yet smoking cessation support (SCS) is inconsistently provided. The MOMHQUIT intervention was developed to address this evidence-practice gap, using the Behaviour Change Wheel method by mapping barriers to intervention strategies. MOHMQuit includes systems, leadership and clinician elements. This implementation trial will determine the effectiveness and cost-effectiveness of MOHMQuit in improving smoking cessation rates in pregnant women in public maternity care services in Australia; test the mechanisms of action of the intervention strategies; and examine implementation outcomes. METHODS A stepped-wedge cluster-randomised design will be used. Implementation of MOHMQuit will include reinforcing leadership investment in SCS as a clinical priority, strengthening maternity care clinicians' knowledge, skills, confidence and attitudes towards the provision of SCS, and clinicians' documentation of guideline-recommended SCS provided during antenatal care. Approximately, 4000 women who report smoking during pregnancy will be recruited across nine sites. The intervention and its implementation will be evaluated using a mixed methods approach. The primary outcome will be 7-day point prevalence abstinence at the end of pregnancy, among pregnant smokers, verified by salivary cotinine testing. Continuous data collection from electronic medical records and telephone interviews with postpartum women will occur throughout 32 months of the trial to assess changes in cessation rates reported by women, and SCS documented by clinicians and reported by women. Data collection to assess changes in clinicians' knowledge, skills, confidence and attitudes will occur prior to and immediately after the intervention at each site, and again 6 months later. Questionnaires at 3 months following the intervention, and semi-structured interviews at 6 months with maternity service leaders will explore leaders' perceptions of acceptability, adoption, appropriateness, feasibility, adaptations and fidelity of delivery of the MOHMQuit intervention. Structural equation modelling will examine causal linkages between the strategies, mediators and outcomes. Cost-effectiveness analyses will also be undertaken. DISCUSSION This study will provide evidence of the effectiveness of a multi-level implementation intervention to support policy decisions; and evidence regarding mechanisms of action of the intervention strategies (how the strategies effected outcomes) to support further theoretical developments in implementation science. TRIAL REGISTRATION ACTRN12622000167763, registered February 2nd 2022.
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Affiliation(s)
- Larisa Ariadne Justine Barnes
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
| | - Jo Longman
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
| | - Catherine Adams
- Northern New South Wales Local Health District, Byron Central Hospital, Ewingsdale Rd, Byron Bay, NSW 2480 Australia
| | - Christine Paul
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308 Australia
| | - Lou Atkins
- grid.83440.3b0000000121901201University College London, Centre for Behaviour Change, Gower Street, London, WC1E 6BT UK
| | - Billie Bonevski
- grid.1014.40000 0004 0367 2697Flinders University, College of Medicine & Public Health, Flinders Health and Medical Research Institute, Sturt Road, Bedford Park, SA 5042 Australia
| | - Aaron Cashmore
- grid.416088.30000 0001 0753 1056NSW Ministry of Health, Centre for Epidemiology and Evidence, 1 Reserve Road, St Leonards, NSW 2065 Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Camperdown, NSW 2006 Australia
| | - Laura Twyman
- grid.266842.c0000 0000 8831 109XTobacco Control Unit, Cancer Prevention and Advocacy Division, Cancer Council NSW, and Conjoint Fellow, School of Medicine and Public Health, University of Newcastle, 153 Dowling St., Woolloomooloo, NSW 2011 Australia
| | - Ross Bailie
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
| | - Alison Pearce
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, and Sydney School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Camperdown, NSW 2006 Australia
| | - Daniel Barker
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308 Australia
| | - Andrew J. Milat
- grid.416088.30000 0001 0753 1056NSW Ministry of Health, Centre for Epidemiology and Evidence, 1 Reserve Road, St Leonards, NSW 2065 Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Camperdown, NSW 2006 Australia
| | - Julie Dorling
- grid.492318.50000 0004 0619 0853Western NSW Local Health District, 7 Commercial Avenue, Dubbo, NSW 2830 Australia
| | - Michael Nicholl
- grid.1013.30000 0004 1936 834XClinical Excellence Commission-NSW Health and The University of Sydney Faculty of Medicine and Health, 1 Reserve Road, St. Leonards, NSW 2065 Australia
| | - Megan Passey
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
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Ahmed S, LePage K, Benc R, Erez G, Litvin A, Werbitt A, Chartier G, Berlin C, Loiselle CG. Lessons Learned from the Implementation of a Person-Centred Digital Health Platform in Cancer Care. Curr Oncol 2022; 29:7171-7180. [PMID: 36290841 PMCID: PMC9600520 DOI: 10.3390/curroncol29100564] [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] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 01/13/2023] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic has accelerated the development and use of digital health platforms to support individuals with health-related challenges. This is even more frequent in the field of cancer care as the global burden of the disease continues to increase every year. However, optimal implementation of these platforms into the clinical setting requires careful planning and collaboration. An implementation project was launched between the Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Ouest-de-I'Île-de-Montreal and BELONG-Beating Cancer Together-a person-centred cancer navigation and support digital health platform. The goal of the project was to implement content and features specific to the CIUSSS, to be made available exclusively for individuals with cancer (and their caregivers) treated at the institution. Guided by Structural Model of Interprofessional Collaboration, we report on implementation processes involving diverse stakeholders including clinicians, hospital administrators, researchers and local community/patient representatives. Lessons learned include earlier identification of shared goals and clear expectations, more consistent reliance on virtual means to communicate among all involved, and patient/caregiver involvement in each step to ensure informed and shared decision making.
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Affiliation(s)
- Saima Ahmed
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences McGill University, Montreal, QC H4A 3J1, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Centre-Ouest-de l’Île-de Montréal, Montreal, QC H3T 1E2, Canada
| | - Karine LePage
- Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Centre-Ouest-de l’Île-de Montréal, Montreal, QC H3T 1E2, Canada
| | - Renata Benc
- Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Centre-Ouest-de l’Île-de Montréal, Montreal, QC H3T 1E2, Canada
| | - Guy Erez
- Belong.life Inc., New York, NY 10001, USA
| | | | | | - Gabrielle Chartier
- Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Centre-Ouest-de l’Île-de Montréal, Montreal, QC H3T 1E2, Canada
| | - Carly Berlin
- Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Centre-Ouest-de l’Île-de Montréal, Montreal, QC H3T 1E2, Canada
| | - Carmen G. Loiselle
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences McGill University, Montreal, QC H4A 3J1, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Centre-Ouest-de l’Île-de Montréal, Montreal, QC H3T 1E2, Canada
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3T2, Canada
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 2M7, Canada
- Correspondence:
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8
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El-Helou R, Ryan B, Kneebone I. Development of the "Kalmer" relaxation intervention: co-design with stroke survivors with aphasia. Disabil Rehabil 2022; 45:1517-1529. [PMID: 35549790 DOI: 10.1080/09638288.2022.2069294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Anxiety is common after stroke and more prevalent in survivors with aphasia. Relaxation is an effective first-line therapy. The current study aimed to obtain the perspectives of stroke survivors with aphasia to inform the development of an accessible, technology-based, relaxation intervention. MATERIALS AND METHODS Qualitative co-design methods were used with twelve people with aphasia after stroke. The "Kalmer" Relaxation treatment package materials were iteratively based on participants' experiences and preferences; barriers and facilitators to treatment compliance were explored. Participants were also asked to consider how the intervention might be evaluated in a research trial. RESULTS A thematic analysis highlighted the importance and need for the development of an appropriate and inclusive relaxation product, to be implemented by health professionals early post-stroke. Several behavioural strategies to improve treatment adherence were recommended. Participants had varying perspectives on clinically meaningful treatment outcomes. CONCLUSIONS Overall, a co-designed accessible relaxation product was viewed as a necessary component of usual stroke care. Acceptability and feasibility and preliminary efficacy of the "Kalmer" intervention should be trialled in future studies. IMPLICATIONS FOR REHABILITATIONCo-designing psychological interventions for people with aphasia after stroke is needed to meet the needs of this at-risk population.Technology-based relaxation interventions to manage anxiety after stroke are viewed positively by people with aphasia and deemed acceptable and feasible.Clinical trials of these co-designed relaxation interventions are required before recommending integration into routine practice.
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Affiliation(s)
- Rebecca El-Helou
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Brooke Ryan
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
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9
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Goodyear M, Zechmeister-Koss I, Bauer A, Christiansen H, Glatz-Grugger M, Paul JL. Development of an Evidence-Informed and Codesigned Model of Support for Children of Parents With a Mental Illness- "It Takes a Village" Approach. Front Psychiatry 2022; 12:806884. [PMID: 35173638 PMCID: PMC8841827 DOI: 10.3389/fpsyt.2021.806884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Providing support to parents and their children to help address the cycle of intergenerational impacts of mental illness and reduce the negative consequences for children is a key focus of selective prevention approaches in public mental health. However, a key issue for children of parents with a mental illness is the lack of access to early intervention and prevention support when needed. They are not easily identifiable (until presenting with significant mental health issues of their own) and not easily accessing the necessary support that address the complex interplay of parental mental illness within families. There are significant barriers to the early identification of these children, particularly for mental health care. Furthermore, there is a lack of collaborative care that might enhance identification as well as offer services and support for these families. The "It takes a Village" project seeks to improve mental health outcomes for children through the co-development, implementation and evaluation of an approach to collaborative practice concerned with the identification of families where a parent has a mental illness, and establishing a service model to promote child-focused support networks in Austria. Here we describe the development of service delivery approach for the "It takes a Village" project that aims to improve identification and support of these children within enhancements of the existing service systems and informal supports. The paper describes the use of codesign and other implementation strategies, applied to a research setting, with the aim of impacting the sustainability of workforce reform to achieve lasting social impact. Results highlight the steps involved in translating evidence-based components, local practice wisdom and lived experience into the "It takes a Village" practice model for Tyrol, Austria. We highlight through this paper how regional context-specific solutions are essential in the redesign of care models that meet the complex needs of children of parents with a mental illness. Service system and policy formation with local and experienced stakeholders are also vital to ensure the solutions are implementation-ready, particularly when introducing new practice models that rely on organizational change and new ways of practice with vulnerable families. This also creates a solid foundation for the evaluation of the "It take a Village" approach for children of parents with a mental illness in Austria.
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Affiliation(s)
- Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, VIC, Australia
- Emerging Minds, National Workforce Centre for Child Mental Health, Hilton, SA, Australia
| | | | - Annette Bauer
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Hanna Christiansen
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Martina Glatz-Grugger
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria
| | - Jean Lillian Paul
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
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10
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Sensing and seizing in the apparel industry: the role of dynamic capabilities in fostering sustainable strategic orientations. INTERNATIONAL JOURNAL OF ORGANIZATIONAL ANALYSIS 2021. [DOI: 10.1108/ijoa-02-2021-2620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to explore how the dynamic capabilities sensing and seizing could support a sustainable (either instrumental or stewardship) strategic orientation in the apparel industry.
Design/methodology/approach
Through qualitative and inductive research design, ten companies from the Sustainable Apparel Coalition, specifically focusing on brands, were researched. Employees in strategic positions were interviewed. Subsequently, thematic analysis was realized to extract findings from both instrumental and stewardship organizations.
Findings
Instrumental organizations focus on increasing their brand, mainly by following market demands. They sense opportunities via a hierarchical organizational structure that allows for incremental innovation based on internal competition. Stewardship organizations believe in a collective approach toward conducting business effectively. While building a “sustainable case for business”, a stewardship-oriented company senses by involving their stakeholders and seeks unorthodox opportunities using a long-term internal compass as a beacon for decision-making.
Originality/value
Key capabilities are revealed that allow businesses and managers to reach higher levels of sustainability in a specific sector: the apparel industry. Especially the capabilities of stewardship-oriented companies and its ambidexterity provide a fertile base for future research at the nexus of organization development and sustainability.
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11
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Varallyay NI, Bennett SC, Kennedy C, Ghaffar A, Peters DH. How does embedded implementation research work? Examining core features through qualitative case studies in Latin America and the Caribbean. Health Policy Plan 2021; 35:ii98-ii111. [PMID: 33156937 PMCID: PMC7646734 DOI: 10.1093/heapol/czaa126] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 01/04/2023] Open
Abstract
Innovative strategies are needed to improve the delivery of evidence-informed health interventions. Embedded implementation research (EIR) seeks to enhance the generation and use of evidence for programme improvement through four core features: (1) central involvement of programme/policy decision-makers in the research cycle; (2) collaborative research partnerships; (3) positioning research within programme processes and (4) research focused on implementation. This paper examines how these features influence evidence-to-action processes and explores how they are operationalized, their effects and supporting conditions needed. We used a qualitative, comparative case study approach, drawing on document analysis and semi-structured interviews across multiple informant groups, to examine three EIR projects in Bolivia, Colombia and the Dominican Republic. Our findings are presented according to the four core EIR features. The central involvement of decision-makers in EIR was enhanced by decision-maker authority over the programme studied, professional networks and critical reflection. Strong research-practice partnerships were facilitated by commitment, a clear and shared purpose and representation of diverse perspectives. Evidence around positioning research within programme processes was less conclusive; however, as all three cases made significant advances in research use and programme improvement, this feature of EIR may be less critical than others, depending on specific circumstances. Finally, a research focus on implementation demanded proactive engagement by decision-makers in conceptualizing the research and identifying opportunities for direct action by decision-makers. As the EIR approach is a novel approach in these low-resource settings, key supports are needed to build capacity of health sector stakeholders and create an enabling environment through system-level strategies. Key implications for such supports include: promoting EIR and creating incentives for decision-makers to engage in it, establishing structures or mechanisms to facilitate decision-maker involvement, allocating funds for EIR, and developing guidance for EIR practitioners.
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Affiliation(s)
- N Ilona Varallyay
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
- Corresponding author. Malabia 1970, Buenos Aires CABA 1414,
Argentina. E-mail:
| | - Sara C Bennett
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Caitlin Kennedy
- Social and Behavioral Interventions Program, Department of
International Health, Johns Hopkins School of Public Health, 615 N Wolfe St,
Baltimore, MD 21205, United States
| | - Abdul Ghaffar
- The Alliance for Health Policy and Systems Research at the
World Health Organization, 20 avenue Appia, 1211 Geneva, Switzerland
| | - David H Peters
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
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12
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Options for Meaningful Engagement in Clinical Research for Busy Frontline Clinicians. J Gen Intern Med 2021; 36:2100-2104. [PMID: 33528778 PMCID: PMC8298624 DOI: 10.1007/s11606-020-06587-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
In order for health care innovations to be effective and actionable, they must align with the needs and practice patterns of those delivering care at the bedside. While research has started to incorporate the patient voice, it has yet to fully invest in the expertise of frontline clinicians. Frontline clinicians carry a wealth of clinical knowledge and the lived experience of providing real-world medical care that the research community seeks to improve. We consider options for clinicians as research stakeholders along a continuum of engagement as outlined by the UCSF Clinical and Translational Science Institute from minimal to supportive to participatory. In order to make an effective value proposition to support reallocation of clinician time to research engagement, we advocate evaluating the impact of clinicians as stakeholders at both the process level (e.g., clinician satisfaction, study recruitment rates) and endpoint level (e.g., clinical outcomes). Investing in clinicians as research stakeholders can offer benefits for the individual, health system, and population by increasing the generalizability, adoption, and sustainability of effective interventions.
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13
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Kirk J, Bandholm T, Andersen O, Husted RS, Tjørnhøj-Thomsen T, Nilsen P, Pedersen MM. Challenges in co-designing an intervention to increase mobility in older patients: a qualitative study. J Health Organ Manag 2021; 35:140-162. [PMID: 33960175 PMCID: PMC9251644 DOI: 10.1108/jhom-02-2020-0049] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose The aim of this study is to explore and discuss key challenges associated with having stakeholders take part in co-designing a health care intervention to increase mobility in older medical patients admitted to two medical departments at two hospitals in Denmark. Design/methodology/approach The study used a qualitative design to investigate the challenges of co-designing an intervention in five workshops involving health professionals, patients and relatives. “Challenges” are understood as “situations of being faced with something that needs great mental or physical effort in order to be done successfully and therefore tests a person's ability” (Cambridge Dictionary). Thematic content analysis was conducted with a background in the analytical question: “What key challenges arise in the material in relation to the co-design process?”. Findings Two key challenges were identified: engagement and facilitation. These consisted of five sub-themes: recruiting patients and relatives, involving physicians, adjusting to a new researcher role, utilizing contextual knowledge and handling ethical dilemmas. Research limitations/implications The population of patients and relatives participating in the workshops was small, which likely affected the co-design process. Practical implications Researchers who want to use co-design must be prepared for the extra time required and the need for skills concerning engagement, communication, facilitation, negotiation and resolution of conflict. Time is also required for ethical discussions and considerations concerning different types of knowledge creation. Originality/value Engaging stakeholders in co-design processes is increasingly encouraged. This study documents the key challenges in such processes and reports practical implications.
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Affiliation(s)
- Jeanette Kirk
- Department of Clinical Research and Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark.,Amager and Hvidovre Hospital, University Hospital of Copenhagen, Hvidovre, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.,Department of Physical and Occupational Therapy, Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Amager and Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Rasmus Skov Husted
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Sønderborg, Denmark
| | - Per Nilsen
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
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14
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Potts A, Shearn K, Frith G, Christy E. Working with local people as part of a whole-systems approach to physical activity: reflections from local delivery pilots. Perspect Public Health 2021; 141:74-75. [PMID: 33733943 DOI: 10.1177/1757913920982645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alexandra Potts
- Institute for Sport, Physical Activity, and Leisure, Leeds Beckett University, Fairfax Hall 113, Leeds LS6 3QS, UK
| | - Katie Shearn
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Gabriella Frith
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Elizabeth Christy
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
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15
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Elbers S, van Gessel C, Renes RJ, van der Lugt R, Wittink H, Hermsen S. Innovation in Pain Rehabilitation Using Co-Design Methods During the Development of a Relapse Prevention Intervention: Case Study. J Med Internet Res 2021; 23:e18462. [PMID: 33470937 PMCID: PMC7857944 DOI: 10.2196/18462] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/16/2020] [Accepted: 11/23/2020] [Indexed: 01/29/2023] Open
Abstract
Background Many intervention development projects fail to bridge the gap from basic research to clinical practice. Instead of theory-based approaches to intervention development, co-design prioritizes the end users’ perspective as well as continuous collaboration between stakeholders, designers, and researchers throughout the project. This alternative approach to the development of interventions is expected to promote the adaptation to existing treatment activities and to be responsive to the requirements of end users. Objective The first objective was to provide an overview of all activities that were employed during the course of a research project to develop a relapse prevention intervention for interdisciplinary pain treatment programs. The second objective was to examine how co-design may contribute to stakeholder involvement, generation of relevant insights and ideas, and incorporation of stakeholder input into the intervention design. Methods We performed an embedded single case study and used the double diamond model to describe the process of intervention development. Using all available data sources, we also performed deductive content analysis to reflect on this process. Results By critically reviewing the value and function of a co-design project with respect to idea generation, stakeholder involvement, and incorporation of stakeholder input into the intervention design, we demonstrated how co-design shaped the transition from ideas, via concepts, to a prototype for a relapse prevention intervention. Conclusions Structural use of co-design throughout the project resulted in many different participating stakeholders and stimulating design activities. As a consequence, the majority of the components of the final prototype can be traced back to the information that stakeholders provided during the project. Although this illustrates how co-design facilitates the integration of contextual information into the intervention design, further experimental testing is required to evaluate to what extent this approach ultimately leads to improved usability as well as patient outcomes in the context of clinical practice.
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Affiliation(s)
- Stefan Elbers
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Utrecht, Netherlands.,Department of Rehabilitation Medicine, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, Netherlands
| | - Christa van Gessel
- Co-design Research Group, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Reint Jan Renes
- Research Group Psychology of Sustainable Cities, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Remko van der Lugt
- Co-design Research Group, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Harriët Wittink
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Sander Hermsen
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Utrecht, Netherlands.,OnePlanet Research Center, imec The Netherlands, Wageningen, Netherlands
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16
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Haynes A, Garvey K, Davidson S, Milat A. What Can Policy-Makers Get Out of Systems Thinking? Policy Partners' Experiences of a Systems-Focused Research Collaboration in Preventive Health. Int J Health Policy Manag 2020; 9:65-76. [PMID: 32124590 PMCID: PMC7054651 DOI: 10.15171/ijhpm.2019.86] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 10/02/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is increasing interest in using systems thinking to tackle 'wicked' policy problems in preventive health, but this can be challenging for policy-makers because the literature is amorphous and often highly theoretical. Little is known about how best to support health policy-makers to gain skills in understanding and applying systems thinking for policy action. METHODS In-depth interviews were conducted with 18 policy-makers who are participating in an Australian research collaboration that uses a systems approach. Our aim was to explore factors that support policy-makers to use systems approaches, and to identify any impacts of systems thinking on policy thinking or action, including the pathways through which these impacts occurred. RESULTS All 18 policy-makers agreed that systems thinking has merit but some questioned its practical policy utility. A small minority were confused about what systems thinking is or which approaches were being used in the collaboration. The majority were engaged with systems thinking and this group identified concrete impacts on their work. They reported using systems-focused research, ideas, tools and resources in policy work that were contributing to the development of practical methodologies for policy design, scaling up, implementation and evaluation; and to new prevention narratives. Importantly, systems thinking was helping some policy-makers to reconceptualise health problems and contexts, goals, potential policy solutions and methods. In short, they were changing how they think about preventive health. CONCLUSION These results show that researchers and policy-makers can put systems thinking into action as part of a research collaboration, and that this can result in discernible impacts on policy processes. In this case, action-oriented collaboration and capacity development over a 5-year period facilitated mutual learning and practical application. This indicates that policy-makers can get substantial applied value from systems thinking when they are involved in extended co-production processes that target policy impact and are supported by responsive capacity strategies.
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Affiliation(s)
- Abby Haynes
- The Australian Prevention Partnership Centre, Sydney, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Kate Garvey
- The Australian Prevention Partnership Centre, Sydney, NSW, Australia
- Australia Public Health Services, Department of Health Tasmania, Hobart, TAS, Australia
| | - Seanna Davidson
- The Australian Prevention Partnership Centre, Sydney, NSW, Australia
- The Systems School, Melbourne, VIC, Australia
| | - Andrew Milat
- The Australian Prevention Partnership Centre, Sydney, NSW, Australia
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW, Australia
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17
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Haynes A, Rowbotham S, Grunseit A, Bohn-Goldbaum E, Slaytor E, Wilson A, Lee K, Davidson S, Wutzke S. Knowledge mobilisation in practice: an evaluation of the Australian Prevention Partnership Centre. Health Res Policy Syst 2020; 18:13. [PMID: 32005254 PMCID: PMC6995057 DOI: 10.1186/s12961-019-0496-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/21/2019] [Indexed: 12/04/2022] Open
Abstract
Background Cross-sector collaborative partnerships are a vital strategy in efforts to strengthen research-informed policy and practice and may be particularly effective at addressing the complex problems associated with chronic disease prevention. However, there is still a limited understanding of how such partnerships are implemented in practice and how their implementation contributes to outcomes. This paper explores the operationalisation and outcomes of knowledge mobilisation strategies within the Australian Prevention Partnership Centre — a research collaboration between policy-makers, practitioners and researchers. Methods The Centre’s programme model identifies six knowledge mobilisation strategies that are hypothesised to be essential for achieving its objectives. Using a mixed methods approach combining stakeholder interviews, surveys, participant feedback forms and routine process data over a 5-year period, we describe the structures, resources and activities used to operationalise these strategies and explore if and how they have contributed to proximal outcomes. Results Results showed that Centre-produced research, resources, tools and methods were impacting policy formation and funding. Policy-makers reported using new practical methodologies that were helping them to design, implement, evaluate and obtain funding for scaled-up policies and programmes, and co-creating compelling prevention narratives. Some strategies were better implemented and more impactful than others in supporting these outcomes, with variation in who they worked for. The activities used to effect engagement, capacity-building and partnership formation were mostly generating positive results, but co-production could be enhanced by greater shared decision-making. Considerably more work is needed to successfully operationalise knowledge integration and adaptive learning. Conclusions Describing how collaborative cross-sector research partnerships are operationalised in practice, and with what effects, can provide important insights into practical strategies for establishing and growing such partnerships and for maximising their contributions to policy. Findings suggest that the Centre has many strengths but could benefit from more inclusive and transparent governance and internal processes that facilitate dialogue about roles, expectations and co-production practices.
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Affiliation(s)
- Abby Haynes
- The Australian Prevention Partnership Centre, The Sax Institute, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia. .,Menzies Centre for Health Policy, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Samantha Rowbotham
- The Australian Prevention Partnership Centre, The Sax Institute, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia.,Menzies Centre for Health Policy, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Anne Grunseit
- The Australian Prevention Partnership Centre, The Sax Institute, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia.,Prevention Research Collaboration, Charles Perkins Centre, The University of Sydney, Sydney School of Public Health, Camperdown, NSW, 2006, Australia
| | - Erika Bohn-Goldbaum
- The Australian Prevention Partnership Centre, The Sax Institute, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia.,Prevention Research Collaboration, Charles Perkins Centre, The University of Sydney, Sydney School of Public Health, Camperdown, NSW, 2006, Australia
| | - Emma Slaytor
- The Australian Prevention Partnership Centre, The Sax Institute, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia
| | - Andrew Wilson
- The Australian Prevention Partnership Centre, The Sax Institute, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia.,Menzies Centre for Health Policy, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Karen Lee
- The Australian Prevention Partnership Centre, The Sax Institute, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia.,Prevention Research Collaboration, Charles Perkins Centre, The University of Sydney, Sydney School of Public Health, Camperdown, NSW, 2006, Australia
| | - Seanna Davidson
- The Australian Prevention Partnership Centre, The Sax Institute, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia
| | - Sonia Wutzke
- The Australian Prevention Partnership Centre, The Sax Institute, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia
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18
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What happened and why? A programme theory-based qualitative evaluation of a healthcare-academia partnership reform in primary care. BMC Health Serv Res 2019; 19:785. [PMID: 31675956 PMCID: PMC6825344 DOI: 10.1186/s12913-019-4665-1] [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: 04/23/2019] [Accepted: 10/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing interest in and demands for partnerships between academia and healthcare practices. Few empirical studies have described the influence of such partnerships from a practice perspective. The purpose of this study was to evaluate the impact of a reform launched to increase integration between primary care and academia and to identify potential reasons for why the observed impact occurred in three areas targeted by the reform: research, student education, and continued professional development. METHODS The study was conducted in Stockholm County, the largest healthcare region in Sweden, at the introduction of a partnership between primary care and academia, including eight coordinating centres and approximately 500 surrounding primary care units. A programme theory-based qualitative approach to evaluation was used, building on document analysis, and in-depth interviews with the centre managers (n = 6) and coordinators (n = 8) conducted 42-66 months after the initiation of the reform. RESULTS The analysis showed that the reform had some impact on all three areas targeted by the reform: research, student education, and continued professional development. The input that contributed most extensively to the impact was the establishment of facilitating roles. Most changes occurred at the coordinating centres and primarily in the area of student education. The effect on student education was primarily due to having prior experience in this area and perceptions of timely benefits of students to care practice. CONCLUSIONS Partnerships between primary care and academia hold the potential of practice impact. To increase integration between primary care and academia, the components of the integration must be understandable and relevant for primary care practitioners, and importantly, compliant with delivery of primary care.
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19
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Vanyoro KP, Hawkins K, Greenall M, Parry H, Keeru L. Local ownership of health policy and systems research in low-income and middle-income countries: a missing element in the uptake debate. BMJ Glob Health 2019; 4:e001523. [PMID: 31543986 PMCID: PMC6730582 DOI: 10.1136/bmjgh-2019-001523] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 11/05/2022] Open
Abstract
Health policy and systems researchers (HPSRs) in low-income and middle-income countries (LMICs) aim to influence health systems planning, costing, policy and implementation. Yet, there is still much that we do not know about the types of health systems evidence that are most compelling and impactful to policymakers and community groups, the factors that facilitate the research to decision-making process and the real-world challenges faced when translating research findings into practice in different contexts. Drawing on an analysis of HPSR from LMICs presented at the Fifth Global Symposium on Health Systems Research (HSR 2018), we argue that while there is a recognition in policy studies more broadly about the role of co-production, collective ownership and the value of localised HPSR in the evidence-to-policy discussion, ‘ownership’ of research at country level is a research uptake catalyst that needs to be further emphasised, particularly in the HPSR context. We consider embedded research, participatory or community-initiated research and emergent/responsive research processes, all of which are ‘owned’ by policymakers, healthcare practitioners/managers or community members. We embrace the view that ownership of HPSR by people directly affected by health problems connects research and decision-making in a tangible way, creating pathways to impact.
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Affiliation(s)
- Kudakwashe Paul Vanyoro
- African Centre for Migration & Society, University of the Witwatersrand School of Social Sciences, Johannesburg, South Africa
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Dickerson J, Bird PK, Bryant M, Dharni N, Bridges S, Willan K, Ahern S, Dunn A, Nielsen D, Uphoff EP, Bywater T, Bowyer-Crane C, Sahota P, Small N, Howell M, Thornton G, Pickett KE, McEachan RRC, Wright J. Integrating research and system-wide practice in public health: lessons learnt from Better Start Bradford. BMC Public Health 2019; 19:260. [PMID: 30832626 PMCID: PMC6399808 DOI: 10.1186/s12889-019-6554-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 02/15/2019] [Indexed: 11/16/2022] Open
Abstract
Many interventions that are delivered within public health services have little evidence of effect. Evaluating interventions that are being delivered as a part of usual practice offers opportunities to improve the evidence base of public health. However, such evaluation is challenging and requires the integration of research into system-wide practice. The Born in Bradford’s Better Start experimental birth cohort offers an opportunity to efficiently evaluate multiple complex community interventions to improve the health, wellbeing and development of children aged 0–3 years. Based on the learning from this programme, this paper offers a pragmatic and practical guide to researchers, public health commissioners and service providers to enable them to integrate research into their everyday practice, thus enabling relevant and robust evaluations within a complex and changing system. Using the principles of co-production the key challenges of integrating research and practice were identified, and appropriate strategies to overcome these, developed across five key stages: 1) Community and stakeholder engagement; 2) Intervention design; 3) Optimising routinely collected data; 4) Monitoring implementation; and 5) Evaluation. As a result of our learning we have developed comprehensive toolkits (https://borninbradford.nhs.uk/what-we-do/pregnancy-early-years/toolkit/) including: an operational guide through the service design process; an implementation and monitoring guide; and an evaluation framework. The evaluation framework incorporates implementation evaluations to enable understanding of intervention performance in practice, and quasi experimental approaches to infer causal effects in a timely manner. We also offer strategies to harness routinely collected data to enhance the efficiency and affordability of evaluations that are directly relevant to policy and practice. These strategies and tools will help researchers, commissioners and service providers to work together to evaluate interventions delivered in real-life settings. More importantly, however, we hope that they will support the development of a connected system that empowers practitioners and commissioners to embed innovation and improvement into their own practice, thus enabling them to learn, evaluate and improve their own services.
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Affiliation(s)
- Josie Dickerson
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, England.
| | - Philippa K Bird
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, England
| | - Maria Bryant
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, England
| | - Nimarta Dharni
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, England
| | - Sally Bridges
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, England
| | - Kathryn Willan
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, England
| | - Sara Ahern
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, England
| | - Abigail Dunn
- Department of Health Sciences, The University of York, York, England
| | - Dea Nielsen
- Psychology in Education Research Centre, Department of Education, The University of York, York, England
| | - Eleonora P Uphoff
- Department of Health Sciences, The University of York, York, England
| | - Tracey Bywater
- Department of Health Sciences, The University of York, York, England
| | - Claudine Bowyer-Crane
- Psychology in Education Research Centre, Department of Education, The University of York, York, England
| | - Pinki Sahota
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, England
| | - Neil Small
- Faculty of Health Studies, University of Bradford, Bradford, England
| | | | - Gill Thornton
- Better Start Bradford, Bradford Trident, Bradford, England
| | - Kate E Pickett
- Department of Health Sciences, The University of York, York, England
| | - Rosemary R C McEachan
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, England
| | - John Wright
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, England
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Wutzke S, Rowbotham S, Haynes A, Hawe P, Kelly P, Redman S, Davidson S, Stephenson J, Overs M, Wilson A. Knowledge mobilisation for chronic disease prevention: the case of the Australian Prevention Partnership Centre. Health Res Policy Syst 2018; 16:109. [PMID: 30445963 PMCID: PMC6240292 DOI: 10.1186/s12961-018-0379-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/08/2018] [Indexed: 04/12/2023] Open
Abstract
Background Cross-sectoral, multidisciplinary partnership research is considered one of the most effective means of facilitating research-informed policy and practice, particularly for addressing complex problems such as chronic disease. Successful research partnerships tend to be underpinned by a range of features that enable knowledge mobilisation (KMb), seeking to connect academic researchers with decision-makers and practitioners to improve the nature, quality and use of research. This paper contributes to the growing discourse on partnership approaches by illustrating how knowledge mobilisation strategies are operationalised within the Australian Prevention Partnership Centre (the Centre), a national collaboration of academics, policy-makers and practitioners established to develop systems approaches for the prevention of lifestyle-related chronic diseases. Methods We undertook interviews with key academics, policy, and practice partners and funding representatives at the mid-point of the Centre’s initial 5-year funding cycle. We aimed to explore how the Centre is functioning in practice, to develop a conceptual model of KMb within the Centre for use in further evaluation, and to identify ways of strengthening our approach to partnership research. Inductive and deductive thematic analysis was used to identify the key mechanisms underpinning the Centre’s KMb approach. Results Six key mechanisms appeared to facilitate KMb within our Centre, namely Engagement, Partnerships, Co-production, Capacity and Skills, Knowledge Integration, and Adaptive Learning and Improvement. We developed a conceptual model that articulated these mechanisms in relation to the structures and processes that support them, as well as the Centre’s goals. Findings also informed adaptations designed to strengthen the Centre. Conclusions Findings provide insights into the practical realities of operationalising KMb strategies within a research partnership. Overall, the centre is perceived to be progressing towards its KMb goals, but challenges include stakeholders from different settings understanding each other’s contexts and working together effectively, and ensuring knowledge generated across different projects within the Centre is integrated into a more comprehensive understanding of chronic disease prevention policy and practice. Our conceptual model is now informing ongoing developmental evaluation activities within the Centre, where it is being tested and refined.
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Affiliation(s)
- Sonia Wutzke
- The Australian Prevention Partnership Centre, The Sax Institute, Ultimo, NSW, 2007, Australia
| | - Samantha Rowbotham
- The Australian Prevention Partnership Centre, The Sax Institute, Ultimo, NSW, 2007, Australia.,Menzies Centre for Health Policy, Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Abby Haynes
- The Australian Prevention Partnership Centre, The Sax Institute, Ultimo, NSW, 2007, Australia. .,Menzies Centre for Health Policy, Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Penelope Hawe
- The Australian Prevention Partnership Centre, The Sax Institute, Ultimo, NSW, 2007, Australia.,Menzies Centre for Health Policy, Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Paul Kelly
- Population Health, ACT Government Health Directorate, GPO Box 825, Canberra City, ACT, 2601, Australia
| | | | - Seanna Davidson
- The Australian Prevention Partnership Centre, The Sax Institute, Ultimo, NSW, 2007, Australia
| | - Jackie Stephenson
- The Australian Prevention Partnership Centre, The Sax Institute, Ultimo, NSW, 2007, Australia
| | - Marge Overs
- The Australian Prevention Partnership Centre, The Sax Institute, Ultimo, NSW, 2007, Australia
| | - Andrew Wilson
- The Australian Prevention Partnership Centre, The Sax Institute, Ultimo, NSW, 2007, Australia.,Menzies Centre for Health Policy, Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
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Burrola-Mendez Y, Toro-Hernández ML, Goldberg M, Pearlman J. Implementation of the hybrid course on basic wheelchair service provision for Colombian wheelchair service providers. PLoS One 2018; 13:e0204769. [PMID: 30286127 PMCID: PMC6172015 DOI: 10.1371/journal.pone.0204769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/13/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction People with mobility impairments often rely on wheelchairs as their primary means of mobility. Untrained wheelchair service providers may provide inappropriate wheelchairs and services which result in negative consequences in wheelchair users’ health, quality of life, safety, and social participation. This study aimed to evaluate the influence of the Spanish Hybrid Course on Basic Wheelchair Service Provision, a training based on the World Health Organization’s Wheelchair Service Training Program-Basic Level, to increase knowledge in basic level wheelchair service provision among a group of wheelchair service providers from Colombia. In addition, we developed a satisfaction survey which participants completed after the training to understand levels of satisfaction with the training intervention. Methods A quasi-experimental study was conducted to evaluate changes in basic level wheelchair knowledge using the Wheelchair Service Provision–Basic Test. Paired sample t tests were used to assess pre-and post-training changes in basic level wheelchair knowledge. The Hybrid Satisfaction Survey was developed in collaboration with a multidisciplinary, international stakeholders’ group. The survey’s construct of interest was level of satisfaction determined by interaction, instructor, instruction methodology, content, and technology, using a five-point Likert scale (0 = strongly disagree to 4 = strongly agree). The survey was completed anonymously after the training intervention and analyzed using frequencies and percentages. Results Fifteen wheelchair service providers in Colombia completed the Spanish Hybrid Course. Mean post-scores were significantly higher (Mean (M) = 56.13, Standard Deviation (SD) = 7.8), than pre-assessment scores (M = 50.07, SD = 8.38, t(14) = 4.923, p = <0.0001). Participants who completed the surveys (N = 15) reported that the Spanish Hybrid Course was well received, with 98.66% of responses distributed in favorable levels (>3). Conclusions The Spanish Hybrid Course proved to be effective in increasing basic level wheelchair knowledge with a high satisfaction level among participants. Further testing is needed to evaluate the effectiveness of this course across different individuals and countries as a potential tool to build professional capacity in basic level wheelchair provision.
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Affiliation(s)
- Yohali Burrola-Mendez
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,Consejo Nacional de Ciencia y Tecnología, México City, México
| | | | - Mary Goldberg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jon Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.,International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Hossain LN, Tudball J, Franco-Trigo L, Durks D, Benrimoj SI, Sabater-Hernández D. A multilevel stakeholder approach for identifying the determinants of implementation of government-funded community pharmacy services at the primary care level. Res Social Adm Pharm 2018; 14:765-775. [DOI: 10.1016/j.sapharm.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/20/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
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Boaz A, Hanney S, Borst R, O'Shea A, Kok M. How to engage stakeholders in research: design principles to support improvement. Health Res Policy Syst 2018; 16:60. [PMID: 29996848 PMCID: PMC6042393 DOI: 10.1186/s12961-018-0337-6] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/06/2018] [Indexed: 11/17/2022] Open
Abstract
Background Closing the gap between research production and research use is a key challenge for the health research system. Stakeholder engagement is being increasingly promoted across the board by health research funding organisations, and indeed by many researchers themselves, as an important pathway to achieving impact. This opinion piece draws on a study of stakeholder engagement in research and a systematic literature search conducted as part of the study. Main body This paper provides a short conceptualisation of stakeholder engagement, followed by ‘design principles’ that we put forward based on a combination of existing literature and new empirical insights from our recently completed longitudinal study of stakeholder engagement. The design principles for stakeholder engagement are organised into three groups, namely organisational, values and practices. The organisational principles are to clarify the objectives of stakeholder engagement; embed stakeholder engagement in a framework or model of research use; identify the necessary resources for stakeholder engagement; put in place plans for organisational learning and rewarding of effective stakeholder engagement; and to recognise that some stakeholders have the potential to play a key role. The principles relating to values are to foster shared commitment to the values and objectives of stakeholder engagement in the project team; share understanding that stakeholder engagement is often about more than individuals; encourage individual stakeholders and their organisations to value engagement; recognise potential tension between productivity and inclusion; and to generate a shared commitment to sustained and continuous stakeholder engagement. Finally, in terms of practices, the principles suggest that it is important to plan stakeholder engagement activity as part of the research programme of work; build flexibility within the research process to accommodate engagement and the outcomes of engagement; consider how input from stakeholders can be gathered systematically to meet objectives; consider how input from stakeholders can be collated, analysed and used; and to recognise that identification and involvement of stakeholders is an iterative and ongoing process. Conclusion It is anticipated that the principles will be useful in planning stakeholder engagement activity within research programmes and in monitoring and evaluating stakeholder engagement. A next step will be to address the remaining gap in the stakeholder engagement literature concerned with how we assess the impact of stakeholder engagement on research use. Electronic supplementary material The online version of this article (10.1186/s12961-018-0337-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annette Boaz
- Faculty of Health, Social Care and Education, a partnership between Kingston University and St George's, University of London, London, United Kingdom.
| | - Stephen Hanney
- Health Economics Research Group, Brunel University London, Uxbridge, United Kingdom
| | - Robert Borst
- Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Alison O'Shea
- Faculty of Health, Social Care and Education, a partnership between Kingston University and St George's, University of London, London, United Kingdom
| | - Maarten Kok
- VU University Amsterdam, Amsterdam, The Netherlands
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Burrola-Mendez Y, Goldberg M, Gartz R, Pearlman J. Development of a Hybrid Course on Wheelchair Service Provision for clinicians in international contexts. PLoS One 2018; 13:e0199251. [PMID: 29906794 PMCID: PMC6003808 DOI: 10.1371/journal.pone.0199251] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/04/2018] [Indexed: 01/30/2023] Open
Abstract
Introduction Wheelchair users worldwide are at high risk of developing secondary health conditions and premature death due to inappropriate wheelchair provision by untrained providers. The International Society of Wheelchair Professionals (ISWP) has developed a Hybrid Course based on the World Health Organization’s Wheelchair Service Training Package—Basic Level. The Hybrid Course leverages online modules designed for low-bandwidth internet access that reduces the in-person training exposure from five to three and a half days, making it less expensive and more convenient for both trainees and trainers. Methods The Hybrid Course was designed using a systematic approach guided by an international group of stakeholders. The development followed the Quality Matters Higher Educational Rubric, web design guidelines for low bandwidth, experts’ opinions, and the best practices for blended course design. A quasi-experimental approach was used to evaluate the effectiveness of the Hybrid Course taken by six graduate students in Rehabilitation Sciences at the University of Pittsburgh by measuring pre- and post knowledge using the validated ISWP Wheelchair Service Provision—Basic Test. The outcome measure was assessed using a paired sample t-test between pretest and posttest scores. The quality of the Hybrid Course was evaluated by three external reviewers using the Quality Matters Higher Educational Rubric who were blind to each others’ evaluation and the results of the training intervention. Results Hybrid Course participants reported significant increases in scores on the ISWP Wheelchair Service Provision—Basic Test after participating in the training, with an average increase of 10.84±5.42, p = 0.004, Cohen’s d = 1.99. In addition, the Hybrid Course met the Quality Matters Standards in two out of three evaluations and reported a percentage of agreement between evaluators of 84%. Conclusions The Hybrid Course met quality standards and proved to be effective in increasing basic level wheelchair knowledge in a group of Rehabilitation Science graduate students.
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Affiliation(s)
- Yohali Burrola-Mendez
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mary Goldberg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Rachel Gartz
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jon Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- International Society of Wheelchair Professionals (ISWP), University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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A stakeholder visioning exercise to enhance chronic care and the integration of community pharmacy services. Res Social Adm Pharm 2018; 15:31-44. [PMID: 29496521 DOI: 10.1016/j.sapharm.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/22/2017] [Accepted: 02/15/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Collaboration between relevant stakeholders in health service planning enables service contextualization and facilitates its success and integration into practice. Although community pharmacy services (CPSs) aim to improve patients' health and quality of life, their integration in primary care is far from ideal. Key stakeholders for the development of a CPS intended at preventing cardiovascular disease were identified in a previous stakeholder analysis. Engaging these stakeholders to create a shared vision is the subsequent step to focus planning directions and lay sound foundations for future work. OBJECTIVES This study aims to develop a stakeholder-shared vision of a cardiovascular care model which integrates community pharmacists and to identify initiatives to achieve this vision. METHODS A participatory visioning exercise involving 13 stakeholders across the healthcare system was performed. A facilitated workshop, structured in three parts (i.e., introduction; developing the vision; defining the initiatives towards the vision), was designed. The Chronic Care Model inspired the questions that guided the development of the vision. Workshop transcripts, researchers' notes and materials produced by participants were analyzed using qualitative content analysis. RESULTS Stakeholders broadened the objective of the vision to focus on the management of chronic diseases. Their vision yielded 7 principles for advanced chronic care: patient-centered care; multidisciplinary team approach; shared goals; long-term care relationships; evidence-based practice; ease of access to healthcare settings and services by patients; and good communication and coordination. Stakeholders also delineated six environmental factors that can influence their implementation. Twenty-four initiatives to achieve the developed vision were defined. CONCLUSIONS The principles and factors identified as part of the stakeholder shared-vision were combined in a preliminary model for chronic care. This model and initiatives can guide policy makers as well as healthcare planners and researchers to develop and integrate chronic disease services, namely CPSs, in real-world settings.
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Raftery J, Hanney S, Greenhalgh T, Glover M, Blatch-Jones A. Models and applications for measuring the impact of health research: update of a systematic review for the Health Technology Assessment programme. Health Technol Assess 2018; 20:1-254. [PMID: 27767013 DOI: 10.3310/hta20760] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This report reviews approaches and tools for measuring the impact of research programmes, building on, and extending, a 2007 review. OBJECTIVES (1) To identify the range of theoretical models and empirical approaches for measuring the impact of health research programmes; (2) to develop a taxonomy of models and approaches; (3) to summarise the evidence on the application and use of these models; and (4) to evaluate the different options for the Health Technology Assessment (HTA) programme. DATA SOURCES We searched databases including Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and The Cochrane Library from January 2005 to August 2014. REVIEW METHODS This narrative systematic literature review comprised an update, extension and analysis/discussion. We systematically searched eight databases, supplemented by personal knowledge, in August 2014 through to March 2015. RESULTS The literature on impact assessment has much expanded. The Payback Framework, with adaptations, remains the most widely used approach. It draws on different philosophical traditions, enhancing an underlying logic model with an interpretative case study element and attention to context. Besides the logic model, other ideal type approaches included constructionist, realist, critical and performative. Most models in practice drew pragmatically on elements of several ideal types. Monetisation of impact, an increasingly popular approach, shows a high return from research but relies heavily on assumptions about the extent to which health gains depend on research. Despite usually requiring systematic reviews before funding trials, the HTA programme does not routinely examine the impact of those trials on subsequent systematic reviews. The York/Patient-Centered Outcomes Research Institute and the Grading of Recommendations Assessment, Development and Evaluation toolkits provide ways of assessing such impact, but need to be evaluated. The literature, as reviewed here, provides very few instances of a randomised trial playing a major role in stopping the use of a new technology. The few trials funded by the HTA programme that may have played such a role were outliers. DISCUSSION The findings of this review support the continued use of the Payback Framework by the HTA programme. Changes in the structure of the NHS, the development of NHS England and changes in the National Institute for Health and Care Excellence's remit pose new challenges for identifying and meeting current and future research needs. Future assessments of the impact of the HTA programme will have to take account of wider changes, especially as the Research Excellence Framework (REF), which assesses the quality of universities' research, seems likely to continue to rely on case studies to measure impact. The HTA programme should consider how the format and selection of case studies might be improved to aid more systematic assessment. The selection of case studies, such as in the REF, but also more generally, tends to be biased towards high-impact rather than low-impact stories. Experience for other industries indicate that much can be learnt from the latter. The adoption of researchfish® (researchfish Ltd, Cambridge, UK) by most major UK research funders has implications for future assessments of impact. Although the routine capture of indexed research publications has merit, the degree to which researchfish will succeed in collecting other, non-indexed outputs and activities remains to be established. LIMITATIONS There were limitations in how far we could address challenges that faced us as we extended the focus beyond that of the 2007 review, and well beyond a narrow focus just on the HTA programme. CONCLUSIONS Research funders can benefit from continuing to monitor and evaluate the impacts of the studies they fund. They should also review the contribution of case studies and expand work on linking trials to meta-analyses and to guidelines. FUNDING The National Institute for Health Research HTA programme.
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Affiliation(s)
- James Raftery
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Steve Hanney
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Matthew Glover
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Amanda Blatch-Jones
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
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Greenhalgh T, Ovseiko PV, Fahy N, Shaw S, Kerr P, Rushforth AD, Channon KM, Kiparoglou V. Maximising value from a United Kingdom Biomedical Research Centre: study protocol. Health Res Policy Syst 2017; 15:70. [PMID: 28806989 PMCID: PMC5556344 DOI: 10.1186/s12961-017-0237-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/28/2017] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Biomedical Research Centres (BRCs) are partnerships between healthcare organisations and universities in England. Their mission is to generate novel treatments, technologies, diagnostics and other interventions that increase the country's international competitiveness, to rapidly translate these innovations into benefits for patients, and to improve efficiency and reduce waste in healthcare. As NIHR Oxford BRC (Oxford BRC) enters its third 5-year funding period, we seek to (1) apply the evidence base on how best to support the various partnerships in this large, multi-stakeholder research system and (2) research how these partnerships play out in a new, ambitious programme of translational research. METHODS Organisational case study, informed by the principles of action research. A cross-cutting theme, 'Partnerships for Health, Wealth and Innovation' has been established with multiple sub-themes (drug development, device development, business support and commercialisation, research methodology and statistics, health economics, bioethics, patient and public involvement and engagement, knowledge translation, and education and training) to support individual BRC research themes and generate cross-theme learning. The 'Partnerships' theme will support the BRC's goals by facilitating six types of partnership (with patients and citizens, clinical services, industry, across the NIHR infrastructure, across academic disciplines, and with policymakers and payers) through a range of engagement platforms and activities. We will develop a longitudinal progress narrative centred around exemplar case studies, and apply theoretical models from innovation studies (Triple Helix), sociology of science (Mode 2 knowledge production) and business studies (Value Co-creation). Data sources will be the empirical research studies within individual BRC research themes (who will apply separately for NHS ethics approval), plus documentary analysis and interviews and ethnography with research stakeholders. This study has received ethics clearance through the University of Oxford Central University Research Ethics Committee. DISCUSSION We anticipate that this work will add significant value to Oxford BRC. We predict accelerated knowledge translation; closer alignment of the innovation process with patient priorities and the principles of responsible, ethical research; reduction in research waste; new knowledge about the governance and activities of multi-stakeholder research partnerships and the contexts in which they operate; and capacity-building that reflects the future needs of a rapidly-evolving health research system.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
| | - Pavel V. Ovseiko
- Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU United Kingdom
| | - Nick Fahy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
| | - Polly Kerr
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
| | - Alexander D. Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
| | - Keith M. Channon
- Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU United Kingdom
| | - Vasiliki Kiparoglou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU United Kingdom
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Cooke J, Langley J, Wolstenholme D, Hampshaw S. "Seeing" the Difference: The Importance of Visibility and Action as a Mark of "Authenticity" in Co-production Comment on "Collaboration and Co-production of Knowledge in Healthcare: Opportunities and Challenges". Int J Health Policy Manag 2017; 6:345-348. [PMID: 28812827 PMCID: PMC5458796 DOI: 10.15171/ijhpm.2016.136] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/04/2016] [Indexed: 11/09/2022] Open
Abstract
The Rycroft-Malone paper states that co-production relies on 'authentic' collaboration as a context for action. Our commentary supports and extends this assertion. We suggest that 'authentic' co-production involves processes where participants can 'see' the difference that they have made within the project and beyond. We provide examples including: the use of design in health projects which seek to address power issues and make contributions visible through iteration and prototyping; and the development of 'actionable outputs' from research that are the physical embodiment of co-production. Finally, we highlight the elements of the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) architecture that enables the inclusion of such collaborative techniques that demonstrate visible co-production. We reinforce the notion that maintaining collaboration requires time, flexible resources, blurring of knowledge producer-user boundaries, and leaders who promote epistemological tolerance and methodological exploration.
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Affiliation(s)
- Jo Cooke
- NIHR Collaboration and Leadership in Applied Health Research and Care for Yorkshire and Humber (CLAHRC YH), Sheffield, UK
| | - Joe Langley
- Lab4Living, Sheffield Hallam University, Sheffield, UK
| | - Dan Wolstenholme
- Translating Knowledge Into Action, NIHR CLAHRC Yorkshire and Humber, Sheffield, UK
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Greenhalgh T, Jackson C, Shaw S, Janamian T. Achieving Research Impact Through Co-creation in Community-Based Health Services: Literature Review and Case Study. Milbank Q 2017; 94:392-429. [PMID: 27265562 PMCID: PMC4911728 DOI: 10.1111/1468-0009.12197] [Citation(s) in RCA: 462] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Policy Points: Co‐creation—collaborative knowledge generation by academics working
alongside other stakeholders—is an increasingly popular approach to
aligning research and service development. It has potential for “moving beyond the ivory towers” to deliver
significant societal impact via dynamic, locally adaptive
community‐academic partnerships. Principles of successful co‐creation include a systems perspective,
a creative approach to research focused on improving human
experience, and careful attention to governance and process. If these principles are not followed, co‐creation efforts may
fail.
Context Co‐creation—collaborative knowledge generation by academics working
alongside other stakeholders—reflects a “Mode 2” relationship (knowledge
production rather than knowledge translation) between universities and society.
Co‐creation is widely believed to increase research impact. Methods We undertook a narrative review of different models of co‐creation
relevant to community‐based health services. We contrasted their diverse
disciplinary roots and highlighted their common philosophical assumptions,
principles of success, and explanations for failures. We applied these to an
empirical case study of a community‐based research‐service partnership led by the
Centre of Research Excellence in Quality and Safety in Integrated
Primary‐Secondary Care at the University of Queensland, Australia. Findings Co‐creation emerged independently in several fields, including
business studies (“value co‐creation”), design science (“experience‐based
co‐design”), computer science (“technology co‐design”), and community development
(“participatory research”). These diverse models share some common features, which
were also evident in the case study. Key success principles included (1) a systems
perspective (assuming emergence, local adaptation, and nonlinearity); (2) the
framing of research as a creative enterprise with human experience at its core;
and (3) an emphasis on process (the framing of the program, the nature of
relationships, and governance and facilitation arrangements, especially the style
of leadership and how conflict is managed). In both the literature review and the
case study, co‐creation “failures” could often be tracked back to abandoning (or
never adopting) these principles. All co‐creation models made strong claims for
significant and sustainable societal impacts as a result of the adaptive and
developmental research process; these were illustrated in the case study. Conclusions Co‐creation models have high potential for societal impact but
depend critically on key success principles. To capture the nonlinear chains of
causation in the co‐creation pathway, impact metrics must reflect the dynamic
nature and complex interdependencies of health research systems and address
processes as well as outcomes.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Claire Jackson
- Discipline of General Practice, School of Medicine, University of Queensland
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Tina Janamian
- Discipline of General Practice, School of Medicine, University of Queensland
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Stolk-Vos AC, van de Klundert JJ, Maijers N, Zijlmans BL, Busschbach JJ. Multi-stakeholder perspectives in defining health-services quality in cataract care. Int J Qual Health Care 2017; 29:470-476. [DOI: 10.1093/intqhc/mzx048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/20/2017] [Indexed: 11/14/2022] Open
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Franco-Trigo L, Hossain L, Durks D, Fam D, Inglis S, Benrimoj S, Sabater-Hernández D. Stakeholder analysis for the development of a community pharmacy service aimed at preventing cardiovascular disease. Res Social Adm Pharm 2017; 13:539-552. [DOI: 10.1016/j.sapharm.2016.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/16/2016] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
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Cairney P, Oliver K. Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy? Health Res Policy Syst 2017; 15:35. [PMID: 28446185 PMCID: PMC5407004 DOI: 10.1186/s12961-017-0192-x] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/12/2017] [Indexed: 11/10/2022] Open
Abstract
There is extensive health and public health literature on the ‘evidence-policy gap’, exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems. We identify insights from secondary data, namely systematic reviews, critical analysis and policy theories relevant to evidence-based policymaking. The studies are drawn primarily from countries such as the United States, United Kingdom, Canada, Australia and New Zealand. We combine empirical and normative elements to identify the ways in which scientists can, do and could influence policy. We identify two important dilemmas, for scientists and researchers, that arise from our initial advice. First, effective actors combine evidence with manipulative emotional appeals to influence the policy agenda – should scientists do the same, or would the reputational costs outweigh the policy benefits? Second, when adapting to multi-level policymaking, should scientists prioritise ‘evidence-based’ policymaking above other factors? The latter includes governance principles such the ‘co-production’ of policy between local public bodies, interest groups and service users. This process may be based primarily on values and involve actors with no commitment to a hierarchy of evidence. We conclude that successful engagement in ‘evidence-based policymaking’ requires pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories. To maximise the use of scientific evidence in health and public health policy, researchers should recognise the tendency of policymakers to base judgements on their beliefs, and shortcuts based on their emotions and familiarity with information; learn ‘where the action is’, and be prepared to engage in long-term strategies to be able to influence policy; and, in both cases, decide how far you are willing to go to persuade policymakers to act and secure a hierarchy of evidence underpinning policy. These are value-driven and political, not just ‘evidence-based’, choices.
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Affiliation(s)
- Paul Cairney
- Politics and Public Policy at the University of Stirling, Stirling, United Kingdom. .,Division of History and Politics, University of Stirling, Stirling, FK9 4LA, United Kingdom.
| | - Kathryn Oliver
- Departmental Lecturer in Evidence-Based Social Intervention and Policy Evaluation, Oxford University, Oxford, United Kingdom.,Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
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Vojvodic K, Terzic-Supic Z, Santric-Milicevic M, Wolf GW. Socio-Economic Inequalities, Out-of-Pocket Payment and Consumers' Satisfaction with Primary Health Care: Data from the National Adult Consumers' Satisfaction Survey in Serbia 2009-2015. Front Pharmacol 2017; 8:147. [PMID: 28400728 PMCID: PMC5368255 DOI: 10.3389/fphar.2017.00147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/08/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Zorica Terzic-Supic
- School of Medicine, Institute of Social Medicine, University of Belgrade Belgrade, Serbia
| | | | - Gert W Wolf
- Department of Geography, University of Klagenfurt Klagenfurt, Austria
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Dombrádi V, Csenteri OK, Sándor J, Gődény S. Association between the application of ISO 9001:2008 alone or in combination with health-specific standards and quality-related activities in Hungarian hospitals. Int J Qual Health Care 2017; 29:283-289. [DOI: 10.1093/intqhc/mzx016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/07/2017] [Indexed: 11/14/2022] Open
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Greenfield D, Debono D, Hogden A, Hinchcliff R, Mumford V, Pawsey M, Westbrook J, Braithwaite J. Examining challenges to reliability of health service accreditation during a period of healthcare reform in Australia. J Health Organ Manag 2017; 29:912-24. [PMID: 26556158 DOI: 10.1108/jhom-02-2015-0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Health systems are changing at variable rates. Periods of significant change can create new challenges or amplify existing barriers to accreditation program credibility and reliability. The purpose of this paper is to examine, during the transition to a new Australian accreditation scheme and standards, challenges to health service accreditation survey reliability, the salience of the issues and strategies to manage threats to survey reliability. DESIGN/METHODOLOGY/APPROACH Across 2013-2014, a two-phase, multi-method study was conducted, involving five research activities (two questionnaire surveys and three group discussions). This paper reports data from the transcribed group discussions involving 100 participants, which was subject to content and thematic analysis. Participants were accreditation survey coordinators employed by the Australian Council on Healthcare Standards. FINDINGS Six significant issues influencing survey reliability were reported: accreditation program governance and philosophy; accrediting agency management of the accreditation process, including the program's framework; survey coordinators; survey team dynamics; individual surveyors; and healthcare organizations' approach to accreditation. A change in governance arrangements promoted reliability with an independent authority and a new set of standards, endorsed by Federal and State governments. However, potential reliability threats were introduced by having multiple accrediting agencies approved to survey against the new national standards. Challenges that existed prior to the reformed system remain. ORIGINALITY/VALUE Capturing lessons and challenges from healthcare reforms is necessary if improvements are to be realized. The study provides practical and theoretical strategies to promote reliability in accreditation programs.
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Affiliation(s)
- David Greenfield
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Farmanova E, Kirvan C, Verma J, Mukerji G, Akunov N, Phillips K, Samis S. Triple Aim in Canada: developing capacity to lead to better health, care and cost. Int J Qual Health Care 2016; 28:830-837. [PMID: 28423164 PMCID: PMC5892163 DOI: 10.1093/intqhc/mzw118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 12/27/2022] Open
Abstract
QUALITY PROBLEM Many modern health systems strive for 'Triple Aim' (TA)-better health for populations, improved experience of care for patients and lower costs of the system, but note challenges in implementation. Outcomes of applying TA as a quality improvement framework (QI) have started to be realized with early lessons as to why some systems make progress while others do not. INITIAL ASSESSMENT Limited evidence is available as to how organizations create the capacity and infrastructure required to design, implement, evaluate and sustain TA systems. CHOICE OF SOLUTION To support embedding TA across Canada, the Canadian Foundation for Healthcare Improvement supported enrolment of nine Canadian teams to participate in the Institute for Healthcare Improvement's TA Improvement Community. IMPLEMENTATION Structured support for TA design, implementation, evaluation and sustainability was addressed in a collaborative programme of webinars and action periods. Teams were coached to undertake and test small-scale improvements before attempting to scale. EVALUATION A summative evaluation of the Canadian cohort was undertaken to assess site progress in building TA infrastructure across various healthcare settings. The evaluation explored the process of change, experiences and challenges and strategies for continuous QI. LESSONS LEARNED Delivering TA requires a sustained and coordinated effort supported by strong leadership and governance, continuous QI, engaged interdisciplinary teams and partnering within and beyond the healthcare sector.
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Affiliation(s)
- Elina Farmanova
- University of Ottawa, Faculty of Health Sciences, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada
| | - Christine Kirvan
- Canadian Foundation for Healthcare Improvement, 1565 Carling Avenue, Suite 700, Ottawa, ON K1Z 8R1, Canada
| | - Jennifer Verma
- Canadian Foundation for Healthcare Improvement, 1565 Carling Avenue, Suite 700, Ottawa, ON K1Z 8R1, Canada
| | - Geetha Mukerji
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada
- Department of Medicine, University of Toronto, 76 Grenville Street, Toronto, ON M5S 1B2, Canada
| | - Nurdin Akunov
- Canadian Foundation for Healthcare Improvement, 1565 Carling Avenue, Suite 700, Ottawa, ON K1Z 8R1, Canada
| | - Kaye Phillips
- Canadian Foundation for Healthcare Improvement, 1565 Carling Avenue, Suite 700, Ottawa, ON K1Z 8R1, Canada
| | - Stephen Samis
- Canadian Foundation for Healthcare Improvement, 1565 Carling Avenue, Suite 700, Ottawa, ON K1Z 8R1, Canada
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Greenfield D, Hogden A, Hinchcliff R, Mumford V, Pawsey M, Debono D, Westbrook JI, Braithwaite J. The impact of national accreditation reform on survey reliability: a 2-year investigation of survey coordinators' perspectives. J Eval Clin Pract 2016; 22:662-7. [PMID: 26804610 DOI: 10.1111/jep.12512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Accrediting health care organizations against standards is a recognized safety and quality intervention. The credibility of an accreditation programme relies on surveying reliability. We investigated accreditation survey coordinators' perceptions of reliability issues and their continued relevancy, during a period of national accreditation reform. METHOD In 2013 and 2014, questionnaire surveys were developed using survey coordinators' feedback of their experiences and concerns regarding the accreditation process. Each year, a purpose-designed questionnaire survey was administered during the accrediting agency survey coordinator training days. RESULTS Participants reported that survey reliability was informed by five categories of issues: the management of the accreditation process, including standards and health care organizational issues; surveyor workforce management; survey coordinator role; survey team; and individual surveyors. A new accreditation system and programme did not alter the factors reported to shape survey reliability. However, across the reform period, there was a noted change within each category of the specific issues that were of concern. Furthermore, consensus between coordinators that existed in 2013 appears to have diminished in 2014. Across all categories, in 2014 there was greater diversity of opinion than in 2013. CONCLUSIONS The known challenges to the reliability of an accreditation programme retained their potency and relevancy during a period of reform. The diversity of opinion identified across the coordinator workforce could potentially place the credibility and reliability of the new scheme at risk. The study highlights that reliability of an accreditation scheme is an ongoing achievement, not a one-off attainment.
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Affiliation(s)
- David Greenfield
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Anne Hogden
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reece Hinchcliff
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales
| | - Virginia Mumford
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Marjorie Pawsey
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Debono
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Nabyonga-Orem J, Gebrikidane M, Mwisongo A. Assessing policy dialogues and the role of context: Liberian case study before and during the Ebola outbreak. BMC Health Serv Res 2016; 16 Suppl 4:219. [PMID: 27454117 PMCID: PMC4959377 DOI: 10.1186/s12913-016-1454-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background In the last decade participatory approaches have gained prominence in policy-making, becoming the focus of good policy-making processes. Policy dialogue is recognised as an important aspect of policy-making among several interactive and innovative policy-making models applied in different contexts and sectors. Recently there has been emphasis on the quality of policy dialogue in terms of how it should be conducted to attain participation and inclusiveness. However, there is paucity of evidence on how the context influences policy dialogue, particularly participation of stakeholders. Liberia’s context, which is characterised as post-war, highly donor dependent and in recovery from the recent catastrophic Ebola outbreak, provides an opportunity to understand the influence of context on policy dialogue. Methods This was an exploratory study using qualitative methods. Key informant interviews were conducted using an interview guide. A total of 16 interviews were conducted, 12 at the national level and 4 at the sub national level. Data were analysed using inductive thematic content analysis. Results The respondents felt that the dialogues were a success and involved important stakeholders; however, there were concerns about the improper methodology and facilitation used to conduct them. Opinions among the respondents about the process of generating and selecting the themes for the dialogues were extremely divergent. Both before and during the Ebola outbreak, the context was instrumental in shaping the dialogues according to the issue of focus, requirements for participation and the decisions to be made. Policy dialogues have become a platform for policy discussions and decisions in Liberia. It is a process that is well recognised and appreciated and is highly attributed to the success of the negotiations during the Ebola outbreak. Conclusions To sustain and strengthen policy dialogues in future, there needs to be proper information sharing through diverse forums and avenues, stakeholders’ empowerment and competent facilitation. These will ensure that the process is credible and legitimate.
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Affiliation(s)
- Juliet Nabyonga-Orem
- Health Systems and Services Cluster, World Health Organization Regional Office for Africa, B.P. 06, Brazzaville, Congo.
| | - Mesfin Gebrikidane
- Health Systems and Services, World Health Organization Liberia Country Office, PO Box 316, Monrovia, Liberia
| | - Aziza Mwisongo
- Health Systems and Services Cluster, World Health Organization Regional Office for Africa, B.P. 06, Brazzaville, Congo
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Hinchcliff R, Greenfield D, Hogden A, Sarrami-Foroushani P, Travaglia J, Braithwaite J. Levers for change: an investigation of how accreditation programmes can promote consumer engagement in healthcare. Int J Qual Health Care 2016; 28:561-565. [DOI: 10.1093/intqhc/mzw074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 06/05/2016] [Accepted: 06/20/2016] [Indexed: 01/09/2023] Open
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Jackson CL, Greenhalgh T. Co-creation: a new approach to optimising research impact? Med J Aust 2016; 203:283-4. [PMID: 26424059 DOI: 10.5694/mja15.00219] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 08/04/2015] [Indexed: 11/17/2022]
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Ashraf S, Moore C, Gupta V, Chowdhury A, Azad AK, Singh N, Hagan D, Labrique AB. Overview of a multi-stakeholder dialogue around Shared Services for Health: the Digital Health Opportunity in Bangladesh. Health Res Policy Syst 2015; 13:74. [PMID: 26646372 PMCID: PMC4673719 DOI: 10.1186/s12961-015-0063-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND National level policymaking and implementation includes multiple stakeholders with varied interests and priorities. Multi-stakeholder dialogues (MSDs) can facilitate consensus building through collective identification of challenges, recognition of shared goals and interests, and creation of solution pathways. This can shape joint planning and implementation for long-term efficiency in health and other sectors. Scaling up the effective use of information and communication technologies (ICTs) requires cohesive strategic planning towards a shared goal. In Bangladesh, the government and partners convened an MSD in March 2015 to increase stakeholder engagement in policymaking and implementation of a national ICT or electronic or mobile health (eHealth or mHealth) strategy, which seeks to incorporate ICTs into the national health system, aligning with the Digital Bangladesh Vision 2021. METHODS Relevant stakeholders were identified and key priorities and challenges were mapped through key informant interviews. An MSD was conducted with key stakeholders in Dhaka, Bangladesh. The MSD included presentations, group option generation, agreement and prioritization of barriers to scaling up ICTs. RESULTS The MSD approach to building consensus on key priorities highlights the value of dialogue and collaboration with relevant stakeholders to encourage country ownership of nationwide efforts such as ICT scale-up. This MSD showed the dynamic context in which stakeholders operate, including those from academia, donors and foundations, healthcare professionals, associations, multilateral organizations, non-governmental organizations, partner countries and the private sector. Through this MSD, participants improved understanding of each other's contributions and interests, identified existing relationships, and agreed on policy and implementation gaps that needed to be filled. Collaboration among stakeholders in ICT efforts and research can promote a cohesive approach to scaling up, as well as improve policymaking by integrating interests and feedback of different key cross sectoral actors. CONCLUSION MSDs can align stakeholders to identify challenges and solution pathways, and lead to coordinated action and accountability for resources and results. In addition, the MSD template and approach has been useful to guide ICT scale up in Bangladesh and could be replicated in other contexts to facilitate multi-constituency, multi-sector collaboration.
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Affiliation(s)
- Sania Ashraf
- Bloomberg School of Public Health, Johns Hopkins, Baltimore, USA.
| | - Carolyn Moore
- mPowering Frontline Health Workers/Jhpiego, Washington, DC, USA.
| | - Vaibhav Gupta
- Partnership for Maternal, Newborn & Child Health, World Health Organization, Avenue Appia 20, 1211, Geneva, 27, Switzerland.
| | | | - Abul K Azad
- Management Information System of the Directorate General of Health Services under the Ministry of Health & Family Welfare, Dhaka, Bangladesh.
| | - Neelu Singh
- Bloomberg School of Public Health, Johns Hopkins, Baltimore, USA.
| | - David Hagan
- eSHIFT Partners Network, Geneva, Switzerland.
| | - Alain B Labrique
- Bloomberg School of Public Health, Johns Hopkins, Baltimore, USA.
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Gill SD, Redden-Hoare J, Dunning TL, Hughes AJ, Dolley PJ. Health services should collect feedback from inpatients at the point of service: opinions from patients and staff in acute and subacute facilities. Int J Qual Health Care 2015; 27:507-12. [PMID: 26586730 DOI: 10.1093/intqhc/mzv081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Point of service feedback (POSF) enables patients to give health services feedback about their experiences during or immediately after care. Despite the increasing use of POSF, little is known regarding patients' and staffs' opinions of this practice and whether they consider it acceptable or useful. The study aimed to determine patient and staff opinions regarding POSF. DESIGN A cross-sectional survey. SETTING Acute and subacute healthcare facilities. PARTICIPANTS Two hundred and forty-seven patients and 221 staff. RESULTS Participants indicated that patients should be invited to evaluate health services when they are in hospital or subacute care and improving services was the most important reason for doing so. Staff indicated that: collecting patients' feedback during their stay was an important part of providing care and not an interruption to it (n = 187 of 221, 85%); collecting patients' feedback was best done with a variety of methods; talking directly with patients during their stay was the preferred option (n = 161 of 219, 74%). More patients preferred to: give feedback during their stay (51%) than after discharge from care (15%); give feedback by talking with someone (45%) than completing a questionnaire (31%). Some patients (14%) were concerned about reprisals from staff if they gave negative feedback. CONCLUSIONS POSF can be acceptable and useful for evaluating health services and should be incorporated into a person-centred approach that allows patients to choose from a variety of feedback options both during and after their stay. To be most useful, feedback should be incorporated into a quality improvement system.
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Affiliation(s)
- Stephen D Gill
- Research Directorate, Barwon Health, Geelong 3220, Australia
| | - Jane Redden-Hoare
- Nursing, Midwifery and Residential and Aged Care, Barwon Health, Geelong 3220, Australia
| | - Trisha L Dunning
- Deakin University School of Nursing and Midwifery, and Deakin University and Barwon Health Centre for Nursing and Allied Health Research, Geelong 3220, Australia
| | - Andrew J Hughes
- Department of General Medicine and School of Medicine, Barwon Health and Deakin University, Geelong 3220, Australia
| | - Pamela J Dolley
- Safety, Quality and Innovation Unit, Barwon Health, Geelong 3220, Australia
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Goodyear-Smith F, Jackson C, Greenhalgh T. Co-design and implementation research: challenges and solutions for ethics committees. BMC Med Ethics 2015; 16:78. [PMID: 26573410 PMCID: PMC4647576 DOI: 10.1186/s12910-015-0072-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/12/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Implementation science research, especially when using participatory and co-design approaches, raises unique challenges for research ethics committees. Such challenges may be poorly addressed by approval and governance mechanisms that were developed for more traditional research approaches such as randomised controlled trials. DISCUSSION Implementation science commonly involves the partnership of researchers and stakeholders, attempting to understand and encourage uptake of completed or piloted research. A co-creation approach involves collaboration between researchers and end users from the onset, in question framing, research design and delivery, and influencing strategy, with implementation and broader dissemination strategies part of its design from gestation. A defining feature of co-creation is its emergent and adaptive nature, making detailed pre-specification of interventions and outcome measures impossible. This methodology sits oddly with ethics committee protocols that require precise pre-definition of interventions, mode of delivery, outcome measurements, and the role of study participants. But the strict (and, some would say, inflexible) requirements of ethics committees were developed for a purpose - to protect participants from harm and help ensure the rigour and transparency of studies. We propose some guiding principles to help square this circle. First, ethics committees should acknowledge and celebrate the diversity of research approaches, both formally (through training) and informally (by promoting debate and discussion); without active support, their members may not understand or value participatory designs. Second, ground rules should be established for co-design applications (e.g. how to judge when 'consultation' or 'engagement' becomes research) and communicated to committee members and stakeholders. Third, the benefits of power-sharing should be recognised and credit given to measures likely to support this important goal, especially in research with vulnerable communities. Co-design is considered best practice, for example, in research involving indigenous peoples in New Zealand, Australia and Canada.
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Affiliation(s)
- Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, PB, 920919, Auckland, New Zealand.
| | - Claire Jackson
- Centre for Primary Care Reform Research Excellence, School of Medicine, University of Queensland, Brisbane, Australia.
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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Greenfield D, Hinchcliff R, Hogden A, Mumford V, Debono D, Pawsey M, Westbrook J, Braithwaite J. A hybrid health service accreditation program model incorporating mandated standards and continuous improvement: interview study of multiple stakeholders in Australian health care. Int J Health Plann Manage 2015; 31:e116-30. [PMID: 26044988 DOI: 10.1002/hpm.2301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi-structured interviews. Across 2011-12 there were 47 group and individual interviews involving 258 participants. Interviews lasted, on average, 1 h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies; shifting of program content focus and details; different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance; continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from "malicious compliance" to "performance audits" to "quality improvement journeys". Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- David Greenfield
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Reece Hinchcliff
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Anne Hogden
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Virginia Mumford
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Deborah Debono
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Marjorie Pawsey
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
| | - Johanna Westbrook
- University of New South Wales, Australian Institute of Health Innovation, Centre for Health Systems and Safety Research, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- University of New South Wales, Centre for Clinical Governance Research, Faculty of Medicine, Sydney, NSW, Australia
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Riggs E, Yelland J, Szwarc J, Casey S, Chesters D, Duell-Piening P, Wahidi S, Fouladi F, Brown S. Promoting the inclusion of Afghan women and men in research: reflections from research and community partners involved in implementing a 'proof of concept' project. Int J Equity Health 2015; 14:13. [PMID: 25637274 PMCID: PMC4316798 DOI: 10.1186/s12939-015-0145-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 01/21/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction With mounting evidence that poor maternal and child health outcomes are related to the social determinants of health, researchers need to engage with vulnerable and isolated communities to gather the evidence that is essential to determine appropriate solutions. Conventional research methods may not ensure the degree and quality of participation that is necessary for meaningful study findings. Participatory methods provide reciprocal opportunities for often excluded communities to both take part in, and guide the conduct of research. Method/design The Having a baby in a new country research project was undertaken to provide evidence about how women and men of refugee background experience health services at the time of having a baby. This two year, multifaceted proof of concept study comprised: 1) an organisational partnership to oversee the project; 2) a community engagement framework including: female and male Afghan community researchers, community and sector stakeholder advisory groups and community consultation and engagement. Discussion Inclusive research strategies that address power imbalances in research, and diversity of and within communities, are necessary to obtain the evidence required to address health inequalities in vulnerable populations. Such an approach involves mindfully adapting research processes to ensure that studies have regard for the advice of community members about the issues that affect them. Researchers have much to gain by committing time and resources to engaging communities in reciprocal ways in research processes.
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Affiliation(s)
- Elisha Riggs
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, 3052, Parkville, VIC, Australia. .,General Practice and Primary Health Care Academic Centre, University of Melbourne, 3052, Parkville, VIC, Australia.
| | - Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, 3052, Parkville, VIC, Australia. .,General Practice and Primary Health Care Academic Centre, University of Melbourne, 3052, Parkville, VIC, Australia.
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, 4 Gardiner Street, 3056, Brunswick, VIC, Australia.
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, 4 Gardiner Street, 3056, Brunswick, VIC, Australia.
| | - Donna Chesters
- Victorian Foundation for Survivors of Torture, 4 Gardiner Street, 3056, Brunswick, VIC, Australia.
| | - Philippa Duell-Piening
- Victorian Foundation for Survivors of Torture, 4 Gardiner Street, 3056, Brunswick, VIC, Australia.
| | - Sayed Wahidi
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, 3052, Parkville, VIC, Australia.
| | - Fatema Fouladi
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, 3052, Parkville, VIC, Australia.
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, 3052, Parkville, VIC, Australia. .,School of Population and Global Health, University of Melbourne, 3052, Parkville, VIC, Australia.
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Kislov R, Waterman H, Harvey G, Boaden R. Rethinking capacity building for knowledge mobilisation: developing multilevel capabilities in healthcare organisations. Implement Sci 2014; 9:166. [PMID: 25398428 PMCID: PMC4234886 DOI: 10.1186/s13012-014-0166-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/19/2014] [Indexed: 11/29/2022] Open
Abstract
Background Knowledge mobilisation in healthcare organisations is often carried out through relatively short-term projects dependent on limited funding, which raises concerns about the long-term sustainability of implementation and improvement. It is becoming increasingly recognised that the translation of research evidence into practice has to be supported by developing the internal capacity of healthcare organisations to engage with and apply research. This process can be supported by external knowledge mobilisation initiatives represented, for instance, by professional associations, collaborative research partnerships and implementation networks. This conceptual paper uses empirical and theoretical literature on organisational learning and dynamic capabilities to enhance our understanding of intentional capacity building for knowledge mobilisation in healthcare organisations. Discussion The discussion is structured around the following three themes: (1) defining and classifying capacity building for knowledge mobilisation; (2) mechanisms of capability development in organisational context; and (3) individual, group and organisational levels of capability development. Capacity building is presented as a practice-based process of developing multiple skills, or capabilities, belonging to different knowledge domains and levels of complexity. It requires an integration of acquisitive learning, through which healthcare organisations acquire knowledge and skills from knowledge mobilisation experts, and experience-based learning, through which healthcare organisations adapt, absorb and modify their knowledge and capabilities through repeated practice. Although the starting point for capability development may be individual-, team- or organisation-centred, facilitation of the transitions between individual, group and organisational levels of learning within healthcare organisations will be needed. Summary Any initiative designed to build capacity for knowledge mobilisation should consider the subsequent trajectory of newly developed knowledge and skills within the recipient healthcare organisations. The analysis leads to four principles underpinning a practice-based approach to developing multilevel knowledge mobilisation capabilities: (1) moving from ‘building’ capacity from scratch towards ‘developing’ capacity of healthcare organisations; (2) moving from passive involvement in formal education and training towards active, continuous participation in knowledge mobilisation practices; (3) moving from lower-order, project-specific capabilities towards higher-order, generic capabilities allowing healthcare organisations to adapt to change, absorb new knowledge and innovate; and (4) moving from single-level to multilevel capability development involving transitions between individual, group and organisational learning.
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Affiliation(s)
- Roman Kislov
- Manchester Business School, The University of Manchester, Room D38 MBS East, Booth Street West, Manchester, M15 6PB, UK.
| | - Heather Waterman
- School of Nursing, Midwifery and Social Work, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Gill Harvey
- Manchester Business School, The University of Manchester, Room D38 MBS East, Booth Street West, Manchester, M15 6PB, UK. .,School of Nursing, The University of Adelaide, Level 3, Eleanor Harrald Building, Adelaide, 5005, SA, Australia.
| | - Ruth Boaden
- Manchester Business School, The University of Manchester, Room D38 MBS East, Booth Street West, Manchester, M15 6PB, UK.
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Greenfield D, Hinchcliff R, Banks M, Mumford V, Hogden A, Debono D, Pawsey M, Westbrook J, Braithwaite J. Analysing 'big picture' policy reform mechanisms: the Australian health service safety and quality accreditation scheme. Health Expect 2014; 18:3110-22. [PMID: 25367049 DOI: 10.1111/hex.12300] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Agencies promoting national health-care accreditation reform to improve the quality of care and safety of patients are largely working without specific blueprints that can increase the likelihood of success. OBJECTIVE This study investigated the development and implementation of the Australian Health Service Safety and Quality Accreditation Scheme and National Safety and Quality Health Service Standards (the Scheme), their expected benefits, and challenges and facilitators to implementation. METHODS A multimethod study was conducted using document analysis, observation and interviews. Data sources were eight government reports, 25 h of observation and 34 interviews with 197 diverse stakeholders. RESULTS Development of the Scheme was achieved through extensive consultation conducted over a prolonged period, that is, from 2000 onwards. Participants, prior to implementation, believed the Scheme would produce benefits at multiple levels of the health system. The Scheme offered a national framework to promote patient-centred care, allowing organizations to engage and coordinate professionals' quality improvement activities. Significant challenges are apparent, including developing and maintaining stakeholder understanding of the Scheme's requirements. Risks must also be addressed. The standardized application of, and reliable assessment against, the standards must be achieved to maintain credibility with the Scheme. Government employment of effective stakeholder engagement strategies, such as structured consultation processes, was viewed as necessary for successful, sustainable implementation. CONCLUSION The Australian experience demonstrates that national accreditation reform can engender widespread stakeholder support, but implementation challenges must be overcome. In particular, the fundamental role of continued stakeholder engagement increases the likelihood that such reforms are taken up and spread across health systems.
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Affiliation(s)
- David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Reece Hinchcliff
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Margaret Banks
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Virginia Mumford
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Deborah Debono
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Marjorie Pawsey
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
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