Sharing of lessons learned from multisite research

Developing and Testing an Evaluation Framework for Collaborative Mental Health Services in Primary Care Systems in Latin America

To develop and pilot-test a feasible and meaningful evaluation framework to support the ongoing improvement and performance measurement of services and systems in Latin America regarding Collaborative Mental health Care (CMHC). This mixed methods study, guided by a developmental evaluation approach, included: (1) a critical review of the literature; (2) an environmental scan at three selected health networks in Mexico, Nicaragua and Chile; (3) a Delphi group with experts; (4) a final consultation in the three sites; and (5) a pilot-test of the framework. A comprehensive evaluation framework was developed and successfully piloted. It considers five levels, 28 dimensions and 40 domains, as well as examples of indicators and an implementation plan. This evaluation framework represents an important effort to foster accountability and quality regarding CMHC in Latin America. Recommendations to build upon current capacity and to effectively address the existing implementation challenges are further discussed.

Therapists' Perceptions of Participating in a Large Research Study: Benefits, Challenges, and Impact on Practice

Aims: Clinician participation in research is important to expand clinical research. However, there is limited understanding of the impact of such participation. The purpose of this survey-based study was to describe school-based physical therapists' perceptions of the impact, benefits, and challenges of research participation.Methods: Participants were school-based physical therapists (n = 67) who had been research personnel in a year-long study. Participants completed a questionnaire regarding their experiences participating in the study.Results: Most therapists (59%) perceived that participating in the study improved their competency as a school-based PT a small extent. Participation impacted some therapists a moderate to a great extent in their student assessments (43%), decision-making (28%), and team collaboration (25%). Almost all therapists (96%) responded that they would participate in research again. Researchers identified three themes regarding benefits of participating in research: 1) research and promoting the growth of the profession, 2) support for and expansion of my school-based practice, and 3) reflective practitioner. Researchers identified four themes regarding challenges of participating in research: 1) administrative aspects; 2) time; 3) training; and 4) implementing the tools.Conclusions: Findings from this study support therapist participation in research, and have implications for clinicians, supervisors, and researchers.

Overcoming Challenges in Multisite Trials

BACKGROUND

Conducting multisite studies has many challenges, including determining the geographic distance between sites, ensuring effective communication, monitoring intervention and data integrity, handling institutional policy variations, seeking institutional review board approval with unique site needs or complex subcontracts, and planning for additional costs.

OBJECTIVES

This article discusses common challenges in conducting multisite studies and identifies strategies to overcome these challenges using real-world examples from the literature, the authors' research studies, and their personal experiences.

METHODS

A summary of articles on multisite trials conducted within the past 10 years was explored to uncover common challenges in conducting multisite trials. To enrich the context, exemplars from authors' works are included. Based on literature and experience, strategies to combat challenges are summarized.

RESULTS

Unique issues related to multisite studies include site selection, use of epicenters/coordinating centers, hiring/managing staff, fidelity monitoring, institutional review board approval, statistical considerations, and approaches to authorship.

CONCLUSION

Addressing challenges a priori can improve scientific rigor, reproducibility, and evidence from multisite studies. Given the benefits to scientific rigor, reproducibility, and design, findings from multisite studies are more likely to provide evidence to transform clinical practice and influence policy.

Innovative Collaborative Partnerships to Conduct Multisite Research: Strategies for Success

Multisite nursing research can be a challenging endeavor. A unique partnership between 5 clinical sites and a national research center of a healthcare technology organization led to the successful implementation of a multisite study. Strategies for success, obstacles encountered, benefits, implications for the Magnet journey, and leadership are discussed.

Harmonization, data management, and statistical issues related to prospective multicenter studies in Ankylosing spondylitis (AS): Experience from the Prospective Study Of Ankylosing Spondylitis (PSOAS) cohort

Ankylosing spondylitis (AS) is characterized by inflammation of the spine and sacroiliac joints causing pain and stiffness and, in some patients, ultimately new bone formation, and progressive joint ankyloses. The classical definition of AS is based on the modified New York (mNY) criteria. Limited data have been reported regarding data quality assurance procedure for multicenter or multisite prospective cohort of patients with AS. Since 2002, 1272 qualified AS patients have been enrolled from five sites (4 US sites and 1 Australian site) in the Prospective Study Of Ankylosing Spondylitis (PSOAS). In 2012, a Data Management and Statistical Core (DMSC) was added to the PSOAS team to assist in study design, establish a systematic approach to data management and data quality, and develop and apply appropriate statistical analysis of data. With assistance from the PSOAS investigators, DMSC modified Case Report Forms and developed database in Research Electronic Data Capture (REDCap). DMSC also developed additional data quality assurance procedure to assure data quality. The error rate for various forms in PSOAS databases ranged from 0.07% for medications data to 1.1% for arthritis activity questionnaire-Global pain. Furthermore, based on data from a sub study of 48 patients with AS, we showed a strong level (90.0%) of agreement between the two readers of X-rays with respect to modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). This paper not only could serve as reference for future publications from PSOAS cohort but also could serve as a basic guide to ensuring data quality for multicenter clinical studies.

Experiences of community members and researchers on community engagement in an Ecohealth project in South Africa and Zimbabwe

Background

Community engagement (CE) models have provided much needed guidance for researchers to conceptualise and design engagement strategies for research projects. Most of the published strategies, however, still show very limited contribution of the community to the engagement process. One way of achieving this is to document experiences of community members in the CE processes during project implementation. The aim of our study was to explore the experiences of two research naïve communities, regarding a CE strategy collaboratively developed by researchers and study communities in a multicountry study.

Methods

The study was carried out in two research naïve communities; Gwanda, Zimbabwe and uMkhanyakude, South Africa. The multicentre study was a community based participatory ecohealth multicentre study. A qualitative case study approach was used to explore the CE strategy. Data was collected through Focus Group Discussions, Key Informant Interviews and Direct Observations. Data presented in this paper was collected at three stages of the community engagement process; soon after community entry, soon after sensitisation and during study implementation. Data was analysed through thematic analysis.

Results

The communities generally had positive experiences of the CE process. They felt that the continuous solicitation of their advice and preferences enabled them to significantly contribute to shaping the engagement process. Communities also perceived the CE process as having been flexible, and that the researchers had presented an open forum for sharing responsibilities in all decision making processes of the engagement process.

Conclusions

This study has demonstrated that research naïve communities can significantly contribute to research processes if they are adequately engaged. The study also showed that if researchers put in maximum effort to demystify the research process, communities become empowered and participate as partners in research.

Initiating community engagement in an ecohealth research project in Southern Africa

Background

Community Engagement (CE) in health research ensures that research is consistent with the socio-cultural, political and economic contexts where the research is conducted. The greatest challenges for researchers are the practical aspects of CE in multicentre health research. This study describes the CE in an ecohealth community-based research project focusing on two vulnerable and research naive rural communities.

Methods

A qualitative, longitudinal multiple case study approach was used. Data was collected through Participatory Rural Appraisals, Focus Group Discussions, In-depth Interviews, and observations.

Results

The two sites had different cultural values, research literacy levels, and political and administrative structures. The engagement process included

introductions to the administrative and political leaders of the area;

establishing a community advisory mechanism;

community empowerment and

initiating sustainable post-study activities.

In both sites the study employed community liaison officers to facilitate the community entry and obtaining letters of permission. Both sites opted to form Community Advisory Boards as their main advisory mechanism together with direct advice from community leaders. Empowerment was achieved through the education of ordinary community members at biannual meetings, employment of community research assistants and utilising citizen science. Through the research assistants and the citizen science group, the study has managed to initiate activities that the community will continue to utilise after the study ends. General strategies developed are similar in principle, but implementation and emphasis of various aspects differed in the two communities.

Conclusions

We conclude that it is critical that community engagement be consistent with community values and attitudes, and considers community resources and capacity. A CE strategy fully involving the community is constrained by community research literacy levels, time and resources, but creates a conducive research environment.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-016-0231-9) contains supplementary material, which is available to authorized users.

Methodological issues for designing and conducting a multicenter, international clinical trial in Acute Stroke: Experience from ARTSS-2 trial

BACKGROUND

We describe innovations in the study design and the efficient data coordination of a randomized multicenter trial of Argatroban in Combination with Recombinant Tissue Plasminogen Activator for Acute Stroke (ARTSS-2).

METHODS

ARTSS-2 is a 3-arm, multisite/multiregional randomized controlled trials (RCTs) of two doses of Argatroban injection (low, high) in combination with recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke patients and rt-PA alone. We developed a covariate adaptive randomization program that balanced the study arms with respect to study site as well as hemorrhage after thrombolysis (HAT) score and presence of distal internal carotid artery occlusion (DICAO). We used simulation studies to validate performance of the randomization program before making any adaptations during the trial. For the first 90 patients enrolled in ARTSS-2, we evaluated performance of our randomization program using chi-square tests of homogeneity or extended Fisher's exact test. We also designed a four-step partly Bayesian safety stopping rule for low and high dose Argatroban arms.

RESULTS

Homogeneity of the study arms was confirmed with respect to distribution of study site (UK sites vs. US sites, P=0.98), HAT score (0-2 vs. 3-5, P=1.0), and DICAO (N/A vs. No vs. Yes, P=0.97). Our stopping thresholds for safety of low and high dose Argatroban were not crossed. Despite challenges, data quality was assured.

CONCLUSIONS

We recommend adaptive designs for randomization and Bayesian safety stopping rules for multisite Phase I/II RCTs for maintaining additional flexibility. Efficient data coordination could lead to improved data quality.

Lessons learned in multisite, nursing education research while studying a technology learning innovation

Multiple challenges must be addressed when educational research is being conducted that involves a teaching innovation at multiple sites over time, including the consistent adoption and use of the intervention, attrition, response rates, and other aspects related to managing a complex study. After an 18-month nursing education study was conducted at multiple institutions across the United States, the authors' study team reflected on strategies that worked well, the challenges faced, and what could have been done differently. This article details the challenges and offers recommendations for other researchers conducting similar studies. Recommendations related to communication and engagement, innovation fidelity, survey fatigue, multiple institutional review board applications, and flexibility are provided.

Conducting a paediatric multi-centre RCT with an industry partner: challenges and lessons learned

There are many benefits of multi-centred research including large sample sizes, statistical power, timely recruitment and generalisability of results. However, there are numerous considerations when planning and implementing a multi-centred study. This article reviews the challenges and successes of planning and implementing a multi-centred prospective randomised control trial involving an industry partner. The research investigated the impact on psychosocial functioning of a cosmetic camouflage product for children and adolescents with burn scarring. Multi-centred studies commonly have many stakeholders. Within this study, six Australian and New Zealand paediatric burn units as well as an industry partner were involved. The inclusion of an industry partner added complexities as they brought different priorities and expectations to the research. Further, multifaceted ethical and institutional approval processes needed to be negotiated. The challenges, successes, lessons learned and recommendations from this study regarding Australian and New Zealand ethics and research governance approval processes, collaboration with industry partners and the management of differing expectations will be outlined. Recommendations for future multi-centred research with industry partners include provision of regular written reports for the industry partner; continual monitoring and prompt resolution of concerns; basic research practices education for industry partners; minimisation of industry partner contact with participants; clear roles and responsibilities of all stakeholders and utilisation of single ethical review if available.