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Olufson HT, Ottrey E, Green TL, Young AM. Enhancing or impeding? The influence of digital systems on interprofessional practice and person-centred care in nutrition care systems across rehabilitation units. Nutr Diet 2023. [PMID: 37850243 DOI: 10.1111/1747-0080.12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
AIMS Digital health transformation may enhance or impede person-centred care and interprofessional practice, and thus the provision of high-quality rehabilitation and nutrition services. We aimed to understand how different elements and factors within existing digital nutrition and health systems in subacute rehabilitation units influence person-centred and/or interprofessional nutrition and mealtime care practices through the lens of complexity science. METHODS Our ethnographic study was completed through an interpretivist paradigm. Data were collected from observation and interviews with patients, support persons and staff. Overall, 58 h of ethnographic field work led to observing 125 participants and interviewing 77 participants, totalling 165 unique participants. We used reflexive thematic analysis to analyse the data with consideration of complexity science. RESULTS We developed four themes: (1) the interplay of local context and technology use in nutrition care systems; (2) digitalisation affects staff participation in nutrition and mealtime care; (3) embracing technology to support nutrition and food service flexibility; and (4) the (in)visibility of digitally enabled nutrition care systems. CONCLUSIONS While digital systems enhance the visibility and flexibility of nutrition care systems in some instances, they may also reduce the ability to customise nutrition and mealtime care and lead to siloing of nutrition-related activities. Our findings highlight that the introduction of digital systems alone may be insufficient to enable interprofessional practice and person-centred care within nutrition and mealtime care and thus should be accompanied by local processes and workflows to maximise digital potential.
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Affiliation(s)
- Hannah T Olufson
- School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
- Dietetics & Food Services, Surgical, Treatment & Rehabilitation Service (STARS), Metro North Health, Herston, Queensland, Australia
- STARS Education & Research Alliance, STARS, University of Queensland & Metro North Health, Herston, Queensland, Australia
| | - Ella Ottrey
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
| | - Theresa L Green
- School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
- STARS Education & Research Alliance, STARS, University of Queensland & Metro North Health, Herston, Queensland, Australia
| | - Adrienne M Young
- Dietetics & Food Services, Royal Brisbane & Women's Hospital, Metro North Health, Herston, Queensland, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
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Cook N, Collins J, Porter J, Goodwin D. Applying the theoretical domains framework and behavior change wheel to inform interventions for food and food-related waste audits in hospital foodservices. Front Nutr 2023; 10:1204980. [PMID: 37654474 PMCID: PMC10465701 DOI: 10.3389/fnut.2023.1204980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/01/2023] [Indexed: 09/02/2023] Open
Abstract
Background Completing aggregate food and food-related waste audits in hospital foodservices is an intense practice, however they can demonstrate problem areas that require attention to reduce waste. Identifying interventions to facilitate and improve the implementation of these audits can be guided by behavior change science. The aims of this study were to use behavior change theories and frameworks to (1) describe the drivers of behavior to complete food and food-related waste audits and (2) identify possible interventions that support the implementation and uptake of these audits. Methods Purposive sampling was used to recruit participants from hospitals in Victoria, Australia who worked in their foodservice system. Semi-structured interviews sought knowledge of participant's perceived barriers and enablers to completing food and food-related waste audits. Deductive analysis using the Theoretical Domains Framework (TDF) and Capability Opportunity Motivation Behavior theory (COM-B) identified dominant drivers of behavior. TDF domains were then matched to their corresponding intervention functions according to the Behavior Change Wheel framework (BCW) to identify relevant strategies that may support audit implementation. Results Data from 20 interviews found the dominant COM-B constructs (TDF domains) were psychological capability (knowledge, skills), physical opportunity (environmental context and resources), and reflective motivation (social/professional role and identity, beliefs about capabilities). These dominant domains come from narratives that participants shared about foodservice staffs' lack of knowledge, labor, time, and the hospital avoiding responsibility for audit completion. Corresponding intervention functions that could have the most potential for implementing waste audits were education, training, environmental restructuring, modeling, and enablement. Participants' shared perspectives of audit enablers resembled these: for example, obtaining staff buy-in, reinforcing behavior through incentives and installing an audit champion. Conclusion To transition toward regular food and food-related waste auditing practices in hospital foodservices these findings may help identify practice and policy change that delivers standardized auditing activities to encourage long term behavior change. Interventions to support audit completion should address each behavioral construct and relevant domain, as individual hospital sites will experience unique contextual factors and expectations influencing audit outcomes. A co-design process that includes staff and stakeholders of hospital foodservices is recommended to enable engagement and practical solutions to audit implementation.
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Affiliation(s)
- Nathan Cook
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
- Eastern Health, Box Hill, VIC, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Denise Goodwin
- BehaviourWorks Australia, Monash University, Clayton, VIC, Australia
- Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
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Wilson HK, Eliot KA, Kolasa KM. Considerations for Incorporating Implementation Science into Dietetics Education. J Acad Nutr Diet 2023; 123:379-385. [PMID: 36496125 DOI: 10.1016/j.jand.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/02/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Kathryn M Kolasa
- East Carolina University Brody School of Medicine, Family Medicine, Greenville, North Carolina
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Czosnek L, Zopf EM, Cormie P, Rosenbaum S, Richards J, Rankin NM. Developing an implementation research logic model: using a multiple case study design to establish a worked exemplar. Implement Sci Commun 2022; 3:90. [PMID: 35974402 PMCID: PMC9382723 DOI: 10.1186/s43058-022-00337-8] [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] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Implementation science frameworks explore, interpret, and evaluate different components of the implementation process. By using a program logic approach, implementation frameworks with different purposes can be combined to detail complex interactions. The Implementation Research Logic Model (IRLM) facilitates the development of causal pathways and mechanisms that enable implementation. Critical elements of the IRLM vary across different study designs, and its applicability to synthesizing findings across settings is also under-explored. The dual purpose of this study is to develop an IRLM from an implementation research study that used case study methodology and to demonstrate the utility of the IRLM to synthesize findings across case sites. METHOD The method used in the exemplar project and the alignment of the IRLM to case study methodology are described. Cases were purposely selected using replication logic and represent organizations that have embedded exercise in routine care for people with cancer or mental illness. Four data sources were selected: semi-structured interviews with purposely selected staff, organizational document review, observations, and a survey using the Program Sustainability Assessment Tool (PSAT). Framework analysis was used, and an IRLM was produced at each case site. Similar elements within the individual IRLM were identified, extracted, and re-produced to synthesize findings across sites and represent the generalized, cross-case findings. RESULTS The IRLM was embedded within multiple stages of the study, including data collection, analysis, and reporting transparency. Between 33-44 determinants and 36-44 implementation strategies were identified at sites that informed individual IRLMs. An example of generalized findings describing "intervention adaptability" demonstrated similarities in determinant detail and mechanisms of implementation strategies across sites. However, different strategies were applied to address similar determinants. Dependent and bi-directional relationships operated along the causal pathway that influenced implementation outcomes. CONCLUSIONS Case study methods help address implementation research priorities, including developing causal pathways and mechanisms. Embedding the IRLM within the case study approach provided structure and added to the transparency and replicability of the study. Identifying the similar elements across sites helped synthesize findings and give a general explanation of the implementation process. Detailing the methods provides an example for replication that can build generalizable knowledge in implementation research.
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Affiliation(s)
- Louise Czosnek
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Eva M Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Cabrini Cancer Institute, The Szalmuk Family Department of Medical Oncology, Cabrini Health, Melbourne, Australia
| | - Prue Cormie
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Justin Richards
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Nicole M Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Wu XS, Miles A, Braakhuis A. The Effectiveness of International Dysphagia Diet Standardization Initiative-Tailored Interventions on Staff Knowledge and Texture-Modified Diet Compliance in Aged Care Facilities: A Pre-Post Study. Curr Dev Nutr 2022; 6:nzac032. [PMID: 35415388 PMCID: PMC8994209 DOI: 10.1093/cdn/nzac032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/18/2022] [Accepted: 02/24/2022] [Indexed: 11/12/2022] Open
Abstract
Background The International Dysphagia Diet Standardization Initiative (IDDSI) has created global standardized definitions for texture-modified diets (TMDs) and thickened liquids to improve the safety and care for individuals with swallowing difficulties. The IDDSI framework guides health care facilities, such as aged care, to provide food to at-risk patients. Objectives This study aims to design, deliver, and evaluate a tailored intervention to facilitate IDDSI implementation in aged care. Methods Five aged care facilities received tailored interventions, which were guided by the Expert Recommendation for Implementing Change process and used the corresponding barriers identified in the previous study: 1) tailored material, delivery, and planning; 2) opinion leaders and professional input; 3) strategies to attract and involve staff; and 4) reflections and evaluations. Meal compliance against IDDSI standards and staff knowledge acquisition were the primary outcomes evaluating the impact of the intervention. Written consent was obtained from facility managers. Staff trainings were delivered by a dietitian, accompanied with electronic and printed materials. An audit was conducted on all items listed on the TMD daily menu (lunch, dinner, and midmeals). TMD IDDSI audits and staff self-administered surveys were conducted before and 6 mo after the intervention. Results Audits of 68 and 79 TMD meals/items were conducted pre- and postintervention, respectively. Significant improvement in meal compliance was found in all 3 levels of TMDs, including soft and bite-sized (50%; P = 0.0001), minced and moist (44%; P = 0.0024), and puréed (42%; P = 0.0024). The overall IDDSI compliance increased by 46% postintervention (P < 0.0001). Staff achieved higher scores in both dysphagia and IDDSI knowledge sections (P < 0.0001). Conclusions Tailored interventions facilitated IDDSI implementation in aged care evidenced by increased TMD compliance and staff knowledge, which remained at 6 mo postintervention.
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Affiliation(s)
- Xiaojing S Wu
- Department of Nutrition, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anna Miles
- Department of Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Andrea Braakhuis
- Department of Nutrition, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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