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Feather J, Kaehne A, Kiernan J. Evaluating the implementation of a person-centred transition programme for adolescents and young adults with long-term conditions: the role of context and organisational behaviour. J Health Organ Manag 2023; ahead-of-print. [PMID: 38057278 DOI: 10.1108/jhom-03-2023-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
PURPOSE Drawing on the experiences of healthcare professionals in one paediatric hospital, this paper explores the influence of context and organisational behaviour on the implementation of a person-centred transition programme for adolescents and young adults (AYA) with long-term conditions. DESIGN/METHODOLOGY/APPROACH A single embedded qualitative case study design informed by a realist evaluation framework, was used. Participants who had experience of implementing the transition programme were recruited from across seven individual services within the healthcare organisation. The data were gathered through semi-structured interviews (n = 20) and analysed using thematic analysis. FINDINGS Implementation of the transition programme was influenced by the complex interaction of macro, meso and micro processes and contexts. Features of organisational behaviour including routines and habits, culture, organisational readiness for change and professional relationships shaped professional decision-making around programme implementation. ORIGINALITY/VALUE There exists a significant body of research relating to the role of context and its influence on the successful implementation of complex healthcare interventions. However, within the area of healthcare transition there is little published evidence on the role that organisational behaviour and contextual factors play in influencing transition programme implementation. This paper provides an in-depth understanding of how organisational behaviour and contextual factors affect transition programme implementation.
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Affiliation(s)
- Julie Feather
- Evaluation and Policy Analysis Unit, Edge Hill University, Ormskirk, UK
| | - Axel Kaehne
- Medical School, Edge Hill University, Ormskirk, UK
| | - Joann Kiernan
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
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Wang Y, Wong ELY, Nilsen P, Chung VCH, Tian Y, Yeoh EK. A scoping review of implementation science theories, models, and frameworks - an appraisal of purpose, characteristics, usability, applicability, and testability. Implement Sci 2023; 18:43. [PMID: 37726779 PMCID: PMC10507824 DOI: 10.1186/s13012-023-01296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/26/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND A proliferation of theories, models, and frameworks (TMFs) have been developed in the implementation science field to facilitate the implementation process. The basic features of these TMFs have been identified by several reviews. However, systematic appraisals on the quality of these TMFs are inadequate. To fill this gap, this study aimed to assess the usability, applicability, and testability of the current TMFs in a structured way. METHODS A scoping review method was employed. Electronic databases were searched to locate English and Chinese articles published between January 2000 and April 2022. Search terms were specific to implementation science. Additionally, hand searches were administered to identify articles from related reviews. Purpose and characteristics such as the type of TMF, analytical level, and observation unit were extracted. Structured appraisal criteria were adapted from Birken et al.'s Theory Comparison and Selection Tool (T-CaST) to conduct an in-depth analysis of the TMFs' usability, applicability, and testability. RESULTS A total of 143 TMFs were included in this analysis. Among them, the most common purpose was to identify barriers and facilitators. Most TMFs applied the descriptive method to summarize the included constructs or the prescriptive method to propose courses of implementation actions. TMFs were mainly mid-range theories built on existing conceptual frameworks or demonstrated grand theories. The usability of the TMFs needs to be improved in terms of the provision of conceptually matched strategies to barriers and facilitators and instructions on the TMFs usage. Regarding the applicability, little attention was paid to the constructs of macro-level context, stages of scale-up and sustainability, and implementation outcomes like feasibility, cost, and penetration. Also, fewer TMFs could propose recommended research and measurement methods to apply the TMFs. Lastly, explicit hypotheses or propositions were lacking in most of the TMFs, and empirical evidence was lacking to support the claimed mechanisms between framework elements in testability. CONCLUSIONS Common limitations were found in the usability, application, and testability of the current TMFs. The findings of this review could provide insights for developers of TMFs for future theoretical advancements.
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Affiliation(s)
- Yingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Vincent Chi-Ho Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yue Tian
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Johnsen H, Lichtenberg VD, Rydahl E, Karentius SM, Dueholm SCH, Friis-Alstrup M, Backhausen MG, Røhder K, Schiøtz ML, Broberg L, Juhl M. The Feasibility and Acceptability of the Adverse Childhood Experiences Questionnaire in Danish Antenatal Care-A Qualitative Study of Midwives' Implementation Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105897. [PMID: 37239623 DOI: 10.3390/ijerph20105897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Adverse childhood experiences have a potential lifelong impact on health. A traumatic upbringing may increase antenatal health risks in mothers-to-be and impact child development in their offspring. Yet, little is known about the identification of adverse childhood experiences in antenatal care. The objective of this study was to explore the feasibility and acceptability of the adverse childhood experiences questionnaire among midwives and factors affecting its implementation. Three Danish maternity wards participated in the study. The data consisted of observations of midwifery visits and informal conversations with midwives, as well as mini group interviews and dialogue meetings with midwives. The data were analysed using systematic text condensation. Analysis of the data revealed three main categories; "Relevance of the adverse childhood experiences questionnaire", "Challenges related to use of the adverse childhood experiences questionnaire" and "Apprehensions, emotional strain, and professional support". The findings showed that the adverse childhood experiences questionnaire was feasible to implement in Danish antenatal care. Midwives' acceptability of the questionnaire was high. Training courses and dialogue meetings motivated the midwives to work with the questionnaire in practice. The main factors affecting the implementation process were time restrictions, worries of overstepping women's boundaries, and a lack of a specific intervention for women affected by their traumatic upbringing circumstances.
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Affiliation(s)
- Helle Johnsen
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Vibeke de Lichtenberg
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Eva Rydahl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | - Sara Mbaye Karentius
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | | | | | - Mette Grønbæk Backhausen
- Department of Gynecology and Obstetrics, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Katrine Røhder
- Institute for Psychology, Copenhagen University, Øster Farimagsgade 2A, 1350 Copenhagen K, Denmark
- The Family Clinic, Department of Obstetrics and Gynaecology, Amager and Hvidovre Hospital, Pavillon 4, Østre Hospitalsvej 5A, 2650 Hvidovre, Denmark
| | - Michaela Louise Schiøtz
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Lotte Broberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Mette Juhl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark
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Horton A, Loban K, Fortin MC, Charbonneau S, Nugus P, Pâquet MR, Chaudhury P, Cantarovich M, Sandal S. Living Donor Kidney Transplantation in Quebec: A Qualitative Case Study of Health System Barriers and Facilitators. Can J Kidney Health Dis 2023; 10:20543581221150675. [PMID: 36704234 PMCID: PMC9871975 DOI: 10.1177/20543581221150675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/05/2022] [Indexed: 01/21/2023] Open
Abstract
Background Patients with kidney failure represent a major public health burden, and living donor kidney transplantation (LDKT) is the best treatment option for these patients. Current work to optimize LDKT delivery to patients has focused on microlevel interventions and has not addressed interdependencies with meso and macro levels of practice. Objective We aimed to learn from a health system with historically low LDKT performance to identify facilitators and barriers to LDKT. Our specific aims were to understand how LDKT delivery is organized through interacting macro, meso, and micro levels of practice and identify what attributes and processes of this health system facilitate the delivery of LDKT to patients with kidney failure and what creates barriers. Design We conducted a qualitative case study, applying a complex adaptive systems approach to LDKT delivery, that recognizes health systems as being made up of dynamic, nested, and interconnected levels, with the patient at its core. Setting The setting for this case study was the province of Quebec, Canada. Participants Thirty-two key stakeholders from all levels of the health system. This included health care professionals, leaders in LDKT governance, living kidney donors, and kidney recipients. Methods Semi-structured interviews with 32 key stakeholders and a document review were undertaken between February 2021 and December 2021. Inductive thematic analysis was used to generate themes. Results Overall, we identified strong links between system attributes and processes and LDKT delivery, and more barriers than facilitators were discerned. Barriers that undermined access to LDKT included fragmented LDKT governance and expertise, disconnected care practices, limited resources, and regional inequities. Some were mitigated to an extent by the intervention of a program launched in 2018 to increase LDKT. Facilitators driven by the program included advocacy for LDKT from individual member(s) of the care team, dedicated resources, increased collaboration, and training opportunities that targeted LDKT delivery at multiple levels of practice. Limitations Delineating the borders of a "case" is a challenge in case study research, and it is possible that some perspectives may have been missed. Participants may have produced socially desirable answers. Conclusions Our study systematically investigated real-world practices as they operate throughout a health system. This novel approach has cross-disciplinary methodological relevance, and our findings have policy implications that can help inform multilevel interventions to improve LDKT.
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Affiliation(s)
- Anna Horton
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada
| | - Katya Loban
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Division of Nephrology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre
hospitalier de l’Université de Montréal, QC, Canada,Division of Nephrology, Department of
Medicine, Centre hospitalier de l’Université de Montréal, QC, Canada
| | | | - Peter Nugus
- Department of Family Medicine and
Institute of Health Sciences Education, McGill University, Montreal, QC,
Canada
| | - Michel R. Pâquet
- Centre de recherche du Centre
hospitalier de l’Université de Montréal, QC, Canada,Division of Nephrology, Department of
Medicine, Centre hospitalier de l’Université de Montréal, QC, Canada
| | - Prosanto Chaudhury
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Department of Surgery, McGill
University Health Centre, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Division of Nephrology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Shaifali Sandal
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Division of Nephrology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada,Shaifali Sandal, Research Institute of the
McGill University Health Centre, Royal Victoria Hospital Glen Site, D05-7176,
1001 boul Decarie, Montreal, QC H4A 3J1, Canada.
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A M, K LBC, E S, S C, P F. A protocol for a multi-site cohort study to evaluate child and adolescent mental health service transformation in England using the i-THRIVE model. PLoS One 2023; 18:e0265782. [PMID: 37155627 PMCID: PMC10166497 DOI: 10.1371/journal.pone.0265782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/14/2023] [Indexed: 05/10/2023] Open
Abstract
The National i-THRIVE Programme seeks to evaluate the impact of the NHS England-funded whole system transformation on child and adolescent mental health services (CAMHS). This article reports on the design for a model of implementation that has been applied in CAMHS across over 70 areas in England using the 'THRIVE' needs-based principles of care. The implementation protocol in which this model, 'i-THRIVE' (implementing-THRIVE), will be used to evaluate the effectiveness of the THRIVE intervention is reported, together with the evaluation protocol for the process of implementation. To evaluate the effectiveness of i-THRIVE to improve care for children and young people's mental health, a cohort study design will be conducted. N = 10 CAMHS sites that adopt the i-THRIVE model from the start of the NHS England-funded CAMHS transformation will be compared to N = 10 'comparator sites' that choose to use different transformation approaches within the same timeframe. Sites will be matched on population size, urbanicity, funding, level of deprivation and expected prevalence of mental health care needs. To evaluate the process of implementation, a mixed-methods approach will be conducted to explore the moderating effects of context, fidelity, dose, pathway structure and reach on clinical and service level outcomes. This study addresses a unique opportunity to inform the ongoing national transformation of CAMHS with evidence about a popular new model for delivering children and young people's mental health care, as well as a new implementation approach to support whole system transformation. If the outcomes reflect benefit from i-THRIVE, this study has the potential to guide significant improvements in CAMHS by providing a more integrated, needs-led service model that increases access and involvement of patients with services and in the care they receive.
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Affiliation(s)
- Moore A
- The Anna Freud National Centre for Children and Families, London, United Kingdom
- Psychoanalysis Unit, Division of Psychology and Language Sciences, University College London, London, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Lindley Baron-Cohen K
- Psychoanalysis Unit, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Simes E
- The Anna Freud National Centre for Children and Families, London, United Kingdom
- Psychoanalysis Unit, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Chen S
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Fonagy P
- The Anna Freud National Centre for Children and Families, London, United Kingdom
- Psychoanalysis Unit, Division of Psychology and Language Sciences, University College London, London, United Kingdom
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Yazdi-Feyzabadi V, Khedmati Morasae E, Delavari S. Implications of COVID-19 for Public Health Theory and Praxis From a Complex Systems Perspective. Int J Health Policy Manag 2022; 12:7349. [PMID: 37579449 PMCID: PMC10125154 DOI: 10.34172/ijhpm.2022.7349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/16/2022] [Indexed: 08/16/2023] Open
Affiliation(s)
- Vahid Yazdi-Feyzabadi
- Health Services Management Research Centre, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmaeil Khedmati Morasae
- Centre for Circular Economy, Exeter University Business School, University of Exeter, Exeter, UK
| | - Sajad Delavari
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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English M, Nzinga J, Oliwa J, Maina M, Oluoch D, Barasa E, Irimu G, Muinga N, Vincent C, McKnight J. Improving facility-based care: eliciting tacit knowledge to advance intervention design. BMJ Glob Health 2022; 7:e009410. [PMID: 35985694 PMCID: PMC9396143 DOI: 10.1136/bmjgh-2022-009410] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/16/2022] [Indexed: 12/23/2022] Open
Abstract
Attention has turned to improving the quality and safety of healthcare within health facilities to reduce avoidable mortality and morbidity. Interventions should be tested in health system environments that can support their adoption if successful. To be successful, interventions often require changes in multiple behaviours making their consequences unpredictable. Here, we focus on this challenge of change at the mesolevel or microlevel. Drawing on multiple insights from theory and our own empirical work, we highlight the importance of engaging managers, senior and frontline staff and potentially patients to explore foundational questions examining three core resource areas. These span the physical or material resources available, workforce capacity and capability and team and organisational relationships. Deficits in all these resource areas may need to be addressed to achieve success. We also argue that as inertia is built into the complex social and human systems characterising healthcare facilities that thought on how to mobilise five motive forces is needed to help achieve change. These span goal alignment and ownership, leadership for change, empowering key actors, promoting responsive planning and procurement and learning for transformation. Our aim is to bridge the theory-practice gap and offer an entry point for practical discussions to elicit the critical tacit and contextual knowledge needed to design interventions. We hope that this may improve the chances that interventions are successful and so contribute to better facility-based care and outcomes while contributing to the development of learning health systems.
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Affiliation(s)
- Mike English
- Health Services Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya
- Health Systems Collaborative, Nuffield Department of Medicine, Oxford, UK
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacquie Oliwa
- Health Services Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Michuki Maina
- Health Services Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Dorothy Oluoch
- Health Services Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
| | - Grace Irimu
- Health Services Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Naomi Muinga
- Health Services Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Jacob McKnight
- Health Systems Collaborative, Nuffield Department of Medicine, Oxford, UK
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Horton A, Nugus P, Fortin MC, Landsberg D, Cantarovich M, Sandal S. Health system barriers and facilitators to living donor kidney transplantation: a qualitative case study in British Columbia. CMAJ Open 2022; 10:E348-E356. [PMID: 35440483 PMCID: PMC9022938 DOI: 10.9778/cmajo.20210049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In patients with kidney failure, living donor kidney transplantation (LDKT) is the best treatment option; yet, LDKT rates have stagnated in Canada and vary widely across provinces. We aimed to identify barriers and facilitators to LDKT in a high-performing health system. METHODS This study was conducted using a qualitative exploratory case study of British Columbia. Data collection, conducted between October 2020 and January 2021, entailed document review and semistructured interviews with key stakeholders, including provincial leadership, care teams and patients. We recruited participants via purposive sampling and snowballing technique. We generated themes using thematic analysis. RESULTS After analysis of interviews conducted with 22 participants (5 representatives from provincial organizations, 7 health care providers at transplant centres, 8 health care providers from regional units and 2 patients) and document review, we identified the following 5 themes as facilitators to LDKT: a centralized infrastructure, a mandate for timely intervention, an equitable funding model, a commitment to collaboration and cultivating distributed expertise. The relationship between 2 provincial organizations (BC Transplant and BC Renal Agency) was identified as key to enabling the mandate and processes for LDKT. Five barriers were identified that arose from silos between provincial organizations and manifested as inconsistencies in coordinating LDKT along the spectrum of care. These were divided accountability structures, disconnected care processes, missed training opportunities, inequitable access by region and financial burden for donors and recipients. INTERPRETATION We found strong links between provincial infrastructure and the processes that facilitate or impede timely intervention and referral of patients for LDKT. Our findings have implications for policy-makers and provide opportunities for cross-jurisdictional comparative analyses.
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Affiliation(s)
- Anna Horton
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Peter Nugus
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Marie-Chantal Fortin
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - David Landsberg
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Marcelo Cantarovich
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Shaifali Sandal
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que.
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9
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Johnson AH, Harrison TC. Advanced Practice Registered Nurse Transition to Practice in the Long-Term Care Setting: An Ethnography. Glob Qual Nurs Res 2022; 9:23333936221108701. [PMID: 35832603 PMCID: PMC9272163 DOI: 10.1177/23333936221108701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022] Open
Abstract
Advanced practice registered nurses are successful in improving quality outcomes and filling provider care gaps in long-term care. However, little is known about the nurse’s transition to practice in this setting. A 12-month ethnography was conducted via participant-observation with nine advanced practice registered nurses in five long-term care facilities to understand practice environment influence on the nurses’ transition and on the reciprocal influence of the nurse on the practice environment. Transition was fraught with uncertainty as documented by five themes: where’s my authority, institutional acceptance, personal role fulfillment, provider relationships, and individual versus organizational care. These findings suggest that transition in this setting is complex, characterized by insecurity whether the individual is new to advanced practice or experienced. Transition in long-term care could be strengthened by formal programs that include clinical practice, reconceived mentorship for advanced practice registered nurses, and education designed to improve comfort and expertise with indirect care.
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10
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Appiah R, Wilson Fadiji A, Wissing MP, Schutte L. The Inspired Life Program: Development of a multicomponent positive psychology intervention for rural adults in Ghana. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:302-328. [PMID: 33821476 DOI: 10.1002/jcop.22566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Although several theories and studies have explored human strengths and mental well-being at the global level, these insights are rarely tested and translated into practice in sub-Saharan Africa. This study aims to describe the development of a 10-session multicomponent positive psychology intervention, the Inspired Life Program (ILP), designed to promote mental health and reduce symptoms of depression and negative affect in rural adults in Ghana. Guided by the Medical Research Council's framework for developing complex interventions, a seven-step iterative community-based participatory research approach was adopted to develop the ILP, based on constructs and principles of positive psychology and cognitive-behavioral model. The final intervention components included a 10-session, two-hourly, once-weekly manualized program designed to promote meaningful and purposeful living, self-acceptance, personal growth, goal-setting and problem-solving skills, and positive thinking through group discussion and activity sessions. We describe the program theory and implementation strategy of the final intervention, and reflect on the challenges and lessons learned from applying this framework in the study context. The development of strengths-based interventions and practicality of methods to promote positive mental health in rural adults are feasible, and have important policy implications for mental health and social care in sub-Saharan Africa.
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Affiliation(s)
- Richard Appiah
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
- College of Health Sciences, University of Ghana, Accra, Ghana
| | - Angelina Wilson Fadiji
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
- Department of Educational Psychology, Faculty of Education, University of Pretoria, Pretoria, South Africa
| | - Marié P Wissing
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Lusilda Schutte
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
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Bleecker L, Sauveplane-Stirling V, Di Ruggiero E, Sellen D. Evaluating the integration of strategic priorities within a complex research-for-development funding program. EVALUATION AND PROGRAM PLANNING 2021; 89:102009. [PMID: 34562669 DOI: 10.1016/j.evalprogplan.2021.102009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/26/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
This paper examines the application of Complexity Theory constructs to a research-for-development program evaluation and presents an overview of the implications and promising approaches for evaluating complex programs. We discuss lessons learned from an evaluation completed for the International Development Research Centre's Food, Environment and Health (FEH) program, which investigated the integration and outcomes of five strategic program priorities: partnerships, southern leadership, gender and equity, scale, and environmental sustainability. We present interpretations from a secondary, thematic content analysis that categorized evaluation findings across four complexity constructs: emergence, unpredictability, contradiction and self-organization. Viewing the evaluation through these constructs surfaced some important features of the FEH program to date, specifically its evolving approach, adaptiveness to emergent issues, non-linear outcomes, and self-organizing agents, which had several implications for the evaluative process. We conclude that the most appropriate evaluation designs for complex funding programs are participatory (to explore all stakeholders' influence), adaptive (to capture the unexpected) and assess external contexts. The application of complexity constructs may be useful for evaluators to gain a deeper understanding of how program contexts change in the face of complexity and why some evaluation methods work more effectively than others.
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12
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Morgan-Trimmer S, Kudlicka A, Warmoth K, Leroi I, Oyebode JR, Pool J, Woods R, Clare L. Implementation processes in a cognitive rehabilitation intervention for people with dementia: a complexity-informed qualitative analysis. BMJ Open 2021; 11:e051255. [PMID: 34702730 PMCID: PMC8549661 DOI: 10.1136/bmjopen-2021-051255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Healthcare is often delivered through complex interventions. Understanding how to implement these successfully is important for optimising services. This article demonstrates how the complexity theory concept of 'self-organisation' can inform implementation, drawing on a process evaluation within a randomised controlled trial of the GREAT (Goal-oriented cognitive Rehabilitation in Early-stage Alzheimer's and related dementias: a multi-centre single-blind randomised controlled Trial) intervention which compared a cognitive rehabilitation intervention for people with dementia with usual treatment. DESIGN A process evaluation examined experiences of GREAT therapists and participants receiving the intervention, through thematic analysis of a focus group with therapists and interviews with participants and their carers. Therapy records of participants receiving the intervention were also analysed using adapted framework analysis. Analysis adopted a critical realist perspective and a deductive-inductive approach to identify patterns in how the intervention operated. SETTING The GREAT intervention was delivered through home visits by therapists, in eight regions in the UK. PARTICIPANTS Six therapists took part in a focus group, interviews were conducted with 25 participants and 26 carers, and therapy logs for 50 participants were analysed. INTERVENTION A 16-week cognitive rehabilitation programme for people with mild-to-moderate dementia. RESULTS 'Self-organisation' of the intervention occurred through adaptations made by therapists. Adaptations included simplifying the intervention for people with greater cognitive impairment, and extending it to meet additional needs. Relational work by therapists produced an emergent outcome of 'social support'. Self-organised aspects of the intervention were less visible than formal components, but were important aspects of how it operated during the trial. This understanding can help to inform future implementation. CONCLUSIONS Researchers are increasingly adopting complexity theory to understand interventions. This study extends the application of complexity theory by demonstrating how 'self-organisation' was a useful concept for understanding aspects of the intervention that would have been missed by focusing on formal intervention components. Analysis of self-organisation could enhance future process evaluations and implementation studies. TRIAL REGISTRATION NUMBER ISRCTN21027481.
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Affiliation(s)
| | | | - Krystal Warmoth
- School of Health and Social Work & NIHR Applied Research Collaboration East of England, University of Hertfordshire, Hatfield, UK
| | - Iracema Leroi
- School of Medicine and Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Jan R Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jackie Pool
- Dementia Pal Ltd, QCS Quality Compliance Systems, Guildford, UK
| | - Robert Woods
- Dementia Services Development Centre Wales, School of Health Sciences, Bangor University, Bangor, UK
| | - Linda Clare
- College of Medicine and Health & NIHR Applied Research Collaboration South-West Peninsula, University of Exeter, Exeter, UK
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13
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English M, Ogola M, Aluvaala J, Gicheha E, Irimu G, McKnight J, Vincent CA. First do no harm: practitioners' ability to 'diagnose' system weaknesses and improve safety is a critical initial step in improving care quality. Arch Dis Child 2021; 106:326-332. [PMID: 33361068 PMCID: PMC7982941 DOI: 10.1136/archdischild-2020-320630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Healthcare systems across the world and especially those in low-resource settings (LRS) are under pressure and one of the first priorities must be to prevent any harm done while trying to deliver care. Health care workers, especially department leaders, need the diagnostic abilities to identify local safety concerns and design actions that benefit their patients. We draw on concepts from the safety sciences that are less well-known than mainstream quality improvement techniques in LRS. We use these to illustrate how to analyse the complex interactions between resources and tools, the organisation of tasks and the norms that may govern behaviours, together with the strengths and vulnerabilities of systems. All interact to influence care and outcomes. To employ these techniques leaders will need to focus on the best attainable standards of care, build trust and shift away from the blame culture that undermines improvement. Health worker education should include development of the technical and relational skills needed to perform these system diagnostic roles. Some safety challenges need leadership from professional associations to provide important resources, peer support and mentorship to sustain safety work.
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Affiliation(s)
- Mike English
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK .,Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Muthoni Ogola
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya,Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Jalemba Aluvaala
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya,Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Edith Gicheha
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya,Kenya Paediatric Research Consortium, Nairobi, Kenya
| | - Grace Irimu
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya,Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya,Kenya Paediatric Research Consortium, Nairobi, Kenya
| | - Jacob McKnight
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
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14
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Haynes A, Rychetnik L, Finegood D, Irving M, Freebairn L, Hawe P. Applying systems thinking to knowledge mobilisation in public health. Health Res Policy Syst 2020; 18:134. [PMID: 33203438 PMCID: PMC7670767 DOI: 10.1186/s12961-020-00600-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Knowledge mobilisation (KM) is a vital strategy in efforts to improve public health policy and practice. Linear models describing knowledge transfer and translation have moved towards multi-directional and complexity-attuned approaches where knowledge is produced and becomes meaningful through social processes. There are calls for systems approaches to KM but little guidance on how this can be operationalised. This paper describes the contribution that systems thinking can make to KM and provides guidance about how to put it into action. METHODS We apply a model of systems thinking (which focuses on leveraging change in complex systems) to eight KM practices empirically identified by others. We describe how these models interact and draw out some key learnings for applying systems thinking practically to KM in public health policy and practice. Examples of empirical studies, tools and targeted strategies are provided. FINDINGS Systems thinking can enhance and fundamentally transform KM. It upholds a pluralistic view of knowledge as informed by multiple parts of the system and reconstituted through use. Mobilisation is conceived as a situated, non-prescriptive and potentially destabilising practice, no longer conceptualised as a discrete piece of work within wider efforts to strengthen public health but as integral to and in continual dialogue with those efforts. A systems approach to KM relies on contextual understanding, collaborative practices, addressing power imbalances and adaptive learning that responds to changing interactions between mobilisation activities and context. CONCLUSION Systems thinking offers valuable perspectives, tools and strategies to better understand complex problems in their settings and for strengthening KM practice. We make four suggestions for further developing empirical evidence and debate about how systems thinking can enhance our capacity to mobilise knowledge for solving complex problems - (1) be specific about what is meant by 'systems thinking', (2) describe counterfactual KM scenarios so the added value of systems thinking is clearer, (3) widen conceptualisations of impact when evaluating KM, and (4) use methods that can track how and where knowledge is mobilised in complex systems.
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Affiliation(s)
- Abby Haynes
- The Australian Prevention Partnership Centre, Sydney, Australia.
- University of Sydney, Menzies Centre for Health Policy, Sydney, Australia.
- University of Sydney, School of Public Health, Institute for Musculoskeletal Health, PO Box M179, Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Lucie Rychetnik
- The Australian Prevention Partnership Centre, Sydney, Australia
- University of Sydney, School of Public Health, Sydney, Australia
- University of Notre Dame Australia, School of Medicine, Sydney, Australia
| | - Diane Finegood
- Morris J. Wosk Centre for Dialogue and Department of Biomedical Physiology & Kinesiology, Simon Fraser University, Vancouver, Canada
| | - Michelle Irving
- The Australian Prevention Partnership Centre, Sydney, Australia
- University of Sydney, Menzies Centre for Health Policy, Sydney, Australia
| | - Louise Freebairn
- The Australian Prevention Partnership Centre, Sydney, Australia
- ACT Health Directorate, ACT Government, Canberra, Australia
| | - Penelope Hawe
- The Australian Prevention Partnership Centre, Sydney, Australia
- University of Sydney, Menzies Centre for Health Policy, Sydney, Australia
- O'Brien Institute of Public Health, University of Calgary, Calgary, Canada
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15
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Busnel C, Ludwig C, Da Rocha Rodrigues MG. [Complexity in nursing practice : Toward a new conceptual framework in nursing care]. Rech Soins Infirm 2020; 140:7-16. [PMID: 32524804 DOI: 10.3917/rsi.140.0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
While complexity theory has gradually influenced the field of health and social sciences, it has also had an impact on nursing care by introducing a wealth of terminology into the field. The terms “complex patient,” “complex case,” “complex care,” “complex practice,” and “complex needs” have been proposed to describe different aspects of complexity in nursing care. As these qualifiers reflect, nurses become actors in multidefined care and must integrate complexity into their reflective practice. By way of a narrative literature review, this article aims to offer a new perspective on nursing by explaining the different terms used in the discipline, using a multi-level approach. At the end of this review, the authors propose a new integrative conceptual framework for complexity in nursing practice.
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16
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Collingridge Moore D, Payne S, Van den Block L, Ling J, Froggatt K. Strategies for the implementation of palliative care education and organizational interventions in long-term care facilities: A scoping review. Palliat Med 2020; 34:558-570. [PMID: 32009516 PMCID: PMC7222696 DOI: 10.1177/0269216319893635] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The number of older people dying in long-term care facilities is increasing; however, care at the end of life can be suboptimal. Interventions to improve palliative care delivery within these settings have been shown to be effective in improving care, but little is known about their implementation. AIM The aim of this study was to describe the nature of implementation strategies and to identify facilitators and/or barriers to implementing palliative care interventions in long-term care facilities. DESIGN Scoping review with a thematic synthesis, following the ENTREQ guidelines. DATA SOURCES Published literature was identified from electronic databases, including MEDLINE, EMBASE, PsycINFO and CINAHL. Controlled, non-controlled and qualitative studies and evaluations of interventions to improve palliative care in long-term care facilities were included. Studies that met the inclusion criteria were sourced and data extracted on the study characteristics, the implementation of the intervention, and facilitators and/or barriers to implementation. RESULTS The review identified 8902 abstracts, from which 61 studies were included in the review. A matrix of implementation was developed with four implementation strategies (facilitation, education/training, internal engagement and external engagement) and three implementation stages (conditions to introduce the intervention, embedding the intervention within day-to-day practice and sustaining ongoing change). CONCLUSION Incorporating an implementation strategy into the development and delivery of an intervention is integral in embedding change in practice. The review has shown that the four implementation strategies identified varied considerably across interventions; however, similar facilitators and barriers were encountered across the studies identified. Further research is needed to understand the extent to which different implementation strategies can facilitate the uptake of palliative care interventions in long-term care facilities.
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Affiliation(s)
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Lieve Van den Block
- VUB-UGhent End of Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Julie Ling
- European Association for Palliative Care, Vilvoorde, Belgium
| | - Katherine Froggatt
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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Olsson A, Thunborg C, Björkman A, Blom A, Sjöberg F, Salzmann-Erikson M. A scoping review of complexity science in nursing. J Adv Nurs 2020. [PMID: 32281684 DOI: 10.1111/jan.14382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 11/26/2022]
Abstract
AIM To describe how complexity science has been integrated into nursing. DESIGN A scoping review. DATA SOURCE/REVIEW METHOD Academic Search Elite, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science were searched November 2016, updated in October 2017 and January 2020. The working process included: problem identification, literature search, data evaluation, synthesizing and presentation. RESULTS Four categories were found in the included 89 articles: (a) how complexity science is integrated into the nursing literature in relation to nursing education and teaching; (b) patients' symptoms, illness outcome and safety as characteristics of complexity science in nursing; (c) that leaders and managers should see organizations as complex and adaptive systems, rather than as linear machines; and (d) the need for a novel approach to studying complex phenomena such as healthcare organizations. Lastly, the literature explains how complexity science has been incorporated into the discourse in nursing and its development. CONCLUSION The review provided strong support for use in complexity science in the contemporary nursing literature. Complexity science is also highly applicable and relevant to clinical nursing practice and nursing management from an organizational perspective. The application of complexity science as a tool in the analysis of complex nursing systems could improve our understanding of effective interactions among patients, families, physicians and hospital and skilled nursing facility staff as well as of education. IMPACT Understanding complexity science in relation to the key role of nurses in the healthcare environment can improve nursing work and nursing theory development. The use of complexity science provides nurses with a language that liberates them from the reductionist view on nursing education, practice and management.
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Affiliation(s)
- Annakarin Olsson
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden
| | - Charlotta Thunborg
- Department of Neurobiology, Care Sciences and Society, Division of Clinical geriatrics, Karolinska Institutet, Stockholm, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Annica Björkman
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden.,Health Services Research, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anneli Blom
- Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden
| | - Fredric Sjöberg
- Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Martin Salzmann-Erikson
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden
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18
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Kalpazidou Schmidt E, Ovseiko PV, Henderson LR, Kiparoglou V. Understanding the Athena SWAN award scheme for gender equality as a complex social intervention in a complex system: analysis of Silver award action plans in a comparative European perspective. Health Res Policy Syst 2020; 18:19. [PMID: 32059678 PMCID: PMC7023775 DOI: 10.1186/s12961-020-0527-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 01/15/2020] [Indexed: 12/24/2022] Open
Abstract
Background Given the complex mix of structural, cultural and institutional factors that produce barriers for women in science, an equally complex intervention is required to understand and address them. The Athena SWAN Award Scheme for Gender Equality has become a widespread means to address barriers for women’s advancement and leadership in the United Kingdom, Ireland, Australia, the United States of America and Canada, while the European Commission is exploring the introduction of a similar award scheme across Europe. Methods This study analyses the design and implementation of 16 departmental Athena SWAN Silver Action Plans in Medical Sciences at one of the world’s leading universities in Oxford, United Kingdom. Data pertaining to the design and implementation of gender equality interventions were extracted from the action plans, analysed thematically, coded using categories from the 2015 Athena SWAN Charter Awards Handbook and synthesised against a typology of gender equality interventions in the European Research Area. The results were further analysed against the complexity research literature framework, where research organisations are perceived as dynamic systems that adapt, interact and co-evolve with other systems. Results Athena SWAN is a complex contextually embedded system of action planning within the context of universities. It depends on a multitude of contextual variables that relate in complex, non-linear ways and dynamically adapt to constantly moving targets and new emergent conditions. Athena SWAN Silver Action Plans conform to the key considerations of complexity – (1) multiple actions and areas of intervention with a focus on the complex system being embedded in local dynamics, (2) the non-linearity of interventions and the constantly emerging conditions, and (3) impact in terms of contribution to change, improved conditions to foster change and the increased probability that change can occur. Conclusions To enact effective sustainable structural and cultural change for gender equality, it is necessary to acknowledge and operationalise complexity as a frame of reference. Athena SWAN is the single most comprehensive and systemic gender equality scheme in Europe. It can be further strengthened by promoting the integration of sex and gender analysis in research and education. Gender equality policies in the wider European Research Area can benefit from exploring Athena SWAN’s contextually embedded systemic approach to dynamic action planning and inclusive focus on all genders and categories of staff and students.
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Affiliation(s)
| | - Pavel V Ovseiko
- Radcliffe Department of Medicine, Medical Science Division, University of Oxford, Oxford, United Kingdom
| | - Lorna R Henderson
- Radcliffe Department of Medicine, Medical Science Division, University of Oxford, Oxford, United Kingdom.,NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Vasiliki Kiparoglou
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom.,Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
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19
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Horvat A, Filipovic J. Healthcare system quality indicators: the complexity perspective. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2020. [DOI: 10.1080/14783363.2017.1421062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ana Horvat
- Department for Quality Management and Standardization, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Jovan Filipovic
- Department for Quality Management and Standardization, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
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21
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Ferraz L, Pereira RPG, Pereira AMRDC. Tradução do Conhecimento e os desafios contemporâneos na área da saúde: uma revisão de escopo. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-11042019s215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A implementação das melhores evidências científicas nos serviços de saúde ainda não ocorre de forma satisfatória. Diante dessa problemática, o objetivo deste estudo foi investigar os desafios da Tradução do Conhecimento (TC) na área da saúde na atualidade. A metodologia desta revisão foi desenvolvida de acordo com os propósitos da revisão de escopo. Para tanto, as palavras-chave ‘translational medical research’ e ‘knowledge translation’ foram consultadas nos bancos de dados de periódicos da PubMed, Scopus e Web of Science. Foram incluídos os estudos publicados a partir do ano de 2008 até abril de 2018. Entre os 1.677 estudos encontrados, 839 artigos eram duplicados, e 818 não atendiam plenamente ao objetivo desta revisão; assim, 20 estudos foram submetidos à apreciação desse escopo. De acordo com as análises dos estudos, o desafio da TC advém de dois fatores: por um lado, a falta de coesão entre a comunidade científica e os tomadores de decisão em saúde; por outro, a inabilidade dos profissionais em traduzir e aplicar novos conhecimentos, além da omissão de apoio e de incentivos das instituições de saúde. Outrossim, esta revisão aborda um corpo significativo de diversos outros aspectos que limitam e/ou dificultam a TC área da saúde.
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Affiliation(s)
- Lucimare Ferraz
- Universidade do Estado de Santa Catarina, Brasil; Universidade Comunitária da Região de Chapecó, Brasil
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22
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Côté-Boileau É, Denis JL, Callery B, Sabean M. The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review. Health Res Policy Syst 2019; 17:84. [PMID: 31519185 PMCID: PMC6744644 DOI: 10.1186/s12961-019-0482-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/01/2019] [Indexed: 11/20/2022] Open
Abstract
Innovation has the potential to improve the quality of care and health service delivery, but maximising the reach and impact of innovation to achieve large-scale health system transformation remains understudied. Interest is growing in three processes of the innovation journey within health systems, namely the spread, sustainability and scale-up (3S) of innovation. Recent reviews examine what we know about these processes. However, there is little research on how to support and operationalise the 3S. This study aims to improve our understanding of the 3S of healthcare innovations. We focus specifically on the definitions of the 3S, the mechanisms that underpin them, and the conditions that either enable or limit their potential. We conducted a scoping review, systematically investigating six bibliographic databases to search, screen and select relevant literature on the 3S of healthcare innovations. We screened 641 papers, then completed a full-text review of 112 identified as relevant based on title and abstract. A total of 24 papers were retained for analysis. Data were extracted and synthesised through descriptive and inductive thematic analysis. From this, we develop a framework of actionable guidance for health system actors aiming to leverage the 3S of innovation across five key areas of focus, as follows: (1) focus on the why, (2) focus on perceived-value and feasibility, (3) focus on what people do, rather than what they should be doing, (4) focus on creating a dialogue between policy and delivery, and (5) focus on inclusivity and capacity building. While there is no standardised approach to foster the 3S of healthcare innovations, a variety of practical frameworks and tools exist to support stakeholders along this journey.
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Affiliation(s)
- Élizabeth Côté-Boileau
- Health Sciences Research, Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada. .,Charles-Le Moyne - Saguenay-Lac-Saint-Jean Research Center on Health Innovations, Quebec, Canada. .,Doctoral Award Fellow from Quebec's Fonds de recherche du Québec - Santé (FRQS), Quebec, Canada. .,Health Standards Organization, Ottawa, Canada.
| | - Jean-Louis Denis
- Health Administration Department, School of Public Health, University of Montreal, Quebec, Canada.,University of Montreal Hospital Research Center, Quebec, Canada.,Canada Research Chair (Tier I) holder on Health system design and adaptation (Canadian Institutes of Health Research), Montreal, Canada
| | - Bill Callery
- Canadian Foundation for Healthcare Improvement, Corporate Strategy and Program Development, Ottawa, Canada
| | - Meghan Sabean
- Canadian Foundation for Healthcare Improvement, Corporate Strategy and Program Development, Ottawa, Canada
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Noyes J, Booth A, Moore G, Flemming K, Tunçalp Ö, Shakibazadeh E. Synthesising quantitative and qualitative evidence to inform guidelines on complex interventions: clarifying the purposes, designs and outlining some methods. BMJ Glob Health 2019; 4:e000893. [PMID: 30775016 PMCID: PMC6350750 DOI: 10.1136/bmjgh-2018-000893] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 01/28/2023] Open
Abstract
Guideline developers are increasingly dealing with more difficult decisions concerning whether to recommend complex interventions in complex and highly variable health systems. There is greater recognition that both quantitative and qualitative evidence can be combined in a mixed-method synthesis and that this can be helpful in understanding how complexity impacts on interventions in specific contexts. This paper aims to clarify the different purposes, review designs, questions, synthesis methods and opportunities to combine quantitative and qualitative evidence to explore the complexity of complex interventions and health systems. Three case studies of guidelines developed by WHO, which incorporated quantitative and qualitative evidence, are used to illustrate possible uses of mixed-method reviews and evidence. Additional examples of methods that can be used or may have potential for use in a guideline process are outlined. Consideration is given to the opportunities for potential integration of quantitative and qualitative evidence at different stages of the review and guideline process. Encouragement is given to guideline commissioners and developers and review authors to consider including quantitative and qualitative evidence. Recommendations are made concerning the future development of methods to better address questions in systematic reviews and guidelines that adopt a complexity perspective.
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Affiliation(s)
- Jane Noyes
- School of Social Sciences, Bangor University, Wales, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Wales, UK
| | - Kate Flemming
- Department of Health Sciences, The University of York, York, UK
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Elham Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Complexity Theory: An Overview with Potential Applications for the Social Sciences. SYSTEMS 2019. [DOI: 10.3390/systems7010004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Systems theory has been challenged in the recent literature due to its perceived disconnection from today’s research and practice demands. Moving away from the reductionist frameworks and the complicated domain predominated by known unknowns and order, a call is being made to the social sciences to begin adopting complexity theory and newer connectionist methods that better address complexity and open social systems. Scholars and scholar-practitioners will continue to find the need to apply complexity theory as wicked problems become more prevalent in the social sciences. This paper differentiates between general systems theory (GST) and complexity theory, as well as identifies advantages for the social sciences in incorporating complexity theory as a formal theory. Complexity theory is expanded upon and identified as providing a new perspective and a new method of theorizing that can be practiced by disciplines within the social sciences. These additions could better position the social sciences to address the complexity associated with advancing technology, globalization, intricate markets, cultural change, and the myriad of challenges and opportunities to come.
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Brocklehurst PR, Baker SR, Listl S, Peres MA, Tsakos G, Rycroft-Malone J. How Should We Evaluate and Use Evidence to Improve Population Oral Health? Dent Clin North Am 2019; 63:145-156. [PMID: 30447789 DOI: 10.1016/j.cden.2018.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Generating and implementing evidence-based policy is an important aim for many publicly funded health systems. In dentistry, this is based on the assumption that evidence-based health care increases the efficiency and effectiveness of interventions to improve oral health at a population level. This article argues that a linear logic model that links the generation of research evidence with its use is overly simplistic. It also challenges an uncritical interpretation of the evidence-based paradigm and explores approaches to the evaluation of complex interventions and how they can be embedded into policy and practice to improve oral health at a population level.
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Affiliation(s)
| | - Sarah R Baker
- The School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Stefan Listl
- Faculty of Medical Sciences, Radboud University, The Netherlands
| | - Marco A Peres
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College, 1-19 Torrington Place, London, UK
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Moore GF, Evans RE, Hawkins J, Littlecott H, Melendez-Torres G, Bonell C, Murphy S. From complex social interventions to interventions in complex social systems: Future directions and unresolved questions for intervention development and evaluation. EVALUATION (LONDON, ENGLAND : 1995) 2019; 25:23-45. [PMID: 30705608 PMCID: PMC6330692 DOI: 10.1177/1356389018803219] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Complex systems approaches to social intervention research are increasingly advocated. However, there have been few attempts to consider how models of intervention science, such as the UK's Medical Research Council complex interventions framework, might be reframed through a complex systems lens. This article identifies some key areas in which this framework might be reconceptualized, and a number of priority areas where further development is needed if alignment with a systems perspective is to be achieved. We argue that a complex systems perspective broadens the parameters of 'relevant' evidence and theory for intervention development, before discussing challenges in defining feasibility in dynamic terms. We argue that whole systems evaluations may be neither attainable, nor necessary; acknowledgment of complexity does not mean that evaluations must be complex, or investigate all facets of complexity. However, a systems lens may add value to evaluation design through guiding identification of key uncertainties, and informing decisions such as timings of follow-up assessments.
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Affiliation(s)
| | | | | | | | | | - Chris Bonell
- London School of Hygiene & Tropical Medicine, UK
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Femi-Ajao O. Intimate partner violence and abuse against Nigerian women resident in England, UK: a cross- sectional qualitative study. BMC WOMENS HEALTH 2018; 18:123. [PMID: 29986675 PMCID: PMC6038296 DOI: 10.1186/s12905-018-0610-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 06/20/2018] [Indexed: 11/10/2022]
Abstract
Background Intimate partner violence and abuse is a public health problem affecting more than one third of all women globally. It usually takes place between individuals in intimate relationships and/or within the family. In the United Kingdom (UK), while theoretical and policy interventions have led to an increase in intimate partner violence and abuse service provision for women, there is paucity of research on the disclosure and help-seeking practices of women from ethnic minority populations. Methods A cross-sectional qualitative research design was utilised. This included individual, in-depth semi-structured interviews with Nigerian women (n = 16) resident in England with lived experience of intimate partner violence and abuse. The interviews were conducted between May 2012 and May 2013, and data were analysed using thematic analysis technique. Results Three main themes were identified as factors influencing the disclosure and help-seeking practices of Nigerian (ethnic minority population) women in England, UK. These are socialisation from country of birth, immigration status, and acculturation in the country of immigration. Conclusions Nigerian (ethnic minority populations) women resident in England with lived experience of abuse are likely to seek help from leaders and members of their ethnic community groups and faith-based organisations. There is need for collaborative working with ethnic community groups and faith-based organisations to enhance access and facilitate the utilisation of existing intimate partner violence services.
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Affiliation(s)
- Omolade Femi-Ajao
- Division of Dentistry, School of Medical Sciences, The University of Manchester, JR Moore Building, Manchester, UK.
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Busnel C, Marjollet L, Perrier-Gros-Claude O. Complexité des prises en soins à domicile : développement d’un outil d’évaluation infirmier et résultat d’une étude d’acceptabilité. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.refiri.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rycroft-Malone J. From Linear to Complicated to Complex Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation". Int J Health Policy Manag 2018; 7:566-568. [PMID: 29935136 PMCID: PMC6015516 DOI: 10.15171/ijhpm.2018.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/09/2018] [Indexed: 11/10/2022] Open
Abstract
Attention to collaborative approaches to encouraging evidence use in healthcare practice are gaining traction. The inherent complexities in collaborative and networked approaches to knowledge translation (KT) have been embraced by Kitson and colleagues in their complexity network model. In this commentary, the potential of complexity as presented by Kitson et al within their model is considered. The utility of such a model will be contingent upon how easy users find it to understand and apply to their challenge, and doing so in a way that is useful to not only help with explanation, but also with prediction.
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Chandler J. The Paradox of Intervening in Complex Adaptive Systems Comment on "Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation". Int J Health Policy Manag 2018; 7:569-571. [PMID: 29935137 PMCID: PMC6015514 DOI: 10.15171/ijhpm.2018.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/13/2018] [Indexed: 11/30/2022] Open
Abstract
This commentary addresses two points raised by Kitson and colleagues’ article. First, increasing interest in applying the Complexity Theory lens in healthcare needs further systematic work to create some commonality between concepts used. Second, our need to adopt a better understanding of how these systems organise so we can change the systems overall behaviour, creates a paradox. We seek to manipulate systems that self-organise and follow their own internal rules. Although, our actions may impact and indeed meet some of our objectives, system behaviour will always emerge with unpredictable consequences. Likewise, outcomes at the aggregated level of the system never reaches an optimal point as defined by the ‘external controller.’ Kitson and colleagues’ theoretical model may struggle to resolve the paradox of gaining control over the multiple knowledge translation (KT) systems covered by the model, because theoretically these systems retain control under the principle of self-organisation. That is not to suggest that individual agents cannot influence system dynamics just that the desired outcome cannot be guaranteed. Indeed, for systems to change they will need strong incentives.
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Kitson A, Brook A, Harvey G, Jordan Z, Marshall R, O'Shea R, Wilson D. Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation. Int J Health Policy Manag 2018. [PMID: 29524952 PMCID: PMC5890068 DOI: 10.15171/ijhpm.2017.79] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Many representations of the movement of healthcare knowledge through society exist, and multiple models for the
translation of evidence into policy and practice have been articulated. Most are linear or cyclical and very few come close
to reflecting the dense and intricate relationships, systems and politics of organizations and the processes required to
enact sustainable improvements. We illustrate how using complexity and network concepts can better inform knowledge
translation (KT) and argue that changing the way we think and talk about KT could enhance the creation and movement
of knowledge throughout those systems needing to develop and utilise it. From our theoretical refinement, we propose
that KT is a complex network composed of five interdependent sub-networks, or clusters, of key processes (problem
identification [PI], knowledge creation [KC], knowledge synthesis [KS], implementation [I], and evaluation [E]) that
interact dynamically in different ways at different times across one or more sectors (community; health; government;
education; research for example). We call this the KT Complexity Network, defined as a network that optimises the
effective, appropriate and timely creation and movement of knowledge to those who need it in order to improve what
they do. Activation within and throughout any one of these processes and systems depends upon the agents promoting
the change, successfully working across and between multiple systems and clusters. The case is presented for moving to
a way of thinking about KT using complexity and network concepts. This extends the thinking that is developing around
integrated KT approaches. There are a number of policy and practice implications that need to be considered in light of
this shift in thinking.
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Affiliation(s)
- Alison Kitson
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Green Templeton College, University of Oxford, Oxford, UK
| | - Alan Brook
- Adelaide Dental School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Institute of Dentistry, Queen Mary University of London, London, UK
| | - Gill Harvey
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Zoe Jordan
- Faculty of Health and Medical Sciences, The Joanna Briggs Institute, University of Adelaide, Adelaide, SA, Australia
| | - Rhianon Marshall
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Rebekah O'Shea
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - David Wilson
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
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Horvat A, Filipovic J. Service quality and maturity of health care organizations through the lens of Complexity Leadership Theory. J Eval Clin Pract 2018; 24:301-307. [PMID: 28714561 DOI: 10.1111/jep.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES This research focuses on Complexity Leadership Theory and the relationship between leadership-examined through the lens of Complexity Leadership Theory-and organizational maturity as an indicator of the performance of health organizations. METHODS The research adopts a perspective that conceptualizes organizations as complex adaptive systems and draws upon a survey of opinion of 189 managers working in Serbian health organizations. RESULTS AND CONCLUSIONS As the results indicate a dependency between functions of leadership and levels of the maturity of health organizations, we propose a model that connects the two. The study broadens our understanding of the implications of complexity thinking and its reflection on leadership functions and overall organizational performance. The correlations between leadership functions and maturity could have practical applications in policy processing, thus improving the quality of outcomes and the overall level of service quality.
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Affiliation(s)
- Ana Horvat
- University of Belgrade, Faculty of Organizational Sciences, Belgrade, Serbia
| | - Jovan Filipovic
- University of Belgrade, Faculty of Organizational Sciences, Belgrade, Serbia
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Real K, Bardach SH, Bardach DR. The Role of the Built Environment: How Decentralized Nurse Stations Shape Communication, Patient Care Processes, and Patient Outcomes. HEALTH COMMUNICATION 2017; 32:1557-1570. [PMID: 27901600 DOI: 10.1080/10410236.2016.1239302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Increasingly, health communication scholars are attending to how hospital built environments shape communication, patient care processes, and patient outcomes. This multimethod study was conducted on two floors of a newly designed urban hospital. Nine focus groups interviews were conducted with 35 health care professionals from 10 provider groups. Seven of the groups were homogeneous by profession or level: nursing (three groups), nurse managers (two groups), and one group each of nurse care technicians ("techs") and physicians. Two mixed groups were comprised of staff from pharmacy, occupational therapy, patient care facilitators, physical therapy, social work, and pastoral care. Systematic qualitative analysis was conducted using a conceptual framework based on systems theory and prior health care design and communication research. Additionally, quantitative modeling was employed to assess walking distances in two different hospital designs. Results indicate nurses walked significantly more in the new hospital environment. Qualitative analysis revealed three insights developed in relationship to system structures, processes, and outcomes. First, decentralized nurse stations changed system interdependencies by reducing nurse-to-nurse interactions and teamwork while heightening nurse interdependencies and teamwork with other health care occupations. Second, many nursing-related processes remained centralized while nurse stations were decentralized, creating systems-based problems for nursing care. Third, nursing communities of practices were adversely affected by the new design. Implications of this study suggest that nurse station design shapes communication, patient care processes, and patient outcomes. Further, it is important to understand how the built environment, often treated as invisible in communication research, is crucial to understanding communication within complex health care systems.
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Affiliation(s)
- Kevin Real
- a Department of Communication , University of Kentucky
| | - Shoshana H Bardach
- b Graduate Center for Gerontology and Sanders-Brown Center on Aging , University of Kentucky
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Moore GF, Evans RE, Hawkins J, Littlecott HJ, Turley R. All interventions are complex, but some are more complex than others: using iCAT_SR to assess complexity. Cochrane Database Syst Rev 2017; 7:ED000122. [PMID: 28758680 PMCID: PMC10284250 DOI: 10.1002/14651858.ed000122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Graham F Moore
- Cardiff UniversityCentre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social SciencesUK
| | - Rhiannon E Evans
- Cardiff UniversityCentre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social SciencesUK
| | - Jemma Hawkins
- Cardiff UniversityCentre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social SciencesUK
| | - Hannah J Littlecott
- Cardiff UniversityCentre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social SciencesUK
| | - Ruth Turley
- Cardiff UniversityCentre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social SciencesUK
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Orlowski S, Lawn S, Matthews B, Venning A, Jones G, Winsall M, Antezana G, Bidargaddi N, Musiat P. People, processes, and systems: An observational study of the role of technology in rural youth mental health services. Int J Ment Health Nurs 2017; 26:259-272. [PMID: 27878940 DOI: 10.1111/inm.12262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 11/27/2022]
Abstract
The merits of technology-based mental health service reform have been widely debated among academics, practitioners, and policy makers. The design of new technologies must first be predicated on a detailed appreciation of how the mental health system works before it can be improved or changed through the introduction of new products and services. Further work is required to better understand the nature of face-to-face mental health work and to translate this knowledge to computer scientists and system designers responsible for creating technology-based solutions. Intensive observation of day-to-day work within two rural youth mental health services in South Australia, Australia, was undertaken to understand how technology could be designed and implemented to enhance young people's engagement with services and improve their experience of help seeking. Data were analysed through a lens of complexity theory. Results highlight the variety of professional roles and services that can comprise the mental health system. The level of interconnectedness evident in the system contrasted with high levels of service self-organization and disjointed information flow. A mental health professional's work was guided by two main constructs: risk and engagement. Most clients presented with a profile of disability, disadvantage, and isolation, so complex client presentations and decision-making were core practices. Clients (and frequently, their families) engaged with services in a crisis-dependent manner, characterized by multiple disengagements and re-engagements over time. While significant opportunities exist to integrate technology into existing youth mental health services, technologies for this space must be usable for a broad range of medical, psychological and cognitive disability, social disadvantage, and accommodate repeat cycles of engagement/disengagement over time.
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Affiliation(s)
- Simone Orlowski
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Ben Matthews
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Venning
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Gabrielle Jones
- Country and Outback Health, Port Augusta, South Australia, Australia
| | - Megan Winsall
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Gaston Antezana
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Niranjan Bidargaddi
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Peter Musiat
- Institute of Psychiatry, King's College London, London, UK
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Rycroft-Malone J, Gradinger F, Griffiths HO, Crane R, Gibson A, Mercer S, Anderson R, Kuyken W. Accessibility and implementation in the UK NHS services of an effective depression relapse prevention programme: learning from mindfulness-based cognitive therapy through a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05140] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BackgroundDepression affects as many as one in five people in their lifetime and often runs a recurrent lifetime course. Mindfulness-based cognitive therapy (MBCT) is an effective psychosocial approach that aims to help people at risk of depressive relapse to learn skills to stay well. However, there is an ‘implementation cliff’: access to those who could benefit from MBCT is variable and little is known about why that is the case, and how to promote sustainable implementation. As such, this study fills a gap in the literature about the implementation of MBCT.ObjectivesTo describe the existing provision of MBCT in the UK NHS, develop an understanding of the perceived costs and benefits of MBCT implementation, and explore the barriers and critical success factors for enhanced accessibility. We aimed to synthesise the evidence from multiple data sources to create an explanatory framework of the how and why of implementation, and to co-develop an implementation resource with key stakeholders.DesignA two-phase qualitative, exploratory and explanatory study, which was conceptually underpinned by the Promoting Action on Research Implementation in Health Services framework.SettingUK NHS services.MethodsPhase 1 involved interviews with participants from 40 areas across the UK about the current provision of MBCT. Phase 2 involved 10 case studies purposively sampled with differing degrees of MBCT provision, and from each UK country. Case study methods included interviews with key stakeholders, including commissioners, managers, MBCT practitioners and teachers, and service users. Observations were conducted and key documents were also collected. Data were analysed using a modified approach to framework analysis. Emerging findings were verified through stakeholder discussions and workshops.ResultsPhase 1: access to and the format of MBCT provision across the NHS remains variable. NHS services have typically adapted MBCT to their context and its integration into care pathways was also highly variable even within the same trust or health board. Participants’ accounts revealed stories of implementation journeys that were driven by committed individuals that were sometimes met by management commitment. Phase 2: a number of explanations emerged that explained successful implementation. Critically, facilitation was the central role of the MBCT implementers, who were self-designated individuals who ‘championed’ implementation, created networks and over time mobilised top-down organisational support. Our explanatory framework mapped out a prototypical implementation journey, often over many years. This involved implementers working through grassroots initiatives and over time mobilising top-down organisational support, and a continual fitting of evidence, with the MBCT intervention, contextual factors and the training/supervision of MBCT teachers. Key pivot points in the journey provided windows of challenge or opportunity.LimitationsThe findings are largely based on informants’ accounts and, therefore, are at risk of the bias of self-reporting.ConclusionsAlthough access to MBCT across the UK is improving, it remains very patchy. This study provides an explanatory framework that helps us understand what facilitates and supports sustainable MBCT implementation.Future workThe framework and stakeholder workshops are being used to develop online implementation guidance.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jo Rycroft-Malone
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Felix Gradinger
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Heledd O Griffiths
- Bangor Institute for Health & Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Rebecca Crane
- Centre for Mindfulness Research and Practice, School of Psychology, Bangor University, Bangor, UK
| | - Andy Gibson
- Health and Social Sciences, University of the West of England, Bristol, UK
| | - Stewart Mercer
- General Practice and Primary Care, Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rob Anderson
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
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Abstract
BACKGROUND Context is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice. DISCUSSION We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems. CONCLUSION Implementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of 'real world' contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants' discretion over resource mobilisation and actors' contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.
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Affiliation(s)
- Carl R May
- Faculty of Health Sciences, University of Southampton, Building 67 (Nightingale), University Road, Highfield, Southampton, SO17 1BJ, UK. .,University Hospital Southampton NHS Foundation Trust, Southampton, UK. .,NIHR CLAHRC Wessex, University of Southampton, Southampton, UK.
| | - Mark Johnson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Tracy Finch
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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38
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Abstract
BACKGROUND Context is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice. DISCUSSION We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems. CONCLUSION Implementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of 'real world' contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants' discretion over resource mobilisation and actors' contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.
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39
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Affiliation(s)
- Kate Young
- Principal Lecturer and Research Lead, Adult Nursing, University of Hertfordshire
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40
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Pierrat V, Coquelin A, Cuttini M, Khoshnood B, Glorieux I, Claris O, Durox M, Kaminski M, Ancel PY, Arnaud C. Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France-The EPIPAGE-2 Cohort Study. Pediatr Crit Care Med 2016; 17:957-967. [PMID: 27518584 PMCID: PMC5049969 DOI: 10.1097/pcc.0000000000000914] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice. DESIGN Prospective national cohort study of all births before 32 weeks of gestation. SETTING Twenty-five French regions. PARTICIPANTS All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p < 0.001). Individual factors associated with kangaroo care initiation were gestational age (odds ratio, 5.79; 95% CI, 4.49-7.48 for babies born at 27-31 wk compared with babies born at 23-26 wk) and, to a lesser extent, single pregnancy, birthweight above the 10th centile, and mother's employment before pregnancy. At unit level, policies and training in neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8-7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p < 0.0001). CONCLUSIONS Dissemination of neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies.
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Affiliation(s)
- Veronique Pierrat
- 1Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France.2Paris Descartes University, Paris, France.3CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France.4Research Unit of Perinatal Epidemiology, Pediatric Hospital Bambino Gesù, Rome, Italy.5Department of Neonatology, Toulouse University Hospital, Toulouse, France.6Department of Neonatology, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.7EAM 4128, Claude Bernard University Lyon 1,Villeurbanne, France.8Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France.9Inserm U 1027, Toulouse, France.10Paul-Sabatier University, Toulouse, France.11Purpan, Clinical epidemiology Unit, Toulouse, France
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