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Seruwagi G, English M, Djellouli N, Shawar Y, Mwaba K, Kuddus A, Kyamulabi A, Akter K, Nakidde C, Namakula H, Kinney M, Colbourn T. How to evaluate a multi-country implementation-focused network: Reflections from the Quality of Care Network (QCN) evaluation. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001897. [PMID: 39208232 PMCID: PMC11361611 DOI: 10.1371/journal.pgph.0001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/03/2024] [Indexed: 09/04/2024]
Abstract
Learning about how to evaluate implementation-focused networks is important as they become more commonly used. This research evaluated the emergence, legitimacy and effectiveness of a multi-country Quality of Care Network (QCN) aiming to improve maternal, newborn and child health (MNCH) outcomes. We examined the QCN global level, national and local level interfaces in four case study countries. This paper presents the evaluation team's reflections on this 3.5 year multi-country, multi-disciplinary project. Specifically, we examine our approach, methodological innovations, lessons learned and recommendations for conducting similar research. We used a reflective methodological approach to draw lessons on our practice while evaluating the QCN. A 'reflections' tool was developed to guide the process, which happened within a period of 2-4 weeks across the different countries. All country research teams held focused 'reflection' meetings to discuss questions in the tool before sharing responses with this paper's lead author. Similarly, the different lead authors of all eight QCN papers convened their writing teams to reflect on the process and share key highlights. These data were thematically analysed and are presented across key themes around the implementation experience including what went well, facilitators and critical methodological adaptations, what can be done better and recommendations for undertaking similar work. Success drivers included the team's global nature, spread across seven countries with members affiliated to nine institutions. It was multi-level in expertise and seniority and highly multidisciplinary including experts in medicine, policy and health systems, implementation research, behavioural sciences and MNCH. Country Advisory Boards provided technical oversight and support. Despite complexities, the team effectively implemented the QCN evaluation. Strong leadership, partnership, communication and coordination were key; as were balancing standardization with in-country adaptation, co-production, flattening hierarchies among study team members and the iterative nature of data collection. Methodological adaptations included leveraging technology which became essential during COVID-19, clear division of roles and responsibilities, and embedding capacity building as both an evaluation process and outcome, and optimizing technology use for team cohesion and quality outputs.
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Affiliation(s)
- Gloria Seruwagi
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - Mike English
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Nehla Djellouli
- Institute for Global Health, University College London, London, United Kingdom
| | - Yusra Shawar
- International Health, John Hopkins University, Baltimore, Maryland, United States of America
| | - Kasonde Mwaba
- Institute for Global Health, University College London, London, United Kingdom
| | - Abdul Kuddus
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Agnes Kyamulabi
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - Kohenour Akter
- International Health, John Hopkins University, Baltimore, Maryland, United States of America
| | - Catherine Nakidde
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Hilda Namakula
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Mary Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
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Tuangratananon T, Rajatanavin N, Khuntha S, Rittimanomai S, Asgari-Jirhandeh N, Tangcharoensathien V. Governance, policy, and health systems responses to the COVID-19 pandemic in Thailand: a qualitative study. Front Public Health 2024; 12:1250192. [PMID: 38584930 PMCID: PMC10996397 DOI: 10.3389/fpubh.2024.1250192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/12/2024] [Indexed: 04/09/2024] Open
Abstract
Background Since 2020, Thailand has experienced four waves of COVID-19. By 31 January 2022, there were 2.4 million cumulative cases and 22,176 deaths nationwide. This study assessed the governance and policy responses adapted to different sizes of the pandemic outbreaks and other challenges. Methods A qualitative study was applied, including literature reviews and in-depth interviews with 17 multi-sectoral actors purposively identified from those who were responsible for pandemic control and vaccine rollout. We applied deductive approaches using health systems building blocks, and inductive approaches using analysis of in-depth interview content, where key content formed sub-themes, and different sub-themes formed the themes of the study. Findings Three themes emerged from this study. First, the large scale of COVID-19 infections, especially the Delta strain in 2021, challenged the functioning of the health system's capacity to respond to cases and maintain essential health services. The Bangkok local government insufficiently performed due to its limited capacity, ineffective multi-sectoral collaboration, and high levels of vulnerability in the population. However, adequate financing, universal health coverage, and health workforce professionalism and commitment were key enabling factors that supported the health system. Second, the population's vulnerability exacerbated infection spread, and protracted political conflicts and political interference resulted in the politicization of pandemic control measures and vaccine roll-out; all were key barriers to effective pandemic control. Third, various innovations and adaptive capacities minimized the supply-side gaps, while social capital and civil society engagement boosted community resilience. Conclusion This study identifies key governance gaps including in public communication, managing infodemics, and inadequate coordination with Bangkok local government, and between public and private sectors on pandemic control and health service provisions. The Bangkok government had limited capacity in light of high levels of population vulnerability. These gaps were widened by political conflicts and interference. Key strengths are universal health coverage with full funding support, and health workforce commitment, innovations, and capacity to adapt interventions to the unfolding emergency. Existing social capital and civil society action increases community resilience and minimizes negative impacts on the population.
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Affiliation(s)
| | | | - Sarayuth Khuntha
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Salisa Rittimanomai
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
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van Rensburg AJ, Petersen I, Awotiwon A, Bachmann MO, Curran R, Murdoch J, Ras CJ, Fairall L. Applying learning health systems thinking in codeveloping integrated tuberculosis interventions in the contexts of COVID-19. BMJ Glob Health 2022; 7:e009567. [PMID: 36316026 PMCID: PMC9627575 DOI: 10.1136/bmjgh-2022-009567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 pandemic reversed much of global progress made in combatting tuberculosis, with South Africa experiencing one of the largest impacts on tuberculosis detection. The aim of this paper is to share our experiences in applying learning health systems (LHS) thinking to the codevelopment of an intervention improving an integrated response to COVID-19 and tuberculosis in a South African district. A sequential partially mixed-methods study was undertaken between 2018 and 2021 in the district of Amajuba in KwaZulu-Natal. Here, we report on the formulation of a Theory of Change, codesigning and refining proposed interventions, and piloting and evaluating codesigned interventions in primary healthcare facilities, through an LHS lens. Following the establishment and formalisation of a district Learning Community, diagnostic work and a codevelopment of a theory of change, intervention packages tailored according to pandemic lockdowns were developed, piloted and scaled up. This process illustrates how a community of learning can generate more responsive, localised interventions, and suggests that the establishment of a shared space of research governance can provide a degree of resilience to facilitate adaption to external shocks. Four main lessons have been gleaned from our experience in adopting an LHS approach in a South African district, which are (1) the importance of building and sustaining relationships, (2) the utility of colearning, coproduction and adaptive capacity, (3) the centrality of theory-driven systems strengthening and (4) reflections on LHS as a framework.
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Affiliation(s)
- André Janse van Rensburg
- Centre for Rural Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
- Centre for Health Systems Research & Development, University of the Free State Faculty of Humanities, Bloemfontein, South Africa
| | - Inge Petersen
- Centre for Rural Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
- Institute of Global Health, University College London, London, UK
| | - Ajibola Awotiwon
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Max Oscar Bachmann
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | - Robyn Curran
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Jamie Murdoch
- School of Life Course and Population Sciences, King's College, London, UK
| | - Christy Joy Ras
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
- King's Global Health Institute, King's College, London, UK
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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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Siu E, Chaloupka FJ, Drope J, Dorokhina M. Achieving policy impact on tobacco economics research: experiences and lessons learnt. Tob Control 2022; 31:tobaccocontrol-2021-056923. [PMID: 35803673 DOI: 10.1136/tobaccocontrol-2021-056923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Erika Siu
- Institute for Health Research and Policy, University of Illinois, Chicago, Illinois, USA
| | - Frank J Chaloupka
- Institute for Health Research and Policy, University of Illinois, Chicago, Illinois, USA
| | - Jeffrey Drope
- Institute for Health Research and Policy, University of Illinois, Chicago, Illinois, USA
| | - Margaret Dorokhina
- Institute for Health Research and Policy, University of Illinois, Chicago, Illinois, USA
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Griewing S, Wagner U, Lingenfelder M, Fischer R, Kalder M. Chronological development of in-patient oncology in times of COVID-19: a retrospective analysis of hospitalized oncology and COVID-19 patients of a German University Hospital. J Cancer Res Clin Oncol 2022; 149:2551-2558. [PMID: 35771262 PMCID: PMC9244885 DOI: 10.1007/s00432-022-04044-8] [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: 04/04/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
Abstract
Purpose The goal of this study is to examine the chronological development of hospitalized oncology and COVID-19 patients, and compare effects on oncology sub-disciplines for pre-pandemic (2017–19) and pandemic (2020–21) years in the setting of a German university maximum care provider. Methods Data were retrospectively retrieved from the hospital performance controlling system for patient collectives with oncological main (nOnco) and COVID-19 secondary diagnosis (nCOVID-19). Data analysis is based on descriptive statistical assessment. Results The oncology patient collective (nOnco = 27,919) shows a decrease of hospitalized patients for the whole pandemic (− 4% for 2020 and − 2,5% for 2021 to 2019). The number of hospitalized COVID-19 patients increases from first to second pandemic year by + 106.71% (nCOVID-19 = 868). Maximum decline in monthly hospitalized oncology patients amounts to − 19% (May 2020) during the first and − 21% (December 2020) during the second lockdown. Relative monthly hospitalization levels of oncology patients reverted to pre-pandemic levels from February 2021 onwards. Conclusion The results confirm a decline in hospitalized oncology patients for the entire pandemic in the setting of a maximum care provider. Imposed lockdown and contact restrictions, rising COVID-19 case numbers, as well as discovery of new virus variants have a negative impact on hospitalized treated oncological patients.
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Affiliation(s)
- Sebastian Griewing
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany. .,Chair of General Business Administration, Institute for Health Care Management e.V., Philipps-University Marburg, Universitätsstraße 24, 35037, Marburg, Germany.
| | - Uwe Wagner
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Michael Lingenfelder
- Chair of General Business Administration, Institute for Health Care Management e.V., Philipps-University Marburg, Universitätsstraße 24, 35037, Marburg, Germany
| | - Rebecca Fischer
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
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Listl S, Lavis JN, Cohen LK, Mathur MR. Engaging citizens to improve service provision for oral health. Bull World Health Organ 2022; 100:294-294A. [PMID: 35521040 PMCID: PMC9047427 DOI: 10.2471/blt.22.287944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Stefan Listl
- Department of Dentistry, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX Nijmegen, Netherlands
| | - John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, Canada
| | - Lois K Cohen
- Paul G. Rogers Society for Global Health Research, Bethesda, United States of America
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Lyu B, Li W, Xu M, Chen H, Yang Y. All Normal Occupations are Sunny and Joyful: Qualitative Analysis of Thai Ladyboys' Occupational Wellbeing. Psychol Res Behav Manag 2022; 14:2197-2208. [PMID: 35002338 PMCID: PMC8722689 DOI: 10.2147/prbm.s340209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background As the modern social division of labour is becoming increasingly specified, various occupations have emerged. Ladyboy, as a special occupation, is receiving a surging amount of attention from society and academia. Ladyboy is an individual who is engaged in performing with female psychology but still retains male sexual characteristics, and this special characteristic has an impact on their occupational identity and occupational satisfaction. Methods This study investigated the current situation of ladyboys’ occupational wellbeing through interviews, and analyzed and coded the interview texts via Nvivo 11.0 guided by Grounded Theory. Results Through open coding, axial coding, and selective coding, the study found that ladyboys’ occupational wellbeing was generally high, and they were still full of love and confidence in their occupation even in the context of the COVID-19 epidemic. Conclusion Concurrently, the study also found that for the profession of ladyboy, there are still many areas for improvement in society, such as the lack of supporting facilities, absence of supportive and protective policies, and unemployment livelihood security, etc. Feasible measures were then proposed for these specific problems.
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Affiliation(s)
- Bei Lyu
- School of Economics and Management, Huaibei Normal University, Huaibei, 235000, People's Republic of China.,Chinese Graduate School, Panyapiwat Institute of Management, Nonthaburi, 11120, Thailand
| | - Wenwen Li
- School of Economics and Management, Huaibei Normal University, Huaibei, 235000, People's Republic of China
| | - Mingyu Xu
- School of Economics and Management, Huaibei Normal University, Huaibei, 235000, People's Republic of China
| | - Hui Chen
- Chinese Graduate School, Panyapiwat Institute of Management, Nonthaburi, 11120, Thailand.,School of Management, Suzhou University, Suzhou, 234000, People's Republic of China
| | - Yanchao Yang
- Faculty of Education, University of Macau, Macau, 999078, People's Republic of China
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Political economy analysis of universal health coverage and health financing reforms in low- and middle-income countries: the role of stakeholder engagement in the research process. Health Res Policy Syst 2021; 19:143. [PMID: 34895251 PMCID: PMC8665578 DOI: 10.1186/s12961-021-00788-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Progress towards universal health coverage (UHC) is an inherently political process. Political economy analysis (PEA) is gaining momentum as a tool to better understand the role of the political and economic dimensions in shaping and achieving UHC in different contexts. Despite the acknowledged importance of actors and stakeholders in political economy considerations, their role in the PEA research process beyond “study subjects” as potential cocreators of knowledge and knowledge users has been overlooked so far. We therefore aimed to review the approaches with reference to stakeholder engagement during the research process adopted in the current published research on the political economy of UHC and health financing reforms, and the factors favouring (or hindering) uptake and usability of PEA work. Methods We reviewed the literature to describe whether, when and how stakeholders were involved in the research process of studies looking at the political economy of UHC and health financing reforms, and to identify challenges and lessons learned on effective stakeholder engagement and research uptake. We used a standardized search strategy with key terms across several databases; we screened and included articles that focused on PEA and UHC. Additionally, we conducted a short survey of the authors of the included studies to complement the information retrieved. Results Fifty articles met the inclusion criteria and were included in the analysis. We found overall little evidence of systematic engagement of stakeholders in the research process, which focused mostly on the data collection phase of the research (i.e., key informant interviews). Our study identifies some reasons for the varying stakeholder engagement. Challenges include PEA requiring specific skills, a focus on sensitive issues, and the blurriness in researchers’ and stakeholders’ roles and the multiple roles of stakeholders as research participants, study subjects and research users. Among the approaches that might favour usability of PEA work, we identified early engagement, coproduction of research questions, local partners and personal contact, political willingness, and trust and use of prospective analysis. Conclusions Stakeholder engagement and research uptake are multifaceted concepts and complex processes, particularly when applied to PEA. As such, stakeholder engagement in the research process of PEA of UHC and health financing reforms is limited and underreported. Despite the challenges, however, stakeholder engagement remains key to ensuring relevance, usability and research uptake of PEA studies. More efforts are required to ensure engagement at different stages of the research process and better reporting in published articles.
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Affiliation(s)
- S Redman
- Sax Institute, Sydney, Australia
| | | | - L Adedokun
- Doris Duke Charitable Foundation, New York, USA
| | - S Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Warwick UK
| | - S Denegri
- Academy of Medical Sciences, London, UK
| | - on behalf of the Co-production of Knowledge Collection Steering Committee
- Sax Institute, Sydney, Australia
- University of Oxford, Oxford, UK
- Doris Duke Charitable Foundation, New York, USA
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Warwick UK
- Academy of Medical Sciences, London, UK
- Correspondence to: S Redman
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