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Keel T, Machaczek K, King JA, Breen K, Stubbs B, Kinnafick F. Physical activity interventions for inpatients in secure mental health settings: what works, for whom, in what circumstances and why? A protocol for a realist synthesis. BMJ Open 2023; 13:e073453. [PMID: 37890973 PMCID: PMC10619065 DOI: 10.1136/bmjopen-2023-073453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION The physical health of individuals with severe mental illness (SMI) is a cause for concern. While the purpose of inpatient mental health settings is rehabilitation and treatment, the physical health of hospitalised patients commonly deteriorates. Physical activity (PA) has been identified as an appropriate intervention to help improve the psychological and physical health of inpatients. We aim to address the gaps in the current literature by exploring how, why, for whom and in what contexts PA interventions help patients with SMI, who receive inpatient treatment, to increase their PA engagement. METHODS AND ANALYSIS Realist synthesis: Six steps will be followed: (1) identification of the review question and scope of the review; (2) searching for evidence; (3) screening and appraisal; (4) extraction of data; (5) synthesis of the data and (6) dissemination. Five databases will be searched: Web of Science, PubMed, PsycINFO, PsychArticles and EmBase. A total of 10-15 stakeholders made up of academics and people living with SMI, sport and exercise therapists, psychiatrists, physiotherapists of low, medium and highly secure inpatient settings, will form an expert advisory group. They will provide their insight and knowledge of the secure setting contexts and perceived principles of how PA initiatives being undertaken in their hospitals for patients with SMI work, or not. The results will be published in accordance with the Realist And Meta-narrative Evidence Syntheses-Evolving Standards publication standards. ETHICS AND DISSEMINATION Ethical approval has been granted. The review will produce context-specific guidance for Clinical Commissioning Groups and practitioners on how to optimise the provision of PA interventions for people with SMI in inpatient settings.
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Affiliation(s)
- Toby Keel
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Katarzyna Machaczek
- Centre for Applied Health & Social Care Research (CARe), Sheffield Hallam University, Sheffield, UK
| | - James A King
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | | | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Florence Kinnafick
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough, UK
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Steiner A, Calò F, Shucksmith M. Rurality and social innovation processes and outcomes: A realist evaluation of rural social enterprise activities. JOURNAL OF RURAL STUDIES 2023; 99:284-292. [PMID: 37089783 PMCID: PMC10116647 DOI: 10.1016/j.jrurstud.2021.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/29/2021] [Indexed: 05/03/2023]
Abstract
Although increasingly prominent in research, policy and practice, little is known about social innovation in a rural context. To address this knowledge gap, our paper explores how rurality might affect the social innovation process. Drawing on 68 interviews carried out with beneficiaries, service providers and external stakeholders of a rural social enterprise initiative in Scotland, the paper adopts a realist evaluation theory (Pawson and Tilley, 1997) approach combined with Calò et al.'s (2019) social innovation analytical framework to identify Context-Mechanism-Outcome configurations for rural social innovation. The findings highlight that specific characteristics of rural places can act as stimuli of social innovation. Positive outcomes of a social innovation can potentially be rooted in rural peculiarity and its problematic context. Push factors, born out of necessity, lead to reactive social innovation and pull factors, derived through harnessing perceived opportunities in the environment, lead to proactive social innovation. Importantly, push factors do not undermine the establishment of social innovation - indeed, they can actually promote social innovation and strengthen its validity. The paper also shows that outcomes of the social innovation process might not be specific to rural areas. Instead, the pathway to the desired outcomes is conditioned by rural factors, shaping the contexts and mechanisms of rural social innovation. As different rural locations might have different resources to address local challenges, social innovation processes vary from one case to another, although the challenges being addressed might be similar. As such, rural social innovation policies should not be 'over prescribed'. Context creates both challenges and solutions and influences the type and form of mechanisms used to achieve a desirable social innovation outcome.
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Affiliation(s)
- Artur Steiner
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, M201 George Moore Building, Cowcaddens Road, Glasgow, G4 0BA, UK
- Corresponding author.
| | - Francesca Calò
- Public Leadership and Social Enterprise, Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
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3
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Affiliation(s)
- Kathryn Jack
- Surgical Division, Nottingham University Hospitals NHS Trust, Nottingham, UK
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4
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Weston L, Rybczynska-Bunt S, Quinn C, Lennox C, Maguire M, Pearson M, Stirzaker A, Durcan G, Stevenson C, Graham J, Carroll L, Greer R, Haddad M, Hunter R, Anderson R, Todd R, Goodier S, Brand S, Michie S, Kirkpatrick T, Leonard S, Harris T, Henley W, Shaw J, Owens C, Byng R. Interrogating intervention delivery and participants' emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager. PLoS One 2022; 17:e0270691. [PMID: 35834470 PMCID: PMC9282559 DOI: 10.1371/journal.pone.0270691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background ‘Engager’ is an innovative ‘through-the-gate’ complex care intervention for male prison-leavers with common mental health problems. In parallel to the randomised-controlled trial of Engager (Trial registration number: ISRCTN11707331), a set of process evaluation analyses were undertaken. This paper reports on the depth multiple case study analysis part of the process evaluation, exploring how a sub-sample of prison-leavers engaged and responded to the intervention offer of one-to-one support during their re-integration into the community. Methods To understand intervention delivery and what response it elicited in individuals, we used a realist-informed qualitative multiple ‘case’ studies approach. We scrutinised how intervention component delivery lead to outcomes by examining underlying causal pathways or ‘mechanisms’ that promoted or hindered progress towards personal outcomes. ‘Cases’ (n = 24) were prison-leavers from the intervention arm of the trial. We collected practitioner activity logs and conducted semi-structured interviews with prison-leavers and Engager/other service practitioners. We mapped data for each case against the intervention logic model and then used Bhaskar’s (2016) ‘DREIC’ analytic process to categorise cases according to extent of intervention delivery, outcomes evidenced, and contributing factors behind engagement or disengagement and progress achieved. Results There were variations in the dose and session focus of the intervention delivery, and how different participants responded. Participants sustaining long-term engagement and sustained change reached a state of ‘crises but coping’. We found evidence that several components of the intervention were key to achieving this: trusting relationships, therapeutic work delivered well and over time; and an in-depth shared understanding of needs, concerns, and goals between the practitioner and participants. Those who disengaged were in one of the following states: ‘Crises and chaos’, ‘Resigned acceptance’, ‘Honeymoon’ or ‘Wilful withdrawal’. Conclusions We demonstrate that the ‘implementability’ of an intervention can be explained by examining the delivery of core intervention components in relation to the responses elicited in the participants. Core delivery mechanisms often had to be ‘triggered’ numerous times to produce sustained change. The improvements achieved, sustained, and valued by participants were not always reflected in the quantitative measures recorded in the RCT. The compatibility between the practitioner, participant and setting were continually at risk of being undermined by implementation failure as well as changing external circumstances and participants’ own weaknesses. Trial registration number ISRCTN11707331, Wales Research Ethics Committee, Registered 02-04-2016—Retrospectively registered https://doi.org/10.1186/ISRCTN11707331.
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Affiliation(s)
- Lauren Weston
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
- * E-mail:
| | - Sarah Rybczynska-Bunt
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Cath Quinn
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Charlotte Lennox
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Mike Maguire
- Department of Criminology, University of South Wales, Cardiff, United Kingdom
| | - Mark Pearson
- Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Alex Stirzaker
- South West Mental Health Clinical Network, Taunton, United Kingdom
| | | | - Caroline Stevenson
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jonathan Graham
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Lauren Carroll
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Rebecca Greer
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Mark Haddad
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Rachael Hunter
- Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Rob Anderson
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Roxanne Todd
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sara Goodier
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sarah Brand
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Susan Michie
- Division of Psychology and Language Sciences, Research Department of Clinical, Educational and Health Psychology, Kings College London, London, United Kingdom
| | - Tim Kirkpatrick
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Sarah Leonard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Tirril Harris
- Division of Psychology and Language Sciences, Research Department of Clinical, Educational and Health Psychology, Kings College London, London, United Kingdom
| | - William Henley
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Jenny Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Christabel Owens
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Richard Byng
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
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Reddington M, Baxter S, Walters SJ. A qualitative exploration of patient experiences of medication for sciatica. Musculoskelet Sci Pract 2021; 55:102419. [PMID: 34186473 DOI: 10.1016/j.msksp.2021.102419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sciatica is often a painful and disabling condition, with medication routinely the first line of management. It is important to describe patients experiences of taking medication for sciatica, the reasons for commencing and reasons for cessation, the effects of the medication in symptom management and any other potential positive or deleterious effects. OBJECTIVES To describe patient experiences of medication for the relief of symptoms of sciatica. STUDY DESIGN Qualitative analysis of data from a mixed-methods randomised controlled pilot study. METHODS A total of 46 semi-structured interviews were conducted with 33 consenting participants (19 female) recruited from 14 GP practices. A purposive sampling strategy ensured a range of age, severity of pain and disability. Interviews were recorded and transcribed verbatim prior to thematic analysis, which aimed to identify the important, interesting or divergent views within the data. FINDINGS Participant experiences of pain were often severe with significant disability and fear. The use of a combination of medications was common, including the use of opioids and other medication inconsistent with national (NICE) guidance. Most participants found medication ineffective and reported significant side-effects, often necessitating cessation of the drugs or the use of alternatives. Despite the regularity of participants stopping all medication for sciatica, their pain levels still significantly eased over the 6-month period of the study. CONCLUSIONS The study highlighted a lack of perceived effectiveness for prescribed medication, often with concomitant side-effects. Clinicians should be cognisant of the fears that patients hold in terms of the cause and severity of sciatica, as well as fears of prescribed medication.
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Affiliation(s)
- Michael Reddington
- Therapy Services Outpatient Department Northern General Hospital Herries Road Sheffield, S5 7AU, UK.
| | - Susan Baxter
- Section of Public Health ScHARR, University of Sheffield 30 Regents Court Sheffield, S1 4DA, UK.
| | - Stephen J Walters
- Designs, Trials and Statistics, ScHARR, University of Sheffield, 30 Regents Court, Sheffield, S1 4DA, UK.
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Rotteau L, Albert M, Bhattacharyya O, Berta W, Webster F. When all else fails: The (mis)use of qualitative research in the evaluation of complex interventions. J Eval Clin Pract 2021; 27:264-271. [PMID: 32424993 DOI: 10.1111/jep.13396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 11/29/2022]
Abstract
RATIONAL, AIMS, AND OBJECTIVES Qualitative research has been promoted as an important component of the evaluation of complex interventions to support the scale up and spread of health service interventions, but is currently not being maximized in practice. We aim to identify and explore the sociocultural and structural factors that impact the uses (and misuses) of qualitative research in the evaluation of complex health services interventions. METHODS We conducted a qualitative analysis of data collected in a multiple case study of the evaluation and scale up and spread of three health service intervention. RESULTS Our findings demonstrate the challenges of meaningfully integrating qualitative research in evaluation programmes lead by clinicians with limited qualitative expertise and operating within an environment dominated by biomedical research, even with methodological support. CONCLUSIONS Based on these findings we encourage ongoing engagement of qualitative researchers in evaluation programmes to begin to refine our methodological understanding, while also suggesting changes to medical education and evaluation funding models to create fertile environments for interdisciplinary collaborations.
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Affiliation(s)
- Leahora Rotteau
- Institute for Healthcare Policy, Measurement and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mathieu Albert
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Onil Bhattacharyya
- Institute for Healthcare Policy, Measurement and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada.,Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Whitney Berta
- Institute for Healthcare Policy, Measurement and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fiona Webster
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
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Augustsson H, Churruca K, Braithwaite J. Change and improvement 50 years in the making: a scoping review of the use of soft systems methodology in healthcare. BMC Health Serv Res 2020; 20:1063. [PMID: 33228657 PMCID: PMC7684911 DOI: 10.1186/s12913-020-05929-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Improving the quality of healthcare has proven to be a challenging task despite longstanding efforts. Approaches to improvements that consider the strong influence of local context as well as stakeholders’ differing views on the situation are warranted. Soft systems methodology (SSM) includes contextual and multi-perspectival features. However, the way SSM has been applied and the outcomes of using SSM to stimulate productive change in healthcare have not been sufficiently investigated. Aim This scoping review aimed to examine and map the use and outcomes of SSM in healthcare settings. Method The review was based on Arksey and O’Malley’s framework. We searched six academic databases to January 2019 for peer-reviewed journal articles in English. We also reviewed reference lists of included citations. Articles were included if they were empirical studies focused on the application of SSM in a healthcare setting. Two reviewers conducted the abstract review and one reviewer conducted the full-text review and extracted data on study characteristics, ways of applying SSM and the outcomes of SSM initiatives. Study quality was assessed using Hawker’s Quality Assessment Tool. Result A total of 49 studies were included in the final review. SSM had been used in a range of healthcare settings and for a variety of problem situations. The results revealed an inconsistent use of SSM including departing from Checkland’s original vision, applying different tools and involving stakeholders idiosyncratically. The quality of included studies varied and reporting of how SSM had been applied was sometimes inadequate. SSM had most often been used to understand a problem situation and to suggest potential improvements to the situation but to a lesser extent to implement and evaluate these improvements. Conclusion SSM is flexible and applicable to a range of problem situations in healthcare settings. However, better reporting of how SSM has been applied as well as evaluation of different types of outcomes, including implementation and intervention outcomes, is needed in order to appreciate more fully the utility and contribution of SSM in healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05929-5.
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Affiliation(s)
- Hanna Augustsson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia. .,Procome research group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
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Bugge C, Kearney R, Dembinsky M, Khunda A, Graham M, Agur W, Breeman S, Dwyer L, Elders A, Forrest M, Goodman K, Guerrero K, Hemming C, Mason H, McClurg D, Melone L, Norrie J, Thakar R, Hagen S. The TOPSY pessary self-management intervention for pelvic organ prolapse: a study protocol for the process evaluation. Trials 2020; 21:836. [PMID: 33032651 PMCID: PMC7542744 DOI: 10.1186/s13063-020-04729-w] [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] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 09/08/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Process evaluations have become a valued component, alongside clinical trials, of the wider evaluation of complex health interventions. They support understanding of implementation, and fidelity, related to the intervention and provide valuable insights into what is effective in a practical setting by examining the context in which interventions are implemented. The TOPSY study consists of a large multi-centre randomised controlled trial comparing the effectiveness of pessary self-management with clinic-based care in improving women's condition-specific quality of life, and a nested process evaluation. The process evaluation aims to examine and maximise recruitment to the trial, describe intervention fidelity and explore participants' and healthcare professionals' experiences. METHODS The trial will recruit 330 women from approximately 17 UK centres. The process evaluation uses a mixed-methods approach. Semi-structured interviews will be conducted with randomised women (18 per randomised group/n = 36), women who declined trial participation but agreed to interview (non-randomised women) (n = 20) and healthcare professionals recruiting to the trial (n ~ 17) and delivering self-management and clinic-based care (n ~ 17). The six internal pilot centres will be asked to record two to three recruitment discussions each (total n = 12-18). All participating centres will be asked to record one or two self-management teaching appointments (n = 30) and self-management 2-week follow-up telephone calls (n = 30). Process data (quantitative and qualitative) will be gathered in participant completed trial questionnaires. Interviews will be analysed thematically and recordings using an analytic grid to identify fidelity to the intervention. Quantitative analysis will be predefined within the process evaluation analysis plan. DISCUSSION The wide variety of pessary care delivered across the UK for women with pelvic organ prolapse presents specific localised contexts in which the TOPSY interventions will be implemented. Understanding this contextual variance is central to understanding how and in what circumstances pessary self-management can be implemented (should it be effective). The inclusion of non-randomised women provides an innovative way of collecting indispensable information about eligible women who decline trial participation, allowing broader contextualisation and considerations of generalisability of trial findings. Methodological insights from examination of recruitment processes and mechanisms have the potential to inform recruitment mechanisms and future recruitment strategies and study designs. TRIAL REGISTRATION ISRCTN62510577 . Registered on 6 October 2017.
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Affiliation(s)
- Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK.
| | - Rohna Kearney
- The Warrell Unit, St. Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Faculty of Biology Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Melanie Dembinsky
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Aethele Khunda
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
| | - Margaret Graham
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Wael Agur
- NHS Ayrshire & Arran, Crosshouse Hospital, School of Medicine, Dentistry & Nursing, University of Glasgow, Kilmarnock, UK
| | - Suzanne Breeman
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - Lucy Dwyer
- The Warrell Unit, St. Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Mark Forrest
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - Kirsteen Goodman
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Karen Guerrero
- Department of Urogynaecology, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Christine Hemming
- Grampian University Hospitals NHS Trust, Aberdeen Maternity Hospital & Aberdeen Royal Infirmary, Aberdeen, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Lynn Melone
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - John Norrie
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Ranee Thakar
- Croydon Health Services NHS Trust, Croydon University Hospital, Croydon, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Morden A, Ong BN, Jinks C, Healey E, Finney A, Dziedzic KS. Resistance or appropriation? : Uptake of exercise after a nurse-led intervention to promote self-management for osteoarthritis. Health (London) 2020; 26:221-243. [PMID: 32486866 PMCID: PMC8928233 DOI: 10.1177/1363459320925879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The philosophical underpinning of trials of complex interventions is critiqued for not taking into account causal mechanisms that influence potential outcomes. In this article, we draw from in-depth interviews (with practice nurses and patients) and observations of practice meetings and consultations to investigate the outcomes of a complex intervention to promote self-management (in particular exercise) for osteoarthritis in primary care settings. We argue that nurses interpreted the intervention as underpinned by the need to educate rather than work with patients, and, drawing from Habermasian theory, we argue that expert medicalised knowledge (system) clashed with lay ‘lifeworld’ prerogatives in an uneven communicative arena (the consultation). In turn, the advice and instructions given to patients were not always commensurate with their ‘lifeworld’. Consequently, patients struggled to embed exercise routines into their daily lives for reasons of unsuitable locality, sense-making that ‘home’ was an inappropriate place to exercise and using embodied knowledge to test the efficacy of exercise on pain. We conclude by arguing that using Habermasian theory helped to understand reasons why the trial failed to increase exercise levels. Our findings suggest that communication styles influence the outcomes of self-management interventions, reinforce the utility of theoretically informed qualitative research embedded within trials to improve conduct and outcomes and indicate incorporating perspectives from human geography can enhance Habermas-informed research and theorising.
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Rotteau L, Albert M, Bhattacharyya O, Berta W, Webster F. Understanding decisions to scale up: a qualitative case study of three health service intervention evaluations. J Health Serv Res Policy 2020; 26:37-45. [PMID: 32380915 DOI: 10.1177/1355819620921892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Efforts to scale up evidence-based health care interventions are seen as a key strategy to address complex health system challenges. However, scale-up efforts have shown significant variability. We address the gap between scale-up theory and practice by exploring the socio-cultural factors at play in the evaluation and scale-up of three interventions within the clinical field. METHODS A qualitative multiple case study was conducted to characterize the evaluation and scale-up efforts of three interventions. We interviewed 18 participants, including clinicians and researchers across the three cases. Using Pierre Bourdieu's concepts of field and capital as a theoretical lens, we conducted a thematic analysis of the data. RESULTS Despite the espoused goals of ensuring that health service interventions are always based on high-quality evidence within the clinical field, this study demonstrates that the outcomes of the evaluations are not the only factor in the decision to engage in scale-up efforts. Important socio-cultural factors also come into play. Bourdieu uses the term capital to refer to the resources that agents compete for and with their acquisition, accumulate power and/or social standing. The type of evidence valued in the clinical field and the ability to leverage capital in demonstrating that value are also important factors. CONCLUSIONS Determining if an intervention is effective and should be scaled up is more complex in practice than described in the literature. Efforts are needed to explicitly include the role of social processes in the current frameworks guiding scaling-up efforts.
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Affiliation(s)
- Leahora Rotteau
- PhD Candidate, Institute for Healthcare Policy, Measurement and Evaluation, University of Toronto, Canada
| | - Mathieu Albert
- Scientist, The Wilson Centre, University of Toronto, Canada
- Associate Professor, Department of Psychiatry, University of Toronto, Canada
| | - Onil Bhattacharyya
- Frigon-Blau Chair in Family Medicine Research, Women's College Hospital, Canada
- Associate Professor and Clinician Scientist, Family and Community Medicine, University of Toronto, Canada
- Associate Professor, Institute for Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Whitney Berta
- Professor, Institute for Healthcare Policy, Measurement and Evaluation, University of Toronto, Canada
| | - Fiona Webster
- Associate Professor, Arthur Labatt Family School of Nursing, University of Western Ontario, Canada
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Jeffries M, Gude WT, Keers RN, Phipps DL, Williams R, Kontopantelis E, Brown B, Avery AJ, Peek N, Ashcroft DM. Understanding the utilisation of a novel interactive electronic medication safety dashboard in general practice: a mixed methods study. BMC Med Inform Decis Mak 2020; 20:69. [PMID: 32303219 PMCID: PMC7164282 DOI: 10.1186/s12911-020-1084-5] [Citation(s) in RCA: 8] [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: 02/01/2019] [Accepted: 03/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving medication safety is a major concern in primary care settings worldwide. The Salford Medication safety dASHboard (SMASH) intervention provided general practices in Salford (Greater Manchester, UK) with feedback on their safe prescribing and monitoring of medications through an online dashboard, and input from practice-based trained clinical pharmacists. In this study we explored how staff working in general practices used the SMASH dashboard to improve medication safety, through interactions with the dashboard to identify potential medication safety hazards and their workflow to resolve identified hazards. METHODS We used a mixed-methods study design involving quantitative data from dashboard user interaction logs from 43 general practices during the first year of receiving the SMASH intervention, and qualitative data from semi-structured interviews with 22 pharmacists and physicians from 18 practices in Salford. RESULTS Practices interacted with the dashboard a median of 12.0 (interquartile range, 5.0-15.2) times per month during the first quarter of use to identify and resolve potential medication safety hazards, typically starting with the most prevalent hazards or those they perceived to be most serious. Having observed a potential hazard, pharmacists and practice staff worked together to resolve that in a sequence of steps (1) verifying the dashboard information, (2) reviewing the patient's clinical records, and (3) deciding potential changes to the patient's medicines. Over time, dashboard use transitioned towards regular but less frequent (median of 5.5 [3.5-7.9] times per month) checks to identify and resolve new cases. The frequency of dashboard use was higher in practices with a larger number of at-risk patients. In 24 (56%) practices only pharmacists used the dashboard; in 12 (28%) use by other practice staff increased as pharmacist use declined after the initial intervention period; and in 7 (16%) there was mixed use by both pharmacists and practice staff over time. CONCLUSIONS An online medication safety dashboard enabled pharmacists to identify patients at risk of potentially hazardous prescribing. They subsequently worked with GPs to resolve risks on a case-by-case basis, but there were marked variations in processes between some practices. Workload diminished over time as it shifted towards resolving new cases of hazardous prescribing.
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Affiliation(s)
- Mark Jeffries
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Wouter T. Gude
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Richard N. Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Denham L. Phipps
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Richard Williams
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Health eResearch Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Benjamin Brown
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Health eResearch Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Anthony J. Avery
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Niels Peek
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Health eResearch Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
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Spacey A, Scammell J, Board M, Porter S. Systematic critical realist review of interventions designed to improve end-of-life care in care homes. Nurs Health Sci 2019; 22:343-354. [PMID: 31797527 DOI: 10.1111/nhs.12665] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/28/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022]
Abstract
The demand for high-quality end-of-life care is rising. Frequently evidenced concerns about the provision of end-of-life in care homes relate to inter-disciplinary communication and engagement in advance care planning. A number of interventions employing different mechanisms have been designed to address these issues. Therefore, the aim of this systematic critical realist review was to describe and explain the effectiveness of interventions designed to improve end-of-life care in care homes. Electronic searches were conducted in ScienceDirect, MEDLINE, PubMed, PsychINFO, and CINAHL from January 2000 to August 2018. Forty one studies were included in the review. While most of the evidence identified in this review was not strong, there was evidence to suggest that education and inter-professional collaboration can be effective intervention mechanisms for improving end-of-life care in care homes. High staff turnover was a significant contextual mechanism impacting on the sustainability of interventions. In terms of human agency, it is important to note a consistent finding related to the dedication and enthusiasm of care home staff who deliver end-of-life care.
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Affiliation(s)
- Adam Spacey
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Janet Scammell
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Michele Board
- Department of Adult Nursing, Bournemouth University, Poole, UK
| | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
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Claus N, Marzano L, Loechner J, Starman K, Voggt A, Loy F, Wermuth I, Haemmerle S, Engelmann L, Bley M, Schulte-Koerne G, Platt B. Qualitative evaluation of a preventive intervention for the offspring of parents with a history of depression. BMC Psychiatry 2019; 19:290. [PMID: 31533676 PMCID: PMC6751651 DOI: 10.1186/s12888-019-2273-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Meta-analyses of randomised controlled trials suggest that psychological interventions to reduce children's risk of depression are effective. Nevertheless, these effects are modest and diminish over time. The Medical Research Council recommends a mixed-methods approach to the evaluation of complex interventions. By gaining a more thorough understanding of participants' perspectives, qualitative evaluations of preventive interventions could improve their efficacy, longevity and transfer into clinical practice. METHODS 18 parents and 22 children who had received a 12-session family- and group-based cognitive-behavioural intervention to prevent youth depression as part of a randomised controlled trial took part in semi-structured interviews or a focus group about aspects which had been perceived as helpful, elements they were still using after the intervention had ended, and suggestions they had for improving the intervention. RESULTS The chance to openly share and discuss their experiences of depression within and between families was considered helpful by both children and parents. Children benefitted the most from learning coping strategies for dealing with stress and many still used them in everyday life. Parents profited mostly from increasing positive family time, but noted that maintaining new routines after the end of the intervention proved difficult. Participants were generally content with the intervention but commented on how tiring and time consuming it was. CONCLUSIONS Managing parents' expectations of family-based interventions in terms of their own mental health needs (versus those of their children) and leaving more room for open discussions may result in interventions which are more appealing to participating families. Increasing intervals between sessions may be one means of improving the longevity of interventions. TRIAL REGISTRATION The original RCT this evaluation is a part of was registered under NCT02115880 .
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Affiliation(s)
- Nathalie Claus
- Department of Psychology, Clinical Psychology and Psychotherapy, Ludwig-Maximilians-Universität München, Leopoldstr. 13, 80802 Munich, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Nussbaumstr. 5a, 80336 Munich, Germany
| | - Lisa Marzano
- Department of Psychology, Middlesex University London, The Burroughs, Hendon, London, NW4 4BT UK
| | - Johanna Loechner
- Department of Psychology, Clinical Psychology and Psychotherapy, Ludwig-Maximilians-Universität München, Leopoldstr. 13, 80802 Munich, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Nussbaumstr. 5a, 80336 Munich, Germany
| | - Kornelija Starman
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Nussbaumstr. 5a, 80336 Munich, Germany
| | - Alessandra Voggt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Nussbaumstr. 5a, 80336 Munich, Germany
| | - Fabian Loy
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Nussbaumstr. 5a, 80336 Munich, Germany
| | - Inga Wermuth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Nussbaumstr. 5a, 80336 Munich, Germany
| | - Stephanie Haemmerle
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Nussbaumstr. 5a, 80336 Munich, Germany
| | - Lina Engelmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Nussbaumstr. 5a, 80336 Munich, Germany
| | - Mirjam Bley
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Nussbaumstr. 5a, 80336 Munich, Germany
| | - Gerd Schulte-Koerne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Nussbaumstr. 5a, 80336 Munich, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Munich, Nussbaumstr. 5a, 80336 Munich, Germany
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Goldsmith LP, Morshead R, McWilliam C, Forbes G, Ussher M, Simpson A, Lucock M, Gillard S. Co-producing Randomized Controlled Trials: How Do We Work Together? FRONTIERS IN SOCIOLOGY 2019; 4:21. [PMID: 33869347 PMCID: PMC8022576 DOI: 10.3389/fsoc.2019.00021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/05/2019] [Indexed: 05/26/2023]
Abstract
In the light of the declaration "Nothing about us without us" (Charlton, 2000), interest in co-production, and coproduced research is expanding. Good work has been done establishing principles for co-production (Hickey et al., 2018) and for good quality involvement (Involve, 2013; 4Pi, 2015) and describing how this works in practice in mental health research (Gillard et al., 2012a,b, 2013). In the published literature, co-production has worked well in qualitative research projects in which there is often methodological flexibility. However, to change treatment guidelines in the UK, e.g., the National Institute for Health and Care Excellence guidelines, and influence service commissioning, high quality quantitative research is also needed. This type of research is characterized by formal methodological rules, which pose challenges for the scope of co-production. In this paper we describe the significant challenges and solutions we adopted to design and deliver a coproduced randomized controlled trial of mental health peer support. Given the methodological rigidity of a randomized controlled trial, establishing clearly which methodological and practical decisions and processes can be coproduced, by whom, and how, has been vital to our ongoing co-production as the project has progressed and the team has expanded. Creating and maintaining space for the supported dialogue, reflection, and culture that co-production requires has been vital. This paper aims to make our learning accessible to a wide audience of people developing co-production of knowledge in this field.
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Affiliation(s)
| | - Rosaleen Morshead
- Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Charlotte McWilliam
- Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Gordon Forbes
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Alan Simpson
- Institute of Psychiatry, Psychology & Neuroscience, and Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Mike Lucock
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Steve Gillard
- Population Health Research Institute, St George's, University of London, London, United Kingdom
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Caló F, Roy MJ, Donaldson C, Teasdale S, Baglioni S. Exploring the contribution of social enterprise to health and social care: A realist evaluation. Soc Sci Med 2019; 222:154-161. [DOI: 10.1016/j.socscimed.2019.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/29/2018] [Accepted: 01/04/2019] [Indexed: 11/28/2022]
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Lim WS, Wong CH, Ding YY, Rockwood K, Lien C. Translating the Science of Frailty in Singapore: Results from the National Frailty Consensus Discussion. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2019. [DOI: 10.47102/annals-acadmedsg.v48n1p25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Wee Shiong Lim
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
| | | | - Yew Yoong Ding
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
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Developing a Policy Flight Simulator to Facilitate the Adoption of an Evidence-Based Intervention. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:4800112. [PMID: 29805921 PMCID: PMC5957263 DOI: 10.1109/jtehm.2018.2833847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 03/13/2018] [Accepted: 04/24/2018] [Indexed: 11/17/2022]
Abstract
While the use of evidence-based interventions (EBIs) has been advocated by the medical research community for quite some time, uptake of these interventions by healthcare providers has been slow. One possible explanation is that it is challenging for providers to estimate impacts of a specific EBI on their particular organization. To address that concern, we developed and evaluated a type of simulation called a policy flight simulator to determine if it could improve the adoption decision about a specific EBI, the transitional care model (TCM). The TCM uses an advanced practice nurse-led model of care to transition older adults with multiple chronic conditions from a hospitalization to home. An evaluation by a National Advisory Committee, made up of senior representatives from various stakeholders in the U.S. healthcare system, found the policy flight simulator to be a useful tool that has the potential to better inform adoption decisions. This paper describes the simulation development effort and documents lessons learned that may be useful to the healthcare modeling community and those interested in using simulation to support decisions based on EBIs.
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Porter S, McConnell T, Clarke M, Kirkwood J, Hughes N, Graham-Wisener L, Regan J, McKeown M, McGrillen K, Reid J. A critical realist evaluation of a music therapy intervention in palliative care. BMC Palliat Care 2017; 16:70. [PMID: 29221475 PMCID: PMC5723094 DOI: 10.1186/s12904-017-0253-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Music therapy is increasingly used as an adjunct therapy to support symptom management in palliative care. However, studies to date have paid little attention to the processes that lead to changes in patient outcomes. To fill this gap, we examined the processes and experiences involved in the introduction of music therapy as an adjunct complementary therapy to palliative care in a hospice setting in the United Kingdom (UK). METHODS Using a realistic evaluation approach, we conducted a qualitative study using a variety of approaches. These consisted of open text answers from patients (n = 16) on how music therapy helped meet their needs within one hospice in Northern Ireland, UK. We also conducted three focus groups with a range of palliative care practitioners (seven physicians, seven nursing staff, two social workers and three allied health professionals) to help understand their perspectives on music therapy's impact on their work setting, and what influences its successful implementation. This was supplemented with an interview with the music therapist delivering the intervention. RESULTS Music therapy contains multiple mechanisms that can provide physical, psychological, emotional, expressive, existential and social support. There is also evidence that the hospice context, animated by a holistic approach to healthcare, is an important facilitator of the effects of music therapy. Examination of patients' responses helped identify specific benefits for different types of patients. CONCLUSIONS There is a synergy between the therapeutic aims of music therapy and those of palliative care, which appealed to a significant proportion of participants, who perceived it as effective.
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Affiliation(s)
- Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Poole, Northern Ireland
| | - Tracey McConnell
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland
| | - Jenny Kirkwood
- Every Day Harmony Music Therapy, Belfast, Northern Ireland
| | - Naomi Hughes
- Every Day Harmony Music Therapy, Belfast, Northern Ireland
| | | | - Joan Regan
- Marie Curie Hospice Belfast, Marie Curie, Northern Ireland
| | - Miriam McKeown
- Marie Curie Hospice Belfast, Marie Curie, Northern Ireland
| | | | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
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Making meaning around experiences in interventions: identifying meaningfulness in a group-based occupational therapy intervention targeting older people. AGEING & SOCIETY 2017. [DOI: 10.1017/s0144686x17000344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTThere is a need to understand the underlying mechanisms at work within health promotion and occupational therapy interventions. The aim of this article was, therefore, to explore and describe how the participants of a group-based occupational therapy intervention with positive health outcomes created meaning of and around their experiences of the intervention. The studied intervention was part of the evaluation of a single-blinded, exploratory randomised controlled trial of three different interventions. A total of 19 participants between 77 and 82 years of age with experiences from the group-based intervention were interviewed, and the transcribed interviews were analysed from a constructivist approach. The results showed five different perspectives of meaning, including enjoyment, usefulness, togetherness, respect for individuality and self-reflection. Based on our findings, we argue that the possibility of getting information, sharing with others and having fun, and the ability to adjust the activities in the intervention so that they met the individual's needs, created meaning for the participants. Moreover, meeting with others supported the participants’ perspectives of themselves. The results are discussed in relation to the pervasive discourse of successful ageing, including how it was present but also challenged within the participants’ accounts of the intervention.
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Sharma S, Adetoro OO, Vidler M, Drebit S, Payne BA, Akeju DO, Adepoju A, Jaiyesimi E, Sotunsa J, Bhutta ZA, Magee LA, von Dadelszen P, Dada O. A process evaluation plan for assessing a complex community-based maternal health intervention in Ogun State, Nigeria. BMC Health Serv Res 2017; 17:238. [PMID: 28351355 PMCID: PMC5371276 DOI: 10.1186/s12913-017-2124-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 03/01/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite increased investment in community-level maternal health interventions, process evaluations of such interventions are uncommon, and can be instrumental in understanding mediating factors leading to outcomes. In Nigeria, where an unacceptably number of maternal deaths occur (maternal mortality ratio of 814/100,000 livebirths), the Community Level Interventions for Pre-eclampsia (CLIP) study (NCT01911494) aimed to reduce maternal and neonatal mortality and morbidity with a complex intervention of five interrelated components. Building from previous frameworks, we illustrate a methodology to evaluate implementation processes of the complex CLIP intervention, assess mechanisms of impact and identify emerging unintended causal pathways. METHODS The study was conducted from 2013-2016 in five Local Government Areas in Ogun State, Nigeria. A six-step approach was developed to evaluate key constructs of context (external factors related to intervention), implementation (fidelity, dose, reach, and adaption) and mechanisms of impact (unintended outcomes and mediating pathways). The steps are: 1) describing the intervention by a logic model, 2) defining acceptable delivery, 3) formulating questions, 4) determining methodology, 5) planning resources in context, lastly, step 6) finalising the plan in consideration with relevant stakeholders. RESULTS Quantitative data were collected from 32,785 antenatal and postnatal visits at the primary health care level, from 66 community engagement sessions, training assessments of community health workers, and standard health facility questionnaires. Forty-three focus group discussions, 38 in-depth interviews, and 23 structured observations were conducted to capture qualitative data. A total of 103 community engagement reports and 182 suspected pre-eclampsia case reports were purposively collected. Timing of data collection was staggered to understand feedback mechanisms that may have resulted from the delivery of the intervention. Data will be analysed using R and NVivo. Diffusions of innovations and realist evaluation theories will underpin analysis of the interaction between context, mechanisms and outcomes. CONCLUSION This comprehensive approach can serve as a guide for researchers and policy makers to plan the evaluation of similar complex health interventions in resource-constrained settings, and to aid in measuring 'effectiveness' of interventions and not just 'efficacy'. TRIAL REGISTRATION This research is a part of the Community Level Interventions for Pre-eclampsia Study, NCT01911494. The trial is registered in Clinicaltrials.gov, the URL is https://clinicaltrials.gov/ct2/show/NCT01911494 The trial was registered on June 28, 2013 and the first participant was enrolled for intervention on March 1, 2014.
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Affiliation(s)
- Sumedha Sharma
- Department of Obstetrics and Gynaecology and Child & Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Olalekan O. Adetoro
- Centre for Research in Reproductive Health, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology and Child & Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Sharla Drebit
- Department of Obstetrics and Gynaecology and Child & Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Beth A. Payne
- Department of Obstetrics and Gynaecology and Child & Family Research Institute, University of British Columbia, Vancouver, Canada
| | | | - Akinmade Adepoju
- Centre for Research in Reproductive Health, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Ebunoluwa Jaiyesimi
- Centre for Research in Reproductive Health, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | | | - Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Laura A. Magee
- Institute of Cardiovascular and Cell Sciences, St George’s, University of London, London, UK
- Department of Obstetrics and Gynaecology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Peter von Dadelszen
- Institute of Cardiovascular and Cell Sciences, St George’s, University of London, London, UK
- Department of Obstetrics and Gynaecology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Olukayode Dada
- Centre for Research in Reproductive Health, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
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Porter S, McConnell T, Reid J. The possibility of critical realist randomised controlled trials. Trials 2017; 18:133. [PMID: 28327182 PMCID: PMC5359862 DOI: 10.1186/s13063-017-1855-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/19/2017] [Indexed: 11/17/2022] Open
Abstract
Background Some realists have criticised randomised controlled trials for their inability to explain the causal relations that they identify; to take into account the influence of the social context of the interventions they evaluate; and to account for individual difference. However, among realists, there is controversy over whether it is possible to improve trials by making them realist, or whether realism and the philosophical assumptions underlying trials are incompatible. This paper contributes to the debate in Trials on this issue. The debate thus far has concentrated on the possibility of combining trial methodology with that of realist evaluation. Main body We concur with the contention that it is not feasible to combine randomised controlled trial design with the realist evaluation approach. However, we argue that a different variant of realism, critical realism, provides a more appropriate theoretical grounding for realist trials. In contrast to realist evaluation, which regards social mechanisms as an amalgam of social resources and people’s reasoning, critical realism insists on their distinction. It does so on the basis of its assertion of the need to distinguish between social structures (in which resources lie) and human agency (which is at least partly guided by reasoning). From this perspective, conceiving of social mechanisms as external to participants can be seen as a valid methodological strategy for supplementing the exclusive concentration of trials on outcomes. While accepting realist evaluation’s insistence that causality in open systems involves a configuration of multiple generative mechanisms, we adopt the critical realist interpretation of the experimental method, which sees it as creating artificial closure in order to identify the effects of specific causal mechanisms. If randomised controlled trials can be regarded as epidemiological proxies that substitute probabilistic controls over extraneous factors for closed experiments, their examination of the powers of discrete mechanisms through observation of the variation of outcomes is appropriate. Conclusion While there are still issues to be resolved, critical realist randomised controlled trials are possible and have the potential to overcome some of the difficulties faced by traditional trial designs in accounting for the influence of social context and individual interpretation.
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Affiliation(s)
- Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, R203, Royal London House, Christchurch Road, BH1 3LT, Bournemouth, UK
| | - Tracey McConnell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT7 1NN, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT7 1NN, UK.
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Abstract
OBJECTIVE Music therapy has experienced a rising demand as an adjunct therapy for symptom management among palliative care patients. We conducted a realist review of the literature to develop a greater understanding of how music therapy might benefit palliative care patients and the contextual mechanisms that promote or inhibit its successful implementation. METHOD We searched electronic databases (CINAHL, Embase, Medline, and PsychINFO) for literature containing information on music therapy for palliative care. In keeping with the realist approach, we examined all relevant literature to develop theories that could explain how music therapy works. RESULTS A total of 51 articles were included in the review. Music therapy was found to have a therapeutic effect on the physical, psychological, emotional, and spiritual suffering of palliative care patients. We also identified program mechanisms that help explain music therapy's therapeutic effects, along with facilitating contexts for implementation. SIGNIFICANCE OF RESULTS Music therapy may be an effective nonpharmacological approach to managing distressing symptoms in palliative care patients. The findings also suggest that group music therapy may be a cost-efficient and effective way to support staff caring for palliative care patients. We encourage others to continue developing the evidence base in order to expand our understanding of how music therapy works, with the aim of informing and improving the provision of music therapy for palliative care patients.
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Van Belle S, Wong G, Westhorp G, Pearson M, Emmel N, Manzano A, Marchal B. Can "realist" randomised controlled trials be genuinely realist? Trials 2016; 17:313. [PMID: 27387202 PMCID: PMC4936237 DOI: 10.1186/s13063-016-1407-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 05/03/2016] [Indexed: 11/30/2022] Open
Abstract
In this paper, we respond to a paper by Jamal and colleagues published in Trials in October 2015 and take an opportunity to continue the much-needed debate about what applied scientific realism is. The paper by Jamal et al. is useful because it exposes the challenges of combining a realist evaluation approach (as developed by Pawson and Tilley) with the randomised controlled trial (RCT) design. We identified three fundamental differences that are related to paradigmatic differences in the treatment of causation between post-positivist and realist logic: (1) the construct of mechanism, (2) the relation between mediators and moderators on one hand and mechanisms and contexts on the other hand, and (3) the variable-oriented approach to analysis of causation versus the configurational approach. We show how Jamal et al. consider mechanisms as observable, external treatments and how their approach reduces complex causal processes to variables. We argue that their proposed RCT design cannot provide a truly realist understanding. Not only does the proposed realist RCT design not deal with the RCT’s inherent inability to “unpack” complex interventions, it also does not enable the identification of the dynamic interplay among the intervention, actors, context, mechanisms and outcomes, which is at the core of realist research. As a result, the proposed realist RCT design is not, as we understand it, genuinely realist in nature.
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Affiliation(s)
- Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium.
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Mark Pearson
- NIHR Collaboration for Applied Health Research and Care South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Nick Emmel
- School of Sociology & Social Policy, University of Leeds, Leeds, UK
| | - Ana Manzano
- Centre for Health, Technologies & Social Practice, School of Sociology & Social Policy, University of Leeds, Leeds, UK
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp, Belgium
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Raine R, Fitzpatrick R, Barratt H, Bevan G, Black N, Boaden R, Bower P, Campbell M, Denis JL, Devers K, Dixon-Woods M, Fallowfield L, Forder J, Foy R, Freemantle N, Fulop NJ, Gibbons E, Gillies C, Goulding L, Grieve R, Grimshaw J, Howarth E, Lilford RJ, McDonald R, Moore G, Moore L, Newhouse R, O’Cathain A, Or Z, Papoutsi C, Prady S, Rycroft-Malone J, Sekhon J, Turner S, Watson SI, Zwarenstein M. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04160] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
HeadlineEvaluating service innovations in health care and public health requires flexibility, collaboration and pragmatism; this collection identifies robust, innovative and mixed methods to inform such evaluations.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helen Barratt
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames, Department of Applied Health Research, University College London, London, UK
| | - Gywn Bevan
- Department of Management, London School of Economics and Political Science, London, UK
| | - Nick Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Boaden
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jean-Louis Denis
- Canada Research Chair in Governance and Transformation of Health Organizations and Systems, École Nationale d’Administration Publique, Ville de Québec, QC, Canada
| | - Kelly Devers
- Health Policy Centre, Urban Institute, Washington, DC, USA
| | - Mary Dixon-Woods
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), University of Sussex, Brighton, UK
| | - Julien Forder
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - Robbie Foy
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - Elizabeth Gibbons
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Clare Gillies
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands and NIHR Research Design Service East Midlands, University of Leicester, Leicester, UK
| | - Lucy Goulding
- King’s Improvement Science, Centre for Implementation Science, King’s College London, London, UK
| | - Richard Grieve
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Emma Howarth
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, University of Cambridge, Cambridge, UK
| | | | - Ruth McDonald
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Laurence Moore
- Medical Research Council (MRC)/Chief Scientist Office (CSO) Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Robin Newhouse
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Zeynep Or
- Institut de Recherche et Documentation en Économie de la Santé, Paris, France
| | - Chrysanthi Papoutsi
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, Imperial College London, London, UK
| | | | | | - Jasjeet Sekhon
- Department of Political Science and Statistics, University of California Berkeley, Berkeley, CA, USA
| | - Simon Turner
- Department of Applied Health Research, University College London, London, UK
| | | | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University, London, ON, Canada
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Atchan M, Davis D, Foureur M. A methodological review of qualitative case study methodology in midwifery research. J Adv Nurs 2016; 72:2259-71. [PMID: 26909766 DOI: 10.1111/jan.12946] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/29/2022]
Abstract
AIM To explore the use and application of case study research in midwifery. BACKGROUND Case study research provides rich data for the analysis of complex issues and interventions in the healthcare disciplines; however, a gap in the midwifery research literature was identified. DESIGN A methodological review of midwifery case study research using recognized templates, frameworks and reporting guidelines facilitated comprehensive analysis. DATA SOURCES An electronic database search using the date range January 2005-December 2014: Maternal and Infant Care, CINAHL Plus, Academic Search Complete, Web of Knowledge, SCOPUS, Medline, Health Collection (Informit), Cochrane Library Health Source: Nursing/Academic Edition, Wiley online and ProQuest Central. REVIEW METHODS Narrative evaluation was undertaken. Clearly worded questions reflected the problem and purpose. The application, strengths and limitations of case study methods were identified through a quality appraisal process. RESULTS The review identified both case study research's applicability to midwifery and its low uptake, especially in clinical studies. Many papers included the necessary criteria to achieve rigour. The included measures of authenticity and methodology were varied. A high standard of authenticity was observed, suggesting authors considered these elements to be routine inclusions. Technical aspects were lacking in many papers, namely a lack of reflexivity and incomplete transparency of processes. CONCLUSION This review raises the profile of case study research in midwifery. Midwives will be encouraged to explore if case study research is suitable for their investigation. The raised profile will demonstrate further applicability; encourage support and wider adoption in the midwifery setting.
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Affiliation(s)
- Marjorie Atchan
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, New South Wales, Australia
| | - Deborah Davis
- Faculty of Health, ACT Health Directorate and University of Canberra, University of Canberra, Australian Capital Territory, Australia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, New South Wales, Australia
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Duggleby W, Williams A. Methodological and Epistemological Considerations in Utilizing Qualitative Inquiry to Develop Interventions. QUALITATIVE HEALTH RESEARCH 2016; 26:147-153. [PMID: 26063607 DOI: 10.1177/1049732315590403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this article is to discuss methodological and epistemological considerations involved in using qualitative inquiry to develop interventions. These considerations included (a) using diverse methodological approaches and (b) epistemological considerations such as generalization, de-contextualization, and subjective reality. Diverse methodological approaches have the potential to inform different stages of intervention development. Using the development of a psychosocial hope intervention for advanced cancer patients as an example, the authors utilized a thematic study to assess current theories/frameworks and interventions. However, to understand the processes that the intervention needed to target to affect change, grounded theory was used. Epistemological considerations provided a framework to understand and, further, critique the intervention. Using diverse qualitative methodological approaches and examining epistemological considerations were useful in developing an intervention that appears to foster hope in patients with advanced cancer.
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Healey EL, Jinks C, Tan VA, Chew-Graham CA, Lawton SA, Nicholls E, Finney AG, Porcheret M, Cooper V, Lewis M, Dziedzic KS, Wathall S, Mallen CD. Improving the care of people with long-term conditions in primary care: protocol for the ENHANCE pilot trial. JOURNAL OF COMORBIDITY 2015; 5:135-149. [PMID: 29090162 PMCID: PMC5636040 DOI: 10.15256/joc.2015.5.60] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Long-term conditions (LTCs) are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. OBJECTIVE To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. DESIGN The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENAHNCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes) will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. DISCUSSION Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418.
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Affiliation(s)
- Emma L Healey
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Clare Jinks
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Valerie A Tan
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | | | - Sarah A Lawton
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Elaine Nicholls
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | | | - Mark Porcheret
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Vince Cooper
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Martyn Lewis
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Krysia S Dziedzic
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Simon Wathall
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Christian D Mallen
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
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Snowdon C. Qualitative and mixed methods research in trials. Trials 2015; 16:558. [PMID: 26646545 PMCID: PMC4672490 DOI: 10.1186/s13063-015-1084-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/26/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- Claire Snowdon
- London School of Hygiene and Tropical Medicine, London, UK.
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Hansen HP, Tjørnhøj-Thomsen T. Meeting the Challenges of Intervention Research in Health Science: An Argument for a Multimethod Research Approach. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2015; 9:193-200. [DOI: 10.1007/s40271-015-0153-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McMullen H, Griffiths C, Leber W, Greenhalgh T. Explaining high and low performers in complex intervention trials: a new model based on diffusion of innovations theory. Trials 2015; 16:242. [PMID: 26026849 PMCID: PMC4465492 DOI: 10.1186/s13063-015-0755-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Complex intervention trials may require health care organisations to implement new service models. In a recent cluster randomised controlled trial, some participating organisations achieved high recruitment, whereas others found it difficult to assimilate the intervention and were low recruiters. We sought to explain this variation and develop a model to inform organisational participation in future complex intervention trials. METHODS The trial included 40 general practices in a London borough with high HIV prevalence. The intervention was offering a rapid HIV test as part of the New Patient Health Check. The primary outcome was mean CD4 cell count at diagnosis. The process evaluation consisted of several hundred hours of ethnographic observation, 21 semi-structured interviews and analysis of routine documents (e.g., patient leaflets, clinical protocols) and trial documents (e.g., inclusion criteria, recruitment statistics). Qualitative data were analysed thematically using--and, where necessary, extending--Greenhalgh et al.'s model of diffusion of innovations. Narrative synthesis was used to prepare case studies of four practices representing maximum variety in clinicians' interest in HIV (assessed by level of serological testing prior to the trial) and performance in the trial (high vs. low recruiters). RESULTS High-recruiting practices were, in general though not invariably, also innovative practices. They were characterised by strong leadership, good managerial relations, readiness for change, a culture of staff training and available staff time ('slack resources'). Their front-line staff believed that patients might benefit from the rapid HIV test ('relative advantage'), were emotionally comfortable administering it ('compatibility'), skilled in performing it ('task issues') and made creative adaptations to embed the test in local working practices ('reinvention'). Early experience of a positive HIV test ('observability') appeared to reinforce staff commitment to recruiting more participants. Low-performing practices typically had less good managerial relations, significant resource constraints, staff discomfort with the test and no positive results early in the trial. CONCLUSIONS An adaptation of the diffusion of innovations model was an effective analytical tool for retrospectively explaining high and low-performing practices in a complex intervention research trial. Whether the model will work prospectively to predict performance (and hence shape the design of future trials) is unknown. TRIAL REGISTRATION ISRCTN Registry number: ISRCTN63473710. Date assigned: 22 April 2010.
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Affiliation(s)
- Heather McMullen
- Centre for Primary Care and Public Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
| | - Werner Leber
- Centre for Primary Care and Public Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
| | - Trisha Greenhalgh
- Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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Abstract
The rapidly growing body of research regarding the use of meditation interventions in chronic disease presents an opportunity to compare outcomes based on intervention content. For this review, meditation interventions were described as those interventions delivered to persons with chronic disease where sitting meditation was the main or only content of the intervention with or without the addition of mindful movement. This systematic review identified 45 individual research studies that examined meditations effect on levels of anxiety, depression, and chronic disease symptoms in persons with chronic disease. Individual studies were assessed based on interventional content, the consistency with which interventions were applied, and the research quality. This study identified seven categories of meditation interventions based on the meditation skills and mindful movement practices that were included in the intervention. Overall, half of the interventions had clearly defined and specific meditation interventions (25/45) and half of the studies were conducted using randomized control trials (24/45).
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Morden A, Jinks C, Ong BN, Porcheret M, Dziedzic KS. Acceptability of a 'guidebook' for the management of Osteoarthritis: a qualitative study of patient and clinician's perspectives. BMC Musculoskelet Disord 2014; 15:427. [PMID: 25496765 PMCID: PMC4301067 DOI: 10.1186/1471-2474-15-427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Written information can be of benefit to both practitioners and patients and the provision of quality information is emphasised as a core intervention by United Kingdom National Institute of Clinical Excellence (NICE) OA guidelines. Researchers, patients and HCPs developed an 'OA guidebook' to provide; a) a balanced source of information for patients; b) a resource to aid practitioners when discussing self-management. This study aimed to evaluate the acceptability and usefulness of the OA guidebook as part of complex intervention to deliver NICE OA guidelines in General Practice. METHODS The intervention comprises a series of consultations with GPs and practice nurses in which supported self-management is offered to patients. Eight practices in the West Midlands and North West of England were recruited to take part: four control practices and four intervention practices. Semi-structured interviews were undertaken with patients (n = 29), GPs (n = 9) and practice nurses (n = 4) from the intervention practices to explore experiences of the intervention and use of the guidebook. Data were analysed using thematic analysis and constant comparison of data within and across interviews. RESULTS GPs thought the guidebook helped provide patients with information about OA aetiology, prognosis and self-management. Thus, it backed up key messages they provided patients during consultations. GPs also found the guidebook helped them 'close off' consultations. Nurses also thought the guidebook helped them describe OA disease processes in consultations. Patients valued the explanations of disease onset, process and prognosis. The use of 'real' people and 'real life' situations contained within the guidebook made self-management strategies seem more tangible. A sense of inclusion and comfort was obtained from knowing other people encountered similar problems and feelings. CONCLUSION An OA specific written information guidebook was deemed acceptable and useful to practitioners and patients alike as part of the MOSAICS study. Findings reinforce the utility of this model of patient information as a resource to support patients living with chronic illnesses. An OA guidebook featuring a mixture of lay and professional information developed by professionals and lay people is useful and could effectively be used more widely in usual care.
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Affiliation(s)
- Andrew Morden
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Clare Jinks
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Bie Nio Ong
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Mark Porcheret
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Krysia S Dziedzic
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
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Recruiting Participants for Randomized Controlled Trials of Music Therapy: A Practical Illustration. J Music Ther 2014; 51:355-81. [DOI: 10.1093/jmt/thu031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Munier T, Porter S. The struggle for safe staffing levels in the USA: a political economy of evidence-based practice. J Res Nurs 2014. [DOI: 10.1177/1744987114557108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper examines the debate over nursing staff to patient ratios through the lens of Marxist political economy, arguing that the owners and controllers of healthcare in the USA have a vested interest in opposing mandated minimum ratios, while those involved in carrying out nursing care have a vested interest in their implementation, which coincides with the interests of patients. We examine how evidence-based practice articulates with social power, and proceed to interrogate the research methods used to generate evidence for practice, noting that randomised controlled trials are not suitable for evaluating nurse/patient ratios, which means that observational studies are the primary source of evidence. Representatives of nursing managers have used the fact that observational studies, while demonstrating an association between high ratios and poor outcomes, have not established a causal relationship, to support their argument that there is not sufficient evidence for the imposition of mandatory ratios. We argue that the precautionary principle provides firm justification for mandatory ratios, unless and until a causal relationship has been disproved. We conclude that those involved in the generation of evidence have to choose between technical arguments about the inferiority of observational studies, or emphasising their sufficiency in triggering the precautionary principle.
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Affiliation(s)
- Timothy Munier
- Strong Memorial Hospital Wilmot Cancer Institute 601 Elmwood Ave Rochester, NY, USA
| | - Sam Porter
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
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Randell R, Greenhalgh J, Hindmarsh J, Dowding D, Jayne D, Pearman A, Gardner P, Croft J, Kotze A. Integration of robotic surgery into routine practice and impacts on communication, collaboration, and decision making: a realist process evaluation protocol. Implement Sci 2014; 9:52. [PMID: 24885669 PMCID: PMC4017969 DOI: 10.1186/1748-5908-9-52] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/29/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Robotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes. METHODS AND DESIGN We will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders' theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to refine the resulting theories to reflect the experience of a broader range of surgical disciplines. The study will provide (i) guidance to healthcare organisations on factors likely to facilitate successful implementation and integration of robotic surgery, and (ii) guidance on how to ensure effective communication and teamwork when undertaking robotic surgery.
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Affiliation(s)
- Rebecca Randell
- School of Healthcare, Baines Wing, University of Leeds, Leeds LS2 9JT, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds LS2 9UT, UK
| | - Jon Hindmarsh
- Department of Management, King’s College London, London SE1 9NH, UK
| | - Dawn Dowding
- Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032, USA
- Center for Home Care Policy and Research, Visiting Nursing Service of New York, 5 Penn Plaza, New York, NY 10001, USA
| | - David Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St. James’s University Hospital, Leeds LS9 7TF, UK
| | - Alan Pearman
- Centre for Decision Research, University of Leeds, Leeds LS2 9JT, UK
| | - Peter Gardner
- Institute of Psychological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Julie Croft
- Clinical Trials Research Unit, University of Leeds, Leeds LS2 9JT, UK
| | - Alwyn Kotze
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds LS1 3EX, UK
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Higgins A, Porter S, O'Halloran P. General practitioners' management of the long-term sick role. Soc Sci Med 2014; 107:52-60. [PMID: 24607666 DOI: 10.1016/j.socscimed.2014.01.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/27/2014] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
Abstract
In this paper, we use qualitative research techniques to examine the role of general practitioners in the management of the long-term sickness absence. In order to uncover the perspectives of all the main agents affected by the actions of general practitioners, a case study approach focussing on one particular employment sector, the public health service, is adopted. The role of family physicians is viewed from the perspectives of health service managers, occupational health physicians, employees/patients, and general practitioners. Our argument is theoretically framed by Talcott Parsons's model of the medical contribution to the sick role, along with subsequent conceptualisations of the social role and position of physicians. Sixty one semi-structured interviews and three focus group interviews were conducted in three Health and Social Care Trusts in Northern Ireland between 2010 and 2012. There was a consensus among respondents that general practitioners put far more weight on the preferences and needs of their patients than they did on the requirements of employing organisations. This was explained by respondents in terms of the propinquity and longevity of relationships between doctors and their patients, and by the ideology of holistic care and patient advocacy that general practitioners viewed as providing the foundations of their approach to patients. The approach of general practitioners was viewed negatively by managers and occupational health physicians, and more positively by general practitioners and patients. However, there is some evidence that general practitioners would be prepared to forfeit their role as validators of sick leave. Given the imperatives of both state and capital to reduce the financial burden of long-term sickness, this preparedness puts into doubt the continued role of general practitioners as gatekeepers to legitimate long-term sickness absence.
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Affiliation(s)
- Angela Higgins
- Occupational Health, Northern Health and Social Care Trust, Antrim Hospital, Antrim BT41 2RL, Northern Ireland, UK.
| | - Sam Porter
- School of Nursing and Midwifery, Queen's University Belfast, University Road, Belfast BT7 1NN, Northern Ireland, UK.
| | - Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, University Road, Belfast BT7 1NN, Northern Ireland, UK.
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Abstract
BACKGROUND Despite its prevalence and prognostic impact, primary cachexia is not well understood. Its potential to cause considerable psychological stress indicates the need for qualitative research to help understand the perspectives of those affected. OBJECTIVE The aims of this study were to describe the perspectives of patients with primary cachexia, of their relatives, and of the healthcare professionals involved in their care and to demonstrate how this evidence can be applied in practice at 4 different levels of application ranging from empathy to coaching. METHODS A review of the qualitative literature and empirical qualitative investigation was used to understand the experiences of patients and relatives and the perspectives of professionals. RESULTS The main worries expressed by patients and relatives concerned appetite loss, changing appearance, prognosis, and social interaction. We also describe their coping responses and their views of professionals' responses. The main concerns of professionals related to poor communication, lack of clinical guidance, and lack of professional education. CONCLUSIONS Understanding patients', families', and professionals' perspectives, and mapping that understanding onto what we know about the trajectory and prognosis of the condition, provides the evidence base for good practice. Qualitative research has a central role to play in providing the knowledge base for the nursing care of patients with cachexia. IMPLICATIONS FOR PRACTICE The evidence provided can improve nurses' insight and assist them in assessment of status, the provision of guidance, and coaching. There is a need for the development of a holistic, information-based integrated care pathway for those with cancer cachexia and their families.
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Prince MA, Carey KB, Maisto SA. Protective behavioral strategies for reducing alcohol involvement: a review of the methodological issues. Addict Behav 2013; 38:2343-51. [PMID: 23584196 DOI: 10.1016/j.addbeh.2013.03.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 01/18/2013] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
Abstract
Alcohol use among college students remains a major public health concern with many students experiencing negative alcohol-related consequences as a result of their drinking. Protective behavioral strategies (PBS) have been conceptualized as skills used by drinkers to moderate their drinking and/or resulting consequences. The correlational evidence for the relationships among PBS, alcohol use, and related problems has been mixed. Experimental research reveals inconsistent relationships among intervention condition, PBS use, and alcohol outcomes. There is currently insufficient evidence to support the claim that PBS function as a mechanism of behavior change for college drinkers. We propose that the inconsistencies found in the correlational and experimental research are explained in part by psychometric and methodological issues. This review summarizes measurement and methodological issues in studies that have directly assessed the relationship between PBS and alcohol use and/or alcohol-related consequences in college drinking samples. Additionally, we provide some suggestions and future directions to overcome methodological and conceptual limitations and to advance understanding of the role of protective behavioral strategy use in reducing alcohol involvement among college drinkers.
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Mixing a grounded theory approach with a randomized controlled trial related to intimate partner violence: what challenges arise for mixed methods research? Nurs Res Pract 2013; 2013:798213. [PMID: 23577245 PMCID: PMC3615605 DOI: 10.1155/2013/798213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 11/18/2022] Open
Abstract
Little is known about how to systematically integrate complex qualitative studies within the context of randomized controlled trials. A two-phase sequential explanatory mixed methods study was conducted in Canada to understand how women decide to disclose intimate partner violence in emergency department settings. Mixing a RCT (with a subanalysis of data) with a grounded theory approach required methodological modifications to maintain the overall rigour of this mixed methods study. Modifications were made to the following areas of the grounded theory approach to support the overall integrity of the mixed methods study design: recruitment of participants, maximum variation and negative case sampling, data collection, and analysis methods. Recommendations for future studies include: (1) planning at the outset to incorporate a qualitative approach with a RCT and to determine logical points during the RCT to integrate the qualitative component and (2) consideration for the time needed to carry out a RCT and a grounded theory approach, especially to support recruitment, data collection, and analysis. Data mixing strategies should be considered during early stages of the study, so that appropriate measures can be developed and used in the RCT to support initial coding structures and data analysis needs of the grounded theory phase.
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Bonell C, Fletcher A, Morton M, Lorenc T, Moore L. Realist randomised controlled trials: a new approach to evaluating complex public health interventions. Soc Sci Med 2012; 75:2299-306. [PMID: 22989491 DOI: 10.1016/j.socscimed.2012.08.032] [Citation(s) in RCA: 289] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 06/11/2012] [Accepted: 08/29/2012] [Indexed: 11/27/2022]
Abstract
Randomized trials of complex public health interventions generally aim to identify what works, accrediting specific intervention 'products' as effective. This approach often fails to give sufficient consideration to how intervention components interact with each other and with local context. 'Realists' argue that trials misunderstand the scientific method, offer only a 'successionist' approach to causation, which brackets out the complexity of social causation, and fail to ask which interventions work, for whom and under what circumstances. We counter-argue that trials are useful in evaluating social interventions because randomized control groups actually take proper account of rather than bracket out the complexity of social causation. Nonetheless, realists are right to stress understanding of 'what works, for whom and under what circumstances' and to argue for the importance of theorizing and empirically examining underlying mechanisms. We propose that these aims can be (and sometimes already are) examined within randomized trials. Such 'realist' trials should aim to: examine the effects of intervention components separately and in combination, for example using multi-arm studies and factorial trials; explore mechanisms of change, for example analysing how pathway variables mediate intervention effects; use multiple trials across contexts to test how intervention effects vary with context; draw on complementary qualitative and quantitative data; and be oriented towards building and validating 'mid-level' program theories which would set out how interventions interact with context to produce outcomes. This last suggestion resonates with recent suggestions that, in delivering truly 'complex' interventions, fidelity is important not so much in terms of precise activities but, rather, key intervention 'processes' and 'functions'. Realist trials would additionally determine the validity of program theory rather than only examining 'what works' to better inform policy and practice in the long-term.
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Affiliation(s)
- Chris Bonell
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, Oxford OX1 2ER, UK.
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Möhler R, Bartoszek G, Köpke S, Meyer G. Proposed criteria for reporting the development and evaluation of complex interventions in healthcare (CReDECI): guideline development. Int J Nurs Stud 2011; 49:40-6. [PMID: 21924424 DOI: 10.1016/j.ijnurstu.2011.08.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/19/2011] [Accepted: 08/20/2011] [Indexed: 10/17/2022]
Abstract
Methods of research on complex interventions have received increasing awareness in nursing and health care science. The British Medical Research Council's (MRC) framework on the development and evaluation of complex interventions has been widely applied. It does, however, not specifically support authors to comprehensively and transparently report their complex study to ensure interpretation of study results and replicability of the intervention. So far, no reporting criteria for the development and evaluation of complex interventions have been published. Based on the updated MRC framework and corresponding methodological literature, a set of criteria on the reporting and evaluation of complex interventions has been developed and reviewed by experts in the field. As a result, a criteria list comprising 16 items has been created covering the first three stages of the MRC framework: (1) development; (2) feasibility and piloting; and (3) introduction of the intervention and evaluation. The list provides a minimum standard of criteria necessary to ensure high quality reporting of studies on the development and evaluation of complex interventions. In a final step, the reporting criteria on complex interventions have to pass a formal consensus process according to the methods recommended by the EQUATOR network.
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Affiliation(s)
- Ralph Möhler
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
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Porter S, O’Halloran P. The use and limitation of realistic evaluation as a tool for evidence-based practice: a critical realist perspective. Nurs Inq 2011; 19:18-28. [DOI: 10.1111/j.1440-1800.2011.00551.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bringing values back into evidence-based nursing: the role of patients in resisting empiricism. ANS Adv Nurs Sci 2011; 34:106-18. [PMID: 21427560 DOI: 10.1097/ans.0b013e31821690d9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examine problems resulting from the narrow empirical focus associated with evidence-based nursing, including the deleterious influence of vested interests, disattention to patients' experiences, underestimation of the importance of social processes, lack of an individualized research perspective, marginalization of other forms of knowledge, and the undermining of patients' autonomy. Addressing each problem in turn, we argue that inclusion of patients at all stages of evidence-based practice can counter or ameliorate these problems. While we concede that patient involvement is not a complete solution to the problem of empiricism, it is the most effective means available to defend nursing values.
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