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Mitani S, Ogawara H, Haruta J, Sakakibara T, Fukahori H. Characteristics of the studies using realist evaluation to assess interventions that address psychosocial healthcare issues in older adults: a scoping review. BMJ Open 2024; 14:e078256. [PMID: 39214655 PMCID: PMC11367357 DOI: 10.1136/bmjopen-2023-078256] [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: 07/28/2023] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES Interventions to address psychosocial healthcare issues in older adults are increasing. Realist evaluation (RE) helps us understand how these interventions work for their issues. It is significant to obtain implications for further developing such research. We aimed to identify the characteristics of studies using RE to assess interventions that address psychosocial healthcare issues in older adults by mapping relevant literature. DESIGN Scoping review. DATA SOURCES MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, Cochrane Library, ICHUSHI (a Japanese database) and Google Scholar were used for searches between 5 January 2022 and 4 January 2024. ELIGIBILITY CRITERIA (1) Showing that most of the participants were older adults or their stakeholders; (2) stating in the research background or aim sections that the target interventions aimed at addressing older adults' psychosocial healthcare issues and (3) using RE to assess these interventions. DATA EXTRACTION Data on country of origin, type of research, study design, qualitative data collection and analysis methods, desirable items for RE and intervention aims and purposes were extracted and summarised using descriptive statistics. RESULTS Fifty-four studies were analysed. Most studies were conducted in the UK (54.5%). Mixed methods were used in 28 studies (51.9%), while only qualitative methods were used in 25 studies (46.2 %). Fourteen intervention aims and purposes were identified: improving dementia care, avoiding emergency admissions, preventing social isolation and promoting family involvement in the care of older adults. CONCLUSION RE is useful for promoting an understanding of how interventions work for addressing psychosocial healthcare issues in older adults. RE also promotes the updating of plausible theories that lead to improving interventions. Our findings show the implications of managing time and resources to address the challenge of RE's time and resource intensiveness and carefully considering the data collection methods to reduce burdens on older adults.
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Affiliation(s)
- Shinya Mitani
- Graduate School of Health Management, Keio University, Fujisawa, Japan
| | - Hirofumi Ogawara
- Department of Nursing, Faculty of Human Sciences, Sophia University, Shinjuku-ku, Japan
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Junji Haruta
- Medical Education Center/Center for General Medicine Education, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Japan
| | - Tetsuya Sakakibara
- Department of Philosophy, Tokyo Woman's Christian University School of Arts and Sciences, Suginami-ku, Japan
| | - Hiroki Fukahori
- Faculty of Nusing and Medical Care, Keio University, Fujisawa, Japan
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Kim B, Cruden G, Crable EL, Quanbeck A, Mittman BS, Wagner AD. A structured approach to applying systems analysis methods for examining implementation mechanisms. Implement Sci Commun 2023; 4:127. [PMID: 37858215 PMCID: PMC10588196 DOI: 10.1186/s43058-023-00504-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 09/23/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND It is challenging to identify and understand the specific mechanisms through which an implementation strategy affects implementation outcomes, as implementation happens in the context of complex, multi-level systems. These systems and the mechanisms within each level have their own dynamic environments that change frequently. For instance, sequencing may matter in that a mechanism may only be activated indirectly by a strategy through another mechanism. The dosage or strength of a mechanism may vary over time or across different health care system levels. To elucidate the mechanisms relevant to successful implementation amidst this complexity, systems analysis methods are needed to model and manage complexity. METHODS The fields of systems engineering and systems science offer methods-which we refer to as systems analysis methods-to help explain the interdependent relationships between and within systems, as well as dynamic changes to systems over time. When applied to studying implementation mechanisms, systems analysis methods can help (i) better identify and manage unknown conditions that may or may not activate mechanisms (both expected mechanisms targeted by a strategy and unexpected mechanisms that the methods help detect) and (ii) flexibly guide strategy adaptations to address contextual influences that emerge after the strategy is selected and used. RESULTS In this paper, we delineate a structured approach to applying systems analysis methods for examining implementation mechanisms. The approach includes explicit steps for selecting, tailoring, and evaluating an implementation strategy regarding the mechanisms that the strategy is initially hypothesized to activate, as well as additional mechanisms that are identified through the steps. We illustrate the approach using a case example. We then discuss the strengths and limitations of this approach, as well as when these steps might be most appropriate, and suggest work to further the contributions of systems analysis methods to implementation mechanisms research. CONCLUSIONS Our approach to applying systems analysis methods can encourage more mechanisms research efforts to consider these methods and in turn fuel both (i) rigorous comparisons of these methods to alternative mechanisms research approaches and (ii) an active discourse across the field to better delineate when these methods are appropriate for advancing mechanisms-related knowledge.
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Affiliation(s)
- Bo Kim
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Gracelyn Cruden
- Chestnut Health Systems, Lighthouse Institute-Oregon Group, 1255 Pearl Street, Eugene, OR, 97401, USA
| | - Erika L Crable
- UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Andrew Quanbeck
- University of Wisconsin-Madison, 610 North Whitney Way, Madison, WI, 53705, USA
| | - Brian S Mittman
- Kaiser Permanente Southern California, 200 North Lewis Street, Orange, CA, 92868, USA
- University of Southern California, 2025 Zonal Avenue, Los Angeles, CA, 90089, USA
- UCLA, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA
| | - Anjuli D Wagner
- University of Washington, 3980 15Th Avenue NE, Seattle, WA, 98195, USA
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Total Quality and Innovation Management in Healthcare (TQIM-H) for an Effective Innovation Development: A Conceptual Framework and Exploratory Study. APPLIED SYSTEM INNOVATION 2022. [DOI: 10.3390/asi5040070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To thrive, an organization must adapt to the fast and constant change in the economic environment caused by an aging society, technological changes, and the pandemic crisis. Innovation becomes important for the adaptation of industries. Healthcare is one of them. Innovation development in hospitals is effective and acceptable when its management is effective and aligns with the healthcare quality context since quality is a philosophy of work in life-related settings. To the best of our knowledge, quality management and innovation management in healthcare have never been integrated. Therefore, this research aimed to create an integrated framework of quality and innovation management in healthcare (TQIM-H). To establish the effectiveness of applying TQIM-H for the development of effective healthcare innovation, this study developed a TQIM-H conceptual framework using multiple methodologies including a literature review, multiple case studies analysis, Delphi study with healthcare experts, Technology Acceptance Model (TAM), and triangulation with an external dataset. We constructed a TQIM-H conceptual framework, consisting of seven dimensions, that can be used in developing innovation projects in hospitals and which agrees with safety and quality principles in hospitals.
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Song Y, MacEachern L, Doupe MB, Ginsburg L, Chamberlain SA, Cranley L, Easterbrook A, Hoben M, Knopp-Sihota J, Reid RC, Wagg A, Estabrooks CA, Keefe JM, Rappon T, Berta WB. Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions. BMC Health Serv Res 2022; 22:666. [PMID: 35581651 PMCID: PMC9116057 DOI: 10.1186/s12913-022-08026-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Complex interventions are increasingly applied to healthcare problems. Understanding of post-implementation sustainment, sustainability, and spread of interventions is limited. We examine these phenomena for a complex quality improvement initiative led by care aides in 7 care homes (long-term care homes) in Manitoba, Canada. We report on factors influencing these phenomena two years after implementation. Methods Data were collected in 2019 via small group interviews with unit- and care home-level managers (n = 11) from 6 of the 7 homes using the intervention. Interview participants discussed post-implementation factors that influenced continuing or abandoning core intervention elements (processes, behaviors) and key intervention benefits (outcomes, impact). Interviews were audio-recorded, transcribed verbatim, and analyzed with thematic analysis. Results Sustainment of core elements and sustainability of key benefits were observed in 5 of the 6 participating care homes. Intra-unit intervention spread occurred in 3 of 6 homes. Factors influencing sustainment, sustainability, and spread related to intervention teams, unit and care home, and the long-term care system. Conclusions Our findings contribute understanding on the importance of micro-, meso-, and macro-level factors to sustainability of key benefits and sustainment of some core processes. Inter-unit spread relates exclusively to meso-level factors of observability and practice change institutionalization. Interventions should be developed with post-implementation sustainability in mind and measures taken to protect against influences such as workforce instability and competing internal and external demands. Design should anticipate need to adapt interventions to strengthen post-implementation traction. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08026-x.
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Affiliation(s)
- Yuting Song
- School of Nursing, Qingdao University, 308 Ningxia Road, Qingdao, 266071, Shandong Province, China. .,Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada.
| | - Lauren MacEachern
- Management & Evaluation, Institute for Health Policy, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 1P8, Canada
| | - Malcolm B Doupe
- Max Rady College of Medicine, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Liane Ginsburg
- School of Health Policy & Management, York University, Stong College 353, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Stephanie A Chamberlain
- Department of Family Medicine, University of Alberta, 6-50 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Lisa Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588 - 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada
| | - Jennifer Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada
| | - R Colin Reid
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan campus, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, 1-198 Clinical Sciences building, 11350 - 83Avenue, Edmonton, AB, T6G 2P4, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada
| | - Janice M Keefe
- Nova Scotia Centre On Aging, Mount Saint Vincent University, McCain 201F, 166 Bedford Hwy, Halifax, NS, B3M 2J6, Canada
| | - Tim Rappon
- Management & Evaluation, Institute for Health Policy, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 1P8, Canada
| | - Whitney B Berta
- Management & Evaluation, Institute for Health Policy, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 1P8, Canada
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