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Yousefi Nooraie R, Qin Q, Wagg A, Berta W, Estabrooks C. Building a communication and support network among quality improvement teams in nursing homes: a longitudinal study of the SCOPE trial. Implement Sci Commun 2024; 5:19. [PMID: 38438921 PMCID: PMC10913450 DOI: 10.1186/s43058-024-00559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND We applied a longitudinal network analysis approach to assess the formation of knowledge sharing and collaboration networks among care aide-led quality improvement (QI) teams in Canadian nursing homes participating in the Safer Care for Older Persons (in residential) Environments (SCOPE) trial which aimed to support unregulated front-line staff to lead unit-based quality improvement (QI) teams in nursing homes. We hypothesized that SCOPE's communicative and participatory nature would provide opportunities for peer support, knowledge sharing, and collaboration building among teams. METHODS Fourteen QI teams in Alberta (AB) and seventeen QI teams in British Columbia (BC) participated in the study. Communications across nursing homes occurred through a series of 4 collaborative Learning Congresses (training sessions) over a 1-year period. The senior leaders of QI teams participated in two online network surveys about the communication/collaboration between teams in their province, 1 month after the first, and 6 months later, after the fourth Learning Congress. We developed communication and collaboration network maps pertaining to three time points: before SCOPE, at 2 months, and at 9 months. RESULTS Over time, teams made significantly more new connections and strengthened existing ones, within and across regions. Geographic proximity and co-membership in organizational chains were important predictors of connectivity before and during SCOPE. Teams whose members were well connected at baseline disproportionately improved connectivity over time. On the other hand, teams that did not have prior opportunities to connect appeared to use SCOPE to build new ties. CONCLUSIONS Our findings suggest the importance of network-altering activities to the formation of collaboration networks among QI teams across nursing homes. Active strategies could be used to better connect less connected teams and facilitate collaboration among geographically proximate teams. These findings may inform the development of interventions to leverage existing networks and provide new networking opportunities to develop and sustain organizational improvements.
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Affiliation(s)
- Reza Yousefi Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.
| | - Qiuyuan Qin
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Adrian Wagg
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Whitney Berta
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Bunger AC, Yousefi-Nooraie R, Warren K, Cao Q, Dadgostar P, Bustos TE. Developing a typology of network alteration strategies for implementation: a scoping review and iterative synthesis. Implement Sci 2023; 18:10. [PMID: 37024916 PMCID: PMC10080780 DOI: 10.1186/s13012-023-01266-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/25/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Social networks transmit knowledge, influence, and resources. These relationships among patients, professionals, and organizations can shape how innovations are disseminated, adopted, implemented, and sustained. Network alteration interventions-interventions that change or rewire social networks-have the potential to be used as implementation strategies. Yet, the types, mechanisms, and effectiveness of these interventions for implementation are unclear. This scoping review and iterative synthesis identified and described network alteration strategies that could be tested for implementation. METHODS We used forward and backward citation tracking of influential articles on network interventions, bibliometric searches, and hand searches of peer-reviewed social network journals. At least two team members screened article titles/abstracts to identify studies that met inclusion criteria: empirical studies of an intervention, the intervention was designed to alter some element of a social network, and changes in social network metrics were measured at two or more time points. During full-text reviews, information about the network interventions, actors, ties, and main findings was extracted. Reporting was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). To develop our typology, we synthesized these results using an iterative team-based and consensus-building process. RESULTS Fifty-three articles met the inclusion criteria. The interventions described were conducted in healthcare systems or behavioral health systems (34%), communities (26.4%), and schools (22.6%). The majority included records describing interventions designed to alter social support, information-sharing, or friendship networks (65%) among individual actors (84.9%), or to increase ties. Eight strategies emerged. Three strategies targeted the general context: (1) change the environment, (2) create groups, and (3) change the composition. Four strategies targeted individual actors: change (4) motivations, (5) skills for networking, (6) knowledge of one's social network, and (7) prominence/roles. One strategy (8) targeted specific ties within the network (targeting a particular pair-wise relationship or changing the nature of an existing tie). CONCLUSION The network alteration strategies in this typology provide further operational specificity for how implementation strategies target relationships. Advancing these strategies will require greater theoretical specification, the development of strategies that target professionals and organizations, and studies that examine the impact on implementation outcomes.
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Affiliation(s)
- Alicia C Bunger
- College of Social Work, The Ohio State University, Columbus, OH, USA.
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Keith Warren
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Qiuchang Cao
- Pepper Institute On Aging and Public Policy & Claude Pepper Center, Florida State University, Tallahassee, FL, USA
| | - Porooshat Dadgostar
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Tatiana E Bustos
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Gaid D, Ahmed S, Thomas A, Bussières A. Barriers and Facilitators to Knowledge Brokering Activities: Perspectives from Knowledge Brokers Working in Canadian Rehabilitation Settings. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:87-95. [PMID: 36859412 DOI: 10.1097/ceh.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/29/2022] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Knowledge translation experts advocate for employing knowledge brokers (KBs) to promote the uptake of research evidence in health care settings. Yet, no previous research has identified potential barriers for KBs to promote the uptake of research evidence in rehabilitation settings. This study aimed to identify the barriers and facilitators for KBs in Canadian rehabilitation settings as perceived by individuals serving as KBs. METHODS Qualitative study using semistructured telephone interviews with individuals performing KB activities in rehabilitation settings across Canada. The interview topic guide was informed by the Consolidated Framework for Implementation Research (CFIR) and consisted of 20 questions covering three domains (characteristics of individuals, inner setting, and outer settings). We conducted qualitative descriptive analysis combining deductive coding guided by the CFIR. RESULTS Characteristics of individuals included having communication skills, clinical experience, research skills, and interpersonal features, in addition to being confident and motivated and receiving training. The inner setting domain included having constant networking with stakeholders and being aware of stakeholders' needs, in addition to resources availability, leadership engagement, knowledge accessibility, prioritizing brokering activities, and monitoring KBs' performance. Finally, the outer setting domain showed that KBs need to be connected to a community of practice to promote information exchange and avoid work duplications. DISCUSSION Factors likely to hinder or promote the optimal use of KBs within Canadian rehabilitation settings include skill sets and networking abilities; organizational culture, resources, and leadership engagement; and the need for specific training for KBs and for evaluation tools to monitor their performance.
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Affiliation(s)
- Dina Gaid
- Dr. Gaid: McGill University, School of Physical and Occupational Therapy, Montreal, Quebec, Canada, and The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada. Dr. Ahmed: McGill University, School of Physical and Occupational Therapy, Montreal, Quebec, Canada, and The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada, and Research Institute McGill University Health Center, Centre for Outcomes Research and Evaluation (CORE), Montreal, Quebec, Canada. Dr. Thomas: McGill University, School of Physical and Occupational Therapy, Montreal, Quebec, Canada, and The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada, and Institute of Health Sciences Education, Montreal, Quebec, Canada. Dr. Bussières: Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada, and McGill University, School of Physical and Occupational Therapy, Montreal, Quebec, Canada, and The Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
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Ruppel EH, Child S, Fischer CS, Botchway M. Causal Relationships between Personal Networks and Health: A Comparison of Three Modeling Strategies. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:392-409. [PMID: 35164576 DOI: 10.1177/00221465211072310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Prior research documents associations between personal network characteristics and health, but establishing causation has been a long-standing research priority. To evaluate approaches to causal inference in egocentric network data, this article uses three waves from the University of California Berkeley Social Networks Study (N = 1,159) to investigate connections between nine network variables and two global health outcomes. We compare three modeling strategies: cross-sectional ordinary least squares regression, regression with lagged dependent variables (LDVs), and hybrid fixed and random effects models. Results suggest that cross-sectional and LDV models may overestimate the causal effects of networks on health because hybrid models show that network-health associations operate primarily between individuals, as opposed to network changes causing within-individual changes in health. These findings demonstrate uses of panel data that may advance scholarship on networks and health and suggest that causal effects of network support on health may be more limited than previously thought.
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Haruta J, Tsugawa S, Ogura K. Analyzing annual changes in network structures of a social media application-based information-sharing system in a Japanese community. BMC Health Serv Res 2022; 22:1107. [PMID: 36045365 PMCID: PMC9429297 DOI: 10.1186/s12913-022-08478-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Understanding the evolution of social network services (SNSs) can provide insights into the functions of interprofessional information-sharing systems. Using social network analysis, we aimed to analyze annual changes in the network structure of SNS-based information sharing among healthcare professionals over a 3-year period in Japan.
Methods
We analyzed data on SNS-based information sharing networks with online message boards for healthcare professionals for 2018, 2019, and 2020 in a Japanese community.
These networks were created for each patient so that healthcare professionals could post and view messages on the web platform. In the social network analysis (SNA), healthcare professionals registered with a patient group were represented as nodes, and message posting and viewing relationships were represented as links. We investigated the structural characteristics of the networks using several measures for SNA, including reciprocity, assortativity and betweenness centrality, which reflect interrelational links, the prevalence of similar nodes with neighbors, and the mediating roles of other nodes, respectively. Next, to compare year-to-year trends in networks of patients overall, and between receiving nursing care levels 1–3 (lighter care requirement) and levels 4–5 (heavier care requirement), we described the annual structural differences and analyzed each measure for SNA using the Steel–Dwass test.
Results
Among 844, 940, and 1063 groups in each year, groups for analysis in care levels 1–3/4–5 were identified as 106/135, 79/89, and 57/57, respectively. The overall annual assessment showed a trend toward increased diameter and decreased density, but the differences were not significant. For those requiring care levels 1–3, assortativity decreased significantly, while for those requiring care levels 4–5, reciprocity decreased and betweenness centrality increased significantly. No significant differences were found in the other items.
Discussion
This study revealed that the network of patients with a lighter care requirement had more connections consisting of nodes with different links, whereas the network of patients with a heavier care requirement had more fixed intermediary roles and weaker interrelationships among healthcare professionals. Clarifying interprofessional collaborative mechanisms underlying development patterns among healthcare professionals can contribute to future clinical quality improvement.
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Bechel M, Pah AR, Persell SD, Weiss CH, Nunes Amaral LA. The first step is recognizing there is a problem: a methodology for adjusting for variability in disease severity when estimating clinician performance. BMC Med Res Methodol 2022; 22:69. [PMID: 35296240 PMCID: PMC8924737 DOI: 10.1186/s12874-022-01543-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Adoption of innovations in the field of medicine is frequently hindered by a failure to recognize the condition targeted by the innovation. This is particularly true in cases where recognition requires integration of patient information from different sources, or where disease presentation can be heterogeneous and the recognition step may be easier for some patients than for others. Methods We propose a general data-driven metric for clinician recognition that accounts for the variability in patient disease severity and for institutional standards. As a case study, we evaluate the ventilatory management of 362 patients with acute respiratory distress syndrome (ARDS) at a large academic hospital, because clinician recognition of ARDS has been identified as a major barrier to adoption to evidence-based ventilatory management. We calculate our metric for the 48 critical care physicians caring for these patients and examine the relationships between differences in ARDS recognition performance from overall institutional levels and provider characteristics such as demographics, social network position, and self-reported barriers and opinions. Results Our metric was found to be robust to patient characteristics previously demonstrated to affect ARDS recognition, such as disease severity and patient height. Training background was the only factor in this study that showed an association with physician recognition. Pulmonary and critical care medicine (PCCM) training was associated with higher recognition (β = 0.63, 95% confidence interval 0.46–0.80, p < 7 × 10− 5). Non-PCCM physicians recognized ARDS cases less frequently and expressed greater satisfaction with the ability to get the information needed for making an ARDS diagnosis (p < 5 × 10− 4), suggesting that lower performing clinicians may be less aware of institutional barriers. Conclusions We present a data-driven metric of clinician disease recognition that accounts for variability in patient disease severity and for institutional standards. Using this metric, we identify two unique physician populations with different intervention needs. One population consistently recognizes ARDS and reports barriers vs one does not and reports fewer barriers. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01543-7.
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Affiliation(s)
- Meagan Bechel
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Adam R Pah
- Northwestern Institute on Complex Systems, Northwestern University, 2145 Sheridan Road (Room E136), Evanston, IL, 60208, USA.,Kellogg School of Management, Northwestern University, Evanston, IL, USA
| | - Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Curtis H Weiss
- Division of Pulmonary, Critical Care, Allergy, and Immunology, NorthShore University HealthSystem, 1001 University Place, Suite 162, Evanston, IL, 60201, USA.
| | - Luís A Nunes Amaral
- Northwestern Institute on Complex Systems, Northwestern University, 2145 Sheridan Road (Room E136), Evanston, IL, 60208, USA. .,Department of Chemical and Biological Engineering, Northwestern University, Evanston, IL, USA. .,Department of Physics and Astronomy, Northwestern University, Evanston, IL, USA.
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Gaid D, Mate K, Ahmed S, Thomas A, Bussières A. Nationwide Environmental Scan of Knowledge Brokers Training. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:e3-e11. [PMID: 33929357 PMCID: PMC8876370 DOI: 10.1097/ceh.0000000000000355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Knowledge brokers (KBs) can promote the uptake of best practice guidelines in rehabilitation. Although many institutions offer training opportunities to health care professionals who wish to undertake KBs roles, the characteristics and content of those educational training opportunities (ETOs) are currently unknown. This study aimed to describe the ETOs available to rehabilitation professionals in Canada and determine whether the ETOs meet the competencies expected of the KBs roles. METHODS We conducted a Canada-wide environmental scan to identify ETOs using three strategies: online search, phone calls, and snowball. To be included in the study, ETOs had to be offered to rehabilitation professionals in Canada and be targeting KBs competencies and/or roles. We mapped each of the content to the KBs competencies (knowledge and skills) within the five roles of KBs: information manager, linking agent, capacity builder, facilitator, and evaluator. RESULTS A total of 51 ETOs offered in three Canadian provinces, British Columbia, Ontario, and Quebec, were included in the analysis. For KBs competencies, 76% of ETOs equipped attendees with research skills, 55% with knowledge brokering skills, and 53% with knowledge on implementation science. For KBs roles, over 60% of ETOs supported attendees to in performing the capacity builder role and 39% the evaluator role. DISCUSSION Findings suggest that ETOs focused primarily on preparing participants with the research and knowledge brokering skills required to perform the capacity builder and evaluator roles. Comprehensive educational training covering all KBs roles and competencies are needed.
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Hu H, Yang Y, Zhang C, Huang C, Guan X, Shi L. Review of social networks of professionals in healthcare settings-where are we and what else is needed? Global Health 2021; 17:139. [PMID: 34863221 PMCID: PMC8642762 DOI: 10.1186/s12992-021-00772-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/28/2021] [Indexed: 01/08/2023] Open
Abstract
Background Social Network Analysis (SNA) demonstrates great potential in exploring health professional relationships and improving care delivery, but there is no comprehensive overview of its utilization in healthcare settings. This review aims to provide an overview of the current state of knowledge regarding the use of SNA in understanding health professional relationships in different countries. Methods We conducted an umbrella review by searching eight academic databases and grey literature up to April 30, 2021, enhanced by citation searches. We completed study selection, data extraction and quality assessment using predetermined criteria. The information abstracted from the reviews was synthesized quantitatively, qualitatively and narratively. Results Thirteen reviews were included in this review, yielding 330 empirical studies. The degree of overlaps of empirical studies across included reviews was low (4.3 %), indicating a high diversity of included reviews and the necessity of this umbrella review. Evidence from low- and middle-income countries (LMIC), particularly Asian countries, was limited. The earliest review was published in 2010 and the latest in 2019. Six reviews focused on the construction or description of professional networks and seven reviews reported factors or influences of professional networks. We synthesized existing literature on social networks of health care professionals in the light of (i) theoretical frameworks, (ii) study design and data collection, (iii) network nodes, measures and analysis, and (iv) factors of professional networks and related outcomes. From the perspective of methodology, evidence lies mainly in cross-sectional study design and electronic data, especially administrative data showing “patient-sharing” relationships, which has become the dominant data collection method. The results about the impact of health professional networks on health-related consequences were often contradicting and not truly comparable. Conclusions Methodological limitations, inconsistent findings, and lack of evidence from LMIC imply an urgent need for further investigations. The potential for broader utilization of SNA among providers remains largely untapped and the findings of this review may contain important value for building optimal healthcare delivery networks. PROSPERO registration number The protocol was published and registered with PROSPERO, the International Prospective Register of Systematic Reviews (CRD42020205996). Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00772-7.
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Affiliation(s)
- Huajie Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 100191, Beijing, China
| | - Yu Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 100191, Beijing, China
| | - Chi Zhang
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Cong Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 100191, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 100191, Beijing, China. .,International Research Center for Medicinal Administration, Peking University, Beijing, China.
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 100191, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
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Walker AE, Wattick RA, Olfert MD. The Application of Systems Science in Nutrition-Related Behaviors and Outcomes Implementation Research: A Scoping Review. Curr Dev Nutr 2021; 5:nzab105. [PMID: 34522835 PMCID: PMC8435056 DOI: 10.1093/cdn/nzab105] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/14/2022] Open
Abstract
Use of systems science can improve the dissemination and implementation (D&I) process. However, little is known about use of systems science in nutrition D&I research. The purpose of this article is to synthesize the ways in which systems science methodology is applied in nutrition D&I research. Scoping review methodology involved searching 6 academic databases for full-text, peer-reviewed, English articles published between 1970 and 2020 that employed systems science within nutrition D&I research. Data extraction included intervention type, population, study aim, methods, theoretical approach, outcomes, and results. Descriptive statistics and qualitative thematic analysis followed. Thirty-four retained articles qualitatively identified benefits (successful planning and organization of complex interventions) and challenges (limited resources, trainings, and lack of knowledge) to utilizing systems science in nutrition D&I research. Future research should work toward building knowledge capacity among nutrition practitioners by increasing available trainings and resources to enhance the utilization of systems science in nutrition D&I research.
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Affiliation(s)
- Ayron E Walker
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources and Design, West Virginia University, Morgantown, WV, USA
| | - Rachel A Wattick
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources and Design, West Virginia University, Morgantown, WV, USA
| | - Melissa D Olfert
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources and Design, West Virginia University, Morgantown, WV, USA
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Barnes M, Gatti E, Rich K. Assessing the relevance of parks in a multi-sectoral park-health programme. MANAGING SPORT AND LEISURE 2021. [DOI: 10.1080/23750472.2021.1932563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Martha Barnes
- Department of Recreation and Leisure Studies, Brock University, St. Catharines, Canada
| | - Elise Gatti
- Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, Canada
| | - Kyle Rich
- Department of Recreation and Leisure Studies, Brock University, St. Catharines, Canada
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Smit LC, Dikken J, Schuurmans MJ, de Wit NJ, Bleijenberg N. Value of social network analysis for developing and evaluating complex healthcare interventions: a scoping review. BMJ Open 2020; 10:e039681. [PMID: 33203632 PMCID: PMC7674094 DOI: 10.1136/bmjopen-2020-039681] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Most complex healthcare interventions target a network of healthcare professionals. Social network analysis (SNA) is a powerful technique to study how social relationships within a network are established and evolve. We identified in which phases of complex healthcare intervention research SNA is used and the value of SNA for developing and evaluating complex healthcare interventions. METHODS A scoping review was conducted using the Arksey and O'Malley methodological framework. We included complex healthcare intervention studies using SNA to identify the study characteristics, level of complexity of the healthcare interventions, reported strengths and limitations, and reported implications of SNA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews 2018 was used to guide the reporting. RESULTS Among 2466 identified studies, 40 studies were selected for analysis. At first, the results showed that SNA seems underused in evaluating complex intervention research. Second, SNA was not used in the development phase of the included studies. Third, the reported implications in the evaluation and implementation phase reflect the value of SNA in addressing the implementation and population complexity. Fourth, pathway complexity and contextual complexity of the included interventions were unclear or unable to access. Fifth, the use of a mixed methods approach was reported as a strength, as the combination and integration of a quantitative and qualitative method clearly establishes the results. CONCLUSION SNA is a widely applicable method that can be used in different phases of complex intervention research. SNA can be of value to disentangle and address the level of complexity of complex healthcare interventions. Furthermore, the routine use of SNA within a mixed method approach could yield actionable insights that would be useful in the transactional context of complex interventions.
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Affiliation(s)
- Linda C Smit
- Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Jeroen Dikken
- Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Marieke J Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niek J de Wit
- Department of General Practice, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
- Department of Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Ramanadhan S, Daly J, Lee RM, Kruse GR, Deutsch C. Network-Based Delivery and Sustainment of Evidence-Based Prevention in Community-Clinical Partnerships Addressing Health Equity: A Qualitative Exploration. Front Public Health 2020; 8:213. [PMID: 32671008 PMCID: PMC7332771 DOI: 10.3389/fpubh.2020.00213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/08/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Increased delivery of evidence-based preventive services can improve population health and increase health equity. Community-clinical partnerships offer particular promise, but delivery and sustainment of preventive services through these systems face several challenges related to service integration and collaboration. We used a social network analysis perspective to explore (a) the range of contributions made by community-clinical partnership network members to support the delivery of evidence-based preventive services and (b) important influences on the ability of these partnerships to sustain service delivery. Methods: Data come from an implementation evaluation of the Prevention and Wellness Trust Fund initiative, which supported nine Massachusetts communities to coordinate delivery of evidence-based prevention and address inequities in hypertension, pediatric asthma, falls among older adults, or tobacco use. In 2016, we conducted semi-structured interviews with (a) leadership teams representing nine community-level partnerships and (b) practitioners from four high-implementation partnerships (n = 23). We managed data using NVivo11 and utilized a framework analysis approach. Results: Key network contributions for delivery of evidence-based preventive services included creating referrals, delivering services, providing links to community members, and administration and leadership. Less emphasized contributions included wraparound services, technical assistance, and venue provision. Implementers from high-implementation partnerships also highlighted contributions such as program adaptation, creating buy-in, and sharing information to improve service delivery. Expected drivers of program sustainability included the ability to develop a business case, ongoing network facilitation, technology support, continued integrated action, and sufficient staffing to maintain programming. Conclusion: The study highlights the need to take a long-term, infrastructure-focused approach when designing community-clinical partnerships. Strategic partnership composition, including identifying sources of necessary network contributions, in conjunction with efforts from the outset to link systems, align effort, and build a long-term funding structure can support the required coordinated action around preventive services needed to improve health equity.
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Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - James Daly
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Rebekka M. Lee
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Gina R. Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Charles Deutsch
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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Norton TC, Rodriguez DC, Willems S. Applying the Theoretical Domains Framework to understand knowledge broker decisions in selecting evidence for knowledge translation in low- and middle-income countries. Health Res Policy Syst 2019; 17:60. [PMID: 31186014 PMCID: PMC6560763 DOI: 10.1186/s12961-019-0463-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/23/2019] [Indexed: 11/12/2022] Open
Abstract
Background Health-related organisations disseminate an abundance of clinical and implementation evidence that has potential to improve health outcomes in low- and middle-income countries (LMICs), but little is known about what influences a user decision to select particular evidence for action. Knowledge brokers (KBs) play a part as intermediaries supporting evidence-informed health policy and practice by selecting and synthesising evidence for research users, and therefore understanding the basis for KB decisions, can help inform knowledge translation strategies. The Theoretical Domains Framework (TDF), a synthesis of psychological theories, was selected as a promising analysis approach because of its widespread use in identifying influences on decisions to act on evidence-based healthcare guidelines. This study explored its application in the context of KB decisions regarding evidence for use in LMICs. Methods The study analysed data collected from participants of a 2015 global maternal and newborn health conference in Mexico. A total of 324 conference participants from 56 countries completed an online survey and 20 from 15 countries were interviewed about evidence use and sharing after the conference. TDF domains and constructs were retrospectively applied and adapted during coding of qualitative data to enhance understanding of the KB decision process in selecting evidence for action. Results Application of the TDF involved challenges related to overlapping constructs, retrospective use, and complexities of global health settings and relevant knowledge. Codes needed to be added or adapted to account for how KBs’ internal reflections on external factors influenced their actions in selecting evidence to share and use, and the decisions they made during the process. Four themes of the rationale for changing the TDF were identified during analysis, namely Influences from Beyond the Organisation, Knowledge Selection as a Process, Access and Packaging of Knowledge, and Fit for Use. Conclusions Theories of individual behaviour, such as those in the TDF, can enhance understanding of the decisions made by actors such as KBs along dissemination and knowledge translation pathways. Understanding how KBs reflect on evidence and interact with their environment has the potential for improving global dissemination efforts and LMIC-to-LMIC exchange of implementation evidence. Electronic supplementary material The online version of this article (10.1186/s12961-019-0463-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Theresa C Norton
- Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, United States of America.
| | - Daniela C Rodriguez
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States of America
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Campus UZ, K3, 6de verdieping, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Hunter RF, Wickramasinghe K, Ergüder T, Bolat A, Arı HO, Yıldırım HH, Ursu P, Robinson G, Breda J, Mikkelsen B, Connolly P, Clarke M, Kee F. National action plans to tackle NCDs: role of stakeholder network analysis. BMJ 2019; 365:l1871. [PMID: 31110055 PMCID: PMC6526679 DOI: 10.1136/bmj.l1871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Network science approaches can enhance global and national coordinated efforts to prevent and manage non-communicable diseases, say Ruth Hunter and colleagues
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Kremlin Wickramasinghe
- WHO European Office for Prevention and Control of Non-communicable Diseases, WHO Regional Office for Europe, Moscow, Russia
| | | | | | - Hakan Oğuz Arı
- Turkish Institute for Health Policies, Health Institutes of Turkey, Ankara, Turkey
| | | | | | - Gareth Robinson
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Joao Breda
- WHO European Office for Prevention and Control of Non-communicable Diseases, WHO Regional Office for Europe, Moscow, Russia
| | - Bente Mikkelsen
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe, Moscow, Russia
| | - Paul Connolly
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Mike Clarke
- Centre for Public Health/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
- Evidence Aid, Oxford, UK
| | - Frank Kee
- Centre for Public Health/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
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Glegg SMN, Jenkins E, Kothari A. How the study of networks informs knowledge translation and implementation: a scoping review. Implement Sci 2019; 14:34. [PMID: 30917844 PMCID: PMC6437864 DOI: 10.1186/s13012-019-0879-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 03/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background To date, implementation science has focused largely on identifying the individual and organizational barriers, processes, and outcomes of knowledge translation (KT) (including implementation efforts). Social network analysis (SNA) has the potential to augment our understanding of KT success by applying a network lens that examines the influence of relationships and social structures on research use and intervention acceptability by health professionals. The purpose of this review was to comprehensively map the ways in which SNA methodologies have been applied to the study of KT with respect to health professional networks. Methods Systematic scoping review methodology involved searching five academic databases for primary research on KT that employed quantitative SNA methods, and inclusion screening using predetermined criteria. Data extraction included information on study aim, population, variables, network properties, theory use, and data collection methods. Descriptive statistics and chronology charting preceded theoretical analysis of findings. Results Twenty-seven retained articles describing 19 cross-sectional and 2 longitudinal studies reported on 28 structural properties, with degree centrality, tie characteristics (e.g., homophily, reciprocity), and whole network density being most frequent. Eleven studies examined physician-only networks, 9 focused on interprofessional networks, and 1 reported on a nurse practitioner network. Diffusion of innovation, social contagion, and social influence theories were most commonly applied. Conclusions Emerging interest in SNA for KT- and implementation-related research is evident. The included articles focused on individual level evidence-based decision-making: we recommend also applying SNA to meso- or macro-level KT activities. SNA research that expands the range of professions under study, examines network dynamics over time, extends the depth of analysis of the role of network structure on KT processes and outcomes, and employs mixed methods to triangulate findings, is needed to advance the field. SNA is a valuable approach for evaluating key network characteristics, structures and positions of relevance to KT, implementation, and evidence informed practice. Examining how network structure influences connections and the implications of those holding prominent network positions can provide insights to improve network-based KT processes.
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Affiliation(s)
- Stephanie M N Glegg
- Rehabilitation Sciences, The University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Therapy Department, Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, BC, V5M 3E8, Canada. .,BC Children's Hospital Research Institute, 938 West 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
| | - Emily Jenkins
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Anita Kothari
- School of Health Studies, Western University, Arthur and Sonia Labatt Health Sciences Building, Room 222, London, ON, V6A 5B9, Canada
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16
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Bunger AC, Doogan N, Hanson RF, Birken SA. Advice-seeking during implementation: a network study of clinicians participating in a learning collaborative. Implement Sci 2018; 13:101. [PMID: 30055629 PMCID: PMC6064109 DOI: 10.1186/s13012-018-0797-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Successful implementation depends on the transfer of knowledge and expertise among clinicians, which can occur when professionals seek advice from one another. This study examines advice-seeking patterns among mental health clinicians participating in learning collaboratives (a multi-component implementation and quality improvement strategy) to implement trauma-focused cognitive behavioral therapy (TF-CBT). We apply transactive memory system theory, which explains how professionals access and retrieve knowledge, to examine factors associated with the evolution of advice-seeking relationships during implementation. Our aim is to unpack learning collaboratives' mechanisms by investigating how and why advice-seeking networks change, which may help us understand how implementation strategies can best target networks. METHODS Using social network analysis and a pretest-post-test design, we examined patterns in general and treatment-specific advice-seeking among 146 participants (including five clinical experts) from 27 agencies participating in a regional scale-up of TF-CBT. Surveys were administered in-person at the first and last of three in-person learning sessions (10 months apart) that comprise a core component of learning collaboratives. Participants nominated up to five individuals from whom they seek general and treatment-specific advice. Exponential random graph models (ERGMs) tested the likelihood of maintaining or forming advice-seeking relationships based on indicators of expertise quality, accessibility, need, and prior advice-seeking relationships. RESULTS Participants formed or maintained advice-seeking relationships with those who possess perceived expertise (e.g., learning collaborative faculty experts, supervisors, and those with greater field experience than themselves). Participants also tended to seek advice from those within the same organization and with similar disciplinary training, highlighting the importance of expertise accessibility. Prior relationships and network structural features were associated with advice-seeking, indicating that participants built on existing social ties. Advice-seeking did not vary based on participants' role or experience. CONCLUSIONS Given the importance of accessible clinical expertise and ongoing supervision for delivering treatment with fidelity, learning collaboratives may support implementation by promoting clinicians' awareness of and access to others' expertise, especially those with substantial expertise to share (e.g., faculty experts and supervisors). Future controlled studies are needed to verify the effectiveness of learning collaboratives for building networks that connect clinicians and experts and for improving implementation.
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Affiliation(s)
- Alicia C Bunger
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH, 43210, USA.
| | - Nathan Doogan
- The Ohio Colleges of Medicine Government Resource Center , The Ohio State University, 1070 Carmack Road, Columbus, OH, 43210, USA
| | - Rochelle F Hanson
- National Crime Victims Research and Training Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 100 Doughty Street, Charleston, SC, 29425, USA
| | - Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC, 27599, USA
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Yousefi Nooraie R, Khan S, Gutberg J, Baker GR. A Network Analysis Perspective to Implementation: The Example of Health Links to Promote Coordinated Care. Eval Health Prof 2018; 42:395-421. [PMID: 29719988 DOI: 10.1177/0163278718772887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although implementation models broadly recognize the importance of social relationships, our knowledge about applying social network analysis (SNA) to formative, process, and outcome evaluations of health system interventions is limited. We explored applications of adopting an SNA lens to inform implementation planning, engagement and execution, and evaluation. We used Health Links, a province-wide program in Canada aiming to improve care coordination among multiple providers of high-needs patients, as an example of a health system intervention. At the planning phase, an SNA can depict the structure, network influencers, and composition of clusters at various levels. It can inform the engagement and execution by identifying potential targets (e.g., opinion leaders) and by revealing structural gaps and clusters. It can also be used to assess the outcomes of the intervention, such as its success in increasing network connectivity; changing the position of certain actors; and bridging across specialties, organizations, and sectors. We provided an overview of how an SNA lens can shed light on the complexity of implementation along the entire implementation pathway, by revealing the relational barriers and facilitators, the application of network-informed and network-altering interventions, and testing hypotheses on network consequences of the implementation.
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Affiliation(s)
- Reza Yousefi Nooraie
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sobia Khan
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jennifer Gutberg
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - G Ross Baker
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Francis-Coad J, Etherton-Beer C, Bulsara C, Blackburn N, Chivers P, Hill AM. Evaluating the impact of a falls prevention community of practice in a residential aged care setting: a realist approach. BMC Health Serv Res 2018; 18:21. [PMID: 29334963 PMCID: PMC5769423 DOI: 10.1186/s12913-017-2790-2] [Citation(s) in RCA: 12] [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: 03/22/2016] [Accepted: 12/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a major socio-economic problem among residential aged care (RAC) populations resulting in high rates of injury including hip fracture. Guidelines recommend that multifactorial prevention strategies are implemented but these require translation into clinical practice. A community of practice (CoP) was selected as a suitable model to support translation of the best available evidence into practice, as it could bring together like-minded people with falls expertise and local clinical knowledge providing a social learning opportunity in the pursuit of a common goal; falls prevention. The aims of this study were to evaluate the impact of a falls prevention CoP on its membership; actions at facility level; and actions at organisation level in translating falls prevention evidence into practice. METHODS A convergent, parallel mixed methods evaluation design based on a realist approach using surveys, audits, observations and semi-structured interviews. Participants were 20 interdisciplinary staff nominating as CoP members between Nov 2013-Nov 2015 representing 13 facilities (approximately 780 beds) of a RAC organisation. The impact of the CoP was evaluated at three levels to identify how the CoP influenced the observed outcomes in the varying contexts of its membership (level i.), the RAC facility (level ii.) and RAC organisation (level iii.). RESULTS Staff participating as CoP members gained knowledge and awareness in falls prevention (p < 0.001) through connecting and sharing. Strategies prioritised and addressed at RAC facility level culminated in an increase in the proportion of residents supplemented with vitamin D (p = 0.002) and development of falls prevention education. At organisation level a falls policy reflecting preventative evidence-based guidelines and a new falls risk assessment procedure with aligned management plans were written, modified and implemented. A key disenabling mechanism identified by CoP members was limited time to engage in translation of evidence into practice whilst enabling mechanisms included proactive behaviours by staff and management. CONCLUSIONS Interdisciplinary staff participating in a falls prevention CoP gained connectivity and knowledge and were able to facilitate the translation of falls prevention evidence into practice in the context of their RAC facility and RAC organisation. Support from RAC organisational and facility management to make the necessary investment in staff time to enable change in falls prevention practice is essential for success.
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Affiliation(s)
- Jacqueline Francis-Coad
- School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, 19 Mouat St, Fremantle, Western Australia 6959 Australia
| | - Christopher Etherton-Beer
- School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia 6009 Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, The University of Notre Dame Australia, 19 Mouat St, Fremantle, Western Australia 6959 Australia
| | - Nicole Blackburn
- Brightwater Group, 355 Scarborough Beach Rd, Osborne Park, Western Australia 6017 Australia
| | - Paola Chivers
- Institute for Health Research, The University of Notre Dame Australia, 19 Mouat St, Fremantle, Western Australia 6959 Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia 6845 Australia
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19
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Mehta TG, Atkins MS, Neal JW, Walden AL. Supporting mental health providers: The feasibility and promise of a virtual professional learning community. ACTA ACUST UNITED AC 2018; 3:236-251. [PMID: 31538111 DOI: 10.1080/23794925.2018.1486687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Tara G Mehta
- Institute of Juvenile Research, Department of Psychiatry, University of Illinois at Chicago
| | - Marc S Atkins
- Institute of Juvenile Research, Department of Psychiatry, University of Illinois at Chicago
| | | | - Angela L Walden
- Institute of Juvenile Research, Department of Psychiatry, University of Illinois at Chicago
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D Agostino M, Mejía F, Brooks I, Marti M, Novillo-Ortiz D, de Cosio G. Fear on the networks: analyzing the 2014 Ebola outbreak. Rev Panam Salud Publica 2017; 41:e134. [PMID: 31384264 PMCID: PMC6645359 DOI: 10.26633/rpsp.2017.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/31/2017] [Indexed: 11/24/2022] Open
Abstract
During the 2014 Ebola outbreak, information spread via multiple platforms, including social networks and Internet search engines. This report analyzes Twitter tweets, Facebook posts, and Google trends, as well as several other Internet resources, from March - November 2014. Understanding the types of discussions, social behaviors, feelings expressed, and information shared during the Ebola outbreak can help health organizations improve communication interventions and avert misinformation and panic during health emergencies. In all, 6 422 170 tweets, 83 Facebook posts, and Google search trends were integrated with 63 chronological Ebola-related events. Events that prompted a surge in tweets using #ebola were related to new cases of infection or the entry of the disease into a new goegraphic area. Most tweets were re-tweets of information provided by news agencies and official health organizations. Events related to new infections and deaths seemed to correlate with an increase of words that express fear. Google results concurred with Twitter and Facebook. Data from social media activity can be used to form hypotheses about how the public responds to and behaves during public health events, prompting health organizations to adopt new strategies for communications interventions. Furthermore, a spike in activity around a topic can be used as a surveillance technique to signal to health authorities that an outbreak may be underway. It is also recommended that news agencies, which engage with the public most often, consider content review by health experts as part of their health communications process.
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Affiliation(s)
- Marcelo D Agostino
- Health Information and Analysis Unit Department of Communicable Diseases and Health Analysis, Pan American Health Organization Regional Office of the World Health Organization Washington, DC. United States of America Health Information and Analysis Unit, Department of Communicable Diseases and Health Analysis, Pan American Health Organization, Regional Office of the World Health Organization, Washington, DC, United States of America. Send correspondence to Marcelo D'Agostino
| | - Felipe Mejía
- International Consultant International Consultant Bogotá Colombia International Consultant, Bogotá, Colombia
| | - Ian Brooks
- School of Information Sciences University of Illinois, Urbana-Champagne Illinois United States School of Information Sciences, University of Illinois, Urbana-Champagne, Illinois, United States
| | - Myrna Marti
- Department of Knowledge Management Bioethics,and Research, Pan American Health Organization Washington, DC. United States Department of Knowledge Management, Bioethics, and Research, Pan American Health Organization,Washington, DC, United States
| | - David Novillo-Ortiz
- Department of Knowledge Management Bioethics,and Research, Pan American Health Organization Washington, DC. United States Department of Knowledge Management, Bioethics, and Research, Pan American Health Organization,Washington, DC, United States
| | - Gerardo de Cosio
- Health Information and Analysis Unit Department of Communicable Diseases and Health Analysis, Pan American Health Organization Regional Office of the World Health Organization Washington, DC. United States of America Health Information and Analysis Unit, Department of Communicable Diseases and Health Analysis, Pan American Health Organization, Regional Office of the World Health Organization, Washington, DC, United States of America. Send correspondence to Marcelo D'Agostino
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Yousefi Nooraie R, Marin A, Hanneman R, Lohfeld L, Dobbins M. Implementation of evidence-informed practice through central network actors; a case study of three public health units in Canada. BMC Health Serv Res 2017; 17:208. [PMID: 28298209 PMCID: PMC5353959 DOI: 10.1186/s12913-017-2147-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/08/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Workforce development is an important aspect of evidence-informed decision making (EIDM) interventions. The social position of individuals in formal and informal social networks, and the relevance of formal roles in relation to EIDM are important factors identifying key EIDM players in public health organizations. We assessed the role of central actors in information sharing networks in promoting the adoption of EIDM by the staff of three public health units in Canada, over a two-year period during which an organization-wide intervention was implemented. METHODS A multi-faceted and tailored intervention to train select staff applying research evidence in practice was implemented in three public health units in Canada from 2011 to 2013. Staff (n = 572) were asked to identify those in the health unit whom they turned to get help using research in practice, whom they considered as experts in EIDM, and friends. We developed multi-level linear regression models to predict the change in EIDM behavior scores predicted by being connected to peers who were central in networks and were engaged in the intervention. RESULTS Only the group of highly engaged central actors who were connected to each other, and the staff who were not engaged in the intervention but were connected to highly engaged central actors significantly improved their EIDM behavior scores. Among the latter group, the staff who were also friends with their information sources showed a larger improvement in EIDM behavior. CONCLUSIONS If engaged, central network actors use their formal and informal connections to promote EIDM. Central actors themselves are more likely to adopt EIDM if they communicate with each other. These social communications should be reinforced and supported through the implementation of training interventions as a means to promoting EIDM.
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Affiliation(s)
- Reza Yousefi Nooraie
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- 175 Longwood Road South, Suite 210a, Hamilton, ON L8P 0A1 Canada
| | - Alexandra Marin
- Department of Sociology, University of Toronto, Toronto, Canada
| | - Robert Hanneman
- Department of Sociology, College of Humanities, Arts, and Social Sciences, University of California, Riverside, USA
| | - Lynne Lohfeld
- Queen’s University Belfast, Centre for Public Health, Belfast, UK
| | - Maureen Dobbins
- School of Nursing and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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Yousefi Nooraie R, Lohfeld L, Marin A, Hanneman R, Dobbins M. Informing the implementation of evidence-informed decision making interventions using a social network analysis perspective; a mixed-methods study. BMC Health Serv Res 2017; 17:122. [PMID: 28178958 PMCID: PMC5299784 DOI: 10.1186/s12913-017-2067-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/01/2017] [Indexed: 11/12/2022] Open
Abstract
Background Workforce development is an important aspect of evidence-informed decision making (EIDM) interventions. The structure of formal and informal social networks can influence, and be influenced, by the implementation of EIDM interventions. Methods In a mixed methods study we assessed the outcomes of a targeted training intervention to promote EIDM among the staff in three public health units in Ontario, Canada. This report focuses on the qualitative phase of the study in which key staff were interviewed about the process of engagement in the intervention, communications during the intervention, and social consequences. Results Senior managers identified staff to take part in the intervention. Engagement was a top-down process determined by the way organizational leaders promoted EIDM and the relevance of staff’s jobs to EIDM. Communication among staff participating in the workshops and ongoing progress meetings was influential in overcoming personal and normative barriers to implementing EIDM, and promoted the formation of long-lasting social connections among staff. Organization-wide presentations and meetings facilitated the recognition of expertise that the trained staff gained, including their reputation as experts according to their peers in different divisions. Conclusion Selective training and capacity development interventions can result in forming an elite versus ordinary pattern that facilitates the recognition of in-house qualified experts while also strengthening social status inequality. The role of leadership in public health units is pivotal in championing and overseeing the implementation process. Network analysis can guide and inform the design, process, and evaluation of the EIDM training interventions.
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Affiliation(s)
- Reza Yousefi Nooraie
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. .,, 175 Longwood Road South, Suite 210a, Hamilton, ON, L8P 0A1, Canada.
| | - Lynne Lohfeld
- Queen's University Belfast, Centre for Public Health, Belfast, UK
| | - Alexandra Marin
- Department of Sociology, University of Toronto, Toronto, Canada
| | - Robert Hanneman
- Department of Sociology, College of Humanities, Arts, and Social Sciences, University of California, Riverside, USA
| | - Maureen Dobbins
- School of Nursing and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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