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Pétein C, Dujardin N, de Montigny M, Dewez E, Spinewine A, Henrard S. Deprescribing benzodiazepine receptor agonists in older adults: a mixed-methods study to adapt the Canadian D-PRESCRIBE intervention to the Belgian community setting. BMJ Open 2024; 14:e085396. [PMID: 39153767 DOI: 10.1136/bmjopen-2024-085396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2024] Open
Abstract
OBJECTIVE Guidelines recommend deprescribing benzodiazepine receptor agonists (BZRA) in older adults, yet implementation in clinical practice remains limited. Adapting effective, evidence-based interventions to a new context is a resource-saving strategy. In Canada, the D-PRESCRIBE intervention comprised a patient educational brochure and a pharmaceutical opinion inviting physicians to revise BZRA prescribing and consider safer alternatives. Due to its effectiveness on BZRA deprescribing among Canadian older adults, we aimed to adapt the D-PRESCRIBE intervention to the Belgian community setting. DESIGN Recommendations from the ADAPT guidance, that provides a systematic approach for adapting interventions to new contexts, were followed. We conducted a mixed-methods study that comprised (1) group discussions and cognitive interviews to assess the acceptability and need for adaptation of the intervention's components and (2) a survey on the adapted pharmaceutical opinion. A research committee involving stakeholders' representatives decided on the adaptations, respecting the core functions of both tools. Changes in intervention components were reported following the Model for Adaptation Design and Impact framework. SETTING Belgian French-speaking community setting. PARTICIPANTS Six older adults (≥65 years), six general practitioners (GPs) and seven pharmacists participated in the group discussions or interviews. 46 GPs and 91 pharmacists responded to the survey. RESULTS Participants welcomed the brochure positively. Still, some changes in the vocabulary, wording, photos and icons were made for several purposes including making the patient feel concerned about the brochure and softening the use of fear. The pharmaceutical opinion aroused mixed perceptions. Its name, layout and content were adapted to enhance its acceptability and fit with our healthcare system, practices and national guidelines. The survey highlighted several enablers and barriers to its use from the perspectives of GP and pharmacist. CONCLUSIONS The Canadian D-PRESCRIBE intervention was adapted to the Belgian setting following a thorough and transparent process. Its feasibility will be tested in a future pilot study (NCT:05929417).
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Affiliation(s)
- Catherine Pétein
- Clinical Pharmacy and Pharmacoepidemiology Research Group, UCLouvain, Louvain Drug Research Institute, Brussels, Belgium
| | - Nathalie Dujardin
- Academic Center for Pharmaceutical Care, Faculté de Pharmacie et des Sciences Biomédicales, UCLouvain, Brussels, Belgium
| | - Manon de Montigny
- Centre académique de Médecine Générale, Faculté de Médecine et Médecine dentaire, UCLouvain, Brussels, Belgium
| | - Evelyne Dewez
- Ligue des Usagers des Services de Santé (LUSS), Namur, Belgium
| | - Anne Spinewine
- Clinical Pharmacy and Pharmacoepidemiology Research Group, UCLouvain, Louvain Drug Research Institute, Brussels, Belgium
- Pharmacy Deparment, CHU UCL Namur, UCLouvain, Yvoir, Belgium
| | - Séverine Henrard
- Clinical Pharmacy and Pharmacoepidemiology Research Group, UCLouvain, Louvain Drug Research Institute, Brussels, Belgium
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
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Tantum LK, Mahamane E, Bauza V, Mahamadou KOB, Sanoussi EY, Salzberg A, Anderson DM. Environmental Infrastructure Maintenance Bottlenecks in Healthcare Facilities and Coping Strategies Among Healthcare Workers in Niger. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302241271554. [PMID: 39148586 PMCID: PMC11325333 DOI: 10.1177/11786302241271554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/01/2024] [Indexed: 08/17/2024]
Abstract
Infrastructure for water, sanitation, hygiene, cleaning, and waste management is essential for supporting safe environmental conditions in healthcare facilities. Routine maintenance is important for preventing infrastructure breakdowns, but few studies have examined healthcare facility maintenance practices. This study documented environmental maintenance tasks in healthcare facilities in Niger, described bottlenecks to maintenance, and assessed strategies for coping with breakdowns. At 34 rural healthcare facilities in Niger, we conducted quantitative surveys to assess frequency of maintenance tasks and held qualitative interviews with healthcare facility staff to understand bottlenecks to maintenance. On at least a monthly basis, 4% of healthcare facilities inspected their water source and pump for the purpose of detecting and replacing worn parts, 15% inspected water taps and basins, and 29% inspected incinerators. Healthcare facility staff described barriers to accessing government funds for maintenance. Instead, they paid out of their own salaries or raised funds through appeals to community members or revenue generation initiatives. Other bottlenecks included ill-defined management responsibilities and difficulty of finding skilled technicians for maintenance. Findings highlight opportunities to support healthcare facilities in budgeting, advocacy, and training skilled technicians. Initiatives to install infrastructure at healthcare facilities will be more sustainable if they are accompanied by postconstruction planning, training, and funding for maintenance.
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Affiliation(s)
- Lucy K Tantum
- The Water Institute at UNC, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Valerie Bauza
- The Water Institute at UNC, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Elisha Y Sanoussi
- Department of Bioengineering & Therapeutic Sciences, University of California San Francisco/University of California Berkeley, Berkeley, CA, USA
| | - Aaron Salzberg
- The Water Institute at UNC, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Darcy M Anderson
- The Water Institute at UNC, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sweeney AM, Wilson DK, Zarrett N, Simmons T, Mansfield M, Decker L. Using formative process evaluation to improve program implementation and accessibility of competitive group-based physical activity in the TEAM-PA trial. Int J Behav Nutr Phys Act 2024; 21:88. [PMID: 39138496 PMCID: PMC11321224 DOI: 10.1186/s12966-024-01635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND This study demonstrates how formative process evaluation was used to assess implementation and improve dose and fidelity in the Together Everyone Achieves More Physical Activity (TEAM-PA) randomized controlled trial. TEAM-PA uses a randomized group cohort design to evaluate the efficacy of a group-based intervention for increasing physical activity among African American women. METHODS Intervention groups met for 10 weeks and were co-led by female African American facilitators, with intervention sessions consisting of group feedback, a health curriculum, group-based physical activity games, and group-based goal-setting. Drawing from a multi-theoretical framework, the intervention targeted social affiliation using collaborative and competitive group strategies, including essential elements focused on group-based behavioral skills, peer-to-peer positive communication, collectivism, optimal challenge, social facilitation, and peer to peer challenges. Formative process evaluation was used to monitor reach, dose, and fidelity, and implement feedback and solutions. RESULTS Across two cohorts, four groups (n = 54) were randomized to the TEAM-PA intervention. On average 84.8% of participants attended each week, which exceeded the a priori criteria. Results from the systematic observations indicated that on average 93% of the dose items were completed in each session and adequate levels of fidelity were achieved at both the facilitator and group-levels. Participants were compliant with wearing the FitBits (6.73 ± 0.42 days/week) and most participants successfully contributed to meeting the group-based goals. The use of open-ended items also revealed the need for additional modifications to the group-based PA games, including allowing for individuals to take breaks, incorporating a broader range of exercises, minimizing activities that required bending/reaching down without assistance, and providing facilitators with additional training for implementing the games. Initial evidence suggests that these changes were successful in increasing participants' comprehension of the games from Cohort 1 (M = 1.83, SD = 0.71) to Cohort 2 (M = 3.33, SD = 0.69). CONCLUSION Findings from this study demonstrated high levels of reach, dose, and fidelity, while also highlighting strategies for implementing competitive group-based PA games that are accessible across physical fitness levels. Formative process evaluation, including open-ended items and collaborative brainstorming, holds tremendous potential for improving future interventions. TRIAL REGISTRATION This study was registered on Clinicaltrials.gov (# NCT05519696) on August 22, 2022 prior to the enrollment of the first participant on September 12, 2022 ( https://clinicaltrials.gov/study/NCT05519696?term=NCT05519696&rank=1 ).
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Affiliation(s)
- Allison M Sweeney
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29201, USA.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, USA
| | - Nicole Zarrett
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, USA
| | - Timothy Simmons
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, USA
| | - Makayla Mansfield
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29201, USA
| | - Lindsay Decker
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29201, USA
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Genovesi E, Ahmed I, Ayele M, Belay W, Burningham O, Chen A, Girma F, Tesfaye Lakew L, Hanlon C, Hoekstra RA. Exploring context for implementation of inclusive education for children with developmental disabilities in mainstream primary schools in Ethiopia. PLoS One 2024; 19:e0307576. [PMID: 39121044 PMCID: PMC11315310 DOI: 10.1371/journal.pone.0307576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/08/2024] [Indexed: 08/11/2024] Open
Abstract
A large gap in provision of services for children with developmental disabilities (DD) has been identified in Ethiopia, especially in the education system. Including children with disabilities in mainstream schools is encouraged by policies, but progress in this direction has been limited. This study aimed to explore stakeholders' perspectives on contextual factors relevant for inclusive education for children with DD in mainstream schools in Ethiopia, with a focus on Adis Ababa. Data were collected through semi-structured interviews with 39 local stakeholders, comprising caregivers of children with DD, school teachers and principals/managers, non-governmental organisation representatives, government officials, clinicians and academics/consultants. We used template analysis to code the data and map them onto domains of the Context and Setting dimensions of the Context and Implementation of Complex Interventions framework. Stakeholders discussed frameworks in the Legal and Ethical context endorsing the right of all children to education. However, they reported multiple reasons why children with DD in Ethiopia have limited access to education, either in special or mainstream schools. First, individual features, such as gender and support needs, discussed in the Epidemiological context, may affect the likelihood of a child with DD to be accepted in school. Transportation challenges are a key barrier in the Geographical context. Socio-economic and Socio-cultural contexts present barriers at the levels of the nation, school and family, mostly related to limited services and material and financial resources and limited awareness of DD. Stakeholders believe the currently limited but growing commitment in the Political context can support progress towards the removal of these barriers. Our findings can form the basis for development of an implementation plan that addresses such barriers and capitalises on existing facilitators.
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Affiliation(s)
- Elisa Genovesi
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Ikram Ahmed
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Moges Ayele
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Winini Belay
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Olivia Burningham
- Department of International Development, London School of Economics and Political Science, London, United Kingdom
| | - Amanda Chen
- St Andrew’s Mission School, Singapore, Singapore
| | - Fikirte Girma
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Charlotte Hanlon
- Centre for Clinical Brain Sciences, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Rosa Anna Hoekstra
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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Dunsmore J, Duncan E, MacLennan S, N'Dow J, MacLennan S. Specifying behavioural and strategy components of de-implementation efforts targeting low-value prescribing practices in secondary health care. Implement Sci Commun 2024; 5:88. [PMID: 39113160 PMCID: PMC11304722 DOI: 10.1186/s43058-024-00624-6] [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: 12/22/2023] [Accepted: 07/27/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND /Aims De-implementation, including the removal or reduction of unnecessary or inappropriate prescribing, is crucial to ensure patients receive appropriate evidence-based health care. The utilization of de-implementation efforts is contingent on the quality of strategy reporting. To further understand effective ways to de-implement medical practices, specification of behavioural targets and components of de-implementation strategies are required. This paper aims to critically analyse how well the behavioural targets and strategy components, in studies that focused on de-implementing unnecessary or inappropriate prescribing in secondary healthcare settings, were reported. METHODS A supplementary analysis of studies included in a recently published review of de-implementation studies was conducted. Article text was coded verbatim to two established specification frameworks. Behavioural components were coded deductively to the five elements of the Action, Actor, Context, Target, Time (AACTT) framework. Strategy components were mapped to the nine elements of the Proctor's 'measuring implementation strategies' framework. RESULTS The behavioural components of low-value prescribing, as coded to the AACTT framework, were generally specified well. However, the Actor and Time components were often vague or not well reported. Specification of strategy components, as coded to the Proctor framework, were less well reported. Proctor's Actor, Action target: specifying targets, Dose and Justification elements were not well reported or varied in the amount of detail offered. We also offer suggestions of additional specifications to make, such as the 'interactions' participants have with a strategy. CONCLUSION Specification of behavioural targets and components of de-implementation strategies for prescribing practices can be accommodated by the AACTT and Proctor frameworks when used in conjunction. These essential details are required to understand, replicate and successfully de-implement unnecessary or inappropriate prescribing. In general, standardisation in the reporting quality of these components is required to replicate any de-implementation efforts. TRIAL REGISTRATION Not registered.
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Affiliation(s)
| | - Eilidh Duncan
- Health Service Research Unit, University of Aberdeen, Aberdeen, U.K
| | - Sara MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, U.K
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, U.K
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Petrasso C, Bayly J, Arculeo S, Bowers M, Costi S, Nottelmann L, Turola E, Vanzulli E, Maddocks M. Non-pharmacological interventions targeting mobility among people with advanced cancer: a systematic review. Support Care Cancer 2024; 32:569. [PMID: 39102127 DOI: 10.1007/s00520-024-08767-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE To synthesise evidence evaluating non-pharmacological interventions targeting mobility among people with advanced cancer, considering the type, efficacy and contextual factors that may influence outcome. METHODS Systematic review of studies of non-pharmacological interventions in adults (≥ 18 years) with advanced (stage III-IV) cancer, and assessing mobility using clinical or patient-reported outcome measures. Searches were conducted across three electronic databases (MEDLINE, EMBASE and CINAHL) up to June 2024. Methodological quality was assessed using Joanna Briggs Institute tools and contextual factors were evaluated through the Context and Implementation of Complex Interventions framework. A narrative synthesis was conducted due to clinical heterogeneity of included studies. RESULTS 38 studies encompassing 2,464 participants were included. The most frequent mobility outcome measure was the 6-min walk test (26/38 studies). Exercise was the most common intervention, (33 studies: 27 aerobic and resistance, 5 aerobic, 1 resistance versus aerobic training) and improvements in mobility were found in 21/33 outcomes. Electrotherapy interventions led to significant improvements in mobility in 3/5 studies. Geographical factors (e.g. distance, transport, parking requirements) potentially limited participation in 18/38 studies. A lack of ethnic diversity among populations was evident and language proficiency was an inclusion criterion in 12 studies. CONCLUSION Exercise and neuromuscular electrical stimulation appear to improve mobility outcomes in advanced cancer. The evaluation of other non-pharmacological interventions targeting mobility should consider access and inclusivity, and be adaptable to the needs of this population.
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Affiliation(s)
- Carmine Petrasso
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation Bessemer Road, London, SE5 9PJ, UK.
| | - Joanne Bayly
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation Bessemer Road, London, SE5 9PJ, UK
| | - Simona Arculeo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Megan Bowers
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation Bessemer Road, London, SE5 9PJ, UK
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Lise Nottelmann
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Elena Turola
- Research and Statistics Infrastructure, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Vanzulli
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation Bessemer Road, London, SE5 9PJ, UK
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7
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Tu H, Yang S, Liu R. Reflection on analyzing the long-term quality of life between duodenum-preserving pancreatic head resection and pancreatoduodenectomy. Int J Surg 2024; 110:5246-5247. [PMID: 38704629 PMCID: PMC11325903 DOI: 10.1097/js9.0000000000001519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Hanyun Tu
- School of Medicine, Jinan University, Guangzhou
| | - Sufei Yang
- Department of Cardiology, Daping Hospital, Army Medical University, Third Military Medical University, Chongqing
| | - Rong Liu
- Sichuan Institute of Product Quality Supervision and Inspection, Chengdu
- Graduate School, The Chinese Academy of Sciences, Kunming, People's Republic of China
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Sun L, Booth A, Sworn K. Adaptability, Scalability and Sustainability (ASaS) of complex health interventions: a systematic review of theories, models and frameworks. Implement Sci 2024; 19:52. [PMID: 39020399 PMCID: PMC11253497 DOI: 10.1186/s13012-024-01375-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/23/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Complex health interventions (CHIs) are increasingly used in public health, clinical research and education to reduce the burden of disease worldwide. Numerous theories, models and frameworks (TMFs) have been developed to support implementation of CHIs. This systematic review aims to identify and critique theoretical frameworks concerned with three features of implementation; adaptability, scalability and sustainability (ASaS). By dismantling the constituent theories, analysing their component concepts and then exploring factors that influence each theory the review team hopes to offer an enhanced understanding of considerations when implementing CHIs. METHODS This review searched PubMed MEDLINE, CINAHL, Web of Science, and Google Scholar for research investigating the TMFs of complex health interventions. Narrative synthesis was employed to examine factors that may influence the adaptability, scalability and sustainability of complex health interventions. RESULTS A total of 9763 studies were retrieved from the five databases (PubMed, MEDLINE, CINAHL, Web of Science, and Google Scholar). Following removal of duplicates and application of the eligibility criteria, 35 papers were eligible for inclusion. Influencing factors can be grouped within outer context (socio-political context; leadership funding, inter-organisational networks), inner context; (client advocacy; organisational characteristics), intervention characteristics (supervision, monitoring and evaluation), and bridging factors (individual adopter or provider characteristics). CONCLUSION This review confirms that identified TMFS do not typically include the three components of adaptability, scalability, and sustainability. Current approaches focus on high income countries or generic "whole world" approaches with few frameworks specific to low- and middle-income countries. The review offers a starting point for further exploration of adaptability, scalability and sustainability, within a low- and middle-income context. TRIAL REGISTRATION Not registered.
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Affiliation(s)
- Lixin Sun
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Andrew Booth
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Katie Sworn
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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Roberts MC, Holt KE, Del Fiol G, Baccarelli AA, Allen CG. Precision public health in the era of genomics and big data. Nat Med 2024; 30:1865-1873. [PMID: 38992127 DOI: 10.1038/s41591-024-03098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/29/2024] [Indexed: 07/13/2024]
Abstract
Precision public health (PPH) considers the interplay between genetics, lifestyle and the environment to improve disease prevention, diagnosis and treatment on a population level-thereby delivering the right interventions to the right populations at the right time. In this Review, we explore the concept of PPH as the next generation of public health. We discuss the historical context of using individual-level data in public health interventions and examine recent advancements in how data from human and pathogen genomics and social, behavioral and environmental research, as well as artificial intelligence, have transformed public health. Real-world examples of PPH are discussed, emphasizing how these approaches are becoming a mainstay in public health, as well as outstanding challenges in their development, implementation and sustainability. Data sciences, ethical, legal and social implications research, capacity building, equity research and implementation science will have a crucial role in realizing the potential for 'precision' to enhance traditional public health approaches.
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Affiliation(s)
- Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA.
| | - Kathryn E Holt
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Guilherme Del Fiol
- Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Andrea A Baccarelli
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Caitlin G Allen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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10
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Fullaondo A, Hamu Y, Txarramendieta J, de Manuel E. Scaling-Out Digitally Enabled Integrated Care in Europe Through Good Practices Transfer: The JADECARE Study. Int J Integr Care 2024; 24:15. [PMID: 39131232 PMCID: PMC11312721 DOI: 10.5334/ijic.8605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 08/01/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction The absence of a coordinated approach to health and social care compromises the ability of health systems to provide universal, equitable, high-quality, and financially sustainable care. Transferring evidence-based practices focused on digitally-enabled integrated care to new contexts can overcome this challenge if implementation is satisfactory. This paper presents the scaling-out methodology that JADECARE has designed to spread effective innovative practices across Europe. Methodology The scaling-out methodology pretends to guide the Next Adopters in the transfer and adoption of practices, whereas increasing their implementation capacity and providing an evaluation framework to assess impact and success. Discussion JADECARE scaling-out effort is based on guiding principles found in the literature such as the balance between fidelity to the original practice and the degree of adaptation required to fit the new context, the need for capacity building in implementation to bridge the gap between research and routine practice and the focus on explaining why, for whom and in what circumstances an intervention works. Conclusion The JADECARE scaling-out methodology is theory-driven and pragmatic and aims to facilitate the transfer of complex interventions across different contexts.
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Affiliation(s)
- Ane Fullaondo
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Yhasmine Hamu
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Jon Txarramendieta
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
- Osakidetza, Gorliz Hospital, Basque Country, Spain
| | - Esteban de Manuel
- Biosistemak Institute for Health Systems Research, Basque Country, Spain
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Palacz-Poborczyk I, Naughton F, Luszczynska A, Januszewicz A, Quested E, Hagger MS, Pagoto S, Verboon P, Robinson S, Kwasnicka D. Choosing Health: acceptability and feasibility of a theory-based, online-delivered, tailored weight loss, and weight loss maintenance intervention. Transl Behav Med 2024; 14:434-443. [PMID: 38768381 DOI: 10.1093/tbm/ibae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Few weight loss and weight loss maintenance interventions are tailored to include factors demonstrated to predict the user's behavior. Establishing the feasibility and acceptability of such interventions is crucial. The aim of this study was to assess the acceptability and feasibility of a theory-based, tailored, online-delivered weight loss and weight loss maintenance intervention (Choosing Health). We conducted a mixed methods process evaluation of the Choosing Health tailored intervention, nested in a randomized controlled trial (N = 288) with an embedded N-of-1 study, investigating participants' and implementers' experiences related to intervention context, implementation, and mechanisms of impact. Measures included: (i) surveys, (ii) data-prompted interviews (DPIs) with study participants, (iii) semi-structured interviews with implementers, and (iv) intervention access and engagement data. Five themes described the acceptability of the intervention to participants: (i) monitoring behavior change and personal progress to better understand the weight management process, (ii) working collaboratively with the intervention implementers to achieve participants' goals, (iii) perceived benefits of non-judgmental and problem-solving tone of the intervention, (iv) changes in personal perception of the weight management process due to intervention tailoring, and (v) insufficient intervention content tailoring. The intervention delivery was feasible, however, emails and text messages differed in terms of accessibility and resources required to deliver the content. The use of Ecological Momentary Assessment as a technique to gather personal data for further tailoring was acceptable, and facilitated behavior change monitoring. Personalization of the intervention content above and beyond domain-specific issues, for example, by addressing participants' social roles may better match their needs. Support from the implementers and feedback on body composition changes may increase participants' engagement.
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Affiliation(s)
- Iga Palacz-Poborczyk
- Faculty of Psychology, SWPS University, Aleksandra Ostrowskiego 30b, 53-238 Wroclaw, Poland
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK
| | - Aleksandra Luszczynska
- Faculty of Psychology, SWPS University, Aleksandra Ostrowskiego 30b, 53-238 Wroclaw, Poland
| | - Anna Januszewicz
- Faculty of Psychology, SWPS University, Aleksandra Ostrowskiego 30b, 53-238 Wroclaw, Poland
| | - Eleanor Quested
- Physical Activity and Well-being Research Group, enAble Institute, Curtin University, Perth, Australia
- Curtin School of Population Health, Curtin University, Kent Street, 6102 Perth, Australia
| | - Martin S Hagger
- Department of Psychological Sciences, University of California, Merced, 5200 N. Lake Rd., Merced, CA 95343, USA
- Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Rd., Merced, CA 95343, USA
- Faculty of Sport and Health Sciences, University of Jyväskylä, Seminaarinkatu 15, 40014 Jyväskylä, Finland
- School of Applied Psychology, Griffith University, Mt. Gravatt Campus,176 Messines Ridge Rd, Mount Gravatt QLD 4122, Australia
| | - Sherry Pagoto
- Department of Allied Health Sciences, The UConn Center for mHealth and Social Media, University of Connecticut, Connecticut, USA
| | - Peter Verboon
- Department of Psychology, Open Universiteit Nederland, Heerlen, The Netherlands
| | - Suzanne Robinson
- Curtin School of Population Health, Curtin University, Kent Street, 6102 Perth, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Victoria, Australia
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University, Aleksandra Ostrowskiego 30b, 53-238 Wroclaw, Poland
- Melbourne School of Population and Global Health, University of Melbourne, 333 Exhibition Street, 3000 Melbourne, Australia
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Mendieta MJ, Goderis G, Zeller A, Yip O, Siqeca F, Zúñiga F, Zullig LL, De Geest SM, Deschodt M, Flamaing J, Dhaini S. Mapping implementation strategies to reach community-dwelling older adults in Northwest Switzerland. Implement Sci 2024; 19:44. [PMID: 38926758 PMCID: PMC11210125 DOI: 10.1186/s13012-024-01374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND In Northwestern Switzerland, recent legislation tackles the needs of community-dwelling older adults by creating Information and Advice Centers (IACs). IACs are a new service in the community that aims to assess the needs and provide information on age-related issues to community-dwelling older adults and their families. Previous studies reported difficulties in reaching community-dwelling older adults for community-based programs. We aimed to: 1) systematically identify implementation strategies to promote the IAC among community care providers, older adults and informal caregivers; 2) monitor the delivery of these strategies by the IAC management; and 3) describe the impact of those strategies on reach of community-dwelling older adults. This study was conducted as part of the TRANS-SENIOR project. METHODS As part of the INSPIRE feasibility assessment, we conducted a pre-test post-test study between March and September 2022. The sample included 8,840 older adults aged 65 + visiting/calling or being referred to the IAC for the first time. Implementation strategies were selected using implementation mapping and organized in bundles for each group of community care providers and older adults/caregivers. Our evaluation included: estimation of fidelity to the delivery of implementation strategies and bundles by the IAC management and their coverage; referral source of older adults to the IAC; and impact of the strategies on reach of the IAC on the 65 + population living in the care region. Adaptations to the strategies were documented using the FRAME-IS. Descriptive statistics were calculated and reported. RESULTS Seven implementation strategies were selected and organized in bundles for each community care provider and older adults and their caregivers. The lowest fidelity score was found in implementation strategies selected for nursing homes whereas the highest score corresponded to strategies targeting older adults and caregivers. "Informational visits" was the strategy with the lowest coverage (2.5% for nursing homes and 10.5% for hospitals and specialized clinics). The main referral sources were self-referrals and referrals by caregivers, followed by nursing homes. The IAC reach among the 65 + population was 5.4%. CONCLUSION We demonstrated the use of implementation mapping to select implementation strategies to reach community-dwelling older adults. The reach was low suggesting that higher fidelity to the delivery of the strategies, and reflection on the causal pathway of the implementation strategies might be needed.
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Affiliation(s)
- Maria Jose Mendieta
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Louvain, Belgium
| | - Geert Goderis
- Academic Center of General Practice, Department of Public Health and Primary Care, KU, Louvain, Belgium
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Olivia Yip
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Flaka Siqeca
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Franziska Zúñiga
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, UK
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, UK
| | - Sabina M De Geest
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Louvain, Belgium.
| | - Mieke Deschodt
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU, Louvain, Belgium
- Competence Center of Nursing, University Hospitals Leuven, Louvain, Belgium
| | - Johan Flamaing
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU, Louvain, Belgium
- Department of Geriatric Medicine, University Hospital Leuven, Louvain, Belgium
| | - Suzanne Dhaini
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- University Children's Hospital Zurich, The Eleonore Foundation, Zurich, Switzerland
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Krishnamoorthy S, Mathieu S, Armstrong G, Ross V, Francis J, Reifels L, Kõlves K. Implementation of Complex Suicide Prevention Interventions: Insights into Barriers, Facilitators and Lessons Learned. Arch Suicide Res 2024:1-24. [PMID: 38900080 DOI: 10.1080/13811118.2024.2368127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Effective suicide prevention interventions are infrequently translated into practice and policy. One way to bridge this gap is to understand the influence of theoretical determinants on intervention delivery, adoption, and sustainment and lessons learned. This study aimed to examine barriers, facilitators and lessons learned from implementing complex suicide prevention interventions across the world. METHODS AND MATERIALS This study was a secondary analysis of a systematic review of complex suicide prevention interventions, following updated PRISMA guidelines. English published records and grey literature between 1990 and 2022 were searched on PubMed, CINAHL, PsycINFO, ProQuest, SCOPUS and CENTRAL. Related reports were organized into clusters. Data was extracted from clusters of reports on interventions and were mapped using the updated Consolidated Framework for Implementation Research. RESULTS The most frequently-reported barriers were reported within the intervention setting and were related to the perceived appropriateness of interventions within settings; shared norms, beliefs; and maintaining formal and informal networks and connections. The most frequently reported facilitators concerned individuals' motivation, capability/capacity, and felt need. Lessons learned focused on the importance of tailoring the intervention, responding to contextual needs and the importance of community engagement throughout the process. CONCLUSION This study emphasizes the importance of documenting and analyzing important influences on implementation. The complex interplay between the contextual determinants and implementation is discussed. These findings contribute to a better understanding of barriers and facilitators salient for implementation of complex suicide prevention interventions.
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Schoemans H, Burns LJ, Liptrott SJ, Murray J, Kenyon M, Barata A, Bolaños N, Scholl I, Hamilton B, Phelan R, Buchbinder D, Penack O, Moiseev I, Boreland W, Peczynski C, De Geest S, Sureda A, Snowden JA, Shaw B, Peric Z, Kroeger N. Patient engagement in hematopoietic stem cell transplantation and cell therapy: a survey by the EBMT patient engagement task force & transplantation complications working party. Bone Marrow Transplant 2024:10.1038/s41409-024-02290-7. [PMID: 38890544 DOI: 10.1038/s41409-024-02290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 06/20/2024]
Abstract
The EBMT (European Blood and Marrow Transplantation Society) aims to connect patients, the scientific community, and other stakeholders to improve hematopoietic stem cell transplantation and cellular therapy outcomes. We performed a cross-sectional online survey to understand the perceptions regarding Patient Reported Outcomes (PROs) and Patient Active Involvement in Research (PAIR) in over 800 stakeholders (n = 813). Patients (n = 278) and health care professionals (HCPs) (n = 351) were compared. We observed high openness for EBMT PRO collection (n = 680, 84.5% across stakeholders' groups; patients n = 256, 93.1% versus HCPs n = 273, 78.4% [p < 0.001]) and PAIR (n = 702, 87.3% across stakeholder groups; patients n = 256, 92.4% versus HCPs n = 296, 85.8% [p = 0.009]), with a significantly higher proportion of patients expressing interest compared to HCPs. Priority domains for PROs data-collection identified were the assessment of symptom experience, psychosocial and cognitive functioning. The most important issues for patients specifically were the data-collection of PROs reflecting cognitive function, the option of reporting data at home, the importance of identifying actionable targets to improve their recovery, and receiving feedback on their input when participating in research projects. Our multistakeholder approach suggests an added value to embracing patient engagement in the development of meaningful research and service design within the transplantation and cellular therapy community.
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Affiliation(s)
- Hélène Schoemans
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium.
- Department of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium.
- EBMT Transplant Complications Working Party, Paris, France.
| | - Linda J Burns
- Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | - Sarah J Liptrott
- Nursing Research and Development Office, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Nursing, Regional Hosptial of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - John Murray
- Haematology and Transplant Unit, The Christie NHS FT, Manchester, UK
| | - Michelle Kenyon
- Department of Haematology, King's College Hospital, London, UK
| | - Anna Barata
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Natacha Bolaños
- EBMT, Chair, Patient Advocacy Committee, Paris, France
- Lymphoma Coalition, Mississauga, ON, Canada
| | - Isabelle Scholl
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, Hamburg, Germany
| | - Betty Hamilton
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rachel Phelan
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | - Olaf Penack
- EBMT Transplant Complications Working Party, Paris, France
- Medical Clinic, Department for Haematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ivan Moiseev
- EBMT Transplant Complications Working Party, Paris, France
- First Pavlov State Medical University of St Petersburg, St Petersburg, Russia
| | - William Boreland
- EBMT Transplant Complications Working Party, Paris, France
- EBMT Paris study office; Department of Haematology, Saint Antoine Hospital; INSERM UMR-S 938, Sorbonne University, Paris, France
| | - Christophe Peczynski
- EBMT Transplant Complications Working Party, Paris, France
- EBMT Paris study office; Department of Haematology, Saint Antoine Hospital; INSERM UMR-S 938, Sorbonne University, Paris, France
| | - Sabina De Geest
- Department of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Institut de Ciències Biomèdiques de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, 08908, Spain
| | - John A Snowden
- Sheffield Blood & Marrow Transplant and Cellular Therapy Programme, Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bronwen Shaw
- CIBMTR, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Zinaida Peric
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, University Hospital Centre Rijeka, Rijeka, Croatia
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Shire SY, Shih W, Chang YC, Kodjoe M, Nodzo S, Kasari C. Comparing the Implementation Context for Early Intervention Services Before and During the COVID-19 Pandemic. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01696-5. [PMID: 38862831 DOI: 10.1007/s11121-024-01696-5] [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] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
The COVID-19 pandemic not only led to drastic changes in the implementation context for early intervention and early childhood special education services in 2020, but has had an enduring effect on the organizations, educators, families, and children with developmental delays and disorders. Through secondary data analysis, characteristics of toddlers with autism being served in a publicly funded center-based early intervention program as well as the characteristics of their educators are examined, comparing those who were enrolled in (a) two randomized trials conducted prior to the pandemic and (b) one ongoing randomized trial that launched in return to in-person educational services after the pandemic shutdown. Significant demographic differences are found for toddlers, where the current study includes more girls (p = 0.002), who are younger (p < .001) than the prior studies. Further, toddlers enrolled in the current trial are entering with significantly younger receptive (p < .001) and expressive language age-equivalent scores (p < .001) than toddlers from the prior studies. In addition, significant differences are also found for teaching assistants (TAs), who are younger (p < .001), less experienced supporting children with autism (p < .001), have spent less time in this position (p < .001), and who are still working toward college degrees (p < .001) than TAs in the prior studies. Implications of these changes for both intervention strategies to support the strengths and needs of the toddlers (e.g., reduce frequency of TA-child pairing changes to build rapport, increase time in adult-child JASPER before adding peers) as well as implementation strategies (e.g., increase foundational content, TA teaming) to support the training and retention of the TAs are discussed. Clinical Trials Registry number: NCT04283045.
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Affiliation(s)
- Stephanie Y Shire
- Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, USA.
| | - Wendy Shih
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Ya-Chih Chang
- Special Education and Counseling, College of Education, California State University Los Angeles, Los Angeles, USA
| | - Maria Kodjoe
- Behavioral Services, New York Center for Infants and Toddlers, Inc., New York, NY, USA
| | - Stephanie Nodzo
- New York Center for Infants & Toddlers, Inc., New York, NY, USA
| | - Connie Kasari
- Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
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Duan Y, Wang J, Lanham HJ, Berta W, Chamberlain SA, Hoben M, Choroschun K, Iaconi A, Song Y, Perez JS, Shrestha S, Beeber A, Anderson RA, Hayduk L, Cummings GG, Norton PG, Estabrooks CA. How context links to best practice use in long-term care homes: a mixed methods study. Implement Sci Commun 2024; 5:63. [PMID: 38849909 PMCID: PMC11157780 DOI: 10.1186/s43058-024-00600-0] [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: 10/23/2023] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements interrelate and influence best practice use by LTC care aides. METHODS In this secondary analysis study, we combined coincidence analysis (a configurational comparative method) and qualitative analysis to examine data collected through the Translating Research in Elder Care (TREC) program. Coincidence analysis of clinical microsystem (care unit)-level data aggregated from a survey of 1,506 care aides across 36 Canadian LTC homes identified configurations (paths) of context elements linked consistently to care aides' best practices use, measured with a scale of conceptual research use (CRU). Qualitative analysis of ethnographic case study data from 3 LTC homes (co-occurring with the survey) further informed interpretation of the configurations. RESULTS Three paths led to very high CRU at the care unit level: very high leadership; frequent use of educational materials; or a combination of very high social capital (teamwork) and frequent communication between care aides and clinical educators or specialists. Conversely, 2 paths led to very low CRU, consisting of 3 context elements related to unfavorable conditions in relationships, resources, and formal learning opportunities. Our qualitative analysis provided insights into how specific context elements served as facilitators or barriers for best practices. This qualitative exploration was especially helpful in understanding 2 of the paths, illustrating the pivotal role of leadership and the function of teamwork in mitigating the negative impact of time constraints. CONCLUSIONS Our study deepens understanding of the complex interrelationships between context elements and their impact on the implementation of best practices in LTC homes. The findings underscore that there is no singular, universal bundle of context-related elements that enhance or hinder best practice use in LTC homes.
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Affiliation(s)
- Yinfei Duan
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Jing Wang
- Nursing Department, College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Holly J Lanham
- Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health, San Antonio, TX, USA
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | | | - Alba Iaconi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yuting Song
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Janelle Santos Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leslie Hayduk
- Sociology Department, Faculty of Arts, University of Alberta, Edmonton, AB, Canada
| | - Greta G Cummings
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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Scourfield J, Evans R, Pallmann P, Petrou S, Robling M, Au KM, Jones-Williams D, Lugg-Widger F, Meindl M, Schroeder EA, Wood S, Wilkins D. Family group conferencing for children and families: Evaluation of implementation, context and effectiveness (Family VOICE). Study protocol. PLoS One 2024; 19:e0300834. [PMID: 38843190 PMCID: PMC11156304 DOI: 10.1371/journal.pone.0300834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/05/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Family group conferences (FGCs) in child welfare bring immediate and wider family members together to decide on the best way to meet a child's needs. Unlike professionally led meetings, the aim is for decisions to be made by or with family members. Qualitative and mixed-method research with FGC participants tends to show positive experiences: most participants feel their voices are heard; FGCs facilitate family-driven solutions and closer relationships-within families and with social workers. Although there is existing literature on FGCs, there is a paucity of robust comparative UK evaluations, i.e., randomised controlled trials or quasi-experimental studies. Comparative studies internationally have focused on a narrow range of outcomes, not recognised the importance of context, and paid little attention to the quality of delivery. Some qualitative studies have considered process and context but there is scant measurement of these. The aims of this study are, firstly, to establish how FGCs improve outcomes for families and what factors vary their quality, and, secondly, to assess longer-term outcomes in terms of service use and associated costs. METHODS Given the importance of process and context, evaluation informed by realist and complex systems approaches is needed. This multi-method evaluation includes a survey of FGC services in all UK local authorities (n = 212) to map service provision; co-design of programme theory and evaluation measures with family members who have experienced an FGC (n = 16-24) and practitioners (n = 16-24) in two sites; a prospective single-arm study of FGC variability and outcomes after six months; and comparison of service use and costs in FGC participants (n≥300 families) and a control group (n≥1000) after two years using a quasi-experiment. DISCUSSION This is a pragmatic evaluation of an existing intervention, to identify what mechanisms and contexts influence effective process and longer-term outcomes. The study is registered with Research Registry (ref. 7432).
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Affiliation(s)
- Jonathan Scourfield
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Rhiannon Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), United Kingdom
| | - Philip Pallmann
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Kar-Man Au
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Delyth Jones-Williams
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Fiona Lugg-Widger
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Melissa Meindl
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Elizabeth-Ann Schroeder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sophie Wood
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - David Wilkins
- Children’s Social Care Research and Development Centre (CASCADE), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
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Sterckx A, Delbaere B, De Blust G, Spacova I, Samson R, Van den Broeck K, Remmen R, Keune H. Fine-tuning the practical relevance of a quality framework for integrated nature-based interventions in healthcare facilities. A qualitative interview study. Front Public Health 2024; 12:1379230. [PMID: 38898895 PMCID: PMC11186510 DOI: 10.3389/fpubh.2024.1379230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Integrated nature-based interventions in healthcare facilities are gaining importance as promising health and biodiversity promotion strategies. This type of interventions combines the restoration of biodiversity in the vicinity of the healthcare facility with guiding patients in that natural environment for health outcomes. However, quality appraisal of these interventions is still poorly developed. Based on a recent scoping review, the authors developed a preliminary quality framework in support of healthcare facilities designing, implementing and evaluating integrated nature-based interventions. This present study aims to fine-tune the practical relevance of the quality framework within the emerging practice. Methods A qualitative interview study was conducted in seven healthcare facilities in Belgium. Using a combination of snowball and purposive sampling, 22 professionals, involved in the integrated nature-based intervention in their facility, participated in the study. The semi-structured interviews were transcribed and imported into NVivo. A deductive and inductive thematic analysis was used to explore the practical relevance of the quality framework. A stakeholders' assembly review and a member checking of the findings were also part of the study. Findings Twenty-two interviews with nature management coordinators, healthcare professionals, and healthcare managers were conducted by three principal investigators in seven healthcare facilities implementing integrated nature-based interventions. The contextualization and complexity of integrated nature-based interventions in the participating healthcare facilities demonstrated the need for an evidence-based quality framework describing nature-based interventions. The study led to nine quality criteria, confirming the eight quality criteria derived from a previous scoping review, and the identification of a new quality criterion 'Capacity building, leverage and continuity'. These quality criteria have been refined. Finally, a proposal for a quality framework was developed and operationalized in a checklist. Deployment of the quality framework should be embedded in a continuous cyclical, adaptive process of monitoring and adjusting based on evaluations at each phase of an integrated nature-based intervention. Discussion Bridging the domains of healthcare and nature management in the context of an integrated nature-based intervention in a healthcare facility requires a transdisciplinary approach. Scientific frameworks such as "complex interventions," Planetary Health and One Health can support the co-design, implementation and evaluation of integrated nature-based interventions within a cyclical, adaptive process. In addition, the importance of the quality of the interactions with nature could gain from more sophisticated attention. Finally, the implications for healthcare facilities, policymakers and education are discussed, as well as the strengths and limitations of the study.
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Affiliation(s)
- Ann Sterckx
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ben Delbaere
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Geert De Blust
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Irina Spacova
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Roeland Samson
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Chair Public Mental Health, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hans Keune
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Jacobsen JS, O'Brien MJM, Christensen JR, Risberg MA, Milne L, Balakumar J, Jakobsen SS, Mechlenburg I, Kemp J. Rehabilitation following periacetabular osteotomy for acetabular dysplasia: A qualitative interview study exploring challenges, hopes and expectations among patients in Denmark and Australia. Int J Orthop Trauma Nurs 2024; 54:101116. [PMID: 38925029 DOI: 10.1016/j.ijotn.2024.101116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/13/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Guidelines have been proposed for post-operative rehabilitation following periacetabular osteotomy (PAO). However, the perspectives of individuals undergoing PAO have not been considered. AIM The present study aimed to explore the perceived challenges of everyday life and hopes for and expectations of post-PAO rehabilitation from the perspective of individuals with acetabular dysplasia living in Denmark and Australia. METHODS In this qualitative study, we used a hermeneutic phenomenological approach with semi-structured interviews to explore the perspectives of 25 participants (four males), aged 16-43 years, who underwent a PAO. Purposeful sampling was used to provide variations in age and sex. Inclusion criteria were age above 15 years, radiographic evidence of acetabular dysplasia, PAO within the last seven weeks and undergoing post-operative rehabilitation. Inductive content analysis was adopted to code and analyse interviews. RESULTS The analysis of the interview transcripts revealed four major themes: different expectations, self-confidence, tailored rehabilitation and aligning expectations. Several subthemes emerged within each theme, and similar patterns with minor variations were identified across countries. However, the financial burden of self-funded surgery and rehabilitation challenged some Australian participants, whereas none of the Danish participants mentioned this challenge. CONCLUSION Our findings elucidate the diverse range of hopes and expectations in individuals undergoing PAO, and how these relate to their perceived challenges. In particular, the findings highlight the importance of aligning expectations between individuals and clinicians when designing the rehabilitation.
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Affiliation(s)
- Julie S Jacobsen
- Research Centre for Rehabilitation, VIA University College, Aarhus, Denmark; Research Unit for General Practice, Aarhus, Denmark.
| | - Michael J M O'Brien
- La Trobe Sport Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia. m.o'
| | - Jeanette Reffstrup Christensen
- Research Unit for General Practice, Aarhus, Denmark; Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - May Arna Risberg
- Division of Orthopaedic Surgery, Oslo University Hospital and Department of Sport Medicine, Norwegian School Sport Sciences, Oslo, Norway.
| | | | | | | | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Joanne Kemp
- La Trobe Sport Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
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Emke H, Altenburg T, Dijkstra C, Pinzon AL, Stronks K, Waterlander W, Kremers S, Chinapaw M. Applying systems thinking in youth-centred participatory action research for health promotion in an underserved neighbourhood. Front Public Health 2024; 12:1272663. [PMID: 38887247 PMCID: PMC11180748 DOI: 10.3389/fpubh.2024.1272663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/22/2024] [Indexed: 06/20/2024] Open
Abstract
Purpose Childhood overweight is considered a complex problem influenced by a range of factors, including energy balance-related behaviours (EBRBs) and interacting drivers of these behaviours. There is growing support that applying a systems approach is required to tackle complex problems resulting in actions that attempt to change the system's dynamics. Additionally, a participatory approach is advocated to include the lived experience of the population of interest both in the understanding of the system as well as the development, implementation and evaluation of relevant actions. We therefore combined Intervention Mapping, Participatory Action Research (PAR) and system dynamics in the development, implementation and evaluation of actions contributing to healthy EBRBs together with adolescents. Methods Four PAR groups comprising of 6-8 adolescent co-researchers (10-14 years) and 1-2 adult facilitators met weekly during 3-4 years. The structured Intervention Mapping protocol guided the process of the systematic development, implementation and evaluation of actions. System dynamics tools were included for the creation of Causal Loop Diagrams and development of systemic actions. Results Our approach comprised six steps that were executed by the PAR groups: (1) build Causal Loop Diagrams for each EBRB through peer research and identify overarching mechanisms, (2) determine leverage points using the Intervention Level Framework, (3) develop action ideas, (4) develop detailed actions including an implementation plan, (5) implement and, (6) evaluate the actions. PAR ensured that the actions fitted the lived experience of the adolescents, whilst system dynamics promoted actions at different levels of the system. The Intervention Mapping protocol ensured that the actions were theory-based. The main challenge involved integrating system dynamics within our practise in cooperation with adolescent co-researchers. Conclusion We experienced that combining Intervention Mapping, PAR and system dynamics worked well in developing, implementing and evaluating actions that target different levels of the system that drive adolescents' EBRBs. This study serves as an example to other studies aimed at developing, implementing and evaluating actions using a participatory and systems approach.
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Affiliation(s)
- Helga Emke
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Teatske Altenburg
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
| | - Angie Luna Pinzon
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Maastricht, Netherlands
| | - Karien Stronks
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Maastricht, Netherlands
| | - Wilma Waterlander
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Maastricht, Netherlands
| | - Stef Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mai Chinapaw
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. Int J Nurs Stud 2024; 154:104705. [PMID: 38564982 DOI: 10.1016/j.ijnurstu.2024.104705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The UK Medical Research Council's widely used guidance for developing and evaluating complex interventions has been replaced by a new framework, commissioned jointly by the Medical Research Council and the National Institute for Health Research, which takes account of recent developments in theory and methods and the need to maximise the efficiency, use, and impact of research.
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Affiliation(s)
- Kathryn Skivington
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Anne Simpson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jane M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Bristol Biomedical Research Centre, Bristol, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Laurence Moore
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Lubanga AF, Bwanali AN, Kambiri F, Harawa G, Mudenda S, Mpinganjira SL, Singano N, Makole T, Kapatsa T, Kamayani M, Ssebibubbu S. Tackling antimicrobial resistance in sub-Saharan Africa: challenges and opportunities for implementing the new people-centered WHO guidelines. Expert Rev Anti Infect Ther 2024; 22:379-386. [PMID: 38809689 DOI: 10.1080/14787210.2024.2362270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/28/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Antimicrobial drugs form an essential component of medical treatment in human and animal health. Resistance associated with their use has posed a global public health threat. Multiple efforts have been made at the global level directed by the World Health Organization and associated partners to develop policies aimed at combatting antimicrobial resistance. AREAS COVERED Whilst the Global Action Plan on antimicrobial resistance and people-centered framework aim to guide countries in implementing successful antimicrobial resistance policies, their adoption and success depend on different implementation contexts. Therefore, this paper highlights the challenges and opportunities for implementing the World Health Organization's people-centered approach in sub-Saharan Africa, whilst recognizing antimicrobial resistance as a multifaceted problem rooted in 'complex systems.' EXPERT OPINION The people-centered approach provides a solid framework for combating antimicrobial resistance. Countries should build sustainable national action plans, adopt the One Health approach, limit over-the-counter antibiotic consumption, and educate communities on rational antibiotic use. They should also promote inter-country collaborations and innovative solutions, strengthen drug regulatory capacities, invest in infection control, water sanitation, hygiene, diagnostics, and surveillance tools, and promote vaccine uptake to prevent drug-resistant infections.
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Affiliation(s)
- Adriano Focus Lubanga
- Education and Research, Clinical Research Education and Management Services (CREAMS), Lilongwe, Malawi
- Department of Clinical Services, Kamuzu Central Hospital (KCH), Lilongwe, Malawi
| | - Akim Nelson Bwanali
- Education and Research, Clinical Research Education and Management Services (CREAMS), Lilongwe, Malawi
- Department of Clinical Services, Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi
| | - Frank Kambiri
- Education and Research, Clinical Research Education and Management Services (CREAMS), Lilongwe, Malawi
| | - Gracian Harawa
- Antimicrobial Resistance Champion, Public Health Institute of Malawi (PHIM), Lilongwe, Malawi
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Samuel L Mpinganjira
- Department of Epidemiology and Statistics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nathan Singano
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Tumaini Makole
- Pharmacist, Pharmacy Council of Tanzania, Dar es Salaam, Tanzania
| | - Thandizo Kapatsa
- Department of Laboratory Science, Phalombe District Hospital, Ministry of Health, Phalombe, Malawi
| | - Mapeesho Kamayani
- Disease Surveillance, Churches Association of Zambia, Lusaka, Zambia
| | - Stuart Ssebibubbu
- Afya na Haki Institute, Department of Evidence Generated, Kampala, Uganda
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Sakas Z, Rodriguez K, Hester KA, Darwar R, Dounebaine B, Ellis AS, Rosenblum S, Isett KR, Orenstein W, Freeman MC, Kilembe W, Bednarczyk RA. The role of Zambia's expansive Inter-agency Coordinating Committee (ICC) in supporting evidence-based vaccine and health sector programming. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002820. [PMID: 38814959 PMCID: PMC11139285 DOI: 10.1371/journal.pgph.0002820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/20/2024] [Indexed: 06/01/2024]
Abstract
New vaccines, technologies, and regulations, alongside increased demand for vaccines, all require prioritization and coordination from key players within the vaccine sector. Inter-agency Coordinating Committees (ICC) support decision-making and coordination at the national-level and act as key drivers for sustainable improvements in vaccination programming. We utilized a previous qualitative case study, which investigated critical success factors for high routine immunization coverage in Zambia from 2000-2018, specifically to study the Zambian ICC. Qualitative data were collected between October 2019 and February 2020, including key informant interviews (n = 66) at the national, provincial, district, and health facility levels. Thematic analysis was applied to understand the role of the Zambian ICC and its impact on the policy environment over time. Within our study period, the ICC demonstrated the following improvements: 1) expanded membership to include diverse representation; 2) expanded scope and mandate to include maternal and child health in decision-making; and 3) distinct roles for collaboration with the Zambia Immunization Technical Advisory Group (ZITAG). The diverse and expansive membership of the Zambian ICC, along with its ability to foster government commitment and lobby for additional resources, supported improvements in immunization programming. The Zambian ICC holds considerable influence on government agencies and external partners, which facilitates procurement of funding, policy decisions, and strategic planning.
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Affiliation(s)
- Zoe Sakas
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Katie Rodriguez
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Kyra A. Hester
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Roopa Darwar
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Bonheur Dounebaine
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Anna S. Ellis
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Simone Rosenblum
- School of Public Policy, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Kimberley R. Isett
- Biden School of Public Policy and Administration, University of Delaware, Newark, Delaware, United States of America
| | - Walter Orenstein
- Emory School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Matthew C. Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Robert A. Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Mukherjee A, Yatirajula SK, Kallakuri S, Paslawar S, Lempp H, Raman U, Kumar A, Essue BM, Sagar R, Singh R, Peiris D, Norton R, Thornicroft G, Maulik PK. Protocol for process evaluation of ARTEMIS cluster randomised controlled trial: an intervention for management of depression and suicide among adolescents living in slums in India. BMJ Open 2024; 14:e081844. [PMID: 38772584 PMCID: PMC11110603 DOI: 10.1136/bmjopen-2023-081844] [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: 11/08/2023] [Accepted: 04/12/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION There are around 250 million adolescents (10-19 years) in India. The prevalence of mental health-related morbidity among adolescents in India is approximately 7.3%. Vulnerable subpopulations among adolescents such as those living in slum communities are particularly at risk due to poor living conditions, financial difficulty and limited access to support services. Adolescents' Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) is a cluster randomised controlled trial of an intervention that intends to improve the mental health of adolescents living in slum communities in India. The aim of this paper is to describe the process evaluation protocol for ARTEMIS trial. The process evaluation will help to explain the intervention outcomes and understand how and why the intervention worked or did not work. It will identify contextual factors, intervention barriers and facilitators and the adaptations required for optimising implementation. METHODS Case study method will be used and the data will include a mix of quantitative metrics and qualitative data. The UK Medical Research Council's guidance on evaluating complex interventions, the Reach, Efficacy, Adoption, Implementation and Maintenance Framework and the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Safety/Side Effects and, Equity criteria will be used to develop a conceptual framework and a priori codes for qualitative data analysis. Quantitative data will be analysed using descriptive statistics. Implementation fidelity will also be measured. DISCUSSION The process evaluation will provide an understanding of outcomes and causal mechanisms that influenced any change in trial outcomes. ETHICS AND DISSEMINATION Ethics Committee of the George Institute for Global Health India (project number 17/2020) and the Research Governance and Integrity Team, Imperial College, London (ICREC reference number: 22IC7718) have provided ethics approval. The Health Ministry's Screening Committee has approved to the study (ID 2020-9770). TRIAL REGISTRATION NUMBER CTRI/2022/02/040307.
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Affiliation(s)
| | | | | | | | - Heidi Lempp
- Inflammation Biology, King's College London, London, UK
| | - Usha Raman
- Department of Communication, University of Hyderabad, Hyderabad, India
| | - Ashok Kumar
- Dr.A.V. Baliga Memorial Trust, New Delhi, India
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | - David Peiris
- The George Institute for Global Health, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Norton
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Imperial College London, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pallab Kumar Maulik
- The George Institute for Global Health India, New Delhi, India
- University of New South Wales, Sydney, New South Wales, Australia
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Zaleskiewicz H, Kulis E, Siwa M, Szczuka Z, Banik A, Grossi F, Chrysochou P, Nystrand BT, Perrea T, Samoggia A, Xhelili A, Krystallis A, Luszczynska A. Characteristics of built food environments associated with alternative protein food choices: a systematic review. Int J Behav Nutr Phys Act 2024; 21:58. [PMID: 38755618 PMCID: PMC11100026 DOI: 10.1186/s12966-024-01606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND This systematic review contributes to the understanding of the characteristics of built food environments that may be associated with choices of alternative protein foods (APF). Using the built food environment typology proposed by Downs et al., we investigated various environmental structures (e.g., supermarkets, other retailers, farmers' markets, restaurants, schools, and online vendors) and the characteristics that may facilitate or hinder consumers' choices. For example, facilitators and barriers may refer to the physical characteristics of environmental structures, food presentation practices, the organizational strategies or policies operating in the setting, or the actions that retailers or consumers engage in while selling, serving, choosing, trying, or purchasing APF in these environmental structures. METHODS A systematic review (PROSPERO database preregistration; no. CRD42023388700) was conducted by searching 13 databases for peer-reviewed journals focusing on the fields of economics and business, agriculture, medical sciences, and social sciences. Data searches, coding, and quality evaluations were conducted by at least 2 researchers. A total of 31 papers (36 original studies) were included. The risk of bias was evaluated with the Joanna Briggs Institute quality evaluation tool, with 24 publications presenting low risk of bias. RESULTS The findings indicate that perceived and actual availability facilitate consumers' APF choices across a built food environment. Several barriers/facilitators were associated with APF choices in specific types of built food environments: the way food is presented in produce sections (supermarkets), consumer habits in terms of green and specialty shopping (grocery stores), and mismatches among retailer actions in regard to making APF available in one type of food environment structure (e-commerce) and consumers' preferences for APF being available in other food environment structures (supermarkets, grocery stores). The effect of a barrier/facilitator may depend on the APF type; for example, social norms regarding masculinity were a barrier affecting plant-based APF choices in restaurants, but these norms were not a barrier affecting the choice of insect-based APF in restaurants. CONCLUSIONS Addressing barriers/facilitators identified in this review will help in developing environment-matching interventions that aim to make alternative proteins mainstream. TRIAL REGISTRATION PROSPERO database registration: #CRD42023388700.
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Affiliation(s)
- Hanna Zaleskiewicz
- Faculty of Psychology CARE-BEH Center for Applied Research On Health Behavior and Health, SWPS University, 30B Ostrowskiego Street, Wroclaw, 53238, Poland
| | - Ewa Kulis
- Faculty of Psychology CARE-BEH Center for Applied Research On Health Behavior and Health, SWPS University, 30B Ostrowskiego Street, Wroclaw, 53238, Poland
| | - Maria Siwa
- Faculty of Psychology CARE-BEH Center for Applied Research On Health Behavior and Health, SWPS University, 30B Ostrowskiego Street, Wroclaw, 53238, Poland
| | - Zofia Szczuka
- Faculty of Psychology CARE-BEH Center for Applied Research On Health Behavior and Health, SWPS University, 30B Ostrowskiego Street, Wroclaw, 53238, Poland
| | - Anna Banik
- Faculty of Psychology CARE-BEH Center for Applied Research On Health Behavior and Health, SWPS University, 30B Ostrowskiego Street, Wroclaw, 53238, Poland
| | - Francesca Grossi
- Collaborating Centre On Sustainable Consumption and Production (CSCP), 30 Hagenauer Street, Wuppertal, E42107, Germany
| | - Polymeros Chrysochou
- Department of Management, MAPP Centre, Aarhus University, 4 Fuglesangs Allé, Aarhus V, DK8210, Denmark
- American College of Greece Research Center, 6 Gravias Street, GR15342 Aghia Paraskevi, Athens, Greece
| | | | - Toula Perrea
- American College of Greece Research Center, 6 Gravias Street, GR15342 Aghia Paraskevi, Athens, Greece
| | - Antonella Samoggia
- Department of Agriculture and Food Sciences, University of Bologna, 33 Via Zamboni, Bologna, T40126, Italy
| | - Arlind Xhelili
- Collaborating Centre On Sustainable Consumption and Production (CSCP), 30 Hagenauer Street, Wuppertal, E42107, Germany
| | - Athanasios Krystallis
- American College of Greece Research Center, 6 Gravias Street, GR15342 Aghia Paraskevi, Athens, Greece
| | - Aleksandra Luszczynska
- Faculty of Psychology CARE-BEH Center for Applied Research On Health Behavior and Health, SWPS University, 30B Ostrowskiego Street, Wroclaw, 53238, Poland.
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Salvador-Carulla L, Woods C, de Miquel C, Lukersmith S. Adaptation of the technology readiness levels for impact assessment in implementation sciences: The TRL-IS checklist. Heliyon 2024; 10:e29930. [PMID: 38726201 PMCID: PMC11078766 DOI: 10.1016/j.heliyon.2024.e29930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
Background Intervention development is a critical process in implementation research. There are key stages involved in the process to design, pilot, demonstrate and release a technology or an intervention. The Technology Readiness Level (TRL) is a globally accepted instrument for assessing the maturity of research development. However, the original levels do not fit all, and some adjustments are required for its applicability in implementation sciences. Aims This study aimed to gather the prior knowledge base on TRL in public and population health research; to develop a standard definition of readiness, and to adapt and validate the TRL to an implementation science context (TRL-IS). Materials and methods A Mixed methods approach has been followed in this study. A scoping review using the PRISMA extension (PRISMA-ScR) informed a nominal expert panel for developing a standard definition of readiness and to modify the TRL following an ontoterminology approach. Then the maturity of six practical case study examples were rated by ten researchers using the modified TRL to estimate inter-rater reliability, and a group of experts provided final content and face validity and feasibility.This mixed methods study included 1) a scoping review to examine the current literature and develop a knowledge base, identify knowledge gaps and to clarify concepts; 2) the development of a standard definition of 'Readiness' and related terms; and 3) adaptation of the TRL to implementation science and development of a checklist to rate the maturity of applications.A standard definition of readiness and related terms was produced by the core team, and an international nominal group (n = 30) was conducted to discuss and validate the definition and terms, and the location of 'Readiness' in the initiation and early development phases of implementation.Following feedback from the nominal group, the development of the TRL-IS was finalised and a TRL-IS rating checklist was developed to rate the maturity of applications. The TRL-IS checklist was tested using six cases based on real world studies on implementation research.The inter-rater reliability of the TRL-IS was evaluated by ten raters and finally six raters evaluated the content and face validity, and feasibility, of the TRL-IS checklist using the System Usability Scale (SUS). Results Few papers (n = 11) utilised the TRL to evaluate the readiness of readiness of health and social science implementation research. The main changes in the adaption of the TRL-IS included the removal of laboratory testing, limiting the use of "operational" environment and a clearer distinction between level 6 (pilot in a relevant environment) and 7 (demonstration in the real world prior to release). The adapted version was considered relevant by the expert panel. The TRL-IS checklist showed evidence of good inter-rater reliability (ICC = 0.90 with 95 % confident interval = 0.74-0.98, p < .001) and provides a consistent metric. Conclusions In spite of recommendations made by national and international research funding agencies, few health and social science implementation studies include the TRL as part of their evaluation protocol. The TRL-IS offers a high degree of conceptual clarity between scientific maturity phases or readiness levels, and good reliability among raters of varying experience. This study highlights that adoption of the TRL-IS framework in implementation sciences will bolster the scientific robustness and comparability of research maturity in this domain.
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Affiliation(s)
| | | | - Carlota de Miquel
- University of Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Spain
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Michalopoulou S, Sifaki M, Packer J, Lanigan J, Stansfield C, Viner RM, Russell S. Assessing the impact of obesity interventions in the early years: a systematic review of UK-based studies. BMJ Open 2024; 14:e076479. [PMID: 38740507 PMCID: PMC11097867 DOI: 10.1136/bmjopen-2023-076479] [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: 06/08/2023] [Accepted: 02/13/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Childhood obesity rates in the UK are high. The early years of childhood are critical for establishing healthy behaviours and offer interventional opportunities. We aimed to identify studies evaluating the impact of UK-based obesity interventions in early childhood. DESIGN Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Nine databases were searched in March 2023. ELIGIBILITY CRITERIA We included UK-based obesity intervention studies delivered to children aged 6 months to 5 years that had diet and/or physical activity components and reported anthropometric outcomes. The primary outcome of interest was z-score Body Mass Index (zBMI) change (within and between subjects). Studies evaluating the effects of breastfeeding interventions were not included as obesity prevention interventions, given that best-practice formula feeding is also likely to encourage healthy growth. The publication date for studies was limited to the previous 12 years (2011-23), as earlier reviews found few evaluations of interventions in the UK. DATA EXTRACTION AND SYNTHESIS The reviewers worked independently using standardised approach to search, screen and code the included studies. Risk of bias was assessed using Cochrane tools (ROB 2 or ROBINS-I). RESULTS Six trials (five studies) were identified, including two randomised controlled trials (RCT), one cluster randomised trial (CRT), two feasibility CRTs and one impact assessment. The total number of participants was 566. Three trials focused on disadvantaged families and two included high-risk children categorised as having overweight or obesity. Compared with baseline, five interventions reported reductions in zBMI, three of which were statistically significant (p<0.05). Compared with control, five interventions showed zBMI reductions, one of which was significant. Only two trials were followed up beyond 12 months. All studies were found to have a high risk of bias. Meta-analysis was not possible due to the heterogeneity of studies. CONCLUSION UK evidence was limited but some interventions showed promising results in promoting healthy growth. As part of a programme of policies, interventions in the early years may have an important role in reducing the risk of childhood obesity. PROSPERO REGISTRATION NUMBER CRD42021290676.
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Affiliation(s)
- Semina Michalopoulou
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Maria Sifaki
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Jessica Packer
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Julie Lanigan
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Russell M Viner
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Simon Russell
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Littlecott H, Krishnaratne S, Burns J, Rehfuess E, Sell K, Klinger C, Strahwald B, Movsisyan A, Metzendorf MI, Schoenweger P, Voss S, Coenen M, Müller-Eberstein R, Pfadenhauer LM. Measures implemented in the school setting to contain the COVID-19 pandemic. Cochrane Database Syst Rev 2024; 5:CD015029. [PMID: 38695826 PMCID: PMC11064884 DOI: 10.1002/14651858.cd015029.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
BACKGROUND More than 767 million coronavirus 2019 (COVID-19) cases and 6.9 million deaths with COVID-19 have been recorded as of August 2023. Several public health and social measures were implemented in schools to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and prevent onward transmission. We built upon methods from a previous Cochrane review to capture current empirical evidence relating to the effectiveness of school measures to limit SARS-CoV-2 transmission. OBJECTIVES To provide an updated assessment of the evidence on the effectiveness of measures implemented in the school setting to keep schools open safely during the COVID-19 pandemic. SEARCH METHODS We searched the Cochrane COVID-19 Study Register, Educational Resources Information Center, World Health Organization (WHO) COVID-19 Global literature on coronavirus disease database, and the US Department of Veterans Affairs Evidence Synthesis Program COVID-19 Evidence Reviews on 18 February 2022. SELECTION CRITERIA Eligible studies focused on measures implemented in the school setting to contain the COVID-19 pandemic, among students (aged 4 to 18 years) or individuals relating to the school, or both. We categorized studies that reported quantitative measures of intervention effectiveness, and studies that assessed the performance of surveillance measures as either 'main' or 'supporting' studies based on design and approach to handling key confounders. We were interested in transmission-related outcomes and intended or unintended consequences. DATA COLLECTION AND ANALYSIS Two review authors screened titles, abstracts and full texts. We extracted minimal data for supporting studies. For main studies, one review author extracted comprehensive data and assessed risk of bias, which a second author checked. We narratively synthesized findings for each intervention-comparator-outcome category (body of evidence). Two review authors assessed certainty of evidence. MAIN RESULTS The 15 main studies consisted of measures to reduce contacts (4 studies), make contacts safer (7 studies), surveillance and response measures (6 studies; 1 assessed transmission outcomes, 5 assessed performance of surveillance measures), and multicomponent measures (1 study). These main studies assessed outcomes in the school population (12), general population (2), and adults living with a school-attending child (1). Settings included K-12 (kindergarten to grade 12; 9 studies), secondary (3 studies), and K-8 (kindergarten to grade 8; 1 study) schools. Two studies did not clearly report settings. Studies measured transmission-related outcomes (10), performance of surveillance measures (5), and intended and unintended consequences (4). The 15 main studies were based in the WHO Regions of the Americas (12), and the WHO European Region (3). Comparators were more versus less intense measures, single versus multicomponent measures, and measures versus no measures. We organized results into relevant bodies of evidence, or groups of studies relating to the same 'intervention-comparator-outcome' categories. Across all bodies of evidence, certainty of evidence ratings limit our confidence in findings. Where we describe an effect as 'beneficial', the direction of the point estimate of the effect favours the intervention; a 'harmful' effect does not favour the intervention and 'null' shows no effect either way. Measures to reduce contact (4 studies) We grouped studies into 21 bodies of evidence: moderate- (10 bodies), low- (3 bodies), or very low-certainty evidence (8 bodies). The evidence was very low to moderate certainty for beneficial effects of remote versus in-person or hybrid teaching on transmission in the general population. For students and staff, mostly harmful effects were observed when more students participated in remote teaching. Moderate-certainty evidence showed that in the general population there was probably no effect on deaths and a beneficial effect on hospitalizations for remote versus in-person teaching, but no effect for remote versus hybrid teaching. The effects of hybrid teaching, a combination of in-person and remote teaching, were mixed. Very low-certainty evidence showed that there may have been a harmful effect on risk of infection among adults living with a school student for closing playgrounds and cafeterias, a null effect for keeping the same teacher, and a beneficial effect for cancelling extracurricular activities, keeping the same students together and restricting entry for parents and caregivers. Measures to make contact safer (7 studies) We grouped studies into eight bodies of evidence: moderate- (5 bodies), and low-certainty evidence (3 bodies). Low-certainty evidence showed that there may have been a beneficial effect of mask mandates on transmission-related outcomes. Moderate-certainty evidence showed full mandates were probably more beneficial than partial or no mandates. Evidence of a beneficial effect of physical distancing on risk of infection among staff and students was mixed. Moderate-certainty evidence showed that ventilation measures probably reduce cases among staff and students. One study (very low-certainty evidence) found that there may be a beneficial effect of not sharing supplies and increasing desk space on risk of infection for adults living with a school student, but showed there may be a harmful effect of desk shields. Surveillance and response measures (6 studies) We grouped studies into seven bodies of evidence: moderate- (3 bodies), low- (1 body), and very low-certainty evidence (3 bodies). Daily testing strategies to replace or reduce quarantine probably helped to reduce missed school days and decrease the proportion of asymptomatic school contacts testing positive (moderate-certainty evidence). For studies that assessed the performance of surveillance measures, the proportion of cases detected by rapid antigen detection testing ranged from 28.6% to 95.8%, positive predictive value ranged from 24.0% to 100.0% (very low-certainty evidence). There was probably no onward transmission from contacts of a positive case (moderate-certainty evidence) and replacing or shortening quarantine with testing may have reduced missed school days (low-certainty evidence). Multicomponent measures (1 study) Combining multiple measures may have led to a reduction in risk of infection among adults living with a student (very low-certainty evidence). AUTHORS' CONCLUSIONS A range of measures can have a beneficial effect on transmission-related outcomes, healthcare utilization and school attendance. We rated the current findings at a higher level of certainty than the original review. Further high-quality research into school measures to control SARS-CoV-2 in a wider variety of contexts is needed to develop a more evidence-based understanding of how to keep schools open safely during COVID-19 or a similar public health emergency.
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Affiliation(s)
- Hannah Littlecott
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Shari Krishnaratne
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Kerstin Sell
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Carmen Klinger
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Brigitte Strahwald
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Petra Schoenweger
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Roxana Müller-Eberstein
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Knamiller C, Rashid R, Bryant M, Bailey E, McEachan RR. Who shouts the loudest? A qualitative study exploring barriers and enablers to implementing a low emission zone in a Northern UK city. TRANSPORTATION RESEARCH INTERDISCIPLINARY PERSPECTIVES 2024; 25:None. [PMID: 38899121 PMCID: PMC11184590 DOI: 10.1016/j.trip.2024.101112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/05/2024] [Accepted: 05/12/2024] [Indexed: 06/21/2024]
Abstract
Pollution is a major cause of ill health globally. Low emission zones (LEZ) have been identified as effective in reducing pollution and are increasing in popularity but remain divisive. Understanding what factors help or hinder implementation is important. In the UK, Clean Air Zones (CAZ, a type of LEZ) are being implemented in several cities. We aimed to identify key barriers and enablers to the implementation of a CAZ in real time, as policy was being developed and implemented in a large Northern city in England, UK. Twenty-five semi-structured interviews were conducted with city stakeholders and implementors approximately 6 months before a CAZ charging non-compliant taxis, buses, heavy goods vehicles and vans was launched. Thematic analysis was used to analyse data. Implementers were required to operate within a tight policy framework. Key enablers included: freedom to adapt the framework to local context, financial support, and cross-sector working. A focus on health was felt to be useful in justifying the policy to the public. Key barriers included conflict and opposition from local industry, politicians, and communities. Implementation of air quality policy which involves traffic restrictions remains controversial. The voices which 'shout the loudest' are often those with negative views, and these can create divisive discourse which shape public opinion and damage confidence of implementers. A systems perspective is needed to understand socio-political contexts which can influence implementation success. We provide recommendations to other areas considering implementing a LEZ.
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Affiliation(s)
- Cathy Knamiller
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire BD9 6RJ, United Kingdom
| | - Rukhsana Rashid
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire BD9 6RJ, United Kingdom
| | - Maria Bryant
- Department of Health Sciences, University of York, Heslington, York, West Yorkshire, YO10 5DD, United Kingdom
- Hull York Medical School, University of York, Heslington, York, West Yorkshire, YO10 5DD, United Kingdom
| | - Emma Bailey
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire BD9 6RJ, United Kingdom
| | - Rosemary R.C. McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire BD9 6RJ, United Kingdom
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Granberg A, Lundqvist LO, Duberg A, Matérne M. The influence of contextual factors on an intervention for people with disabilities from support persons' and health personnel's perspectives: a focus group study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1294990. [PMID: 38751820 PMCID: PMC11094220 DOI: 10.3389/fresc.2024.1294990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Introduction Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons' and health personnel's experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons' and health personnel's experience of contextual factors during involvement in an intervention for people with PIMD. Methods This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach. Results Three themes emerged from the analysis of the informants' perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention's benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons' and health personnel's motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention. Discussion Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.
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Affiliation(s)
- Anette Granberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Lars-Olov Lundqvist
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Anna Duberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Marie Matérne
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
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Kienast-von Einem C, Panter J, Ogilvie D, Reid A. Exploring residential relocation- differences between newcomers and settled residents in health, travel behaviour and neighbourhood perceptions. Health Place 2024; 87:103254. [PMID: 38701677 DOI: 10.1016/j.healthplace.2024.103254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
This study explores whether people who have recently moved to an area differ from longer-term residents in their health, travel behaviour, and perceptions of the environment. Using a large, representative sample from the UKHLS, Newcomers demonstrate significantly lower mental and physical health, reduced car commuting, and a higher likelihood of liking their neighbourhood. Area deprivation, urbanicity, household income, and age emerge as influential moderators with i.e. Newcomers in affluent areas experiencing lower physical health than Settled Residents, and rural Newcomers expressing less neighbourhood satisfaction. Our findings highlight that Newcomers' perceptions of their environment diverge and environmental influences vary among population segments, potentially impacting related health behaviours such as active travel. Furthermore, residential relocation introduces Newcomers with distinct characteristics into areas, affecting the context in which potential population health interventions aiming to influence health behaviours operate. This necessitates a deeper understanding of what influences reactions to the environment as well as ongoing adaptation of environmental interventions to respond to changing contexts within the same location over time.
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Affiliation(s)
- Caroline Kienast-von Einem
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom; Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom.
| | - Jenna Panter
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.
| | - David Ogilvie
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.
| | - Alice Reid
- Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom.
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Schmitt T, Czabanowska K, Schröder-Bäck P. What is context in knowledge translation? Results of a systematic scoping review. Health Res Policy Syst 2024; 22:52. [PMID: 38685073 PMCID: PMC11057149 DOI: 10.1186/s12961-024-01143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Knowledge Translation (KT) aims to convey novel ideas to relevant stakeholders, motivating their response or action to improve people's health. Initially, the KT literature focused on evidence-based medicine, applying findings from laboratory and clinical research to disease diagnosis and treatment. Since the early 2000s, the scope of KT has expanded to include decision-making with health policy implications.This systematic scoping review aims to assess the evolving knowledge-to-policy concepts, that is, macro-level KT theories, models and frameworks (KT TMFs). While significant attention has been devoted to transferring knowledge to healthcare settings (i.e. implementing health policies, programmes or measures at the meso-level), the definition of 'context' in the realm of health policymaking at the macro-level remains underexplored in the KT literature. This study aims to close the gap.A total of 32 macro-level KT TMFs were identified, with only a limited subset of them offering detailed insights into contextual factors that matter in health policymaking. Notably, the majority of these studies prompt policy changes in low- and middle-income countries and received support from international organisations, the European Union, development agencies or philanthropic entities.
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Affiliation(s)
- Tugce Schmitt
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Peter Schröder-Bäck
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Hodson N, Powell BJ, Nilsen P, Beidas RS. How can a behavioral economics lens contribute to implementation science? Implement Sci 2024; 19:33. [PMID: 38671508 PMCID: PMC11046816 DOI: 10.1186/s13012-024-01362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Implementation science in health is an interdisciplinary field with an emphasis on supporting behavior change required when clinicians and other actors implement evidence-based practices within organizational constraints. Behavioral economics has emerged in parallel and works towards developing realistic models of how humans behave and categorizes a wide range of features of choices that can influence behavior. We argue that implementation science can be enhanced by the incorporation of approaches from behavioral economics. Main body First, we provide a general overview of implementation science and ways in which implementation science has been limited to date. Second, we review principles of behavioral economics and describe how concepts from BE have been successfully applied to healthcare including nudges deployed in the electronic health record. For example, de-implementation of low-value prescribing has been supported by changing the default in the electronic health record. We then describe what a behavioral economics lens offers to existing implementation science theories, models and frameworks, including rich and realistic models of human behavior, additional research methods such as pre-mortems and behavioral design, and low-cost and scalable implementation strategies. We argue that insights from behavioral economics can guide the design of implementation strategies and the interpretation of implementation studies. Key objections to incorporating behavioral economics are addressed, including concerns about sustainment and at what level the strategies work. CONCLUSION Scholars should consider augmenting implementation science theories, models, and frameworks with relevant insights from behavioral economics. By drawing on these additional insights, implementation scientists have the potential to boost efforts to expand the provision and availability of high quality care.
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Affiliation(s)
- Nathan Hodson
- Price School of Public Policy, University of Southern California, Los Angeles, USA.
- Warwick Medical School, Unit of Mental Health and Wellbeing, Division of Health Sciences, University of Warwick, Coventry, UK.
- Department of Medical Social Sciences, Feinberg School of Medicine Northwestern University, Chicago, USA.
| | - Byron J Powell
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Per Nilsen
- Department of Health, Medicine, and Caring Sciences (HMV), Linköping University, Linköping, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine Northwestern University, Chicago, USA
- Center for Dissemination and Implementation Science, Institute for Public Health and Medicine, Chicago, USA
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Marshall J, Papavasiliou E, Fox C, Hawkes M, Irvine A, Moniz-Cook E, Pick A, Polley MJ, Reeve J, Robinson L, Rook G, Sadler E, Wolverson E, Walker S, Cross JL. Social prescribing for people living with dementia (PLWD) and their carers: what works, for whom, under what circumstances and why - protocol for a complex intervention systematic review. BMJ Open 2024; 14:e080551. [PMID: 38589260 PMCID: PMC11015224 DOI: 10.1136/bmjopen-2023-080551] [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: 10/05/2023] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Dementia is a complex medical condition that poses significant challenges to healthcare systems and support services. People living with dementia (PLWD) and their carers experience complex needs often exacerbated by social isolation and challenges in accessing support. Social prescribing (SP) seeks to enable PLWD and their carers to access community and voluntary sector resources to support them address such needs. Existing research, however, does not describe what SP interventions are currently in place in dementia care. Little is known about the needs these interventions are designed to address, the reasons that lead PLWD and their carers to participate in them, their effectiveness and the extent to which they could increase positive health outcomes if adopted and how. METHODS AND ANALYSIS A complex intervention systematic review of SP for PLWD and/or their carers will be conducted using an iterative logic model approach. Six electronic (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus and Cochrane/CENTRAL) and two grey literature databases (EThOS and CORE) were searched for publications between 1 January 2003 and June 2023, supplemented by handsearching of reference lists of included studies. Study selection, data extraction and risk of bias assessment, using Gough's Weight of Evidence Framework, will be independently performed by two reviewers. A narrative approach will be employed to synthesise and report quantitative and qualitative data. Reporting will be informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis Complex Interventions extension statement and checklist. ETHICS AND DISSEMINATION No ethical approval is required due to this systematic review operating only with secondary sources. Findings will be disseminated through peer-reviewed publications, conference presentations and meetings with key stakeholders including healthcare professionals, patient and carer groups, community organisations (eg, the Social Prescribing Network and the Evidence Collaborative at the National Academy for Social Prescribing), policymakers and funding bodies. PROSPERO REGISTRATION NUMBER CRD42023428625.
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Affiliation(s)
- Jessica Marshall
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | | | | | | | | | - Aimee Pick
- University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | | | | | - Louise Robinson
- Institute for Health and Society, Newcastle University, Newcastle, UK
| | - George Rook
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Euan Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Emma Wolverson
- Faculty of Health Sciences, University of Hull, Hull, UK
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Ogutu EA, Ellis AS, Hester KA, Rodriguez K, Sakas Z, Jaishwal C, Yang C, Dixit S, Bose AS, Sarr M, Kilembe W, Bednarczyk R, Freeman MC. Success in vaccination programming through community health workers: a qualitative analysis of interviews and focus group discussions from Nepal, Senegal and Zambia. BMJ Open 2024; 14:e079358. [PMID: 38569679 PMCID: PMC11146414 DOI: 10.1136/bmjopen-2023-079358] [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: 08/29/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES Community health workers are essential to front-line health outreach throughout low-income and middle-income countries, including programming for early childhood immunisation. Understanding how community health workers are engaged for successful early childhood vaccination among countries who showed success in immunisation coverage would support evidence-based policy guidance across contexts. DESIGN We employed a multiple case study design using qualitative research methods. SETTING We conducted research in Nepal, Senegal and Zambia. PARTICIPANTS We conducted 207 interviews and 71 focus group discussions with 678 participants at the national, regional, district, health facility and community levels of the health systems of Nepal, Senegal and Zambia, from October 2019 to April 2021. We used thematic analysis to investigate contributing factors of community health worker programming that supported early childhood immunisation within each country and across contexts. RESULTS Implementation of vaccination programming relied principally on the (1) organisation, (2) motivation and (3) trust of community health workers. Organisation was accomplished by expanding cadres of community health workers to carry out their roles and responsibilities related to vaccination. Motivation was supported by intrinsic and extrinsic incentives. Trust was expressed by communities due to community health worker respect and value placed on their work. CONCLUSION Improvements in immunisation coverage was facilitated by community health worker organisation, motivation and trust. With the continued projection of health worker shortages, especially in low-income countries, community health workers bridged the equity gap in access to vaccination services by enabling wider reach to underserved populations. Although improvements in vaccination programming were seen in all three countries-including government commitment to addressing human resource deficits, training and remuneration; workload, inconsistency in compensation, training duration and scope, and supervision remain major challenges to immunisation programming. Health decision-makers should consider organisation, motivation and trust of community health workers to improve the implementation of immunisation programming.
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Affiliation(s)
- Emily A Ogutu
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Anna S Ellis
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Kyra A Hester
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Katie Rodriguez
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Zoe Sakas
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Chandni Jaishwal
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - Chenmua Yang
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | | | | | - Moussa Sarr
- Institut de Recherche en Santé, de Surveillance Epidemiologique et de Formations, Dakar, Senegal
| | | | - Robert Bednarczyk
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - Matthew C Freeman
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
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Langergaard S, Evans R, Andreasen J, Petersen KS, Overgaard C. Targeting belongingness among older people through engagement in senior centres: intervention development study in Denmark. Health Promot Int 2024; 39:daae032. [PMID: 38610110 PMCID: PMC11015047 DOI: 10.1093/heapro/daae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Adults often experience a loss of social relations and sense of belonging in later life, leading to the risk of social isolation. Municipal senior centres offer a potential site for intervention, as they provide social communities targeting older people. However, not all older people find it easy to access these social communities due to experiencing physical and/or psychosocial frailties and could therefore continue to experience a decline in social relations and sense of belonging, which potentiates poor physical and psychosocial health and well-being. To date, there are limited evidence-based interventions in Denmark. The present article describes the development of an intervention to increase belongingness and decrease social isolation among older people with frailties who attend Danish municipal senior centres. The development process was conducted with reference to the INDEX (IdentifyiNg and assessing different approaches to DEveloping compleX intervention) guidance. The development process resulted in a 6-month supportive intervention, consisting of four elements: skills development workshops for all staff members; a start conversation including frailty screening; allocation of a 'buddy' among existing service users; and monthly follow-up conversations with staff members. This theory-informed approach can progress to feasibility testing and outcome evaluation in order to generate an evidence base. Concurrently, the article reflects on current guidance for intervention development and how it may be used and optimized to strengthen developmental processes in the future.
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Affiliation(s)
- Sofie Langergaard
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Selma Lagerloefs Vej 249, 9260 Gistrup, Aalborg, Denmark
| | - Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Jane Andreasen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Selma Lagerloefs Vej 249, 9260 Gistrup, Aalborg, Denmark
- Aalborg Centre of Health and Rehabilitation, Aalborg Municipality, Teglgårds Plads 1, 9000 Aalborg, Denmark
| | - Kirsten Schultz Petersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Selma Lagerloefs Vej 249, 9260 Gistrup, Aalborg, Denmark
| | - Charlotte Overgaard
- Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Degnevej 14, 6705 Esbjerg Ø, Denmark
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Adeagbo OA, Badru OA, Nkfusai CN, Bain LE. Effectiveness of Linkage to Care and Prevention Interventions Following HIV Self-Testing: A Global Systematic Review and Meta-analysis. AIDS Behav 2024; 28:1314-1326. [PMID: 37668817 DOI: 10.1007/s10461-023-04162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
Over 38.4 million people were living with HIV globally in 2021. The HIV continuum includes HIV testing, diagnosis, linkage to combined antiretroviral therapy (cART), and retention in care. An important innovation in the HIV care continuum is HIV self-testing. There is a paucity of evidence regarding the effectiveness of interventions aimed at linking self-testers to care and prevention, including pre-exposure prophylaxis (PrEP). To bridge this gap, we carried out a global systematic review and meta-analysis to ascertain the effectiveness of interventions post-HIV self-testing regarding: (1) linkage to care or ART, (2) linkage to PrEP, and (3) the impact of HIV self-test (HIVST) interventions on sexual behaviors. We searched PubMed, Web of Science, SCOPUS, Cochrane Library, CINAHL Plus (EBSCO), MEDLINE (Ovid), Google Scholar, and ResearchGate. We included only published randomized controlled trials (RCTs) and quasi-experiment that compared HIVST to the standard of care (SoC). Studies with sufficient data were aggregated using meta-analysis on RevMan 5.4 at a 95% confidence interval. Cochrane's Q test was used to assess heterogeneity between the studies, while Higgins and Thompson's I2 was used to quantify heterogeneity. Subgroup analyses were conducted to identify the source of heterogeneity. Of the 2669 articles obtained from the databases, only 15 studies were eligible for this review, and eight were included in the final meta-analysis. Overall, linkage to care was similar between the HIVST arm and SoC (effect size: 0.92 [0.45-1.86]; I2: 51%; p: 0.04). In the population subgroup analysis, female sex workers (FSWs) in the HIVST arm were significantly linked to care compared to the SoC arm (effect size: 0.53 [0.30-0.94]; I2: 0%; p: 0.41). HIVST interventions did not significantly improve ART initiation in the HIVST arm compared to the SoC arm (effect size: 0.90 [0.45-1.79]; I2: 74%; p: < 0.001). We found that more male partners of women living with HIV in the SoC arm initiated PrEP compared to partners in the HIVST arm. The meta-analysis showed no difference between the HIVST and SoC arm regarding the number of clients (effect size: - 0.66 [1.35-0.02]; I2: 64%; p: 0.09) and non-clients FSWs see per night (effect size: - 1.45 [- 1.45 to 1.38]; I2: 93%; p: < 0.001). HIVST did not reduce the use of condoms during insertive or receptive condomless anal intercourse among MSM. HIVST does not improve linkage to care in the general population but does among FSWs. HIVST intervention does not improve linkage to ART nor significantly stimulate healthy sexual behaviors among priority groups. The only RCT that linked HIVST to PrEP found that PrEP uptake was higher among partners of women living with HIV in the SoC arm than in the HIVST arm. More RCTs among priority groups are needed, and the influence of HIVST on PrEP uptake should be further investigated.
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Affiliation(s)
- Oluwafemi Atanda Adeagbo
- Department of Community and Behavioral Health, University of Iowa, Iowa City, USA
- Department of Sociology, University of Johannesburg, Johannesburg, South Africa
| | - Oluwaseun Abdulganiyu Badru
- Department of Community and Behavioral Health, University of Iowa, Iowa City, USA.
- Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria.
- Institute of Human Virology, Abuja, Nigeria.
| | - Claude Ngwayu Nkfusai
- Department of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Clinton Health Access Initiative, Yaoundé, Cameroon
| | - Luchuo Engelbert Bain
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Auckland Park, Johannesburg, South Africa
- International Development Research Centre, Ottawa, Canada
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Riguzzi M, Thaqi Q, Lorch A, Blum D, Peng-Keller S, Naef R. Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses. Eur J Oncol Nurs 2024; 70:102555. [PMID: 38626610 DOI: 10.1016/j.ejon.2024.102555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/09/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE In end-of-life cancer care, 10-20% of bereaved family members experience adverse mental health effects, including prolonged grief disorder. Despite great efforts, evidence-based recommendations to support their grieving process and well-being are often not successfully adopted into routine clinical care. This study identified facilitators and barriers using implementation science methodology. METHODS 81 registered nurses working in cancer care from four hospitals and three home care services in Switzerland assessed their current family support practices in end-of-life care and bereavement care. They then assessed organisational attributes of their institution and their own individual characteristics and skills regarding literature-based factors of potential relevance. Facilitators and barriers to guideline-based family support were determined using fractional logistic regression. RESULTS Service specialisation in palliative care, a culture that supports change, the availability of family support guidelines, billing/reimbursement of bereavement support services, and individual knowledge of family support and skill were systematically associated with higher adoption of guideline-based family support practices. Lack of privacy with families and insufficient training acted as significant barriers. CONCLUSIONS While several potentially relevant factors have emerged in the literature, certain organisational and individual determinants actually empirically predict guideline-based family support according to nurses in end-of-life cancer care, with some determinants having much stronger implications than others. This provides crucial guidance for focussing quality improvement and implementation efforts through tailored strategies, especially with scarce resources. Furthermore, adoption is lower in bereavement care than in end-of-life care, suggesting a particular need for supportive organisational cultures including specific training and billing/reimbursement options.
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland.
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Haematology Clinic, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Centre for Palliative Care, City Hospital Zurich, Tièchestrasse 99, 8037 Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Kirchgasse 9, 8001 Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
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Jabali SH, Yazdani S, Pourasghari H, Maleki M. From bench to policy: a critical analysis of models for evidence-informed policymaking in healthcare. Front Public Health 2024; 12:1264315. [PMID: 38596514 PMCID: PMC11002157 DOI: 10.3389/fpubh.2024.1264315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background The use of research evidence in policy making is a complex and challenging process that has a long history in various fields, especially in healthcare. Different terms and concepts have been used to describe the relationship between research and policy, but they often lack clarity and consensus. To address this gap, several strategies and models have been proposed to facilitate evidence informed policy making and to identify the key factors and mechanisms involved. This study aims to critically review the existing models of evidence informed policy making (EIPM) in healthcare and to assess their strengths and limitations. Method A systematic search and review conducted to identify and critically assess EIPM models in healthcare. We searched PubMed, Web of Science and Scopus databases as major electronic databases and applied predefined inclusion criteria to select the models. We also checked the citations of the included models to find other scholars' perspectives. Each model was described and critiqued each model in detail and discussed their features and limitations. Result Nine models of EIPM in healthcare were identified. While models had some strengths in comprehension, flexibility and theoretical foundations, analysis also identified limitations including: presupposing rational policymaking; lacking alternatives for time-sensitive situations; not capturing policy complexity; neglecting unintended effects; limited context considerations; inadequate complexity concepts; limited collaboration guidance; and unspecified evidence adaptations. Conclusion The reviewed models provide useful frameworks for EIPM but need further improvement to address their limitations. Concepts from sociology of knowledge, change theory and complexity science can enrich the models. Future EIPM models should better account for the complexity of research-policy relationships and provide tailored strategies based on the policy context.
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Affiliation(s)
- Seyyed Hadi Jabali
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Yazdani
- Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Pourasghari
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Glasgow RE, Ford BS, Bradley CJ. Implementation science for cancer control: One center's experience addressing context, adaptation, equity, and sustainment. Transl Behav Med 2024; 14:215-224. [PMID: 38159246 PMCID: PMC10956964 DOI: 10.1093/tbm/ibad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Implementation science (IS) has great potential to enhance the frequency, speed, and quality of the translation of evidence-based programs, policies, products, and guidelines into practice. Progress has been made, but with some notable exceptions, this promise has not been achieved for cancer prevention and control. We discuss five interrelated but conceptually distinct, crosscutting issues important to accelerate IS for cancer prevention and control and how our Colorado Implementation Science Center in Cancer Control (COISC3) addressed these issues. These needs and opportunities include more fully addressing changing, multi-level context; guiding rapid, iterative adaptations; evaluating innovative approaches to engagement and health equity; greater attention to costs and economic issues; and sustainability. We summarize conceptual issues; evaluation needs and capacity building activities and then provide examples of how our IS center addressed these five needs for cancer prevention and control. We discuss changes made to address priorities of (i) guiding adaptations of implementation strategies to address changing context and (ii) working on issues identified and prioritized by our primary care partners rather than the research team. We conclude with discussion of lessons learned, limitations, and directions for future research and practice in IS to enhance cancer prevention and control as well as translational behavioral medicine more generally.
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Affiliation(s)
- Russell E Glasgow
- Colorado Implementation Science Center in Cancer Control, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bryan S Ford
- Colorado Implementation Science Center in Cancer Control, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cathy J Bradley
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Hendry A, Baker SR, Tsakos G, McKenna G, Jenkins A, Syed SS, Harvey M, Mirza A, Morgan L, Brocklehurst PR. Using a theoretically informed process evaluation alongside a trial to improve oral health for care home residents. Gerodontology 2024; 41:159-168. [PMID: 37496265 DOI: 10.1111/ger.12705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Poor oral health is common among older adults residing in care homes impacting their diet, quality of life, self-esteem, general health and well-being. The care home setting is complex and many factors may affect the successful implementation of oral care interventions. Exploring these factors and their embedded context is key to understanding how and why interventions may or may not be successfully implemented within their intended setting. OBJECTIVES This methodology paper describes the approach to a theoretically informed process evaluation alongside a pragmatic randomised controlled trial, so as to understand contextual factors, how the intervention was implemented and important elements that may influence the pathways to impact. MATERIALS AND METHODS SENIOR is a pragmatic randomised controlled trial designed to improve the oral health of care home residents in the United Kingdom. The trial uses a complex intervention to promote and provide oral care for residents, including education and training for staff. RESULTS An embedded, theoretically informed process evaluation, drawing on the PAHRIS framework and utilising a qualitative approach, will help to understand the important contextual factors within the care home that influence both the trial processes and the implementation of the intervention. CONCLUSION Utilising an implementation framework as the basis for a theoretically informed process evaluation provides an approach that specifically focuses on the contextual factors that may influence and shape the pathways to impact a given complex intervention a priori, while also providing an understanding of how and why an intervention may be effective. This contrasts with the more common post hoc approach that only focuses on implementation after the empirical results have emerged.
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Affiliation(s)
- Annie Hendry
- Bangor Institute of Health and Medical Research, Bangor University, Bangor, UK
| | - Sarah R Baker
- Unit of Oral Health, Dentistry and Society, University of Sheffield, Sheffield, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Gerald McKenna
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Alison Jenkins
- Bangor Institute of Health and Medical Research, Bangor University, Bangor, UK
| | - Saif Sayeed Syed
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Michelle Harvey
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Afshan Mirza
- Department of Epidemiology and Public Health, University College London, London, UK
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Butscher F, Ellinger J, Singer M, Mall C. Influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low socioeconomic status: a systematic review. Implement Sci Commun 2024; 5:12. [PMID: 38347649 PMCID: PMC10860312 DOI: 10.1186/s43058-024-00548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Health inequity (HI) remains a major challenge in public health. Improving the health of children with low socioeconomic status (SES) can help to reduce overall HI in children. Childhood obesity is a global problem, entailing several adverse health effects. It is crucial to assess the influencing factors for adoption, implementation, and sustainment of interventions. This review aims to identify articles reporting about influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low SES. It aims to critically appraise the articles' quality, assess influencing factors, categorize and evaluate them, and to discuss possible implications. METHODS A systematic search was conducted in 7 databases with the following main inclusion criteria: (1) school-based interventions and (2) target group aged 5-14 years. The Consolidated Framework for Implementation Research, its five domains (intervention characteristics, inner setting, outer setting, characteristics of individuals, process) along with 39 categories within these domains were used as deductive category system for data analysis. We grouped the articles with regard to the characteristics of the interventions in simple and complex interventions. For each domain, and for the groups of simple and complex interventions, the most commonly reported influencing factors are identified. RESULTS In total, 8111 articles were screened, and 17 met all eligibility criteria. Included articles applied mixed methods (n=11), qualitative (n=5), and quantitative design (n=1). Of these, six were considered to report simple interventions and eleven were considered to report complex interventions. In total, 301 influencing factors were assessed. Aspects of the inner setting were reported in every study, aspects of the outer setting were the least reported domain. In the inner setting, most reported influencing factors were time (n=8), scheduling (n=6), and communication (n=6). CONCLUSION This review found a wide range of influencing factors for implementation and contributes to existing literature regarding health equity as well as implementation science. Including all stakeholders involved in the implementation process and assessing the most important influencing factors in the specific setting, could enhance implementation and intervention effectiveness. More empirical research and practical guidance are needed to promote obesity prevention behaviors among children with low SES. REGISTRATION CRD42021281209 (PROSPERO).
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Affiliation(s)
- Friederike Butscher
- TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.
| | - Jan Ellinger
- TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Monika Singer
- TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Christoph Mall
- TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
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Lee YJ, Taft A, Stevenson DK, Darmstadt GL. Integrating evidence and causal mapping of factors that influence medication decision-making by pregnant women at risk of hypertensive disorder: protocol for a scoping review. BMJ Open 2024; 14:e074775. [PMID: 38316590 PMCID: PMC10860053 DOI: 10.1136/bmjopen-2023-074775] [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: 04/17/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION In 2018, the American College of Obstetricians and Gynecologists recommended low-dose aspirin to prevent the onset of pre-eclampsia among women who were at high risk. Factors influencing women's acceptance of this recommendation span multiple sectors and levels. Understanding how these factors interact will help stakeholders design effective population-level intervention strategies. Our study aims to identify and map relationships among factors influencing the medication decisions of pregnant women at risk of hypertensive disorders. METHODS AND ANALYSIS Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines will be followed for this review. A research librarian developed a comprehensive search strategy to retrieve published and unpublished English studies after 1 January 1980, involving factors that influence pregnant women's uptake and adherence to medication for gestational hypertensive disorders. This literature includes perceptions, patterns, acceptance, refusal, tendencies, probability and service utilisation. We will search PubMed, Embase, Web of Science and CINAHL. Reference lists of the selected papers will be searched manually to identify more relevant studies. A two-stage independent screening, consisting of title and abstract screening, followed by full-text screening, will be conducted by two independent reviewers to identify eligible articles. Extracted data will be recorded in a customised variable extraction form and input into a Microsoft Access database. The PRISMA-ScR will be used to guide the presentation of the results, which will be presented in a table and causal map to demonstrate the relationships between extracted variables and medication uptake and adherence. A conceptual simulation model will be formulated to validate the logic of the relationships between variables and identify knowledge gaps. Lastly, experts and stakeholders will be invited to critique and comment on the results. ETHICS AND DISSEMINATION This study does not require ethical approval. The full review results will be presented at a relevant conference and submitted to a peer-reviewed scientific journal for publication.
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Affiliation(s)
- Yin Jien Lee
- Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Anita Taft
- School of Humanities and Sciences, Stanford University, Stanford, California, USA
| | - David K Stevenson
- Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- California Maternal Quality Care Collaborative (CMQCC), Stanford, California, USA
| | - Gary L Darmstadt
- Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Horgan S, Hegarty J, Drennan J, Keane D, Saab MM. The effect of interventions on the incidence of surgical site infections in acute care settings: A systematic review. J Tissue Viability 2024; 33:75-88. [PMID: 37977894 DOI: 10.1016/j.jtv.2023.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/22/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
AIM Surgical site infections (SSIs) are common healthcare associated infections with serious consequences for patients and healthcare organisations. It is critical that healthcare professionals implement prevention strategies to reduce the incidence of such infections. Prevention strategies are key to reducing the incidence of SSIs. The aim of this systematic review is to describe the effect of interventions conducted in acute care settings on the incidence of SSIs (primary outcome), length of stay, intensive care unit admission, and mortality rate (secondary outcomes). MATERIALS AND METHODS This review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis checklist. A search was undertaken in Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2017 and March 2022. Studies that focused on interventions within acute hospital settings in patients undergoing elective surgery with the aim of reducing the incidences of SSIs were included. Due to heterogeneity results were synthesised narratively. RESULTS In total, 23 studies were included. Findings show that interventions that are effective in reducing the incidences of SSIs have multiple components including care bundles, stakeholder engagement, targeted surveillance and education. Few studies were identified that evaluated the effect of SSI prevention interventions on length of stay and mortality, and none assessed intensive care admission rates. CONCLUSIONS The included interventions varied widely, which made it difficult to draw definitive conclusions regarding specific interventions that reduce SSI. Multicomponent interventions and care bundles showed promise in reducing the occurrence of SSIs. Further studies should focus on standardised evidence-based interventions and compliance using randomised controlled designs.
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Affiliation(s)
- Sinéad Horgan
- South/South West Hospitals Group, Department of Nursing and Midwifery, Erinville, Western Road, Cork, Ireland; Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - Danielle Keane
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
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McNeil-Gauthier AL, Milot DM, Levasseur M. How environments can promote active aging: results from a case study of two municipalities in Quebec, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:117-131. [PMID: 37589791 PMCID: PMC10853091 DOI: 10.17269/s41997-023-00806-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/16/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES To address global aging, a paradigm shift is needed from disease prevention and treatment towards active aging, i.e., optimizing opportunities for health, participation, and security as people age. Little is known about how age-friendly environments promote active aging. This study thus aimed to explore how (through which mechanisms and in what contexts) environments can promote active aging and, specifically, positive health, social participation, and health equity. METHODS Using a realist approach and semi-structured focus groups, a case study was used in two Quebec municipalities known for best fostering active aging. Data also included participants' logbooks, sociodemographic questionnaires, municipalities' sociodemographic profiles, and policy documents. A conceptual framework and thematic content analysis were carried out. RESULTS A total of 24 participants (9 older adults, 4 health professionals, 3 community-based actors, 5 municipal employees, and 3 elected officials) took part in 5 focus groups. Regarding contexts, both cases were midsize municipalities having an income and education level higher to Quebec's averages with supportive active aging policies. Two main themes explained how the environments promoted active aging: (1) by ensuring proximity through built (urban planning), social (network structures), services (variety and availability of local and outreach resources), and organizational (active listening to older adults' needs for active aging) environments; and (2) by fostering transversality through built (universal accessibility, intergenerational spaces), social (intergenerational opportunities for social participation), and political/organizational (unified and complementary policies) environments. CONCLUSION To better promote active aging through age-friendly environments, practices should focus on fostering proximity and transversality, and act simultaneously on multiple environments.
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Affiliation(s)
- Anne-Lou McNeil-Gauthier
- Direction Régionale de Santé Publique de La Montérégie, CISSS of Montérégie Centre, Longueuil, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - David-Martin Milot
- Direction Régionale de Santé Publique de La Montérégie, CISSS of Montérégie Centre, Longueuil, QC, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Mélanie Levasseur
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
- Research Centre On Aging, CIUSSS de L'Estrie-CHUS, Sherbrooke, QC, Canada.
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Huiberts I, Singh A, Collard D, Hendriks M, van Lenthe FJ, Chinapaw M. Untangling the complex implementation process of community-based health promotion: a multiple-case study in the Netherlands. Health Promot Int 2024; 39:daae005. [PMID: 38400834 PMCID: PMC10893857 DOI: 10.1093/heapro/daae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024] Open
Abstract
Community-based programmes are a widely implemented approach for population health promotion. Due to the context-dependent and dynamic nature of these programmes, evaluating their implementation is challenging. Identifying key events in the implementation process in evaluation could enable us to support future implementation, while acknowledging the complexity of real-world implementation. We studied the nationwide implementation of the Dutch Healthy Youth, Healthy Future (JOGG) approach, a community-based programme for childhood overweight prevention. The aims of our study were (i) to gain insights into the implementation process of the JOGG approach, and (ii) to identify key events that influenced said process. In nine communities, we conducted interviews (n = 24) with coordinators and stakeholders involved in the implementation of the JOGG approach and collected documents on the programme's implementation. We applied the analytical tool 'Critical Event Card' to identify key events in the implementation process. Results showed that in 5-10 years of implementing the JOGG approach, communities have undergone different phases: preparation, upscaling, resource mobilization, integration with other policy initiatives and adaptation of the implementation strategy. Key events influencing the implementation process included national policy developments (e.g. new health programmes), framing of the JOGG approach in local policy, staff turnover and coordination teams' experiences and actions. Furthermore, changes in implementation were often triggered by the destabilization of the implementation process and linked to opportunities for change in the policy process. The identified key events can inform future implementation of the JOGG approach as well as other community-based health promotion programmes.
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Affiliation(s)
- Irma Huiberts
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands
- Mulier Instituut, Herculesplein 269, 3584AA Utrecht, The Netherlands
| | - Amika Singh
- Mulier Instituut, Herculesplein 269, 3584AA Utrecht, The Netherlands
- Human Movement, School and Sport, Applied University of Windesheim, Campus 2, 8017CA Zwolle, The Netherlands
| | - Dorine Collard
- Mulier Instituut, Herculesplein 269, 3584AA Utrecht, The Netherlands
| | - Mara Hendriks
- Mulier Instituut, Herculesplein 269, 3584AA Utrecht, The Netherlands
| | - Frank, J van Lenthe
- Department of Public Health, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Mai Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands
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Bauernschmidt D, Wittmann J, Hirt J, Meyer G, Bieber A. The Implementation Success of Technology-Based Counseling in Dementia Care: Scoping Review. JMIR Aging 2024; 7:e51544. [PMID: 38271050 PMCID: PMC10853855 DOI: 10.2196/51544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Implementing technology-based counseling as a complex intervention in dementia care poses challenges such as adaptation to stakeholders' needs and limited resources. While studies have examined the effectiveness of technology-based counseling, its successful implementation remains largely unexplored. OBJECTIVE We aimed to review the knowledge about the implementation success of technology-based counseling interventions for people with dementia and their informal caregivers. METHODS We conducted a scoping review and systematically searched CINAHL, the Cochrane Library including the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and Web of Science Core Collection databases (April 2021) in combination with citation searching and web searching (November 2021). Studies reporting on technology-based counseling interventions for people with dementia or their informal caregivers were included, irrespective of the design. We used the conceptual framework for implementation outcomes to operationalize implementation success and applied the outcomes acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability as categories to inform data extraction. We identified dimensions within the categories and synthesized results narratively and graphically. RESULTS We included 52 publications reporting on 27 technology-based counseling interventions. The studies were conducted in 9 countries and published between 1993 and 2021. As the design of the included studies varied, the number of participants and the type of data reported varied as well. The intervention programs were heterogeneous and ranged from single counseling interventions (such as helpline services) to counseling as part of a multicomponent program. Telephone, email, videoconferencing, social media (respectively chats), and web-based platforms were used for delivering counseling. We found data on appropriateness for all interventions and data on acceptability for most interventions, describing aspects such as consumer-perceived usefulness and helpfulness of services, as well as satisfaction. Information on the other categories of adoption, feasibility, fidelity, implementation cost, penetration, and sustainability was fragmented. CONCLUSIONS The scope and depth of information on conceptual categories of the implementation success of technology-based counseling for people with dementia and informal caregivers varied. The data only partially covered the concept of implementation success, which highlights the need for a systematic evaluation accompanying the implementation. The application of theoretical approaches for implementation and adherence to the framework for developing and evaluating complex interventions are required to promote the implementation of complex interventions and to comprehensively assess implementation success. TRIAL REGISTRATION PROSPERO CRD42021245473; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=245473.
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Affiliation(s)
- Dorothee Bauernschmidt
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Janina Wittmann
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Julian Hirt
- Center for Dementia Care, Institute of Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St Gallen, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gabriele Meyer
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Bieber
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Oestman K, Rechis R, Williams PA, Brown JA, Treiman K, Zulkiewicz B, Walsh MT, Basen-Engquist K, Rodriguez T, Chennisi C, Macneish A, Neff A, Pomeroy M, Bhojani FA, Hawk E. Reducing risk for chronic disease: evaluation of a collective community approach to sustainable evidence-based health programming. BMC Public Health 2024; 24:240. [PMID: 38245669 PMCID: PMC10799505 DOI: 10.1186/s12889-024-17670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Community initiatives can shape health behaviors, such as physical activity and dietary habits, across a population and help reduce the risk of developing chronic disease. To achieve this goal and impact health outcomes, Pasadena Vibrant Community aimed to engage communities in an ongoing dialogue about the importance of healthy behaviors, implement and advance community-based strategies to promote health, and improve diet and physical activity behaviors. The initiative was centered around a collaboration between a backbone organization, steering committee, and 7 collaborating organizations funded to implement multicomponent, evidence-based programs.. The common agenda was detailed in a community action plan, which included 19 interventions targeting healthy eating and active living among adults and youth in Pasadena, Texas. METHODS A mixed methods evaluation of the initiative was conducted over 4 years. Data sources included document reviews of quarterly progress reports (n = 86) and supplemental data reports (n = 16) provided by collaborating organizations, annual Steering Committee surveys (n = 4), and interviews conducted with staff from a subset of Collaborating Organizations (n = 4). RESULTS The initiative reached over 50,000 community members per year through 19 evidence-based interventions and impacted health outcomes, including knowledge and adoption of healthy eating practices and increased physical activity. Thirty-one systems-level changes were implemented during the initiative, including 16 environmental changes. Steering Committee meetings and shared goals enabled connections, communication, and cooperation, which allowed Collaborating Organizations to address challenges and combine resources to deliver their programs. CONCLUSIONS Community initiatives can effectively permeate the community by reaching individuals, improving physical activity and dietary habits, and ensuring sustainability. Based on the experience reported here, the success of a community initiative can be facilitated if collaborating organizations come together to implement evidence-based interventions and tailor them to the community, and if they are empowered by significant leadership and supportive collaboration and aligned by a common agenda.
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Affiliation(s)
- Katherine Oestman
- The University of Texas MD Anderson Cancer Center, 7007 Bertner Ave Unit 1628, Houston, TX, 77030, USA
| | - Ruth Rechis
- The University of Texas MD Anderson Cancer Center, 7007 Bertner Ave Unit 1628, Houston, TX, 77030, USA.
| | - Pamela A Williams
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Jill A Brown
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Katherine Treiman
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Brittany Zulkiewicz
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Michael T Walsh
- The University of Texas MD Anderson Cancer Center, 7007 Bertner Ave Unit 1628, Houston, TX, 77030, USA
| | - Karen Basen-Engquist
- The University of Texas MD Anderson Cancer Center, 7007 Bertner Ave Unit 1628, Houston, TX, 77030, USA
| | - Trina Rodriguez
- City of Pasadena Texas Parks and Recreation Department, 3111 San Augustine Avenue, Pasadena, TX, 77503, USA
| | - Catherine Chennisi
- Harris County Public Health, 2223 West Loop South, Houston, TX, 77027, USA
| | - Amber Macneish
- Pasadena Independent School District, 1515 Cherrybrook Lane, Pasadena, TX, 77502, USA
| | - Alise Neff
- Pasadena Independent School District, 1515 Cherrybrook Lane, Pasadena, TX, 77502, USA
| | - Mike Pomeroy
- Brighter Bites, 535 Portwall Street, Houston, TX, 77029, USA
| | - Faiyaz A Bhojani
- Shell USA, Inc, 150 N. Dairy Ashford Road, Houston, TX, 77002, USA
| | - Ernest Hawk
- The University of Texas MD Anderson Cancer Center, 7007 Bertner Ave Unit 1628, Houston, TX, 77030, USA
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Ribaut J, DeVito Dabbs A, Dobbels F, Teynor A, Mess EV, Hoffmann T, De Geest S. Developing a Comprehensive List of Criteria to Evaluate the Characteristics and Quality of eHealth Smartphone Apps: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e48625. [PMID: 38224477 PMCID: PMC10825776 DOI: 10.2196/48625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND The field of eHealth is growing rapidly and chaotically. Health care professionals need guidance on reviewing and assessing health-related smartphone apps to propose appropriate ones to their patients. However, to date, no framework or evaluation tool fulfills this purpose. OBJECTIVE Before developing a tool to help health care professionals assess and recommend apps to their patients, we aimed to create an overview of published criteria to describe and evaluate health apps. METHODS We conducted a systematic review to identify existing criteria for eHealth smartphone app evaluation. Relevant databases and trial registers were queried for articles. Articles were included that (1) described tools, guidelines, dimensions, or criteria to evaluate apps, (2) were available in full text, and (3) were written in English, French, German, Italian, Portuguese, or Spanish. We proposed a conceptual framework for app evaluation based on the dimensions reported in the selected articles. This was revised iteratively in discussion rounds with international stakeholders. The conceptual framework was used to synthesize the reported evaluation criteria. The list of criteria was discussed and refined by the research team. RESULTS Screening of 1258 articles yielded 128 (10.17%) that met the inclusion criteria. Of these 128 articles, 30 (23.4%) reported the use of self-developed criteria and described their development processes incompletely. Although 43 evaluation instruments were used only once, 6 were used in multiple studies. Most articles (83/128, 64.8%) did not report following theoretical guidelines; those that did noted 37 theoretical frameworks. On the basis of the selected articles, we proposed a conceptual framework to explore 6 app evaluation dimensions: context, stakeholder involvement, features and requirements, development processes, implementation, and evaluation. After standardizing the definitions, we identified 205 distinct criteria. Through consensus, the research team relabeled 12 of these and added 11 more-mainly related to ethical, legal, and social aspects-resulting in 216 evaluation criteria. No criteria had to be moved between dimensions. CONCLUSIONS This study provides a comprehensive overview of criteria currently used in clinical practice to describe and evaluate apps. This is necessary as no reviewed criteria sets were inclusive, and none included consistent definitions and terminology. Although the resulting overview is impractical for use in clinical practice in its current form, it confirms the need to craft it into a purpose-built, theory-driven tool. Therefore, in a subsequent step, based on our current criteria set, we plan to construct an app evaluation tool with 2 parts: a short section (including 1-3 questions/dimension) to quickly disqualify clearly unsuitable apps and a longer one to investigate more likely candidates in closer detail. We will use a Delphi consensus-building process and develop a user manual to prepare for this undertaking. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021227064; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227064.
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Affiliation(s)
- Janette Ribaut
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Annette DeVito Dabbs
- School of Nursing, Department of Acute & Tertiary Care, University of Pittsburgh, Pittsburgh, PA, United States
- Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Fabienne Dobbels
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Alexandra Teynor
- Department of Computer Science, University of Applied Sciences, Augsburg, Germany
| | | | - Theresa Hoffmann
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Department Pflege und Betreuung, Genossenschaft Alterszentrum Kreuzlingen, Kreuzlingen, Switzerland
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Sterckx A, Delbaere B, De Blust G, Spacova I, Samson R, Remmen R, Keune H. Quality criteria of nature-based interventions in healthcare facilities: a scoping review. Front Public Health 2024; 11:1327108. [PMID: 38274513 PMCID: PMC10808570 DOI: 10.3389/fpubh.2023.1327108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Implementing integrated nature-based interventions that simultaneously serve human health and the restoration of biodiversity in healthcare facilities is considered a promising strategy. As an emerging field of research and practice in healthcare, identification of quality criteria is necessary to support desired outcomes related to biodiversity, human health and intervention processes. This study is part of a larger research project in collaboration with the Flemish Agency of Nature and Forest in Belgium. Methods A scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews, in PubMed, Medline, Web of Science and Scopus. A step-by-step tabular screening process was conducted to identify relevant studies and reviews of nature-based interventions, published in English between January 2005 and April 2023. A qualitative content analysis was conducted and the results were then presented to the project steering group and a panel of stakeholders for refinement. Results After filtering on the eligibility criteria, and with focus on healthcare facilities, 14 articles were included in this study. A preliminary nature-based interventions quality framework with a set of quality indicators has been developed. Discussion When designing integrated nature-based interventions, a needs analysis of users and the outdoor environment should be conducted. Next, the integration of a One Health and biodiversity perspective and the application of a complex intervention framework, could support the quality of the design and implementation of nature-based interventions in healthcare facilities and facilitate their assessment. In future work, more rigorous research into the design and implementation of integrated nature-based interventions is needed to test and refine the quality criteria in practice.
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Affiliation(s)
- Ann Sterckx
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ben Delbaere
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Geert De Blust
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Irina Spacova
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Roeland Samson
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hans Keune
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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