1
|
Wathne H, May C, Morken IM, Storm M, Husebø AML. Acceptability and usability of a nurse-assisted remote patient monitoring intervention for the post-hospital follow-up of patients with long-term illness: A qualitative study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100229. [PMID: 39166216 PMCID: PMC11334779 DOI: 10.1016/j.ijnsa.2024.100229] [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: 02/28/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/22/2024] Open
Abstract
Background Patients living with long-term chronic illnesses often need ongoing medical attention, lifestyle adjustments, and psychosocial support beyond the initial diagnosis and treatment phases. Many experience illness deterioration and subsequently require hospitalisation, especially in the transition period after hospital discharge. A promising strategy for managing long-term conditions is promoting self-management. eHealth interventions involving remote patient monitoring have the potential to promote self-management and offer a more seamless bridge between the hospital and the patient´s home environment. However, such interventions can only significantly impact health and health care if they are effective, accepted and adopted by users, normalised into routine practice and everyday life, and able to be widely implemented. Feasibility studies are used to determine whether an intervention is suitable for the target population and effective in achieving its intended goal. They may also provide critical information about an intervention´s acceptability and usability. Objectives We aimed to evaluate the acceptability and usability of a nurse-assisted remote patient monitoring intervention for the post-hospital follow-up of patients with long-term illnesses by use of the core constructs of normalisation process theory. Design A descriptive and explanatory qualitative approach was used, with patients observed during training and semi-structured interviews conducted with patients and nurses after study completion. Settings Participants were recruited from two university hospitals in Norway between December 2021 and February 2023. Participants Ten patients were observed during training, and 27 patients and eight nurses were interviewed after study completion. Methods Structured and overt observations were made while the patients received training to operate the remote patient monitoring service, guided by an observation guide. Semi-structured interviews were conducted with patients and nurse navigators about their experiences of remote follow-up care, guided by open ended questions. Data analysis followed a stepwise deductive inductive method. Results `Achieving acceptance and usability through digital social interaction´ emerged as a unifying theme that bridged the experiences of patients with long-term illnesses and the nurse navigators. This overarching theme was illustrated by four sub-themes, which all reflected the usability and acceptability of the nurse-assisted remote patient monitoring service in various ways. Conclusion Acceptability and usability are critical factors to consider when evaluating remote patient monitoring interventions. In this study, the most important feature for promoting acceptability and usability was the interaction between patients and nurse navigators. Therefore, the intervention´s feasibility and implementation potential rested upon the relationship between its deliverer and receiver.
Collapse
Affiliation(s)
- Hege Wathne
- Department of Public Health, University of Stavanger, Faculty of Health Science, Stavanger, Norway
| | - Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ingvild Margreta Morken
- Department of Quality and Health Technologies, University of Stavanger, Faculty of Health Science, Stavanger, Norway
- Research Group for Health and Nursing Sciences, Stavanger University Hospital, Stavanger, Norway
| | - Marianne Storm
- Department of Public Health, University of Stavanger, Faculty of Health Science, Stavanger, Norway
- Research Group for Health and Nursing Sciences, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health, University of Stavanger, Faculty of Health Science, Stavanger, Norway
- Research Group for Health and Nursing Sciences, Stavanger University Hospital, Stavanger, Norway
| |
Collapse
|
2
|
Zeng Z, Li X, Bai Y, Gong W. Barriers and facilitators of screening postpartum depression by primary maternal health workers: A mixed methods study based on the normalization process theory. Midwifery 2024; 138:104148. [PMID: 39168051 DOI: 10.1016/j.midw.2024.104148] [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: 11/28/2023] [Revised: 07/15/2024] [Accepted: 08/13/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Postpartum depression (PPD) significantly impacts mothers and children's health. China aims to incorporate PPD screening in postpartum home visits, but research on implementation barriers and facilitators is scarce. We designed and implemented a new PPD screening program in Changsha, China, requiring maternal health workers to integrate PPD screening into their postpartum home visits. AIMS To identify real-world barriers and facilitators associated with integrating PPD screening into routine home visits from the perspective of maternal health workers. METHODS We employed a mixed-methods approach. Maternal health workers involved in the newly introduced PPD screening program were included. Guided by Normalization Process Theory (NPT), quantitative data were collected using the NoMAD instrument, and qualitative data were obtained through semi-structured interviews. Data were analyzed using descriptive statistics for the survey and thematic analysis for the interviews. RESULTS All 42 maternal health workers involved in the new PPD program completed the quantitative survey, and nine participated in qualitative interviews. The NoMAD survey revealed high scores for Coherence and Cognitive Participation, but lower scores for Collective Action, particularly regarding insufficient skills and resource adequacy. Thematic analysis identified several barriers, including workload concerns, the need for enhanced psychological healthcare capacity, and lack of economic incentives. Facilitators included the integration of structured feedback and clear referral pathways. CONCLUSION Addressing identified barriers through targeted skill training, well-defined referral pathways, and formal recognition of the screening program in performance evaluations could help achieve successful normalization.
Collapse
Affiliation(s)
- Zhen Zeng
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Hunan 410013, China
| | - Xiaoyu Li
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Hunan 410013, China
| | - Yanping Bai
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Hunan 410013, China
| | - Wenjie Gong
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Hunan 410013, China; FuRong Laboratory, Changsha 410078, Hunan, China; Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK; Department of Psychiatry, University of Rochester, Rochester, New York, USA.
| |
Collapse
|
3
|
Kennedy KA, Snow AL, Mills WL, Haigh S, Mochel A, Curyto K, Bishop T, Hartmann CW, Camp CJ, Hilgeman MM. Implementing Montessori approaches after training: A mixed methods study to examine staff understanding and movement toward action. DEMENTIA 2024; 23:1126-1151. [PMID: 39039035 DOI: 10.1177/14713012241263712] [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: 07/24/2024]
Abstract
Background: This paper uses Normalization Process Theory (NPT) to examine staff impressions of Montessori-based program training and implementation at Veterans Affairs Community Living Centers (VA CLCs; nursing homes). Methods: We conducted a mixed-methods evaluation of Montessori Approaches to Person-Centered Care (MAP-VA) at eight VA CLCs. Trainings were conducted as either a live virtual course or a pre-recorded asynchronous class. Two NPT constructs, coherence building and cognitive participation, informed qualitative interview questions, surveys, and analyses focused on staff movement from knowledge to action during initial implementation. Data collection included staff-completed standardized post-training exams (N = 906), post-training evaluations (N = 761), and optional validated surveys on perceptions of Montessori training (N = 307). Champions (peer-leaders) from each CLC completed semi-structured qualitative interviews post-training (N = 22). Findings: The majority of staff (83%-90%) passed all courses. Staff evaluated the training highly (80%+ agreement) on learning relevant new knowledge and confidence applying new skills. On average, staff felt MAP-VA would become a normal part of their work (7.68/10 scale), and reported increased familiarity with Montessori approaches after training (p = .002). Qualitative interview data from staff trained in Montessori supported three themes concordant with the NPT dimensions of coherence building and cognitive participation. (1) Coherence regarding Montessori: staff demonstrated an understanding of the program and mentioned the benefits of Montessori compared to their previous usual routines. Cognitive participation or engagement with Montessori: (2) staff had positive feelings about Montessori principles/applications and demonstrated a willingness to try the Montessori approach, and (3) staff made sense of the new intervention through early rehearsal of Montessori principles/practices and recognized opportunities for using Montessori in future interactions. Conclusions: Montessori virtual training resulted in high levels of coherence and cognitive participation among multidisciplinary staff, evidenced by high knowledge, self-efficacy, and readiness to act. The asynchronous and synchronous trainings were accessible, relevant, and supported diverse learners.
Collapse
Affiliation(s)
- Katherine A Kennedy
- Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, USA
| | - A Lynn Snow
- Research & Development Service, Tuscaloosa VA Medical Center, USA; Department of Psychology & Alabama Research Institute on Aging, The University of Alabama, USA
| | - Whitney L Mills
- Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, USA
| | - Sylvia Haigh
- Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, USA
| | - Amy Mochel
- Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, USA
| | - Kimberly Curyto
- Center for Integrated Healthcare, VA Western NY Healthcare System, USA
| | - Teddy Bishop
- Research & Development Service, Tuscaloosa VA Medical Center, USA
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, VA Edith Nourse Rogers Memorial Veterans Hospital, USA; Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, USA
| | | | - Michelle M Hilgeman
- Research & Development Service, Tuscaloosa VA Medical Center, USA; Department of Psychology & Alabama Research Institute on Aging, The University of Alabama, USA; Division of Gerontology, Geriatrics, & Palliative Care, Department of Medicine, The University of Alabama at Birmingham, USA
| |
Collapse
|
4
|
Fults E, Gerwin JN, Boyce MW, Joseph M, Wong AH, Evans LV. Educational and personal impacts of the COVID-19 pandemic on emergency medicine resident physicians: a qualitative study. BMC MEDICAL EDUCATION 2024; 24:1055. [PMID: 39334215 DOI: 10.1186/s12909-024-05972-4] [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: 03/07/2024] [Accepted: 08/30/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND The COVID-19 pandemic had a significant impact on both the clinical practice and the psychological states of frontline physicians in the emergency department. Trainees, at the beginning of their careers and thus still developing their practice styles and identities as physicians, were uniquely affected. OBJECTIVE In this qualitative study, we sought to explore how the pandemic environment shaped the experiences of emergency medicine resident physicians. METHODS This was a qualitative study. We conducted in-depth interviews with emergency medicine faculty, resident physicians, and staff at a single emergency department based at an urban academic institution in the northeastern United States. Interviews were audio recorded and transcribed, and transcripts were then analyzed in an iterative process by our coding team for recurring themes related to the resident experience. RESULTS We reached data saturation with 27 individuals. Of those who were interviewed, 10 were resident physicians [6 senior residents (PGY-3 or PGY-4) and 4 junior residents (PGY-1 or PGY-2)]. Three major recurring themes regarding resident physician experience emerged during our analysis of the interviews: (1) novel educational experiences dampened by negative structural forces from the pandemic, (2) fracturing of social interactions and mitigation through ad-hoc support systems and community of practice, and (3) development of negative emotions and psychological trauma including fear, resentment, and moral injury causing lasting harm. CONCLUSIONS Our results suggest that emergency medicine resident physicians training during the COVID-19 pandemic faced unique experiences concerning their education, social support systems, and emotional states. While the educational and social experiences were described as having both negative and positive impacts, the emotional experiences were largely negative. Residency program leadership may use these insights to improve resident preparation, wellness, and resilience in the face of future adverse events.
Collapse
Affiliation(s)
- Elyse Fults
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey N Gerwin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael W Boyce
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Melissa Joseph
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Leigh V Evans
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
| |
Collapse
|
5
|
Mwanga JR, Hokororo A, Ndosi H, Masenge T, Kalabamu FS, Tawfik D, Mediratta RP, Rozenfeld B, Berg M, Smith ZH, Chami N, Mkopi NP, Mwanga C, Diocles E, Agweyu A, Meaney PA. Evaluating the implementation of the Pediatric Acute Care Education (PACE) program in northwestern Tanzania: a mixed-methods study guided by normalization process theory. BMC Health Serv Res 2024; 24:1066. [PMID: 39272036 PMCID: PMC11401409 DOI: 10.1186/s12913-024-11554-3] [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: 05/16/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND In low- and middle-income countries (LMICs), such as Tanzania, the competency of healthcare providers critically influences the quality of pediatric care. To address this issue, we introduced Pediatric Acute Care Education (PACE), an adaptive learning program to enhance provider competency in Tanzania's guidelines for managing seriously ill children. Adaptive learning is a promising alternative to current in-service education, yet optimal implementation strategies in LMIC settings are unknown. OBJECTIVES (1) To evaluate the initial PACE implementation in Mwanza, Tanzania, using the construct of normalization process theory (NPT); (2) To provide insights into its feasibility, acceptability, and scalability potential. METHODS Mixed-methods study involving healthcare providers at three facilities. Quantitative data was collected using the Normalization MeAsure Development (NoMAD) questionnaire, while qualitative data was gathered through in-depth interviews (IDIs) and focus groups discussions (FGDs). RESULTS Eighty-two healthcare providers completed the NoMAD survey. Additionally, 24 senior providers participated in IDIs, and 79 junior providers participated in FGDs. Coherence and cognitive participation were high, demonstrating that PACE is well understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practices, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly those affecting collective action, were noted. Early indicators point toward the potential for long-term sustainability of the PACE, but assessment of reflexive monitoring was limited due to the study's focus on PACE's initial implementation. CONCLUSION This study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanzanian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges as well as conducting a longer-term study to assess reflexive monitoring is crucial for its successful implementation. Furthermore, the study underscores the value of the NPT as a framework for guiding implementation processes, with broader implications for implementation science and pediatric acute care in LMICs.
Collapse
Affiliation(s)
- Joseph R Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Adolfine Hokororo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Hanston Ndosi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Florence S Kalabamu
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
- Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Daniel Tawfik
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | - Marc Berg
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Neema Chami
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Namala P Mkopi
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Castory Mwanga
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Enock Diocles
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ambrose Agweyu
- London School of Hygiene and Tropical Medicine, London, UK
| | - Peter A Meaney
- Stanford University School of Medicine, Palo Alto, CA, USA.
| |
Collapse
|
6
|
Costea VA, Bäck A, Bergström A, Lundin A, Hasson H, Eriksson L. A longitudinal mixed methods evaluation of a facilitation training intervention to build implementation capacity. FRONTIERS IN HEALTH SERVICES 2024; 4:1408801. [PMID: 39347375 PMCID: PMC11427355 DOI: 10.3389/frhs.2024.1408801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/30/2024] [Indexed: 10/01/2024]
Abstract
Background There is a demand for facilitators who can ease the collaboration within a team or an organization in the implementation of evidence-based interventions (EBIs) and who are positioned to build the implementation capacity in an organization. This study aimed to evaluate the results the Building implementation capacity for facilitation (BIC-F) intervention had on the participants' perceived knowledge, skills, and self-efficacy to facilitate implementation and the normalization of a systematic implementation model into their work routines, and its use into their respective organizations. Methods The BIC-F intervention was delivered to 37 facilitators in six workshops, which focused on teaching participants to apply a systematic implementation model and various facilitation tools and strategies. A longitudinal mixed methods design was used to evaluate the intervention. Data was collected pre- and post-intervention using questionnaires and semi-structured interviews grounded on the Normalization Process Theory (NPT). Quantitative data were analyzed using descriptive (mean, SD) and inferential (paired t-tests) methods. Qualitative data were analyzed using deductive content analysis according to NPT. Results An increase in the participants' perceived knowledge, skills, and self-efficacy was observed post-intervention. Normalization of the systematic implementation model in the participants' work routines was in an early phase, facilitated by high coherence, however, other NPT mechanisms were not sufficiently activated yet to contribute to full normalization. In the organizations where participants initiated the normalization process, they were still working towards achieving coherence and cognitive participation among relevant stakeholders. Conclusion The intervention had positive results on the participants' perceived knowledge, skills, and self-efficacy and these recognized the value of a systematic implementation model for their practice. However, further efforts are needed to apply it consistently as a part of their work routines and in the organization. Future interventions should provide long-term support for facilitators, and include methods to transfer training between organizational levels and to overcome contextual barriers.
Collapse
Affiliation(s)
- Veronica-Aurelia Costea
- PROCOME Research Group, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Annika Bäck
- PROCOME Research Group, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Anna Bergström
- PROCOME Research Group, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Andreas Lundin
- Unit for Health Care Analysis, Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Henna Hasson
- PROCOME Research Group, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Leif Eriksson
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm, Sweden
| |
Collapse
|
7
|
Varese F, Allsopp K, Carter LA, Shields G, Hind D, Davies L, Barrett A, Bhutani G, McGuirk K, Huntley F, Jordan J, Rowlandson A, Sarsam M, Ten Cate H, Walker H, Watson R, Wilkinson J, Willbourn J, French P. The Resilience Hub approach for addressing mental health of health and social care workers during the COVID-19 pandemic: a mixed-methods evaluation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-164. [PMID: 39264827 DOI: 10.3310/hgqr5133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2024]
Abstract
Background Resilience Hubs provide mental health screening, facilitation of access and direct provision of psychosocial support for health and social care keyworkers in England affected by the coronavirus disease 2019 pandemic. Aim To explore implementation of the Hubs, including characteristics of staff using the services, support accessed, costing data and a range of stakeholder perspectives on the barriers and enablers to Hub use and implementation of staff well-being support within the context of the pandemic. Design Mixed-methods evaluation. Setting Four Resilience Hubs. Methods Findings were integrated via mixed-method case studies, including: analyses of Hub mental health screening (N = 1973); follow-up questionnaire data (N = 299) on service use and health status of Hub clients; economic information provided by the Hubs; 63 interviews with Hub staff, wider stakeholders, Hub clients and keyworkers who did not use the Hubs. Results Findings were consistent across Hubs and workstreams. Most Hub clients were NHS staff. Under-represented groups included men, keyworkers from minority ethnic communities, care homes and emergency services staff. Clients reported comorbid mental health needs across multiple domains (anxiety; depression; post-traumatic stress; alcohol use; functioning). Their health status was lower than population norms and relevant pre-pandemic data. Several factors predicted higher needs, but having pre-pandemic emotional well-being concerns was one of the most robust predictors of higher need. Sixty per cent of participants who completed follow-up questionnaires reported receiving mental health support since Hub screening, most of which was directly or indirectly due to Hub support. High levels of satisfaction were reported. As in many services, staffing was the central component of Hub cost. Hubs were predominantly staffed by senior clinicians; this staffing model was consistent with the generally severe difficulties experienced by clients and the need for systemic/team-based working. Costs associated with health and social care use for Hub clients were low, which may be due to barriers to accessing support in general. Enablers to accessing Hubs included: a clear understanding of the Hubs, how to self-refer, and managerial support. Barriers included confusion between Hubs and other support; unhelpful beliefs about job roles, unsupportive managers, negative workplace cultures and difficulties caused by systemic issues. Some keyworkers highlighted a perceived need for further diversity and cultural competency training to improve reach to under-represented communities. Other barriers for these groups included prior negative experiences of services, structural inequalities and stigma. Some wider stakeholders had concerns around growing waiting times for Hub-provided therapy, and insufficient data on Hub usage and outcomes. Feedback was otherwise very positive. Limitations Main limitations included lack of comparative and pre-pandemic/baseline data, small numbers from under-represented groups limiting fine-grained analysis, and participant self-selection. Conclusions Findings highlighted the value of the Hub model of outreach, screening, support navigation and provision of direct support during the coronavirus disease 2019 pandemic, and as a potential model to respond to future crises. The research provided recommendations to improve Hub promotion, equality/diversity/inclusion access issues, management of specialist resources and collection of relevant data on Hub outcomes and activities. Broader recommendations for the primary prevention of mental health difficulties across the health and care system are made, as individual support offers should be an adjunct to, not a replacement for, resolutions to systemic challenges. Research recommendations are made to conduct more robust evaluations of the clinical and cost-effectiveness of the Hubs, using larger data sets and comparative data. Study registration This study is registered as researchregistry6303. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132269) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 29. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Filippo Varese
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, Manchester, UK
| | - Kate Allsopp
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, Manchester, UK
| | - Lesley-Anne Carter
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Gemma Shields
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Daniel Hind
- University of Sheffield, School of Health and Related Research, Sheffield, UK
| | - Linda Davies
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Alan Barrett
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Lancashire, UK
- University of Salford, School of Health and Society, Salford, UK
| | - Gita Bhutani
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Katherine McGuirk
- Greater Manchester Health and Social Care Partnership, Manchester, UK
| | - Fay Huntley
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Prescot, UK
| | - Joanne Jordan
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Darlington, UK
| | - Aleix Rowlandson
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - May Sarsam
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, Prescot, UK
| | - Hein Ten Cate
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Holly Walker
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Darlington, UK
| | - Ruth Watson
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, Manchester, UK
| | - Jack Wilkinson
- Faculty of Biology, Medicine and Health, University of Manchester, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Jenni Willbourn
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Lancashire, UK
| | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
- Pennine Care NHS Foundation Trust, Lancashire, UK
| |
Collapse
|
8
|
Berrou I, Hobbs L, Jones S, Hughes S, Bailey H, Quigg S, Manning T, Morris A. Lessons learnt from the implementation of the Covid-19 vaccination programme in the Southwest of England. PLoS One 2024; 19:e0309230. [PMID: 39197010 PMCID: PMC11356399 DOI: 10.1371/journal.pone.0309230] [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: 10/19/2023] [Accepted: 08/07/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Vaccination remains one of the most successful public health interventions in preventing severe disease and death. The roll-out of Covid-19 vaccination programmes has helped protect billions of people around the world against Covid-19. Most of these programmes have been unprecedented in terms of scale and resources, and have been implemented at times of significant humanitarian crisis. This study aims to outline the lessons learnt from the implementation of a regional Covid-19 vaccination programme. These will help inform emergency preparedness and future crisis management. METHODS This qualitative study sought to explore the key drivers to the successful implementation of the Covid-19 vaccination programme in a region in the Southwest of England, applying the Normalisation Process Theory lens (NPT) to examine multi-stakeholder perspectives. Data collection involved semi-structured interviews with 75 participants. Document analysis was also used to corroborate the findings emerging from the interviews. Inductive thematic analysis of the data was used to identify the key drivers for the successful implementation of the programme. The NPT lens was then applied to map the themes identified to the domains and constructs of the framework. RESULTS Ten key drivers to the successful implementation of the Covid-19 vaccination programme locally were identified, including: the clarity and consistency of the programme's goal; the diverse representation of stakeholders within the programme leadership team and the mechanisms created by this team to ensure psychological safety, autonomy, operational flexibility and staff empowerment; Communication and data specialists' input, and collaboration with local communities to maximise the reach of the programme; and allocating funding to tackle health inequalities. CONCLUSIONS This study highlights the lessons learnt from the implementation of the Covid-19 vaccination programme at a local level, and the mechanisms that can be used in future crises to respond efficiently to the needs of individuals, communities and governments.
Collapse
Affiliation(s)
- Ilhem Berrou
- School of Health & Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
| | - Laura Hobbs
- Science Communication Unit, School of Applied Sciences, College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
| | - Sue Jones
- Bristol, North Somerset and South Gloucestershire Integrated Vaccination Programme, North Bristol NHS Trust, Bristol, United Kingdom
| | - Sian Hughes
- Insights and Public Engagement, Bristol, North Somerset and South Gloucestershire Vaccination Programme, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hannah Bailey
- Bristol, North Somerset and South Gloucestershire Integrated Vaccination Programme, North Bristol NHS Trust, Bristol, United Kingdom
| | - Sally Quigg
- Bristol, North Somerset and South Gloucestershire Integrated Vaccination Programme, North Bristol NHS Trust, Bristol, United Kingdom
| | - Thomas Manning
- Business Intelligence (Transformation), NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board, Bristol, United Kingdom
| | - Anne Morris
- Bristol, North Somerset and South Gloucestershire Integrated Vaccination Programme, North Bristol NHS Trust, Bristol, United Kingdom
| |
Collapse
|
9
|
Parasuraman G, Jeemon P, Thankappan KR, Ali MK, Mahal A, McPake B, Chambers J, Absetz P, Thirunavukkarasu S, Nabil AM, Shiby Kripa SV, Akshay PK, Ayyasamy L, Nambirajan MK, Ramalingam A, Nagarajan R, Shrestha A, Gopal B, Selvam JM, Haregu T, Oldenburg B. Community Control of Hypertension and Diabetes (CoCo-HD) program in the Indian states of Kerala and Tamil Nadu: a study protocol for a type 3 hybrid trial. BMC Public Health 2024; 24:2275. [PMID: 39169312 PMCID: PMC11340170 DOI: 10.1186/s12889-024-19746-6] [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: 03/14/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024] Open
Abstract
INTRODUCTION India grapples with a formidable health challenge, with an estimated 315 million adults afflicted with hypertension and 100 million living with diabetes mellitus. Alarming statistics reveal rates for poor treatment and control of hypertension and diabetes. In response to these pressing needs, the Community Control of Hypertension and Diabetes (CoCo-HD) program aims to implement structured lifestyle interventions at scale in the southern Indian states of Kerala and Tamil Nadu. AIMS This research is designed to evaluate the implementation outcomes of peer support programs and community mobilisation strategies in overcoming barriers and maximising enablers for effective diabetes and hypertension prevention and control. Furthermore, it will identify contextual factors that influence intervention scalability and it will also evaluate the program's value and return on investment through economic evaluation. METHODS The CoCo-HD program is underpinned by a longstanding collaborative effort, engaging stakeholders to co-design comprehensive solutions that will be scalable in the two states. This entails equipping community health workers with tailored training and fostering community engagement, with a primary focus on leveraging peer supportat scale in these communities. The evaluation will undertake a hybrid type III trial in, Kerala and Tamil Nadu states, guided by the Institute for Health Improvement framework. The evaluation framework is underpinned by the application of three frameworks, RE-AIM, Normalisation Process Theory, and the Consolidated Framework for Implementation Research. Evaluation metrics include clinical outcomes: diabetes and hypertension control rates, as well as behavioural, physical, and biochemical measurements and treatment adherence. DISCUSSION The anticipated outcomes of this study hold immense promise, offering important learnings into effective scaling up of lifestyle interventions for hypertension and diabetes control in low- and middle-income countries (LMICs). By identifying effective implementation strategies and contextual determinants, this research has the potential to lead to important changes in healthcare delivery systems. CONCLUSIONS The project will provide valuable evidence for the scaling-up of structured lifestyle interventions within the healthcare systems of Kerala and Tamil Nadu, thus facilitating their future adaptation to diverse settings in India and other LMICs.
Collapse
Affiliation(s)
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Mohammed K Ali
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, 30322, USA
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | | | | | - Sathish Thirunavukkarasu
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, 30322, USA
| | - Abdul Majeed Nabil
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | | | | | | | - Abha Shrestha
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Bipin Gopal
- State Health Department of Kerala, Trivandrum, India
| | | | - Tilahun Haregu
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia.
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
- Baker Heart and Diabetes Institute, Melbourne, Australia.
| | - Brian Oldenburg
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| |
Collapse
|
10
|
Talbot R, Higham R, Croft J, Ainsworth G, Brown S, Kelly R, Stocken D, Thomson S, Rousseau N. Rapid qualitative analysis of recruitment obstacles in the FORVAD (Posterior Cervical Foraminotomy surgery versus Anterior Cervical Discectomy surgery in the treatment of cervical brachialgia) randomised, controlled trial. Trials 2024; 25:546. [PMID: 39152476 PMCID: PMC11330054 DOI: 10.1186/s13063-024-08391-4] [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: 03/12/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND The number of surgical trials is increasing but such trials can be complex to deliver and pose specific challenges. A multi-centre, Phase III, RCT comparing Posterior Cervical Foraminotomy versus Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Brachialgia (FORVAD Trial) was unable to recruit to target. A rapid qualitative study was conducted during trial closedown to understand the experiences of healthcare professionals who participated in the FORVAD Trial, with the aim of informing future research in this area. METHODS Semi-structured interviews were conducted with 18 healthcare professionals who had participated in the FORVAD Trial. Interviews explored participants' experiences of the FORVAD trial. A rapid qualitative analysis was conducted, informed by Normalisation Process Theory. RESULTS Four main themes were generated in the data analysis: (1) individual vs. community equipoise; (2) trial set-up and delivery; (3) identifying and approaching patients; and (4) timing of randomisation. The objectives of the FORVAD trial made sense to participants and they supported the idea that there was clinical or collective equipoise regarding the two FORVAD interventions; however, many surgeons had treatment preferences and lacked individual equipoise. The site which had most recruitment success had adopted a more structured process for identification and recruitment of patients, whereas other sites that adopted more "ad hoc" screening strategies struggled to identify patients. Randomisation on the day of surgery caused both medico-legal and practical concerns at some sites. CONCLUSIONS Organisation and implementation of a surgical trial in neurosurgery is complex and presents many challenges. Sites often reported low recruitment and discussed the logistical issues of conducting a complex surgical RCT. Future trials in neurosurgery may need to offer more flexibility and time during set-up to maximise opportunities for larger recruitment numbers. Rapid qualitative analysis informed by Normalisation Process Theory was able to quickly identify key issues with trial implementation so rapid qualitative analysis may be a useful approach for teams conducting qualitative research in trials. TRIAL REGISTRATION ISRCTN, ISRCTN reference: 10,133,661. Registered 23rd November 2018.
Collapse
Affiliation(s)
- Rebecca Talbot
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ruchi Higham
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Gemma Ainsworth
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sarah Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Rachel Kelly
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Deborah Stocken
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Simon Thomson
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nikki Rousseau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| |
Collapse
|
11
|
Bradshaw A, Birtwistle J, Evans CJ, Sleeman KE, Richards S, Foy R, Millares Martin P, Carder P, Allsop MJ, Twiddy M. Factors Influencing the Implementation of Digital Advance Care Planning: Qualitative Interview Study. J Med Internet Res 2024; 26:e50217. [PMID: 39151167 PMCID: PMC11364948 DOI: 10.2196/50217] [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: 06/23/2023] [Revised: 10/18/2023] [Accepted: 05/30/2024] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND Palliative care aims to improve the quality of life for people with life-limiting illnesses. Advance care planning conversations that establish a patient's wishes and preferences for care are part of a person-centered approach. Internationally, electronic health record systems are digital interventions used to record and share patients' advance care plans across health care services and settings. They aim to provide tools that support electronic information sharing and care coordination. Within the United Kingdom, Electronic Palliative Care Coordination Systems (EPaCCS) are an example of this. Despite over a decade of policy promoting EPaCCS nationally, there has been limited implementation and consistently low levels of use by health professionals. OBJECTIVE The aim of this study is to explore the factors that influence the implementation of EPaCCS into routine clinical practice across different care services and settings in 2 major regions of England. METHODS A qualitative interview study design was used, guided by Normalization Process Theory (NPT). NPT explores factors affecting the implementation of complex interventions and consists of 4 primary components (coherence, cognitive participation, collective action, and reflexive monitoring). Health care and social care practitioners were purposively sampled based on their professional role and work setting. Individual web-based semistructured interviews were conducted. Data were analyzed using thematic framework analysis to explore issues which affected the implementation of EPaCCS across different settings at individual, team, organizational, and technical levels. RESULTS Participants (N=52) representing a range of professional roles were recruited across 6 care settings (hospice, primary care, care home, hospital, ambulatory, and community). In total, 6 themes were developed which mapped onto the 4 primary components of NPT and represented the multilevel influences affecting implementation. At an individual level, these included (1) EPaCCS providing a clear and distinct way of working and (2) collective contributions and buy-in. At a team and organizational level, these included (3) embedding EPaCCS into everyday practice and (4) championing driving implementation. At a technical level, these included (5) electronic functionality, interoperability, and access. Breakdowns in implementation at different levels led to variations in (6) confidence and trust in EPaCCS in terms of record accuracy and availability of access. CONCLUSIONS EPaCCS implementation is influenced by individual, organizational, and technical factors. Key challenges include problems with access alongside inconsistent use and engagement across care settings. EPaCCS, in their current format as digital advance care planning systems are not consistently facilitating electronic information sharing and care coordination. A redesign of EPaCCS is likely to be necessary to determine configurations for their optimal implementation across different settings and locations. This includes supporting health care practitioners to document, access, use, and share information across multiple care settings. Lessons learned are relevant to other forms of digital advance care planning approaches being developed internationally.
Collapse
Affiliation(s)
- Andy Bradshaw
- Cicely Saunders Institute, Kings College London, London, United Kingdom
| | | | - Catherine J Evans
- Cicely Saunders Institute, Kings College London, London, United Kingdom
- Sussex Community NHS Foundation Trust, Brighton, United Kingdom
| | | | - Suzanne Richards
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Paul Carder
- NHS West Yorkshire Integrated Care Board, White Rose House, Wakefield, United Kingdom
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Maureen Twiddy
- Hull York Medical School, Institute of Clinical and Applied Health Research, Allam Medical Building, University of Hull, Hull, United Kingdom
| |
Collapse
|
12
|
Jorro-Baron F, Loudet CI, Cornistein W, Suarez-Anzorena I, Arias-Lopez P, Balasini C, Cabana L, Cunto E, Corral PRJ, Gibbons L, Guglielmino M, Izzo G, Lescano M, Meregalli C, Orlandi C, Perre F, Ratto ME, Rivet M, Rodriguez AP, Rodriguez VM, Vilca Becerra J, Villegas PR, Vitar E, Roberti J, García-Elorrio E, Rodriguez V. Optimising antibacterial utilisation in Argentine intensive care units: a quality improvement collaborative. BMJ Qual Saf 2024:bmjqs-2024-017069. [PMID: 39147572 DOI: 10.1136/bmjqs-2024-017069] [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: 01/02/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND There is limited evidence from antimicrobial stewardship programmes in less-resourced settings. This study aimed to improve the quality of antibacterial prescriptions by mitigating overuse and promoting the use of narrow-spectrum agents in intensive care units (ICUs) in a middle-income country. METHODS We established a quality improvement collaborative (QIC) model involving nine Argentine ICUs over 11 months with a 16-week baseline period (BP) and a 32-week implementation period (IP). Our intervention package included audits and feedback on antibacterial use, facility-specific treatment guidelines, antibacterial timeouts, pharmacy-based interventions and education. The intervention was delivered in two learning sessions with three action periods along with coaching support and basic quality improvement training. RESULTS We included 912 patients, 357 in BP and 555 in IP. The latter had higher APACHE II (17 (95% CI: 12 to 21) vs 15 (95% CI: 11 to 20), p=0.036), SOFA scores (6 (95% CI: 4 to 9) vs 5 (95% CI: 3 to 8), p=0.006), renal failure (41.6% vs 33.1%, p=0.009), sepsis (36.1% vs 31.6%, p<0.001) and septic shock (40.0% vs 33.8%, p<0.001). The days of antibacterial therapy (DOT) were similar between the groups (change in the slope from BP to IP 28.1 (95% CI: -17.4 to 73.5), p=0.2405). There were no differences in the antibacterial defined daily dose (DDD) between the groups (change in the slope from BP to IP 43.9, (95% CI: -12.3 to 100.0), p=0.1413).The rate of antibacterial de-escalation based on microbiological culture was higher during the IP (62.0% vs 45.3%, p<0.001).The infection prevention control (IPC) assessment framework was increased in eight ICUs. CONCLUSION Implementing an antimicrobial stewardship program in ICUs in a middle-income country via a QIC demonstrated success in improving antibacterial de-escalation based on microbiological culture results, but not on DOT or DDD. In addition, eight out of nine ICUs improved their IPC Assessment Framework Score.
Collapse
Affiliation(s)
- Facundo Jorro-Baron
- Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
- PICU, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Cecilia Inés Loudet
- Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
- Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | - Wanda Cornistein
- Sociedad Argentina de Infectología, Ciudad Autónoma de Buenos Aires, Argentina
| | - Inés Suarez-Anzorena
- Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | | | - Carina Balasini
- Hospital General de Agudos Dr Ignacio Pirovano, Buenos Aires, Argentina
| | - Laura Cabana
- Intensive Care Unit, Hospital Pablo Soria, Jujuy, Argentina
| | - Eleonora Cunto
- Intensive Care Unit, Hospital de Infecciosas Dr Francisco Javier Muñiz, Buenos Aires, Argentina
| | | | - Luz Gibbons
- Instituto de Efectividad Clinica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Marina Guglielmino
- Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Gabriela Izzo
- Intensive Care Unit, Hospital Simplemente Evita, Buenos Aires, Argentina
| | - Marianela Lescano
- Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | | | - Cristina Orlandi
- Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
- Intensive Care Unit, Hospital Francisco López-Lima, Río Negro, Argentina
| | - Fernando Perre
- Intensive Care Unit, Hospital Provincial de Neuquén Dr Castro Rendón, Neuquen, Argentina
| | | | - Mariano Rivet
- Hospital General de Agudos Bernardino Rivadavia, Buenos Aires, Argentina
| | - Ana Paula Rodriguez
- Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | | | | | | | - Emilse Vitar
- Instituto de Efectividad Clinica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Javier Roberti
- Instituto de Efectividad Clinica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Viviana Rodriguez
- Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| |
Collapse
|
13
|
Vandrevala T, Montague A, Boulton R, Coxon K, Jones CE. Exploring the implementation of an educational film within antenatal care to reduce the risk of cytomegalovirus infection in pregnancy: A qualitative study. BMC Pregnancy Childbirth 2024; 24:524. [PMID: 39127657 DOI: 10.1186/s12884-024-06715-5] [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: 08/16/2023] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection is a leading cause of sensorineural hearing loss and neuro-disability in childhood. In the absence of a licensed vaccine, adoption of hygiene-based measures may reduce the risk of CMV infection in pregnancy, however these measures are not routinely discussed with pregnant women as part of National Health Service (NHS) antenatal care in the United Kingdom (UK). METHODS An exploratory qualitative study was conducted, underpinned by Normalization Process Theory (NPT), to investigate how an educational intervention comprising of a short film about CMV may best be implemented, sustained, and enhanced in real-world routine antenatal care settings. Video, semi-structured interviews were conducted with participants who were recruited using a purposive sample that comprised of midwives providing antenatal care from three NHS hospitals (n = 15) and participants from professional colleges and from organisations or charities providing, or with an interest in, antenatal education or health information in the UK (n = 15). FINDINGS Midwives were reluctant to include CMV as part of early pregnancy discussions about reducing the risk of other infections due to lack of time, knowledge and absence of guidance or policies relating to CMV in antenatal education. However, the educational intervention was perceived to be a useful tool to encourage conversations and empower women to manage risk by all stakeholders, which would overcome some identified barriers. Macro-level challenges such as screening policies and lack of official guidelines to legitimise dissemination were identified. DISCUSSION Successful implementation of education about CMV as part of routine NHS care in the UK will require an increase in awareness and knowledge about CMV amongst midwives. NPT revealed that 'coherence' and 'cognitive participation' between service members are vital to imbed CMV education in routine practice. 'Collective action' and 'reflexive monitoring' is required to sustain service changes.
Collapse
Affiliation(s)
- Tushna Vandrevala
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and Education, Kingston University, London, UK.
| | - Amy Montague
- Department of Psychology, Faculty of Business and Social Sciences, Kingston University, London, UK
| | - Richard Boulton
- Centre for Applied Health and Social Care Research, Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
- Centre for Allied Health, St George's, University of London, London, UK
| | - Kirstie Coxon
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Christine E Jones
- Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University of Southamptonand, University Hospital Southampton NHS Foundation Trust , Southampton, UK
| |
Collapse
|
14
|
Wu J, Xu S, Liu X, Zhao J, He Z, Pan A, Wu J. High-precision Helicobacter pylori infection diagnosis using a dual-element multimodal gas sensor array. Analyst 2024; 149:4168-4178. [PMID: 38860637 DOI: 10.1039/d4an00520a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Helicobacter pylori (H. pylori) is a globally widespread bacterial infection. Early diagnosis of this infection is vital for public and individual health. Prevalent diagnosis methods like the isotope 13C or 14C labelled urea breath test (UBT) are not convenient and may do harm to the human body. The use of cross-response gas sensor arrays (GSAs) is an alternative way for label-free detection of metabolite changes in exhaled breath (EB). However, conventional GSAs are complex to prepare, lack reliability, and fail to discriminate subtle changes in EB due to the use of numerous sensing elements and single dimensional signal. This work presents a dual-element multimodal GSA empowered with multimodal sensing signals including conductance (G), capacitance (C), and dissipation factor (DF) to improve the ability for gas recognition and H. pylori-infection diagnosis. Sensitized by poly(diallyldimethylammonium chloride) (PDDA) and the metal-organic framework material NH2-UiO66, the dual-element graphene oxide (GO)-composite GSAs exhibited a high specific surface area and abundant adsorption sites, resulting in high sensitivity, repeatability, and fast response/recovery speed in all three signals. The multimodal sensing signals with rich sensing features allowed the GSA to detect various physicochemical properties of gas analytes, such as charge transfer and polarization ability, enhancing the sensing capabilities for gas discrimination. The dual-element GSA could differentiate different typical standard gases and non-dehumidified EB samples, demonstrating the advantages in EB analysis. In a case-control clinical study on 52 clinical EB samples, the diagnosis model based on the multimodal GSA achieved an accuracy of 94.1%, a sensitivity of 100%, and a specificity of 90.9% for diagnosing H. pylori infection, offering a promising strategy for developing an accurate, non-invasive and label-free method for disease diagnosis.
Collapse
Affiliation(s)
- Jiaying Wu
- Lab of Nanomedicine and Omic-based Diagnostics, Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou 310058, P.R. China.
| | - Shiyuan Xu
- Lab of Nanomedicine and Omic-based Diagnostics, Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou 310058, P.R. China.
| | - Xuemei Liu
- Lab of Nanomedicine and Omic-based Diagnostics, Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou 310058, P.R. China.
| | - Jingwen Zhao
- Lab of Nanomedicine and Omic-based Diagnostics, Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou 310058, P.R. China.
| | - Zhengfu He
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou 310016, P.R. China
| | - Aiwu Pan
- Department of Internal Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, P.R. China.
| | - Jianmin Wu
- Lab of Nanomedicine and Omic-based Diagnostics, Institute of Analytical Chemistry, Department of Chemistry, Zhejiang University, Hangzhou 310058, P.R. China.
| |
Collapse
|
15
|
Quayle E, Schwannauer M, Varese F, Allsopp K, Cartwright K, Chan C, Chitsabesan P, Green V, Hewins W, Larkin A, Newton A, Niebauer E, Radford G, Richards C, Sandys M, Shafi S, Ward J, Whelan P, Bucci S. Implementation of a digital health intervention for young people exposed to Technology Assisted Sexual Abuse. CHILD ABUSE & NEGLECT 2024; 154:106883. [PMID: 38870708 DOI: 10.1016/j.chiabu.2024.106883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The internet has become a place of increased risk of abuse, including sexual abuse, for young people (YP). One potential risk factor to online abuse and exploitation is the ability to mentalise. We developed the i-Minds app, a mentalisation-based digital health intervention (DHI) for YP who have experienced technology assisted sexual abuse (TASA), which we tested in a clinical feasibility trial. Nested within the trial was a qualitative implementation study with clinicians who referred to the trial. OBJECTIVE To explore the barriers and enablers to the future integration of i-Minds into clinical practice. PARTICIPANTS AND SETTING Twelve HCPs were recruited from across two trial recruitment sites (Manchester and Edinburgh). METHODS Semi-structured interviews were informed by Normalisation Process Theory (NPT). Framework analysis was used; transcripts were coded deductively to NPT constructs. RESULTS Practitioners were positive about the need for, and added value of, the i-Minds app over existing interventions, including other DHIs. While they felt confident with the app, concerns remained around the safety of using the app without practitioner support. i-Minds promoted changes in practitioners' work and impacted online behaviour of YP. There was an identified need for further training and organisational support. CONCLUSIONS Practitioners are aware of TASA but have limited knowledge, skills and tools to work with TASA in clinical practice with YP. There is a need for awareness raising and education about TASA and DHI. i-Minds offers a theory-informed DHI for working with YP exposed to TASA that is acceptable to practitioners and YP.
Collapse
Affiliation(s)
- Ethel Quayle
- School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom; NHS Lothian, Edinburgh, United Kingdom
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester Academic Health Science, University of Manchester, Manchester, United Kingdom.; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kate Allsopp
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Cartwright
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Cindy Chan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | - Amanda Larkin
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Alice Newton
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | - Marina Sandys
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Pauline Whelan
- Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester Academic Health Science, University of Manchester, Manchester, United Kingdom.; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
| |
Collapse
|
16
|
Cadilhac DA, Ross AG, Bagot KL, Blennerhassett JM, Kilkenny MF, Kim J, Purvis T, Barclay KM, Ellery F, Morrison J, Cranefield J, Kleinig TJ, Grimley R, Jaques K, Wong D, Murphy L, Russell G, Nelson MR, Thijs V, Scott C, Middleton S. Protocol for a feasibility registry-based randomised controlled trial investigating a tailored follow-up service for stroke (A-LISTS). Pilot Feasibility Stud 2024; 10:103. [PMID: 39080727 PMCID: PMC11290067 DOI: 10.1186/s40814-024-01527-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Stroke affects long-term physical and cognitive function; many survivors report unmet health needs, such as pain or depression. A hospital-led follow-up service designed to address ongoing health problems may avoid unplanned readmissions and improve quality of life. METHODS This paper outlines the protocol for a registry-based, randomised controlled trial with allocation concealment of participants and outcome assessors. Based on an intention-to-treat analysis, we will evaluate the feasibility, acceptability, potential effectiveness and cost implications of a new tailored, codesigned, hospital-led follow-up service for people within 6-12 months of stroke. Participants (n = 100) from the Australian Stroke Clinical Registry who report extreme health problems on the EuroQol EQ-5D-3L survey between 90 and 180 days after stroke will be randomly assigned (1:1) to intervention (follow-up service) or control (usual care) groups. All participants will be independently assessed at baseline and 12-14-week post-randomisation. Primary outcomes for feasibility are the proportion of participants completing the trial and for intervention participants the proportion that received follow-up services. Acceptability is satisfaction of clinicians and participants involved in the intervention. Secondary outcomes include effectiveness: change in extreme health problems (EQ-5D-3L), unmet needs (Longer-term Unmet Needs questionnaire), unplanned presentations and hospital readmission, functional independence (modified Rankin Scale) and cost implications estimated from self-reported health service utilisation and productivity (e.g. workforce participation). To inform future research or implementation, the design contains a process evaluation including clinical protocol fidelity and an economic evaluation. DISCUSSION The results of this study will provide improved knowledge of service design and implementation barriers and facilitators and associated costs and resource implications to inform a future fully powered effectiveness trial of the intervention. TRIAL REGISTRATION ACTRN12622001015730pr. TRIAL SPONSOR Florey Institute of Neuroscience and Mental Health, 245 Burgundy Street, Heidelberg, VIC, 3084, PH: +61 3 9035 7032.
Collapse
Affiliation(s)
- Dominique A Cadilhac
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
| | - Andrew G Ross
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- College of Sports, Health and Engineering, Victoria University, Melbourne, Australia
| | - Kathleen L Bagot
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Jannette M Blennerhassett
- Physiotherapy Department and Health Independence Program, Austin Health, Heidelberg, VIC, Australia
- Department of Nursing & Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Vic, Australia
| | - Monique F Kilkenny
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Joosup Kim
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Karen M Barclay
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Care Economy Research Institute, La Trobe University, Bundoora, Australia
| | - Fiona Ellery
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Julie Morrison
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | | | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Rohan Grimley
- School of Medicine and Dentistry, Griffith University, Birtinya, QLD, Australia
- Medicine, Sunshine Coast University Hospital, Birtinya, Australia
| | | | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC, Australia
| | - Lisa Murphy
- Stroke Foundation, Melbourne, VIC, Australia
| | - Grant Russell
- Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Vincent Thijs
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Department of Neurology, Austin Health, Melbourne, VIC, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Colin Scott
- Stroke Association of Victoria, Melbourne, VIC, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney and Australian Catholic University, Sydney, NSW, Australia
| |
Collapse
|
17
|
Rodrigues AM, Nichol B, Wilson R, Charlton C, Gibson B, Finch T, Haighton C, Maniatopoulos G, Giles E, Harrison D, Orange D, Robson C, Harland J. Mapping regional implementation of 'Making Every Contact Count': mixed-methods evaluation of implementation stage, strategies, barriers and facilitators of implementation. BMJ Open 2024; 14:e084208. [PMID: 39038864 PMCID: PMC11268057 DOI: 10.1136/bmjopen-2024-084208] [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: 01/12/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The Making Every Contact Count (MECC) programme provides training and materials to support public-facing workers to encourage health-promoting behaviour change by using the day-to-day interactions between organisations and individuals. This project aimed to analyse MECC implementation through a comparative analysis of implementation stage, strategies used for implementation and enablers/barriers of the implementation process within a region in England-the North East and North Cumbria (NENC). METHODS A mixed-methods process evaluation was conducted applying normalisation process theory and theoretical domains framework. MECC programme documents were reviewed and mapped against specific criteria (eg, implementation strategies). An online mapping survey was conducted to establish current implementation/delivery of MECC within NENC settings (eg, local government, healthcare and voluntary community sector). Qualitative research, using individual interviews and group discussions, was conducted to establish further understanding of MECC implementation. RESULTS Our findings were informed by reviewing documents (n=5), surveying participants (n=34), interviews (n=18) and group discussions (n=48). Overall, the implementation of MECC within the region was at an early stage, with training mostly delivered between, rather than within, organisations. Qualitative findings highlighted factors that influence stakeholders to implement MECC (eg, organisational goals that were facilitated by MECC implementation, including the prevention agenda), supported resources that facilitate the implementation of MECC (eg, logic models) and enabling factors that promote MECC sustainability across the region (eg, buy-in from leadership and management). CONCLUSIONS The NENC MECC programme is built around regional leadership that supports the implementation process. This process evaluation identified key influences of MECC implementation across the region. We discuss evidence-based recommendation for policy and practice that can be taken forward to develop targeted strategies to support future MECC implementation. For example, a co-ordinated infrastructure and strategy is needed to combat delivery and implementation issues identified.
Collapse
Affiliation(s)
- Angela M Rodrigues
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Bethany Nichol
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Rob Wilson
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, UK
| | - Caroline Charlton
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Beckie Gibson
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | | | - Emma Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Deborah Harrison
- Newcastle University Business School, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Orange
- Office for Health Improvement & Disparities, Newcastle upon Tyne, UK
| | - Craig Robson
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Jill Harland
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| |
Collapse
|
18
|
Linnerud S, Kvæl LAH, Bjerk M, Taraldsen K, Skelton DA, Brovold T. Feasibility of an implementation strategy for preventing falls in homecare services. Implement Sci Commun 2024; 5:79. [PMID: 39030646 PMCID: PMC11264773 DOI: 10.1186/s43058-024-00615-7] [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: 12/03/2023] [Accepted: 07/10/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Falls among older adults represent a major health hazard across the world. In 2022, the World Falls Guidelines was published, summarising research evidence and expert recommendations on how to prevent falls, but we need more knowledge on how the evidence can be successfully implemented into routine practice. In this study we used an implementation strategy co-created by healthcare providers, older adults who had fallen and researchers, to facilitate uptake of fall prevention recommendations. This current study aimed to evaluate the feasibility of this co-created implementation strategy in homecare services and provide information on the intervention and measurements for a full-scale cluster-randomized trial. METHODS This study was a single-armed feasibility study with an embedded mixed-method approach completed in two city districts of Oslo, Norway, over a period of ten weeks. The co-created implementation strategy consists of a package for implementing national recommendations for preventing falls, empowering leaders to facilitate implementation, establish implementation teams, competence improvement and implementation support. City districts established implementation teams who were responsible for the implementation. Feasibility was assessed both qualitatively and quantitatively, using focus group interviews with implementation team members and individual interviews with leaders and staff members and the Feasibility of Intervention Measure (FIM). Qualitative data were analysed using thematic analysis and the Normalisation Process Theory. RESULTS Qualitative data were collected from 19 participants: 12 implementation team members, 2 leaders and 5 staff members. 8 of the implementation team members responded to FIM. The analysis revealed four themes: 1) Fostering consensus through tailored implementation and discussions on fall prevention, 2) The importance of multi-level and interdisciplinary collaboration in fall prevention implementation, 3) Minimizing perceived time usage through utilization of existing areas for implementation activities, and 4) Reflective monitoring demonstrates the importance of facilitation and structure in the implementation strategy. For FIM, there were a high level of agreement related to how implementable, possible, doable, and easy to use the implementation strategy was. CONCLUSIONS Overall, we found the implementation strategy to be feasible to enhance uptake of fall prevention recommendations in the Norwegian homecare services. To succeed with the implementation, a dedicated implementation team should receive support through the implementation process, they should choose small implementation activities to enhance fall prevention competence and managers should possess implementation knowledge. TRIAL REGISTRATION The trial is registered in the Open Science Registry: https://doi.org/10.17605/OSF.IO/2JFHV Registered: January 11, 2023.
Collapse
Affiliation(s)
- Siv Linnerud
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway.
| | - Linda Aimée Hartford Kvæl
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
- Department of Housing and Ageing Research, Norwegian Social Science, OsloMet - Oslo Metropolitan University, Olavs plass, P.O. Box 4 St, N-0130, Oslo, Norway
| | - Maria Bjerk
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
| | - Dawn A Skelton
- Research Centre for Health (ReaCH), Department of Physiotherapy and Paramedicine, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Therese Brovold
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
| |
Collapse
|
19
|
Carter H, Beard D, Leighton P, Moffatt F, Smith BE, Webster KE, Logan P. Development of an intervention for patients following an anterior cruciate ligament rupture: an online nominal group technique consensus study. BMJ Open 2024; 14:e082387. [PMID: 39025812 PMCID: PMC11261705 DOI: 10.1136/bmjopen-2023-082387] [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: 11/21/2023] [Accepted: 07/03/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES (1) To develop an intervention for to support patients diagnosed with an anterior cruciate ligament (ACL) rupture with decision-making regarding treatment. (2) To define evidence-based recommendations for the treatment of patients following an ACL rupture. DESIGN Nominal group technique consensus study. SETTING Online meetings with patients and key stakeholders working and receiving treatment in the National Health Service, UK. PARTICIPANTS Consensus meetings composed of eight voting participants and five non-voting facilitators. Voting participants included five clinicians, one outpatient therapy manager and two patients with experience in an ACL rupture and reconstructive surgery. Non-voting facilitators supported group discussions and/or observed study procedures. This included a clinical academic expert, two methodology experts and two patient representatives. METHOD Two online meetings were held. Pre-elicitation material was distributed ahead of the first meeting. Premeeting voting was conducted ahead of both meetings. A draft of the shared decision-making intervention and recommendations were shared ahead of the second meeting. Components were discussed and ranked for inclusion based on a 70% agreement threshold. RESULTS The meetings led to the development of a shared decision-making intervention to support treatment decision-making following an ACL rupture. The intervention includes two components: (1) a patient information leaflet and key questions diagram and (2) option grid. The evidence-based recommendations encompass core components of treatment reaching the 70% threshold agreed by the group. The recommendations cover: (1) advice and education, (2) exercise guidance, (3) intervention delivery, (4) outcome measure use and (5) shared decision-making. CONCLUSION This study has successfully developed a shared decision-making intervention to support ACL treatment decision-making, ready for testing in a future feasibility study. Evidence-based recommendations for the treatment of patients following ACL injury, ready for testing in a National Health Service (UK) setting, are also presented. TRIAL REGISTRATION NUMBER NCT05529511.
Collapse
Affiliation(s)
- Hayley Carter
- Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - David Beard
- Surgical Intervention Trials Unit, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Benjamin E Smith
- Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Phillipa Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
20
|
Marcuzzi A, Klevanger NE, Aasdahl L, Gismervik S, Bach K, Mork PJ, Nordstoga AL. An Artificial Intelligence-Based App for Self-Management of Low Back and Neck Pain in Specialist Care: Process Evaluation From a Randomized Clinical Trial. JMIR Hum Factors 2024; 11:e55716. [PMID: 38980710 PMCID: PMC11267091 DOI: 10.2196/55716] [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: 12/22/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Self-management is endorsed in clinical practice guidelines for the care of musculoskeletal pain. In a randomized clinical trial, we tested the effectiveness of an artificial intelligence-based self-management app (selfBACK) as an adjunct to usual care for patients with low back and neck pain referred to specialist care. OBJECTIVE This study is a process evaluation aiming to explore patients' engagement and experiences with the selfBACK app and specialist health care practitioners' views on adopting digital self-management tools in their clinical practice. METHODS App usage analytics in the first 12 weeks were used to explore patients' engagement with the SELFBACK app. Among the 99 patients allocated to the SELFBACK interventions, a purposive sample of 11 patients (aged 27-75 years, 8 female) was selected for semistructured individual interviews based on app usage. Two focus group interviews were conducted with specialist health care practitioners (n=9). Interviews were analyzed using thematic analysis. RESULTS Nearly one-third of patients never accessed the app, and one-third were low users. Three themes were identified from interviews with patients and health care practitioners: (1) overall impression of the app, where patients discussed the interface and content of the app, reported on usability issues, and described their app usage; (2) perceived value of the app, where patients and health care practitioners described the primary value of the app and its potential to supplement usual care; and (3) suggestions for future use, where patients and health care practitioners addressed aspects they believed would determine acceptance. CONCLUSIONS Although the app's uptake was relatively low, both patients and health care practitioners had a positive opinion about adopting an app-based self-management intervention for low back and neck pain as an add-on to usual care. Both described that the app could reassure patients by providing trustworthy information, thus empowering them to take actions on their own. Factors influencing app acceptance and engagement, such as content relevance, tailoring, trust, and usability properties, were identified. TRIAL REGISTRATION ClinicalTrials.gov NCT04463043; https://clinicaltrials.gov/study/NCT04463043.
Collapse
Affiliation(s)
- Anna Marcuzzi
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nina Elisabeth Klevanger
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lene Aasdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Unicare Helsefort Rehabilitation Center, Rissa, Norway
| | - Sigmund Gismervik
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kerstin Bach
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Lovise Nordstoga
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
21
|
Weyya G, Belay A, Tadesse E. Passion fruit ( Passiflora edulis Sims) by-products as a source of bioactive compounds for non-communicable disease prevention: extraction methods and mechanisms of action: a systematic review. Front Nutr 2024; 11:1340511. [PMID: 38903622 PMCID: PMC11187344 DOI: 10.3389/fnut.2024.1340511] [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: 11/27/2023] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction The review titled Passion fruit by-products as a source of bioactive compounds for non-communicable disease prevention: extraction methods and mechanisms provide valuable insights into the health benefits and industrial applications of passion fruit waste. Passion fruits are a tropical and subtropical vine species, which produces edible fruits. Many food product types can be made from passion fruits. However, during passion fruit processing, large amounts of waste are released in to the environment. This review focuses on extraction methods of bioactive compounds from passion fruit by-products such as leaves, peels, seeds, and bagasse. Methods This comprehensive review focuses on the bioactive compounds present in passion fruit by-products, emphasis on their mechanisms of action on non-communicable diseases. It also provides a detailed analysis of the extraction methods used to obtain these bioactive compounds, their potential industrial applications, and the factors that affect extraction efficiency. Results This review encourages further research and innovation in utilization of passion fruit waste as a source of bioactive compounds for non- communicable disease prevention and their mechanisms of action. This can advance the circular economy. It also highlights the importance of sustainable and green extraction methods, which have gained attention due to environmental concerns. Discussion Unlike previous reviews, this comprehensive article explores the potential health benefits of multiple passion fruit waste products. It also examines the possible applications of these extracts for industrial goods such as food additives, colorants, nutraceuticals, natural antioxidants, and antimicrobial agents. Overall, it contributes new information emphasizing the potential of passion fruit by-products as a source of bioactive, and the findings have implications for the scientific community and industry, promoting a deeper understanding of the health benefits and sustainable practices associated with passion fruit waste utilization.
Collapse
Affiliation(s)
- Getu Weyya
- Department of Food Science and Applied Nutrition, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| | - Abera Belay
- Department of Food Science and Applied Nutrition, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| | - Eneyew Tadesse
- Department of Food Science and Applied Nutrition, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| |
Collapse
|
22
|
Loudet CI, Jorro Barón F, Reina R, Arias López MDP, Alegría SL, Barrios CDV, Buffa R, Cabana ML, Cunto ER, Fernández Nievas S, García MA, Gibbons L, Izzo G, Llanos MN, Meregalli C, Joaquín Mira J, Ratto ME, Rivet ML, Roberti J, Silvestri AM, Tévez A, Uranga LJ, Zakalik G, Rodríguez V, García-Elorrio E. Quality improvement collaborative for improving patient care delivery in Argentine public health sector intensive care units. BMJ Open Qual 2024; 13:e002618. [PMID: 38830729 PMCID: PMC11149125 DOI: 10.1136/bmjoq-2023-002618] [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: 09/21/2023] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll. OBJECTIVE The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs). METHODS We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs. RESULTS We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p<0.001). We observed 7428 patient encounters to evaluate compliance with 9 OPF (879 in BP and 6549 in IP) with an improvement in compliance from 53.9% to 67% (RR 1.24, 95% CI 1.17 to 1.32, p<0.001). The results showed that HCWs did not use the support tool for self-mental health evaluation as much as expected. CONCLUSION A QIC was effective in improving healthcare processes and adequate PPE use, even in the context of a pandemic, indicating the possibility of expanding QIC networks nationwide to improve overall healthcare delivery. The limited reception of emotional support tools requires further analyses.
Collapse
Affiliation(s)
- Cecilia Inés Loudet
- Sociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina
- Hospital Interzonal General de Agudos General San Martín, La Plata, Buenos Aires, Argentina
| | - Facundo Jorro Barón
- Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Rosa Reina
- Sociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | | | | | - Eleonora Roxana Cunto
- Hospital de Infecciosas Dr Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Simón Fernández Nievas
- Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriela Izzo
- Hospital Simplemente Evita, González Catán, Buenos Aires, Argentina
| | | | - Claudia Meregalli
- Sociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina
| | - José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan, Sant Joan d'Alacant, Spain
| | - María Elena Ratto
- Sociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariano Luis Rivet
- Hospital General de Agudos Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires, Argentina
| | - Javier Roberti
- Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
- CIESP/CONICET, Buenos Aires, Argentina
| | | | - Analía Tévez
- Hospital Balestrini, La Matanza, Buenos Aires, Argentina
| | | | | | - Viviana Rodríguez
- Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | | |
Collapse
|
23
|
Svensson I, Bridges J, Ellis J, Brady N, Dello S, Hooft J, Kleine J, Kohnen D, Lehane E, Lindqvist R, Maier CB, Mc Carthy VJC, Strømseng Sjetne I, Eriksson LE, Smeds Alenius L. Laying the foundations for implementing Magnet principles in hospitals in Europe: A qualitative analysis. Int J Nurs Stud 2024; 154:104754. [PMID: 38522183 DOI: 10.1016/j.ijnurstu.2024.104754] [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: 10/04/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Magnet hospitals, a concept developed in the U.S., have been associated with improved nurse recruitment and retention, and better patient outcomes. Magnet principles may be useful to address workforce challenges in European hospitals, but they have not been implemented or evaluated on a large scale in the European hospital context. OBJECTIVE This study aims to explore the initial phase of implementing Magnet principles in 11 acute care hospitals in six European countries. The specific objectives of the study were to investigate the type of work that characterises the early phase of implementation and how implementation leaders engage with their context. METHODS A multinational qualitative study was conducted, with data from 23 semi-structured, one-to-one interviews with implementation leaders in 11 acute care hospitals in six European countries. Thematic analyses guided the analysis of data. FINDINGS Three themes of core work processes during the early phase of implementing Magnet principles in European hospitals were identified. The first theme, 'Creating space for Magnet', describes how work was directed towards creating both political and organisational space for the project. The second theme, 'Framing to fit: understanding and interpreting Magnet principles', describes the translational work to understand what the Magnet model entails and how it relates to the local hospital context. Finally, the third theme, 'Calibrating speed and dose', describes the strategic work of considering internal and external factors to adjust the process of implementation. CONCLUSIONS The first phase of implementation was characterised by conceptual and relational work; translating the Magnet concepts, considering the fit into existing structures and practices and making space for Magnet in the local context. Understanding the local context played an important role in shaping and guiding the navigation of professional and organisational tensions. Hospitals employed diverse strategies to either emphasise or downplay the role of nurses and nursing to facilitate progress in the implementation.
Collapse
Affiliation(s)
- Ingrid Svensson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | - Jackie Bridges
- School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - Jaimie Ellis
- School of Health Sciences, University of Southampton, Southampton, Hampshire, United Kingdom
| | - Noeleen Brady
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Simon Dello
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Jonathan Hooft
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Joan Kleine
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | - Dorothea Kohnen
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium; Occupational & Organisational Psychology and Professional Learning, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Elaine Lehane
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rikard Lindqvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Claudia B Maier
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | | | - Ingeborg Strømseng Sjetne
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Lovisenberg Diakonale Sykehus, Oslo, Norway
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; School of Health and Psychological Sciences, City, University of London, London, United Kingdom; Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Lisa Smeds Alenius
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
24
|
Jones F, Domeny A, Fish J, Leggat F, Patel I, McRae J, Rowe C, Busse ME. Using co-design methods to develop new personalised support for people living with Long Covid: The 'LISTEN' intervention. Health Expect 2024; 27:e14093. [PMID: 38783782 PMCID: PMC11116943 DOI: 10.1111/hex.14093] [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] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Many Covid-19 survivors are living with unresolved, relapsing and remitting symptoms and no 'one size' of treatment is likely to be effective for everyone. Supported self-management for the varied symptoms of Long Covid (LC) is recommended by the National Institute for Health and Care Excellence in the United Kingdom. We aimed to develop a new personalised support intervention for people living with LC using a structured co-design framework to guide replication and evaluation. METHODS We used the improvement methodology, Experience-Based Co-Design, in an accelerated form to harness the collective experiences of people with LC. Incorporating evidence from 'Bridges Self-Management' (Bridges) an approach in which healthcare professionals (HCPs)are trained to support knowledge, confidence and skills of individuals living with long term conditions. Co-designed resources are also central to Bridges. Adults who self-identified as living with or recovered from LC, from England or Wales, aged 18 years and over were recruited, and HCPs, with experience of supporting people with LC. Participants took part in a series of small co-design group meetings and larger mixed meetings to agree priorities, core principles and generate resources and intervention content. RESULTS People with LC (n = 28), and HCPs (n = 9) supported co-design of a book (hard-copy and digital form) to be used in 1:1 support sessions with a trained HCP. Co-design stages prioritised stories about physical symptoms first, and psychological and social challenges which followed, nonlinear journeys and reconceptualising stability as progress, rich descriptions of strategies and links to reputable advice and support for navigating healthcare services. Co-design enabled formulation of eight core intervention principles which underpinned the training and language used by HCPs and fidelity assessments. CONCLUSION We have developed a new personalised support intervention, with core principles to be used in one-to-one sessions delivered by trained HCPs, with a new co-designed book as a prompt to build personalised strategies and plans using narratives, ideas, and solutions from other people with LC. Effectiveness and cost effectiveness of the 'LISTEN' intervention will be evaluated in a randomised controlled trial set within the context of the updated Framework for Developing and Evaluating Complex Interventions. PATIENT AND PUBLIC CONTRIBUTION The LISTEN Public and Patient Involvement (PPI) group comprised seven people living with LC. They all contributed to the design of this study and five members were part of a larger co-design community described in this paper. They have contributed to this paper by interpreting stages of intervention design and analysis of results. Three members of our PPI group are co-authors of this paper.
Collapse
Affiliation(s)
- Fiona Jones
- Population Health Research InstituteSt George's University of LondonLondonUK
- Bridges Self‐ManagementLondonUK
| | - Anne Domeny
- Bridges Self‐ManagementLondonUK
- LISTEN Lived Experience Advisory GroupLondonUK
| | - Jessica Fish
- Department of Clinical Neuropsychology and Clinical Health PsychologySt George's University Hospitals NHS Foundation TrustLondonUK
- Mental Health and Wellbeing, School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Fiona Leggat
- Population Health Research InstituteSt George's University of LondonLondonUK
| | - Ian Patel
- LISTEN Lived Experience Advisory GroupLondonUK
| | - Jackie McRae
- Centre for Allied Health, Institute for Medical, Biomedical and Allied EducationSt George's University of LondonLondonUK
| | - Carol Rowe
- LISTEN Lived Experience Advisory GroupLondonUK
| | - Monica E. Busse
- Centre For Trials Research, School of MedicineCardiff UniversityCardiffWalesUK
| |
Collapse
|
25
|
Wheeler TF, Leitch S, Marra CA. The experiences of healthcare providers who refer to a campus-based pharmacy clinic: a qualitative analysis. J Prim Health Care 2024; 16:190-197. [PMID: 38941248 DOI: 10.1071/hc24022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/07/2024] [Indexed: 06/30/2024] Open
Abstract
Introduction The University of Otago School of Pharmacy Clinic (the Clinic) is a campus-based non-dispensing clinic that offers consultation-based medicines optimisation services to patients. Aim This project aims to understand the experiences and opinions of healthcareproviders who have referred patients to the School of Pharmacy Clinic, specifically: their motivation for referring patients; how the Clinic impacts providers, patients and the wider health system; provider satisfaction; and opportunities for further collaboration. Methods Semi-structured interviews were used to collect data from 15 participants who represented five health professions. An inductive reflexive thematic analysis approach was used to analyse the dataset from which codes and themes were developed. Normalisation Process Theory (NPT) was used to structure the interview guide and as a framework to present themes. Results Seven themes were developed; 'Perceptions of Pharmacists' (Coherence), 'Motivators for Engagement' and 'Barriers to Engagement' (Cognitive Participation), 'Utility of Pharmacist Feedback' and 'Opportunities' (Collective Action) and 'Referrers' Experiences' and 'Patient-centred Care' (Reflexive Action). Discussion Healthcare providers described predominantly positive experiences. Medically complex cases and patients requiring medicines education were most likely to be referred for consultation. Engaging with the Clinic presented valuable opportunities for interprofessional collaborative practice and continuing professional education. Referrers would like more regular contact with Clinic pharmacists to encourage interprofessional collaborative relationships. Patients were thought to benefit from their pharmacist's clinical expertise, time, patient-centred approach and subsequent medication and health optimisation. Integration of Clinic pharmacists into specialist outpatient clinics at Dunedin Hospital may broaden the scope and improve efficiency of their services.
Collapse
Affiliation(s)
- Tara F Wheeler
- School of Pharmacy, University of Otago, 18 Frederick Street, Dunedin, 9016, New Zealand
| | - Sharon Leitch
- Department of General Practice and Rural Health, Otago Medical School, University of Otago, 55 Hanover Street, Dunedin, 9016, New Zealand
| | - Carlo A Marra
- School of Pharmacy, University of Otago, 18 Frederick Street, Dunedin, 9016, New Zealand
| |
Collapse
|
26
|
Rimmer B, Finch T, Balla M, Dutton L, Williams S, Lewis J, Gallagher P, Burns R, Araújo‐Soares V, Menger F, Sharp L. Understanding supported self-management for people living with a lower-grade glioma: Implementation considerations through the lens of normalisation process theory. Health Expect 2024; 27:e14073. [PMID: 38733245 PMCID: PMC11087884 DOI: 10.1111/hex.14073] [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: 12/22/2023] [Revised: 02/16/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Supported self-management can improve clinical and psychosocial outcomes in people with cancer; the considerations required to implement self-management support (SMS) for people living with a lower-grade glioma (LGG)-who often have complex support needs-are not known. We aimed to identify and understand these implementation considerations through the lens of normalisation process theory (NPT), from the perspectives of healthcare professionals (HCP) and people with LGG. METHODS We conducted semistructured interviews with HCPs who support adults with brain tumours (n = 25; 12 different healthcare professions), and people with LGG who had completed primary treatment (n = 28; male n = 16, mean age 54.6 years, mean time since diagnosis 8.7 years), from across the United Kingdom. Interviews were transcribed and inductive open coding conducted, before deductively mapping to constructs of NPT. We first mapped HCP data, then integrated data from people with LGG to explore alignment in experiences and perspectives. RESULTS We generated supporting evidence for all four NPT constructs and related subconstructs, namely: 'Coherence', 'Cognitive participation', 'Collective action' and 'Reflexive monitoring'. Data from HCPs and people with LGG clearly demonstrated that effective SMS constitutes a collective activity. Key implementation considerations included: ensuring awareness of, and access to, support; building strong HCP-support recipient relationships; and careful inclusion of close family and friends. We identified pertinent challenges, such as identifying support needs (influenced by the extent to which those with LGG engage in help-seeking), resistance to support (e.g., technology literacy), training for HCPs and HCP cooperation. CONCLUSIONS This study demonstrates the collective nature of, and provides insight into the individual roles within, supported self-management. We outline considerations to operationalise, sustain and appraise the implementation of SMS for people with LGG. PATIENT OR PUBLIC CONTRIBUTION People with brain tumours, and informal caregivers, were involved in the development of information materials and topic guides to ensure accessibility and pertinence. They also had opportunities to comment on interview findings.
Collapse
Affiliation(s)
- Ben Rimmer
- Population Health Sciences Institute, Newcastle University Centre for CancerNewcastle UniversityNewcastle upon TyneUK
| | - Tracy Finch
- Department of Nursing, Midwifery and HealthNorthumbria UniversityNewcastle upon TyneUK
| | - Michelle Balla
- Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Lizzie Dutton
- Population Health Sciences Institute, Newcastle University Centre for CancerNewcastle UniversityNewcastle upon TyneUK
| | - Sophie Williams
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Joanne Lewis
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | | | - Richéal Burns
- Faculty of ScienceAtlantic Technological UniversitySligoIreland
- Health and Biomedical Strategic Research CentreAtlantic Technological UniversitySligoIreland
| | - Vera Araújo‐Soares
- Population Health Sciences Institute, Newcastle University Centre for CancerNewcastle UniversityNewcastle upon TyneUK
- Department for Prevention of Cardiovascular and Metabolic Disease, Centre for Preventive Medicine and Digital Health, Medical Faculty MannheimHeidelberg UniversityHeidelbergGermany
| | - Fiona Menger
- School of Education, Communication and Language SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for CancerNewcastle UniversityNewcastle upon TyneUK
| | | |
Collapse
|
27
|
Mwanga JR, Hokororo A, Ndosi H, Masenge T, Kalabamu FS, Tawfik D, Mediratta RP, Rozenfeld B, Berg M, Smith ZH, Chami N, Mkopi NP, Mwanga C, Diocles E, Agweyu A, Meaney PA. Evaluating the Implementation of the Pediatric Acute Care Education (PACE) Program in Northwestern Tanzania: A Mixed-Methods Study Guided by Normalization Process Theory. RESEARCH SQUARE 2024:rs.3.rs-4432440. [PMID: 38854141 PMCID: PMC11160918 DOI: 10.21203/rs.3.rs-4432440/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background In low- and -middle-income countries (LMICs) like Tanzania, the competency of healthcare providers critically influences the quality of pediatric care. To address this, we introduced PACE (Pediatric Acute Care Education), an adaptive e-learning program tailored to enhance provider competency in line with Tanzania's national guidelines for managing seriously ill children. Adaptive e-learning presents a promising alternative to traditional in-service education, yet optimal strategies for its implementation in LMIC settings remain to be fully elucidated. Objectives This study aimed to (1) evaluate the initial implementation of PACE in Mwanza, Tanzania, using the constructs of Normalization Process Theory (NPT), and (2) provide insights into its feasibility, acceptability, and scalability potential. Methods A mixed-methods approach was employed across three healthcare settings in Mwanza: a zonal hospital and two health centers. NPT was utilized to navigate the complexities of implementing PACE. Data collection involved a customized NoMAD survey, focus groups and in-depth interviews with healthcare providers. Results The study engaged 82 healthcare providers through the NoMAD survey and 79 in focus groups and interviews. Findings indicated high levels of coherence and cognitive participation, demonstrating that PACE is well-understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practice, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly affecting collective action, were noted. The short duration of the study limited the assessment of reflexive monitoring, though early indicators point towards the potential for PACE's long-term sustainability. Conclusion This study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanzanian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges is crucial for its successful and sustainable implementation. Furthermore, the study underscores the value of NPT as a framework in guiding implementation processes, with broader implications for implementation science and pediatric acute care in LMICs.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Marc Berg
- Stanford University School of Medicine
| | | | - Neema Chami
- Catholic University of Health and Allied Sciences
| | | | | | | | | | | |
Collapse
|
28
|
Sait MI, Christie RA, Cox C, Board M, Thomas S, O'Sullivan C, Davies C, Walker DM, Vassallo M, Sadler EA, Allen-Pick M, Moore P, Bradbury K, Murphy J. DIALOR (DIgitAL cOaching for fRailty): protocol for a single-arm mixed-methods feasibility study of a digital health coaching intervention for older people with frailty in primary care. BMJ Open 2024; 14:e080480. [PMID: 38760042 PMCID: PMC11103224 DOI: 10.1136/bmjopen-2023-080480] [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: 10/02/2023] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Multidomain interventions in older adults offer the best opportunity to prevent, delay or reverse existing symptoms in the earlier stages of frailty and improve independence but can be costly, and difficult to deliver at scale. However, digital health interventions enable personalised care and empowerment through self-management of long-term conditions, used at any time and when combined with health coaching offer the potential to enhance well-being and facilitate the achievement of health-related goals. We aim to evaluate the feasibility and acceptability of a digital health platform for long-term disease management combined with health coaching for people living with mild-moderate frailty, targeting self-identified goals-activity, nutrition, mood, enhancing social engagement and well-being. METHODS AND ANALYSIS This is a non-randomised feasibility, single-group, pretest/post-test study, using qualitative and quantitative methods. The digital health coaching intervention (DIALOR-DIgitAL cOaching for fRailty) has been developed for implementation to older adults, aged 65 years or older with mild to moderate frailty and diagnosis of one or more long-term health conditions in the community. Participants will receive 12 weeks of health coaching and have access to a mobile health platform for 6 months. The primary outcome measure is the acceptability and feasibility of DIALOR along with a range of secondary outcome measures (including frailty, functioning measures, quality of life, social engagement, diet quality and self-reported indicators) collected at baseline and at 6 months. The findings will inform whether a wider effectiveness trial is feasible and if so, how it should be designed. ETHICS AND DISSEMINATION Ethical approval has been granted by the Southeast Scotland Research Ethics Committee 02 (reference: 22/SS/0064). Research findings will be disseminated in a range of different ways to engage different audiences, including publishing in open-access peer-reviewed journals, conference presentations, social media, dissemination workshop with patients, carers, and healthcare professionals and on institution websites.
Collapse
Affiliation(s)
- Matthew I Sait
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Rachel A Christie
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Chantel Cox
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Michele Board
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Sarah Thomas
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | | | - Cheryl Davies
- Wessex Academic Health Science Network, Chilworth, UK
| | - Dawn-Marie Walker
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Michael Vassallo
- Older Person Medicine, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - E A Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Mark Allen-Pick
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | | | | | - Jane Murphy
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| |
Collapse
|
29
|
Bakare AA, Salako J, King C, Olojede OE, Bakare D, Olasupo O, Burgess R, McCollum ED, Colbourn T, Falade AG, Molsted-Alvesson H, Graham HR. 'Let him die in peace': understanding caregiver's refusal of medical oxygen treatment for children in Nigeria. BMJ Glob Health 2024; 9:e014902. [PMID: 38760025 PMCID: PMC11103205 DOI: 10.1136/bmjgh-2023-014902] [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: 12/21/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Efforts to improve oxygen access have focused mainly on the supply side, but it is important to understand demand barriers, such as oxygen refusal among caregivers. We therefore aimed to understand caregiver, community and healthcare provider (HCP) perspectives and experiences of medical oxygen treatments and how these shape oxygen acceptance among caregivers of sick children in Lagos and Jigawa states, which are two contrasting settings in Nigeria. METHODS Between April 2022 and January 2023, we conducted an exploratory qualitative study using reflexive thematic analysis, involving semistructured interviews with caregivers (Jigawa=18 and Lagos=7), HCPs (Jigawa=7 and Lagos=6) and community group discussions (Jigawa=4 and Lagos=5). We used an inductive-deductive approach to identify codes and themes through an iterative process using the theoretical framework of acceptability and the normalisation process theory as the analytic lens. RESULTS Medical oxygen prescription was associated with tension, characterised by fear of death, hopelessness about a child's survival and financial distress. These were driven by community narratives around oxygen, past negative experiences and contextual differences between both settings. Caregiver acceptance of medical oxygen was a sense-making process from apprehension and scepticism about their child's survival chances to positioning prescribed oxygen as an 'appropriate' or 'needed' intervention. Achieving this transition occurred through various means, such as trust in HCPs, a perceived sense of urgency for care, previous positive experience of oxygen use and a symbolic perception of oxygen as a technology. Misconceptions and pervasive negative narratives were acknowledged in Jigawa, while in Lagos, the cost was a major reason for oxygen refusal. CONCLUSION Non-acceptance of medical oxygen treatment for sick children is modifiable in the Nigerian context, with the root causes of refusal being contextually specific. Therefore, a one-size-fits-all policy is unlikely to work. Financial constraints and community attitudes should be addressed in addition to improving client-provider interactions.
Collapse
Affiliation(s)
- Ayobami Adebayo Bakare
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Julius Salako
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Omotayo E Olojede
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Damola Bakare
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Olabisi Olasupo
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Rochelle Burgess
- Institute for Global Health, University College London, London, UK
| | - Eric D McCollum
- Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
- Department of Paediatrics, University of Ibadan College of Medicine, Ibadan, Nigeria
| | | | - Hamish R Graham
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
- Centre for International Child Health, Murdoch Children's Research Institute, University of Melbourne, MCRI, Royal Children's Hospital, Parkville, Victoria, Australia
| |
Collapse
|
30
|
Bø KE, Halvorsen KH, Le AYN, Lehnbom EC. Barriers and facilitators of pharmacists' integration in a multidisciplinary home care team: a qualitative interview study based on the normalization process theory. BMC Health Serv Res 2024; 24:567. [PMID: 38698483 PMCID: PMC11064233 DOI: 10.1186/s12913-024-11014-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: 10/19/2023] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND There is a growing recognition of multidisciplinary practices as the most rational approach to providing better and more efficient healthcare services. Pharmacists are increasingly integrated into primary care teams, but there is no universal approach to implementing pharmacist services across healthcare settings. In Norway, most pharmacists work in pharmacies, with very few employed outside this traditional setting. The home care workforce is primarily made up of nurses, assistant nurses, and healthcare assistants. General practitioners (GPs) are not based in the same location as home care staff. This study utilized the Normalization Process Theory (NPT) to conduct a process evaluation of the integration of pharmacists in a Norwegian home care setting. Our aim was to identify barriers and facilitators to optimal utilization of pharmacist services within a multidisciplinary team. METHODS Semi-structured interviews (n = 9) were conducted with home care unit leaders, ward managers, registered nurses, and pharmacists in Norway, in November 2022-February 2023. Constructs from the NPT were applied to qualitative data. RESULTS Findings from this study pertain to the four constructs of the NPT. Healthcare professionals struggled to conceptualize the pharmacists' competencies and there were no collectively agreed-upon objectives of the intervention. Consequently, some participants questioned the necessity of pharmacist integration. Further, participants reported conflicting preferences regarding how to best utilize medication-optimizing services in everyday work. A lack of stakeholder empowerment was reported across all participants. Moreover, home care unit leaders and managers reported being uninformed of their roles and responsibilities related to the implementation process. However, the presence of pharmacists and their services were well received in the setting. Moreover, participants reported that pharmacists' contributions positively impacted the multidisciplinary practice. CONCLUSION Introducing new work methods into clinical practice is a complex task that demands expertise in implementation. Using the NTP model helped pinpoint factors that affect how pharmacists' skills are utilized in a home care setting. Insights from this study can inform the development of tailored implementation strategies to improve pharmacist integration in a multidisciplinary team.
Collapse
Affiliation(s)
- Karl-Erik Bø
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway.
| | - Kjell H Halvorsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
| | - Anna Yen-Ngoc Le
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
| | - Elin C Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, N-9037, Norway
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Hus Vita, Kalmar, 431 26, Sweden
| |
Collapse
|
31
|
Lee C, Buswell M, Coker J, Buckner S, Cowan A, Lhussier M. Addressing health inequalities in times of austerity: implementation of a place-based approach in multitiered local government. Perspect Public Health 2024; 144:153-161. [PMID: 38676341 PMCID: PMC11103920 DOI: 10.1177/17579139241241194] [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: 04/28/2024]
Abstract
AIMS This article focuses on how local authorities in England are tackling wider determinants of health and inequalities in their population's outcomes while budgets for public services are diminishing. METHODS It reports the experience from one case study engaged in rolling out a devolved, place- and asset-based strategy over multiple tiers of local government. Relating these findings to relevant social theory, we draw out aspects of context and mechanisms of change. We offer plausible hypotheses for the experiences observed, which supports transferability and implementation of place-based strategies in other local authority areas struggling with similar challenges. RESULTS Findings highlight the importance of high-level and political buy-in, as well as the role of the COVID-19 pandemic as a potential catalyst to rollout. Creating the foundations for a new, place-based working was important for achieving coherence among partners around what local government was trying to achieve. These included investment in infrastructure, both relational and tangible inputs such as organisational and human resources, to establish the conditions for systemic change towards early intervention and prevention. CONCLUSION This study identified clear foundations for place-based action, plus enablers and barriers to significant transformation of practice towards asset-based approaches between local authorities, partners and the public.
Collapse
Affiliation(s)
- C Lee
- Cambridge Public Health, Interdisciplinary Research Centre, Department of Engineering, University of Cambridge, and Cambridge Institute for Sustainability Leadership, Trumpington Street, Cambridge, CB2 1PZ, UK
| | - M Buswell
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
| | - J Coker
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
| | - S Buckner
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
| | - A Cowan
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
| | - M Lhussier
- Director, Centre for Health and Social Equity (CHASE), Northumbria University, Newcastle upon Tyne, UK
| |
Collapse
|
32
|
Trebacz A, McKean C, Stringer H, Pert S. Piloting building early sentences therapy for pre-school children with low language abilities: An examination of efficacy and the role of sign as an active ingredient. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:1128-1151. [PMID: 37975431 DOI: 10.1111/1460-6984.12980] [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: 05/04/2023] [Accepted: 10/14/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Early intervention is recommended for pre-school children with low language. However, few robustly evaluated language interventions for young children exist. Furthermore, in many interventions the theoretical underpinnings are underspecified and the 'active ingredients' of the interventions not tested. This paper presents a quasi-experimental study to test the efficacy and examine the active ingredients of Building Early Sentences Therapy (BEST): an intervention based on usage-based theory designed to support young children to understand and produce two-, three- and four-clause element sentences. BEST manipulates the input children hear to support them to harness the cognitive mechanisms hypothesized in usage-based theories to promote the development of abstract linguistic representations. One such input manipulation is the use of signing alongside verbal input signalling both content and morphology of target sentences. AIMS To examine whether (1) BEST is more efficacious than treatment as usual (TAU); and (2) signing of content and morphology is an active ingredient of the intervention. METHODS & PROCEDURES A quasi-experimental study recruited children aged 3;5-4;5 years from 13 schools. Schools were assigned to receive either BEST with sign, BEST without sign or TAU. The TAU group received their usual classroom provision. Across arms schools were matched with respect to classroom oral language environment and indices of deprivation. Participants were 48 children (28 boys) with expressive and/or receptive language abilities ≤ 16th centile measured using the New Reynell Developmental Language Scales (NRDLS). Outcomes gathered by researchers blind to treatment arm were NRDLS production and comprehension standard scores and measures of production of targeted sentence structures. OUTCOMES & RESULTS Primary outcomes indicate that BEST with sign was significantly more efficacious than TAU with respect to NRDLS production standard score, but not comprehension. The advantage for production was maintained at follow-up. BEST without sign was significantly more efficacious than TAU on measures of targeted vocabulary, sentence structure and morphology. The results from this quasi-experimental study provide evidence for the efficacy of a usage-based intervention on expressive language outcomes for preschool children with low language abilities. There is also evidence to support the inclusion of sign as an active ingredient, and so efforts to train interventionists in its use are worthwhile. CONCLUSIONS & IMPLICATIONS Patterns of findings across outcomes suggest signing of content and morphology may support the development of abstract linguistic representations and accelerate language learning. Given these positive results and the scale of this study, a fully powered randomized controlled trial is warranted. WHAT THIS PAPER ADDS What is already known on the subject Robust language skills are crucial for positive social, emotional, academic and economic outcomes across the lifespan. There is a paucity of robustly evaluated interventions for preschool children with language difficulties. The development of such interventions is crucial for ameliorating language difficulties and promoting positive educational and psychosocial outcomes. What this study adds to the existing knowledge This paper evaluates BEST, a novel usage-based language intervention targeting children with language difficulties in the early years. Findings indicate that a usage-based intervention is efficacious for treating language difficulties. In particular, BEST benefited expressive language development, bringing benefits to both treated and untreated language structures and improving standard scores. The role of sign as an active ingredient is also supported. Further evaluation is warranted. What are the practical and clinical implications of this work? Findings suggest that BEST may be effective for targeting children who have been identified as having language difficulties. In particular, expressive language may be improved when the intervention is delivered as it was originally manualized, including a signing system to represent content and grammatical morphology. More broadly, these findings also provide preliminary evidence that the use of a signing system does not hinder oral language development in children with language difficulties and may conversely support their expressive language. Future research exploring the role and underpinning mechanisms of sign in language intervention is warranted.
Collapse
Affiliation(s)
- Anastasia Trebacz
- School of Medicine, University of Sunderland, Sunderland, UK
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Cristina McKean
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Stringer
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sean Pert
- Division of Human Communication, Development and Hearing, University of Manchester, Manchester, UK
| |
Collapse
|
33
|
Jones K, Chisnall G, Crocker-Buque T, Elliman D, Horwood J, Mounier-Jack S, Campbell CN, Saliba V, Chantler T. A new neonatal BCG vaccination pathway in England: a mixed methods evaluation of its implementation. BMC Public Health 2024; 24:1175. [PMID: 38671383 PMCID: PMC11046867 DOI: 10.1186/s12889-024-18586-8] [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: 11/30/2023] [Accepted: 02/25/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The introduction of a national evaluation of newborn screening for Severe Combined Immunodeficiency (SCID) in England triggered a change to the selective Bacillus Calmette-Guerin (BCG) vaccination programme delivery pathway, as this live attenuated vaccine is contraindicated in infants with SCID. The neonatal BCG vaccination programme is a targeted programme for infants at increased risk of tuberculosis and used to be offered shortly after birth. Since September 2021 the BCG vaccine is given to eligible infants within 28 days of birth, when the SCID screening outcome is available. We explore the experiences of those implementing the new pathway, and how they made sense of, engaged with, and appraised the change. METHODS A mixed-methods evaluation was conducted between October 2022 and February 2023. This involved national online surveys with BCG commissioners and providers and qualitative semi-structured interviews with commissioners, providers, and Child Health Information System stakeholders in two urban areas. Survey data was analysed using descriptive statistics and interview data was analysed thematically. The data was triangulated using Normalization Process Theory as a guiding framework. RESULTS Survey respondents (n = 65) and qualitative interviewees (n = 16) revealed that making sense of the new pathway was an iterative process. Some expressed a desire for more direction on how to implement the new pathway. The perceived value of the change varied from positive, ambivalent, to concerned. Some felt well-prepared and that improvements to data capture, eligibility screening, and accountably brought by the change were valuable. Others were concerned about the feasibility of the 28-day target, reductions in vaccination coverage, increased resource burden, and the outcome of the SCID evaluation. New collaborations and communities of practice were required to facilitate the change. Three main challenges in implementing the pathway and meeting the 28-day vaccination target were identified: appointment non-attendance; appointment and data systems; and staffing and resourcing. Feedback mechanisms were informal and took place in tandem with implementation. CONCLUSION The new NHS neonatal BCG service specification has created an effective structure for monitoring and managing the BCG vaccination programme, but further work is required to support delivery of the 28-day vaccination target and improve uptake rates.
Collapse
Affiliation(s)
| | - Georgia Chisnall
- London School of Hygiene and Tropical Medicine, London, England.
| | | | | | | | | | | | | | - Tracey Chantler
- London School of Hygiene and Tropical Medicine, London, England
| |
Collapse
|
34
|
Finch TL, Bührmann L, Potthoff S, May CR, Gibson B, Gumancik J, Wilson-Dickson O, Girling M, Rapley T. Systematic review of applications and properties of the NoMAD instrument for assessing implementation outcomes: Study protocol. NIHR OPEN RESEARCH 2024; 4:21. [PMID: 39286463 PMCID: PMC11403288 DOI: 10.3310/nihropenres.13559.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 09/19/2024]
Abstract
Background Implementation outcomes measures can be used to assess the implementation of complex health and social care interventions, but evidence for the use of these measures, and their psychometric properties, remains limited. The NoMAD ( Normalisation Me asure Development) survey, based on Normalisation Process Theory, was developed to assess, monitor, or measure factors likely to affect normalisation of a new practice from the perspective of participants who are engaged in an implementation process. Since publication in 2015, NoMAD has been translated into several languages and is increasingly being used in health and care research. This systematic review will identify, appraise, and synthesise the existing literature on the use of NoMAD as an implementation outcome measure, focusing on use and application across different studies and settings, and on its properties as a measurement tool. Methods We will systematically search the bibliographic databases Web of Science, Scopus and PubMed for articles reporting empirical data in peer-reviewed journals. A citation search will also be undertaken in Google Scholar for primary NoMAD publications. Studies will be eligible for inclusion if they: (a) specify using NoMAD as a method and report results from using it, and/or (b) report a translation and/or validation study of NoMAD's measurement properties. Screening of abstracts and full text articles will be done independently by two researchers. Data extraction will be structured to allow collection and descriptive synthesis of data on study characteristics, use of NoMAD, psychometric results, and authors' reflections and recommendations. Conclusions This review will provide the first synthesis of how NoMAD has been applied in health and care research, and evidence on its properties as an outcome measure since its publication. This will be used to update existing freely accessible guidance for researchers and other users, and disseminated through peer-reviewed publications, and engagement activities with researchers and practitioners.
Collapse
Affiliation(s)
- Tracy L Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, England, NE7 7XA, UK
| | - Leah Bührmann
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, England, NE7 7XA, UK
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, England, NE7 7XA, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Beckie Gibson
- Psychology, Northumbria University, Newcastle upon Tyne, England, NE1 8ST, UK
| | - Jiri Gumancik
- Psychology, Northumbria University, Newcastle upon Tyne, England, NE1 8ST, UK
| | - Oliver Wilson-Dickson
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, England, NE7 7XA, UK
| | - Melissa Girling
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, England, NE7 7XA, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, England, NE7 7XA, UK
| |
Collapse
|
35
|
Richards KL, Phillips M, Grycuk L, Hyam L, Allen K, Schmidt U. Clinician perspectives of the implementation of an early intervention service for eating disorders in England: a mixed method study. J Eat Disord 2024; 12:45. [PMID: 38581055 PMCID: PMC10996085 DOI: 10.1186/s40337-024-01000-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The First Episode Rapid Early Intervention for Eating Disorders (FREED) service has been shown to reduce the wait for care and improve clinical outcomes in initial evaluations. These findings led to the national scaling of FREED in England. To support this scaling, we conducted a mixed method evaluation of the perceptions and experiences of clinicians in the early phases of scaling. The Normalisation Process Theory (NPT) was used as a conceptual lens to understand if and how FREED becomes embedded in routine practice. METHODS The convergent mixed method evaluation included 21 semi-structured interviews with clinicians from early adopter sites and 211 surveys administered to clinicians before, immediately after and 3 months after the FREED training. The interview guide and survey included questions evaluating attitudes towards early intervention for eating disorders (EDs) and NPT mechanisms. Interview data were analysed using an inductive thematic analysis. The NPT was applied to the inductively derived themes to evaluate if and how NPT domains impacted the implementation. Survey data were analysed using multilevel growth models. RESULTS Six themes and 15 subthemes captured barriers and facilitators to implementation at the patient, clinician, service, intervention, implementation and wider system levels. These interacted with the NPT mechanisms to facilitate or hinder the embedding of FREED. Overall, clinicians were enthusiastic and positive towards early intervention for EDs and FREED, largely because of the expectation of improved patient outcomes. This was a considerable driver in the uptake and implementation of FREED. Clinicians also had reservations about capacity and the potential impact on other patients, which, at times, was a barrier for its use. The FREED training led to significant improvements in positive attitudes and NPT mechanisms that were largely maintained at the 3-month follow-up. However, negative attitudes did not significantly improve following training. CONCLUSIONS Positive attitudes towards early intervention for EDs increased enthusiasm and engagement with the model. Features of the model and its implementation were effective at developing adopter commitment and capabilities. However, there were aspects of the model and its implementation which require attention in the future (e.g., capacity and the potential impact on the wider service).
Collapse
Affiliation(s)
- Katie L Richards
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AB, UK.
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Matthew Phillips
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AB, UK
| | - Luiza Grycuk
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AB, UK
| | - Lucy Hyam
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AB, UK
| | - Karina Allen
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AB, UK
- Eating Disorders Outpatient Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AB, UK
- Eating Disorders Outpatient Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| |
Collapse
|
36
|
Simpson SA, Evans RA, Gilbert HR, Branson A, Barber S, McIntosh E, Ahmed Z, Dean SG, Doherty PJ, Gardiner N, Greaves C, Daw P, Ibbotson T, Jani B, Jolly K, Mair F, Ormandy P, Smith S, Singh SJ, Taylor R. Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (PERFORM): protocol for a randomised feasibility trial. BMJ Open 2024; 14:e083255. [PMID: 38580370 PMCID: PMC11002422 DOI: 10.1136/bmjopen-2023-083255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/18/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (PERFORM) is a research programme that seeks to develop and evaluate a comprehensive exercise-based rehabilitation intervention designed for people with multimorbidity, the presence of multiple long-term conditions (MLTCs). This paper describes the protocol for a randomised trial to assess the feasibility and acceptability of the PERFORM intervention, study design and processes. METHODS AND ANALYSIS A multicentre, parallel two-group randomised trial with individual 2:1 allocation to the PERFORM exercise-based intervention plus usual care (intervention) or usual care alone (control). The primary outcome of this feasibility trial will be to assess whether prespecified progression criteria (recruitment, retention, intervention adherence) are met to progress to the full randomised trial. The trial will be conducted across three UK sites and 60 people with MLTCs, defined as two or more LTCs, with at least one having evidence of the beneficial effect of exercise. The PERFORM intervention comprises an 8-week (twice a week for 6 weeks and once a week for 2 weeks) supervised rehabilitation programme of personalised exercise training and self-management education delivered by trained healthcare professionals followed by two maintenance sessions. Trial participants will be recruited over a 4.5-month period, and outcomes assessed at baseline (prerandomisation) and 3 months postrandomisation and include health-related quality of life, psychological well-being, symptom burden, frailty, exercise capacity, physical activity, sleep, cognition and serious adverse events. A mixed-methods process evaluation will assess acceptability, feasibility and fidelity of intervention delivery and feasibility of trial processes. An economic evaluation will assess the feasibility of data collection and estimate the costs of the PERFORM intervention. ETHICS AND DISSEMINATION The trial has been given favourable opinion by the West Midlands, Edgbaston Research Ethics Service (Ref: 23/WM/0057). Participants will be asked to give full, written consent to take part by trained researchers. Findings will be disseminated via journals, presentations and targeted communications to clinicians, commissioners, service users and patients and the public. TRIAL REGISTRATION NUMBER ISRCTN68786622. PROTOCOL VERSION 2.0 (16 May 2023).
Collapse
Affiliation(s)
- Sharon Anne Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | | | - Amy Branson
- Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Shaun Barber
- Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Zahira Ahmed
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, UK
| | | | | | - Nikki Gardiner
- Department of Cardiopulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UK
| | - Paulina Daw
- School of Sport, Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UK
| | - Tracy Ibbotson
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Bhautesh Jani
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Frances Mair
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Paula Ormandy
- University of Salford School of Nursing Midwifery and Social Work, Manchester, UK
| | - Susan Smith
- Community Health and General Practice, Trinity College Dublin, Dublin, Ireland
| | - Sally J Singh
- Cardiac/Pulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rod Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| |
Collapse
|
37
|
Albutt A, Hardman J, McVey L, Odo C, Paleri V, Patterson J, Webb S, Rousseau N, Kellar I, Randell R. Qualitative study exploring the design of a patient-reported symptom-based risk stratification system for suspected head and neck cancer referrals: protocol for work packages 1 and 2 within the EVEREST-HN programme. BMJ Open 2024; 14:e081151. [PMID: 38582535 PMCID: PMC11002383 DOI: 10.1136/bmjopen-2023-081151] [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: 10/19/2023] [Accepted: 02/19/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION Between 2009/2010 and 2019/2020, England witnessed an increase in suspected head and neck cancer (sHNC) referrals from 140 to 404 patients per 100 000 population. 1 in 10 patients are not seen within the 2-week target, contributing to patient anxiety. We will develop a pathway for sHNC referrals, based on the Head and Neck Cancer Risk Calculator. The evolution of a patient-reported symptom-based risk stratification system to redesign the sHNC referral pathway (EVEREST-HN) Programme comprises six work packages (WPs). This protocol describes WP1 and WP2. WP1 will obtain an understanding of language to optimise the SYmptom iNput Clinical (SYNC) system patient-reported symptom questionnaire for sHNC referrals and outline requirements for the SYNC system. WP2 will codesign key elements of the SYNC system, including the SYNC Questionnaire, and accompanying behaviour change materials. METHODS AND ANALYSIS WP1 will be conducted at three acute National Health Service (NHS) trusts with variation in service delivery models and ensuring a broad mixture of social, economic and cultural backgrounds of participants. Up to 150 patients with sHNC (n=50 per site) and 15 clinicians (n=5 per site) will be recruited. WP1 will use qualitative methods including interviews, observation and recordings of consultations. Rapid qualitative analysis and inductive thematic analysis will be used to analyse the data. WP2 will recruit lay patient representatives to participate in online focus groups (n=8 per focus group), think-aloud technique and experience-based codesign and will be analysed using qualitative and quantitative approaches. ETHICS AND DISSEMINATION The committee for clinical research at The Royal Marsden, a research ethics committee and the Health Research Authority approved this protocol. All participants will give informed consent. Ethical issues of working with patients on an urgent cancer diagnostic pathway have been considered. Findings will be disseminated via journal publications, conference presentations and public engagement activities.
Collapse
Affiliation(s)
- Abigail Albutt
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Lynn McVey
- Centre for Digital Innovations in Health & Social Care, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Chinasa Odo
- Centre for Digital Innovations in Health & Social Care, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | | | | | - Sarah Webb
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ian Kellar
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Rebecca Randell
- Centre for Digital Innovations in Health & Social Care, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| |
Collapse
|
38
|
Boman C, Bernhardsson S, Lundqvist S, Melin K, Lauruschkus K. Physical activity on prescription for children with obesity: a focus group study exploring experiences in paediatric healthcare. FRONTIERS IN HEALTH SERVICES 2024; 4:1306461. [PMID: 38638607 PMCID: PMC11024476 DOI: 10.3389/frhs.2024.1306461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
Background Insufficient physical activity is a growing public health concern and is closely linked to obesity in both adults and children. Swedish physical activity on prescription (PAP) is effective in increasing physical activity levels in adults, but knowledge about how PAP is used in paediatric healthcare is lacking. Therefore, this study aimed to explore experiences of working with PAP for children with obesity amongst paediatric staff and managers. Methods Seven focus group discussions with 26 participants from paediatric outpatient clinics in western Sweden were conducted. Data were analysed both inductively and deductively, framed by the Normalization Process Theory's four core constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Results The PAP work for children with obesity was experienced to be about helping children to become physically active, and less about losing weight. Identified barriers for using PAP were the non-uniform nature of the work and a perceived lack of guidelines. Collaboration with physiotherapists and physical activity organisers outside the organisation was identified as an important facilitator. An important contextual factor for implementing PAP is the collaboration between paediatric clinics and physical activity organisers. In the transition between these stakeholders, maintaining a family-centred approach when working with PAP was experienced as challenging. Conclusions PAP is a well-known intervention that is inconsistently used for children with obesity. The intervention should include a family-centred approach for this patient group. It also needs to align better with existing collaborations with other healthcare units as well as with new forms of collaboration with physical activity organisers in the community.
Collapse
Affiliation(s)
- Charlotte Boman
- Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Education Primary Health Care, Gothenburg, Sweden
| | - Stefan Lundqvist
- Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Education Primary Health Care, Gothenburg, Sweden
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Lauruschkus
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Habilitation, Committee on Psychiatry, Habilitation and Technical Aids, Malmö, Sweden
| |
Collapse
|
39
|
Bugge C. What is a process evaluation when used alongside a randomised controlled trial? Evid Based Nurs 2024; 27:45-47. [PMID: 38050052 DOI: 10.1136/ebnurs-2023-103878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Carol Bugge
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
40
|
Ahlqvist-Björkroth S, Axelin A, Lehtonen L. Close Collaboration with Parents-Implementation and effectiveness. Acta Paediatr 2024. [PMID: 38514910 DOI: 10.1111/apa.17210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/23/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
AIM There has been a need to develop programs to facilitate family-centered care. This paper describes the content of a program called Close Collaboration with Parents, its implementation, and research on its effectiveness. METHODS The program is a systematic training with a focus on staff communication and observation skills and skills to support parenting. The primary implementation strategy is mentoring. Staff engage in bedside practices and reflections with mentors covering all four phases of the program. The effects of this unit-wide program have been evaluated using a pre-post study design, a qualitative study design, and a register-based study design. RESULTS The program has been successfully implemented in 26 units so far. Our research has shown that the training benefits infants, parents, staff, and healthcare organisations. Specifically, family-centered care practices improved after the program, the parents' presence and parent-infant skin-to-skin contact increased, infant growth improved and the length of hospital stays shortened. The mothers' depressive symptoms decreased in the long term. CONCLUSION We have described an educational program for the multidisciplinary staff of a neonatal intensive care unit, Close Collaboration with Parents. The program has changed hospital care cultures for the benefit of infants, parents, staff, and even the healthcare organisation.
Collapse
Affiliation(s)
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| |
Collapse
|
41
|
Lindblom S, Flink M, von Koch L, Tistad M, Stenberg U, Elf M, Carlsson AC, Laska AC, Ytterberg C. A person-centred care transition support for people with stroke/TIA: A study protocol for effect and process evaluation using a non-randomised controlled design. PLoS One 2024; 19:e0299800. [PMID: 38483869 PMCID: PMC10939281 DOI: 10.1371/journal.pone.0299800] [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: 07/06/2023] [Accepted: 01/31/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Care transitions following a stroke call for integrated care approaches to reduce death and disability. The proposed research described in this study protocol aims to evaluate the effectiveness of a person-centred multicomponent care transition support and the process in terms of contextual moderators, implementation aspects and mechanisms of impact. METHODS A non-randomized controlled trial design will be used. The intervention includes person-centred dialogue intended to permeate all patient-provider communication, various pedagogical modes of information, a person-centred care and rehabilitation plan, and a bridging e-meeting to prepare patients for homecoming. Patients with stroke or TIA who are to be discharged from the participating hospitals to home and referred to a neurorehabilitation team for continued rehabilitation will be included. Follow-ups will be conducted at one week, 3 months and 12 months. Data will be collected on the primary outcome of perceived quality of the care transition, and on the secondary outcomes of health literacy, medication adherence, and perceived person-centeredness. Data for process evaluation will be collected through semi-structured interviews, focus groups, participatory observations, and the Normalisation Measure Development Questionnaire. DISCUSSION The study will provide insights on implementation, mechanisms of impact, contextual moderators, and effectiveness of a care transition support, targeting a poorly functioning part of the care trajectory for people with stroke and TIA. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05646589.
Collapse
Affiliation(s)
- Sebastian Lindblom
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme of Women’s Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme of Women’s Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme of Heart & Vascular and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Tistad
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Una Stenberg
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Frambu Centre for Rare Disorders, Siggerud, Norway
| | - Marie Elf
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Axel C. Carlsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Ann Charlotte Laska
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme of Women’s Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
42
|
Chisholm A, Tucker KL, Crawford C, Green M, Greenfield S, Hodgkinson J, Lavallee L, Leeson P, Mackillop L, McCourt C, Sandall J, Wilson H, Chappell LC, McManus RJ, Hinton L. Self-monitoring blood pressure in Pregnancy: Evaluation of health professional experiences of the BUMP trials. Pregnancy Hypertens 2024; 35:88-95. [PMID: 38301352 DOI: 10.1016/j.preghy.2024.01.134] [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: 07/13/2023] [Revised: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The BUMP trials evaluated a self-monitoring of blood pressure intervention in addition to usual care, testing whether they improved detection or control of hypertension for women at risk of hypertension or with hypertension during pregnancy. This process evaluation aimed to understand healthcare professionals' perspectives and experiences of the BUMP trials of self-monitoring of blood pressure during pregnancy. METHODS Twenty-two in-depth qualitative interviews and an online survey with 328 healthcare professionals providing care for pregnant people in the BUMP trials were carried out across five maternity units in England. RESULTS Analysis used Normalisation Process Theory to identify factors required for successful implementation and integration into routine practice. Healthcare professionals felt self-monitoring of blood pressure did not over-medicalise pregnancy for women with, or at risk of, hypertension. Most said self-monitored readings positively affected their clinical encounters and professional roles, provided additive information on which to base decisions and enriched their relationships with pregnant people. Self-monitoring of blood pressure shifts responsibilities. Some healthcare professionals felt women having responsibility to decide on timing of monitoring and whether to act on self-monitored readings was unduly burdensome, and resulted in healthcare professionals taking additional responsibility for supporting them. CONCLUSIONS Despite healthcare professionals' early concerns that self-monitoring of blood pressure might over-medicalise pregnancy, our analysis shows the opposite was the case when used in the care of pregnant people with, or at higher risk of, hypertension. While professionals retained ultimate clinical responsibility, they viewed self-monitoring of blood pressure as a means of sharing responsibility and empowering women to understand their bodies, to make judgements and decisions, and to contribute to their care.
Collapse
Affiliation(s)
- Alison Chisholm
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Katherine L Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Marcus Green
- Action on Pre-eclampsia, The Stables, 80 B High Street, Evesham, Worcestershire, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, College of Medical and Dental Sciences, Birmingham B15 2TT, UK
| | - James Hodgkinson
- Institute of Applied Health Research, University of Birmingham, College of Medical and Dental Sciences, Birmingham B15 2TT, UK
| | - Layla Lavallee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Level 1 Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Lucy Mackillop
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Christine McCourt
- Centre for Maternal & Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Hannah Wilson
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| |
Collapse
|
43
|
Carrie S, Fouweather T, Homer T, O'Hara J, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT. Health Technol Assess 2024; 28:1-213. [PMID: 38477237 PMCID: PMC11017631 DOI: 10.3310/mvfr4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting The trial was set in 17 NHS secondary care hospitals in the UK. Participants A total of 378 eligible participants aged > 18 years were recruited. Interventions Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Sean Carrie
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Quentin Gardiner
- Ear, Nose and Throat Department, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Naveed Kara
- Ear, Nose and Throat Department, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Ear, Nose and Throat Department, Manchester Royal Infirmary, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel Chee Leong
- Ear, Nose and Throat Department, Aintree Hospital, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Ear, Nose and Throat Department, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - Paul Nix
- Ear, Nose and Throat Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
44
|
Teixeira MJC, Ahmed R, Tehrany R, Jaggi A, Ramanuj P. Collaborative care model versus usual care for the management of musculoskeletal and co-existing mental health conditions: a randomised feasibility mixed-methods study. BMJ Open 2024; 14:e079707. [PMID: 38387980 PMCID: PMC10882312 DOI: 10.1136/bmjopen-2023-079707] [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: 09/09/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE This study aimed to assess the feasibility of a future trial comparing the collaborative care model with usual care for patients with musculoskeletal conditions and co-existing symptoms of anxiety and depression. DESIGN A single-centre, parallel-arm, one-to-one, randomised controlled trial design using a mixed-methods approach was used. semistructured interviews and focus groups were conducted post intervention with all participants and staff respectively to explore acceptability towards the model and identify recommendations for improvements. SETTING An orthopaedic rehabilitation outpatient tertiary hospital. PARTICIPANTS Adult patients with musculoskeletal conditions and co-existing moderate or severe symptoms of anxiety and depression attending outpatient therapy appointments. INTERVENTION The collaborative care model consisted of a tailored management programme to facilitate the integration of care provided by physical and mental healthcare professionals. A case manager screened and coordinated targeted mental health support for participants. Participants allocated to usual care had no support from the case manager. MAIN OUTCOMES MEASURE Feasibility indicators (rates of recruitment, randomisation and retention), acceptability of clinical outcome measures, usage of additional resources and cost of intervention implementation. RESULTS Of the 89 patients who provided consent to take part, 40 participants who matched the eligibility criteria were randomised to either the intervention (n=20) or usual care arm (n=20). Overall adherence to the intervention was 58.82%, while the withdrawal rate was 37.5% at 6 months. All of the 27 participants who were retained completed self-reported outcomes. Qualitative data highlighted that integrated mental health support was favourably perceived. In addition to prenegotiating protected psychology time, the need for operationalised communication between the case manager and clinicians was identified as a recommendation for a future trial. CONCLUSIONS The trial and intervention were acceptable to patients and healthcare professionals. While the findings demonstrate the feasibility of trial recruitment, a future trial will require optimised retention strategies to improve adherence and withdrawal rates. TRIAL REGISTRATION NUMBER NCT05018039.
Collapse
Affiliation(s)
| | - Refah Ahmed
- East London NHS Foundation Trust, London, UK
| | - Rokhsaneh Tehrany
- Therapies Departament, Royal National Orthopaedic Hospital NHS Trust, London, UK
- University College London, London, UK
| | - Anju Jaggi
- Therapies Departament, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | |
Collapse
|
45
|
Herkama S, Larose MP, Harjuniemi I, Pöyhönen V, Yanagida T, Kankaanpää E, Rissanen E, Salmivalli C. Improving the implementation of KiVa antibullying program with tailored support: Study protocol for a cluster randomized controlled trial. Contemp Clin Trials 2024; 137:107407. [PMID: 38104858 DOI: 10.1016/j.cct.2023.107407] [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: 07/03/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND There are no evidence-based models to support the implementation of school-based bullying prevention programs. Our primary objective is to examine the impact of tailored support on the implementation of the KiVa antibullying program. Our second objective is to evaluate whether the offered support influences student outcomes (e.g., victimization, bullying perpetration). We also assess the cost-effectiveness of the provided support and conduct a process evaluation. METHODS In a cluster randomized control trial (cRCT), we compare program fidelity between schools that receive implementation support and those that do not. Twenty-four (N = 24) schools in Finland were randomized to either the IMPRES condition (receiving support, n = 12) or the control group (KiVa as usual, n = 12). In the IMPRES condition, pre-assessment and staff training were organized, and a selected team of staff members received four mentoring sessions during one academic year. Staff and students answer questionnaires at the end of school year 0, at post-intervention (year 1) and again at the 1-year follow-up (year 2). Our primary outcomes concern two main program components - universal and indicated actions - reflecting program fidelity. As secondary outcomes, we examine the level of bullying victimization and perpetration as well as students' perception of several program fidelity indicators. Finally, we assess several tertiary outcomes, collect resource data and conduct qualitative interviews to perform additional analyses. CONCLUSION This trial will inform us of whether implementation support can boost program fidelity and have a distal impact on bullying prevalence. TRIAL REGISTRATION ISRCTN15558617 https://doi.org/10.1186/ISRCTN15558617.
Collapse
|
46
|
Pattullo C, Suckling B, Salanowski J, Donovan P, Hall L. Describing the acceptability and use of an opioid stewardship self-assessment tool in real-world settings. Res Social Adm Pharm 2024; 20:203-208. [PMID: 38049350 DOI: 10.1016/j.sapharm.2023.11.004] [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: 09/20/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND The Stewardship Framework (Framework) was developed by an expert clinician group and was designed to provide a mechanism for continuous monitoring of improvement in opioid prescribing in acute hospitals. The aim of this study was to modify the Framework into an Opioid Stewardship Self-Assessment Tool (Self-Assessment Tool), and pilot test the acceptability and its use in a variety of acute hospital settings. METHODS The Framework was converted into the Self-Assessment Tool to allow hospitals to undertake a gap analysis of their current opioid stewardship activities. To participate hospitals were required to establish a small team and complete the Self-Assessment Tool. Participating sites were recruited using purposive sampling. Responses were tabulated and coded to enable assessment. 'Acceptability' was defined as the completion of the Self-Assessment Tool (response rate, proportion of questions answered) and responder feedback relating to its content. The use of the Tool was categorised based on the level of detail of responses. RESULTS Nineteen of the 20 facilities approached, agreed to participate. The 16 sites which established a small team to facilitate survey completion are included in the final analysis. The overall response rate was 96 % (413/432) for the (27 survey questions across 16 participating sites), 4 % (19/432) of questions were left unanswered or were not interpretable by the study team. Opportunities were identified to enhance the use of the Self-Assessment Tool, particularly to support its potential to assist reflection and planning of local strategies. CONCLUSION This study demonstrated that the Self-Assessment Tool was an acceptable method of assessing a facility's opioid stewardship capabilities in a real-world setting. The next iteration will be modified using the insights on how the Tool was used by study participants.
Collapse
Affiliation(s)
- Champika Pattullo
- Safety and Implementation Service, Lower Ground Floor, James Mayne Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland, 4006, Australia; School of Public Health, University of Queensland, Herston, Queensland, Australia.
| | - Benita Suckling
- Medication Safety Pharmacist, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Julia Salanowski
- Clinical Pharmacist, Analgesic Stewardship Pharmacist, Pharmacy Department, Barwon Health, Victoria, Queensland, Australia
| | - Peter Donovan
- Clinical Pharmacology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Lisa Hall
- School of Public Health, University of Queensland, Herston, Queensland, Australia
| |
Collapse
|
47
|
Denninger NE, Brefka S, Skudlik S, Leinert C, Mross T, Meyer G, Sulmann D, Dallmeier D, Denkinger M, Müller M. Development of a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers: A multi-method study. Int J Nurs Stud 2024; 150:104645. [PMID: 38091654 DOI: 10.1016/j.ijnurstu.2023.104645] [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: 04/05/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Delirium is a common yet challenging condition in older hospitalized patients, associated with various adverse outcomes. Environmental factors, such as room changes, may contribute to the development or severity of delirium. Most previous research has focused on preventing and reducing this condition by addressing risk factors and facilitating reorientation during hospital stay. OBJECTIVE We aimed to systematically develop a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers during and after these procedures. The intervention combines stakeholder and expert opinions, evidence, and theory. This article provides guidance and inspiration to research groups in developing complex interventions according to the recommendations in the Medical Research Council framework for complex interventions. DESIGN AND METHODS A stepwise multi-method study was conducted. The preparation phase included analysis of the context and current practice via focus groups. Based on these results, an expert workshop was organized, followed by a Delphi survey. Finally, the intervention was modeled and a program theory was developed, including a logic model. RESULTS A complex intervention was developed in an iterative process, involving healthcare professionals, delirium experts, researchers, as well as caregiver and patient representatives. The key intervention component is an 8-point-program, which provides caregivers with recommendations for preventing delirium during the transition phase and in the post-discharge period. Information materials (flyers, handbook, videos, posters, defined "Dos and Don'ts", discharge checklist), training for healthcare professionals, and status analyses are used as implementation strategies. In addition, roles were established for gatekeepers to act as leaders, and champions to serve as knowledge multipliers and trainers for the multi-professional team in the hospitals. CONCLUSIONS This study serves as an example of how to develop a complex intervention. In an additional step, the intervention and implementation strategies will be investigated for feasibility and acceptability in a pilot study with an accompanying process evaluation. TWEETABLE ABSTRACT Delirium prevention can benefit from optimizing discharge and transfer processes and involving caregivers of older patients in these procedures. STUDY REGISTRATION DRKS00017828, German Register of Clinical Studies, date of registration 17.09.2019.
Collapse
Affiliation(s)
- Natascha-Elisabeth Denninger
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany; Martin Luther University Halle-Wittenberg, International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Halle (Saale), Germany; Heidelberg University, Medical Faculty Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany; University Hospital Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany.
| | - Simone Brefka
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Stefanie Skudlik
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany
| | - Christoph Leinert
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Thomas Mross
- Agaplesion Bethanien Hospital Heidelberg, Centre for Geriatric Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Halle (Saale), Germany
| | | | - Dhayana Dallmeier
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Boston University School of Public Health, Department of Epidemiology, Boston, USA
| | - Michael Denkinger
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Martin Müller
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany; Heidelberg University, Medical Faculty Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany; University Hospital Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany
| |
Collapse
|
48
|
Whitehead PJ, Belshaw S, Brady S, Coleman E, Dean A, Doherty L, Fairhurst C, Francis-Farrell S, Golding-Day M, Gray J, Martland M, McAnuff J, McCarthy A, McMeekin P, Mitchell N, Narayanasamy M, Newman C, Parker A, Rapley T, Rodgers S, Rooney L, Russell R, Sheard L, Torgerson D. Bathing Adaptations in the Homes of Older Adults (BATH-OUT-2): study protocol for a randomised controlled trial, economic evaluation and process evaluation. Trials 2024; 25:75. [PMID: 38254164 PMCID: PMC10802044 DOI: 10.1186/s13063-023-07677-3] [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: 08/07/2023] [Accepted: 09/26/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The onset of disability in bathing is particularly important for older adults as it can be rapidly followed by disability in other daily activities; this may represent a judicious time point for intervention in order to improve health, well-being and associated quality of life. An important environmental and preventative intervention is housing adaptation, but there are often lengthy waiting times for statutory provision. In this randomised controlled trial (RCT), we aim to evaluate the effectiveness and cost-effectiveness of bathing adaptations compared to no adaptations and to explore the factors associated with routine and expedited implementation of bathing adaptations. METHODS BATH-OUT-2 is a multicentre, two-arm, parallel-group RCT. Adults aged 60 and over who are referred to their local authority for an accessible level access shower will be randomised, using pairwise randomisation, 1:1, to receive either an expedited provision of an accessible shower via the local authority or a usual care control waiting list. Participants will be followed up for a maximum of 12 months and will receive up to four follow-ups in this duration. The primary outcome will be the participant's physical well-being, assessed by the Physical Component Summary score of the Short Form-36 (SF-36), 4 weeks after the intervention group receives the accessible shower. The secondary outcomes include the Mental Component Summary score of the SF-36, self-reported falls, health and social care resource use, health-related quality of life (EQ-5D-5L), social care-related quality of life (Adult Social Care Outcomes Toolkit (ASCOT)), fear of falling (Short Falls Efficacy Scale), independence in bathing (Barthel Index bathing question), independence in daily activities (Barthel Index) and perceived difficulty in bathing (0-100 scale). A mixed-methods process evaluation will comprise interviews with stakeholders and a survey of local authorities with social care responsibilities in England. DISCUSSION The BATH-OUT-2 trial is designed so that the findings will inform future decisions regarding the provision of bathing adaptations for older adults. This trial has the potential to highlight, and then reduce, health inequalities associated with waiting times for bathing adaptations and to influence policies for older adults. TRIAL REGISTRATION ISRCTN Registry ISRCTN48563324. Prospectively registered on 09/04/2021.
Collapse
Affiliation(s)
- Phillip J Whitehead
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Stuart Belshaw
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
| | - Samantha Brady
- Department of Health Sciences, University of York, York, UK
| | | | - Alexandra Dean
- Department of Health Sciences, University of York, York, UK
| | - Laura Doherty
- Department of Health Sciences, University of York, York, UK
| | | | | | - Miriam Golding-Day
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
| | - Joanne Gray
- Department of Nursing, Midwifery and Health, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | | | - Jennifer McAnuff
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Andrew McCarthy
- Department of Nursing, Midwifery and Health, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Peter McMeekin
- Department of Nursing, Midwifery and Health, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | | | - Melanie Narayanasamy
- Centre for Rehabilitation and Ageing Research, University of Nottingham, Nottingham, UK
| | - Craig Newman
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Adwoa Parker
- Department of Health Sciences, University of York, York, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Sara Rodgers
- Department of Health Sciences, University of York, York, UK
| | - Leigh Rooney
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Laura Sheard
- Department of Health Sciences, University of York, York, UK
| | | |
Collapse
|
49
|
Jones S, Brown TJ, Watson P, Homer C, Freeman C, Bakhai C, Ells L. Commercial provider staff experiences of the NHS low calorie diet programme pilot: a qualitative exploration of key barriers and facilitators. BMC Health Serv Res 2024; 24:53. [PMID: 38200539 PMCID: PMC10782528 DOI: 10.1186/s12913-023-10501-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: 06/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The National Health Service Type 2 Diabetes Path to Remission programme in England (known as the NHS Low Calorie Diet programme when piloted) was established to support people living with excess weight and Type 2 Diabetes to lose weight and improve their glycaemic control. A mixed method evaluation was commissioned to provide an enhanced understanding of the long-term cost effectiveness of the pilot programme, its implementation, equity and transferability across broad and diverse populations. This study provided key insights on implementation and equity from the service providers' perspective. METHODS Thirteen focus groups were conducted with commercial providers of the programme, during the initial pilot rollout. Participants were purposively sampled across all provider organisations and staff roles involved in implementing and delivering the programme. Normalisation Process Theory (NPT) was used to design the topic schedule, with the addition of topics on equity and person-centredness. Data were thematically analysed using NPT constructs with additional inductively created codes. Codes were summarised, and analytical themes generated. RESULTS The programme was found to fulfil the requirements for normalisation from the providers' perspective. However, barriers were identified in engaging GP practices and receiving sufficient referrals, as well as supporting service users through challenges to remain compliant. There was variation in communication and training between provider sites. Areas for learning and improvement included adapting systems and processes and closing the gap where needs of service users are not fully met. CONCLUSIONS The evaluation of the pilot programme demonstrated that it was workable when supported by effective primary care engagement, comprehensive training, and effective internal and external communication. However, limitations were identified in relation to programme specifications e.g. eligibility criteria, service specification and local commissioning decisions e.g. pattern of roll out, incentivisation of general practice. A person-centred approach to care is fundamental and should include cultural adaptation(s), and the assessment and signposting to additional support and services where required.
Collapse
Affiliation(s)
- Susan Jones
- School of Health & Life Sciences, Teesside University, Centuria Building, Middlesbrough, North Yorkshire, TS1 3BX, UK
| | - Tamara J Brown
- Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW, UK.
| | - Patricia Watson
- School of Health & Life Sciences, Teesside University, Centuria Building, Middlesbrough, North Yorkshire, TS1 3BX, UK
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Olympic Legacy Park, 2 Old Hall Road, Sheffield, S9 3TU, UK
| | - Charlotte Freeman
- Public Health Team, Calderdale Council, Princess Buildings, Princess Street, Halifax, West Yorkshire, HX1 1TP, UK
| | - Chirag Bakhai
- Larkside Practice, Churchfield Medical Centre, 322 Crawley Green Road, Luton, Bedfordshire, LU2 9SB, UK
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW, UK
| |
Collapse
|
50
|
de Vos L, Daniels J, Gebengu A, Mazzola L, Gleeson B, Blümel B, Piton J, Mdingi M, Gigi RMS, Ferreyra C, Klausner JD, Peters RPH. Implementation considerations for a point-of-care Neisseria gonorrhoeae rapid diagnostic test at primary healthcare level in South Africa: a qualitative study. BMC Health Serv Res 2024; 24:43. [PMID: 38195446 PMCID: PMC10777514 DOI: 10.1186/s12913-023-10478-8] [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: 10/12/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND South Africa maintains an integrated health system where syndromic management of sexually transmitted infections (STI) is the standard of care. An estimated 2 million cases of Neisseria gonorrhoeae (N. gonorrhoeae) occur in South Africa every year. Point-of-care diagnostic tests (POCT) may address existing STI control limitations such as overtreatment and missed cases. Subsequently, a rapid lateral flow assay with fluorescence-based detection (NG-LFA) with a prototype reader was developed for N. gonorrhoeae detection showing excellent performance and high usability; however, a better understanding is needed for device implementation and integration into clinics. METHODS A qualitative, time-series assessment using 66 in-depth interviews was conducted among 25 trained healthcare workers involved in the implementation of the NG-LFA. Findings were informed by the Normalization Process Theory (NPT) as per relevant contextual (strategic intentions, adaptive execution, and negotiation capacity) and procedural constructs (coherence, cognitive participation, collective action, reflexive monitoring) to examine device implementation within primary healthcare levels. Interviews were audio-recorded, transcribed, and then analyzed using a thematic approach guided by NPT to interpret results. RESULTS Overall, healthcare workers agreed that STI POCT could guide better STI clinical decision-making, with consideration for clinic integration such as space constraints, patient flow, and workload. Perceived NG-LFA benefits included enhanced patient receptivity and STI knowledge. Further, healthcare workers reflected on the suitability of the NG-LFA given current limitations with integrated primary care. Recommendations included sufficient STI education, and appropriate departments for first points of entry for STI screening. CONCLUSIONS The collective action and participation by healthcare workers in the implementation of the NG-LFA revealed adaptive execution within the current facility environment including team compositions, facility-staff receptivity, and STI management experiences. User experiences support future clinic service integration, highlighting the importance of further assessing patient-provider communication for STI care, organizational readiness, and identification of relevant departments for STI screening.
Collapse
Affiliation(s)
- Lindsey de Vos
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Joseph Daniels
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, United States of America.
| | - Avuyonke Gebengu
- Research Unit, Foundation for Professional Development, East London, South Africa
| | | | | | | | | | - Mandisa Mdingi
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Ranjana M S Gigi
- Research Unit, Foundation for Professional Development, East London, South Africa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Jeffrey D Klausner
- Keck School of Medicine, University of Southern California, Los Angeles, United States of America
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa.
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|