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Douglas S, Bovendeerd B, van Sonsbeek M, Manns M, Milling XP, Tyler K, Bala N, Satterthwaite T, Hovland RT, Amble I, Atzil-Slonim D, Barkham M, de Jong K, Kendrick T, Nordberg SS, Lutz W, Rubel JA, Skjulsvik T, Moltu C. A Clinical Leadership Lens on Implementing Progress Feedback in Three Countries: Development of a Multidimensional Qualitative Coding Scheme. Adm Policy Ment Health 2023:10.1007/s10488-023-01314-6. [PMID: 37917313 DOI: 10.1007/s10488-023-01314-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Progress feedback, also known as measurement-based care (MBC), is the routine collection of patient-reported measures to monitor treatment progress and inform clinical decision-making. Although a key ingredient to improving mental health care, sustained use of progress feedback is poor. Integration into everyday workflow is challenging, impacted by a complex interrelated set of factors across patient, clinician, organizational, and health system levels. This study describes the development of a qualitative coding scheme for progress feedback implementation that accounts for the dynamic nature of barriers and facilitators across multiple levels of use in mental health settings. Such a coding scheme may help promote a common language for researchers and implementers to better identify barriers that need to be addressed, as well as facilitators that could be supported in different settings and contexts. METHODS Clinical staff, managers, and leaders from two Dutch, three Norwegian, and four mental health organizations in the USA participated in semi-structured interviews on how intra- and extra-organizational characteristics interact to influence the use of progress feedback in clinical practice, supervision, and program improvement. Interviews were conducted in the local language, then translated to English prior to qualitative coding. RESULTS A team-based consensus coding approach was used to refine an a priori expert-informed and literature-based qualitative scheme to incorporate new understandings and constructs as they emerged. First, this hermeneutic approach resulted in a multi-level coding scheme with nine superordinate categories and 30 subcategories. Second-order axial coding established contextually sensitive categories for barriers and facilitators. CONCLUSIONS The primary outcome is an empirically derived multi-level qualitative coding scheme that can be used in progress feedback implementation research and development. It can be applied across contexts and settings, with expectations for ongoing refinement. Suggestions for future research and application in practice settings are provided. Supplementary materials include the coding scheme and a detailed playbook.
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Affiliation(s)
- Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA.
| | - Bram Bovendeerd
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
- Dimence, Center for Mental Health Care, Deventer, the Netherlands
| | | | - Mya Manns
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA
| | - Xavier Patrick Milling
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA
| | - Ke'Sean Tyler
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA
| | | | - Tim Satterthwaite
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA
| | - Runar Tengel Hovland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Research and Innovation, Førde Hospital Trust, Førde, Norway
| | - Ingunn Amble
- Villa Sana - Centre for Work Health, Modum Bad, Norway
| | | | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Kim de Jong
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Tony Kendrick
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Samuel S Nordberg
- Department of Behavioral Health, Reliant Medical Group, Worcester, MA, USA
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Julian A Rubel
- Department of Psychology, Psychotherapy Research Lab, Justus Liebig University Giessen, Giessen, Germany
| | | | - Christian Moltu
- District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
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Lin C, Rajalahti T, Mjøs SA, Kvalheim OM. Predictive associations between serum fatty acids and lipoproteins in healthy non-obese Norwegians: implications for cardiovascular health. Metabolomics 2016; 12:6. [PMID: 26568746 PMCID: PMC4639572 DOI: 10.1007/s11306-015-0886-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/01/2015] [Indexed: 01/29/2023]
Abstract
A battery of methods for multivariate data analysis has been used to assess the associations between concentrations of fatty acids (FAs) and lipoprotein subclasses and particle size in serum for a normolipidemic population of ethnic Norwegians living in the rural Fjord region. Significant gender differences were found in the lipoprotein and FA patterns. Predictive FA patterns were revealed for lipoprotein features of importance for cardiovascular (CV) health. Thus, the subclasses of atherogenic small and very small low density lipoprotein (LDL) particles and the same subclasses of high density lipoprotein (HDL) particles were associated with a pattern of saturated FAs and mono-unsaturated C16-C18 FAs. Eicosapentaenoic acid (EPA) and the ratio of EPA to arachidonic acid (AA) had strongest associations to features that promotes CV health: (i) large average size of HDL and LDL particles, and, (ii) small average size of very low density lipoprotein (VLDL) particles. Total concentration of HDL in both genders correlated to EPA, but docosahexaenoic acid (DHA) correlated just as strongly for women. For men, docosapentaenoic acid (DPA) showed stronger association to HDL concentration than EPA. For both genders, concentration of large LDL particles showed associations to levels of EPA, but stronger to DHA and DPA. High values of EPA/AA seem to be the strongest single biomarker for good CV health in both men and women.
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Affiliation(s)
- Chenchen Lin
- Department of Chemistry, University of Bergen, Bergen, Norway
- Fjordomics, Førde Hospital Trust, Førde, Norway
| | | | - Svein Are Mjøs
- Department of Chemistry, University of Bergen, Bergen, Norway
| | - Olav Martin Kvalheim
- Department of Chemistry, University of Bergen, Bergen, Norway
- Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway
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Rajalahti T, Lin C, Mjøs SA, Kvalheim OM. Changes in serum fatty acid and lipoprotein subclass concentrations from prepuberty to adulthood and during aging. Metabolomics 2016; 12:51. [PMID: 26900388 PMCID: PMC4744832 DOI: 10.1007/s11306-016-0968-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/10/2015] [Indexed: 01/26/2023]
Abstract
Concentrations in serum were determined for 18 fatty acids (FAs) and 21 lipoprotein main and subclasses by chromatographic analyses and the average size was calculated for very low density (VLDL), low density (LDL) and high density (HDL) particles. 283 ethnic Norwegian children and adults from the rural Fjord region of Western Norway were compared with the objectives to reveal patterns and gender differences during the development from prepuberty to adulthood and during aging in adults. Both genders showed a large increase in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from child to adult. Males, but not females, show a significant increase in most C16-C18 FAs from prepuberty to adulthood. These changes in males correlate to a pattern of increased concentrations of triglycerides, VLDL and LDL particles, especially the atherogenic subclasses of small and very small LDL particles. Furthermore, concentrations of medium, large and very large HDL particles decrease, while concentration of very small HDL particles increase leading to reduced average size of HDL particles. Females only showed significant increase in concentrations of small and very small LDL particles, very small HDL particles and apolipoprotein B. While EPA and DHA continued to increase during aging in women, no validated model for connecting age to FA profile was obtained for men. Women showed significant increase in concentrations of all subclasses of LDL particles during aging, while men exhibited a more complex pattern with increase also in apolipoprotein A1 and HDL particles.
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Affiliation(s)
| | - Chenchen Lin
- />Fjordomics, Førde Central Hospital, Førde, Norway
- />Department of Chemistry, University of Bergen, Bergen, Norway
| | - Svein Are Mjøs
- />Department of Chemistry, University of Bergen, Bergen, Norway
| | - Olav Martin Kvalheim
- />Department of Chemistry, University of Bergen, Bergen, Norway
- />Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway
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Rajalahti T, Lin C, Mjøs SA, Kvalheim OM. Serum fatty acid and lipoprotein subclass concentrations and their associations in prepubertal healthy Norwegian children. Metabolomics 2016; 12:81. [PMID: 27069443 PMCID: PMC4792365 DOI: 10.1007/s11306-016-1020-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/18/2016] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The lipid metabolism is one of the most important and complex processes in the body. Serum concentrations of 18 fatty acids (FAs) and 24 lipoprotein features, i.e. concentrations of lipoprotein main and subclasses and average particle size in main classes, in 195 ethnic Norwegian children from the rural Fjord region were quantified by chromatography. OBJECTIVES To assess gender differences in prepubertal children and reveal predictive FA patterns for lipoprotein features. METHODS Lipoprotein features were modelled from FA profiles using multivariate regression. RESULTS Contrary to observations for adults from the same region, gender differences in prepubertal children were generally small. However, higher concentrations of C16-C18 FAs for girls compared to boys correlated to higher concentrations of triglycerides (TG) and very low density lipoprotein (VLDL) particles and larger average size of VLDL particles. Concentrations of high density lipoprotein (HDL) and its subclass of medium particle size were higher in boys than in girls. These findings are opposite to observations in adults from the same region, but reflect that prepubertal boys are more physically active than girls. Furthermore, children possessed only half the serum levels of eicosapentaenoic acid and docosahexaenoic acid measured in adults. Since sampling was done after 12 h of fasting, these differences may reflect higher rate of utilization of these crucial FAs in children. CONCLUSION Good predictive models were obtained for TGs, VLDL and chylomicrons with C14-C18 FAs as major contributors. Weak predictive associations were observed for HDL and Apolipoprotein A1 (ApoA1) with C20-C24 FAs as contributors.
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Affiliation(s)
| | - Chenchen Lin
- Fjordomics, Førde Hospital Trust, Førde, Norway
- Department of Chemistry, University of Bergen, Bergen, Norway
| | - Svein Are Mjøs
- Department of Chemistry, University of Bergen, Bergen, Norway
| | - Olav Martin Kvalheim
- Department of Chemistry, University of Bergen, Bergen, Norway
- Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway
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