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Lam S, Hoffmann V, Bett B, Fèvre EM, Moodley A, Mohan CV, Meteo-Sagasta J, Nguyen-Viet H. Navigating One Health in research-for-development: Reflections on the design and implementation of the CGIAR Initiative on One Health. One Health 2024; 18:100710. [PMID: 38533195 PMCID: PMC10963858 DOI: 10.1016/j.onehlt.2024.100710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
Adopting One Health approaches is key for addressing interconnected health challenges. Yet, how to best put One Health into practice in research-for-development initiatives aiming to 'deliver impacts' remains unclear. Drawing on the CGIAR Initiative on One Health - a global initiative to address zoonotic diseases, antimicrobial resistance, and food and water safety - we reflect on challenges during program conception and implementation, prompting us to suggest improvements in multisectoral collaboration, coordination, and communication. Our approach involves conducting a researcher-centered process evaluation, comprising individual interviews that are subsequently thematically analyzed and synthesized. The key takeaway is that limited time for planning processes and short program timelines compared to envisioned development impacts may impede research-for-development efforts. Yet, collaborative work can be successful when adequate time and resources are allocated for planning with minimal disruption throughout implementation. Additionally, due to the multifaceted nature of One Health initiatives, it is important to pay attention to co-benefits and trade-offs, where taking action in one aspect may yield advantages and disadvantages in another, aiding to identify sustainable One Health development pathways. Forming close partnerships with national governments and local stakeholders is essential not only to promote sustainability but also to ensure local relevance, enhancing the potential for meaningful impact. Finally, regularly assessing progress toward development goals is critical as development stands as an overarching objective.
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Affiliation(s)
- Steven Lam
- International Livestock Research Institute, Nairobi, Kenya
| | - Vivian Hoffmann
- International Food and Policy Research Institute, Washington, United States
- Department of Economics and School of Public Policy and Administration, Carleton University, Ottawa, Canada
| | - Bernard Bett
- International Livestock Research Institute, Nairobi, Kenya
| | - Eric M. Fèvre
- International Livestock Research Institute, Nairobi, Kenya
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Arshnee Moodley
- International Livestock Research Institute, Nairobi, Kenya
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
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Morgan RM, Trejo C, Trager BM, Boyle SC, Koning IM, LaBrie JW. Process Evaluation and Investigation of Cultural Adaptations for an Online Parent-Based Intervention Using a Mixed-Method Approach. J Prev (2022) 2024:10.1007/s10935-024-00781-3. [PMID: 38678484 DOI: 10.1007/s10935-024-00781-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
Most alcohol intervention research focuses on program efficacy, yet few studies have investigated the acceptability of a program's design and implementation to the target population or adapting existing alcohol interventions to different populations. To address these gaps in the literature, we (1) examined participant responsiveness to and implementation quality of FITSTART+, a web-app delivered parent-based alcohol intervention designed for incoming first-year college students in the United States, and (2) gathered feedback on how this intervention could be adapted to other populations of parents. A sample of U.S. parents of 17-20-year-old first-year college students (N = 109) participated in FITSTART+ during their child's first year of college and completed a survey about parents' responsiveness to the app and its quality. Next, a sample of non-U.S. parents of adolescents aged 13 to 19 (N = 44) participated in one of 11 focus groups in which they briefly explored the app and then discussed how it could be adapted to be applicable and culturally relevant for them and their context. Results revealed that U.S. parents rated the intervention's quality as high and parents were responsive to the web-app's content, but some did not visit one of the most critical aspects of the intervention (i.e., alcohol-related parenting resources). Non-U.S. participants provided a range of suggestions for adapting the intervention to their context, which varied by culture. Results identify areas for improvement, particularly regarding the use of alcohol-related parenting resources, in this intervention and for web-delivered PBIs more broadly.
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Affiliation(s)
- Reed M Morgan
- Department of Psychology, Fordham University, New York, USA
- Department of Psychological Science, Loyola Marymount University, 1 LMU Drive Suite 4700, Los Angeles, CA, 90045, USA
| | - Constanza Trejo
- Psychology Department of Health and Student Welfare, Pontifical Catholic University of Chile, Santiago, Chile
| | - Bradley M Trager
- Department of Psychological Science, Loyola Marymount University, 1 LMU Drive Suite 4700, Los Angeles, CA, 90045, USA.
| | - Sarah C Boyle
- Department of Psychological Science, Loyola Marymount University, 1 LMU Drive Suite 4700, Los Angeles, CA, 90045, USA
| | - Ina M Koning
- Department of Clinical Child and Family Studies, VU University Amsterdam, Amsterdam, Netherlands
| | - Joseph W LaBrie
- Department of Psychological Science, Loyola Marymount University, 1 LMU Drive Suite 4700, Los Angeles, CA, 90045, USA
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Shahrzad S, Overbeck G, Holm A, Høj K, Hølmkjaer P. Factors promoting and impeding efforts to deprescribe antidepressants among nursing home residents with dementia- a process evaluation guided by normalization process theory. BMC Nurs 2024; 23:287. [PMID: 38679697 DOI: 10.1186/s12912-024-01932-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Despite recommendations against psychotropic medication in older nursing homes residents with behavioral and psychological symptoms of dementia (BPSD), antidepressants and other psychotropic drugs are still prescribed. We performed a cluster-randomized controlled trial to evaluate the effect of a complex intervention aiming to promote the deprescribing of antidepressants in institutionalized older persons with dementia. To understand the underlying mechanisms of trial outcomes, we conducted a process evaluation exploring the interventions implementation, areas of impact, and contextual factors. The aim of this study was to explore the implementation process and the key factors that promoted and inhibited intervention implementation in the care home setting (Clinicaltrials.gov: NCT04985305. Registered 30 July 2021). METHODS Qualitative interviews were conducted between August 2022 and February 2023 with four general practitioners and eight nursing home staff from four associated nursing homes in the Capital Region of Denmark. We coded the interview data according to the four constructs of the Normalization Process Theory (coherence, cognitive participation, collective action, and reflexive monitoring). RESULTS There was a common understanding of the intervention aim. We observed a raised awareness concerning the deprescription of antidepressants among healthcare professionals with good collaboration (coherence). An overall buy-in to a deprescribing mentality was seen (cognitive participation). There were barriers to the GPs and nursing home staff's use of the intervention elements and how they implemented it, but to some, a common language was created (collective action). Professionals overall valued the idea of deprescribing, but lack of time, high staff turnover, and low education level among nursing home staff hampered the integration (reflexive monitoring). CONCLUSION Successful implementation seemed to be dependent on the quality of the relationship between the single GP and the single nursing home professional. A common deprescribing mentality promoted the uptake of the intervention. However, several barriers related to lack of resources hindered implementation. It is imperative to adapt complex interventions to the available resources and context.
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Affiliation(s)
- Sinead Shahrzad
- Department of Public Health, University of Copenhagen, Section of General Practice and Research Unit for General Practice, Copenhagen, Denmark
| | - Gritt Overbeck
- Department of Public Health, University of Copenhagen, Section of General Practice and Research Unit for General Practice, Copenhagen, Denmark
| | - Anne Holm
- Department of Public Health, University of Copenhagen, Section of General Practice and Research Unit for General Practice, Copenhagen, Denmark
| | - Kirsten Høj
- Research Unit for General Practice, Aarhus, Denmark
| | - Pernille Hølmkjaer
- Department of Public Health, University of Copenhagen, Section of General Practice and Research Unit for General Practice, Copenhagen, Denmark.
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Rinne J, Leino-Kilpi H, Koskinen S, Saaranen T, Pasanen M, Vauhkonen A, Salminen L. An intervention to address nurse educators' occupational well-being: A process evaluation. Nurse Educ Today 2024; 138:106219. [PMID: 38636189 DOI: 10.1016/j.nedt.2024.106219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND There is a global need for more support for the occupational well-being of educators working in nurse education, where nurse educators experience challenges when managing their own occupational well-being. However, there is a lack of research studies into occupational well-being interventions. Aim To evaluate the usability and utility of the Self-Help INtervention for Educators in nurse education. DESIGN A process evaluation was conducted after the intervention in Spring 2022. SETTINGS Educational organisations providing national regulated practical nurse education in Finland. PARTICIPANTS Nurse educators (n = 37), completing the 8-workweek intervention. METHODS Data were collected with the self-reported electronic feedback questionnaire consisting of three sections: 1) 10-item System Usability Scale, 2) 7-item Utility scale developed for this study and 3) 4 open ended questions. The data were analysed statistically and with content analysis. RESULTS The intervention was found to be usable; especially the easy learnability and usage of the digital Smart Break-SHINE program and the applicable exercises. It was estimated to be moderately useful as a well-being and break promoter at work. The utility of the intervention to promote physical activity and recovery during working hours was statistically more positive for educators with <5 years of work experience than those with over 15 years. Usability and utility barriers were found especially regarding workload issues. CONCLUSIONS The Self-Help INtervention for Educators supports the occupational well-being of nurse educators and includes well-being actions suitable for different work surroundings (e.g., remote working) without the need for constant facilitating. The intervention was found to be most beneficial for early career nurse educators. The Self-Help INtervention for Educators needs more development to overcome the usability and utility barriers related to workload issues.
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Affiliation(s)
- Jenni Rinne
- Department of Nursing Science, University of Turku, 20014 Turun Yliopisto, Finland.
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, 20014 Turun Yliopisto, Finland; Turku University Hospital, Finland.
| | - Sanna Koskinen
- Department of Nursing Science, University of Turku, 20014 Turun Yliopisto, Finland.
| | - Terhi Saaranen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
| | - Miko Pasanen
- Department of Nursing Science, University of Turku, 20014 Turun Yliopisto, Finland.
| | - Anneli Vauhkonen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
| | - Leena Salminen
- Department of Nursing Science, University of Turku, 20014 Turun Yliopisto, Finland; Turku University Hospital, Finland.
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Wagenaar CA, Toonstra A, Walrabenstein W, van Schaardenburg D, van Nassau F. How the Plants for Joints multidisciplinary lifestyle intervention achieved its effects: a mixed methods process evaluation. BMC Public Health 2024; 24:1034. [PMID: 38615001 PMCID: PMC11016213 DOI: 10.1186/s12889-024-18554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Plants for Joints (PFJ) is a multidisciplinary intervention centered around a whole-food plant-based diet, physical activity, and sleep and stress management. The PFJ intervention successfully improved disease activity and symptoms in people with rheumatoid arthritis (RA) or osteoarthritis (OA), respectively, and metabolic health. To investigate how these effects were achieved a mixed methods process evaluation was conducted to understand the context, implementation, and mechanism of impact of the PFJ intervention. Also, the relationship between degree of implementation and lifestyle changes was explored. METHODS Quantitative and qualitative data were collected across the evaluation domains context (i.e. reach), implementation (i.e. recruitment and delivery), and mechanism of impact (i.e. responsiveness) of both the participants and coaches (incl. dietitians, sport coaches) according to the UK MRC guidelines for process evaluations. Data was collected from the participants via focus groups and questionnaires after the intervention, and interviews with coaches. Qualitative data were analyzed thematically, and quantitative data were assessed with descriptive statistics and linear regression analyses. Degree of implementation was quantified using a theory-driven implementation index score composed of different process evaluation constructs. RESULTS Of the 155 participants who participated in the PFJ intervention, 106 (68%) took part in the questionnaire and 34 (22%) attended a focus group. Participants felt the intervention was complete, coherent, and would recommend the intervention to others (mean score 9.2 (SD 1.4) out of 10). Participants felt heard and empowered to take control of their lifestyle and health outcomes. Components perceived as most useful were self-monitoring, social support, practical and theoretical information, and (individual) guidance by the multidisciplinary team. Participants perceived the intervention as feasible, and many indicated it effectively improved their health outcomes. In an explorative analysis there was no significant difference in healthy lifestyle changes across implementation index score groups. CONCLUSION This process evaluation offers important insights into why the PFJ intervention works and how the intervention can be optimized for future implementation. Results indicating the intervention's high satisfaction, feasibility, and perceived effectiveness, further support the use of plant-based lifestyle interventions as an additional treatment option for patients with RA, OA, or other chronic diseases. TRIAL REGISTRATION International Clinical Trial Registry Platform numbers: NL7800, NL7801, and NL7802, all registered 17-06-2019.
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Affiliation(s)
- Carlijn A Wagenaar
- Reade Center for Rheumtology and Rehabilitation, Amsterdam, The Netherlands.
- Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, Universiteit van Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.
| | - Alie Toonstra
- Reade Center for Rheumtology and Rehabilitation, Amsterdam, The Netherlands
| | | | - Dirkjan van Schaardenburg
- Reade Center for Rheumtology and Rehabilitation, Amsterdam, The Netherlands
- Department of Clinical Immunology and Rheumatology, Amsterdam University Medical Centers, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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McNaught E, Reale S, Bourke L, Brown JE, Collinson M, Day F, Hewison J, Farrin AJ, Ibeggazene S, Innes AQ, Mason E, Meads D, Scope A, Taylor C, Taylor SJ, Turner RR, Rosario DJ. Supported exercise TrAining for Men wIth prostate caNcer on Androgen deprivation therapy (STAMINA): study protocol for a randomised controlled trial of the clinical and cost-effectiveness of the STAMINA lifestyle intervention compared with optimised usual care, including internal pilot and parallel process evaluation. Trials 2024; 25:257. [PMID: 38610058 PMCID: PMC11010375 DOI: 10.1186/s13063-024-07989-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND UK national clinical guidance recommends that men with prostate cancer on androgen deprivation therapy are offered twice weekly supervised aerobic and resistance exercise to address iatrogenic harm caused by treatment. Very few NHS trusts have established adequate provision of such services. Furthermore, interventions fail to demonstrate sustained behaviour change. The STAMINA lifestyle intervention offers a system-level change to clinical care delivery addressing barriers to long-term behaviour change and implementation of new prostate cancer care pathways. This trial aims to establish whether STAMINA is clinically and cost-effective in improving cancer-specific quality of life and/or reducing fatigue compared to optimised usual care. The process evaluation aims to inform the interpretation of results and, if the intervention is shown to benefit patients, to inform the implementation of the intervention into the NHS. METHODS Men with prostate cancer on androgen deprivation therapy (n = 697) will be identified from a minimum of 12 UK NHS trusts to participate in a multi-centre, two-arm, individually randomised controlled trial. Consenting men will have a 'safety to exercise' check and be randomly allocated (5:4) to the STAMINA lifestyle intervention (n = 384) or optimised usual care (n = 313). Outcomes will be collected at baseline, 3-, 6- and 12-month post-randomisation. The two primary outcomes are cancer-specific quality of life and fatigue. The parallel process evaluation will follow a mixed-methods approach to explore recruitment and aspects of the intervention including, reach, fidelity, acceptability, and implementation. An economic evaluation will estimate the cost-effectiveness of the STAMINA lifestyle intervention versus optimised usual care and a discrete choice experiment will explore patient preferences. DISCUSSION The STAMINA lifestyle intervention has the potential to improve quality of life and reduce fatigue in men on androgen deprivation therapy for prostate cancer. Embedding supervised exercise into prostate cancer care may also support long-term positive behaviour change and reduce adverse events caused by treatment. Findings will inform future clinical care and could provide a blueprint for the integration of supervised exercise and behavioural support into other cancer and/or clinical services. TRIAL REGISTRATION ISRCTN 46385239, registered on 30/07/2020. Cancer Research UK 17002, retrospectively registered on 24/08/2022.
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Affiliation(s)
- Emma McNaught
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Sophie Reale
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Liam Bourke
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Janet E Brown
- Division of Clinical Medicine, University of Sheffield, Sheffield, S10 2RX, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Florence Day
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jenny Hewison
- Division of Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Saïd Ibeggazene
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Aidan Q Innes
- Nuffield Health, 2 Ashley Avenue, Epsom, Surrey, KT18 5AL, UK
| | - Ellen Mason
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Alison Scope
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Chris Taylor
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Steph Jc Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Rebecca R Turner
- Division of Psychology and Mental Health in the School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Derek J Rosario
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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Van den Wyngaert I, Van Pottelbergh G, Coteur K, Vaes B, Van den Bulck S. Developing a questionnaire to evaluate an automated audit & feedback intervention: a Rand-modified Delphi method. BMC Health Serv Res 2024; 24:433. [PMID: 38581009 PMCID: PMC10998400 DOI: 10.1186/s12913-024-10915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Audit and feedback (A&F) is a widely used implementation strategy to evaluate and improve medical practice. The optimal design of an A&F system is uncertain and structured process evaluations are currently lacking. This study aimed to develop and validate a questionnaire to evaluate the use of automated A&F systems. METHODS Based on the Clinical Performance Feedback Intervention Theory (CP-FIT) and the REFLECT-52 (REassessing audit & Feedback interventions: a tooL for Evaluating Compliance with suggested besT practices) evaluation tool a questionnaire was designed for the purpose of evaluating automated A&F systems. A Rand-modified Delphi method was used to develop the process evaluation and obtain validation. Fourteen experts from different domains in primary care consented to participate and individually scored the questions on a 9-point Likert scale. Afterwards, the questions were discussed in a consensus meeting. After approval, the final questionnaire was compiled. RESULTS A 34-question questionnaire composed of 57 items was developed and presented to the expert panel. The consensus meeting resulted in a selection of 31 questions, subdivided into 43 items. A final list of 30 questions consisting of 42 items was obtained. CONCLUSION A questionnaire consisting of 30 questions was drawn up for the assessment and improvement of automated A&F systems, based on CP-FIT and REFLECT-52 theory and approved by experts. Next steps will be piloting and implementation of the questionnaire.
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Affiliation(s)
- Ine Van den Wyngaert
- Academic Centre for General Practice, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
| | - Gijs Van Pottelbergh
- Academic Centre for General Practice, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Kristien Coteur
- Academic Centre for General Practice, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Bert Vaes
- Academic Centre for General Practice, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Steve Van den Bulck
- Academic Centre for General Practice, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
- Research Group Healthcare and Ethics, Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
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Akerstrom M, Severin J, Miech EJ, Wikström E, Roczniewska M. Reducing sickness absence among public-sector healthcare employees: the difference-making roles of managerial and employee participation. Int Arch Occup Environ Health 2024; 97:341-351. [PMID: 38409534 PMCID: PMC10944807 DOI: 10.1007/s00420-024-02048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Evaluations of organizational-level interventions to prevent work-related illness have identified enabling factors, but knowledge of necessary and sufficient conditions for intervention success is needed. The aim was to identify difference-making factors that distinguish intervention groups with and without a positive intervention effect on sickness absence. METHODS An organizational-level intervention designed to decrease sickness absence by providing support from process facilitators was implemented at eight healthcare workplaces in Sweden between 2017 and 2018. We applied coincidence analysis (CNA) to analyze 34 factors and determine which factors were necessary and sufficient for a successful implementation of tailored interventional measures on an organizational level (dichotomous) and reduced sickness absence (trichotomous). RESULTS Two factors perfectly explained both the presence and absence of a successful implementation: "a high sense of urgency" and "good anchoring and participation from the strategic management". The presence of either of these factors alone was sufficient for successful implementation, whereas the joint absence of both conditions was necessary and sufficient for the absence of successful implementation and an intervention effect. In addition, high employee participation was both necessary and sufficient for a high intervention effect. For organizations without high employee participation, successful implementation led to a medium-effect size. CONCLUSIONS This study identified participation as a difference-maker in the implementation process. Participation from different stakeholders turned out to be important in different phases. When implementing organizational-level interventions, high participation from both strategic management and employees appears to be crucial in terms of the intervention's effect on sickness absence.
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Affiliation(s)
- M Akerstrom
- Region Västra Götaland, Institute of Stress Medicine, Carl Skottbergs Gata 22B, 413 19, Gothenburg, Sweden.
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - J Severin
- Region Västra Götaland, Institute of Stress Medicine, Carl Skottbergs Gata 22B, 413 19, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - E J Miech
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
| | - E Wikström
- Department of Business Administration, School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden
| | - M Roczniewska
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Institute of Psychology, SWPS University, Sopot, Poland
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Rauwenhoff JCC, Bol Y, Peeters F, van Heugten CM. Acceptance and Commitment Therapy is feasible for people with acquired brain injury: A process evaluation of the BrainACT treatment. Clin Rehabil 2024; 38:530-542. [PMID: 38099720 PMCID: PMC10898201 DOI: 10.1177/02692155231218813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/20/2023] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To evaluate the feasibility of Acceptance and Commitment Therapy for people with acquired brain injury. DESIGN A process evaluation of the BrainACT treatment was conducted alongside a randomised controlled trial. SETTING Psychology departments of hospitals and rehabilitation centres. SUBJECTS Tweny-seven participants with acquired brain injury and 11 therapists. INTERVENTION BrainACT is an Acceptance and Commitment Therapy adapted for the needs and possible cognitive deficits of people with acquired brain injury, provided in eight one-hour face-to-face or video-conference sessions. MEASUREMENTS The attendance and compliance rates, engagement, satisfaction, and perceived barriers and facilitators for delivery in clinical practice were investigated using semi-structured interviews with participants and therapists and therapy logs. RESULTS 212 of the 216 sessions in total were attended and 534 of the 715 protocol elements across participants and sessions were delivered. Participants were motivated and engaged. Participants and therapists were satisfied with the intervention and participants reported to have implemented skills in their daily routines acquired during therapy. Key strengths are the structure provided with the bus of life metaphor, the experiential nature of the intervention, and the materials and homework. Participants and therapists often preferred face-to-face sessions, however, when needed video-conferencing is a good alternative. CONCLUSION BrainACT is a feasible intervention for people with anxiety and depressive symptoms following acquired brain injury. However, when the content of the intervention is too extensive, we recommend adding two extra sessions.
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Affiliation(s)
- Johanne CC Rauwenhoff
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- School for Mental Health and Neuroscience,
Department of Neuropsychology and Psychopharmacology, Limburg Brain Injury Centre, Maastricht, the
Netherlands
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yvonne Bol
- Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands
| | - Frenk Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- School for Mental Health and Neuroscience,
Department of Neuropsychology and Psychopharmacology, Limburg Brain Injury Centre, Maastricht, the
Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Sten-Gahmberg S, Pedersen K, Harsheim IG, Løyland HI, Abelsen B. Experiences with telemedicine-based follow-up of chronic conditions: the views of patients and health personnel enrolled in a pragmatic randomized controlled trial. BMC Health Serv Res 2024; 24:341. [PMID: 38486179 PMCID: PMC10941467 DOI: 10.1186/s12913-024-10732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Telemedicine is often promoted as a possible solution to some of the challenges healthcare systems in many countries face, and an increasing number of studies evaluate the clinical effects. So far, the studies show varying results. Less attention has been paid to systemic factors, such as the context, implementation, and mechanisms of these interventions. METHODS This study evaluates the experiences of patients and health personnel enrolled in a pragmatic randomized controlled trial comparing telemedicine-based follow-up of chronic conditions with usual care. Patients in the intervention group received an individual treatment plan together with computer tablets and home telemonitoring devices to report point-of-care measurements, e.g., blood pressure, blood glucose or oxygen saturation, and to respond to health related questions reported to a follow-up service. In response to abnormal measurement results, a follow-up service nurse would contact the patient and consider relevant actions. We conducted 49 interviews with patients and 77 interviews with health personnel and managers at the local centers. The interview data were analyzed using thematic analysis and based on recommendations for conducting process evaluation, considering three core aspects within the process of delivering a complex intervention: (1) context, (2) implementation, and (3) mechanisms of impact. RESULTS Patients were mainly satisfied with the telemedicine-based service, and experienced increased safety and understanding of their symptoms and illness. Implementation of the service does, however, require dedicated resources over time. Slow adjustment of other healthcare providers may have contributed to the absence of reductions in the use of specialized healthcare and general practitioner (GP) services. An evident advantage of the service is its flexibility, yet this may also challenge cost-efficiency of the intervention. CONCLUSIONS The implementation of a telemedicine-based service in primary healthcare is a complex process that is sensitive to contextual factors and that requires time and dedicated resources to ensure successful implementation. TRIAL REGISTRATION The trial was registered in www. CLINICALTRIALS gov (NCT04142710). Study start: 2019-02-09, Study completion: 2021-06-30, Study type: Interventional, Intervention/treatment: Telemedicine tablet and tools to perform measurements. Informed and documented consent was obtained from all subjects and next of kin participating in the study.
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Affiliation(s)
- Susanna Sten-Gahmberg
- Oslo Economics, Klingenberggata 7, Oslo, 0161, Norway.
- The Finnish Centre for Pensions, Eläketurvakeskus, FI-00065, Finland.
| | - Kine Pedersen
- Oslo Economics, Klingenberggata 7, Oslo, 0161, Norway
- Department of Health Management and Health Economics, University of Oslo, Postboks 1089, Blindern, Oslo, 0317, Norway
| | | | | | - Birgit Abelsen
- Department of Community Health, UiT - The Arctic University of Norway, Tromsø, 9037, Norway
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11
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Portegijs S, van Beek APA, van Tuyl LHD, Wagner C. Implementing a new living concept for persons with dementia in long-term care: evaluation of a quality improvement process. BMC Health Serv Res 2024; 24:306. [PMID: 38454437 PMCID: PMC10921681 DOI: 10.1186/s12913-024-10765-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Improving quality of nursing home care for residents is a constant focus of stakeholders involved within quality improvement projects. Though, achieving change in long-term care is challenging. Process evaluations provide insight into the nature, exposure and experiences of stakeholders and influencing mechanisms for implementation. The aim of this study is to gain insight into the process and facilitating and hindering mechanisms of implementing a quality improvement project that seeks to create a dementia-friendly community with a nursing home at its core. METHODS For the process evaluation we planned a case study design with an ethnographic approach. Various research methods were used: qualitative observations, focus groups, interviews and questionnaires for various stakeholders and document review. Data collection and analyses in this study is based on the Consolidated Framework for Implementation Research. RESULTS Four main lessons were learned. Firstly, nursing staff are crucial to achieve more freedom for residents. Secondly, high-impact changes in daily care need strong and sustainable focus from the care organisation. Thirdly, dementia-friendly societies should be deployed from multiple actors, which entails long-term collaborations with external stakeholders. Fourthly, the transition to a dementia-friendly society requires meeting spaces for and a focus on both residents and people from the community. Consequently, local residents are shifting from external to internal stakeholders, extending beyond the regular involvement of informal carers and volunteers within the nursing home. CONCLUSIONS Nursing homes are part of the local community and provide opportunities to collaborate on a dementia-friendly society. However, the change that is required (promoting freedom, residents' autonomy and the redesign of care processes) is complex and influenced by various mechanisms. Understanding these mechanisms can benefit other care organisations that strive to implement a similar initiative.
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Affiliation(s)
- Suzanne Portegijs
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3513 CR, Utrecht, The Netherlands.
- Viva! Zorggroep, Care Organisation, Parlevinkerstraat 23, 1951 AR, Velsen-Noord, The Netherlands.
| | | | | | - Cordula Wagner
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3513 CR, Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute (APH), Amsterdam UMC, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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12
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Kleffelgård I, Forslund M, Hauger S, Røe C, Bragstad LK, Søberg HL, Løvstad M, Borgen IMH. Process evaluation of a complex intervention evaluating the effectiveness of home-based rehabilitation in the chronic phase of traumatic brain injury. Disabil Rehabil 2024:1-9. [PMID: 38445314 DOI: 10.1080/09638288.2024.2324119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To perform a process evaluation of a randomized controlled trial (RCT) evaluating a manualized intervention aiming to ameliorate long-term symptoms of traumatic brain injury (TBI) by assessing implementation fidelity, delivery context and acceptability of the intervention. METHODS Data from 60 participants were collected during recruitment, intervention delivery and outcome data collection in the RCT. Enrollment records, logs and checklists documented the delivery of the intervention (implementation fidelity) and the collaboration with family members and outside collaborators (delivery context). Attendance-rate, self-reported acceptability and willingness to participate in future studies were used to assess the acceptability of the intervention. RESULTS The main elements and dose of the intervention were delivered as intended with an excellent adherence to the manual items. Family members co-participated in the intervention for 39 (65%) of the participants. Outside collaborators were contacted for 32 (53%) of the participants. Acceptability scores were high for participants, family members and therapists. CONCLUSIONS The intervention was successfully delivered with high acceptability. This process evaluation informs researchers, clinicians and stakeholders about important factors influencing the outcomes of the intervention that should be considered in clinical implementation of rehabilitation interventions. TRIAL REGISTRATION Pre-registered 4th of June 2018 at clinicaltrials.gov (NCT03545594).
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Affiliation(s)
- Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marit Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Solveig Hauger
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Line K Bragstad
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Helene L Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Marianne Løvstad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Ida M H Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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13
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Soepnel LM, Mabetha K, Norris SA, Motlhatlhedi M, Nkosi N, Klingberg S, Lye S, Draper CE. The role of a community health worker-delivered preconception and pregnancy intervention in achieving a more positive pregnancy experience: the Bukhali trial in Soweto, South Africa. BMC Womens Health 2024; 24:161. [PMID: 38443924 PMCID: PMC10916028 DOI: 10.1186/s12905-024-02982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND A patient-centered, human-rights based approach to maternal care moves past merely reducing maternal mortality and morbidity, towards achieving a positive pregnancy experience. When evaluating an intervention, particularly in the context of the complex challenges facing maternal care in South Africa, it is therefore important to understand how intervention components are experienced by women. We aimed to qualitatively explore (i) factors influencing the pregnancy and postpartum experience amongst young women in Soweto, South Africa, and (ii) the influence of Bukhali, a preconception, pregnancy, and early childhood intervention delivered by community health workers (CHWs), on these experiences. METHODS Semi-structured, in-depth interviews were conducted with 15 purposively sampled participants. Participants were 18-28-year-old women who (i) were enrolled in the intervention arm of the Bukhali randomized controlled trial; (ii) were pregnant and delivered a child while being enrolled in the trial; and (iii) had at least one previous pregnancy prior to participation in the trial. Thematic analysis, informed by the positive pregnancy experiences framework and drawing on a codebook analysis approach, was used. RESULTS The themes influencing participants' pregnancy experiences (aim 1) were participants' feelings about being pregnant, the responsibilities of motherhood, physical and mental health challenges, unstable social support and traumatic experiences, and the pressures of socioeconomic circumstances. In terms of how support, information, and care practices influenced these factors (aim 2), four themes were generated: acceptance and mother/child bonding, growing and adapting in their role as mothers, receiving tools for their health, and having ways to cope in difficult circumstances. These processes were found to be complementary and closely linked to participant context and needs. CONCLUSION Our findings suggest that, among women aged 18-28, a CHW-delivered intervention combining support, information, and care practices has the potential to positively influence women's pregnancy experience in South Africa. In particular, emotional support and relevant information were key to better meeting participant needs. These findings can help define critical elements of CHW roles in maternal care and highlight the importance of patient-centred solutions to challenges within antenatal care. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR201903750173871, 27/03/2019.
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Affiliation(s)
- Larske M Soepnel
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Khuthala Mabetha
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, UK
| | - Molebogeng Motlhatlhedi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Nokuthula Nkosi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Lye
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Department of Obstetrics and Gynecology, Department of Physiology and Medicine, University of Toronto, Toronto, ON, Canada
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Karpouzis F, Lindberg R, Walsh A, Shah S, Abbott G, Ball K. Impact and process evaluation of a primary-school Food Education and Sustainability Training (FEAST) program in 10-12-year-old children in Australia: pragmatic cluster non-randomized controlled trial. BMC Public Health 2024; 24:657. [PMID: 38429629 PMCID: PMC10905805 DOI: 10.1186/s12889-024-18079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Environmentally sustainable food initiatives accompanying nutrition education, such as the Food Education and Sustainability Training (FEAST) program, have gained traction in school settings. The aim of this trial was to conduct an impact and process evaluation of FEAST, to evaluate its effect on children's fruit and vegetable (F&V) intakes, and secondary outcomes: F&V variety consumed, nutrition knowledge, food preparation/cooking skills, self-efficacy and behaviours, food waste knowledge and behaviours, and food production knowledge. METHODS FEAST was a 10-week curriculum-aligned program, designed to educate children about healthy eating, food waste, and sustainability, while teaching cooking skills. It was implemented by classroom teachers, face-to-face and online, during COVID-19 school closures, in Australia in 2021. A custom designed survey was used to collect baseline and post-intervention data from students. Generalised linear mixed models (GLMM) estimated group differences in pre-post changes for primary and secondary outcomes. Surveys were also administered to students and teachers to evaluate intervention implementation. RESULTS Twenty schools participated and self-selected to be either intervention schools (n = 10) or wait-list control (WLC) schools (n = 10). A total of 977, 5th and 6th grade children participated in the trial with a mean age of 11.1 years (SD ± 0.7). The FEAST intervention, compared to WLC, did not result in significant increases in primary outcomes nor secondary outcomes. The process evaluation revealed FEAST was well-received by students and teachers, but COVID-19 school closures hindered implementation fidelity with a less intense program delivered under the constraints of pandemic lockdowns. CONCLUSIONS This is the first cluster non-randomized controlled trial designed to independently evaluate FEAST in the primary-school setting. No evidence was found for improved F&V intakes in children, nor secondary outcomes. However, the positive process evaluation results suggest that further trials of the program are warranted. If implemented as originally designed (pre-pandemic), with increased duration and complemented by supporting school policies, such programs have the potential to improve children's daily F&V intakes, cooking skills and food waste behaviours. This would support the Australian curriculum and contribute to: health promotion within schools and sustainable schools initiatives, the national agenda to reduce food waste and sustainable development goals. AUSTRALIAN AND NEW ZEALAND CLINICAL TRIALS REGISTRY: [ACTRN12620001347954]- Registered prospectively on 14/12/2020.
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Affiliation(s)
- F Karpouzis
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia.
- , Rose Bay Nth, Australia, PO Box 2108, NSW, 2030.
| | - R Lindberg
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - A Walsh
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - S Shah
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - G Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - K Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
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Vidor M, Raguenes C, Astier H, Gbaguidi G, Le Tohic S. [Optimizing the use-by date of reusable medical devices. Experience in a healthcare establishment]. Ann Pharm Fr 2024; 82:292-305. [PMID: 38135038 DOI: 10.1016/j.pharma.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Sterilized reusable medical devices have a use-by date, after which sterility is no longer guaranteed. There is currently no consensus on how this should be determined. The aim is to re-evaluate the expiry date of reusable medical devices, by means of a risk analysis and an assessment of the maintenance of the sterile state of reusable medical devices over time. METHODS The risk analysis focused on the stages whose malfunction could compromise the sterility of reusable medical devices over time: packaging, transport and storage. Risk mapping was carried out in accordance with the methodology recommended by the French Health Authority. Based on standard NF EN ISO 11737, the assessment of the maintenance of the sterile state was checked on reusable medical devices after two, four and six months storage and on reusable medical devices that had expired more than a year previously. RESULTS The risk analysis identified four failures and sixty-eight potential causes. The most sensitive stage was storage, which accounted for most of the critical and major causes. Improvement actions were proposed, such as the definition of a container maintenance plan. At the same time, 256 reusable medical devices were tested. The cultures remained sterile for all the containers, for folded products tested at 6 months and more and for the sachets tested at 2 and 4 months and at more than one year of storage. CONCLUSIONS The DLU has been extended to 4 months for sachets, 6 months for folded products and maintained at six months for containers.
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Affiliation(s)
- Manon Vidor
- Service de pharmacie hospitalière, hôpital d'instruction des Armées Laveran, 34, boulevard Laveran, 13013 Marseille, France.
| | - Christelle Raguenes
- Service de pharmacie hospitalière, hôpital d'instruction des Armées Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Hélène Astier
- Service de pharmacie hospitalière, hôpital d'instruction des Armées Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Gilles Gbaguidi
- Service de pharmacie hospitalière, hôpital d'instruction des Armées Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Sarah Le Tohic
- Service de pharmacie hospitalière, hôpital d'instruction des Armées Laveran, 34, boulevard Laveran, 13013 Marseille, France
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Arije O, Titus R, Omisile I, Dadi A, Garba D, Godpower O, Anyanti J, Idogho O, Okeke E, Roebersen C, Vrolings E, Onayade A. Process evaluation of the 'Lafiyan Yara' project on enhancing access to HIV testing services using existing community structures in Nigeria. BMC Public Health 2024; 24:624. [PMID: 38413881 PMCID: PMC10898007 DOI: 10.1186/s12889-024-18045-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The Lafiyan Yara Project aimed to increase demand for HIV counselling, testing, treatment, and prevention services among pregnant women and children in Taraba State, Nigeria. Implemented from 2019 to 2021, the project utilized existing community structures, including traditional birth attendants, village health workers, and patent and proprietary medicine vendors, for mobilization. This study assessed the project's activities, contributors, relevance, effectiveness, and efficiency. METHODS The process evaluation was conducted using focus group discussions and key informant interviews with beneficiaries, community leaders, project staff, health facility personnel, and government officials. Data analysis employed framework analysis. RESULTS The Lafiyan Yara project was reported to have achieved notable successes, including increased HIV testing rates among children and pregnant women, improved linkage to care services, reduced mother-to-child transmission of HIV, increased HIV/AIDS awareness and knowledge, and enhanced community engagement and support. Challenges identified included insufficient funding for community mobilizers, training needs for health workers, and inadequate availability of test kits at health facilities. Confidentiality and stigma issues arose during community mobilizations. A key lesson learned was the importance of a comprehensive HIV care approach, emphasizing testing and ensuring support for individuals testing positive. CONCLUSIONS The project's approach of leveraging community structures to create demand for HIV services among women and children proved effective, provided proper linkage to care for those testing positive. Addressing stigma and involving husbands/fathers in the community approach are crucial for improving outcomes. TRIAL REGISTRATION IPHOAU/12/1384.
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Affiliation(s)
- Olujide Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Rachel Titus
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Idowu Omisile
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Aisha Dadi
- Society For Family Health, Abuja Nigeria Public Health, Abuja, Nigeria
| | - Danjuma Garba
- Taraba AIDS Control Agency, Jalingo Taraba State, Jalingo, Nigeria
| | - Omoregie Godpower
- Society For Family Health, Abuja Nigeria Public Health, Abuja, Nigeria
| | - Jennifer Anyanti
- Society For Family Health, Abuja Nigeria Public Health, Abuja, Nigeria
| | - Omokhudu Idogho
- Society For Family Health, Abuja Nigeria Public Health, Abuja, Nigeria
| | - Emeka Okeke
- Society For Family Health, Abuja Nigeria Public Health, Abuja, Nigeria
| | | | | | - Adedeji Onayade
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Randell E, McNamara R, Busse M, Delport S, Williams-Thomas R, Maboshe W, Gillespie D, Milosevic S, Brookes-Howell L, Wright M, Hastings RP, McKigney AM, Glarou E, Ahuja A. Exploring critical intervention features and trial processes in the evaluation of sensory integration therapy for autistic children. Trials 2024; 25:131. [PMID: 38368387 PMCID: PMC10873975 DOI: 10.1186/s13063-024-07957-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/30/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND We evaluated the clinical and cost-effectiveness of manualised sensory integration therapy (SIT) for autistic children with sensory processing difficulties in a two-arm randomised controlled trial. Trial processes and contextual factors which may have affected intervention outcomes were explored within a nested process evaluation. This paper details the process evaluation methods and results. We also discuss implications for evaluation of individual level, tailored interventions in similar populations. METHODS The process evaluation was conducted in line with Medical Research Council guidance. Recruitment, demographics, retention, adherence, and adverse effects are reported using descriptive statistics. Fidelity of intervention delivery is reported according to the intervention scoring manual. Qualitative interviews with therapists and carers were undertaken to explore the acceptability of the intervention and trial processes. Qualitative interviews with carers explored potential contamination. RESULTS Recruitment, reach and retention within the trial met expected thresholds. One hundred thirty-eight children and carers were recruited (92% of those screened and 53.5% of those who expressed an interest) with 77.5% retained at 6 months and 69.9% at 12 months post-randomisation. The intervention was delivered with structural and process fidelity with the majority (78.3%) receiving a 'sufficient dose' of intervention. However, there was considerable individual variability in the receipt of sessions. Carers and therapists reported that trial processes were generally acceptable though logistical challenges such as appointment times, travel and COVID restrictions were frequent barriers to receiving the intervention. No adverse effects were reported. CONCLUSIONS The process evaluation was highly valuable in identifying contextual factors that could impact the effectiveness of this individualised intervention. Rigorous evaluations of interventions for autistic children are important, especially given the limitations such as limited sample sizes and short-term follow-up as faced by previous research. One of the challenges lies in the variability of outcomes considered important by caregivers, as each autistic child faces unique challenges. It is crucial to consider the role of parents or other caregivers in facilitating access to these interventions and how this may impact effectiveness. TRIAL REGISTRATION This trial is registered as ISRCTN14716440. August 11, 2016.
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Affiliation(s)
| | | | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | | | | | | | | | - Melissa Wright
- School of Medicine, Cardiff University, Ty Dewi Sant, Heath Park, Cardiff, UK
| | - Richard P Hastings
- Centre for Educational Development, Appraisal, and Research (CEDAR), University of Warwick, Coventry, UK
| | | | - Eleni Glarou
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Alka Ahuja
- Aneurin Bevan University Health Board, Newport, UK
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18
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Ratter J, Wiertsema S, Ettahiri I, Mulder R, Grootjes A, Kee J, Donker M, Geleijn E, de Groot V, Ostelo RWJG, Bloemers FW, van Dongen JM. Barriers and facilitators associated with the upscaling of the Transmural Trauma Care Model: a qualitative study. BMC Health Serv Res 2024; 24:195. [PMID: 38350997 PMCID: PMC10865621 DOI: 10.1186/s12913-024-10643-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND To assess the barriers and facilitators associated with upscaling the Transmural Trauma Care Model (TTCM), a multidisciplinary and patient-centred transmural rehabilitation care model. METHODS Semi-structured interviews were conducted with eight trauma surgeons, eight hospital-based physiotherapists, eight trauma patients, and eight primary care physiotherapists who were part of a trauma rehabilitation network. Audio recordings of the interviews were made and transcribed verbatim. Data were analysed using a framework method based on the "constellation approach". Identified barriers and facilitators were grouped into categories related to structure, culture, and practice. RESULTS Various barriers and facilitators to upscaling were identified. Under structure, barriers and facilitators belonged to one of five themes: "financial structure", "communication structure", "physical structures and resources", "rules and regulations", and "organisation of the network". Under culture, the five themes were "commitment", "job satisfaction", "acting as a team", "quality and efficiency of care", and "patients' experience". Under practice, the two themes were "practical issues at the outpatient clinic" and "knowledge gained". CONCLUSION The success of upscaling the TTCM differed across hospitals and settings. The most important prerequisites for successfully upscaling the TTCM were adequate financial support and presence of "key actors" within an organisation who felt a sense of urgency for change and/or expected the intervention to increase their job satisfaction. TRIAL REGISTRATION NL8163 The Netherlands National Trial Register, date of registration 16-11-2019.
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Affiliation(s)
- Julia Ratter
- Amsterdam UMC, location AMC, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Suzanne Wiertsema
- Amsterdam UMC, location AMC, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ilham Ettahiri
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Robin Mulder
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Anne Grootjes
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Julia Kee
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Marianne Donker
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Edwin Geleijn
- Amsterdam UMC, location VUmc, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Vincent de Groot
- Amsterdam UMC, location VUmc, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Epidemiology and Data Science, location VUmc, Amsterdam Movement Sciences, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Amsterdam UMC, location AMC, Department of Trauma Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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McKenzie BL, Mustapha FI, Battumur BE, Batsaikhan E, Chandran A, Michael V, Webster J, Trieu K. Strengthening national salt reduction strategies using multiple methods process evaluations: case studies from Malaysia and Mongolia. Public Health Nutr 2024; 27:e89. [PMID: 38343162 DOI: 10.1017/s1368980023002781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To understand the extent to which national salt reduction strategies in Malaysia and Mongolia were implemented and achieving their intended outcomes. DESIGN Multiple methods process evaluations conducted at the mid-point of strategy implementation, guided by theoretical frameworks. SETTING Malaysia (2018-2019) and Mongolia (2020-2021). PARTICIPANTS Desk-based reviews of related documents, interviews with key stakeholders (n 12 Malaysia, n 10 Mongolia), focus group discussions with health professionals in Malaysia (n 43) and health provider surveys in Mongolia (n 12). RESULTS Both countries generated high-quality local evidence about salt intake and levels in foods and culturally specific education resources. In Malaysia, education and reformulation activities were delivered with moderate dose (quantity) but reach among the population was low. Within 5 years, Mongolia implemented education among schools, health professionals and food producers on salt reduction with high reach, but with moderate dose (quantity) and reach among the general population. Both countries faced challenges in implementing legislative interventions (mandatory salt labelling and salt limits in packaged foods) and both could improve the scaling up of their reformulation and education activities. CONCLUSIONS In the first half of Malaysia's and Mongolia's strategies, both countries generated necessary evidence and education materials, mobilised health professionals to deliver salt reduction education and achieved small-scale reformulation in foods. Both subsequently should focus on implementing regulatory policies and achieving population-wide reach and impact. Process evaluations of existing salt reduction strategies can help strengthen intervention delivery, aiding achievement of WHO's 30 % reduction in salt intake by 2025 target.
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Affiliation(s)
- Briar L McKenzie
- The George Institute for Global Health, UNSW, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, NSW2000, Australia
| | | | | | - Enkhtungalag Batsaikhan
- Department of Nutrition Research of the National Center for Public Health, Ulaanbaatar, Mongolia
| | - Arunah Chandran
- Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan, Malaysia
| | - Viola Michael
- Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan, Malaysia
| | - Jacqui Webster
- The George Institute for Global Health, UNSW, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, NSW2000, Australia
| | - Kathy Trieu
- The George Institute for Global Health, UNSW, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, NSW2000, Australia
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Voss S, Bauer J, Jung-Sievers C, Moore G, Rehfuess E, Rhein VZ, Coenen M. Process evaluation of an integrated community-based intervention for promoting health equity in children in a new residential development area. Arch Public Health 2024; 82:19. [PMID: 38317198 PMCID: PMC10845767 DOI: 10.1186/s13690-024-01246-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 09/13/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Reducing health inequities for children from a disadvantaged background is an important task in public health. While intersectoral partnerships are a promising way to achieve this, few studies have examined the factors influencing the success of these interventions. In this study, we conducted a process evaluation of the integrated community-based intervention Präventionskette Freiham that the city of Munich, Germany, has implemented in a new residential development area. The aim was to investigate the implementation process as well as barriers and facilitators. METHODS Following a mixed methods approach, we collected data from different core groups making up Präventionskette Freiham from April 2020 to August 2022, exploring their perspective on the implementation process. We conducted repeated qualitative interviews with the network coordinators and eleven local professionals from institutions engaged with or relevant for the intervention. We also undertook a focus group with four members of the advisory group representing the three municipal departments guiding the intervention. Ego-centered network maps were drawn by the network coordinators to chart the development of the network. Subsequently, we also conducted an online survey with local network members. RESULTS At the early stage of the implementation process, the intervention was able to integrate actors from different sectors, serving as a platform for mutual exchange. However, the network produced limited output. According to the interviews, this may be mainly attributable to the early development status of the area. We identified seven topics that may act as facilitators or barriers to implementation of Präventionskette Freiham: (1) availability of resources, (2) political and administrative support, (3) the network coordinators, (4) network-internal processes, (5) trans-institutional cooperation, (6) perceived benefits of engagement, and (7) the output of the network. CONCLUSIONS The early development status of the area was a challenge for the intervention. This emphasizes the need to carefully consider context when planning and implementing integrated community-based public health interventions in new residential development areas.
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Affiliation(s)
- Stephan Voss
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany.
- Pettenkofer School of Public Health, Munich, Germany.
| | - Julia Bauer
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Caroline Jung-Sievers
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Eva Rehfuess
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Valerie Zu Rhein
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany
- Pettenkofer School of Public Health, Munich, Germany
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21
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Darker CD, Nicolson G, Reddon H, O'Connor K, Jennings R, O'Connell N. Monthly engagement with EIP keyworkers was associated with a five-fold increase in the odds of engagement with psychosocial interventions. BMC Psychiatry 2024; 24:96. [PMID: 38317157 PMCID: PMC10840293 DOI: 10.1186/s12888-024-05577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) supports people who are experiencing their first episode of psychosis (FEP). A new Model of Care (MoC) for EIP services was launched in Ireland in 2019. Three EIP demonstration sites were chosen to test this MoC through a 'hub and spoke' approach. These services were a new way of organising care for people experiencing FEP, based upon a recovery model of care, and which sought to standardise care, improve access by clinically led multidisciplinary teams. This included newly created EIP keyworker roles whereby keyworkers assumed responsibilities regarding assessment, comprehensive individual care planning and coordination of care. METHODS A mixed methods design utilising the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were utilised. Descriptive analyses and logistic regression were performed to examine how increased keyworker engagement influenced the use of other psychosocial interventions within the EIP demonstration sites. Thematic analyses was used for qualitative data. RESULTS There was a strong positive relationship between keyworker contacts and psychosocial interventions offered. Specifically, the odds of achieving at least monthly engagement with cognitive behavioural therapy for psychosis (CBTp; (5.76 (2.43-13.64), p < 0.001), and behavioural family therapy (BFT; (5.52(1.63-18.69, p < 0.006)) increased by fivefold with each additional monthly keyworker contact. For individual placement support (IPS) each additional monthly keyworker contact was associated with a three-fold increase in the odds of achieving monthly attendance with IPS (3.73 (1.64-8.48), p < 0.002). Qualitative results found that the EIP keyworker role as viewed by both service users and staff as a valuable nodal point, with a particular emphasis on care coordination and effective communication. CONCLUSIONS This study advances the understanding of keyworker effects through qualitative evidence of keyworkers functioning as a "linchpin" to the service, while the positive response association between keyworker contacts and engagement with other services provides quantitative support for keyworkers reducing the organisational or structural barriers to service access. Given the importance of these positions, health systems should ensure that EIP programmes identify qualified and experienced staff to fill these roles, as well as allocate the appropriate funding and protected time to support keyworker engagement and impact.
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Affiliation(s)
- C D Darker
- Discipline of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - G Nicolson
- Health Promotion and Improvement Department, HSE Health and Wellbeing, 1st Floor Old National Ambulance Training Building, St Marys Hospital Campus, Phoenix Park, Dublin 20, Chapelizod, D20 TY72, Ireland
| | - H Reddon
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - K O'Connor
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
| | - R Jennings
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - N O'Connell
- Sexual Health and Crisis Pregnancy Programme, HSE Health and Wellbeing, Strategy and Research, 89-94 Capel St, Dublin 1, Dublin, D01 P281, Ireland
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22
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de Cola MA, Chestnutt EG, Richardson S, Baudry M, Nnaji C, Ibinaiye T, Moukénet A, Rotimi K, Sawadogo B, Okafor J, Compaoré CS, Oguoma C, Rassi C, Roca-Feltrer A. From efficacy to effectiveness: a comprehensive framework for monitoring, evaluating and optimizing seasonal malaria chemoprevention programmes. Malar J 2024; 23:39. [PMID: 38308288 PMCID: PMC10837904 DOI: 10.1186/s12936-024-04860-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/23/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Seasonal Malaria Chemoprevention (SMC) is a highly effective intervention for preventing malaria, particularly in areas with highly seasonal transmission. Monitoring and evaluating (M&E) SMC programmes are complex due to the scale, time-sensitive delivery of the programme, and influence of external factors. This paper describes the process followed to develop a comprehensive M&E framework tailored specifically for the SMC context. METHODS The Framework was developed through a literature and programme review, and stakeholder dialogues across three implementing countries-Burkina Faso, Chad, and Nigeria. Expert consultation further refined the Framework through an iterative approach drawing upon data collected through the three sources. The Framework was designed using the Logical Framework Approach incorporating external factors and intentionally aligned with global malaria M&E standards. RESULTS An overall aim and seven programme objectives were developed measured by 70 indicators. The indicators also capture the causal links between the implementation and results of the programme. The Framework leverages the use of current data sources and existing mechanisms, ensuring efficient data use without requiring a significant increase in resources for overall programme optimization. It also promotes the use of data triangulation, and stratification for a more nuanced understanding of factors affecting programme performance and timely data informed decision-making. CONCLUSIONS The SMC M&E Framework presented here provides a standardized approach for programme implementers to enhance decision-making for optimal programme performance. This is an essential tool as the scope of SMC programmes expands to new geographies and target age groups.
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Affiliation(s)
- Monica Anna de Cola
- Malaria Consortium, 244-254 Cambridge Heath Rd, Cambridge Heath, London, E2 9DA, UK.
| | | | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Chuks Nnaji
- Malaria Consortium, 244-254 Cambridge Heath Rd, Cambridge Heath, London, E2 9DA, UK
| | | | | | | | | | | | | | | | - Christian Rassi
- Malaria Consortium, 244-254 Cambridge Heath Rd, Cambridge Heath, London, E2 9DA, UK
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23
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Liu Y, Wadey CA, Barker AR, Williams CA. Process evaluation of school-based high-intensity interval training interventions for children and adolescents: a systematic review and meta-analysis of randomized controlled trials. BMC Public Health 2024; 24:348. [PMID: 38308213 PMCID: PMC10835840 DOI: 10.1186/s12889-024-17786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Several systematic reviews have been published to investigate the effectiveness of high-intensity interval training (HIIT) in schools. However, there has been limited attention given to understanding the functioning of the intervention processes, which is of paramount importance for interpreting and translating the intervention effectiveness. The aim of this systematic review is to determine the extent to which process evaluation is measured in school-based HIIT interventions and to explore the effects of process evaluation and intervention characteristics on cardiorespiratory fitness (CRF), body composition, muscular strength, and blood pressure. METHODS A comprehensive search was conducted in SPORT Discus (EBSCOhost), Web of Science, Scopus, Medline (Ovid) and Cochrane Central Register of Controlled Trials. The extent to which process evaluation is measured was narratively reported, alongside with the guidance of process evaluation of complex interventions by UK Medical Research Council. Meta-analyses and meta-regressions were conducted to determine the effects of process evaluation and intervention characteristics to the intervention outcomes. RESULTS The literature search identified 77 studies reporting on 45 school-based HIIT interventions. In total, five interventions reported process evaluation in a section or in a separate study, and only one intervention adopted a process evaluation framework. On average, 6 out of 12 process evaluation measures were reported in all interventions. Subgroup analyses did not indicate any beneficial treatment effects for studies with process evaluation group, whereas all pooled data and studies without process evaluation group showed significant improvement for CRF and body composition. CONCLUSION Process evaluation is frequently omitted in the literature of school-based HIIT in children and adolescents. Although reporting of process evaluation measures may not directly associate with better intervention outcomes, it allows accurate interpretation of intervention outcomes, thereby enhancing the generalisability and dissemination of the interventions.
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Affiliation(s)
- Yong Liu
- Children's Health and Exercise Research Centre, Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK
| | - Curtis A Wadey
- Children's Health and Exercise Research Centre, Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK
| | - Alan R Barker
- Children's Health and Exercise Research Centre, Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK
| | - Craig A Williams
- Children's Health and Exercise Research Centre, Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, Devon, EX1 2LU, UK.
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24
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Smith J, Essery R, Yardley L, Richardson A, Slodkowska-Barabasz J, Chavlet C, Foster C, Watson E, Grimmett C, Geraghty AWA, Little P, Sharman G, Burford T, Bacon R, Turner L, Bradbury K. Experiences of using a supported digital intervention for cancer survivors in primary care: a qualitative process evaluation. J Cancer Surviv 2024; 18:144-156. [PMID: 37405560 PMCID: PMC10866764 DOI: 10.1007/s11764-023-01412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/24/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Increasing healthy behaviours (e.g. physical activity) can improve cancer survivors' quality of life. Renewed is a digital intervention developed to provide behaviour change advice with brief healthcare practitioner support. A three-arm randomised controlled trial (Renewed, Renewed with support or a control condition) suggested that prostate cancer survivors in the supported arm had slightly greater estimates of improvements in quality of life compared to other cancer survivors. This study explored participants' experiences using Renewed to understand how it might have worked and why it might have provided greater benefit for prostate cancer survivors and those in the supported arm. METHODS Thirty-three semi-structured telephone interviews with cancer survivors' (breast, colorectal, prostate) from the Renewed trial explored their experiences of using Renewed and their perceptions of the intervention. Data were analysed using inductive thematic analysis. RESULTS Some participants only used Renewed modestly but still made behaviour changes. Barriers to using Renewed included low perceived need, joining the study to advance scientific knowledge or 'to give back', or due to perceived availability of support in their existing social networks. Prostate cancer survivors reported less social support outside of Renewed compared to participants with other cancers. CONCLUSION Renewed may support healthy behaviour changes among cancer survivors even with limited use. Interventions targetting individuals who lack social support may be beneficial. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors' experiences may inform the development of digital interventions to better serve this population.
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Affiliation(s)
- Jazzine Smith
- School of Psychology, University of Southampton, Southampton, UK.
| | - Rosie Essery
- School of Psychology, University of Southampton, Southampton, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, UK
- University Hospital Southampton, Southampton, UK
| | | | | | - Claire Foster
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Eila Watson
- Community and Public Health Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Paul Little
- Primary Care Research, University of Southampton, Southampton, UK
| | | | | | - Roger Bacon
- Patient and Public Involvement Team, Southampton, UK
| | - Lesley Turner
- Patient and Public Involvement Team, Southampton, UK
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Fernandes D, Kemigisha E, Achen D, Akatukwasa C, Ruzaaza GN, Coene G, Delobelle P, Nyakato VN, Michielsen K. Process evaluation of a parent-child communication intervention for adolescent sexual and reproductive health in Uganda. BMC Public Health 2024; 24:319. [PMID: 38287314 PMCID: PMC10826092 DOI: 10.1186/s12889-023-17513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Previous initiatives concerning adolescent sexual and reproductive health (SRH) education in Low-or-Middle Income Countries (LMICs) have been limited by cultural norms and misinformation perpetuated within families. Responding to the paucity of research on the implementation of SRH interventions in LMICs and limited knowledge regarding their mechanisms, this study undertakes a process evaluation of a parent-focused intervention to promote parent-adolescent communication about SRH in Uganda. METHODS This paper explores the implementation, contextual factors and mechanisms of impact of the intervention, using the Medical Research Council (MRC) guidelines for process evaluations. Implementation was evaluated through indicators of dose, fidelity and adaptations, acceptability and feasibility. The contextual factors and mechanisms of impact were evaluated to refine the intervention's causal assumptions. Data was collected during April - October 2021 in South-Western Uganda using a mixed-methods approach, including document analysis, intervention observations, interviews, focus group discussions and most significant change stories. RESULTS The acceptability of the intervention was related to its community engagement, the strong rapport with delivery agents, and individual characteristics of participants. Five contextual factors influencing implementation were highlighted; (i) cultural norms, (ii) perceptions about youth SRH, (iii) poverty, (iv) Covid-19 pandemic, and (v) prior research projects in the community. When considering the intervention's mechanisms of impact, four causal pathways were identified; (i) Awareness of SRH needs helped parents overcome stigma, (ii) Parenting skills training improved SRH communication, (iii) Group learning stimulated shared parenting, and (iv) Group learning improved co-parenting. CONCLUSION The paper presented three key learnings and corresponding recommendations for future research. Firstly, implementation success was credited to meaningful community engagement which improved acceptability and uptake. Secondly, the complex influences of contextual factors highlighted the need for contextual analysis in research studies to inform intervention design. Finally, this evaluation recognised the interplay between mechanisms of impact and suggested further research consider such combined impacts when designing intervention content.
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Affiliation(s)
- Danielle Fernandes
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium.
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium.
| | - Elizabeth Kemigisha
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- African Population and Health Research Center, P.O Box 10787-00100, Nairobi, Kenya
| | - Dorcus Achen
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium
| | - Cecilia Akatukwasa
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium
| | - Gad Ndaruhutse Ruzaaza
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Gily Coene
- Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, 1090, Belgium
| | - Peter Delobelle
- Department of Public Health, Vrije Universiteit Brussels, Brussels, 1090, Belgium
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Viola N Nyakato
- Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Kristien Michielsen
- International Center for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, 9000, Belgium
- Institute for Family and Sexuality Studies, Dept. of Neurosciences, Fac. of Medicine, KU Leuven, Leuven, Belgium
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Farmer AJ, Allen J, Bartlett YK, Bower P, Chi Y, French DP, Gudgin B, Holmes E, Horne R, Hughes DA, Jones L, Kenning C, Locock L, McSharry J, Miles L, Newhouse N, Rea R, Robinson S, Tarassenko L, Velardo C, Williams N, Yu LM. Supporting people with type 2 diabetes in effective use of their medicine through mobile health technology integrated with clinical care (SuMMiT-D pilot): results of a feasibility randomised trial. Pilot Feasibility Stud 2024; 10:15. [PMID: 38273420 PMCID: PMC10809651 DOI: 10.1186/s40814-023-01429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 01/30/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The purpose of this 6-month intervention pilot feasibility randomised trial was to test sending brief messages using mobile phones to promote self-management through taking medication as prescribed to people with type 2 diabetes. This was to inform the design and conduct of a future large-scale United Kingdom-based clinical trial and establish the feasibility of recruitment, the technology used, follow-up, and data collection. METHODS A multicentre individually randomised, controlled parallel group trial in primary care, recruiting adults (≥ 35 years) with type 2 diabetes in England. Consenting participants were randomly allocated to receive short message system text messages up to four times a week, or usual care, for a period of 6 months; messages contained behavioural change techniques targeting medication use. The primary outcome was the rate of recruitment to randomisation of participants to the trial with a planned rate of 22 participants randomised per month. The study also aimed to establish the feasibility of follow-up at 6 months, with an aim of retaining more than 80% of participants. Data, including patient-reported measures, were collected at baseline and the end of the 6-month follow-up period, and a notes review was completed at 24 months. RESULTS The trial took place between 26 November 2018 and 30 September 2019. In total 209 participants were randomly allocated to intervention (n = 103) or usual care (n = 106). The maximum rate of monthly recruitment to the trial was 60-80 participants per month. In total, 12,734 messages were sent to participants. Of these messages, 47 were identified as having failed to be sent by the service provider. Participants sent 2,864 messages to the automated messaging system. Baseline data from medical records were available for > 90% of participants with the exception of cholesterol (78.9%). At 6 months, a further HbA1c measurement was reported for 67% of participants. In total medical record data were available at 6 months for 207 (99.0%) of participants and completed self-report data were available for 177 (84.7%) of participants. CONCLUSION The feasibility of a large-scale randomised evaluation of brief message intervention for people with type 2 diabetes appears to be high using this efficient design. Failure rate of sending messages is low, rapid recruitment was achieved among people with type 2 diabetes, clinical data is available on participants from routine medical records and self-report of economic measures was acceptable. TRIAL REGISTRATION ISCTRN ISRCTN13404264. Registered on 10 October 2018.
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Affiliation(s)
- Andrew J Farmer
- University of Oxford, Oxford, UK.
- Nuffield Department of Primary Care Health Sciences, Woodstock Road, Oxford, OX2 6GG, UK.
| | | | | | | | - Yuan Chi
- University of Oxford, Oxford, UK
| | | | | | | | | | | | | | | | | | | | - Lisa Miles
- University of Manchester, Manchester, UK
| | | | - Rustam Rea
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Katangwe-Chigamba T, Murdoch J, Wilkinson P, Cestaro V, Seeley C, Charami-Roupa E, Clarke T, Dunne A, Gee B, Jarrett S, Laphan A, McIvor S, Meiser-Stedman R, Rhodes T, Shepstone L, Turner DA, Wilson J. Doing research in non-specialist mental health services for children and young people: lessons learnt from a process evaluation of the ICALM (Interpersonal Counselling for Adolescent Low Mood) feasibility randomised controlled trial. Pilot Feasibility Stud 2024; 10:14. [PMID: 38263254 PMCID: PMC10804551 DOI: 10.1186/s40814-023-01427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 07/21/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The rising prevalence of adolescent mild depression in the UK and the paucity of evidence-based interventions in non-specialist sectors where most cases present, creates an urgent need for early psychological interventions. Randomised controlled trials (RCTs) are considered the gold standard for obtaining unbiased estimates of intervention effectiveness. However, the complexity of mental health settings poses great challenges for effectiveness evaluations. This paper reports learning from an embedded process evaluation of the ICALM RCT which tested the feasibility of delivering Interpersonal Counselling for Adolescents (IPC-A) plus Treatment as Usual (TAU) versus TAU only for adolescent (age 12-18) mild depression by non-qualified mental health professionals in non-specialist sectors. METHODS A qualitative mixed methods process evaluation, drawing on Bronfenbrenner's socioecological model to investigate key influences on trial delivery across macro-(e.g. policy), meso-(e.g. service characteristics) and micro-(e.g. on-site trial processes) contextual levels. Data collection methods included 9 site questionnaires, 4 observations of team meetings, policy documents, and 18 interviews with stakeholders including therapists, heads of service and managers. Thematic analysis focused on understanding how contextual features shaped trial implementation. RESULTS The ICALM trial concluded in 2022 having only randomised 14 out of the target 60 young people. At a macro-level, trial delivery was impacted by the COVID-19 pandemic, with services reporting a sharp increase in cases of (social) anxiety over low mood, and backlogs at central referral points which prolonged waiting times for mild cases (e.g. low mood). An interaction between high demand and lack of capacity at a meso-service level led to low prioritisation of trial activities at a micro-level. Unfamiliarity with research processes (e.g. randomisation) and variation in TAU support also accentuated the complexities of conducting an RCT in this setting. CONCLUSIONS Conducting a RCT of IPC-A in non-specialist services is not feasible in the current context. Failure to conduct effectiveness trials in this setting has clinical implications, potentially resulting in escalation of mild mental health problems. Research done in this setting should adopt pragmatic and innovative recruitment and engagement approaches (e.g. creating new referral pathways) and consider alternative trial designs, e.g. cluster, stepped-wedge or non-controlled studies using complex systems approaches to embrace contextual complexity. TRIAL REGISTRATION ISRCTN registry, ISRCTN82180413. Registered on 31 December 2019.
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Affiliation(s)
| | - Jamie Murdoch
- School of Life Course and Population Sciences, Kings College London, London, UK
| | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Carys Seeley
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Tim Clarke
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Aoife Dunne
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Brioney Gee
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Andrew Laphan
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Susie McIvor
- Children and Young People's Services, Suffolk County Council, Ipswich, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Thomas Rhodes
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - David A Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jon Wilson
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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Wilcox H, Bishop S, Francis B, Lombard K, Beresford SAA, Ornelas IJ. Process evaluation of the Yéego! Program to increase healthy eating and gardening among American Indian elementary school children. BMC Public Health 2024; 24:232. [PMID: 38243203 PMCID: PMC10797868 DOI: 10.1186/s12889-024-17689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND American Indian children are at increased risk for obesity and diabetes. School-based health promotion interventions are one approach to promoting healthy behaviors to reduce this risk, yet few studies have described their implementation and fidelity. We conducted a qualitative process evaluation of the Yéego! Healthy Eating and Gardening Program, a school-based intervention to promote healthy eating among Navajo elementary school children. The intervention included a yearlong integrated curriculum, as well as the construction and maintenance of a school-based garden. METHODS Our process evaluation included fidelity checklists completed by program staff and qualitative interviews with program staff and classroom teachers after the intervention was implemented. We used content analysis to identify themes. RESULTS We identified several themes related to evidence of delivery adherence, program satisfaction, and lessons learned about delivery. Intervention staff followed similar procedures to prepare for and deliver lessons, but timing, teaching styles, and school-level factors also impacted overall implementation fidelity. Teachers and students had positive perceptions of the program, especially lessons that were highly visual, experiential, and connected to Navajo culture and the surrounding community. Teachers and program staff identified ways to enhance the usability of the curriculum by narrowing the scope, relating content to student experiences, and aligning content with school curriculum standards. CONCLUSIONS The program was implemented with moderately high fidelity across contexts. We identified areas where modifications could improve engagement, acceptability, efficacy, and sustainability of the program. Our results have implications for the evaluation and dissemination of school-based health interventions to promote healthy eating among children, especially in American Indian communities.
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Affiliation(s)
- Heather Wilcox
- University of Washington, Box 351621, Seattle, WA, 98195, USA
| | - Sonia Bishop
- Fred Hutchinson Cancer Research Center, Seattle, USA
| | | | | | | | - India J Ornelas
- University of Washington, Box 351621, Seattle, WA, 98195, USA.
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Adlbrecht L, Karrer M, Helfenberger N, Ziegler E, Zeller A. Facilitators and barriers to implementing a specialized care unit for persons with cognitive impairment in an acute geriatric hospital: a process evaluation. BMC Geriatr 2024; 24:29. [PMID: 38184542 PMCID: PMC10771665 DOI: 10.1186/s12877-023-04612-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Implementing dementia care interventions in an acute hospital poses multiple challenges. To understand factors influencing the implementation, in-depth knowledge about specific facilitators and barriers is necessary. The aim of this study was to identify facilitators and barriers to implementing an interprofessional, multicomponent intervention of a specialized unit for persons with cognitive impairment in an acute geriatric hospital. METHODS We conducted a process evaluation as part of a participatory action research study. For data collection, semi-structured individual interviews with fifteen professionals involved in the implementation of the specialized unit. We further conducted two focus groups with twelve professionals working on other units of the geriatric hospital. We performed a qualitative content analysis following Kuckartz's content-structuring analysis scheme. RESULTS We identified the following barriers to implementing the specialized unit: uncontrollable contextual changes (e.g., COVID-19 pandemic), staff turnover in key functions, high fluctuation in the nursing team, traditional work culture, entrenched structures, inflexible and efficiency-oriented processes, monoprofessional attitude, neglect of project-related communication, and fragmentation of interprofessional cooperation. An established culture of interprofessionalism, an interprofessionally composed project group, cooperation with a research partner, as well as the project groups' motivation and competence of managing change facilitated the implementation. CONCLUSIONS The implementation faced numerous barriers that can be described using the key constructs of the i-PARIHS framework: context, recipients, innovation, and facilitation. Overcoming these barriers requires an organizational development approach, extended project duration and increased process orientation. Furthermore, strategically planned, precise and ongoing communication towards all persons involved seems crucial. Differences between the work cultures of the professions involved deserve particular attention with regard to project-related roles and processes.
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Affiliation(s)
- Laura Adlbrecht
- Competence Center Dementia Care, Department of Health, Institute of Applied Nursing Sciences, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000, St.Gallen, Switzerland.
| | - Melanie Karrer
- University of Applied Sciences for Health Professions Upper Austria, Semmelweisstraße 34/D, Linz, 4020, Austria
| | - Nicole Helfenberger
- Geriatrische Klinik St. Gallen AG, Rorschacher Strasse 94, St. Gallen, 9000, Switzerland
| | - Eva Ziegler
- Geriatrische Klinik St. Gallen AG, Rorschacher Strasse 94, St. Gallen, 9000, Switzerland
| | - Adelheid Zeller
- Competence Center Dementia Care, Department of Health, Institute of Applied Nursing Sciences, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000, St.Gallen, Switzerland
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Fan Y, Sun YN, Qiao LZ, Mao RQ, Tang SY, Shi C, Yao SJ, Lin DQ. Evaluation of dynamic control of continuous capture with periodic counter-current chromatography under feedstock variations. J Chromatogr A 2024; 1713:464528. [PMID: 38029658 DOI: 10.1016/j.chroma.2023.464528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/19/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023]
Abstract
Multi-column periodic counter-current chromatography is a promising technology for continuous antibody capture. However, dynamic changes due to disturbances and drifts pose some potential risks for continuous processes during long-term operation. In this study, a model-based approach was used to describe the changes in breakthrough curves with feedstock variations in target proteins and impurities. The performances of continuous capture of three-column periodic counter-current chromatography under ΔUV dynamic control were systematically evaluated with modeling to assess the risks under different feedstock variations. As the concentration of target protein decreased rapidly, the protein might not breakthrough from the first column, resulting in the failure of ΔUV control. Small reductions in the concentrations of target proteins or impurities would cause protein losses, which could be predicted by the modeling. The combination of target protein and impurity variations showed complicated effects on the process performance of continuous capture. A contour map was proposed to describe the comprehensive impacts under different situations, and nonoperation areas could be identified due to control failure or protein loss. With the model-based approach, after the model parameters are estimated from the breakthrough curves, it can rapidly predict the process stability under dynamic control and assess the risks under feedstock variations or UV signal drifts. In conclusion, the model-based approach is a powerful tool for continuous process evaluation under dynamic changes and would be useful for establishing a new real-time dynamic control strategy.
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Affiliation(s)
- Yu Fan
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education, Zhejiang Key Laboratory of Smart Biomaterials, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310058, China
| | - Yan-Na Sun
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education, Zhejiang Key Laboratory of Smart Biomaterials, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310058, China
| | - Liang-Zhi Qiao
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education, Zhejiang Key Laboratory of Smart Biomaterials, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310058, China
| | - Ruo-Que Mao
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education, Zhejiang Key Laboratory of Smart Biomaterials, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310058, China
| | - Si-Yuan Tang
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education, Zhejiang Key Laboratory of Smart Biomaterials, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310058, China
| | - Ce Shi
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education, Zhejiang Key Laboratory of Smart Biomaterials, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310058, China
| | - Shan-Jing Yao
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education, Zhejiang Key Laboratory of Smart Biomaterials, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310058, China
| | - Dong-Qiang Lin
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education, Zhejiang Key Laboratory of Smart Biomaterials, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310058, China.
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van Santen J, Dröes RM, Blanson Henkemans O, Schoone M, Valk R, Straten AV, Meiland F. Implementation of exergaming for people with dementia: facilitators, barriers, and recommendations. Aging Ment Health 2024; 28:244-253. [PMID: 37493266 DOI: 10.1080/13607863.2023.2238259] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES To identify facilitators, barriers, and formulate recommendations for the implementation of exergames for people with dementia (PWD) in day-care centers (DCCs). METHODS Within a randomized controlled trial into the effectiveness of exergaming, 73 PWD with their informal caregivers (IC) from 11 DCCs in the Netherlands and two exergame providers participated in a process evaluation. This was a mixed-methods study using focus groups, semi-structured interviews, the Measurement Instrument for Determinants of Innovations, forms for DCC staff, and a short satisfaction questionnaire. We used descriptive statistics for the quantitative outcomes, and thematic analysis for qualitative data. The Medical Research Council guidance for process evaluation was used to identify facilitators and barriers to the implementation, mechanisms of impact, and context. RESULTS Implementation-related facilitators and barriers were the availability of budget, staff, equipment, instructions, location, and supervision. Mechanisms of impact-related facilitators were experienced positive effects on physical functioning and mobility, cognitive, emotional, and social functioning, and quality of life. Barriers were mainly linked to the need to customize the intervention for each participant. Contextual facilitators were support and enthusiasm from others; barriers were costs and planning. Recommendations by DCC staff involved technical support, instructions, responsibility, location, supervision, planning, and exergaming as a group or individually. CONCLUSION Users, IC, and staff positively valued exergaming. We found various facilitators and barriers leading to recommendations for successful implementation. We recommend further research into tailoring exergaming to specific users and contexts, and into usability and cost-effectiveness. This may contribute to further dissemination and implementation of exergaming for PWD.
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Affiliation(s)
- Joeke van Santen
- Department of Psychiatry, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | | | - Ronald Valk
- HilverZorg-Day-Care Center Zonnehoeve, Hilversum, Netherlands
| | - Annemieke van Straten
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Clinical- Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - Franka Meiland
- Department of Psychiatry, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Medicine for Older People, Gerion, Amsterdam, Netherlands
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von der Lühe V, Roos M, Löbberding M, Scholten N, Müller W, Hellmich M, Simic D, Köpke S, Dichter MN. Expanded nursing roles to promote person-centred care for people with cognitive impairment in acute care (ENROLE-acute): study protocol for a controlled clinical trial, process and economic evaluation. BMC Geriatr 2023; 23:858. [PMID: 38097987 PMCID: PMC10722805 DOI: 10.1186/s12877-023-04560-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND For people with cognitive impairment, hospitalisation is challenging and associated with adverse events as well as negative outcomes resulting in a prolonged hospital stay. Person-centred care can improve the quality of care and the experience of people with cognitive impairment during hospitalisation. However, current care processes in German hospitals are rarely person-centred. To enable successful implementation of person-centred care on hospital wards, change agents within the interprofessional team are key. The aim of this study is to test the feasibility and initial effects of a newly developed complex person-centred care intervention for people with cognitive impairment provided by expanded practice nurses in acute care. METHODS We will conduct an exploratory non-randomised controlled clinical trial with accompanying process and cost evaluation with three intervention and three control wards at one university hospital. The person-centred care intervention consists of 14 components reflecting the activities of expanded practice nurses within the interprofessional team on the intervention wards. The intervention will be implemented over a six-month period and compared with optimised care on the control wards. We will include people aged 65 years and older with existing cognitive impairment and/or at risk of delirium. The estimated sample size is 720 participants. The primary outcome is length of hospital stay. Secondary outcomes include prevalence of delirium, prevalence of agitation, sleep quality, and person-centred care. We will collect patient level data at six time points (t1 admission, t2 day 3, t3 day 7, t4 day 14, t5 discharge, t6 30 days after discharge). For secondary outcomes at staff level, we will collect data before and after the intervention period. The process evaluation will examine degree and quality of implementation, mechanisms of change, and the context of the complex intervention. The economic evaluation will focus on costs from the hospital's perspective. DISCUSSION The ENROLE-acute study will provide insights into the effectiveness and underlying processes of a person-centred care intervention for people with cognitive impairment provided by expanded practice nurses on acute hospitals wards. Results may contribute to intervention refinement and evidence-based decision making. TRIAL REGISTRATION Current controlled trials: ISRCTN81391868. Date of registration: 12/06/2023. URL: https://doi.org/10.1186/ISRCTN81391868.
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Affiliation(s)
- Verena von der Lühe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
| | - Marcelina Roos
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany.
| | - Mareike Löbberding
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
| | - Nadine Scholten
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Eupener Straße 129, Cologne, Germany
| | - Wiebke Müller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, Robert-Koch-Straße 10, Cologne, Germany
| | - Martin Hellmich
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, Robert-Koch-Straße 10, Cologne, Germany
| | - Dusan Simic
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Health Economics and Clinical Epidemiology, Gleueler Straße 176-178, Cologne, Germany
| | - Sascha Köpke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
| | - Martin N Dichter
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
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Reed H, Murphy S, Evans R. Optimising a co-production framework for developing public health interventions: application and testing of school-based Research Action Groups. Health Res Policy Syst 2023; 21:133. [PMID: 38098091 PMCID: PMC10720185 DOI: 10.1186/s12961-023-01086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
Existing frameworks for developing public health interventions have limited guidance for researchers on how to work with stakeholders to co-produce context-specific interventions. To address this, a promising framework for the co-production of public health interventions was developed through a previous review of school-based co-production. The present study aimed to optimise this co-production framework through applying and testing it in real-world secondary school contexts. Within schools, Research Action Groups (RAGs) were established with multiple school stakeholders supported by an external facilitator to use school data to produce school-specific mental health and wellbeing interventions. A mixed method process evaluation of two contextually diverse case study secondary schools in the UK was used to optimise the co-production framework. The process evaluation sought the views of those involved (students, school staff, school Senior Management Team (SMT) members, and the external co-production facilitator/researcher) on the co-production functions they were involved in so they could be modified, if needed. Data collected for the process evaluation during co-production were a researcher diary (n = 45 entries), and observations of student photography (n = 21) and RAG meetings (n = 8). Post co-production, interviews, and surveys with RAG students (n = 18) and staff (n = 8), and two school-specific SMT focus groups (n = 10) were conducted. The study identified four recommendations to optimise and integrate co-production into real world practice. They include the need to: assess schools for their readiness to undertake co-production; more effectively communicate the necessity to have stakeholders from the whole system involved; work with SMTs throughout co-production functions; involve stakeholders outside the school to support producing solutions to change school mental health and wellbeing priorities. The framework is intended to be used by researchers to integrate stakeholders into a shared decision-making process to develop interventions that meet the needs and contexts of individual schools. It could be transferred to other settings to support the development of public health interventions for other health areas, and populations. Further evaluation to test its use in other settings is needed.
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Affiliation(s)
- Hayley Reed
- DECIPHer, School of Social Sciences, Cardiff University, Spark, Maindy Rd, Cardiff, CF24 4HQ, United Kingdom.
| | - Simon Murphy
- DECIPHer, School of Social Sciences, Cardiff University, Spark, Maindy Rd, Cardiff, CF24 4HQ, United Kingdom
| | - Rhiannon Evans
- DECIPHer, School of Social Sciences, Cardiff University, Spark, Maindy Rd, Cardiff, CF24 4HQ, United Kingdom
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Barclay R, Webber SC, Hahn F, Jones CA, Mayo NE, Sivakumaran S, Liu Y, Chilibeck PD, Salbach NM. A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial. BMC Geriatr 2023; 23:833. [PMID: 38082248 PMCID: PMC10712059 DOI: 10.1186/s12877-023-04524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Process evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial. METHODS GO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components - warm-up, continuous distance walk, task-oriented walking activities, 2nd continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG. RESULTS All sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high - 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG. CONCLUSIONS This process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.
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Affiliation(s)
- Ruth Barclay
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Sandra C Webber
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Francine Hahn
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Nancy E Mayo
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Shajicaa Sivakumaran
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Yixiu Liu
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Philip D Chilibeck
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
- The KITE Research Institute, University Health Network, Toronto, ON, Canada.
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Low LF, Gresham M, Phillipson L, Jeon YH, Hall D, Tan A, Wong N, Brodaty H. Forward with Dementia: process evaluation of an Australian campaign to improve post-diagnostic support. BMC Health Serv Res 2023; 23:1369. [PMID: 38062410 PMCID: PMC10701926 DOI: 10.1186/s12913-023-10347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Forward with Dementia is a co-designed campaign to improve communication of dementia diagnosis and post-diagnostic support. METHODS Webinars, a website, social and traditional media, and promotions through project partners were used to disseminate campaign messages to health and social care professionals (primary audience) and people with dementia and carers (secondary audience). The campaign ran between October 2021 and June 2022, with 3-months follow-up. The RE-AIM framework was used for process evaluation. Measurements included surveys and interviews, a log of activities (e.g. webinars, social media posts) and engagements (e.g. attendees, reactions to posts), and Google Analytics. RESULTS There were 29,053 interactions with campaign activities. More than three-quarters of professionals (n = 63/81) thought webinars were very or extremely helpful. Professionals and people with dementia and carers reported that the website provided appropriate content, an approachable tone, and was easy to use. Following campaign engagement, professionals planned to (n = 77/80) or had modified (n = 29/44) how they communicated the diagnosis and/or provided post-diagnostic information and referrals. Qualitative data suggested that the campaign may have led to benefits for some people with dementia and carers. CONCLUSIONS Forward with Dementia was successful in terms of reach, appropriateness, adoption and maintenance for professionals, however flow-through impacts on people with dementia are not clear. Targeted campaigns can potentially change health professionals' communication and support around chronic diseases such as dementia.
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Affiliation(s)
- Lee-Fay Low
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Meredith Gresham
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Lyn Phillipson
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Danika Hall
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Amy Tan
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nora Wong
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
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Thompson CA, Daffu-O'Reilly A, Willis T, Gordon A, Noakes C, Khaliq K, Farrin A, Kemp A, Hall T, Bojke C, Spilsbury K. 'Smart' BLE wearables for digital contact tracing in care homes during the COVID-19 pandemic-a process evaluation of the CONTACT feasibility study. Implement Sci Commun 2023; 4:155. [PMID: 38049924 PMCID: PMC10694939 DOI: 10.1186/s43058-023-00533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 08/07/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Rapid and mass transmission of the SARS-CoV-2 virus amongst vulnerable people led to devastating effects from COVID-19 in care homes. The CONTACT intervention introduced Bluetooth Low Energy 'smart' wearable devices (BLE wearables) as a basis for automated contact tracing in, and feedback on infection risks and patterns to, care homes to try and improve infection prevention and control (IPC). We planned a cluster randomised controlled trial (RCT) of CONTACT. To be feasible, homes had to adopt CONTACT's technology and new ways of working. This paper reports on the process evaluation conducted alongside CONTACT's feasibility study and explains why it lacked the feasibility and acceptability for a definitive RCT. METHODS This mixed method process evaluation used Normalisation Process Theory (NPT) qualitative (interviews, field notes, study case report forms and documents, and observation) and quantitative (survey instruments, counts of activity) data to plan, implement, and analyse the mechanisms, effects, and contextual factors that shaped the feasibility and acceptability of the CONTACT intervention. RESULTS Thirteen themes within four core NPT constructs explained CONTACT's lack of feasibility. Coherence: the home's varied in the scale and extent of commitment and understanding of the technology and study procedures. Leadership credibility was important but compromised by competing priorities. Management and direct care staff saw CONTACT differently. Work to promote (cognitive participation) and enact (collective action) CONTACT was burdensome and failed to be prioritised over competing COVID-19-related demands on time and scarce human and cognitive resources. Ultimately, staff appraisal of the value of CONTACT-generated information and study procedures (reflexivity) was that any utility for IPC was insufficient to outweigh the perceived burden and complexity involved. CONCLUSIONS Despite implementation failure, dismissing BLE wearables' potential for contact tracing is premature. In non-pandemic conditions, with more time, better co-design and integration of theory-driven implementation strategies tailored to care homes' unique contexts, researchers could enhance normalisation in readiness for future pandemic challenges. TRIAL REGISTRATION ISRCTN registration: 11,204,126 registered 17/02/2021.
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Affiliation(s)
- Carl A Thompson
- School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK.
| | | | - Thomas Willis
- Trials Research, Leeds Institute of Clinical, University of Leeds, Leeds, LS2 9JT, UK
| | - Adam Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, DE22 3NE, UK
| | - Catherine Noakes
- School of Civil Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Kishwer Khaliq
- School of Civil Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda Farrin
- Trials Research, Leeds Institute of Clinical, University of Leeds, Leeds, LS2 9JT, UK
| | - Andrew Kemp
- School of Electronics and Electrical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Tom Hall
- South Tyneside Council, South Shields, NE33 2RL, UK
| | - Chris Bojke
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Karen Spilsbury
- School of Healthcare, University of Leeds, Leeds, LS2 9JT, UK
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Scott HR, Warran K, Fraser K, Chipp B, McGinnes G, Towers M, Lloyd-Evans B, Sheridan Rains L. A realist interview study of a participatory public mental health project "#KindnessByPost". BMC Public Health 2023; 23:2406. [PMID: 38049751 PMCID: PMC10694983 DOI: 10.1186/s12889-023-17372-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 11/29/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND #KindnessByPost (KbP) is a participatory public health initiative in which people anonymously send and receive cards containing messages of goodwill with others also taking part in the programme. Quantitative evaluations of KbP consistently find evidence of improvements to people's mental wellbeing and feelings of loneliness after participation and three months later. Our aim in the present study is to develop a programme theory of KbP, which describes for whom the KbP intervention improves mental wellbeing, other reported impacts, in which contexts it has these effects, and the mechanisms by which it works. METHODS We use a realist interviewing methodology to develop the programme theory. We conducted a focus group with the KbP executive team, and 20 one-to-one interviews with KbP participants. During analysis, a co-production working group iteratively developed a Theory of Change model comprising context-mechanism-outcome statements [CMOs] to map out the mechanisms present in KbP. RESULTS We developed 145 CMO statements, which we condensed and categorized into 32 overarching CMOs across nine thematic topics: access to scheme; pathways to involvement; resources; culture; giving post; receiving post; content of received post; community; long term impact. These CMOs set out pathways through which KbP benefited participants, including from doing something kind for someone else, of receiving post and appreciating the effort that went into it, and from the creative process of creating post and writing the messages inside them. Effects were sustained in part through people keeping the cards and through the social media communities that emerged around KbP. DISCUSSION Both giving and receiving post and the sense of community benefited participants and improved their mood and feelings of connectedness with others. Connection with a stranger, rather than friends or family, was also an important feature of the initiative for participants. Our wide range of CMO pathways by which KbP produced positive outcomes may mean that the intervention is applicable or adaptable across many communities and settings. Taken together with evidence from the quantitative evaluations, KbP is potentially an effective, low-cost, and highly scalable public health intervention for reducing loneliness and improving wellbeing.
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Affiliation(s)
| | - Katey Warran
- Social Biobehavioural Research Group, University College London, London, UK
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Kathleen Fraser
- Division of Psychiatry, University College London, London, UK
| | - Beverley Chipp
- Division of Psychiatry, University College London, London, UK
| | - Gail McGinnes
- Division of Psychiatry, University College London, London, UK
| | - Mike Towers
- Division of Psychiatry, University College London, London, UK
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Chambers RA, Kemp C, Edwards A, Rosenstock S, Lee A, Pinal L, Cosen E, Larzelere F, Tingey L. Implementation Fidelity and Theory-Informed Dose Effects of a Teen Pregnancy Prevention Program for Native American Youth. Prev Sci 2023; 24:229-240. [PMID: 37191932 PMCID: PMC10764365 DOI: 10.1007/s11121-023-01501-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 05/17/2023]
Abstract
In 2019, Native youth had the highest rate of teen pregnancy of all racial/ethnic groups. "Respecting the Circle of Life" (RCL) is one of the first evidence-based teen pregnancy prevention programs for Native teens and there is interest in replicating the program across tribal communities. To inform replication, it is important to consider process data including quality, fidelity, and dosage as these may all moderate impact of the program. Participants were Native youth aged 11-19 and a trusted adult. This study includes participants randomized to the RCL program only (N = 266). Data sources include independent observations, facilitator self-assessments, attendance logs, and self-report assessments completed by enrolled youth at baseline and 3 months post assessment. Data was compiled and summed by cohort. Dosage was number of minutes participating in activities separated by theoretical constructs. Linear regression models were utilized to assess moderation of the effects of the intervention dosage on outcomes of interest. Eighteen facilitators delivered RCL. One hundred eighteen independent observations and 320 facilitator self-assessments were collected and entered. Findings indicate RCL was implemented with high fidelity and quality (4.40 to 4.82 out of a 5-point Likert scale; 96.6% of planned activities completed). Dosage was high with an average completion of 7 out of 9 lessons. There was no association between theoretical construct dosage and outcomes of interest. Overall, this study indicates RCL was delivered with high fidelity, quality, and dosage in this trial. This paper informs future replication of RCL and provides support for hiring paraprofessionals from the local community as facilitators, delivering the RCL to peer groups of the same age and sex, delivering the RCL with short duration and high frequency, and encouraging youth to attend all RCL lessons, but continue to serve youth who have missed one or more lessons.
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Affiliation(s)
- Rachel A Chambers
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA.
| | - Christopher Kemp
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Abagail Edwards
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Summer Rosenstock
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Angelita Lee
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 102 General Crook Street, Fort Apache, AZ, 85926, USA
| | - Laura Pinal
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 102 General Crook Street, Fort Apache, AZ, 85926, USA
| | - Etheline Cosen
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 102 General Crook Street, Fort Apache, AZ, 85926, USA
| | - Francene Larzelere
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 102 General Crook Street, Fort Apache, AZ, 85926, USA
| | - Lauren Tingey
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
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Aresi G, Giampaolo M, Chiavegatti B, Marta E. Process Evaluation of Food Game: A Gamified School-Based Intervention to Promote Healthier and More Sustainable Dietary Choices. J Prev (2022) 2023; 44:705-727. [PMID: 37544937 PMCID: PMC10638118 DOI: 10.1007/s10935-023-00741-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
Food Game is a gamified school-based intervention that aims to promote healthier dietary choices (i.e., adherence to the Mediterranean diet) and more sustainable behaviors among high school students in an urban area in Northern Italy. The program consists of an offline and online competition in which groups of students participate in peer-led activities to design and communicate products promoting health and sustainability. This study aimed to examine how the program works in practice, understand its mechanisms of change and assess any variation in student outcomes. A mixed methods process evaluation was conducted. Students completed a three-wave longitudinal survey and participated in focus groups. Program staff and teachers were also interviewed. Qualitative and quantitative data analyses indicate that Food Game?s gamification strategy was successful in engaging students, who felt stimulated by the game, its embedded competition and the self-organized group work. Although no significant change in adherence to the Mediterranean diet was found, pro-environmental behaviors, attitudes and perceived peer approval on healthy eating increased over time. Findings provide preliminary support for Food Game as an acceptable and engaging intervention though there is yet not sufficient evidence that it is also promotes healthier and more sustainable behaviors. The results contribute to the limited evidence base for offline gamified school-based interventions and offer insight into the applicability of the gamification approach as a key motivational strategy in other prevention settings and contexts. Suggestions on how to strengthen the program include dosage increase and addition of activities to promote change on relevant school and community factors.
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Affiliation(s)
- Giovanni Aresi
- Psychology Department, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milano, 20123, Italy.
- CERISVICO Research Centre on Community Development and Organizational Quality of Life, via Trieste 17, Brescia, 25121, Italy.
| | - Martina Giampaolo
- Psychology Department, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milano, 20123, Italy
| | - Benedetta Chiavegatti
- Unità Complessa Igiene Alimenti e Nutrizione, Azienda Tutela della Salute, Città Metropolitana di Milano, Italy
| | - Elena Marta
- Psychology Department, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milano, 20123, Italy
- CERISVICO Research Centre on Community Development and Organizational Quality of Life, via Trieste 17, Brescia, 25121, Italy
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Duamor CT, Hampson K, Lankester F, Lugelo A, Changalucha J, Lushasi KS, Czupryna A, Mpolya E, Kreppel K, Cleaveland S, Wyke S. Integrating a community-based continuous mass dog vaccination delivery strategy into the veterinary system of Tanzania: A process evaluation using normalization process theory. One Health 2023; 17:100575. [PMID: 37332884 PMCID: PMC10272491 DOI: 10.1016/j.onehlt.2023.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
Abstract Sustained vaccination coverage of domestic dog populations can interrupt rabies transmission. However, challenges remain including low dog owner participation, high operational costs associated with current (centralized and annually delivered (pulse)) approaches and high dog population turnover. To address these challenges an alternative (community-based continuous mass dog vaccination (CBC-MDV)) approach was designed. We investigated the potential for successful normalization of CBC-MDV into routine practice within the context of local communities and the veterinary system of Tanzania. Methods In a process evaluation of a pilot implementation of CBC-MDV, we conducted in-depth interviews with implementers and community leaders (n = 24), focus group discussion with implementers and community members (n = 12), and non-participant observation (n = 157 h) of delivery of the intervention components. We analyzed these data thematically drawing on the normalization process theory, to assess factors affecting implementation and integration. Main findings Implementers and community members clearly understood the values and benefits of the CBC-MDV, regarding it as an improvement over the pulse strategy. They had a clear understanding of what was required to enact CBC-MDV and considered their own involvement to be legitimate. The approach fitted well into routine schedules of implementers and the context (infrastructure, skill sets and policy). Implementers and community members positively appraised CBC-MDV in terms of its perceived impact on rabies and recommended its use across the country. Implementers and community members further believed that vaccinating dogs free of charge was critical and made community mobilization easier. However, providing feedback to communities and involving them in evaluating outcomes of vaccination campaigns were reported to have not been done. Local politics was cited as a barrier to collaboration between implementers and community leaders. Conclusion This work suggests that CBC-MDV has the potential to be integrated and sustained in the context of Tanzania. Involving communities in design, delivery and monitoring of CBC-MDV activities could contribute to improving and sustaining its outcomes.
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Affiliation(s)
- Christian Tetteh Duamor
- Department of Global Health and Biomedical Sciences, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
- Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute – Tanzania, Ifakara, Tanzania
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Felix Lankester
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
- Global Animal Health Tanzania, Arusha, Tanzania
| | - Ahmed Lugelo
- Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute – Tanzania, Ifakara, Tanzania
- Global Animal Health Tanzania, Arusha, Tanzania
- Sokoine University of Agriculture, Morogoro, Tanzania
| | - Joel Changalucha
- Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute – Tanzania, Ifakara, Tanzania
- Global Animal Health Tanzania, Arusha, Tanzania
| | - Kennedy Selestin Lushasi
- Department of Global Health and Biomedical Sciences, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
- Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute – Tanzania, Ifakara, Tanzania
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Anna Czupryna
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Global Animal Health Tanzania, Arusha, Tanzania
| | - Emmanuel Mpolya
- Department of Global Health and Biomedical Sciences, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Katharina Kreppel
- Department of Global Health and Biomedical Sciences, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
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Celeste-Villalvir A, Then-Paulino A, Armenta G, Jimenez-Paulino G, Palar K, Wallace DD, Derose KP. Exploring feasibility and acceptability of an integrated urban gardens and peer nutritional counselling intervention for people with HIV in the Dominican Republic. Public Health Nutr 2023; 26:3134-3146. [PMID: 37905447 PMCID: PMC10755388 DOI: 10.1017/s1368980023002264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/04/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up. DESIGN Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants (n 45) and qualitative data from a purposive sample of participants (n 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively. SETTING An HIV clinic in the northwest-central part of the Dominican Republic. RESULTS The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93-96 %) rated the gardening as 'helpful' or 'very helpful' for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89-97 %) rated the nutrition counselling 'helpful' or 'very helpful' for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants' households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation. CONCLUSION An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit.
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Affiliation(s)
- Alane Celeste-Villalvir
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
| | - Amarilis Then-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Gabriela Armenta
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
| | - Gipsy Jimenez-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Kartika Palar
- University of California, San Francisco, Department of Medicine, San Francisco, CA94143, USA
| | - Deshira D Wallace
- University of North Carolina at Chapel Hill, Department of Health Behavior, Chapel Hill, NC27599, USA
| | - Kathryn P Derose
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
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Bai Y, Wong CL, Chen J, So WKW. Implementing a tailored communication intervention to increase colonoscopy screening rates among first-degree relatives of people with colorectal cancer: Lessons learned. Eur J Oncol Nurs 2023; 67:102408. [PMID: 37806150 DOI: 10.1016/j.ejon.2023.102408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 07/23/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE To report the process evaluation of a tailored communication intervention for first-degree relatives of colorectal cancer patients in a randomized controlled trial. METHOD Based on the MRC process evaluation framework, the process of delivering a two-arm RCT intervention were evaluated on 3 themes: (1) implementation, (2) mechanism, and (3) contextual factors. Implementation data were collected through a logbook, online tool platform feedback, and questionnaire surveys. Subgroup analysis was conducted for implementation outcomes. The mechanism and contextual factors were analyzed by mediation and moderation analysis. RESULTS From March 2019 to May 2019, 188 (57%) eligible participants were recruited to participate in this study in Shenzhen, China. In the intervention group, 68 (72.3%) participants received written and verbal sessions. Relatively high satisfaction rates (77.6%-100%) were achieved. The mediating effect was found for perceived barriers (95%CI = -0.880, -0.133) and cues to action (95%CI = 0.043, 0.679). No moderators were identified. People who received the first two sessions are more likely to receive a colonoscopy, whereas the time spent on intervention did not influence the colonoscopy uptake. CONCLUSIONS Potential strategies to enlarge the tailored effect were identified, including tailoring communication on the perceived barriers and cues to action and reinforcing patients' compliance in the first written and verbal sessions. To accomplish the difficult task of recruiting at-risk family members, direct approaches and adequate records on contact information of at-risk family members are suggested when the cancer cases were identified for the first time.
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Affiliation(s)
- Yang Bai
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jieling Chen
- School of Nursing, Sun Yat-Sen University, Guangzhou, China.
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
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Brown GK, Owens J, Richards C, Di Folco S, Schwannauer M. Facilitators and Barriers to the Implementation of a School-Based Intervention for Anxiety. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01615-9. [PMID: 37973671 DOI: 10.1007/s10578-023-01615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/19/2023]
Abstract
School-based cognitive behavioural interventions for anxiety are found to be effective, but there is a lack of research on their implementation in real world settings. The current study aims to explore the facilitators and barriers to the implementation of a school-based intervention for anxiety through a qualitative process evaluation. Evaluation of the implementation of Let's Introduce Anxiety Management (LIAM), a six-session school-based cognitive behavioural intervention, was conducted. LIAM was implemented by non-mental health professionals trained and coached on the model. Semi-structured interviews with stakeholders (N = 15) were analysed with grounded theory and framework analysis. Forty-one practitioners were trained and coached on LIAM, with thirty-five children and young people receiving the intervention. Facilitators (e.g. systemic collaboration, self-efficacy and an enabling context) and barriers (e.g. the exclusivity of the intervention and a lack of systemic understanding) to implementation emerged as themes. Implementing school-based interventions is complex and requires the involvement of multiple stakeholders.
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Affiliation(s)
- Gemma K Brown
- Child and Adolescent Mental Health Service, Royal Edinburgh Hospital, NHS Lothian, Edinburgh, UK.
- Section of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Doorway 6, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Jane Owens
- Child and Adolescent Mental Health Service, NHS Lanarkshire, 14 Beckford Street, Hamilton, ML3 OTA, UK
| | - Cathy Richards
- Child and Adolescent Mental Health Service, Royal Edinburgh Hospital, NHS Lothian, Edinburgh, UK
- Section of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Doorway 6, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Simona Di Folco
- Section of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Doorway 6, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Matthias Schwannauer
- Child and Adolescent Mental Health Service, Royal Edinburgh Hospital, NHS Lothian, Edinburgh, UK
- Section of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Doorway 6, Teviot Place, Edinburgh, EH8 9AG, UK
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Kletter M, Griffiths J, Arundel C, Dumville J. Compression therapies for the treatment of venous leg ulcers: study protocol for a process evaluation in a randomised controlled trial, VenUS 6. Trials 2023; 24:727. [PMID: 37964358 PMCID: PMC10644437 DOI: 10.1186/s13063-023-07681-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/27/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The VenUS 6 parallel-group randomised controlled trial (RCT) will compare the clinical and cost-effectiveness of compression wraps, two-layer compression bandage and evidence-based compression therapy, comprising of two-layers of hosiery or four-layer bandages, for healing time of venous leg ulcers. We will conduct an embedded process evaluation to evaluate the implementation of the trial and the various compression therapies and to gain a more in-depth understanding of trial participant and nursing staff views and experiences of these therapies. METHODS This process evaluation will be a mixed-method study, embedded into a wider RCT. Qualitative data will be collected through semi-structured individual in-depth interviews with trial participants and staff members. Quantitative data will be collected using patient questionnaires and case report forms that are part of the main trial data collection process. Interview transcripts will be analysed using the Framework Analysis and interview data will be integrated with quantitative RCT data using the RE-AIM framework and the Pillar Integration Process. DISCUSSION We describe the protocol for a process evaluation, designed to assess the implementation of the various venous leg ulcer compression therapies as evaluated in VenUS6, and the experiences of trial participants and nursing staff using these. This protocol provides one example of how an embedded mixed-method process evaluation can be conducted. TRIAL REGISTRATION ISRCTN 67321719 ( https://doi.org/10.1186/ISRCTN67321719 ). Prospectively registered on 14 September 2020. Recruitment Infographic SWAT-MRC Hub for Trials Methodology Research SWAT repository #116. Registered on 13 April 2020. Retention Thank You Card SWAT-MRC Hub for Trials Methodology Research SWAT repository #119. Registered on 13 April 2020. Retention Newsletter SWAT-MRC Hub for Trials Methodology Research SWAT repository #28. Registered on 01 July 2007. Retention Pen SWAT-MRC Hub for Trials Methodology Research SWAT repository #92. Registered on 01 April 2019. PROTOCOL VERSION V1.5, 26 May 2022.
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Affiliation(s)
- Maartje Kletter
- School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Jane Griffiths
- School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Catherine Arundel
- York Trials Unit, Department of Health Sciences - Faculty of Science, University of York, York, YO10 5DD, UK
| | - Jo Dumville
- School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Frisicale EM, Barbara A, Perilli A, Carini E, Grossi A, Simonetti L, Tammam G, Axelrod S, Tanese A, Goletti M, Parente P. The district operation centres in one of the largest local health authorities in Italy to manage COVID-19 surveillance and homecare: first implementation and results of a survey addressed to general practitioners. BMC Health Serv Res 2023; 23:1218. [PMID: 37936132 PMCID: PMC10629134 DOI: 10.1186/s12913-023-10213-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND COVID-19 pandemic represented a shock for healthcare systems. Italy was one of the first country to deal with a huge number of patients to be diagnosed, isolated, and treated with scarce evidence-based guidelines and resources. Several organizational and structural changes were needed to face the pandemic at local level. The article aims at studying the perceived impact of the newly implemented District Operation Centres (DOCs) of Local Health Authority (LHA) Roma 1 in managing active surveillance and home care of COVID-19 patients and their close contacts in cooperation with general practitioners (GPs). METHODS A questionnaire, developed according to Delphi methodology, was validated by 7 experts and administered to a randomized sample of GPs and family paediatricians (FPs). All medical doctors selected received a phone interview between December 2020 and January 2021. The questionnaire investigated general characteristics of the sample, relations with DOC and its usefulness, and potential developments. A descriptive analysis was performed and inferential statistical tests were used to assess differences. RESULTS In April 2020 the LHA Roma 1 implemented one DOCs in each local health district. 215 medical doctors were interviewed, reaching the sample target for health districts (80% CL and 10% MOE) and the whole LHA (90% CL and 5% MOE). Several aspects in the management of COVID-19 cases and close contacts of COVID-19 cases, and of the support of DOCs to GPs/FPs were investigated. More than 55% of the GPs and FPs interviewed found the DOCs useful and more than 78% would recommend a service DOC-like to other LHAs. The medical professionals interviewed would use DOCs in the future as support in treating vulnerable patients, utilizing digital health tools, enlisting specialist doctors, establishing networks, and facilitating professional counselling by nurses. CONCLUSIONS This study is an attempt to evaluate an organizational change happened during COVID-19 pandemic. DOCs were created to support GPs and FPs as a link between primary healthcare and public health. Although several difficulties were disclosed, DOCs' experience can help to overcome the fragmentation of the systems and the duality between primary care and public health and make the system more resilient.
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Affiliation(s)
| | - Andrea Barbara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
- Local Health Authority Roma 1, Rome, Italy.
| | - Alessio Perilli
- Department of Life Sciences and Public Health, Hygiene Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | | | - Svetlana Axelrod
- World Health Organization, Geneve, Switzerland
- First Sechenov University, Moscow, Russia
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Cederberg M, Barenfeld E, Ali L, Ekman I, Goulding A, Fors A. A lowered threshold to partnerships: a mixed methods process evaluation of participants' experiences of a person-centred eHealth intervention. BMC Health Serv Res 2023; 23:1193. [PMID: 37919705 PMCID: PMC10621160 DOI: 10.1186/s12913-023-10190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND In order to understand pathways of complex interventions, the Medical Research Council has suggested that process evaluations should be conducted alongside randomised controlled trials (RCTs). This paper presents a mixed methods process evaluation of a complex, person-centred eHealth intervention for persons on sick leave with common mental disorders. AIM The aim of the study was to explore participants' experiences of a person-centred eHealth intervention and illuminate meaningful activities and processes. METHODS Participants were recruited from the intervention arm of an RCT (n = 102). Questionnaires on perceived meaningfulness of the overall intervention and intervention activities were sent to participants on two occasions, after 3 and 6 months, and semi-structured interviews were conducted with a purposeful sample of 15 participants in the intervention group. Questionnaire data were analysed using descriptive statistics, and interview data were analysed using qualitative content analysis. The quantitative and qualitative data strands were integrated at interpretation. RESULTS At both follow-ups, a majority of participants reported that the intervention was fully or partly meaningful and that the most meaningful activity was the phone calls with health care professionals working in the intervention. In the qualitative analysis, three categories describing participants' experiences of the intervention were formed: Acknowledgment in a disconcerting situation, Finding ways forward and Unmet expectations. A synthesis of quantitative and qualitative findings resulted in the overarching theme of meaningfulness as constituted by a lowered threshold to partnerships: support within reach, when needed. CONCLUSION Experiences of meaningfulness of the intervention were constituted by a lowered threshold to forming care partnerships, in which support was within reach, when needed. If the content of the intervention was not in accordance with individuals' needs or expectations, access alone did not suffice to constitute meaningfulness. TRIAL REGISTRATION ClinicalTrials.gov; NCT03404583; 19/01/2018.
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Affiliation(s)
- Matilda Cederberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, 405 30, Sweden.
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
- Psychosis Clinic, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Emmelie Barenfeld
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, 405 30, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Occupational therapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, 405 30, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, 405 30, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Department of Internal Medicine and Geriatrics, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
| | - Anneli Goulding
- Psychosis Clinic, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, 405 30, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Education, Development and Innovation, Region Västra Götaland, Primary Health Care, Research, Gothenburg, Sweden
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Janssens KME, Joosen MCW, Henderson C, van Weeghel J, Brouwers EPM. Improving Work Participation Outcomes Among Unemployed People with Mental Health Issues/Mental Illness: Feasibility of a Stigma Awareness Intervention. J Occup Rehabil 2023:10.1007/s10926-023-10141-3. [PMID: 37878158 DOI: 10.1007/s10926-023-10141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE As stigma is a barrier to work participation of unemployed people with mental health issues/mental illness (MHI), a stigma awareness intervention can be helpful to make informed decisions about disclosing MHI. The aim of this process evaluation was to investigate the feasibility of a stigma awareness intervention, to explore experiences of clients and their employment specialists; and to give recommendations for further implementation. METHODS The intervention consisted of a stigma awareness training for employment specialists and a decision aid tool for their clients with (a history of) MHI. For the process evaluation, six process components of the Linnan & Stecklar framework were examined: recruitment, reach, dose delivered, dose received, fidelity and context. Using a mixed-methods design, quantitative and qualitative data were collected and analyzed. RESULTS The six components showed the intervention was largely implemented as planned. Questionnaire data showed that 94% of the clients found the tool useful and 87% would recommend it to others. In addition, more than half (54%) indicated the tool had been helpful in their disclosure decision. Qualitative data showed that participants were mainly positive about the intervention. Nevertheless, only a minority of clients and employment specialists had actually discussed the tool together. According to both, the intervention had increased their awareness of workplace stigma and the disclosure dilemma. CONCLUSION The implementation of a stigma awareness intervention was feasible and did increase stigma awareness. Experiences with the intervention were mainly positive. When implementing the tool, it is recommended to embed it in the vocational rehabilitation system, so that discussing the disclosure dilemma becomes a routine. TRAIL REGISTER The study was retrospectively registered at the Dutch Trial Register (TRN: NL7798, date: 04-06-2019).
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Affiliation(s)
- K M E Janssens
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. box 90513, 5000 LE, Tilburg, The Netherlands.
| | - M C W Joosen
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. box 90513, 5000 LE, Tilburg, The Netherlands
| | - C Henderson
- Department of Health Services and Population Research, King's College London, London, UK
| | - J van Weeghel
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. box 90513, 5000 LE, Tilburg, The Netherlands
- Phrenos Center of Expertise, Utrecht, The Netherlands
| | - E P M Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. box 90513, 5000 LE, Tilburg, The Netherlands
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Freeman S, Peach L, Ross C, Marchal K, Meyer A, Skinner K. Development and evaluation of the Rural and Northern Community Focused Model of COPD Care (RaNCoM). BMC Pulm Med 2023; 23:399. [PMID: 37864243 PMCID: PMC10589932 DOI: 10.1186/s12890-023-02683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The prevalence of COPD continues to rise. To address the challenges to provide high quality COPD care in rural and northern communities, leaders in one rural and northern community in Western Canada sought to change the culture of COPD screening and care. Recognizing effective assessment, diagnosis, and treatment for patients with COPD are crucial to improve outcomes, a program was developed between 2012 and 2021 to enhance primary care for COPD patients. METHODS A process evaluation was undertaken to assess program development, implementation, mechanisms of impact, and context of COPD program. Qualitative thematic analysis of stakeholder interviews (n = 11) and a document review (n = 60; ~ 500 pages) of key clinic documents was conducted. RESULTS We describe five phases of the COPD program's development (Survive; Reorganize and Stabilize; Assess and Respond; Build and Refine; and Sustain and Share), highlighting areas of innovation. Outreach and localizing resources improved access to the program. Acquiring secured physician compensation, capturing quality data, and improving patient and provider self-efficacy built the capacity of the system and stakeholders within it. Finally, relationships were forged through building an integrated facility, collaborative networking, and patient engagement. Key elements of program implementation included the resources (infrastructure, software, operational) required to ensure operation. CONCLUSION Team-based care and service integration enhanced care capacity and the health network. Focused use of infrastructure and resources supported the people in the care system. Upholding a shared value of relationship is critical to deliver robust and sustainable rural healthcare. Quality improvement requires investment in rural community healthcare resources.
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Affiliation(s)
- Shannon Freeman
- School of Nursing, University of Northern British Columbia, British Columbia, 3333 University Way, Prince George, V2N 4Z9, Canada.
- Centre for Technology Adoption for Aging in the North, University of Northern British Columbia, Prince George, British Columbia, Canada.
| | - Laura Peach
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Christopher Ross
- Centre for Technology Adoption for Aging in the North, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Kathy Marchal
- Fort St, James Health Centre, Fort St. James, British Columbia, Canada
| | - Anthon Meyer
- Rural Coordination Centre of BC, British Columbia, Canada
| | - Kelly Skinner
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Brongers K, Hoekstra T, Wilming L, Roelofs P, Brouwer S. Process evaluation of a comprehensive approach to reintegration of disability benefit recipients with multiple problems (CARm) into the labour market. Disabil Rehabil 2023:1-11. [PMID: 37807660 DOI: 10.1080/09638288.2023.2264765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
PURPOSE As the effect evaluation of our randomized controlled trial the "Comprehensive Approach of Reintegration for clients with Multiple problems" (CARm) showed no superior effect on re-integration into paid employment of the clients when compared with clients of the care as usual, we conducted this process evaluation to gain insight into whether the intervention was conducted according to protocol. METHODS Using questionnaires on recruitment, reach, dose delivered, dose received, fidelity, context, and satisfaction we collected data from 40 labour experts of the Public Employment Service of the Dutch Social Security Institute, and from 166 disability benefit recipients dealing with multiple problems. RESULTS Only few of the labour experts provided the key elements of the intervention to their clients. Between the clients of both groups were no significant differences in the dose received. More than half of the labour experts of the intervention group reported organizational changes. CONCLUSION The lack of effect of the CARm intervention was almost certainly caused by implementation failure. Once again this study showed the importance of involving all stakeholders in developing and the conduct of the intervention, and of clarifying the consequences for the organization, to ensure that it can be conducted according to protocol.
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Affiliation(s)
- Kor Brongers
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Center for Labour Expertise, Nijkerk, the Netherlands
- Dutch Social Security Institute, The Institute for Employee Benefits Schemes (UWV), Amsterdam, the Netherlands
| | - Tialda Hoekstra
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Loes Wilming
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Pepijn Roelofs
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VU University Medical Center Amsterdam, Amsterdam, the Netherlands
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Arensman E, Leduc M, O'Brien C, Corcoran P, Griffin E, Leduc C, Coppens E, Tsantila F, Ross V, Abdulla K, Hauck P, Amann BL, Aust B, Pashoja AC, Cresswell-Smith J, D'Alessandro L, Fanaj N, Greiner BA, Luyten J, Mathieu S, Maxwell M, Qirjako G, Reich H, Sanches S, Tóth MD, Kilroy J, Michell K, Reavley N, McDaid D, Van Audenhove C. Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial. Trials 2023; 24:621. [PMID: 37777787 PMCID: PMC10543326 DOI: 10.1186/s13063-023-07537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/25/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Well-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia. METHODS Each intervention country will aim to recruit at least two SMEs in each of the three sectors. The design of the cRCT is based on the experiences of a pilot study and guided by a Theory of Change process that describes how the intervention is assumed to work. SMEs will be randomly assigned to the intervention or control conditions. The aim of the cRCT is to assess whether the MENTUPP intervention is effective in improving mental health and wellbeing (primary outcome) and reducing stigma, depression and suicidal behaviour (secondary outcome) in employees. The study will also involve a process and economic evaluation. CONCLUSIONS At present, there is no known multi-level, tailored, flexible and accessible workplace-based intervention for the prevention of non-clinical and clinical symptoms of depression, anxiety and burnout, and the promotion of mental wellbeing. The results of this study will provide a comprehensive overview of the implementation and effectiveness of such an intervention in a variety of contexts, languages and cultures leading to the overall goal of delivering an evidence-based intervention for mental health in the workplace. TRIAL REGISTRATION Please refer to Item 2a and registration ISRCTN14104664. Registered on 12th July 2022.
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Affiliation(s)
- Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland.
- National Suicide Research Foundation, Cork, Ireland.
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia.
| | | | | | - Paul Corcoran
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Eve Griffin
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Caleb Leduc
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - Evelien Coppens
- Centre for Care Research and Consultancy, LUCAS, KU Leuven, Louvain, Belgium
| | - Fotini Tsantila
- Centre for Care Research and Consultancy, LUCAS, KU Leuven, Louvain, Belgium
| | - Victoria Ross
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Kahar Abdulla
- European Alliance Against Depression E.V, Leipzig, Germany
| | - Pia Hauck
- European Alliance Against Depression E.V, Leipzig, Germany
| | - Benedikt L Amann
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria I Addiccions, Barcelona, 08019, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Univ. Pompeu Fabra, Barcelona, Spain
| | - Birgit Aust
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | | | - Luigia D'Alessandro
- International Association for Suicide Prevention (IASP), Washington, DC, USA
| | - Naim Fanaj
- College of Medical Sciences Rezonanca, Mental Health Center Prizren, Prishtina, Kosovo
| | | | - Jeroen Luyten
- Department of Public Health and Primary Care, Faculty of Medicine, Leuven Institute for Healthcare Policy, KU Leuven, Belgium
| | - Sharna Mathieu
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Gentiana Qirjako
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Hanna Reich
- German Depression Foundation, Leipzig, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Depression Research Centre of the German Depression Foundation, University Hospital, Goethe University, Frankfurt Am Main, Germany
| | - Sarita Sanches
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, The Netherlands
- Altrecht Mental Health Care, Utrecht, The Netherlands
| | - Monika Ditta Tóth
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Joseph Kilroy
- The Chartered Institute of Building, Dublin, Ireland
| | - Karen Michell
- Institution of Occupational Safety and Health, Leicester, UK
| | - Nicola Reavley
- School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, Centre for Mental Health, The University of Melbourne, Melbourne, Australia
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Chantal Van Audenhove
- Centre for Care Research and Consultancy, LUCAS, KU Leuven, Louvain, Belgium
- Academic Center for General Practice, KU Leuven, Louvain, Belgium
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