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Roxane D, Bruno R, Cécile B, Braybrook D, Elise PC, Thibaut R, Guillaume E. What contributes to promote sexual health in cancer palliative care? A realist review. Sex Med Rev 2024:qeae008. [PMID: 38508856 DOI: 10.1093/sxmrev/qeae008] [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: 07/29/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Sexuality is an important determinant of the overall health of a population and remains so at the end of life and in patients with advanced cancers. Despite the abundant literature on sexuality and intimacy, these topics have been rarely discussed in the context of cancer palliative care, and very few interventions to promote sexual health in patients undergoing cancer palliative care have been explored. OBJECTIVES In this study we sought to identify which factors and mechanisms contribute to promoting sexual health in cancer palliative care. METHODS A realist review was performed according to the guidelines of the realist and meta-narrative evidence synthesis method guidelines. Articles published between January 2010 and June 2021 were searched in 4 databases. Records were screened for their relevance regarding a predefined list of context-mechanism-outcome (CMO) configurations. Abstracts were independently screened by 2 authors before the data were extracted from the full-text articles selected for inclusion. With the use of abductive and retroductive reasoning techniques, each article was examined for evidence of its contribution to one of the CMO configurations, which could be refined when relevant. The data were summarized according to the final CMO configurations. RESULTS Of the 2056 articles identified, 38 articles were included in the review. The data reported in these articles contributed to 7 CMO hypotheses: (1) improving communication skills, (2) healthcare provider training, (3) reorganizing the patient environment in care settings or at home, (4) managing sexual symptoms and also general symptoms, (5 and 6) patient-centered counseling or couple counseling, and (7) lifting the taboo. CONCLUSIONS The findings reported here highlight various ways to improve sexual health for patients in cancer palliative care but are limited to genital cancers. Further research should consider all types of cancer rather than being restricted to genital cancers.
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Affiliation(s)
- Donz Roxane
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
| | - Russia Bruno
- Hospitalisation à domicile, Centre Léon Bérard, Lyon 69008, France
| | - Barbaret Cécile
- Service de soins palliatifs, CHU de Grenoble, La Tronche 38700, France
| | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London SE5 9PJ, United-Kingdom
| | - Perceau-Chambard Elise
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
| | - Reverdy Thibaut
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
- Oncology Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
| | - Economos Guillaume
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
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Govindaraj R, Agar M, Currow D, Luckett T. Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes. J Med Internet Res 2023; 25:e48483. [PMID: 38015606 PMCID: PMC10716761 DOI: 10.2196/48483] [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: 04/25/2023] [Revised: 07/13/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. OBJECTIVE This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes. METHODS A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool. RESULTS Overall, 61 studies were included in the realist synthesis: 15 (25%) mixed methods studies, 9 (15%) qualitative studies, 13 (21%) descriptive studies, 21 (34%) randomized controlled trials, and 3 (5%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions-remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload. CONCLUSIONS The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters.
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Affiliation(s)
- Ramkumar Govindaraj
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Meera Agar
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - David Currow
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Tim Luckett
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Dada S, Aivalli P, De Brún A, Barreix M, Chelwa N, Mutunga Z, Vwalika B, Gilmore B. Understanding communication in community engagement for maternal and newborn health programmes in low- and middle-income countries: a realist review. Health Policy Plan 2023; 38:1079-1098. [PMID: 37650702 PMCID: PMC10566325 DOI: 10.1093/heapol/czad078] [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: 03/27/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
As community engagement (CE) is implemented for sustainable maternal and newborn health (MNH) programming, it is important to determine how these approaches work. Low- and middle-income countries (LMICs) have become a particular focus for MNH CE activities due to their high burden of maternal and neonatal deaths. MNH messaging and communication to engage communities are likely to differ by context, but how these approaches are actually developed and implemented within CE is not well understood. Understanding how communications in CE actually work is vital in the translation of learnings across programmes and to inform future projects. The purpose of this realist review is to describe how, why, to what extent and for whom communications in CE contribute to MNH programming in LMICs. After searching academic databases, grey literature and literature suggested by the expert advisory committee, documents were included if they described the CE communication processes/activities used for MNH programming in an LMIC. Relevant documents were assessed for richness (depth of insight) and rigor (trustworthiness and coherence of data/theories). Data were extracted as context-mechanism-outcome configurations (CMOCs) and synthesized into demi-regularities to contribute to theory refinement. After screening 416 records, 45 CMOCs were extracted from 11 documents. This informed five programme theories explaining that communications in CE for an MNH programme work when: communities are actively involved throughout the programme, the messaging and programme are acceptable, communication sources are trusted, the community has a reciprocal relationship with the programme and the community sees value in the programme. While these findings reflect what is often anecdotally known in CE or acknowledged in communications theory, they have implications for policy, practice and research by highlighting the importance of centring the community's needs and priorities throughout the stages of developing and implementing communications for CE in MNH.
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Affiliation(s)
- Sara Dada
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland
| | | | | | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin, School of Nursing Midwifery and Health Systems , Belfield, Dublin 4, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
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Mazzeo Rinaldi F, Leone L. Conditional cash transfers in OECD countries: a realist synthesis. Front Sociol 2023; 8:1202430. [PMID: 37780692 PMCID: PMC10537917 DOI: 10.3389/fsoc.2023.1202430] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/18/2023] [Indexed: 10/03/2023]
Abstract
Conditional Cash Transfers (CCTs) schemes have been adopted mostly in low-income countries as a tool to break the vicious cycle of poverty transmission. Although their use is controversial, behavioral conditionalities have also been widely used in welfare-to-work strategies, minimum income scheme, and labor market "activation" policies in OECD countries. The paper presents the results of a Realist Review to synthesize the evidence of CCTs related to work conditionality, delivered in OECD countries. The evaluation literature of 23 selected CCT programs was analyzed by reconstructing Context-Mechanism-Outcome configurations. The main findings show that CCTs can be an effective counterbalance to work disincentives introduced by welfare measures. The unintended negative impacts, the role of sanctioning, and the causal pathways that may affect the most disadvantaged people and their children are discussed.
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Prieto J, Wilson J, Tingle A, Rycroft-Malone J, Williams L, Loveday H. Realist synthesis protocol for understanding which strategies are effective to prevent urinary tract infection in older people in care homes. J Adv Nurs 2023; 79:3632-3641. [PMID: 37559213 DOI: 10.1111/jan.15707] [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: 07/22/2022] [Revised: 03/06/2023] [Accepted: 05/05/2023] [Indexed: 08/11/2023]
Abstract
AIM To identify and characterize strategies, which contribute to the prevention of urinary tract infection (UTI) in older people living in care homes. DESIGN The realist synthesis has four iterative stages to (1) develop initial programme theory; (2) search for evidence; (3) test and refine theory supported by relevant evidence and (4) formulate recommendations. Data from research articles and other sources will be used to explore the connection between interventions and the context in which they are applied in order to understand the mechanisms, which influence the outcomes to prevent UTI. METHODS A scoping search of the literature and workshops with stakeholders will identify initial programme theories. These theories will be tested and refined through a systematic search for evidence relating to mechanisms that trigger prevention and recognition of UTI in older people in care homes. Interviews with key stakeholders will establish practical relevance of the theories and their potential for implementation. DISCUSSION UTI is the most commonly diagnosed infection in care home residents. Evidence on the effectiveness of strategies to prevent UTI in long-term care facilities does not address the practicality of implementing these approaches in UK care homes. The realist synthesis is designed to examine this important gap in evidence. IMPACT Our evidence-informed programme theory will help inform programmes to improve practice to reduce the incidence of UTI in older people living in care homes and related research. Patient and public involvement will be crucial to ensuring that our findings reach carers and the public. PATIENT AND PUBLIC CONTRIBUTION Involvement of patient and public representatives is embedded throughout the study to ensure it is underpinned by multiple perspectives of importance to care home residents. Our co-investigator representing patient and public involvement is a lay member of the team and will chair the Project Advisory Group, which has two additional lay members. This will help to ensure that our findings and resources reach carers and the public and represent their voice in our publications and presentations to professional and lay audiences.
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Holmes J. When should we conduct large-scale evaluations? Addiction 2023; 118:1622-1623. [PMID: 37545019 DOI: 10.1111/add.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023]
Affiliation(s)
- John Holmes
- University of Sheffield-School of Health and Related Research, Sheffield, UK
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Mills R, Mangone ER, Lesh N, Mohan D, Baraitser P. Chatbots to Improve Sexual and Reproductive Health: Realist Synthesis. J Med Internet Res 2023; 25:e46761. [PMID: 37556194 PMCID: PMC10448286 DOI: 10.2196/46761] [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: 02/24/2023] [Revised: 04/25/2023] [Accepted: 05/25/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Digital technologies may improve sexual and reproductive health (SRH) across diverse settings. Chatbots are computer programs designed to simulate human conversation, and there is a growing interest in the potential for chatbots to provide responsive and accurate information, counseling, linkages to products and services, or a companion on an SRH journey. OBJECTIVE This review aimed to identify assumptions about the value of chatbots for SRH and collate the evidence to support them. METHODS We used a realist approach that starts with an initial program theory and generates causal explanations in the form of context, mechanism, and outcome configurations to test and develop that theory. We generated our program theory, drawing on the expertise of the research team, and then searched the literature to add depth and develop this theory with evidence. RESULTS The evidence supports our program theory, which suggests that chatbots are a promising intervention for SRH information and service delivery. This is because chatbots offer anonymous and nonjudgmental interactions that encourage disclosure of personal information, provide complex information in a responsive and conversational tone that increases understanding, link to SRH conversations within web-based and offline social networks, provide immediate support or service provision 24/7 by automating some tasks, and provide the potential to develop long-term relationships with users who return over time. However, chatbots may be less valuable where people find any conversation about SRH (even with a chatbot) stigmatizing, for those who lack confidential access to digital devices, where conversations do not feel natural, and where chatbots are developed as stand-alone interventions without reference to service contexts. CONCLUSIONS Chatbots in SRH could be developed further to automate simple tasks and support service delivery. They should prioritize achieving an authentic conversational tone, which could be developed to facilitate content sharing in social networks, should support long-term relationship building with their users, and should be integrated into wider service networks.
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Affiliation(s)
| | | | - Neal Lesh
- Dimagi, Cambridge, MA, United States
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Dada S, Dalkin S, Gilmore B, Hunter R, Mukumbang FC. Applying and reporting relevance, richness and rigour in realist evidence appraisals: Advancing key concepts in realist reviews. Res Synth Methods 2023; 14:504-514. [PMID: 36872619 DOI: 10.1002/jrsm.1630] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [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: 11/01/2022] [Revised: 02/08/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023]
Abstract
The realist review/synthesis has become an increasingly prominent methodological approach to evidence synthesis that can inform policy and practice. While there are publication standards and guidelines for the conduct of realist reviews, published reviews often provide minimal detail regarding how they have conducted some methodological steps. This includes selecting and appraising evidence sources, which are often considered for their 'relevance, richness and rigour.' In contrast to other review approaches, for example, narrative reviews and meta-analyses, the inclusion criteria and appraisal of evidence within realist reviews depend less on the study's methodological quality and more on its contribution to our understanding of generative causation, uncovered through the process of retroductive theorising. This research brief aims to discuss the current challenges and practices for appraising documents' relevance, richness and rigour and to provide pragmatic suggestions for how realist reviewers can put this into practice.
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Affiliation(s)
- Sara Dada
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Sonia Dalkin
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK.,Fuse (The Centre for Translational Research in Public Health), Northumbria University, Newcastle Upon Tyne, UK
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Rebecca Hunter
- Department of Nursing and Midwifery, University of Highlands and Islands, Inverness, UK
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Abraham JM, Melendez-Torres GJ. A realist review of interventions targeting maternal health in low- and middle-income countries. Womens Health (Lond) 2023; 19:17455057231205687. [PMID: 37899651 PMCID: PMC10617292 DOI: 10.1177/17455057231205687] [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] [Received: 02/09/2023] [Revised: 09/04/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023]
Abstract
Maternal mortality is disproportionately higher in low- and middle-income countries compared to other parts of the world. International research efforts are reflective of the urgency to improve global maternal outcomes. The existing literature of maternal health interventions in low- and middle-income countries targets a variety of populations and intervention types. However, there is a notable lack of systemic reviews that examine the wider contextual and mechanistic factors that have contributed to the outcomes produced by interventions. This article aims to use realist synthesis design to identify and examine the relationships between the contexts, mechanisms and outcomes of maternal health interventions conducted in low- and middle-income countries. This will inform evidence-based practice for future maternal health interventions. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in low- and middle-income countries published in the last 5 years. We used open and axial coding of contexts, mechanisms and outcomes to develop an explanatory framework for intervention effectiveness. After eligibility screening and full-text analysis, 44 papers were included. The majority of effective interventions reported good healthcare system contexts, especially the importance of infrastructural capacity to implement and sustain the intervention. Most intervention designs used increasing knowledge and awareness at an individual and healthcare-provider level to produce intended outcomes. The majority of outcomes reported related to uptake of healthcare services by women. All mechanism themes had a relationship with this outcome. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilization and involvement to enable tailored interventions with optimal contextual fit.
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Tsang A, Lynes D, McKenzie H, Spencer S, Kelly C. Self-management programmes for adult patients with bronchiectasis: a systematic review and realist synthesis. Disabil Rehabil 2022; 44:6939-6948. [PMID: 34658309 DOI: 10.1080/09638288.2021.1978563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Self-management for patients with bronchiectasis has been identified as an important component that could potentially empower patients to manage their condition and improve their quality of life. Evidence was reviewed to investigate what self-management programmes work, why and in what circumstances. METHODS A systematic review and realist synthesis were conducted. A comprehensive database search was performed on seven databases for evidence published up to July 2021. Leading candidate self-management programmes identified from the systematic review became the focus of the realist synthesis. A realist logic of analysis was applied to produce explanatory context-mechanism-outcome configurations. These explanations were consolidated into programme theories drawing on health behaviour change theory. RESULTS By synthesising the data from eight eligible articles, programme theories articulated how three different self-management programmes work that included: (i) education and action planning, (ii) education and airway clearance techniques (ACT) and, (iii) education, exercise and ACT. Patient characteristics and collaborative partnership between healthcare professionals and patients were identified as important contexts that influenced the improvement in self-efficacy, health-related quality of life, and exercise capacity. CONCLUSIONS This review contributes to a better understanding of how the complex interaction between contexts and mechanisms can improve outcomes of clinical interest.IMPLICATIONS FOR REHABILITATIONThis evidence synthesis has identified potentially important combinations of interventions to be considered in self-management programmes for adults with bronchiectasis.Collaborative partnership between patient and healthcare professionals should be considered to improve short-term self-efficacy.Targeting self-management programmes to increase short-term health-related quality of life and exercise capacity should consider the context of patient characteristics.
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Affiliation(s)
- Anthony Tsang
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK.,Department of Nursing, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| | - Dave Lynes
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Hayley McKenzie
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Sally Spencer
- Faculty of Health & Social Care, Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Carol Kelly
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK.,Faculty of Health & Social Care, Health Research Institute, Edge Hill University, Ormskirk, UK
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Kingstone T, Chew-Graham CA, Corp N. Interventions to identify and manage depression delivered by 'nontraditional' providers to community-dwelling older adults: A realist review. Health Expect 2022; 25:2658-2679. [PMID: 36068931 DOI: 10.1111/hex.13594] [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: 03/21/2022] [Revised: 06/30/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Mental health problems experienced by older adults (60+ years of age) may remain hidden due to individual and system-level barriers. Opportunities to support early identification and management are therefore crucial. The National Health Service recommends wider public services that are embedded within local communities, but are not traditionally part of the healthcare landscape (i.e., 'nontraditional'), could facilitate engagement with healthcare by members of the public. Evidence for interventions involving Fire and Rescue, Police, Library services and postal workers, as nontraditional providers of mental health services, has not been synthesized previously. This review aims to understand how, why and in what contexts mental health interventions delivered by these nontraditional providers, to older adults, work. METHODS A realist review of interventions to identify and/or manage mental health problems (depression with or without anxiety) experienced by older adults. Systematic, cluster and iterative literature searches were conducted. Intervention evidence was appraised for rigour and explanatory relevance and then coded to inform context-mechanism-outcome configurations (CMOCs). A public advisory group supported our initial evidence search strategy and definition of key terms. This review is registered with PROSPERO (CRD42020212498). RESULTS Systematic searches revealed a dearth of evidence reporting mental health interventions delivered by nontraditional providers. Our scope was adjusted to consider interventions delivered by Fire and Police services only and for wider health and wellbeing concerns (e.g., dementia, falls prevention, mental health crises). Forty-three pieces of evidence were synthesized. Key themes included: legitimizing expanded roles, focusing on risk, intervention flexibility and organization integration; further subthemes are described. Themes map onto CMOCs and inform a preliminary programme theory. Findings were transposed to mental health contexts. CONCLUSIONS Findings highlight challenges and opportunities for Fire and Police services, as nontraditional providers, to deliver interventions that identify and/or manage mental health problems among older adults. Our programme theory explains what could work, how, for whom and also by whom (i.e., which public services). Further empirical evidence is needed to test interventions, understand acceptability and inform implementation. PATIENT OR PUBLIC CONTRIBUTION A public advisory group comprising older adults with lived experience of mental health problems and informal caregivers contributed to the original application, reviewed the scope and informed the approach to dissemination.
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Affiliation(s)
- Tom Kingstone
- School of Medicine, Keele University, Staffordshire, UK.,Research and Innovation Department, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Carolyn A Chew-Graham
- School of Medicine, Keele University, Staffordshire, UK.,Research and Innovation Department, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Nadia Corp
- School of Medicine, Keele University, Staffordshire, UK
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Caffrey L, Browne F. Understanding the social worker-family relationship through self-determination theory: A realist synthesis of Signs of Safety. Child Fam Soc Work 2022; 27:513-525. [PMID: 36246041 PMCID: PMC9542870 DOI: 10.1111/cfs.12903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/23/2021] [Accepted: 01/10/2022] [Indexed: 06/15/2023]
Abstract
Signs of Safety (SofS) is a popular framework for child protection social work practice, used in more than 200 jurisdictions worldwide. Although workers tend to find SofS tools easy to use, skilled application of the approach is challenging, and research has found that SofS is often not implemented as intended. This study aimed to deepen and inform the explanation (initial theory) of what key SofS tools and processes are expected to achieve in the family-worker interaction and why. A realist synthesis was used, involving a realist review of literature and focus groups with 22 international SofS experts. Using self-determination theory, we detail how SofS can be conceptualized as aiming to support families to experience 'autonomous' rather than 'controlled' motivation by supporting basic human needs for 'autonomy' (feeling a sense of volition), 'competence' (feeling effective) and 'relatedness' (feeling cared for). This explanation can be used for training and evaluation purposes to better explain and test how SofS expects to engage families in the child protection process. More broadly, we suggest that self-determination theory may contribute a mechanistic explanation of effective social work practice more generally and that this hypothesis should be empirically investigated.
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Affiliation(s)
- Louise Caffrey
- Social Policy, School of Social Work & Social PolicyTrinity College DublinDublinIreland
| | - Freda Browne
- General Nursing, School of Nursing, Midwifery and Health SystemsUniversity College DublinDublinIreland
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Hogervorst S, Vervloet M, Adriaanse MC, Zamboni K, Zullig LL, Schoonmade L, Hugtenburg JG, van Dijk L. Scalability of effective adherence interventions for patients using cardiovascular disease medication - a realist synthesis inspired systematic review. Br J Clin Pharmacol 2022. [PMID: 35617955 DOI: 10.1111/bcp.15418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/30/2021] [Revised: 04/15/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022] Open
Abstract
Upscaling of medication adherence interventions to routine care is still challenging. This realist theory inspired review aimed to assess which intervention aspects are potentially important for the scalability of effective cardiovascular disease (CVD) medication adherence interventions and how they are reported in effectiveness studies. A total of 4097 articles from four databases were screened of which ultimately 31 studies were included. Relevant information on scalability was extracted using a theoretic framework based on the scalability assessment tool used in the QUALIDEC study for the following domains; (i) innovation, (ii) implementers and patients, (iii) adopting organizations and health system and (iv) socio-political context. Extracted articles were analysed for themes and chains of inference, which were grouped based on commonality and source of evidence to form new hypotheses. Six different domains relevant for scalability of adherence interventions were identified: 1) Complexity of the intervention 2) training; 3) customization of the intervention; 4) drivers of the intervention; 5) technical interventions 6) stakeholder involvement. These six domains might be useful for the development of more scalable interventions by bridging the gap between research and practice. Data relevant for scalability is not well reported on in effectiveness trials for CVD medication adherence interventions and only limited data on scalability has been published in additional papers. We believe the adoption and reach of effective CVD medication adherence interventions will improve with increased awareness for the necessity of scalability in all phases of intervention development.
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Affiliation(s)
- Stijn Hogervorst
- Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Marcel C Adriaanse
- Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Karen Zamboni
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Linda Schoonmade
- University Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jacqueline G Hugtenburg
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Amsterdam, The Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of PharmacoTherapy, Epidemiology & Economics (PTEE), Faculty of Mathematics and Natural Sciences, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
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14
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Gasteiger N, van der Veer SN, Wilson P, Dowding D. How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis. JMIR Serious Games 2022; 10:e31644. [PMID: 35156931 PMCID: PMC8893595 DOI: 10.2196/31644] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 06/29/2021] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 01/20/2023] Open
Abstract
Background Using traditional simulators (eg, cadavers, animals, or actors) to upskill health workers is becoming less common because of ethical issues, commitment to patient safety, and cost and resource restrictions. Virtual reality (VR) and augmented reality (AR) may help to overcome these barriers. However, their effectiveness is often contested and poorly understood and warrants further investigation. Objective The aim of this review is to develop, test, and refine an evidence-informed program theory on how, for whom, and to what extent training using AR or VR works for upskilling health care workers and to understand what facilitates or constrains their implementation and maintenance. Methods We conducted a realist synthesis using the following 3-step process: theory elicitation, theory testing, and theory refinement. We first searched 7 databases and 11 practitioner journals for literature on AR or VR used to train health care staff. In total, 80 papers were identified, and information regarding context-mechanism-outcome (CMO) was extracted. We conducted a narrative synthesis to form an initial program theory comprising of CMO configurations. To refine and test this theory, we identified empirical studies through a second search of the same databases used in the first search. We used the Mixed Methods Appraisal Tool to assess the quality of the studies and to determine our confidence in each CMO configuration. Results Of the 41 CMO configurations identified, we had moderate to high confidence in 9 (22%) based on 46 empirical studies reporting on VR, AR, or mixed simulation training programs. These stated that realistic (high-fidelity) simulations trigger perceptions of realism, easier visualization of patient anatomy, and an interactive experience, which result in increased learner satisfaction and more effective learning. Immersive VR or AR engages learners in deep immersion and improves learning and skill performance. When transferable skills and knowledge are taught using VR or AR, skills are enhanced and practiced in a safe environment, leading to knowledge and skill transfer to clinical practice. Finally, for novices, VR or AR enables repeated practice, resulting in technical proficiency, skill acquisition, and improved performance. The most common barriers to implementation were up-front costs, negative attitudes and experiences (ie, cybersickness), developmental and logistical considerations, and the complexity of creating a curriculum. Facilitating factors included decreasing costs through commercialization, increasing the cost-effectiveness of training, a cultural shift toward acceptance, access to training, and leadership and collaboration. Conclusions Technical and nontechnical skills training programs using AR or VR for health care staff may trigger perceptions of realism and deep immersion and enable easier visualization, interactivity, enhanced skills, and repeated practice in a safe environment. This may improve skills and increase learning, knowledge, and learner satisfaction. The future testing of these mechanisms using hypothesis-driven approaches is required. Research is also required to explore implementation considerations.
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Affiliation(s)
- Norina Gasteiger
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom.,Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom.,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Paul Wilson
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
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15
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Ijaz S, Nobles J, Johnson L, Moore T, Savović J, Jago R. Preventing Childhood Obesity in Primary Schools: A Realist Review from UK Perspective. Int J Environ Res Public Health 2021; 18:13395. [PMID: 34949004 PMCID: PMC8702173 DOI: 10.3390/ijerph182413395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022]
Abstract
Childhood obesity is a global public health concern. While evidence from a recent comprehensive Cochrane review indicates school-based interventions can prevent obesity, we still do not know how or for whom these work best. We aimed to identify the contextual and mechanistic factors associated with obesity prevention interventions implementable in primary schools. A realist synthesis following the Realist And Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES) guidance was with eligible studies from the 2019 Cochrane review on interventions in primary schools. The initial programme theory was developed through expert consensus and stakeholder input and refined with data from included studies to produce a final programme theory including all of the context-mechanism-outcome configurations. We included 24 studies (71 documents) in our synthesis. We found that baseline standardised body mass index (BMIz) affects intervention mechanisms variably as a contextual factor. Girls, older children and those with higher parental education consistently benefitted more from school-based interventions. The key mechanisms associated with beneficial effect were sufficient intervention dose, environmental modification and the intervention components working together as a whole. Education alone was not associated with favourable outcomes. Future interventions should go beyond education and incorporate a sufficient dose to trigger change in BMIz. Contextual factors deserve consideration when commissioning interventions to avoid widening health inequalities.
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Affiliation(s)
- Sharea Ijaz
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 2NT, UK; (J.N.); (T.M.); (J.S.); (R.J.)
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - James Nobles
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 2NT, UK; (J.N.); (T.M.); (J.S.); (R.J.)
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK;
| | - Theresa Moore
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 2NT, UK; (J.N.); (T.M.); (J.S.); (R.J.)
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
- Cochrane UK Methods Support Unit, Editorial & Methods Department, London SW1Y 4QX, UK
| | - Jelena Savović
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 2NT, UK; (J.N.); (T.M.); (J.S.); (R.J.)
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Russell Jago
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 2NT, UK; (J.N.); (T.M.); (J.S.); (R.J.)
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK;
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16
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Duddy C, Roberts N. Identifying evidence for five realist reviews in primary health care: A comparison of search methods. Res Synth Methods 2021; 13:190-203. [PMID: 34494358 DOI: 10.1002/jrsm.1523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/19/2021] [Revised: 06/28/2021] [Accepted: 08/20/2021] [Indexed: 01/14/2023]
Abstract
The approach to identifying evidence for inclusion in realist reviews differs from that used in 'traditional' systematic reviews. Guidance suggests that realist reviews should be inclusive of diverse data from a range of sources, gathered in iterative searching cycles. Saturation is prioritised over exhaustiveness. Supplementary techniques such as citation snowballing are emphasised as potentially important sources of evidence. This paper describes the processes used to identify evidence in a selection of realist reviews focused on primary health care settings and examines the origin and type of evidence selected for inclusion. Data from five realist reviews were extracted from (a) reviewers' reference management libraries and (b) records kept by review teams. Although all reviews focused on primary health care, they used data from a wide range of document types and research designs, drawing on learning from multiple perspectives and settings, and sourced the documents containing this data in a variety of ways. Systematic searching of academic databases played an important role, supplementary search techniques such as snowballing were used to identify a significant proportion of documents included in the reviews. Our analysis demonstrates the diverse data sources used within realist reviews and the need for flexible, responsive efforts to identify relevant documents. Reviewers and information specialists should devise approaches to data gathering that reflect the individual needs of realist review projects and report these transparently.
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Affiliation(s)
- Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
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17
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Jenkins G, Maugeri I, Palermo C, Hardwick R. Using realist approaches in nutrition and dietetics research. Nutr Diet 2021; 78:238-251. [PMID: 34155774 PMCID: PMC8361699 DOI: 10.1111/1747-0080.12675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 01/14/2023]
Abstract
AIM The aim of this study was to explore the use and future potential of realist approaches to research in nutrition and dietetics. METHODS A targeted literature review was used to search key journals (n = 7) in nutrition and dietetics to identify existing research using a realist approach. A narrative synthesis was conducted to explore findings in relation to the research aim. RESULTS Nine research papers (four realist evaluations, five realist reviews) describing seven nutrition interventions were found, which revealed the application of realist research in nutrition and dietetics has focused on public health interventions. Realist research provided a deeper, more nuanced understanding of varied outcomes including the role of context, and contributed to the development of theory about how and why interventions work. As a theory-driven research method, realist research was able to assist in overcoming methodological shortcomings to contribute to meaningful, transferable findings. CONCLUSION The results highlight the potential contribution of the realist research in nutrition and dietetics to evaluate interventions and inform future practice.
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Affiliation(s)
- Gemma Jenkins
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Isabella Maugeri
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia.,Monash Centre for Scholarship in Health Education, Monash University, Melbourne, Victoria, Australia
| | - Rebecca Hardwick
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, England
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18
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Maugeri IP, Brimblecombe J, Choi TST, Kleve S, Palermo C. For whom and under what circumstances do nutrition-education cooking interventions work: a realist synthesis. Nutr Rev 2021; 79:479-493. [PMID: 32443146 DOI: 10.1093/nutrit/nuaa021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To explore for whom and under what circumstances nutrition-education cooking interventions affect nutrition outcomes in adults. METHODS A realist synthesis was undertaken. The CINAHL, Ovid Medline, Scopus, and Web of Science databases were searched for literature published between 1980 and 2019, using the terms "cook" and "intervention" and their synonyms; 5759 articles were identified. Grey literature was sourced for further additional program context. A total of 23 articles (n = 11 programs) met inclusion criteria for analysis. Program data were coded in duplicate for context, outcome, and mechanism configurations, and used to build a refined program theory. RESULTS Nutrition-education cooking interventions targeted at low-socioeconomic-status and marginalized populations produced a range of positive nutrition outcomes. Outcomes were observed when the program involved hands-on cooking and a skilled facilitator coupled with individual self-efficacy, knowledge gain, family support, and an expectation of positive health outcomes. CONCLUSION These findings highlight key program components to achieve improvements in nutrition and important recommendations for nutrition-education cooking interventions.
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Affiliation(s)
- Isabella P Maugeri
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia.,Honorary Fellow of the Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tammie S T Choi
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Sue Kleve
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
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19
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Duddy C, Wong G. Efficiency over thoroughness in laboratory testing decision making in primary care: findings from a realist review. BJGP Open 2021; 5:bjgpopen20X101146. [PMID: 33293413 DOI: 10.3399/bjgpopen20X101146] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Existing research demonstrates significant variation in test-ordering practice, and growth in the use of laboratory tests in primary care. Reviews of interventions designed to change test-ordering practice report heterogeneity in design and effectiveness. Improving understanding of clinicians’ decision making in relation to laboratory testing is an important means of understanding practice patterns and developing theory-informed interventions. Aim To develop explanations for the underlying causes of patterns of variation and increasing use of laboratory tests in primary care, and make recommendations for future research and intervention design. Design & setting Realist review of secondary data from primary care. Method Diverse evidence, including data from qualitative and quantitative studies, was gathered via systematic and iterative searching processes. Data were synthesised according to realist principles to develop explanations accounting for clinicians’ decision making in relation to laboratory tests. Results A total of 145 documents contributed data to the synthesis. Laboratory test ordering can fulfil many roles in primary care. Decisions about tests are incorporated into practice heuristics and tests are deployed as a tool to manage patient interactions. Ordering tests may be easier than not ordering tests in existing systems. Alongside high workloads and limited time to devote to decision making, there is a common perception that laboratory tests are relatively inconsequential interventions. Clinicians prioritise efficiency over thoroughness in decision making about laboratory tests. Conclusion Interventions to change test-ordering practice can be understood as aiming to preserve efficiency or encourage thoroughness in decision making. Intervention designs and evaluations should consider how testing decisions are made in real-world clinical practice.
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20
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Defever E, Jones M. Rapid Realist Review of School-Based Physical Activity Interventions in 7- to 11-Year-Old Children. Children (Basel) 2021; 8:52. [PMID: 33467132 PMCID: PMC7830730 DOI: 10.3390/children8010052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 01/05/2023]
Abstract
Meta-analysis of physical activity interventions in school settings have revealed low efficacy and that there is a need to explore implementation fidelity. The aim of this rapid realist review was to determine, what physical activity interventions in school settings for children aged 7- to 11-years-old works, for whom, and in what circumstances. The realist synthesis was conducted following RAMESES guidelines. Relevant studies were identified following a systematic search process and data from 28 studies was extracted for evidence to form context-mechanism-outcome configurations that were clustered and refined. Using the five-level socioecological model, the program theories were classified into the levels of intrapersonal (child), interpersonal (teachers), institutional (program content, school administration, and school environment), community (home and neighborhood), and policy. The school level led to most context-mechanism-outcome configurations related to school leadership and policy, workforce structure, program characteristics, and school environment. At each level, we identified features of interventions, alongside implementation considerations that might work to promote efficacy and sustainability. The need to recognize the school environment as part of a complex system with multi-level interaction and influences was a key finding. In line with realist philosophy, the researchers encouraged primary research to confirm, refute, and refine the program theories presented.
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Affiliation(s)
- Emmanuel Defever
- Health and Social Sciences, Faculty of Sport, Southampton Solent University, Southampton SO14 0YN, UK;
| | - Michelle Jones
- Resilience and Human Performance Research and Knowledge Exchange Group, Plymouth Marjon University, Plymouth PL6 8BH, UK
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21
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Singh S, Yang L, Butalia S, Quan H, Turin TC. Identifying the facilitators, constraints and barriers of community indoor walking programmes: protocol for a realist synthesis. BMJ Open 2020; 10:e034342. [PMID: 32737086 PMCID: PMC7394178 DOI: 10.1136/bmjopen-2019-034342] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Physical inactivity is a costly and leading health risk factor. Engaging in moderate or more intense regular physical activity reduces premature mortality at the population level. Walking is a viable option for achieving the recommended level of physical activity. Yet, the sedentary lifestyle is trending. Determinants of physical activity may be personal, social or environmental. Health promotion endeavours aiming to enhance population-level physical activity are reported in the literature. However, a full range of factors influencing the development and implementation of sustainable indoor walking programmes is unclear. The current review protocol is aimed at describing a process of realist synthesis to uncover contexts, mechanisms and outcomes of indoor walking intervention programmes, which might reveal facilitators, constraints and barriers of planning, implementing and participating in indoor walking initiatives open for the members of the general public. METHODS AND ANALYSIS We will employ a realist synthesis to determine successes or failures in certain circumstances for specific stakeholders, which will aid in developing a sustainable mall walking health promotion and community engagement programme. Qualitative, quantitative and mixed-method articles and reports will be screened for intervention theories and models in order to identify elements of programmes that may be linked to the success or failure of the interventions. Data related to the context, mechanism and outcome of the interventions will be collected, analysed and synthesised iteratively until a theoretical understanding develops, which might explain the intricacies of the success and failure of identified indoor walking programmes. The review process will be conducted and evaluated by using the recommended tools. ETHICS AND DISSEMINATION Ethical approval, such as Conjoint Health Research Ethics Board, was not required for this study because no direct interaction with patients will occur for data collection and analysis. We will disseminate directly to the scholarly community through publication and presentation and may post on social media or websites. PROSPERO REGISTRATION NUMBER CRD42020150415.
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Affiliation(s)
- Shaminder Singh
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lin Yang
- Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tanvir C Turin
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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22
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Hudon C, Chouinard MC, Aubrey-Bassler K, Muhajarine N, Burge F, Bush PL, Danish A, Ramsden VR, Légaré F, Guénette L, Morin P, Lambert M, Fick F, Cleary O, Sabourin V, Warren M, Pluye P. Case Management in Primary Care for Frequent Users of Health Care Services: A Realist Synthesis. Ann Fam Med 2020; 18:218-226. [PMID: 32393557 PMCID: PMC7213991 DOI: 10.1370/afm.2499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/05/2019] [Revised: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Case management (CM) is a promising intervention for frequent users of health care services. Our research question was how and under what circumstances does CM in primary care work to improve outcomes among frequent users with chronic conditions? METHODS We conducted a realist synthesis, searching MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) for articles meeting the following criteria: (1) population: adult frequent users with chronic disease, (2) intervention: CM in a primary care setting with a postintervention evaluation, and (3) primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Academic and gray literature were evaluated for relevance and robustness. Independent reviewers extracted data to identify context, mechanism, and outcome (CMO) configurations. Analysis of CMO configurations allowed for the modification of an initial program theory toward a refined program theory. RESULTS Of the 9,295 records retrieved, 21 peer-reviewed articles and an additional 89 documents were retained. We evaluated 19 CM interventions and identified 11 CMO configurations. The development of a trusting relationship fostering patient and clinician engagement in the CM intervention was recurrent in many CMO configurations. CONCLUSION Our refined program theory proposes that in the context of easy access to an experienced and trusted case manager who provides comprehensive care while maintaining positive interactions with patients, the development of this relationship fosters the engagement of both individuals and yields positive outcomes when the following mechanisms are triggered: patients and clinicians feel supported, respected, accepted, engaged, and committed; and patients feel less anxious, more secure, and empowered to self-manage.
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Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Maud-Christine Chouinard
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Kris Aubrey-Bassler
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Nazeem Muhajarine
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Fred Burge
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Paula Louise Bush
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Alya Danish
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Vivian R Ramsden
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - France Légaré
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Line Guénette
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Paul Morin
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Mireille Lambert
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Fiona Fick
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Olivia Cleary
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Véronique Sabourin
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Mike Warren
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
| | - Pierre Pluye
- Département de Médecine de Famille et de Méde-cine d'Urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada (C.H.); Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada, (M.C.C.); Memorial University, Primary Healthcare Research Unit, St. John's, Newfoundland and Labrador, Canada (K.A.B., O.C.); Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (N.M.); Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada (F.B.); Département de Médecine de Famille, Univer-sité McGill, Montréal, Québec, Canada (P.L.B., P.P.); Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada (A.D.); Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.R.R.); Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Québec, Canada (F.L.); Faculté de Pharmacie, Université Laval, Québec, Québec, Canada (L.G.); École de Travail Social, Université de Sherbrooke, Sherbrooke, Québec, Canada (P.M.); Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec, Canada (M.L.); Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (F.F.); Quebec-SPOR SUPPORT Unit, Qué-bec, Québec, Canada (V.S.); Newfoundland and Labrador-SPOR SUPPORT Unit, Saint John's Newfoundland and Labrador, Canada (M.W.)
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Abstract
Many patients with end-stage kidney disease require haemodialysis, a treatment that requires attending hospital three times a week for four hours each visit. This treatment impacts profoundly on mental health. Arts-based interventions for patients receiving haemodialysis could address the impact of this treatment; however, there is no consensus on methods of implementation and mechanisms underlying these interventions in specific clinical contexts. Using a realist approach, relevant articles were synthesised to inform theory relating to the mechanism and implementation of complex arts-based interventions for haemodialysis patients. The theoretical framework includes two implementation phases, firstly delivery of person-centred art activities during haemodialysis and secondly, display of completed artwork. This intervention triggers mechanisms including flow and social capital. Implementation is hindered by constraints of the haemodialysis unit and patients' lack of confidence in their artistic skills. These issues can be addressed through aflexible approach to implementation and support from healthcare professionals.
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Affiliation(s)
- Claire Carswell
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast UK
| | - Helen McAneney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast UK
| | - Jenny Baxley Lee
- UF Health Shands Arts in Medicine, University of Florida, Gainesville, Florida, USA
| | - Helen Noble
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
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Blane DN, Macdonald S, O'Donnell CA. What works and why in the identification and referral of adults with comorbid obesity in primary care: A realist review. Obes Rev 2020; 21:e12979. [PMID: 31867842 PMCID: PMC7078935 DOI: 10.1111/obr.12979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 12/20/2022]
Abstract
Primary care practitioners (PCPs) are well placed to identify individuals with obesity and weight-related comorbidities and to refer them to weight management services (WMS), but this does not often happen in practice. In this realist review, we searched six databases for intervention studies targeted at PCPs to improve the identification and referral of adults with comorbid obesity. Realist analysis was used to identify context-mechanism-outcome (CMO) configurations across 30 included papers (reporting on 27 studies). Most studies used multiple intervention strategies, categorised into: (a) training, (b) tools to improve identification, (c) tools to improve ease of referral, (d) audit/feedback, (e) working in networks/quality circles, and (f) other. The realist synthesis identified 12 mechanisms through which interventions work to improve identification and referral, including increasing knowledge about obesity and awareness of and confidence in WMS among practitioners, improved communication and trust between practitioners and WMS, and higher priority given to weight management among primary care teams. The theory of "candidacy" (a person's eligibility for medical attention and intervention) provided a robust explanatory framework but required refinement: (a) to take account of the different services (primary care and weight management) that patients must navigate to access support; and (b) to acknowledge the importance of wider contextual factors.
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Affiliation(s)
- David N Blane
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sara Macdonald
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Catherine A O'Donnell
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Booth A, Briscoe S, Wright JM. The "realist search": A systematic scoping review of current practice and reporting. Res Synth Methods 2019; 11:14-35. [PMID: 31714016 DOI: 10.1002/jrsm.1386] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 04/11/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 11/06/2022]
Abstract
The requirement for literature searches that identify studies for inclusion in systematic reviews should be systematic, explicit, and reproducible extends, at least by implication, to other types of literature review. However, realist reviews commonly require literature searches that challenge systematic reporting; searches are iterative and involve multiple search strategies and approaches. Notwithstanding these challenges, reporting of the "realist search" can be structured to be transparent and to facilitate identification of innovative retrieval practices. Our six-component search framework consolidates and extends the structure advanced by Pawson, one of the originators of realist review: formulating the question, conducting the background search, searching for program theory, searching for empirical studies, searching to refine program theory and identifying relevant mid-range theory, and documenting and reporting the search process. This study reviews reports of search methods in 34 realist reviews published within the calendar year of 2016. Data from all eligible reviews were extracted from the search framework. Realist search reports poorly differentiate between the different search components. Review teams often conduct a single "big bang" multipurpose search to fulfill multiple functions within the review. However, it is acknowledged that realist searches are likely to be iterative and responsive to emergent data. Overall, the search for empirical studies appears most comprehensive in conduct and reporting detail. In contrast, searches to identify and refine program theory are poorly conducted, if at all, and poorly reported. Use of this framework offers greater transparency in conduct and reporting while preserving flexibility and methodological innovation.
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Affiliation(s)
- Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Simon Briscoe
- Exeter HS&DR Evidence Synthesis Centre, Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Judy M Wright
- Academic Unit of Health Economics, Leeds Institute of Health Science, University of Leeds, Leeds, UK
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Keen J, Abdulwahid M, Greenhalgh J, King N, Wright J, Randell R. Sustainable Information Infrastructures: Insights from a Realist Synthesis. Stud Health Technol Inform 2019; 265:63-68. [PMID: 31431578 DOI: 10.3233/shti190139] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Policy makers and health system managers in many countries are advocating the deployment of inter-operable health information technology systems, spanning organisations in a health economy, believing that they will be clinically effective. The case for investments has not, however, been made to date. This paper presents early results from a systematic review of the effects of inter-operable systems on patient safety. The review uses the realist synthesis method, which focuses on evidence about the decisions and actions that link interventions and outcomes, as well as the evidence about those outcomes. The evidence base is sufficient to identify plausible arguments for investments in inter-operable systems. This said, there is limited empirical evidence about each of the steps in the sequences of events. We comment on implications for the design of sustainable socio-technical solutions. We suggest that current gaps in the evidence base are in areas where informatics field methods can make a valuable contribution to our understanding of the role of inter-operable systems in patient safety.
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Abstract
INTRODUCTION Holistic healthcare considers the whole person-their body, mind, spirit and emotions-and has been associated with narrative medicine practice. Narrative medicine is medicine performed with narrative skill and has been offered as a model for humanism and effective medical practice. Narrative medicine interventions have been associated with physicians' increased empathy and more meaningful interactions with patients about managing their illness and preventative medicine. However, while there is some evidence that certain groups are more open to narrative practices (eg, traditional vs Western medical students), the extent to which narrative medicine interventions during undergraduate medical education impacts on students' readiness for holistic care, as well as the underlying reasons why, is unknown. METHODS AND ANALYSIS Realist review is a theory-driven approach to evaluate complex interventions. It focuses on understanding how interventions and programmes work (or not) in their contextual setting. This realist synthesis aimed to formulate a theory around the influence of narrative medicine medical students' readiness for holistic care practice. We will follow Pawson's five steps: locate existing theories, search strategy, study selection, data extraction, data analysis and synthesis. We will use the following electronic databases: Web of Science, Medline, Scopus and Embase. Articles between January 2008 and September 2018 will be included. Results will be written according to the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) standard for reporting realist syntheses. ETHICS AND DISSEMINATION Ethics approval was obtained from the Chang Gung Memorial Hospital for the wider study. The findings of this review will provide useful information for academics and policymakers, who will be able to apply the findings in their context when deciding whether and how to introduce narrative medicine programmes into medical students' curricula. We will publish our findings in peer-reviewed journals and international conferences. PROSPERO REGISTRATION NUMBER CRD42018115447.
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Affiliation(s)
- Yufrica Huang
- Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Lynn V Monrouxe
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Chien-Da Huang
- Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Medical Education and Thoracic Medicine of Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Garg P, Eastwood J, Liaw ST. A Realist Synthesis of Literature Informing Programme Theories for Well Child Care in Primary Health Systems of Developed Economies. Int J Integr Care 2019; 19:5. [PMID: 31367204 PMCID: PMC6659757 DOI: 10.5334/ijic.4177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/10/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Well-child Care is the provision of preventative health care services for children and their families. The approach, however, to the universal provision of those services is contentious. METHODS We undertook a realist synthesis to enhance understanding of the theoretical mechanisms driving Well-child Care by searching for published and grey literature from multiple databases. FINDINGS Well-child Care is re-conceptualised as an integrated program delivered in the continuum of pregnancy, infancy and childhood. Depending on the context, Well-child Care can be a policy, a strategy, or an actual clinical practice that promotes child and family health. The main mechanisms include: role, training and continuity of health providers; administrators' views of the return of investment on achieved outcomes; access to services by families; and the adaptation of programs to meet the dynamic needs of stakeholders. Evidence indicates that for most outcomes, Well-child Care is best delivered in partnerships between community health, social care, and early childhood education sectors. CONCLUSIONS We conclude that Well-child Care policy and program leaders should shift their focus to the integration of: human and physical resources; policy instruments; and shared agreement on outcomes measures across health, social and education sectors. In addition, countries should work towards strengthening universal early education programs and parents' health literacy regarding child development, health and safety.
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Affiliation(s)
- Pankaj Garg
- Department of Community Paediatrics, Liverpool Hospital, Liverpool, NSW, AU
- Specialist Disability Health Team, South Western Sydney Local Health District, NSW, AU
- South Western Sydney Local Health District, NSW, AU
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Women’s and Children’s Health, University of New South Wales (UNSW), AU
| | - John Eastwood
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Women’s and Children’s Health, University of New South Wales (UNSW), AU
- School of Public Health, University of Sydney, Sydney, NSW, AU
- School of Public Health, Griffith University, Gold Coast, QLD, AU
- Department of Community Paediatrics, Sydney Local Health District, Croydon, NSW, AU
- School of Public Health and Community Medicine, UNSW, AU
| | - Siaw-Teng Liaw
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Public Health and Community Medicine, UNSW, AU
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Abstract
INTRODUCTION Supervision training aims to develop workplace supervisory competencies. Despite extensive supervision literature, including literature reviews, the processes through which supervision training interventions produce their effects, for whom and under what circumstances is not clearly delineated. The purpose of this study is to explain the effect of contextual factors on the underpinning mechanisms of supervision training outcomes. METHODS AND ANALYSIS We propose to examine supervision training interventions across the health and human services workforce using realist methods. Pawson's five stages for undertaking a realist synthesis will be followed: (1) clarifying the scope of the review; (2) determining the search strategy; (3) study selection; (4) extracting data and (5) synthesising the evidence and drawing conclusions. Extracted data will include study characteristics, characteristics of participant cohort, intervention type, contextual factors, underlying mechanisms and supervision training outcomes. Patterns in context-mechanism-outcome configurations will be identified. Initial programme theories will be developed based on a comprehensive search of the literature, which will include key terms relating to supervision and training. The search strategy will involve: (1) electronic database searching using Medline, Cumulative Index to Nursing and Allied Health Literature, Social Services Abstracts, Educational Resources Information Center, PsycINFO and Australian Public Affairs Information Service and (2) hand and citation searching. We will also contact authors where necessary and discuss identified literature among the project team with extensive expertise in supervision training. ETHICS AND DISSEMINATION The realist synthesis will propose an evidence-informed theory of supervision training interventions (ie, what interventions work for whom and why). The findings will be disseminated in peer-reviewed journals and presentations and through discussions with relevant organisations and stakeholders. The research will be used by educators to develop evidenced-based supervision training interventions. It will also help workplace supervisors to better understand what types of supervision training might work most optimally for them and their colleagues. Other researchers could use the synthesis findings to guide future supervision research. PROSPERO REGISTRATION NUMBER CRD42018094186.
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Affiliation(s)
- Sarah Lee
- Faculty of Medicine, Nursing and Health Sciences, Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Melbourne, Victoria, Australia
| | - Charlotte Denniston
- Faculty of Medicine, Nursing and Health Sciences, Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Melbourne, Victoria, Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vicki Edouard
- Faculty of Medicine, Nursing and Health Sciences, Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Melbourne, Victoria, Australia
| | - Claire Palermo
- Faculty of Medicine, Nursing and Health Sciences, Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Melbourne, Victoria, Australia
| | - Kirsty Pope
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Keith Sutton
- Rural Health, Monash University, Warragul, Victoria, Australia
| | - Susan Waller
- Rural Health, Monash University, Warragul, Victoria, Australia
| | - Bernadette Ward
- Rural Health, Monash University, Bendigo, Victoria, Australia
| | - Charlotte Rees
- Faculty of Medicine, Nursing and Health Sciences, Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Melbourne, Victoria, Australia
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Abstract
INTRODUCTION The validity of feedback as one of the defining components for electronic portfolios (e-portfolios) to be effective and efficacious has yet to be demonstrated. While the literature has shown individual beneficial features of e-portfolios and feedback per se, evidence of feedback as mediated through technology directly resulting in improved educational practice is scarce. The explanation of how feedback via e-portfolio improves educational practice is particularly vague. METHODS AND ANALYSIS The aim of this research is to unpack how and why feedback via e-portfolio is likely to flourish or wither in its path. Given the complexity of intervention, we will apply a theory-driven approach for evidence synthesis called realist synthesis. Informed by realist philosophy of science, it seems the most appropriate method because it explores observed outcomes (O) in terms of causal relationship between relevant contexts (C) and generating mechanisms (M). Initial programme theory will be developed through literature scoping. Later on it will be tested against purposively gathered evidence (through database and journal search), which simultaneously will be evaluated for rigour and relevance (whether method used are trustworthy and whether data contributes to theory building). We strive to (1) uncover 'context sensitive' mechanisms that generate feedback via e-portfolio to be (in) effective and (2) define in what circumstances is this mostly likely to occur. ETHICS AND DISSEMINATION The synthesis report will be written according to the RAMESES guidelines and its findings will be published in peer reviewed articles and presented at relevant conferences. The aim is to inform: (1) policy and decision makers for future-course design; (2) medical educators/clinical supervisors and learners for improved educational use. No formal ethical approval is required. PROSPERO REGISTRATION NUMBER 120863.
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Affiliation(s)
- Mojca Babovič
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital Linkou Branch, Taoyuan City, Taiwan
| | - Ren-Huei Fu
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital Linkou Branch, Taoyuan City, Taiwan
| | - Lynn V Monrouxe
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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Tan SY, Melendez-Torres GJ, Pang T. Implementation of provider payment system reforms in the age of universal health coverage: a realist review of evidence from Asian developing countries. J Health Serv Res Policy 2019; 24:279-287. [PMID: 31007065 DOI: 10.1177/1355819619842305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/15/2022]
Abstract
Objective Launched to assist in achieving universal health coverage, provider payment reform (PPR) is one of the most important policy tools deployed to transform incentives within a health system that is plagued with allocative inefficiency and high out-of-pocket payments to one that is able to deliver basic services and be cost-efficient. However, the black box of such reform – that is, the contexts in which reform operates, the mechanisms by which it changes health systems and behaviour within health systems, and the outcome patterns that arise from – remains unexplored. This review aims to examine the implementation mechanisms underlying PPR in Asian developing countries. Methods A realist synthesis approach was employed to tease out the configurative elements of PPR in developing countries. A multimethod and retrospective search was conducted to locate the evidence. A programme theory and data extraction framework were developed. Data were analysed using thematic synthesis to inform an overarching realist synthesis, expressed as a set of synthesized context-mechanism-outcome configurations. Results This review found that the policy design of PPR, policy capacity, willingness of policy adoption at the local government level and provider autonomy are critical contextual factors that could trigger different policy mechanisms leading to either intended theoretical outcomes or perverse incentives. Conclusions Our findings, demonstrating the PPR implementation contexts and mechanisms that have worked in Asian countries, have implications in terms of policy learning for most developing countries that are contemplating rolling out similar reforms in the future.
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Affiliation(s)
- Si Ying Tan
- Researcher, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - G J Melendez-Torres
- Senior Lecturer, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, UK
| | - Tikki Pang
- Visiting Professor, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
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Power J, Gilmore B, Vallières F, Toomey E, Mannan H, McAuliffe E. Adapting health interventions for local fit when scaling-up: a realist review protocol. BMJ Open 2019; 9:e022084. [PMID: 30679286 PMCID: PMC6347947 DOI: 10.1136/bmjopen-2018-022084] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/21/2018] [Accepted: 10/23/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Scaling-up is essential to ensure universal access of effective health interventions. Scaling-up is a complex process, which occurs across diverse systems and contexts with no one-size-fits-all approach. To date, little attention has been paid to the process of scaling-up in how to make adaptations for local fit. The aim of this research is to develop theory on what actions can be used to make adaptations to health interventions for local fit when scaling-up across diverse contexts that will have practical application for implementers involved in scaling-up. METHODS AND ANALYSIS Given the complexity of this subject, a realist review methodology was selected. Specifically, realist review emphasises an iterative, non-linear process, whereby the review is refined as it progresses. The identification of how the context may activate mechanisms to achieve outcomes is used to generate theories on what works for whom in what circumstances. This protocol will describe the first completed stage of development of an initial programme theory framework, which identified potential actions, contexts, mechanisms and outcomes that could be used to make adaptations when scaling-up. It will then outline the methods for future stages of the review which will focus on identifying case examples of scale-up and adaptation in practice. This realist review consists of six stages: (i) clarifying scope and development of a theoretical framework, (ii) developing a search strategy, (iii) selection and appraisal, (iv) data extraction, (v) data synthesis and analysis and (vi) further theory refinement with stakeholders. ETHICS AND DISSEMINATION This review will develop theory on how adaptations can be made when scaling-up. Findings will be disseminated in a peer-reviewed journal and through stakeholder engagement as part of the research process. Ethical approval has been received through Health Policy and Management/Centre for Global Health Research Ethics Committee of Trinity College Dublin.
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Affiliation(s)
- Jessica Power
- Centre for Global Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Brynne Gilmore
- Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Frédérique Vallières
- Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Hasheem Mannan
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Abstract
Realist synthesis is a literature review methodology for understanding how, for whom, and under what circumstances complex interventions function in complex environments. Using a heuristic called the context-mechanism-outcome (CMO) configuration, realist synthesis produces evidence-informed theories about the interactions between intervention mechanisms and their implementation contexts. Public health interventions and their effects unfold over time and develop differently in different contexts. Much of what causes programs to function remains in a realm beyond empirical measurement. By scrutinizing the theories relevant to the interventions of interest, and by enhancing the conceptualization of complex outcomes, the realist approach deprioritizes evidence hierarchies and harnesses insights from diverse data sources to generate causal understanding. The dynamic learning process that can arise in conducting a realist synthesis may generate new ideas for program development and innovation apart from what can be achieved in reviews providing a summation and aggregation of quantified evidence.
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Affiliation(s)
- Justin Jagosh
- Centre for Advancement in Realist Evaluation and Synthesis (CARES; http://www.realistmethodology-cares.org ); and Institute of Population Health Sciences, University of Liverpool, Liverpool L69 3GL, United Kingdom;
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Stanciu MA, Law RJ, Nafees S, Hendry M, Yeo ST, Hiscock J, Lewis R, Edwards RT, Williams NH, Brain K, Brocklehurst P, Carson-Stevens A, Dolwani S, Emery J, Hamilton W, Hoare Z, Lyratzopoulos G, Rubin G, Smits S, Vedsted P, Walter F, Wilkinson C, Neal RD. Development of an intervention to expedite cancer diagnosis through primary care: a protocol. BJGP Open 2018; 2:bjgpopen18X101595. [PMID: 30564728 PMCID: PMC6189786 DOI: 10.3399/bjgpopen18x101595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/16/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND GPs can play an important role in achieving earlier cancer diagnosis to improve patient outcomes, for example through prompt use of the urgent suspected cancer referral pathway. Barriers to early diagnosis include individual practitioner variation in knowledge, attitudes, beliefs, professional expectations, and norms. AIM This programme of work (Wales Interventions and Cancer Knowledge about Early Diagnosis [WICKED]) will develop a behaviour change intervention to expedite diagnosis through primary care and contribute to improved cancer outcomes. DESIGN & SETTING Non-experimental mixed-method study with GPs and primary care practice teams from Wales. METHOD Four work packages will inform the development of the behaviour change intervention. Work package 1 will identify relevant evidence-based interventions (systematic review of reviews) and will determine why interventions do or do not work, for whom, and in what circumstances (realist review). Work package 2 will assess cancer knowledge, attitudes, and behaviour of GPs, as well as primary care teams' perspectives on cancer referral and investigation (GP survey, discrete choice experiment [DCE], interviews, and focus groups). Work package 3 will synthesise findings from earlier work packages using the behaviour change wheel as an overarching theoretical framework to guide intervention development. Work package 4 will test the feasibility and acceptability of the intervention, and determine methods for measuring costs and effects of subsequent behaviour change in a randomised feasibility trial. RESULTS The findings will inform the design of a future effectiveness trial, with concurrent economic evaluation, aimed at earlier diagnosis. CONCLUSION This comprehensive, evidence-based programme will develop a complex GP behaviour change intervention to expedite the diagnosis of symptomatic cancer, and may be applicable to countries with similar healthcare systems.
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Affiliation(s)
- Marian Andrei Stanciu
- Research Officer, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Rebecca-Jane Law
- Research Officer, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Sadia Nafees
- Research Project Support Officer, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Maggie Hendry
- Research Fellow, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Seow Tien Yeo
- Research Fellow, Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Julia Hiscock
- Research Fellow, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Ruth Lewis
- Research Fellow in Health Sciences Research, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Rhiannon T Edwards
- Professor of Health Economics, Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Nefyn H Williams
- Professor in Primary Care, Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Katherine Brain
- Professor, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Brocklehurst
- Professor in Health Services Research, North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Andrew Carson-Stevens
- Clinical Reader, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Sunil Dolwani
- Senior Clinical Lecturer, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Jon Emery
- Professor of Primary Care Cancer Research, Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - William Hamilton
- Professor of Primary Care Diagnostics, Discovery Research Group, University of Exeter, Exeter, UK
| | - Zoe Hoare
- Principal Trial Statistician, North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Georgios Lyratzopoulos
- Professor of Cancer Epidemiology, Department of Behavioural Science and Health, University College London, London, UK
| | - Greg Rubin
- Professor of General Practice and Primary Care, Institute of Health and Society, University of Newcastle, Newcastle, UK
| | - Stephanie Smits
- Research Associate, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Peter Vedsted
- Professor, Research Director, Department of Public Health, Research Centre for Cancer Diagnosis, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- Professor, Research Director, Department of Clinical Medicine, University Clinic for Innovative Health Care Delivery, Silkeborg Hospital, Aarhus University, Aarhus, Denmark
| | - Fiona Walter
- Principal Researcher in Primary Care Cancer Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Clare Wilkinson
- Professor of General Practice, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Richard D Neal
- Professor of Primary Care Oncology, Academic Unit of Primary Care, Institute of Health Sciences, University of Leeds, Leeds, UK
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Parker S, Prince A, Thomas L, Song H, Milosevic D, Harris MF. Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis. BMJ Open 2018; 8:e019192. [PMID: 30158214 PMCID: PMC6119429 DOI: 10.1136/bmjopen-2017-019192] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 03/06/2018] [Accepted: 03/13/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management. DESIGN We searched MEDLINE, all evidence-based medicine, CINAHL, Embase and PsychINFO covering the period 2009 to 2018 for electronic, mobile or telehealth interventions. Quality was assessed according to rigour and relevance. Those studies providing a richer description ('thick') were synthesised using a realist matrix. SETTING AND PARTICIPANTS Studies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics. RESULTS Eighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed. CONCLUSIONS Research incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.
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Affiliation(s)
- Sharon Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Amy Prince
- South Western Sydney Primary Health Network, Campbelltown, New South Wales, Australia
| | - Louise Thomas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Hyun Song
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Diana Milosevic
- Planning Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mark Fort Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Cornes M, Whiteford M, Manthorpe J, Neale J, Byng R, Hewett N, Clark M, Kilmister A, Fuller J, Aldridge R, Tinelli M. Improving hospital discharge arrangements for people who are homeless: A realist synthesis of the intermediate care literature. Health Soc Care Community 2018; 26:e345-e359. [PMID: 28730744 DOI: 10.1111/hsc.12474] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 06/19/2017] [Indexed: 06/07/2023]
Abstract
This review presents a realist synthesis of "what works and why" in intermediate care for people who are homeless. The overall aim was to update an earlier synthesis of intermediate care by capturing new evidence from a recent UK government funding initiative (the "Homeless Hospital Discharge Fund"). The initiative made resources available to the charitable sector to enable partnership working with the National Health Service (NHS) in order to improve hospital discharge arrangements for people who are homeless. The synthesis adopted the RAMESES guidelines and reporting standards. Electronic searches were carried out for peer-reviewed articles published in English from 2000 to 2016. Local evaluations and the grey literature were also included. The inclusion criteria was that articles and reports should describe "interventions" that encompassed most of the key characteristics of intermediate care as previously defined in the academic literature. Searches yielded 47 articles and reports. Most of these originated in the UK or the USA and fell within the realist quality rating of "thick description". The synthesis involved using this new evidence to interrogate the utility of earlier programme theories. Overall, the results confirmed the importance of (i) collaborative care planning, (ii) reablement and (iii) integrated working as key to effective intermediate care delivery. However, the additional evidence drawn from the field of homelessness highlighted the potential for some theory refinements. First, that "psychologically informed" approaches to relationship building may be necessary to ensure that service users are meaningfully engaged in collaborative care planning and second, that integrated working could be managed differently so that people are not "handed over" at the point at which the intermediate care episode ends. This was theorised as key to ensuring that ongoing care arrangements do not break down and that gains are not lost to the person or the system vis-à-vis the prevention of readmission to hospital.
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Affiliation(s)
- Michelle Cornes
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Martin Whiteford
- Health Services Research, University of Liverpool, Liverpool, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - Richard Byng
- Clinical Trials and Health Research, University of Plymouth, Plymouth, UK
| | - Nigel Hewett
- Pathway, University College Hospital Homeless Team, London, UK
| | - Michael Clark
- The London School of Economics & Political Science, London, UK
| | - Alan Kilmister
- Social Care Workforce Research Unit, King's College London, London, UK
| | - James Fuller
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Robert Aldridge
- Public Health Informatics, University College London, London, UK
| | - Michela Tinelli
- The London School of Economics & Political Science, London, UK
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Brennan C, Greenhalgh J, Pawson R. Guidance on guidelines: Understanding the evidence on the uptake of health care guidelines. J Eval Clin Pract 2018; 24:105-116. [PMID: 28370699 DOI: 10.1111/jep.12734] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 08/05/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 12/25/2022]
Abstract
RATIONALE Regardless of health issue, health sector, patient condition, or treatment modality, the chances are that provision is supported by "a guideline" making professionally endorsed recommendations on best practice. Against this background, research has proliferated seeking to evaluate how effectively such guidance is followed. These investigations paint a gloomy picture with many a guideline prompting lip service, inattention, and even opposition. This predicament has prompted a further literature on how to improve the uptake of guidelines, and this paper considers how to draw together lessons from these inquiries. METHODS This huge body of material presents a considerable challenge for research synthesis, and this paper produces a critical, methodological comparison of 2 types of review attempting to meet that task. Firstly, it provides an overview of the current orthodoxy, namely, "thematic reviews," which aggregate and enumerate the "barriers and facilitators" to guideline implementation. It then outlines a "realist synthesis," focussing on testing the "programme theories" that practitioners have devised to improve guideline uptake. RESULTS Thematic reviews aim to provide a definitive, comprehensive catalogue of the facilitators and barriers to guideline implementation. As such, they present a restatement of the underlying problems rather than an improvement strategy. The realist approach assumes that the incorporation of any guideline into current practice will produce unintended system strains as different stakeholders wrestle over responsibilities. These distortions will prompt supplementary revisions to guidelines, which in turn beget further strains. Realist reviews follow this dynamic understanding of organisational change. CONCLUSIONS Health care decision makers operate in systems that are awash with guidelines. But guidelines only have paper authority. Managers do not need a checklist of their pros and cons, because the fate of guidelines depends on their reception rather than their production. They do need decision support on how to engineer and reengineer guidelines so they dovetail with evolving systems of health care delivery.
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Affiliation(s)
- Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Greenhalgh J, Dalkin S, Gibbons E, Wright J, Valderas JM, Meads D, Black N. How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis. J Health Serv Res Policy 2017; 23:57-65. [PMID: 29260592 PMCID: PMC5768260 DOI: 10.1177/1355819617740925] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Internationally, there has been considerable debate about the role of data in supporting quality improvement in health care. Our objective was to understand how, why and in what circumstances the feedback of aggregated patient-reported outcome measures data improved patient care. Methods We conducted a realist synthesis. We identified three main programme theories underlying the use of patient-reported outcome measures as a quality improvement strategy and expressed them as nine 'if then' propositions. We identified international evidence to test these propositions through searches of electronic databases and citation tracking, and supplemented our synthesis with evidence from similar forms of performance data. We synthesized this evidence through comparing the mechanisms and impact of patient-reported outcome measures and other performance data on quality improvement in different contexts. Results Three programme theories were identified: supporting patient choice, improving accountability and enabling providers to compare their performance with others. Relevant contextual factors were extent of public disclosure, use of financial incentives, perceived credibility of the data and the practicality of the results. Available evidence suggests that patients or their agents rarely use any published performance data when selecting a provider. The perceived motivation behind public reporting is an important determinant of how providers respond. When clinicians perceived that performance indicators were not credible but were incentivized to collect them, gaming or manipulation of data occurred. Outcome data do not provide information on the cause of poor care: providers needed to integrate and interpret patient-reported outcome measures and other outcome data in the context of other data. Lack of timeliness of performance data constrains their impact. Conclusions Although there is only limited research evidence to support some widely held theories of how aggregated patient-reported outcome measures data stimulate quality improvement, several lessons emerge from interventions sharing the same programme theories to help guide the increasing use of these measures.
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Affiliation(s)
- Joanne Greenhalgh
- 1 Associate Professor, School of Sociology and Social Policy, University of Leeds, UK
| | - Sonia Dalkin
- 2 5995 Senior Lecturer, Department of Social Work, Education and Community Well Being, Northumbria University , Newcastle, UK
| | - Elizabeth Gibbons
- 3 6396 Senior Research Scientist, Nuffield Department of Population Health , University of Oxford, UK
| | - Judy Wright
- 4 Senior Information Specialist, Leeds Institute of Health Sciences, University of Leeds, UK
| | - Jose Maria Valderas
- 5 3286 Professor of Health Services and Policy Research, University of Exeter Medical School , UK
| | - David Meads
- 6 Associate Professor of Health Economics, Leeds Institute of Health Sciences, University of Leeds, UK
| | - Nick Black
- 7 Professor of Health Services Research, London School of Hygiene and Tropical Medicine, UK
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Coxon A, Nielsen K, Cross J, Fox C. Implementing enhanced recovery pathways: a literature review with realist synthesis. Hosp Pract (1995) 2017; 45:165-174. [PMID: 28679348 DOI: 10.1080/21548331.2017.1351858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 05/18/2017] [Accepted: 07/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Enhanced Recovery Pathways (ERPs) are an increasingly popular, evidenced-based approach to surgery, designed to improve patient outcomes and reduce costs. Despite evidence demonstrating the benefits of these pathways, implementation and adherence have been inconsistent. METHODS Using realist synthesis, this review explored the current literature surrounding the implementation of ERPs in the UK. Knowledge consolidation between authors and consulting with field experts helped to guide the search strategy. Relevant medical and social science databases were searched from 2000 to 2016, as well as a general web search. A total of 17 papers were identified, including original research, reviews, case studies and guideline documents. Full texts were analysed, cross-examined, and data extracted and synthesised. RESULTS Several implementation strategies were identified, including the contexts in which these operated, the subsequent mechanisms of action that were triggered, and the outcome patterns they produced. Context-Mechanism-Outcome (CMO) configurations were generated, tested, and refined. These were grouped to develop two programme theories concerning ERP implementation, one related to the strategy of consulting with staff, the other with appointing a change agent to coordinate and drive the implementation process. These theories highlight instances in which implementation could be improved. CONCLUSION Current literature in ERP research is primarily focussed on measuring patient outcomes and cost effectiveness, and as a result, important detail regarding the implementation process is often not reported or described robustly. This review not only provides recommendations for future improvements in ERP implementation, but also highlights specific areas of focus for furthering ERP implementation research.
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Affiliation(s)
- Astrid Coxon
- a University of East Anglia Faculty of Medicine and Health Sciences , Norwich Medical School University of East Anglia , Norwich , UK
| | - Karina Nielsen
- b Management School, Institute of Work Psychology Sheffield , University of Sheffield , Sheffield , UK
| | - Jane Cross
- a University of East Anglia Faculty of Medicine and Health Sciences , Norwich Medical School University of East Anglia , Norwich , UK
| | - Chris Fox
- a University of East Anglia Faculty of Medicine and Health Sciences , Norwich Medical School University of East Anglia , Norwich , UK
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Guerrero-Torrelles M, Monforte-Royo C, Rodríguez-Prat A, Porta-Sales J, Balaguer A. Understanding meaning in life interventions in patients with advanced disease: A systematic review and realist synthesis. Palliat Med 2017; 31:798-813. [PMID: 28498025 DOI: 10.1177/0269216316685235] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Among patients with advanced disease, meaning in life is thought to enhance well-being, promote coping and improve the tolerance of physical symptoms. It may also act as a buffer against depression and hopelessness. As yet, there has been no synthesis of meaning in life interventions in which contextual factors, procedures and outcomes are described and evaluated. AIMS To identify meaning in life interventions implemented in patients with advanced disease and to describe their context, mechanisms and outcomes. DESIGN Systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and realist synthesis of meaning in life interventions using criteria from the Realist And Meta-narrative Evidence Syntheses: Evolving Standards project. DATA SOURCES The CINAHL, PsycINFO, PubMed and Web of Science databases were searched. RESULTS A total of 12 articles were included in the systematic review, corresponding to nine different interventions. Five articles described randomized controlled trials, two were qualitative studies, two were commentaries or reflections, and there was one pre-post evaluation, one exploratory study and one description of a model of care. Analysis of context, mechanisms and outcomes configurations showed that a core component of all the interventions was the interpersonal encounter between patient and therapist, in which sources of meaning were explored and a sense of connectedness was re-established. Meaning in life interventions were associated with clinical benefits on measures of purpose-in-life, quality of life, spiritual well-being, self-efficacy, optimism, distress, hopelessness, anxiety, depression and wish to hasten death. CONCLUSION This review provides an explanatory model of the contextual factors and mechanisms that may be involved in promoting meaning in life. These approaches could provide useful tools for relieving existential suffering at the end of life.
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Affiliation(s)
- Mariona Guerrero-Torrelles
- 1 Department of Nursing, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Monforte-Royo
- 1 Department of Nursing, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Josep Porta-Sales
- 3 Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.,4 Palliative Care Service, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Balaguer
- 3 Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Bunn F, Goodman C, Manthorpe J, Durand MA, Hodkinson I, Rait G, Millac P, Davies SL, Russell B, Wilson P. Supporting shared decision-making for older people with multiple health and social care needs: a protocol for a realist synthesis to inform integrated care models. BMJ Open 2017; 7:e014026. [PMID: 28174225 PMCID: PMC5306514 DOI: 10.1136/bmjopen-2016-014026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Including the patient or user perspective is a central organising principle of integrated care. Moreover, there is increasing recognition of the importance of strengthening relationships among patients, carers and practitioners, particularly for individuals receiving substantial health and care support, such as those with long-term or multiple conditions. The overall aims of this synthesis are to provide a context-relevant understanding of how models to facilitate shared decision-making (SDM) might work for older people with multiple health and care needs, and how they might be applied to integrated care models. METHODS AND ANALYSIS The synthesis draws on the principles of realist inquiry, to explain how, in what contexts and for whom, interventions that aim to strengthen SDM among older patients, carers and practitioners are effective. We will use an iterative, stakeholder-driven, three-phase approach. Phase 1: development of programme theory/theories that will be tested through a first scoping of the literature and consultation with key stakeholder groups; phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1; phase 3: validation of programme theory/theories with a purposive sample of participants from phase 1. The synthesis will draw on prevailing theories such as candidacy, self-efficacy, personalisation and coproduction. ETHICS AND DISSEMINATION Ethics approval for the stakeholder interviews was obtained from the University of Hertfordshire ECDA (Ethics Committee with Delegated Authority), reference number HSK/SF/UH/02387. The propositions arising from this review will be used to develop recommendations about how to tailor SDM interventions to older people with complex health and social care needs in an integrated care setting.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Marie-Anne Durand
- The Preference Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Isabel Hodkinson
- Tower Hamlets Clinical Commissioning Group, The Tredegar Practice, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
| | | | - Sue L Davies
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Patricia Wilson
- Centre for Health Service Studies, University of Kent, Canterbury, UK
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Abstract
Despite considerable progress within wilderness and adventure therapy research over the last decade, researchers are still unable to precisely answer why, how, and for whom this treatment modality works. There is also a need for more knowledge regarding the circumstances under which the treatment does not appear to be effective. In this realist synthesis, we attempt to unpack this "black box" of wilderness therapy more specifically, defined as a specialized approach to mental health treatment for adolescents. Through a focused review of the primary qualitative wilderness therapy studies, empirical findings are used to test and refine a key program theory. The synthesis results in a proposed wilderness therapy clinical model and offers informed implications for future theory development, research, and practice.
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Affiliation(s)
| | | | | | - Terje Mesel
- University of Agder, Kristiansand/Grimstad, Norway
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Herens M, Wagemakers A, Vaandrager L, van Ophem J, Koelen M. Contexts, Mechanisms, and Outcomes That Matter in Dutch Community-Based Physical Activity Programs Targeting Socially Vulnerable Groups. Eval Health Prof 2016; 40:294-331. [PMID: 27325611 DOI: 10.1177/0163278716652940] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents a practitioner-based approach to identify key combinations of contextual factors (C) and mechanisms (M) that trigger outcomes (O) in Dutch community-based health-enhancing physical activity (CBHEPA) programs targeting socially vulnerable groups. Data were collected in six programs using semi-structured interviews and focus groups using a timeline technique. Sessions were recorded, anonymized, and transcribed. A realist synthesis protocol was used for data-driven and thematic analysis of CMO configurations. CMO configurations related to community outreach, program sustainability, intersectoral collaboration, and enhancing participants' active lifestyles. We have refined the CBHEPA program theory by showing that actors' passion for, and past experiences with, physical activity programs trigger outcomes, alongside their commitment to socially vulnerable target groups. Project discontinuity, limited access to resources, and a trainer's stand-alone position were negative configurations. The authors conclude that local governance structures appear often to lack adaptive capacity to accommodate multilevel processes to sustain programs.
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Affiliation(s)
- Marion Herens
- 1 Health and Society, Department of Social Sciences, Wageningen University, Wageningen, the Netherlands
| | - Annemarie Wagemakers
- 1 Health and Society, Department of Social Sciences, Wageningen University, Wageningen, the Netherlands
| | - Lenneke Vaandrager
- 1 Health and Society, Department of Social Sciences, Wageningen University, Wageningen, the Netherlands
| | - Johan van Ophem
- 2 Economics of Consumers and Households, Department of Social Sciences, Wageningen University, Wageningen, the Netherlands
| | - Maria Koelen
- 1 Health and Society, Department of Social Sciences, Wageningen University, Wageningen, the Netherlands
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Stolee P, Elliott J, McNeil H, Boscart V, Heckman GA, Hutchinson R, Hedley M, Glouberman S, Judd M. Choosing Healthcare Options by Involving Canada's Elderly: a protocol for the CHOICE realist synthesis project on engaging older persons in healthcare decision-making. BMJ Open 2015; 5:e008190. [PMID: 26534730 PMCID: PMC4636611 DOI: 10.1136/bmjopen-2015-008190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION While patient and citizen engagement has been recognised as a crucial element in healthcare reform, limited attention has been paid to how best to engage seniors-the fastest growing segment of the population and the largest users of the healthcare system. To improve the healthcare services for this population, seniors and their families need to be engaged as active partners in healthcare decision-making, research and planning. This synthesis aims to understand the underlying context and mechanisms needed to achieve meaningful engagement of older adults in healthcare decision-making, research and planning. METHODS AND ANALYSIS The CHOICE Knowledge Synthesis Project: Choosing Healthcare Options by Involving Canada's Elderly aims to address this issue by synthesising current knowledge on patient, family, and caregiver engagement. A realist synthesis will support us to learn from other patient and citizen engagement initiatives, from previous research, and from seniors, families and caregivers themselves. The synthesis will guide development or adaptation of a framework, leading to the development of best practice guidelines and recommendations for engagement of older people and their families and caregivers in clinical decision-making, healthcare delivery, planning and research. ETHICS AND DISSEMINATION The components of this protocol involving consultation with patients or caregivers have received ethics clearance from the University of Waterloo, Office of Research Ethics (ORE#19094). After completion of the project, we will amalgamate the information collected into a knowledge synthesis report which will include best practice guidelines and recommendations for patient, family and caregiver engagement in clinical and health system planning and research contexts. RESULTS Will be further disseminated to citizens, clinicians, researchers and policymakers with the help of our partners. TRIAL REGISTRATION NUMBER CRD42015024749.
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Affiliation(s)
- Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Kitchener, Ontario, Canada
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Heather McNeil
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Veronique Boscart
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Kitchener, Ontario, Canada
- School of Health and Life Sciences and Community Services, Conestoga College, Kitchener, Ontario, Canada
| | - George A Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Kitchener, Ontario, Canada
| | | | - Margaret Hedley
- Guelph-Wellington Seniors Association, Guelph, Ontario, Canada
| | | | - Maria Judd
- Canadian Foundation for Healthcare Improvement, Ottawa, Ontario, Canada
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Thapa S, Hannes K, Cargo M, Buve A, Mathei C. Effect of stigma reduction intervention strategies on HIV test uptake in low- and middle-income countries: a realist review protocol. Syst Rev 2015; 4:142. [PMID: 26527403 PMCID: PMC4630912 DOI: 10.1186/s13643-015-0130-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several stigma reduction intervention strategies have been developed and tested for effectiveness in terms of increasing human immunodeficiency virus (HIV) test uptake. These strategies have been more effective in some contexts and less effective in others. Individual factors, such as lack of knowledge and fear of disclosure, and social-contextual factors, such as poverty and illiteracy, might influence the effect of stigma reduction intervention strategies on HIV test uptake in low- and middle-income countries. So far, it is not clearly known how the stigma reduction intervention strategies interact with these contextual factors to increase HIV test uptake. Therefore, we will conduct a review that will synthesize existing studies on stigma reduction intervention strategies to increase HIV test uptake to better understand the mechanisms underlying this process in low- and middle-income countries. METHODS A realist review will be conducted to unpack context-mechanism-outcome configurations of the effect of stigma reduction intervention strategies on HIV test uptake. Based on a scoping review, we developed a preliminary theoretical framework outlining a potential mechanism of how the intervention strategies influence HIV test uptake. Our realist synthesis will be used to refine the preliminary theoretical framework to better reflect mechanisms that are supported by existing evidence. Journal articles and grey literature will be searched following a purposeful sampling strategy. Data will be extracted and tested against the preliminary theoretical framework. Data synthesis and analysis will be performed in five steps: organizing extracted data into evidence tables, theming, formulating chains of inference from the identified themes, linking the chains of inference and developing generative mechanisms, and refining the framework. DISCUSSION This will be the first realist review that offers both a quantitative and a qualitative exploration of the available evidence to develop and propose a theoretical framework that explains why and how HIV stigma reduction intervention strategies influence HIV test uptake in low- and middle-income countries. Our theoretical framework is meant to provide guidance to program managers on identifying the most effective stigma reduction intervention strategies to increase HIV test uptake. We also include advice on how to effectively implement these strategies to reduce the rate of HIV transmission. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015023687.
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Affiliation(s)
- Subash Thapa
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. .,Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Karin Hannes
- Centre for Sociology Research, Faculty of Social Sciences, KU Leuven, 3000, Leuven, Belgium.
| | - Margaret Cargo
- School of Population Health, University of South Australia, Adelaide, SA, 5001, Australia.
| | - Anne Buve
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Catharina Mathei
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
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Coles E, Cheyne H, Daniel B. Early years interventions to improve child health and wellbeing: what works, for whom and in what circumstances? Protocol for a realist review. Syst Rev 2015; 4:79. [PMID: 26047950 PMCID: PMC4464136 DOI: 10.1186/s13643-015-0068-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/01/2015] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Child health and wellbeing is influenced by multiple factors, all of which can impact on early childhood development. Adverse early life experiences can have lasting effects across the life course, sustaining inequalities and resulting in negative consequences for the health and wellbeing of individuals and society. The potential to influence future outcomes via early intervention is widely accepted; there are numerous policy initiatives, programmes and interventions clustered around the early years theme, resulting in a broad and disparate evidence base. Existing reviews have addressed the effectiveness of early years interventions, yet there is a knowledge gap regarding the mechanisms underlying why interventions work in given contexts. METHODS/DESIGN This realist review seeks to address the question 'what works, for whom and in what circumstances?' in terms of early years interventions to improve child health and wellbeing. The review will be conducted following Pawson's five-stage iterative realist methodology: (1) clarify scope, (2) search for evidence, (3) appraise primary studies and extract data, (4) synthesise evidence and draw conclusions and (5) disseminate findings. The reviewers will work with stakeholders in the early stages to refine the focus of the review, create a review framework and build programme theory. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. A review collaboration group will oversee the review process. DISCUSSION The review will demonstrate how early years interventions do or do not work in different contexts and with what outcomes and effects. Review findings will be written up following the RAMESES guidelines and will be disseminated via a report, presentations and peer-reviewed publications. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015017832.
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Affiliation(s)
- Emma Coles
- Nursing Midwifery & Allied Health Professions Research Unit (NMAHP-RU), Scion House, University of Stirling Innovation Park, FK9 4NF, Stirling, UK.
| | - Helen Cheyne
- Nursing Midwifery & Allied Health Professions Research Unit (NMAHP-RU), Scion House, University of Stirling Innovation Park, FK9 4NF, Stirling, UK.
| | - Brigid Daniel
- School of Applied Social Science, University of Stirling, Colin Bell Building, FK9 4NF, Stirling, UK.
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Blane DN, Macdonald S, Morrison D, O'Donnell CA. Interventions targeted at primary care practitioners to improve the identification and referral of patients with co-morbid obesity: a realist review protocol. Syst Rev 2015; 4:61. [PMID: 25927993 PMCID: PMC4426175 DOI: 10.1186/s13643-015-0046-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is one of the most significant public health challenges in the developed world. Recent policy has suggested that more can be done in primary care to support adults with obesity. In particular, general practitioners (GPs) and practice nurses (PNs) could improve the identification and referral of adults with obesity to appropriate weight management services. Previous interventions targeted at primary care practitioners in this area have had mixed results, suggesting a more complex interplay between patients, practitioners, and systems. The objectives of this review are (i) to identify the underlying 'programme theory' of interventions targeted at primary care practitioners to improve the identification and referral of adults with obesity and (ii) to explore how and why GPs and PNs identify and refer individuals with obesity, particularly in the context of weight-related co-morbidity. This protocol will explain the rationale for using a realist review approach and outline the key steps in this process. METHODS Realist review is a theory-led approach to knowledge synthesis that provides an explanatory analysis aimed at discerning what works, for whom, in what circumstances, how, and why. In this review, scoping interviews with key stakeholders involved in the planning and delivery of adult weight management services in Scotland helped to inform the identification of formal theories - from psychology, sociology, and implementation science - that will be tested as the review progresses. A comprehensive search strategy is described, including scope for iterative searching. Data analysis is outlined in three stages (describing context-mechanism-outcome configurations, exploring patterns in these configurations, and developing and testing middle-range theories, informed by the formal theories previously identified), culminating in the production of explanatory programme theory that considers individual, interpersonal, and institutional/systems-level components. DISCUSSION This is the first realist review that we are aware of looking at interventions targeted at primary care practitioners to improve the weight management of adults with obesity. Engagement with stakeholders at an early stage is a unique feature of realist review. This shapes the scope of the review, identification of candidate theories and dissemination strategies. The findings of this review will inform policy and future interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014009391.
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Affiliation(s)
- David N Blane
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK.
| | - Sara Macdonald
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK.
| | - David Morrison
- Public Health, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Catherine A O'Donnell
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK.
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Abstract
BACKGROUND In most developed nations, there has been a shift from public services to a marketisation of public goods and services - representing a significant reform process aiming to transform the way in which community-based human services, such as health, are delivered and consumed. For services, this means developing the capacity to adapt and innovate in response to changing circumstances to achieve quality. The availability of rigorous research to demonstrate whether a market approach and contestability, in particular, is a coherent reform process is largely absent. Contestability operates on the premise that better procurement processes allow more providers to enter the market and compete for contracts. This is expected to create stimulus for greater efficiencies, innovation and improved service delivery to consumers. There is limited understanding, however, about how community-based providers morph and re-configure in response to the opportunities posed by contestability. This study focuses on the effect of a contestability policy on the community-managed mental health sector. METHODS/DESIGN A realist review will be undertaken to understand how and why the introduction of contestability into a previously incontestable market influences the ways in which community-based mental health providers respond to contestability. The review will investigate those circumstances that shape organisational response and generate outcomes through activating mechanisms. An early scoping has helped to formulate the initial program theory. A realist synthesis will be undertaken to identify relevant journal articles and grey literature. Data will be extracted in relation to the emerging contextual factors, mechanisms and outcomes and their configurations. The analysis will seek patterns and regularities in these configurations across the extracted data and will focus on addressing our theory-based questions. DISCUSSION Increasingly, community-based mental health markets are moving to contestability models. Rigorous research is needed to understand how such markets work and in what contexts. The knowledge gained from this study in community-based mental health will provide valuable lessons in how contestability works, in what circumstances and who benefits when. The results of the proposed research will be useful to policy-makers and may be applicable in other contexts beyond the community-based mental health sector. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015016808.
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Affiliation(s)
- Jo Durham
- Faculty of Medicine & Biomedical Sciences, The University of Queensland, School of Public Health, Herston, Brisbane, Queensland, 4006, Australia.
| | - Amara Bains
- Queensland Alliance for Mental Health, 1/78 Logan Road, Woolloongabba, Brisbane, Queensland, 4102, Australia.
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Randell R, Greenhalgh J, Dowding D. Using realist reviews to understand how health IT works, for whom, and in what circumstances. J Am Med Inform Assoc 2015; 22:e216-7. [PMID: 25755123 DOI: 10.1093/jamia/ocu006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 10/18/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rebecca Randell
- School of Healthcare, University of Leeds, Leeds LS2 9UT, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Dawn Dowding
- Columbia University School of Nursing and Center for Health Care Policy and Research, Visiting Nursing Service of New York, New York, USA
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50
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Mogre V, Scherpbier A, Dornan T, Stevens F, Aryee PA, Cherry MG. A realist review of educational interventions to improve the delivery of nutrition care by doctors and future doctors. Syst Rev 2014; 3:148. [PMID: 25528058 DOI: 10.1186/2046-4053-3-148] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dietary interventions are considered an important aspect of clinical practice, more so in the face of the rising prevalence of obesity, diabetes and cardiovascular diseases globally. Routinely, most doctors do not provide such intervention to their patients, and several barriers, present during both training and clinical practice, have been identified. Educational interventions to improve nutrition care competencies and delivery have been implemented but with variable success, probably, due to the complex nature of such interventions. Using traditional methods only to investigate whether interventions are effective or not could not provide appropriate lessons. It is therefore pertinent to conduct a realist review that investigates how the interventions work. This realist review aims at determining what sort of educational interventions work, how, for whom, and in what circumstances, to improve the delivery of nutrition care by doctors and future doctors. METHODS/DESIGN This realist review will be conducted according to Pawson's five practical steps for conducting a realist review: (1) clarifying the scope of the review, (2) determining the search strategy, including adopting broad inclusion/exclusion criteria and purposive snowballing techniques, (3) ensuring proper article selection and study quality assessment using multiple methods, (4) extracting and organising data through the process of note taking, annotation and conceptualization and (5) synthesising the evidence and drawing conclusions through a process of reasoning. This realist review protocol has not been registered in any database before now. DISCUSSION Findings will be reported according to the publication criteria outlined by the realist and meta-narrative evidence synthesis (RAMESES) group.
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