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Digital storytelling online: a case report exploring virtual design, implementation opportunities and challenges. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:37. [PMID: 38594774 PMCID: PMC11003168 DOI: 10.1186/s40900-024-00570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Digital storytelling is an arts-informed approach that engages short, first-person videos, typically three to five minutes in length, to communicate a personal narrative. Prior to the pandemic, digital storytelling initiatives in health services research were often conducted during face-to-face workshops scheduled over multiple days. However, throughout the COVID-19 lockdowns where social distancing requirements needed to be maintained, many digital storytelling projects were adapted to online platforms. METHODS As part of a research project aiming to explore the day surgery treatment and recovery experiences of women with breast cancer in Peel region, we decided to pivot our digital storytelling process to an online format. During the process, we observed that the online digital storytelling format had multiple opportunities and challenges to implementation. RESULTS This paper outlines our promising practices and lessons learned when designing and implementing an online digital storytelling project including pre-production, production and post-production considerations. CONCLUSIONS We provide lessons learned for future teams intending to conduct an online digital storytelling project.
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Improving the communication between farmers and veterinarians to enhance the acceptability of bovine tuberculosis eradication programmes. Prev Vet Med 2023; 220:106046. [PMID: 37857003 DOI: 10.1016/j.prevetmed.2023.106046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/04/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
France and Spain have been fighting against bovine tuberculosis (bTB) for years, even though new outbreaks continue to appear on both sides of the border, generating misconceptions about the disease and social distrust in the eradication programme and competent authorities. The perceived disease risk and the commitment of all interested parties are key factors for the successful implementation of control programmes, as they might influence the acceptability of recommended measures. Effective communication can contribute to increasing knowledge, trust and stakeholders' engagement, thus ensuring the acceptability of the eradication programme. This study was conducted in Catalonia (Spain) and Pyrenees-Atlantiques (France) in the frame of the INNOTUB project (https://innotub.eu/) to characterise the communication on bTB in the trans-Pyrenees region and provide recommendations to improve it. The communication on bTB was characterised by analysing 153 (Spain) and 66 (France) online freely available texts, published between 2018 and 2020, through Content Analysis and Critical Metaphor Analysis. Moreover, six farmers and four veterinarians were in-depth interviewed in each area to gather information about the communication on bTB. Interviews were made in original languages and analysed using a qualitative thematic approach. A pilot participatory intervention inspired by the Systematic Tool for Behavioural Assumption Validation and Exploration (STAVE) method was used to develop a list of proposals to improve communication and to promote the creation of territorial networks/committees on bTB prevention and control. It included three focus groups with farmers and veterinarians, a meeting with representatives of the regional veterinary services, and a final deliberative workshop. Results highlight the existence of a controversial debate on bTB and a heterogeneous understanding between stakeholders. Institutional and scientific communication mainly focus on bTB detection and control while other aspects are left in the background. On the contrary, farmers extend their communication to a greater variety of topics. The metaphorical framing strongly differed among actors, while veterinary services and researchers "fight" against bTB and "progress" toward the eradication, farmers place themselves in a framework of "sacrifice" and, particularly in Spain, they play a passive role. The proposals developed by the participants to improve the current communication on bTB included: (i) create participatory meeting spaces to share opinions and information; (ii) improve data accessibility (on epidemiological situations); (iii) develop clearer and written protocols and informative visual material; (iv) redesign the training courses (v) increase the stakeholders' participation in the design of protocols.
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The INSCHOOL project: showcasing participatory qualitative methods derived from patient and public involvement and engagement (PPIE) work with young people with long-term health conditions. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:91. [PMID: 37828630 PMCID: PMC10568929 DOI: 10.1186/s40900-023-00496-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Evidence suggests resources and services benefit from being developed in collaboration with the young people they aim to support. Despite this, patient and public involvement and engagement (PPIE) with young people is often tokenistic, limited in engagement and not developmentally tailored to young people. Our paper aims to build knowledge and practice for meaningfully engaging with young people in research design, analysis and as research participants. METHODS We report the participatory processes from the INSCHOOL project, examining long-term health conditions and schooling among 11-18 year olds. Young people were consulted at the inception of the project through a hospital-based youth forum. This began a partnership where young people co-designed study documents, informed the recruitment process, developed creative approaches to data collection, participated in pilot interviews, co-analysed the qualitative data and co-presented results. RESULTS PPIE advisors, participants and researchers all benefitted from consistent involvement of young people throughout the project. Long-term engagement allowed advisors and researchers to build rapport and facilitated openness in sharing perspectives. PPIE advisors valued being able to shape the initial aims and language of the research questions, and contribute to every subsequent stage of the project. Advisors co-designed flexible data collection methods for the qualitative project that provided participants with choices in how they took part (interviews, focus groups, written tasks). Further choice was offered through co-designed preparation activities where participants completed one of four creative activities prior to the interview. Participants were therefore able to have control over how they participated and how they described their school experiences. Through participatory analysis meetings advisors used their first-hand experiences to inform the creation of themes and the language used to describe these themes. PPIE in every stage of the process helped researchers to keep the results grounded in young people's experience and challenge their assumptions as adults. CONCLUSIONS Young people have much to offer and the INSCHOOL project has shown that researchers can meaningfully involve young people in all aspects of research. Consistent PPIE resulted in a project where the voices of young people were prioritised throughout and power imbalances were reduced, leading to meaningful participant-centred data.
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Applying and Assessing Participatory Approaches in an Environmental Flows Case Study. ENVIRONMENTAL MANAGEMENT 2023; 72:754-770. [PMID: 37227515 PMCID: PMC10460341 DOI: 10.1007/s00267-023-01829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/30/2023] [Indexed: 05/26/2023]
Abstract
Environmental flows (e-flows) management takes place within a complex social-ecological system, necessitating the involvement of diverse stakeholders and an appreciation of a range of perspectives and knowledge types. It is widely accepted that incorporating participatory methods into environmental flows decision-making will allow stakeholders to become meaningfully involved, improving potential solutions, and fostering social legitimacy. However, due to substantial structural barriers, implementing participatory approaches can be difficult for water managers. This paper assesses the effectiveness of an e-flows methodology that combines elements of structured decision-making and participatory modeling, whilst constrained by project resources. Three process-based objectives were identified by the group at the start of the process: improving transparency, knowledge exchange, and community ownership. We evaluated the success of the approach according to those objectives using semi-structured interviews and thematic analysis. In evaluating how well the participatory approach achieved the process objectives, we found that at least 80% of respondents expressed positive sentiment in every category (n = 15). We demonstrate that the values-based process objectives defined by the participant group are an effective tool for evaluating participatory success. This paper highlights that participatory approaches can be effective even in resource-constrained environments when the process is adapted to fit the decision-making context.
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Engaging diverse midlife and older adults in a multilevel participatory physical activity intervention: evaluating impacts using Ripple Effects Mapping. Transl Behav Med 2023; 13:666-674. [PMID: 37011041 PMCID: PMC10496429 DOI: 10.1093/tbm/ibad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Multilevel interventions are increasingly recommended to increase physical activity (PA) but can present evaluation challenges. Participatory qualitative evaluation methods can complement standard quantitative methods by identifying participant-centered outcomes and potential mechanisms of individual and community-level change. We assessed the feasibility and utility of Ripple Effects Mapping (REM), a novel qualitative method, within the context of a multi-level cluster randomized trial, Steps for Change. Housing sites with ethnically diverse, low-income aging adults were randomized to a PA behavioral intervention alone or in combination with a citizen science-based intervention (Our Voice) for promoting PA-supportive neighborhoods. Four REM sessions were conducted after 12 months of intervention and involved six housing sites (n = 35 participants) stratified by intervention arm. Interviews (n = 5) were also conducted with housing site staff. Sessions leaders engaged participants in visually mapping intended and unintended outcomes of intervention participation and participant-driven solutions to reported challenges. Maps were analyzed using Excel and Xmind 8 Pro and data were classified according to the socio-ecological model. Eight themes were identified for outcomes, challenges, and solutions. Most themes (6/8) were similar across intervention arms, including increasing PA and PA tracking, improving health outcomes, and increasing social connectedness. Groups (n = 2) engaged in Our Voice additionally identified increased community knowledge and activities directly impacting local environmental change (e.g., pedestrian infrastructure changes). Housing staff interviews revealed additional information to enhance future intervention recruitment, sustainability, and implementation. Such qualitative methodologies can aid in evaluating multi-level, multi-component interventions and inform future intervention optimization, implementation, and dissemination.
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The role of the perceived environment for recreational walking among adults in socioeconomically disadvantaged situations: A study using walk-along interviews. SSM Popul Health 2023; 23:101456. [PMID: 37501782 PMCID: PMC10368917 DOI: 10.1016/j.ssmph.2023.101456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
Background Persons in socioeconomically disadvantaged situations (PSEDS) are generally less likely to engage in recreational walking (RW) compared to higher socioeconomic groups and are often more dependent on their local environment. Studies on RW have primarily focused on the role of the built environment for the general adult population and the older population in urban areas. The aim of this study is to qualitatively identify the perceived environmental factors affecting RW among PSEDS in peri-urban areas. Methods In two peri-urban municipalities in Belgium, walk-along interviews were conducted until data saturation with a purposeful convenience sampling of 38 PSEDS (25-65y/o) to identify local environmental factors affecting RW. A subsample of 22 participants joined a focus group (n = 4) to categorize the identified factors into environmental types (physical, sociocultural, political, and economic) of the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The interviews were transcribed and analyzed thematically using Maxqda 2022.0. Results The information environment (dissemination, retrieving and understanding of information) was added to the ANGELO framework, highlighting the importance of digital literacy. Availability and accessibility of well-maintained walking surfaces, toilets, street lighting and seating options (physical environment), social support, dog-ownership, stigmatization, social isolation, and a sense of belonging (sociocultural environment) and indirect costs (economic environment) were identified as important environmental factors in RW among PSEDS. The identified political and economic factors are intertwined with the other environments. Conclusions Perceived environmental factors affect RW among PSEDS and peri-urban settings offer specific challenges. Local governments should incorporate citizen perception into decision-making processes to create supportive environments that have the potential to promote RW among PSEDS in a peri-urban setting.
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Barriers to Meaningful Participatory Mental Health Services Research and Priority Next Steps: Findings From a National Survey. Psychiatr Serv 2023; 74:902-910. [PMID: 36935620 PMCID: PMC11022526 DOI: 10.1176/appi.ps.20220514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE A growing consensus has emerged regarding the importance of stakeholder involvement in mental health services research. To identify barriers to and the extent of stakeholder involvement in participatory research, the authors undertook a mixed-methods study of researchers and community members who reported participation in such research. METHODS Eight consultative focus groups were conducted with diverse groups of stakeholders in mental health services research (N=51 unique participants, mostly service users), followed by a survey of service users, family members, community providers, and researchers (N=98) with participatory research experience. Focus groups helped identify facilitators and barriers to meaningful research collaboration, which were operationalized in the national survey. Participants were also asked about high-priority next steps. RESULTS The barrier most strongly endorsed as a large or very large problem in the field was lack of funding for stakeholder-led mental health services research (76%), followed by lack of researcher training in participatory methods (74%) and insufficiently diverse backgrounds among stakeholders (69%). The two most frequently identified high-priority next steps were ensuring training and continuing education for researchers and stakeholders (33%) and authentically centering lived experience and reducing tokenism in research (26%). CONCLUSIONS These findings suggest a need for increased attention to and investment in the development, implementation, and sustainment of participatory methods that prioritize collaboration with direct stakeholders, particularly service users, in U.S. mental health services research. The findings also underscore the presence and potentially important role of researchers who dually identify as service users and actively contribute a broader orientation from the service user-survivor movement.
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Improving school children's understanding of water scarcity with a co-produced book on groundwater in Central Chile. HYDROGEOLOGY JOURNAL 2023; 31:1-15. [PMID: 37361320 PMCID: PMC10240114 DOI: 10.1007/s10040-023-02641-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/04/2023] [Indexed: 06/28/2023]
Abstract
Water scarcity is a critical issue worldwide, and Chile is no exception. Since 2010, Central Chile has been enduring an ongoing water crisis due to the coupled effects of a severe drought and the overuse of water resources, especially groundwater. Rural communities have been strongly impacted, mainly because wells from which drinking water is supplied show a dramatic drop in water levels, and some have even dried up. The water scarcity scenario requires the integration of actors and disciplines to increase awareness of groundwater; however, how to make this valuable element visible in society is an issue that remains open to debate. This paper describes and reflects on the process of making educational material about groundwater and water scarcity for children to promote public awareness. Based on transdisciplinary and co-designing processes, this work describes the social perceptions of groundwater among children and community leaders, as well as how scientific information and local knowledge of water scarcity could be integrated into a book for the young population. This research finds that educational projects on groundwater resources increase people's awareness of the role of this hidden resource in the water cycle. Such projects encourage the creation of grounded and contextualised materials that incorporate the knowledge and experience already present in the communities, increasing public awareness of the role of groundwater and associated water scarcity issues, thereby integrating academia and society. This approach could be a tool to lay the foundations for successfully addressing the water crisis in Chile over generations. Supplementary Information The online version contains supplementary material available at 10.1007/s10040-023-02641-6.
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Participatory Methods to Improve and Develop Pediatric Nursing Practice: A Scoping Review. Compr Child Adolesc Nurs 2023; 46:41-64. [PMID: 36630534 DOI: 10.1080/24694193.2022.2153945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Children's nurses in African pediatric settings are often responsible for leading practice improvements. There is a shortage of contextually relevant guidance to inform the design of practice improvement projects in African care settings. Distinctive features of children's nursing practice in Africa include high levels of family caregiver involvement, and organizational and professional cultures which value participation. While established practice improvement methods offer many strengths, methods developed in other geographies should not be adopted uncritically. Our purpose in undertaking this review was to inform selection of methods for a multi-center practice improvement project in Africa. Our aim was to identify types of participatory methods used to improve and develop pediatric nursing practice. We used the PRISMA-ScR method to conduct a scoping review to identify published reports of participatory methods used to improve and develop pediatric nursing practice. We undertook structured searches of five bibliographic databases to identify articles. Only articles written in the English language were included and no limitation was applied to publication date. We identified 7,406 titles and abstracts. After screening, 76 articles met the inclusion criteria. A wide range of participatory methodologies were identified; just under half (n = 34) reported on methods that were not recognized or named methodologies but can be described as collaborative in nature. Plan-do-study-act cycles were reported in 22 articles. There was considerable heterogeneity in frameworks, practical tools and/or nursing models on which the participatory methods were based and there was no apparent relationship between these and the choice of participatory methods. The outcomes identified were also heterogenous in nature and were grouped according to whether they improved structure and/or processes and patient outcomes. Most of the included articles stem from high-income countries with little evidence from low-middle-income countries and none in African settings. Less than half of the included articles involved family caregivers in their practice improvement methodologies. This review highlights the need for greater application of formalized methods for practice improvement and improved rigor and consistency in reporting outcomes. There is also a need to formalize participatory practice improvement methodologies specifically suited to Africa's context of children's nursing.
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Investigating a psychological model of mental conditions and coping during the COVID-19 pandemic driven by participatory methods. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2491-2501. [PMID: 35727333 PMCID: PMC9211778 DOI: 10.1007/s00127-022-02316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is evidence of increased mental health problems during the early stages of the COVID-19 pandemic. We aimed to identify the factors that put certain groups of people at greater risk of mental health problems. METHODS We took a participatory approach, involving people with lived experience of mental health problems and/or carers, to generate a set of risk factors and potential moderators of the effects of COVID on mental health. An online cross-sectional survey was completed by 1464 United Kingdom residents between 24th April and 27th June 2020. The survey had questions on whether respondents were existing mental health service users and or carers, level of depression (PHQ9) and anxiety (GAD7), demographics, threat and coping appraisals, perceived resilience (BRS), and specific coping behaviours (validated as part of this study). The relationship between responses and coping strategies was measured using tetrachoric correlations. Structural equation modelling was used to test the model. RESULTS A model significantly fit our data (rel χ2 = 2.05, RMSEA = 0.029 95%, CI (0.016, 0.042), CFI = 0.99, TLI = 0.98, SRMR = 0.014). Age and coping appraisal predicted anxiety and depression. Whereas, threat appraisal and ethnicity only predicted anxiety, and resilience only predicted depression. Additionally, specific coping behaviours predicted anxiety and depression, with overlap on distraction. CONCLUSIONS Some, but not all, risk factors significantly predict anxiety and depression. While there is a relationship between anxiety and depression, different factors may put people at greater risk of one or the other during the pandemic.
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Abstract
Rapidly growing cities face new and compounding health challenges, leading governments and donors to seek innovative ways to support healthier, more resilient urban growth. One such approach is the systems mapping process developed by Engaging Inquiry (EI) for the USAID-funded Building Healthy Cities project (BHC) in four cities in Asia. This paper provides details on the theory and methods of the process. While systems mapping is not new, the approach detailed in this paper has been uniquely adapted to the purpose of municipal planning. Strategic stakeholder engagement, including participatory workshops with a diverse group of stakeholders, is at the core of this approach and led to deeper insights, greater buy-in, and shared understanding of the city's unique opportunities and challenges. This innovative mapping process is a powerful tool for defining municipal priorities within growing cities across the globe, where the situation is rapidly evolving. It can be used to provide evidence-based information on where to invest to gain the biggest impact on specific goals. This paper is part of a collection in this issue providing a detailed accounting of BHC's systems mapping approach across four project cities.
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Virtual Methodology for Household Waste Characterization During The Pandemic in An Urban District of Peru: Citizen Science for Waste Management. ENVIRONMENTAL MANAGEMENT 2022; 69:1078-1090. [PMID: 35192024 PMCID: PMC8862408 DOI: 10.1007/s00267-022-01610-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/07/2022] [Indexed: 06/06/2023]
Abstract
The Covid-19 pandemic has caused the alteration of many aspects of the solid waste management chain, such as variations in the waste composition, generation and disposal. Various studies have examined these changes with analysis of integrated waste management strategies; qualitative studies on perceived variations and statistical evaluations based on waste collected or disposed in landfills. Despite this information there is a need for updated data on waste generation and composition, especially in developing countries. The objective of this article is to develop a data sampling and analytical approach for the collection of data on household waste generation and composition during the pandemic; and, in addition, estimate the daily generation of masks in the study area. The proposed methodology is based on the principles of citizen science and utilizes virtual tools to contact participants, and for the training and collection of information. The study participants collected the information, installed segregation bins in their homes and trained their relatives in waste segregation. The article presents the results of the application of the methodology in an urban district of Lima (Peru) in August 2020. The results suggest an apparent decrease in household waste per capita and a slight increase in plastics composition in the study area. It is estimated that each participant generates 0.124 masks per day and 0.085 pairs of gloves per day. The method developed and results presented can be used as a tool for public awareness and training on household waste characterization and segregation. Furthermore it can provide the necessary evidence to inform policy directives in response household waste issues and Covid-19 restrictions.
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Advancements of sustainable development goals in co-production for climate change adaptation research. CLIMATE RISK MANAGEMENT 2022; 36:None. [PMID: 35712042 PMCID: PMC9164297 DOI: 10.1016/j.crm.2022.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
The United Nations Sustainable Development Goals (SDGs) is a new discursive regime that encompasses global environmental change challenges and sustainability sciences, including adaptation to climate change. Co-production of knowledge has become a key, intrinsic component in both sustainability sciences and adaptation research. In this review article, we investigate if and how the SDG agenda is included in the application of participatory approaches and co-production of knowledge for climate change adaptation. We review findings from such processes in projects whose objective is to foster adaptation in the context of SDGs and to categorize the methods employed to forward co-production. We investigate 1) whether and how co-production approaches localize SDG targets and address tradeoffs and synergies, 2) whether they focus on power asymmetries and political dimensions in such participatory processes, and 3) whether and how the literature show that the SDG agenda contributes to a shift in the role of researchers towards a more interventionist approach to co-production. Our results show that there is little evidence that the SDG agenda contributes to a shift towards more interventionist or transformative approaches within climate change adaptation. Further, we have a identified a missed opportunity in the exclusion of "social" SDGs (SDG 5 and 10) in the discussions of adaptation and co-production and SGDs. Most importantly, we find that participatory efforts, including the co-production of knowledge, for localizing SDG goals and resolving tradeoffs and benefits, are the most salient aspects that tie the three co-production - adaptation - the SDG agenda together. Such participatory localizing processes have a great potential in facilitating long-enduring empowerment and legitimacy in adaptation efforts.
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More than a method: trusting relationships, productive tensions, and two-way learning as mechanisms of authentic co-production. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:34. [PMID: 34059159 PMCID: PMC8165763 DOI: 10.1186/s40900-021-00262-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/18/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Knowledge mobilisation requires the effective elicitation and blending of different types of knowledge or ways of knowing, to produce hybrid knowledge outputs that are valuable to both knowledge producers (researchers) and knowledge users (health care stakeholders). Patients and service users are a neglected user group, and there is a need for transparent reporting and critical review of methods used to co-produce knowledge with patients. This study aimed to explore the potential of participatory codesign methods as a mechanism of supporting knowledge sharing, and to evaluate this from the perspective of both researchers and patients. METHODS A knowledge mobilisation research project using participatory codesign workshops to explore patient involvement in using health data to improve services. To evaluate involvement in the project, multiple qualitative data sources were collected throughout, including a survey informed by the Generic Learning Outcomes framework, an evaluation focus group, and field notes. Analysis was a collective dialogic reflection on project processes and impacts, including comparing and contrasting the key issues from the researcher and contributor perspectives. RESULTS Authentic involvement was seen as the result of "space to talk" and "space to change". "Space to talk" refers to creating space for shared dialogue, including space for tension and disagreement, and recognising contributor and researcher expertise as equally valuable to the discussion. 'Space to change' refers to space to adapt in response to contributor feedback. These were partly facilitated by the use of codesign methods which emphasise visual and iterative working, but contributors emphasised that relational openness was more crucial, and that this needed to apply to the study overall (specifically, how contributors were reimbursed as a demonstration of how their input was valued) to build trust, not just to processes within the workshops. CONCLUSIONS Specific methods used within involvement are only one component of effective involvement practice. The relationship between researcher and contributors, and particularly researcher willingness to change their approach in response to feedback, were considered most important by contributors. Productive tension was emphasised as a key mechanism in leading to genuinely hybrid outputs that combined contributor insight and experience with academic knowledge and understanding.
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'We need someone to deliver our voices': reflections from conducting remote qualitative research in Syria. Confl Health 2021; 15:28. [PMID: 33865454 PMCID: PMC8052531 DOI: 10.1186/s13031-021-00361-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/01/2021] [Indexed: 01/31/2023] Open
Abstract
The need to generate evidence in spaces considered insecure and inhabited by potentially extremely vulnerable individuals (e.g. conflict-affected people who may not have means to move) has led researchers to study conflict-affected settings remotely. Increased attention to remote research approaches from social scientists, due to COVID-19-related travel restrictions, is sparking interest on appropriate methods and tools. Drawing on several years' experience of remotely conducting qualitative research in Syria, we discuss challenges and approaches to conducting more inclusive, participatory, and meaningful research from a distance. The logistics, ethics, and politics of conducting research remotely are symptomatic of broader challenges in relation to the decolonisation of global and humanitarian health research. Key to the success of remote approaches is the quality of the relationships researchers need to be able to develop with study participants without face-to-face interactions and with limited engagement 'in the field'. Particularly given overdue efforts to decolonise research institutions and methods, lead researchers should have a meaningful connection with the area in which they are conducting research. This is critical both to reduce chances that it will be extractive and exploitative and additionally for the quality of interpretation.
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Causes of short birth interval (kunika) in Bauchi State, Nigeria: systematizing local knowledge with fuzzy cognitive mapping. Reprod Health 2021; 18:74. [PMID: 33823874 PMCID: PMC8022364 DOI: 10.1186/s12978-021-01066-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short birth intervals, defined by the World Health Organization as less than 33 months, may damage the health and wellbeing of children, mothers, and their families. People in northern Nigeria recognise many adverse effects of short birth interval (kunika in the Hausa language) but it remains common. We used fuzzy cognitive mapping to systematize local knowledge of causes of kunika to inform the co-design of culturally safe strategies to address it. METHODS Male and female groups in twelve communities built 48 maps of causes and protective factors for kunika, and government officers from the Local Government Area (LGA) and State made four maps. Each map showed causes of kunika or no-kunika, with arrows showing relationships with the outcome and between causes. Participants assigned weights for the perceived strength of relationships between 5 (strongest) and 1 (weakest). We combined maps for each group: men, women, and government officers. Fuzzy transitive closure calculated the maximum influence of each factor on the outcome, taking account of all relationships in the map. To condense the maps, we grouped individual factors into broader categories and calculated the cumulative net influence of each category. We made further summarised maps and presented these to the community mapping groups to review. RESULTS The community maps identified frequent sex, not using modern or traditional contraception, and family dynamics (such as competition between wives) as the most influential causes of kunika. Women identified forced sex and men highlighted lack of awareness about contraception and fear of side effects as important causes of kunika. Lack of male involvement featured in women's maps of causes and in the maps from LGA and State levels. Maps of protective factors largely mirrored those of the causes. Community groups readily appreciated and approved the summary maps resulting from the analysis. CONCLUSIONS The maps showed how kunika results from a complex network of interacting factors, with culture-specific dynamics. Simply promoting contraception alone is unlikely to be enough to reduce kunika. Outputs from transitive closure analysis can be made accessible to ordinary stakeholders, allowing their meaningful participation in interpretation and use of the findings. For people in Bauchi State, northern Nigeria, kunika describes a short interval between successive births, understood as becoming pregnant again before the previous child is weaned. They recognise it is bad for children, mothers and households. We worked with 12 communities in Bauchi to map their knowledge of the causes and protective factors for kunika. Separate groups of men and women built 48 maps, and government officers at local and state level built four maps. Each group drew two maps showing causes of kunika or of no-kunika with arrows showing the links between causes and the outcome. Participants marked the strength of each link with a number (between 5 for the strongest and 1 for the weakest). We combined maps for women, men and government officers. We grouped similar causes together into broader categories. We calculated the overall influence of each category on kunika or no-kunika and produced summary maps to communicate findings. The maps identified the strongest causes of kunika as frequent sex, not using modern or traditional contraception, and family dynamics. Women indicated forced sex as an important cause, but men focused on lack of awareness about contraception and fear of side effects. The maps of protective factors mirrored those of the causes. The groups who created the maps approved the summary maps. The maps showed the complex causes of kunika in Bauchi. Promoting contraception is unlikely to be enough on its own to reduce kunika. The summary maps will help local stakeholders to co-design culturally safe ways of reducing kunika.
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Skills-based intervention to enhance collaborative decision-making: systematic adaptation and open trial protocol for veterans with psychosis. Pilot Feasibility Stud 2021; 7:89. [PMID: 33781352 PMCID: PMC8005669 DOI: 10.1186/s40814-021-00820-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Collaborative decision-making is an innovative decision-making approach that assigns equal power and responsibility to patients and providers. Most veterans with serious mental illnesses like schizophrenia want a greater role in treatment decisions, but there are no interventions targeted for this population. A skills-based intervention is promising because it is well-aligned with the recovery model, uses similar mechanisms as other evidence-based interventions in this population, and generalizes across decisional contexts while empowering veterans to decide when to initiate collaborative decision-making. Collaborative Decision Skills Training (CDST) was developed in a civilian serious mental illness sample and may fill this gap but needs to undergo a systematic adaptation process to ensure fit for veterans. Methods In aim 1, the IM Adapt systematic process will be used to adapt CDST for veterans with serious mental illness. Veterans and Veteran’s Affairs (VA) staff will join an Adaptation Resource Team and complete qualitative interviews to identify how elements of CDST or service delivery may need to be adapted to optimize its effectiveness or viability for veterans and the VA context. During aim 2, an open trial will be conducted with veterans in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) to assess additional adaptations, feasibility, and initial evidence of effectiveness. Discussion This study will be the first to evaluate a collaborative decision-making intervention among veterans with serious mental illness. It will also contribute to the field’s understanding of perceptions of collaborative decision-making among veterans with serious mental illness and VA clinicians, and result in a service delivery manual that may be used to understand adaptation needs generally in VA PRRCs. Trial registration ClinicalTrials.gov Identifier: NCT04324944
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Operationalizing ecosystem service bundles for strategic sustainability planning: A participatory approach. AMBIO 2021; 50:314-331. [PMID: 32948985 PMCID: PMC7782664 DOI: 10.1007/s13280-020-01378-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/19/2020] [Accepted: 08/05/2020] [Indexed: 05/21/2023]
Abstract
The ecosystem service concept is recognized as a useful tool to support sustainability in decision-making. In this study, we collaborated with actors in the Helge å catchment, southern Sweden, in an iterative participatory ecosystem service assessment. Through workshops and interviews, we jointly decided which ecosystem services to assess and indicators to use in order to achieve a sense of ownership and a higher legitimacy of the assessment. Subsequently, we explored the landscape-level interactions between the 15 assessed services, and found that the area can be described using three distinct ecosystem service bundles. The iterative, participatory process strengthened our analysis and created a shared understanding and overview of the multifunctional landscape around Helge å among participants. Importantly, this allowed for the generated knowledge to impact local strategic sustainability planning. With this study, we illustrate how similar processes can support local decision-making for a more sustainable future.
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Safety and Health through Integrated, Facilitated Teams (SHIFT): stepped-wedge protocol for prospective, mixed-methods evaluation of the Healthy Workplace Participatory Program. BMC Public Health 2020; 20:1463. [PMID: 32993607 PMCID: PMC7526105 DOI: 10.1186/s12889-020-09551-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Healthcare facilities are notorious for occupational health and safety problems. Multi-level interventions are needed to address interacting exposures and their overlapping origins in work organization features. Worker participation in problem identification and resolution is essential. This study evaluates the CPH-NEW Healthy Workplace Participatory Program (HWPP), a Total Worker Health® protocol to develop effective employee teams for worker safety, health, and wellbeing. METHODS Six public sector, unionized healthcare facilities are enrolled, in three pairs, matched by agency. The unit of intervention is a workplace health and safety committee, adapted here to a joint labor-management "Design Team" (DT). The DT conducts root cause analyses, prioritizes problems, identifies feasible interventions in light of the constraints and needs of the specific setting, makes business-case presentations to facility leadership, and assists in evaluation. Following a stepped-wedge (cross-over) design, one site in each pair is randomly assigned to "immediate intervention" status, receiving the full coached intervention at baseline; in the "lagged intervention" site, coaching begins about half-way through the study. Program effectiveness and cost-effectiveness outcomes are assessed at both organizational (e.g., workers' compensation claim and absenteeism rates, perceived management support of safety) and individual levels (e.g., self-rated health, sleep quality, leisure-time exercise). Targeted pre-post analyses will also examine specific outcomes appropriate to the topics selected for intervention. Process evaluation outcomes include fidelity of the HWPP intervention, extent of individual DT member activity, expansion of committee scope to include employee well-being, program obstacles and opportunities in each setting, and sustainability (within the available time frame). DISCUSSION This study aims for a quantitative evaluation of the HWPP over a time period long enough to accomplish multiple intervention cycles in each facility. The design seeks to achieve comparable study engagement and data quality between groups. We will also assess whether the HWPP might be further improved to meet the needs of U.S. public sector healthcare institutions. Potential challenges include difficulty in pooling data across study sites if Design Teams select different intervention topics, and follow-up periods too short for change to be observed. TRIAL REGISTRATION ClinicalTrials.gov NCT04251429 (retrospectively registered January 29, 2020), protocol version 1.
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A System of Systems of Mental Health in Cities, Digging Deep into the Origins of Complexity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:961-971. [PMID: 32222843 PMCID: PMC7547963 DOI: 10.1007/s10488-020-01035-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mental health in urban environments is often treated from a healthcare provision perspective. Research in recent decades showed that mental illness in cities is a result of dysfunctional coordination between different city systems and structures. Given the nature of the city as a system of systems, this work builds through a participatory method, a general system dynamic model of factors that affect mental health in urban and regional environments. Through this method, we investigated the challenges of the application of such methodology to identify essential factors, feedback loops, and dependencies between systems to move forward in planning for mental health in cities. The outcome is a general model that showed the importance of factors that vary from individuals, families to communities and feedback loops that span multiple systems such as the city physical infrastructures, social environments, schools, labor market, and healthcare provision.
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Designing the Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) self-management and support programme for UK African and Caribbean communities: a culturally tailored, complex intervention under-pinned by behaviour change theory. BMC Public Health 2019; 19:1146. [PMID: 31429735 PMCID: PMC6702734 DOI: 10.1186/s12889-019-7411-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/31/2019] [Indexed: 01/02/2023] Open
Abstract
Background UK African and Caribbean (AfC) communities are disproportionately burdened by type 2 diabetes (T2D). Promoting healthy eating and physical activity through structured education is the cornerstone of T2D care, however cultural barriers may limit engagement in these communities. In addition, changes in lifestyle behaviour are shaped by normative influences within social groups and contextual factors need to be understood to facilitate healthful behaviour change. The Behaviour Change Wheel (BCW) and associated COM-B framework offer intervention designers a systematic approach to developing interventions. The aim of this study was to apply the BCW in the design of a culturally sensitive self-management support programme for T2D in UK AfC communities. Methods An intervention development study was conducted. Focus groups were held with 41 AfC patients with T2D to understand healthful weight-management, diet and physical activity behaviours. The COM-B framework and BCW were used to evaluate the qualitative data, identify appropriate behaviour change techniques and specify the intervention components. Results Participants were motivated to avoid diabetes-related consequences although did not always understand the negative impact of their current health behaviours on long-term diabetes outcomes. Barriers to healthful behaviour included gaps in knowledge related to diet, physical activity and weight management guidance. In addition, motivation and social opportunity barriers included an acceptance of larger body sizes, rejection of body mass index for weight guidance and cultural identity being strongly linked to consumption of traditional starches. There was a lack of social opportunity to perform moderate to vigorous physical activity, although walking and dance were culturally acceptable. The resulting Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) intervention uses social support, social comparison, credible sources and demonstration as key behaviour change techniques. Conclusion Use of COM-B and the BCW highlighted the need for an intervention to address motivational and social opportunity barriers to engaging in healthful behaviours, as well as addressing key gaps in knowledge. This framework facilitated the linkage of theoretical behaviour constructs with evidence-based behaviour change techniques, which will enable us to evaluate operationalisation of our chosen BCTs and their impact on behaviour change in a future feasibility study. Electronic supplementary material The online version of this article (10.1186/s12889-019-7411-z) contains supplementary material, which is available to authorized users.
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Spread and impact of goat pox ("sagolay bohonta") in a village smallholder community around Kaziranga National Park, Assam, India. Trop Anim Health Prod 2019; 51:819-829. [PMID: 30649668 PMCID: PMC6469614 DOI: 10.1007/s11250-018-1759-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/13/2018] [Indexed: 11/28/2022]
Abstract
During September and October 2017, a highly fatal outbreak of a disease clinically indistinguishable from goat pox occurred in the villages around the Kaziranga National Park, Assam, India. This was investigated through clinical examination of affected animals, individual interviews with goat keepers and participatory village meetings. Laboratory confirmation was impractical due to the isolation and poverty of the affected community and unnecessary due to the specific nature of the clinical signs. Respondents reported not having encountered the disease previously, and it would appear that a naïve local population developed within an endemically affected region because of a trend to avoid purchasing animals from outside the village. Local grazing practices appear to have had a role in both the spread and control of the outbreak. Goats are an important form of savings and cash income to people in the locality, and the outbreak may result in considerable financial hardship for affected goat keepers. We provide a detailed description of the clinical disease and the spread of the outbreak in the locality. Awareness of the disease with reference to farming practices will provide opportunities for future disease control to enhance animal welfare and rural prosperity.
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Youth participatory research and evaluation to inform a Chagas disease prevention program in Ecuador. EVALUATION AND PROGRAM PLANNING 2018; 69:99-108. [PMID: 29753193 DOI: 10.1016/j.evalprogplan.2018.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 03/15/2018] [Accepted: 04/29/2018] [Indexed: 06/08/2023]
Abstract
This qualitative study engaged a group of young people in participatory research and evaluation activities in order to study to what extent engaging youth in health interventions can inform research and evaluation processes. We applied a youth participatory research and evaluation approach (PRE) to inform research and evaluation on the impact of a Chagas disease control program in southern Ecuador. Our main interest was to examine the methodological contributions of PRE to knowledge sharing for health intervention planning in the context of global health and neglected tropical diseases. The results of this study suggest that by demystifying research and evaluation practices and rendering them accessible and relevant, marginalized youth can develop critical and reflexive thinking skills that could be useful for decision-making on health promotion. Our findings also reveal the potential of youth as active participants in project development in ways that enhance, validate, and improve health interventions. Young people are interested in learning about and sharing local knowledge that can benefit research and evaluation processes. Despite the numerous strengths demonstrated by PRE, the inherent complexities of international development, such as cultural differences, asymmetrical power relations, and the ongoing challenges of sustainability, remain.
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Showing the Unsayable: Participatory Visual Approaches and the Constitution of 'Patient Experience' in Healthcare Quality Improvement. HEALTH CARE ANALYSIS 2018; 26:171-188. [PMID: 29038985 PMCID: PMC5899993 DOI: 10.1007/s10728-017-0349-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This article considers the strengths and potential contributions of participatory visual methods for healthcare quality improvement research. It argues that such approaches may enable us to expand our understanding of 'patient experience' and of its potential for generating new knowledge for health systems. In particular, they may open up dimensions of people's engagement with services and treatments which exceed both the declarative nature of responses to questionnaires and the narrative sequencing of self reports gathered through qualitative interviewing. I will suggest that working with such methods may necessitate a more reflexive approach to the constitution of evidence in quality improvement work. To this end, the article will first consider the emerging rationale for the use of visual participatory methods in improvement before outlining the implications of two related approaches-photo-elicitation and PhotoVoice-for the constitution of 'experience'. It will then move to a participatory model for healthcare improvement work, Experience Based Co-Design (EBCD). It will argue that EBCD exemplifies both the strengths and the limitations of adequating visual participatory approaches to quality improvement ends. The article will conclude with a critical reflection on a small photographic study, in which the author participated, and which sought to harness service user perspectives for the design of psychiatric facilities, as a way of considering the potential contribution of visual participatory methods for quality improvement.
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Ageing with a learning disability: Care and support in the context of austerity. Soc Sci Med 2018; 231:55-61. [PMID: 29580648 DOI: 10.1016/j.socscimed.2018.03.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/19/2018] [Accepted: 03/16/2018] [Indexed: 11/20/2022]
Abstract
Recent work in geography has begun to look at the opportunities for care from siblings, friends and neighbours alongside parents and spouses. This paper examines the daily relationships that middle to older age adults with a learning disability have with remaining kin members, friends, and neighbours, within the context of declining formal day services. Adults with learning disabilities are more likely to have different life course experiences and be living on low incomes and in poor housing than the rest of the population as they have had less opportunity to work and save money through their lives. We draw on two qualitative studies with adults with learning disabilities. Findings suggest that friend and kin networks are anything but certain, as opportunities to meet and socialise shrink, and connections with siblings do not necessarily lend themselves to support. The findings raise the possibility of a space of attenuated care to convey the increasingly limited fronts from which support can be derived.
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Participatory methods for Inuit public health promotion and programme evaluation in Nunatsiavut, Canada. Int J Circumpolar Health 2017; 76:1343637. [PMID: 28691646 PMCID: PMC5533137 DOI: 10.1080/22423982.2017.1343637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Engaging stakeholders is crucial for health promotion and programme evaluations; understanding how to best engage stakeholders is less clear, especially within Indigenous communities. The objectives of this thesis research were to use participatory methods to: (1) co-develop and evaluate a whiteboard video for use as a public health promotion tool in Rigolet, Nunatsiavut, and (2) develop and validate a framework for participatory evaluation of Inuit public health initiatives in Nunatsiavut, Labrador. Data collection tools included interactive workshops, community events, interviews, focus-group discussions and surveys. Results indicated the whiteboard video was an engaging and suitable medium for sharing public health messaging due to its contextually relevant elements. Participants identified 4 foundational evaluation framework components necessary to conduct appropriate evaluations, including: (1) community engagement, (2) collaborative evaluation development, (3) tailored evaluation data collection and (4) evaluation scope. This research illustrates stakeholder participation is critical to develop and evaluate contextually relevant public health initiatives in Nunatsiavut, Labrador and should be considered in other Indigenous communities.
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Understanding the unique experiences, perspectives and sexual and reproductive health needs of very young adolescents: Somali refugees in Ethiopia. Confl Health 2017; 11:26. [PMID: 29163667 PMCID: PMC5688399 DOI: 10.1186/s13031-017-0129-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Kobe Refugee camp hosts roughly 39,000 refugees displaced from Somalia during the 2011–2012 Horn of Africa Crisis. Sexual and reproductive health, as with the greater issues of health and well-being for adolescents displaced from this crisis remain largely unknown and neglected. In 2013, the Women’s Refugee Commission, Johns Hopkins University, and International Medical Corps in Ethiopia, implemented qualitative and quantitative research to explore the factors and risks that impact the health of very young adolescents (VYAs), those 10–14 years of age, in this setting. This paper presents findings from the qualitative effort. Methods Focus group discussions (FGD), incorporating community mapping and photo elicitation activities, were conducted with 10–12 and 13–14 year-olds to obtain information about their own perspectives, experiences and values. FGDs were also implemented with 15–16 year-olds and adults, to consider their perspectives on the sexual and reproductive health needs and risks of VYAs. Results This research identified several factors that were found to influence the health and well-being of VYAs in Kobe refugee camp, including newfound access to education and security, combined with gender divisions and parental communication around early SRH and puberty that remained intact from traditional Somali culture. Girls were found to face an additional risk of child marriage and early pregnancy exacerbated since displacement, which significantly limited their ability to access education and achieve future aspirations. Conclusion Findings from this study could help to inform future programs in Kobe and similar contexts involving long-term displacement from conflict, focusing on the health and development needs of VYAs. Future programs should consider the determinants of positive VYA health and development, including access to education, gender equity, and safety. By better understanding the unique experiences, perspectives and needs of VYAs, practitioners, policy makers and donors can invest in the individual and community assets that reinforce positive behaviors established in early adolescence, in order to achieve long-term SRH impacts.
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What does theory-driven evaluation add to the analysis of self-reported outcomes of diabetes education? A comparative realist evaluation of a participatory patient education approach. PATIENT EDUCATION AND COUNSELING 2016; 99:995-1001. [PMID: 26830513 DOI: 10.1016/j.pec.2016.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the effects of the Next Education (NEED) patient education approach in diabetes education. METHODS We tested the use of the NEED approach at eight intervention sites (n=193). Six additional sites served as controls (n=58). Data were collected through questionnaires, interviews and observations. We analysed data using descriptive statistics, logistic regression and systematic text condensation. RESULTS Results from logistic regression demonstrated better overall assessment of education program experiences and enhanced self-reported improvements in maintaining medications correctly among patients from intervention sites, as compared to control sites. Interviews and observations suggested that improvements in health behavior could be explained by mechanisms related to the education setting, including using person-centeredness and dialogue. However, similar mechanisms were observed at control sites. Observations suggested that the quality of group dynamics, patients' motivation and educators' ability to facilitate participation in education, supported by the NEED approach, contributed to better results at intervention sites. CONCLUSION The use of participatory approaches and, in particular, the NEED patient education approach in group-based diabetes education improved self-management skills and health behavior outcomes among individuals with diabetes. PRACTICE IMPLICATIONS The use of dialogue tools in diabetes education is advised for educators.
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Combining PPI with qualitative research to engage 'harder-to-reach' populations: service user groups as co-applicants on a platform study for a trial. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:7. [PMID: 29062508 PMCID: PMC5611582 DOI: 10.1186/s40900-016-0023-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 02/13/2016] [Indexed: 05/22/2023]
Abstract
PLAIN ENGLISH SUMMARY It is recommended that research studies are carried out with or by patients and the public through their involvement from the beginning and in as many stages as possible (known as PPI). Some studies formally invite patients and the public to participate in interviews and focused group discussions to collect views about topics (known as qualitative research). In our study on financial incentives for giving up smoking in pregnancy and breastfeeding, we combined both PPI and qualitative research to include the views of women with a range of experiences of smoking and breastfeeding. We involved two mother and baby groups in disadvantaged areas of North East Scotland and North West England as research partners on our team. First, we asked members to comment on our research plans and documents, which is standard PPI. Second, we asked members to participate in voice recorded discussions, contributing to qualitative research data. These discussions revealed different views from those that we heard through research interviews. They allowed us to develop more relevant research tools and resources. Members also helped us to identify people outside the groups who we could interview. Combining involvement and participation helped us to include the views of a wide range of women from 'harder-to-reach' groups who don't usually take part in research. This was important because the research was intended for women who could benefit from incentives to stop smoking in pregnancy and breastfeed, often present in such groups. Positive continuing relationships and trust improved on involvement or participation alone. BACKGROUND Patient and public involvement (PPI) in all research studies is recommended from the earliest point and in as many stages as possible. Qualitative research is also recommended in the early stages of designing complex intervention trials. Combining both together might enable inclusion of 'harder-to-reach' perspectives from the target population(s), particularly when the research is intended for their benefit. However, the interface between PPI and qualitative research has received little attention. In a multi-disciplinary, mixed methods study to inform the design of incentive trials for smoking cessation in pregnancy and breastfeeding, we combined PPI and qualitative research, with some overlap. Mother and baby groups from two geographically separate disadvantaged areas, with diverse experiences of the smoking and breastfeeding, but no training or previous involvement in research, were recruited as PPI research grant co-applicants. An iterative partnership approach facilitated involvement in research conduct and design across all project phases. Group PPI members were also invited to contribute to more formal qualitative data collection, as and when indicated by the research questions, and emerging analysis. RESULTS We engaged with 'harder-to-reach' women in mother and baby group settings, rather than in academic or home environments. These settings were relaxed and informal, which facilitated rapport-building, disclosures of unexpected information and maintained trust. Twenty-one women participated in standard PPI activities: feedback on study protocols and documents; piloting questionnaires and interview schedules. PPI members voiced some different perspectives from those captured within the qualitative dataset. Nineteen participated in focused qualitative research. Novel aspects were audio recorded PPI discussions, which contributed qualitative data; first, to interpret systematic review findings and construct intervention vignettes for use in the qualitative research; second, to assist with recruitment to improve sample diversity in the formal qualitative dataset; and third, to translate theory and findings presented in a researcher generated logic model into a lay tool. This had face validity for potential trial participants and used the metaphor of a ladder. CONCLUSIONS Combining and overlapping PPI and qualitative research added 'harder-to-reach' contributions, sample diversity, trust and engagement in creative approaches beyond what could be achieved through PPI or qualitative research alone.
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