'Building our own house' as an insider-only Community-Partnered Participatory Research Council: Co-creating a safe space for Autistic knowledge production

LAY ABSTRACT

In recent years, there has been a growing call for participatory Autism research (i.e. research that meaningfully involves Autistic people in its design and delivery). Community Partnered Participatory Research is a research methodology that aims to share power between researchers and members of the researched community. There is some precedent for Community Partnered Participatory Research in Autism research, but it is still quite uncommon. At the start of our new research study (called Autism: From Menstruation to Menopause), we created a community council. For the first six meetings, our council was made up of four Autistic community members who were experienced in Autism advocacy and activism and three Autistic researchers. We seven are the authors of this article. In these first six meetings, we made plans for recruiting a larger number of lay community members who would join us later for the rest of the project (8 years in total). In this article, we describe and reflect what it felt like during these first six meetings to be part of a community research council where everybody is Autistic. We discuss how we co-created a safe space, how we helped each other feel valued and how we worked together to support each other's sometimes-differing access needs so that everyone could fully participate. We provide recommendations for how to support Autistic people to lead research on their own terms with their unique insights.

Motivational Interviewing Implementation in Primary Care: A "Terrifying Challenge" Becoming a "Professional Revelation"

INTRODUCTION

Motivational interviewing (MI) is an evidence-based counseling approach within primary care. However, MI rarely translates to practice following introductory training programs, and a lack of evidence regarding its implementation persists today. This study describes primary care clinicians' professional transformation in implementing MI through interprofessional communities of practice (ICP-MI).

METHOD

Qualitative data collection involved the research journal, participant observation of four ICP-MIs (76 hours/16 clinicians), and focus groups. A general inductive approach was used for data analysis. Results were conceptualized based on the Consolidated Framework for Implementation Research.

RESULTS

Four processes of MI implementation in primary care are presented as a motivational endeavor: ambivalence, introspection, experimentation, and mobilization. The clinicians were initially ambivalent, taking into consideration the significant challenges involved. After introspecting actual practices, they realized the limits of their previous clinician-centered approaches. The experimentation of MI in the workplace followed and enabled clinicians to witness MI feasibility and its added value. Finally, they were mobilized to ensure MI sustainability in their practices/organization. Intrinsic factors of influence included the clinicians' personal traits and their perception about MI as a clinical priority. Organizational support was also a crucial extrinsic factor in encouraging the clinicians' efforts.

CONCLUSION

As described in a fragmented manner in previous studies, MI implementation processes and influencing factors are presented as integrated findings. Incorporating engaging educational activities to provide clinicians with motivational support and collaborating with health care organizations to plan appropriate resources should be considered in the development of MI implementation programs from the onset.

"From Health Experts to Health Guides": Motivational Interviewing Learning Processes and Influencing Factors

Motivational interviewing is an evidence-based counseling approach. However, its learning processes and their influencing factors are understudied, failing to address the suboptimal use of motivational interviewing in clinical practice. A participatory action research was conducted in collaboration with 16 primary care clinicians, who encountered similar challenges through their previous counseling approaches. The study aimed to facilitate and describe the clinicians' professional transformation through interprofessional communities of practice on motivational interviewing (ICP-MI). Data were collected using the principal investigator's research journal and participant observation of four independent ICP-MIs (76 h) followed by focus groups (8 h). The co-participants performed inductive qualitative data analysis. Results report that learning motivational interviewing requires a paradigm shift from health experts to health guides. The learning processes were initiated by the creation of an openness to the MI spirit and rapidly evolved into iterative processes of MI spirit embodiment and MI skill building. The intrinsic influencing factors involved the clinician's personal traits and professional background; the extrinsic influencing factor was the shared culture disseminating the expert care model. Previously described in a fragmented manner, motivational interviewing learning processes, and its influencing factors were presented as integrated findings. Considerations in elaborating effective MI training/implementation programs are discussed for clinicians, trainers, and decision-makers. Future areas of investigation are also highlighted calling forth the research community to contribute to knowledge advancement on health education in primary care.

[Implementing bedside handover in neurological rehabilitation: An Action Research Approach in Practice Development]

Implementing bedside handover in neurological rehabilitation: An Action Research Approach in Practice Development Abstract. Background: Nursing handovers are considered high-risk tasks but are also an important resource for conveying pertinent insights in the patients' situation and engaging them in the care process. As part of a broader action research project, a participatory approach was used to implement bedside handovers. Aims: It seemed central to sustainable change to gain insights which underlying factors motivate nurses to change handover practices. Methods: A qualitative design was chosen, in which five exploratory interviews were conducted with nurses. Results: The biggest challenges are privacy concerns and dealing with cognitively impaired patients. The motivations for bedside handover are a less error-prone transfer of information and a more accurate impression of the patient, in addition to a patient contact which is experienced as valuable. Discussion: The change in handover structure is accompanied by changes in the ward culture. The challenges faced by the staff require high communication skills to bridge them. The main factor for the preference of the handover form is the effect on the patients. Limitations: Transferability is limited due to the high contextual relevance. Transfer: With the help of a structured implementation strategy, even rituals can be modified. The bedside handover has a beneficial influence on patient-centredness.

An intervention study investigating the effectiveness of contextualizing multimodal strategy on improving hand hygiene at a tertiary hospital in Nigeria

BACKGROUND

Hand hygiene (HH) is a proven low-cost means to curtail the problem of hospital-acquired infection (HAI). However, a low HH compliance rate of 17.1% was found among surgical health workers at Ahmadu Bello University Teaching Hospital (ABUTH) in Zaria, Nigeria.

METHODS

This was an intervention study conducted utilizing mixed methods to investigate the effectiveness of the World Health Organization (WHO) multimodal strategy to improve the HH compliance rate of doctors at ABUTH Zaria. The study was conducted between June and August 2022 and included delivering a behavioural change HH workshop to doctors followed by data collection in the surgical wards that had received environmental modification through the provision of an alcohol-based hand rub (ABHR), HH posters and nurses for visual and/or verbal reminders.

RESULTS

The cumulative HH compliance rate was 69% (n=1774) and was significantly different from the baseline HH compliance rate of 17.1% (confidence interval 45.5 to 57.7, p<0.001). Observed HH was highest in the ward with both visual and verbal reminders (78%) and lowest (59%) where neither visual nor verbal reminders were provided (n=444 per ward). All respondents reported motivation to perform HH with the presence of ABHR.

CONCLUSIONS

The WHO multimodal strategy is good for enhancing HH among health workers in the context of low- and middle-income countries. More research is needed to understand how much of a reduction in HAI is directly associated with efficient HH by health workers.

Medical and surgical nurses' experiences of modifying and implementing contextually suitable Safewards interventions into medical and surgical hospital wards

AIM

To explore general nurses' experiences of modifying and implementing contextually suitable Safewards interventions into medical and surgical hospital wards.

DESIGN

Qualitative action research was used working with nurses as co-researchers.

METHODS

Pre-implementation focus groups were conducted in April 2022 to understand and explore the current strategies nurses utilized to avert, respond to or decrease violence. Following this, two Safewards interventions were modified by the nurses on the wards. Post-implementation focus groups were conducted in October 2022, to explore the nurses' experience of implementing Safewards interventions and the effect on their nursing practice. Data were analysed using Braun and Clarke's framework for thematic analysis.

RESULTS

Three themes emerged from the analysis of the pre-implementation focus groups that reflected the type of violence experienced by these nurses and the context within which they occurred: 'the space is hectic'; 'it can feel like a battlefield'; and 'the aftermath'. These themes encompass the nurses' experience of violence from patients and their visitors. Following the implementation of two modified Safewards interventions, the analysis of the focus groups reflected a change in nursing skills to avert or respond to violence: 'Safewards in action'; 'empathy and self-reflection'; and 'moving forward'.

CONCLUSION

Safewards interventions can be successfully modified and used in general hospital wards and influence nursing practice to manage patient and visitor violence.

IMPLICATIONS FOR THE PROFESSION

In the interests of safety, successful interventions to reduce violence towards general hospital nurses should be a priority for managers and healthcare organizations. Averting, mitigating and managing violence can decrease the negative professional and personal effect on nurses and ultimately improve well-being, job satisfaction and retention rates. Furthermore, decreasing violence or aggressive incidents leads to a safer patient experience and decreased number of nursing errors ultimately improving patient experiences and outcomes. Understanding nurses' experiences of violence and working with them to explore and develop contextually relevant solutions increases their capacity to respond to and avert violent incidents. Contextually modified Safewards interventions offer one such solution and potentially has wider implications for healthcare settings beyond the specific wards studied.

IMPACT

This study addressed the implementation of modified Safewards strategies in medical and surgical wards to prevent violence. Three themes emerged from the analysis of the pre-implementation focus groups that reflected the type of violence experienced by these nurses and the context within which they occurred. Following the implementation of two modified Safewards interventions, the post-implementation focus groups reported positive changes to their practices using the modified resources to prevent violence from patients and their visitors. Mental health interventions, such as those used in the Safewards model can be modified and provide a tool kit of interventions that can be used by medical and surgical nurses.

REPORTING METHOD

This paper has adhered to the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This paper outlines and discusses the action research approach undertaken to work with general hospital nurses to modify mental health nurses' Safewards interventions into their clinical practice. This paper provides evidence of the 'real world' application of Safewards interventions by medical and surgical nurses in general hospital wards. This paper presents qualitative findings based on focus group methods to highlight the narratives of general nurses and their experiences of violence.

How the expert nursing role was used to facilitate the co-design of a patient interview study

BACKGROUND

Co-design is a research method that seeks to engage service users in research. The approach fosters inclusivity and shared power by having researchers and research participants work together for some or all of a study.

AIM

To describe the experience of co-designing a patient interview study from the perspective of an expert stoma nurse, using a case-study approach and reflexive methods.

DISCUSSION

Valuing expert patients' experiences when conducting research about them enabled patients to be trained as participant researchers to co-design and undertake a patient interview study. The co-design process enabled the researcher to develop a greater recognition of the fact that experience of looking after people with stomas does not equate to expertise in knowing what it is like to have a stoma. This enriched her research experience and increased the authenticity of the study.

CONCLUSION

Co-designing a study with service users creates challenges for nurse researchers. They must pay attention to relational changes, time, planning and organisation to ensure that they conduct their research rigorously and ethically, and safeguard the co-researchers and other participants from potential risks.

IMPLICATIONS FOR PRACTICE

Co-designing research is critical for developing effective, patient-centred bodies of evidence. Nurse researchers can play a critical role but must be prepared to shift from directive to participatory methods to identify appropriate, patient-focused improvements.

Enhancing Medical Students' Reflective Capacity: Utilizing Reflective Practice Questionnaire as an Action Research Diagnostic Tool

Introduction Reflection is the intentional evaluation of one's beliefs or understanding in consideration of the available evidence. Reflection has been noted to enhance profound learning and critical thinking and is an essential foundation of experiential learning. The Reflective Practice Questionnaire (RPQ) is a valid and reliable tool for assessing reflective capacity among medical students. It assesses not only reflective capacity but also other psychological constructs relevant to reflective practice, such as job satisfaction, confidence while interacting with patients, stress during patient interaction, desire for improvement, and feelings of uncertainty. The use of RPQ as a diagnostic tool for improving reflective capacity among medical students is scarcely available in the literature. Thus, the present study aimed to utilize the RPQ for identifying discrete action points for training and future improvement in reflective capacity. Materials and methods The present cross-sectional descriptive study was conducted among 300 medical students of a medical college. To identify the clusters or meaningful subgroups within the study population, cluster analysis was done. Inter-correlation between subscales of RPQ was performed by forming Pearson's correlation matrix to understand the dynamics between various subscales of RPQ. Results Five groups were identified in the cluster analysis: typical (25.6%), reflective (27%), non-reflective (16.7%), unconfident (14%), and overconfident (16.7%). This sets the template for specific action points for each group identified above. Reflective capacity was positively correlated with Desire for Improvement (DfI), General Confidence (CG), Communication Confidence (CC), and Job Satisfaction (JS). It was also positively correlated with negative outcomes such as Uncertainty (Unc) and Stress when Interacting with Patients (SiC). Conclusion RPQ can be used as a diagnostic tool in terms of reflective capacity for action research.

Creating a difference - a role for the arts in addressing child wellbeing in conflict-affected areas

BACKGROUND

Details findings from a project on the potential for arts activities and art therapy to support the mental health and wellbeing of children living in Kashmir.

METHODS

The intervention engaged 30 school children over the course of one year who produced various forms of artwork and performances. In this paper, we report on project impacts, drawing on some of our qualitative measures including observations and interviews.

RESULTS

Our research details impacts and improvements in areas of emotional expression, belonging, and agency. We also found an important role for schools to create safe, secure, and caring spaces to allow students to express themselves and work through traumatic feelings in a non-judgemental way.

CONCLUSIONS

School-based arts interventions can play an important role in the mental health and wellbeing of children. Critical here, however, are dedicated space, time, and resources to provide a supportive environment and to sustain activity in long-term.

Improving the reproductive health literacy of couples on the verge of marriage through the FOCUS-PDCA model: Mixed-method study

Background & Aims

Education and counseling during marriage is an opportunity to raise some issues needed by couples on the verge of marriage. This study was conducted with the aim of improving reproductive and sexual health literacy of couples on the verge of marriage.

Methods

This study was a mixed-methods participatory action research conducted based on the Find, Organize, Clarify, Understand, Select-Plan, Do, Check, Act (FOCUS-PDCA) model in nine steps during 2019-2020 in the city of Bandar Abbas. The Reproductive Health Literacy Scale and the Service Quality (SERVQUAL) Questionnaire were used to evaluate the interventions. Data were analyzed by SPSS version 26. A significance level of less than 0.05 was considered.

Results

The mean age of women and men participating in the quantitative part of the study was 21 ± 5 and 25.84 ± 3.9 years, respectively, which was similar to their counterparts in this part of the study, and the difference in the mean scores of reproductive health literacy before and after the changes in the program showed a significant difference (p > 0.001). The study results showed that, except for the understanding dimension, most participants were at an insufficient level in other dimensions of reproductive health literacy. The result of measuring the satisfaction of service recipients indicated good satisfaction in the two dimensions of warranty and accountability, and there was a gap in empathy, assurance, and tangibility dimensions, which the biggest gap was related to the empathy dimension.

Conclusion

The changes made in improving the reproductive health literacy of couples were effective, which can be taken into consideration based on the added items in the current program of providing educational services in marriage preparation classes for couples.

Competing discourses as barriers to change in rehabilitation nursing: a discourse analysis

Introduction

The power of action research to create change by anchoring research results in practice was challenged in an action research project at a specialized rehabilitation unit for persons with acquired spinal cord injury. Despite the co-researchers' new insights, approaches, and actions supporting patient participation, it was not possible to change the basic conditions for the practicing of nursing. We aimed to raise awareness of the mechanisms that govern barriers by exploring these barriers as experienced by nurses in their effort to change their practice to improve patient participation.

Method

We used Fairclough's critical discourse analysis drawing on Foucault's practical systems; ethics (identity, relation to oneself), power (action, relation to others), and knowledge (representation, aspects of the world), which he combines with discourse-analytical concepts.

Results

Our discourse analysis of the empirical data at micro-level uncovers the nature of barriers to change in practice. In addition, our analysis at macro-level unveils how these practices are embedded in larger historical, societal, and institutional discourses. This identified two current discourses: a biomedical discourse and a biopsychosocial discourse. In the light of these two discourses, the nurses at micro-level saw themselves as strong agents for the best rehabilitation by acting in accordance with the biopsychosocial discourse. But they were unable to find the time and space to do so due to tasks, structures, and practices specified by an organization dominated by the biomedical discourse.

Patient safety and quality care for children with intellectual disability: An action research study

Children with intellectual disability experience significant challenges in accessing and receiving high-quality healthcare leading to poorer health outcomes and negative patient experiences. Families of these children often report a need for healthcare staff to better understand, communicate, and collaborate for better care while staff acknowledge a lack of training. To address this, we utilised an action research framework with a pre- and post- survey to evaluate an integrated continuing professional development and quality improvement program combining strategies from education, behavioural psychology and quality improvement that was delivered in two departments within a tertiary children's Hospital in Metropolitan Sydney in 2019-2020. Parents reported noticeable changes in the clinical practice of staff, and staff acknowledged and attributed their shift in behaviour to raising awareness and discussions around necessary adaptations. The program demonstrates a novel method for knowledge translation to practice and systems improvements.

Looking back, moving forward: 50 years of the American Journal of Community Psychology

The American Journal of Community Psychology (AJCP) was founded in 1973 and has since its inception has been the flagship journal for the Society of Community Research and Action. AJCP publishes leading scholarship in community psychology and social action research. This special issue celebrates the 50 years of scholarship in AJCP by curating and assembling previously published articles in virtual special issues (VSIs) with accompanying commentaries. Nine VSIs were compiled as part of this special issue. Each of these VSIs were organized around themes that are of critical importance to community psychology and each VSI summarizes what has been learned from their included articles and future directions for the field. In this paper, we introduce this special issue on this collection of VSIs, discussing how each of these VSIs endeavor to push the field forward.

How Can We Find Out What Indigenous Children and Their Families Need to Manage Weight? Lessons from Formative Nutrition Intervention Research with First Australians

In Australia, Indigenous children have rates of overweight and obesity 1.5 times those of non-Indigenous children. Culturally safe and effective nutrition interventions are needed for this group. This paper aims to describe a Community-based Participatory Action Research (CPAR) approach to designing formative nutrition intervention research with First Australian children and their families and to reflect on the challenges arising from this process. After obtaining ethical approvals, a Steering Committee (SC), including nine Aboriginal and Torres Strait Islander people experienced in delivering or receiving health care, was established as a project governance body to develop culturally safe project materials and methods. The Indigenous research method of yarning circles was chosen by the SC for the community consultation, and the First Australian SC members were trained to collect the data. They liaised with community organizations to recruit yarning circle participants. Individual interviews conducted by an Aboriginal research assistant replaced yarning circles due to the COVID-19 pandemic lockdowns. While the CPAR approach to formative research was successful, the pandemic and other factors tripled the study duration. To authentically, ethically and safely engage First Australians in research, researchers need to decolonize their methodological approach, and funding bodies need to allow adequate time and resources for the process.

Participatory development of a home-based depression care model with lived experience older Nigerians and their caregivers: A theory of change

OBJECTIVES

There is a huge treatment gap for late-life depression in sub-Saharan Africa. Building on prior work to scale-up mental healthcare with the aid of the WHO Mental Health Gap Action Programme Intervention Guide electronic version (emhGAP-IG), this study aims to involve older people in the iterative development of innovations to overcome challenges in the detection and clinical management of late-life depression by frontline non-specialist primary healthcare workers (PHCW) in Nigeria.

METHODS

There were 43 participants in the study. We conducted formative qualitative research using 15 in-depth key informant interviews with persons who were 60 years or older and had a recent experience of depression. We also conducted two focus group discussions comprising 13 of their caregivers. Through a full day stakeholders workshop comprising 15 participants, we drew on the results of our qualitative explorations to identify the pathway to impact of an intervention package (emhGAP-Age) appropriate for the specific needs of persons with late-life depression in Nigeria.

RESULTS

A Theory of Change (ToC) map was produced. It highlights the expected long-term outcomes of emhGAP-Age to include the potential for improvement of the mental health and wellbeing of older people living in Nigeria and the generation of interest among governmental agencies concerned with policy and planning for mental healthcare. Key resources that serve as preconditions were identified to consist of the availability of PHCW who are skilled in the identification and treatment of depression and have interest in and commitment to providing care to older people. Required community resources include support from immediate family, neighbours, and informal groups. Interventions that are appropriate for depression in old age need to incorporate these community resources and address not only the symptoms of the condition but also comorbid physical health problems.

CONCLUSIONS

A participatory ToC process led to the identification of the key components of an age-appropriate version of the emhGAP-IG for delivering care to older persons with depression by PHCW in Nigeria.

We have to turn a transatlantic liner-Leaders' perspectives on creating a meaningful life for older persons receiving municipal care

AIMS

To describe leaders' perspectives on what is important to create a meaningful daily life for older persons receiving municipal elderly care.

DESIGN

This study combined the Participatory Appreciative Action Reflection approach and qualitative methods.

METHODS

Focus Group Discussions were performed with eighty leaders that was analysed with qualitative content analysis.

RESULTS

One overall theme emerged "We have to turn a transatlantic liner". The leaders proposed a need to change from an institutional care to a more person-centered care approach on all levels of the healthcare system. This meant that everyone in the organization needed to think outside the box and find new ways to provide care to older persons. They needed to hire the right persons with the right values and knowledge. The leaders would need to provide for and support staff empowerment. There was also a need to see the older person and their relatives as co-participants. No Patient or Public Contribution.

An Assessment Rubric for a Resident Training Program in Surgery: A Single-Institution Experience

Using a Collaborative Action Research model, our research team established a one-month clinical resident training program for first- and second-year clinical residents. We created and implemented an assessment rubric to assess the residents' progress toward independent practice in surgery, and thereby, to evaluate the program itself. The program included training in three areas: basic techniques and procedures in the operating room, surgical ward management, and academic activities. The rubric measured the residents' performance according to three achievement levels: Level 1 (demonstration), Level 2 (active help) and Level 3 (passive help). The program and rubric implementation began in June 2019 and continued until March 2020, when the program outcomes and shortcomings were analyzed. Among nineteen clinical residents, a total of nine clinical residents participated in the study. Most participants reached achievement Level 3 for their performance of basic techniques in the operating room. Finally, we discussed ideas for improvement and drafted plans for an improved rubric to complete the action research cycle. Our research team found the rubric to be a useful tool in evaluating the status of the new clinical resident training program.

Explaining barriers to childbearing using the risk communication and community engagement (RCCE) strategy: Based on action research

Background and Aims

Reluctance to childbearing and then the reduction of the total fertility rate are common experiences of developed countries and many developing countries, including Iran, therefore, the purpose of this study was explaining barriers to childbearing using the risk communication and community engagement (RCCE) strategy.

Methods

The study was conducted by action research and according to RCCE during 9 months in Ardabil city. The statistical population consisted of 41 married women aged 15-54 who were eligible for childbearing, these women were purposefully selected from among the people covered by Ardabil health centers and interviewed. Data were collected using open and in-depth interviews by the researcher and analyzed by content analysis.

Results

The results of data analysis led to the extraction of three main categories, personal, familial, and social barriers. The "personal barriers" category was classified into three subcategories, namely mental, belief, and awareness barriers, the "familial barriers" category was classified into two subcategories, namely social and financial barriers, and the "social barriers" category was classified into two subcategories, political and managerial barriers.

Conclusions

According to the results, a set of personal, familial, and social factors could affect childbearing among married women. Identification of these factors can play an effective role in designing educational and managerial programs.

Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial

BACKGROUND

Low- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs.

OBJECTIVE

This study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women's self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years.

METHODS

The proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level.

RESULTS

We will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025.

CONCLUSIONS

This study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention.

TRIAL REGISTRATION

Clinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597&EncHid=&userName=V-CaN.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/42450.

Developing and Planning a Protocol for Implementing Health Promoting Animal Assisted Interventions (AAI) in a Tertiary Health Setting

The Ottawa Charter identifies that multiple levels of government, non-government, community, and other organizations should work together to facilitate health promotion, including in acute settings such as hospitals. We outline a method and protocol to achieve this, namely an Action Research (AR) framework for an Animal Assisted Intervention (AAI) in a tertiary health setting. Dogs Offering Support after Stroke (DOgSS) is an AR study at a major tertiary referral hospital. AAI has been reported to improve mood and quality of life for patients in hospitals. Our project objectives included applying for funding, developing a hospital dog visiting Action Research project, and, subsequent to ethics and governance approvals and finance, undertaking and reporting on the Action Research findings. The Action Research project aimed to investigate whether AAI (dog-visiting) makes a difference to the expressed mood of stroke patients and their informal supports (visiting carers/family/friends), and also the impact these visits have on hospital staff and volunteers, as well as the dog handler and dog involved. We provide our protocol for project management and operations, setting out how the project is conducted from conception to assess human and animal wellbeing and assist subsequent decision-making about introducing dog-visiting to the Stroke Unit. The protocol can be used or adapted by other organizations to try to avoid pitfalls and support health promotion in one of the five important action areas of the Ottawa Charter, namely that of reorienting health services.

The Possibility and Promise of Action Research in Pediatrics: A Scoping Review

Action research (AR) is an umbrella term encompassing a range of related research approaches and frameworks such as participatory AR, participatory research, community-based participatory research, and community-engaged research. In contrast to conventional, investigator-led research that is conducted on or about participants, AR is conducted with those who have a "stake" in the research topic. Despite growing acceptance as an established research approach, AR is noticeably limited within pediatric health care literature. Following a structured process, we conducted a scoping review to explore AR in pediatrics within the last 10 years. Twenty-eight articles met eligibility criteria. Study themes included eliciting stakeholder perspectives, improving stakeholder experiences, and developing/evaluating tools. Future AR in pediatrics should include the measurement of specific health outcomes and greater detail of the actionable steps that resulted from the research process. Action research has potential application to improve the quality and stakeholder relevance of pediatric clinical, educational, and community research.

Developing Chinese university students' academic literacies in English language classrooms via a production-oriented approach: an action research perspective

Developing academic literacies is becoming an important research topic in TESOL and has received increasing scholarly attention. One of the difficulties in developing university students' academic literacy in English language speaking is the lack of an authentic English language learning environment and the way to help students more effectively develop their language competence. To address this issue, this study seeks to explore the academic literacy development of 24 non-English major students in an 8-week-long integrated English class at a Chinese university from late 2022 to early 2023. Based on a production-oriented approach (POA) action research design, this study follows the typical framework of driving, enabling, and assessing phases to chain together the teaching and learning actions. Quantitative data from questionnaires were analyzed via SPSS software, whereas thematic analysis and content analysis were adopted in examining the qualitative data including classroom observations, teacher reflection journals, and semi-structured interviews. Based on our data analysis, this study finds that POA can have a positive effect on improving students' participation, performance, and task completion, which improves their academic literacies. Implications on how POA helps in facilitating EFL students' academic literacies development are discussed along with the acquisition model and future research directions like students' identity issues and teachers' perceptions of pedagogical approaches in teaching academic literacy within university settings.

Co-creation of educational commons spaces to reverse inequalities: project SMOOTH and the Children's Club

This article presents an action-research project from the EU-funded SMOOTH project, which focuses on the potential of Educational Commons to address educational inequalities. The project adopts an emergent paradigm that views spaces for collaboration, content co-creation, socialization, governance, and play as catalysts for reversing inequalities. The action-research, conducted in a disadvantaged non-formal education setting in northern Portugal, involved children aged 8-10 years old. Over a span of 10 months, the innovative action-research program aimed to achieve several objectives: (1) reversing inequalities faced by vulnerable social groups, (2) strengthening inter-cultural and inter-generational dialogue and social integration, (3) developing essential social and personal skills, and (4) creating smooth spaces of democratic citizenship based on equality, collaboration, sharing, and caring. By understanding the tensions and conflicts that emerge in children's everyday situations, the project sought to build and foster community through embracing differences. This article analyzes the characteristics, behaviors, challenges, and strengths observed during the 30 sessions. The results provide insights into the dimensions of Children as commoners, in terms of sharing and care, cooperation and collective creativity and active citizenship. This research contributes to the exploration of Educational Commons as a means to promote equity and transform educational contexts.

Clinical Significance of Action Research-Based Seamless Care to Improve Imaging Efficiency and Patients' Cognition, and Alleviate Patient Anxiety

Objective

The present study was undertaken to assess the clinical significance of action research-based seamless care to improve imaging efficiency and alleviate patient anxiety.

Methods

A total of eighty patients who underwent imaging examinations in our hospital between May 2019 and November 2020 were recruited for this study. The patients were randomly assigned to two groups: the control group receiving routine care and the observation group receiving seamless care based on action research. The random assignment was conducted using a simple random sampling technique, ensuring an equal allocation of participants to each group at a 1:1 ratio, resulting in 40 cases in each group. Outcome measures included imaging examination duration, mean nursing duration, examination cognition, and negative emotion scores.

Results

Seamless care provided shorter imaging examination duration and nursing duration, and better ensured uneventful examinations than routine care (P<0.05). Patients given seamless care exhibited higher examination cognition versus those receiving routine care (P<0.05). Seamless care offered more mitigation of negative emotions for patients than routine care (P<0.05).

Conclusion

Action research-based seamless care effectively improves imaging efficiency and patients' awareness of imaging examinations and contributes to alleviating patients' adverse events.

Older Adults in Action: Using Action Research to Address Neighborhood Change

Older adults face distinct challenges amidst changing neighborhood conditions, yet also bring distinct resources to aid their communities. After considering the literature related to well-being in older adulthood, the effects of neighborhood change on older adults, and older adults and social action, this paper explores the experiences of older adults in the Neighborhood Story Project. This action research project engages a group of neighbors to identify a set of research questions about their community, conduct place-based inquiry, and take action based on their learning. This study considers the degree to which the Neighborhood Story Project constitutes a macro therapeutic intervention. Drawing on observational and interview data with participants in seven Neighborhood Story Projects, this study explores the resources older adults brought to the project, what they personally gained from participating, and how their work benefited the broader community. The paper concludes with implications for macro-therapeutic interventions with older adults living through neighborhood change.

'It was kinda like D.I.Y closure'. Using Photovoice to capture the experiences of final year social work students graduating amidst the pandemic

This article examines a recent research project that explored the lived experiences of 5 final year social work students in Scotland who graduated during the coronavirus pandemic. The project used Photovoice as the primary data collection method, followed by a 3 hour long online focus group where the participants and the researcher worked collaboratively to identify themes for further analysis. The findings demonstrated that while the data collected by participants through the photographs and captions were highly personal to each participant, there were recurring themes that connected all of them which were identified broadly as; (dis)connection, closure and identity - all of which were discussed in great detail in a virtual focus group after the data was collected. This article focusses predominantly on the Photovoice method adopted for the study and how this was an effective method for participatory research. This article also focusses on how the pandemic affected the transitionary period between the participants' identity shift from students to professionals. This study followed the principles of Participatory Action Research which meant that participants and the researcher worked together to cultivate and analyse the data collected and the findings that are discussed here reflect this collaborative process. As this report is being written, numerous new studies, reports and predictions as to the pandemics impact on our collective mental health emerge daily and so it is hoped that this project will serve as a small time stamp as to how the pandemic impacted this small group of students in Scotland and will honour their stories, creating a lasting space for them to be heard among the ever-increasing bombardment of news.

Design, implementation, and evaluation of Students as Partners interactive feedback model

In September of 2020, a group of dental students (DDS) and motivated faculty at the University of Western Ontario came together in response to the pandemic and established a real-time feedback model. The goal of this model was to address technical challenges following the quick transition from in-person courses to a fully online format for student learning. This initial offering formed the foundation of the Students as Partners (SaP) program to identify and address technical and curricular issues. We used an action research approach to evaluate and refine the innovation's delivery. Preliminary data from the first cycle suggested that students were unaware of the impact of their feedback and the actionable items from their feedback. Thus, for the second iteration we focused on making the entire process more transparent by using Padlet as a way to streamline posting and responding to feedback. To evaluate the refined system, we distributed surveys to student and faculty participants to obtain feedback on their awareness and satisfaction and effectiveness of the program. For students who utilized the system, the majority indicated that they were informed of changes based on their feedback. Furthermore, students reported that our innovation provided a platform for the student voice. Faculty impressions were generally positive, and the majority of faculty respondents indicated that they implemented changes to their content/curriculum based on feedback. These results demonstrate that the SaP program's real-time feedback system closed the feedback loop and facilitated real-time improvements based on actionable feedback. To our knowledge, this is the first study to design, implement, and evaluate a real-time feedback system for the purpose of modifying how an instructor teaches.NEW & NOTEWORTHY Course feedback surveys at the end of term infrequently result in beneficial change. However, student feedback should be considered to develop meaningful learning. In response to this problem, we report on a novel Students as Partners innovation to address instructional issues in real time with a virtual bulletin board application embedded in the learning management system. Students and instructors valued the system's ability to close the feedback loop and provide transparent, actionable change.

The introduction and implementation of open dialogue in a day center in Athens, Greece: experiences and reflections of mental health professionals

Introduction

The present study is part of a large-scale original action-research project aiming to assess the introduction and implementation of the Open Dialogue approach within the clinical practice of an established multidisciplinary team in a Day Centre in Athens, Greece. More specifically, it aimed to explore the experiences of professionals within the process of implementation both in relation to their clinical practice and their professional identity.

Methods

Data collection employed a focus group, which was set up to explore professional reflections of the implementation and research processes since the introduction of the model. Thematic Analysis of transcripts revealed two main themes that correspond to the impact of Open Dialogue on professionals' clinical practice and on team dynamics, respectively.

Results

Professionals identify several challenges in implementing OD, such as difficulties in linking theory to practice, containing uncertainty, and addressing cultural barriers to dialogical ways of working. Professionals further reflect on their own internal journey stemming from the implementation of Open Dialogue that has led them to greater openness and growth, personally and as a team.

Discussion

The role of mental health professionals is being acknowledged as being at the frontline of any meaningful psychiatric reform through the assimilation and promotion of humanistic paradigms aiming towards a change of culture in psychiatric care across different contexts. Despite variations in implementation across different contexts, the importance of consolidating and embracing Open Dialogue as a philosophical framework underpinning mental health care is being discussed.

Addressing the educational challenges of urban poverty: a case for solution-based research

Introduction

Math achievement for economically disadvantaged students remains low, despite positive developments in research, pedagogy, and funding. In the current paper, we focused on the research-to-practice divide as possible culprit. Our argument is that urban-poverty schools lack the stability that is necessary to deploy the trusted methodology of hypothesis-testing. Thus, a type of efficacy methodology is needed that could accommodate instability.

Method

We explore the details of such a methodology, building on already existing emancipatory methodologies. Central to the proposed solution-based research (SBR) is a commitment to the learning of participating students. This commitment is supplemented with a strength-and-weaknesses analysis to curtail researcher bias. And it is supplemented with an analysis of idiosyncratic factors to determine generalizability. As proof of concept, we tried out SBR to test the efficacy of an afterschool math program.

Results

We found the SBR produced insights about learning opportunities and barrier that would not be known otherwise. At the same time, we found that hypothesis-testing remains superior in establishing generalizability.

Discussion

Our findings call for further work on how to establish generalizability in inherently unstable settings.

A Conceptual Model for Professional Identity in Nursing: An Interdependent Perspective

The purpose of this initiative was to define the development, verification, and evolution of the conceptual model for Professional Identity in Nursing. This action research design occurred over two phases, utilizing observations, a modified Norris process for model development, and focus groups. Analysis consisted of conventional content analysis and the Fawcett method for conceptual model analysis and evaluation. The model was modified, and results are presented based on the model's philosophical underpinnings, content, socialness, and evolution. The model resonates with nurses both in the United States and internationally. The interdependency shown in the model encourages collaboration, accountability, and sustainability within the profession and society.

Individual goal-setting in municipal homecare: A participatory appreciative action and reflection study

Background

There is a need for structural change in municipal homecare to shift power to older persons and to center the individuals in need. To make this change, the individual older persons should have enough self-determination to formulate their own individual homecare goals. Our aim was to explore how stakeholders reason about individual goal-setting in homecare.

Design and methods

We theoretically and methodologically used a participatory appreciative action and reflection (PAAR) design. The stakeholders, that is, the older persons, the older persons' relatives, and the multi-professional team, were seen as co-researchers. Data were collected between 2019 and 2020 through in depth-interviews, focus group discussions, and reference groups. The data were analyzed using thematic analysis.

Results

We learned from the stakeholders that it was a struggle to sustain the individual's goal to continue life as usual, that is, being an ordinary human being with an ordinary everyday life and maintaining individual roles. The individual wants to improve health, be active, and enjoying life. The individuals were struggling against the homecare organization, which tended to overshadow the individual's goals. The individual's goals fall under several legal jurisdictions and come to be overshadowed by the professionals' dominant goal. The organization is rigid, with finances and resources creating the framework.

Conclusion

We learned that older persons receiving homecare must have the same rights as other citizens in society, which is in line with public health goals.

Use of a Living Lab Approach to Implement a Smoke-Free Campus Policy

While universities have increasingly become tobacco-/smoke-free, to our knowledge, no campus has reported 100% policy compliance. Innovative approaches to encourage compliance and ongoing data collection are needed. This paper describes actions undertaken, framed within a Living Lab (LL) approach, to implement smoke-free campus policies in an Irish university. The action research comprised student-collected data on observed smoking on campus to evaluate adherence and compliance, first to a smoke-free zones policy (June 2016-March 2018), and then to a smoke-free campus policy (March 2019-February 2020). From June 2016-February 2020, 2909 smokers were observed. Adherence, defined as the average reduction in number of observed smokers from baseline in May 2016, reduced by 79% from 5.7 to 4.9 . Compliance, defined as the proportion of smokers who complied when reminded of the policy, was 90% (2610/2909). Additional activities included development of a broader health promotion programme; identification of a pattern of 'social smoking'; and promoting increased awareness of the environmental harms of tobacco. Ongoing policy implementation is essential for smoke-free policies and should include data collection and evaluation. Actions framed within the characteristics of a LL achieved fewer observed smokers. A LL approach is recommended to encourage policy adherence and compliance.

Understanding factors affecting implementation success and sustainability of a comprehensive prevention program for cardiovascular disease in primary health care: a qualitative process evaluation study combining RE-AIM and CFIR

AIM

Our aim was to evaluate the implementation process of a comprehensive cardiovascular disease prevention program in general practice, to enhance understanding of influencing factors to implementation success and sustainability, and to learn how to overcome barriers.

BACKGROUND

Cardiovascular disease and its risk factors are the world's leading cause of mortality, yet can be prevented by addressing unhealthy lifestyle behavior. Nevertheless, the transition toward a prevention-oriented primary health care remains limited. A better understanding of factors facilitating or hindering implementation success and sustainability of prevention programs, and how barriers may be addressed, is needed. This work is part of Horizon 2020 project 'SPICES', which aims to implement validated preventive interventions in vulnerable populations.

METHODS

We conducted a qualitative process evaluation with participatory action research approach of implementation in five general practices. Data were collected through 38 semi-structured individual and small group interviews with seven physicians, 11 nurses, one manager and one nursing assistant, conducted before, during, and after the implementation period. We applied adaptive framework analysis guided by RE-AIM Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) and Consolidated Framework for Implementation Research (CFIR).

FINDINGS

Multiple facilitators and barriers affected reach of vulnerable target populations: adoption by primary health care providers, implementation and fidelity and intention to maintain the program into routine practice. In addition, our study revealed concrete actions, linked to implementation strategies, that can be undertaken to address identified barriers. Prioritization of prevention in general practice vision, ownership, and shared responsibility of all team members, compatibility with existing work processes and systems, expanding nurse's roles and upskilling competence profiles, supportive financial and regulatory frameworks, and a strong community - health care link are crucial to increase implementation success and long-term maintenance of prevention programs. COVID-19 was a major barrier to the implementation. RE-AIM QuEST, CFIR, and participatory strategies are useful to guide implementation of prevention programs in primary health care.

[Health simulation in initial training: a device for the benefit of learners]

Three collaborative action-research projects have been carried out at the Institut de formation interhospitalier Théodore-Simon in Neuilly-sur-Marne (93) since the implementation of health simulation in nursing training. Their descriptions show the interest and the advantages of this pedagogical method and of the different "action pedagogies" which result from it for the nursing learners.

Holistic community-based group parenting programs for mothers with maternal mental health issues help address a growing public health need for a diversity of vulnerable mothers, children and families: Findings from an action research study

Background

Maternal mental illness is a major growing global concern which can affect parenting with serious negative implications for offspring. Group-based parenting programs for mothers which both enhance the parent-child relationship and address mental health symptoms in a supportive social setting may optimise better outcomes for mothers and children. The Acorn program in South Australia draws on attachment theory to integrate dance play, reflective diary keeping and therapeutic letters in a holistic program for a diversity of vulnerable mothers and children aged 1-36 months. The program seeks to nurture and enhance parental wellbeing and the quality of the parent-child relationship for mothers experiencing identified mental health illnesses that impinge upon their parenting. This study presents the evaluation of the program and its effectiveness.

Methods

Action research approach for continuous monitoring and program improvement engaging Acorn program staff in evaluation data collection and interpretation of pre and post self-completion measures and standardized observations. Additional data was collected through a telephone interview of attending mothers 6-8 months after program completion to address sustainable impacts on parenting and wellbeing.

Results

The program engaged 353 diverse vulnerable mothers with their children. Many had profound overlapping mental health issues including borderline personality disorder (BPD) and depression. The quality of the parent-child interaction, parental confidence, competence and enjoyment were enhanced; mothers' wellbeing, ability to cope and lasting social supports were augmented. This occurred for a number of "most vulnerable" subgroups including single mothers, mothers with BPD, mothers from non-English speaking households and those with lower levels of education or household income. Mothers reported sustained improvements in their wellbeing, parenting, social and family lives, and feeling closer to their child as a result of participating in the program.

Conclusions

Given the high prevalence of maternal mental health issues and substantial potential negative consequences for mothers and offspring, the Acorn parenting program offers an effective means of addressing this pressing public health issue potentially helping large numbers of vulnerable mothers and their children. This has additional gravitas in the shadow of COVID-19 due to expanded numbers of those experiencing greater parental stress, isolation and mental illness.

Media education and educational commons for youth civic engagement. A case study from the Horizon 2020 project SMOOTH

This study presents the preliminary findings of the first round of implementation of a case study included in the Horizon 2020 project SMOOTH. The project's main objective is to introduce and study the emergent paradigm of the educational commons as an alternative system of values and actions for promoting intercultural and intergenerational dialogue and establishing spaces of democratic citizenship that support the development of local communities. Our case study adopts this paradigm with insights derived from the field of media education. Hence, our research questions were as follows: (a) How do young people collectively experience and build the educational commons? (b) How do participants (youth and adults) in educational commons experience peer governance and how do they handle and resolve conflicts? (c) How does the co-creation of a photo-blog as a shared space of work help young people discover and develop a "civic intentionality" in the (digital) public sphere? (d) What are the effects of applying a commons' logic to address inequalities and achieve social inclusion of young people from vulnerable social groups? Fieldwork, framed in an ethnographic and action-research approach, was developed by examining the three dimensions of the notion of educational commons (commoners, commoning practices, and community). Although data collection and analysis are still in progress, our preliminary results allow us to draw some initial reflections on what worked well in the first round and what could hinder the achievement of the project's objectives. We also propose hypotheses for re-designing the second round to overcome the weaknesses that emerged during the first experimental phase and foster its strengths.

Action research on promoting hand hygiene practices in an intensive care unit

AIM

Evaluate the intensive care acquired infections incidence and the change over time in infection practices in one intensive care unit.

DESIGN

We used an action research approach with cyclical activities.

METHODS

Our study included two cycles with hand hygiene observation based on the WHO's five-moments observation tool, observing hand hygiene practices, analysing the observations, and giving feedback on observations, intensive care acquired infection rates, and alcohol-based hand rub consumption. The Revised Standards for Quality Improvement Reporting Excellence is the basis for this research report describing research aimed at improving patient safety and quality of care.

RESULTS

During the study, annual alcohol-based hand rub consumption increased by 6.7 litres per 1000 patient days and observed hand hygiene compliance improved. In the first cycle of the study, there was a decrease in critical care acquired infection rates, but the improvement was not sustainable.

Perceive, Recall, Plan and Perform (PRPP)-Assessment Based on Parent-Provided Videos of Children with Mitochondrial Disorder: Action Design Research on Implementation Challenges

AIMS

Performing the Perceive, Recall, Plan and Perform (PRPP)-Assessment, using video material of everyday life, seems sensible to lower the patient burden, enhance ecological validity, and provide care at a distance. However, receipt of adequate video material is not self-evident and assessing videos can be challenging. Therefore, this study aims to optimize the process of gaining video material and to optimize the PRPP-Assessment based on parent-provided videos.

METHODS

An action design research method was used, focusing on implementation of the PRPP-Assessment based on parent-provided videos within the care of children with a mitochondrial disorder or similar symptoms.

RESULTS

Five cycles were conducted. To receive input, the cycles used videos of nine children performing activities, written feedback, and semi-structured interviews and focus groups comprising parents (n = 13), a teacher (n = 1), occupational therapists (n = 16), and other professionals (n = 2) . This led to successful implementation of the PRPP-Assessment. General lessons were learned on (1) instructing parents; (2) handling video material; (3) PRPP-Assessment based on parent-provided videos; and (4) PRPP-Assessment of children (with limited functional abilities).

CONCLUSIONS

Lessons learned should be implemented in practice and are incorporated into a manual to guide the implementation of video-based observations with PRPP-Assessment in practice.

A systematic review on the use of action research methods in mental health nursing care

AIMS

To identify and synthesize evidence on the use of action research methods in mental health nursing care.

DESIGN

Systematic review.

DATA SOURCES

CINAHL, Web of Science, PubMed and Scopus databases were searched in January 2021.

REVIEW METHODS

Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Two reviewers independently conducted the study selection, and quality appraisal using Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, data extraction and data analysis procedures.

RESULTS

Sixteen studies, half of which used participatory action research, were included in this review. Nurses, along with other stakeholders, were an active part of the action research process. The main topics of interest addressed were categorized as improving the adoption of a person-centred approach to care and improving decision-making procedures. The use of action research helped the participants to identify the meaning they attached to the topic of interest to be improved. Moreover, this method helped to identify needs and strategies for improving care. The studies concurred that the use of action research enabled participants to gain awareness, improve attitudes and acquire knowledge. In addition, it enabled participants to gain confidence and security in the group context, as key aspects of their empowerment.

CONCLUSION

This review shows the usefulness of action research in any mental health nursing context, contributing to the improvement of care at both the individual and collective levels.

IMPACT

This paper demonstrates the use of the action research method in the field of mental health nursing. Its use has improved the clinical practice of nurses as well as that of teams in both community and hospital settings, addressing issues of the person-centred approach to care and decision-making procedures.

Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study

AIMS AND OBJECTIVES

To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units.

BACKGROUND

In mental health units, the therapeutic relationship is especially relevant for increasing the effectiveness of nursing interventions. Reflective practice is considered an essential aspect for improving nursing care.

DESIGN

Action and observation stages of a participatory action research project.

METHODS

Data were collected through reflective diaries designed for the guided description and reflection of practice interactions related to the therapeutic relationship and content analysis was applied. A total of 152 nurses from 18 acute mental health units participated. The COREQ guidelines were used.

RESULTS

The results were classified into three categories as follows: (i) Nursing attitude as a core of the therapeutic relationship. For the nurses, the attitudinal component was key in the therapeutic relationship. (ii) Nursing practices that are essential to the therapeutic relationship. Nurses identified practices such as creating a conducive environment, using an appropriate verbal approach, offering help and working together with the patient as essential for establishing a therapeutic relationship in practice. (iii) Contextual factors affecting the therapeutic relationship. The nurses considered the patient's condition, the care dynamics of the unit and its regulations, as well as the structure and environment of the unit, as contextual factors involved the establishment of an adequate therapeutic relationship in daily clinical practice.

CONCLUSIONS

This study has provided knowledge of the importance and role of the nurses' attitude in the context of the nurse-patient therapeutic relationship based on the reflections of nurses in mental health units regarding their own practice.

RELEVANCE TO CLINICAL PRACTICE

These findings help nurses to increase awareness and develop improvement strategies based on their own knowledge and day-to-day difficulties. Moreover, managers can evaluate strategies that promote motivation and facilitate the involvement of nurses to improve the therapeutic relationship with patients.

[A hospital foundation for research on precariousness and social exclusion]

The hospital in Nanterre (92) offers a wide range of services for the reception, orientation and medical care of people in precarious situations on a daily basis, both in the social medicine department and in other departments. The medical teams wanted to create a structure that could document and analyze the life trajectories and experiences of people in precarious situations, but above all innovate, propose adapted systems and evaluate them, in order to develop knowledge and practices. The hospital foundation for research on precariousness and social exclusion was thus created at the end of 2019 [1], with the structuring support of the Île-de-France regional health agency.

A Kaupapa Māori conceptualization and efforts to address the needs of the growing precariat in Aotearoa New Zealand: A situated focus on Māori

In Aotearoa New Zealand, the precariat is populated by at least one in six New Zealanders, with Māori (Indigenous peoples) being over-represented within this emerging social class. For Māori, this socio-economic positioning reflects a colonial legacy spanning 150 years of economic and cultural subjugation, and intergenerational experiences of material, cultural and psychological insecurities. Relating our Kaupapa Māori approach (Māori cultural values and principles underlining research initiatives) to the precariat, this article also draws insights from existing scholarship on social class in psychology and Assemblage Theory in the social sciences to extend present conceptualizations of the Māori precariat. In keeping with the praxis orientation central to our approach, we consider three exemplars of how our research into Māori precarity is mobilized in efforts to inform public deliberations and government policies regarding poverty reduction, humanizing the welfare system and promoting decent work. Note: Aotearoa New Zealand has been popularized within the everyday lexicon of New Zealanders as a political statement of Indigenous rights for Māori.

Formation and Implementation of Public Health Policy Toward Salt Reduction in Food Consumption

This action research aimed to study the processes of public health policy toward salt reduction in food consumption. The processes were divided into 3 cycles as follows: 1) Public health policy formation; 2) Development of the policy to reduce dietary salt; and 3) Evaluation of the efficiency of the policy. Participants from the first group involved in policy formation; and a total number of 320 participants were recruited in the study with the criteria of a) age 18 years and above, b) having hypertension or at risk of having high blood pressure; c) overweight; and d) having underlying diseases such as diabetes and hyperlipidemia. The second group was government officials involved in policy development to reduce salt consumption, including the head of the village, assistants of the village head, community leaders, public health personnel, village health volunteers, and a group of housewives. In total, 50 participants were recruited to the study. The results showed that people with hypertension could better control blood pressure which increased from 36.02, 25.6, and 39.06% (in 2018-2020) to 47.32%; and community people could manage their health prevention and control toward non-communicable diseases. Analyzing a return on investment (ROI) found that the ROI was 49.7%; and a social return on investment (SROI) was found that every $1 invested could generate a return of $3.45.

The therapeutic relationship at the heart of nursing care: A participatory action research in acute mental health units

AIMS AND OBJECTIVES

To explore the process of change within the clinical practice of nurses in mental health inpatient units in the context of a participatory process to improve the nurse-patient therapeutic relationship.

DESIGN

Participatory Action Research.

METHODS

Ninety-six nurses from 18 mental health units participated. Data were collected through focus groups and reflective diaries between March 2018 and January 2020. Data were analysed using inductive content analysis. The COREQ guidelines were used.

RESULTS

The research process was carried out through two cycles of four stages each in which the nurses were able to identify the facilitating and limiting elements of their practice in relation to the therapeutic relationship. They then proposed two consensual improvement strategies for all the units, which they called reserved therapeutic space and postincident analysis. Finally, they implemented and evaluated the two strategies for change.

CONCLUSIONS

This study has shown that, despite the different cultural and structural realities of the participating units, it is possible to implement a collaborative process of change, provided the needs and expectations of both the participants and the organisations are similar.

RELEVANCE TO CLINICAL PRACTICE

The results obtained through Participatory Action Research were directly transferred to clinical practice, thus having an impact on individual nurses and patients, as well as on the collective dynamics of the teams and aspects related to the management of the units.

NO PATIENT OR PUBLIC CONTRIBUTION

Patient or public input is not directly applicable to this study. Patients were recipients of the changes that were occurring in the nurses as part of their daily clinical practice.

Including patient-reported measures in performance evaluation systems: Patient contribution in assessing and improving the healthcare systems

In healthcare, the introduction of quality standards and indicators to assess performance triggered the development of multidimensional Performance Management Systems (PMSs). The concept of performance in healthcare has recently evolved and broadened its scope. One of the current challenges of PMSs is measuring and integrating the patient perspective into traditional measures. In the regional healthcare system of Tuscany (Italy), a PMS has been implemented and used since 2005. The PMS counts on the systematic involvement of clinicians and managers. Furthermore, the PMS also includes patients' perspective. Moreover, Tuscany has recently implemented the first regional permanent Patient-Reported Outcome and Experience Measures (PROMs and PREMs) Observatory in Italy. This paper presents the results of an action research aimed at analysing the integration of patient-reported outcome and experience indicators into a consolidated PMS. The study describes the process of identifying and discussing of patient-reported indicators with practitioners and categorising findings into three domains: design of patient-reported indicators, integration process into the PMS, and goal of adoption of the patient-related indicators. The paper also describes facilitators, challenges, and lessons learnt with respect to organisational, methodological, cultural, and responsibility-linked factors. The study discusses the ability to agree on how to transform patient data, especially PROMs, into effective performance indicators. The integration of patient-reported indicators into the PMS poses two main challenges: one in terms of sustainability of the performance system itself, and another regarding the attribution of the responsibility for patient outcomes between care settings and providers. This paper provides initial insights on how the integration of patient-reported indicators can make PMSs more inclusive and focussed on the patient-centred perspective.

A participatory evaluation of legal support in the context of health-focused peer advocacy with people who are homeless in London, UK

Legal problems can be cause and consequence of ill-health and homelessness, necessitating efforts to integrate responses to these challenges. How to respond to legal issues within the context of health services for people who are homeless is though unclear. Groundswell piloted providing legal support to peer advocates (who have current or past experience of homelessness) and clients currently homeless in addition to their health-focused work. A participatory action-research design evaluated the emerging programme. Groundswell staff, both researchers and those involved in service delivery, co-led the research alongside an external researcher. Qualitative methods were used to understand the experiences of legal support. We interviewed peer advocates and volunteers (n = 8), Groundswell clients (n = 3) and sector stakeholders (n = 3). Interviews were linked to regular reflective recorded meetings (n = 7) where Groundswell staff and researchers discussed the programme and the evaluation. Data were analysed thematically. The findings focus on three themes. First, peer advocates' and clients' legal needs involve an experience of being overwhelmed by system complexity. Second, the legal support to peer advocates aided in brokering and signposting to other legal support, in the context of a supportive organisational culture. Third, support to clients can be effective, although the complexity of legal need undermines potential for sustainable responses. In conclusion, legal support for peer advocates should be developed by Groundswell and considered by other similar agencies. Legal support to people who are currently street homeless requires significant resources and so health-focused third-sector organisations maybe unable to offer effective support. Other modes of integration should be pursued. Findings also have implications for how the third sector relates to the government agencies implicated in the legal challenges facing people who are homeless.

Outcomes and challenges of successful clinical nurse specialist role implementation: Participatory action research

AIM

To describe the clinical nurse specialist role and its outcomes and challenges.

DESIGN

Participatory Action Research conducted in Finland between the fall of 2017 and the end of 2018.

METHODS

A core participatory action research team (n = 10) led the design, implementation and evaluation of the research. Multiple data collection methods were used. The study is reported using the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines for participatory action research.

RESULTS

The clinical nurse specialist used most of the time in clinical patient care followed by clinical nursing leadership and scholarship activities. Outcomes of successful implementation led to increased visibility of nursing expertise, development, integration and quality assurance of nursing processes and practice, and promotion of knowledge translation and unit and collaborator cooperation. Furthermore, role challenges were also recognized.

Using social network analysis as a tool in action research

The following paper presents case examples of one research team's use of social network analysis (SNA) with three different collaboratives in South Florida: (a) a Collective Impact initiative seeking to end youth homelessness, (b) a university collaborative of campus organizations working towards Black students' concerns, and (c) a movement network of local social justice organizations. The research team used SNA to assess the level of connectivity of three different community coalitions. While research questions were slightly different for each collaborative, each project asked about the frequency of communication between organizations to determine connectivity. Results vary between case examples. Both the Youth Homeless Collaboration and the Black Student Association used Gephi to analyze results, while The Community Partnership used R to measure network centrality. The paper concludes with a general discussion of challenges related to using SNA as an action research tool, as well as the role of power in organizational networks.

Chronic lower back pain in aquaculture clam farmers: adoption and feasibility of self-management strategies introduced using a rapid prototype participatory ergonomic approach

Objectives. Lower back pain (LBP) is extremely prevalent in seafood harvesters who often have limited or no access to ergonomic consultation, occupational health support and rehabilitation services. This pilot study aimed to describe a participatory ergonomic approach and determine the feasibility and extent of adoption of self-management strategies in clam farmers with LBP. Methods. A rapid prototype participatory ergonomic approach was used to develop context-specific self-management strategies. Options to adjust lifting and repetitive stress were introduced using video clips, demonstrations and discussions in the workplace. Workers chose and implemented three strategies for 8 weeks with weekly reminders. Survey and qualitative data from focus groups were analyzed. Results. Team strategies were the most popular, but individual options were used more often. Strategies were considered feasible, acceptable and relatively easy to use. Strategies were implemented relatively consistently, and most improved productivity with decreased pain. Challenges for uptake included changing habit, culture and team dynamics. Conclusions. Participatory rapid prototyping provided a feasible and efficient option to introduce strategies for clam farmers with small teams, variable work processes and workloads, and time restrictions. Strategies were considered acceptable and easy to use, and most increased productivity. These methods show potential for future research.

Establishing a Guide for Developing Organizational Support in Healthcare Following a Critical or Sentinel Event

Health professionals require support and recognition to help manage the well-known impact of critical or sentinel events relating to patient care. The potential distress can be magnified or mitigated by the response of the organization and colleagues. However, strategies that are accessible, relevant, and effective in the aftermath of a poor outcome are not well established. Using an action research methodology, a support tool was collaboratively designed, developed, and evaluated in a maternity service of one organization and adapted to the mental health and addiction service in another. Four principles that are intrinsic to the establishment of support tools became apparent across the two settings. Through applying these criteria to the customization of the support tool, it became relevant within the new service setting, and an implementation guide for other organizations was created. Although undertaken pre-pandemic, insights derived from this study may benefit post-pandemic situations where the need for health professional support is even greater.