Using the transformative paradigm to conduct a mixed methods needs assessment of a marginalized community: Methodological lessons and implications

Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men and male STD patients in China: the PIONEER pragmatic, cluster randomized controlled trial protocol

BACKGROUND

Gonorrhea and chlamydia are the most common sexually transmitted diseases (STDs) among men who have sex with men (MSM) in China. Previous studies have shown pay-it-forward (PIF) interventions to be associated with a substantial increase in gonorrhea and chlamydia test uptake compared to standard-of-care. We propose a 'pay-it-forward' gonorrhea and chlamydia testing randomized controlled trial (PIONEER). The trial would evaluate the effectiveness of two pay-it-forward strategies in promoting testing uptake compared to the standard of care (in which men pay for their tests out-of-pocket) among MSM and male STD patients in China.

METHODS

PIONEER will be a three-armed, pragmatic cluster randomized controlled trial (RCT), conducted across 12 clinics (six MSM-led and six public STD clinics) to compare the effectiveness of three implementation strategies. Each facility will be randomized to a standard pay-it-forward intervention of gonorrhea/ chlamydia testing with minimal encouragement for testing, a community-engaged pay-it-forward arm, or a control arm where men pay for their tests out-of-pockets. The primary outcome will be dual gonorrhea/chlamydia test uptake. Secondary outcomes will include syphilis testing, amount donated in pay-it-forward, number of positive gonorrhea and chlamydia tests, and measures of antimicrobial resistance. A sequential transformative mixed methods design will be used to evaluate the implementation process in type 2 effectiveness-implementation hybrid design. Data sources will include survey on acceptability, and feelings and attitudes towards the interventions among participants; testing and treatment uptake data from clinic records, WeChat records, and qualitative data to gain insights into men's perceptions and attitudes towards the pay-it-forward, mechanisms driving uptake, and donating behaviors. Implementers and organizers will be interviewed about fidelity and adherence to protocol, sustainability of pay-it-forward intervention, and barriers and facilitators of implementing the intervention.

DISCUSSION

PIONEER will substantially increase gonorrhea/chlamydia testing among MSM in China, providing an innovative and new financial mechanism to sustain STD screening among sexual minorities in low- and middle-income countries. This study will answer compelling scientific questions about how best to implement pay-it-forward and the individual and organizational characteristics that moderate it.

TRIAL REGISTRATION

The study with identification number NCT05723263 has been registered on clinicaltrials.gov/.

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.

A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses

BACKGROUND

Community health needs and assets assessment is a means of identifying and describing community health needs and resources, serving as a mechanism to gain the necessary information to make informed choices about community health. The current review of the literature was performed in order to shed more light on concepts, rationale, tools and uses of community health needs and assets assessment.

METHODS

We conducted a scoping review of the literature published in English using PubMed, Embase, Scopus, Web of Science, PDQ evidence, NIH database, Cochrane library, CDC library, Trip, and Global Health Library databases until March 2021.

RESULTS

A total of 169 articles including both empirical papers and theoretical and conceptual work were ultimately retained for analysis. Relevant concepts were examined guided by a conceptual framework. The empirical papers were dominantly conducted in the  United States. Qualitative, quantitative and mixed-method approaches were used to collect data on community health needs and assets, with an increasing trend of using mixed-method approaches. Almost half of the included empirical studies used participatory approaches to incorporate community inputs into the process.

CONCLUSION

Our findings highlight the need for having holistic approaches to assess community's health needs focusing on physical, mental and social wellbeing, along with considering the broader systems factors and structural challenges to individual and population health. Furthermore, the findings emphasize assessing community health assets as an integral component of the process, beginning foremost with community capabilities and knowledge. There has been a trend toward using mixed-methods approaches to conduct the assessment in recent years that led to the inclusion of the voices of all community members, particularly vulnerable and disadvantaged groups. A notable gap in the existing literature is the lack of long-term or longitudinal-assessment of the community health needs assessment impacts.

A survey of transformational leadership traits for South African academic libraries in Gauteng province, South Africa

Purpose

The purpose of the paper was to survey transformational leadership traits in three academic libraries in the Gauteng province in South Africa. The three academic libraries were chosen based on the fact that two of the universities were residential research-intensive universities and the third was an academic library of a distance learning university.

Design/methodology/approach

The study adopted a quantitative approach with a survey design in three academic libraries in the Gauteng province in South Africa in which a close-ended questionnaire yielded quantitative data. The study included 29 academic staff from the rank of assistant librarian to the director from the three academic libraries, as these are the personnel in leadership positions. To code and analyse, quantitative data from a Likert scale, SPSS version 25 was used. Cronbach's alpha was used to evaluate the instrument's reliability on the five constructs used in this study to determine readiness to adopt a transformational leadership style. The overall level of internal consistency exceeded the theoretical minimum of 70 percent. The Shapiro-Wilk test was used to determine the normality of the data and the p values were greater than 0.05 (p > 0.05). Tables have been used to present descriptive and inferential statistics based on data.

Findings

Participants expressed favourable opinions about academic libraries' ability to learn from the best practices of others in the profession, with mean scores greater than 3.5 on a 5.0 scale. Participants' perceptions of transformative versus traditional management styles yielded a moderate mean score of 3.0, with moderate mean scores ranging from 2.8 to 3.3. The average score for talent identification and succession planning in academic libraries was 3.5. Perceptions of leadership responsibilities had a mean score of 4.1, with attributes on leadership responsibilities scoring at least 3.5. Perceptions of problems for the next generation of leaders in academic libraries were moderate, with a mean score of 3.2 on a scale of 5.0.

Research limitations/implications

Only three of the seven public university libraries in the Gauteng province in South Africa were surveyed in this study. The sample size was reasonably small for generalizations beyond the South African Gauteng province academic libraries. However, it was felt useful for this particular case. A survey of all 26 South African public universities is required to assess transformational leadership traits in academic libraries.

Practical implications

Next-generation leaders in South African academic libraries are perceived as not being aggressive in terms of team building, coaching and motivating others.

Social implications

In the wake of COVID-19, new leadership traits such as scenario planning are needed for academic libraries.

Originality/value

Leadership studies abound in the library and information studies (LIS) profession and they are not new. However, research on transformational leadership in South African libraries is still in its early stages. As a result, this study fills a gap in the literature on transformative leadership in academic libraries in South Africa.

Prevention of Cardiovascular Diseases in Community Settings and Primary Health Care: A Pre-Implementation Contextual Analysis Using the Consolidated Framework for Implementation Research

Cardiovascular diseases are the world’s leading cause of mortality, with a high burden especially among vulnerable populations. Interventions for primary prevention need to be further implemented in community and primary health care settings. Context is critically important to understand potential implementation determinants. Therefore, we explored stakeholders’ views on the evidence-based SPICES program (EBSP); a multicomponent intervention for the primary prevention of cardiovascular disease, to inform its implementation. In this qualitative study, we conducted interviews and focus groups with 24 key stakeholders, 10 general practitioners, 9 practice nurses, and 13 lay community partners. We used adaptive framework analysis. The Consolidated Framework for Implementation Research guided our data collection, analysis, and reporting. The EBSP was valued as an opportunity to improve risk awareness and health behavior, especially in vulnerable populations. Its relative advantage, evidence-based design, adaptability to the needs and resources of target communities, and the alignment with policy evolutions and local mission and vision, were seen as important facilitators for its implementation. Concerns remain around legal and structural characteristics and intervention complexity. Our results highlight context dimensions that need to be considered and tailored to primary care and community needs and capacities when planning EBSP implementation in real life settings.

What older adults and their caregivers need for making better health-related decisions at home: a participatory mixed methods protocol

INTRODUCTION

Shared decision making is an interpersonal process whereby healthcare providers collaborate with and support patients in decision-making. Older adults receiving home care need support with decision-making. We will explore what older adults receiving home care and their caregivers need for making better health-related decisions.

METHODS AND ANALYSIS

This two-phase sequential exploratory mixed methods study will be conducted in a pan-Canadian healthcare organisation, SE Health. First, we will create a participant advisory group to advise us throughout the research process. In phase 1 (qualitative), we will recruit a convenience sample of 15-30 older adults and caregivers receiving home care to participate in open-ended semi-structured interviews. Phase 1 participants will be invited to share what health-related decisions they face at home and what they need for making better decisions. In phase 2 (quantitative), interdisciplinary health and social care providers will be invited to answer a web-based survey to share their views on the decisional needs of older adults and their caregivers. The survey will include questions informed by findings from qualitative interviews in phase 1, and a workbook for assessing decisional needs based on the Ottawa Decision Support Framework. Finally, qualitative and quantitative results will be triangulated (by methods, investigator, theory and source) to develop a comprehensive understanding of decision-making needs from the perspective of older adults, caregivers and health and social care providers. We will use the quality of mixed methods studies in health services research guidelines and the Checklist for Reporting the Results of Internet E-Surveys checklist.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the research ethics boards at Southlake Regional Health Centre and Université Laval. This study will inform the design of decision support interventions. Further dissemination plans include summary briefs for study participants, tailored reports for home care decision makers and policy makers, and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT04327830.

Community health needs assessment for a child health promotion program in Kyrgyzstan

Despite over 10 years of support from government health programs and health organizations, children in migrant villages in Kyrgyzstan remain a public concern owing to high incidence rates of preventable diseases such as anemia. An effective community health promotion program is needed but there is a lack of knowledge of community barriers and health factors affecting children's health in these migrant villages. The purpose of this study was to conduct a community health needs assessment to develop strategies for a child health promotion program in these migrant villages. This study conducted using a mixed method that included literature review, reginal statistics, focus group and key person interviews, and a community survey. The analysis method was descriptive statistics for the questionnaires, and content analysis for the interviews. Results showed the following priorities for child health promotion: strengthening health care provider capacity, overcoming resource shortages, managing child health and preventable diseases, improving public hygiene, promoting a healthy lifestyle, and empowering school health. The strategies were identified: capacity building of health workers, increasing community participation and raising child health awareness, and supporting child health promotion services. These findings will help guide the implementation of a child health promotion program.

Using mixed method approach in measuring effects of training in firms: Case study of the European Social Fund support

Public support of training in firms corresponds to the long-term importance of the quality of human capital in the competitiveness of firms and nations. Thus, the EU supports such training via the European Social Fund (ESF). The evaluation community evaluates the support by using either qualitative or quantitative methods. The simultaneous application of these two approaches is rare. The purpose of this paper is to combine quantitative (counterfactual impact evaluation) and qualitative (qualitative comparative analysis) methods in order to fill the methodological gap. Based on the combination of both approaches, it explores their strengths, complementarity and disadvantages to evaluate public support for employee training in the Czech Republic. The combination of methods makes it possible to identify not only the impacts but also their causes. Linking the ESF support to corporate competitiveness is crucial for demonstrating the effectiveness of public spending.

Interactive Learning Environments for the Educational Improvement of Students With Disabilities in Special Schools

Providing an inclusive and quality education for all contributes toward the Sustainable Development Goals of the United Nations. High-quality learning environments based on what works in education benefit all students and can be particularly beneficial for children with disabilities. This article contributes to advance knowledge to enhance the quality of education of students with disabilities that are educated in special schools. This research analyses in which ways, if any, interactive learning environments can be developed in special schools and create better learning opportunities for children with disabilities. A case study was conducted with students with disabilities (N = 36) and teaching staff in a special school, involving interviews and focus groups. We argue that rethinking the learning context by introducing instruction models based on interaction benefit children with disabilities and provide high-quality learning and safe and supportive relationships for these students, thereby promoting their educational and social inclusion.