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Mengshoel AM. Experiences of shifts in physiotherapy for rheumatoid arthritis over time - an autoethnography. Physiother Theory Pract 2024; 40:1372-1382. [PMID: 36692241 DOI: 10.1080/09593985.2023.2169061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Several shifts in physiotherapy treatment of patients with rheumatoid arthritis (RA) have occurred over time. OBJECTIVE This paper aims to identify shifts in physiotherapy practice for patients with RA based on the author's work experiences from the 1980s until today at two Norwegian rheumatism hospitals, and to explore why shifts may have happened. METHODS A narrative was developed by describing events making a difference, categorizing, and ordering them with the help of narrative analysis and a sensitizing analytic lens on discourses. RESULTS The storyline from the 1980s to approximately the turn of the millennium is called 'Shifts determined mainly by clinical context-driven events' which occurred in response to medical advances and physiotherapists' clinical experiences. These shifts were later justified by physiotherapists' research in the clinical context. The other storyline covers mainly the 2000s and is called 'Shifts increasingly determined by events beyond clinical physiotherapy context.' They include adjustments to further medical advances and implementation of biopsychosocial understanding of disease at the hospital, and to external research-based recommendations, health reforms, and economy. CONCLUSION These processes have moved physiotherapy practice at the hospital from mainly providing individualized remedial and rehabilitative physiotherapy for the purpose to normalize physical function to an increasing focus on generic health measures for the purposes of health promotion and cardiovascular disease prevention. However, this shift may not fully match the complex needs presented by patients in disease remission with unrelenting fatigue and work inability and those who have multiple functional challenges and comorbidities.
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Affiliation(s)
- Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo, Oslo, Norway
- Department of Rehabilitation, Hospital for Rheumatic Diseases, Lillehammer, Norway
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Akintola A, Newbury-Birch D, Kilinc S. Bridging the gap between research evidence and its implementation in public health practice: case studies of embedded research model. BMC Public Health 2024; 24:1299. [PMID: 38741039 DOI: 10.1186/s12889-024-18727-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024] Open
Abstract
AIM To investigate the potential of embedded research in bridging the gap between research evidence and its implementation in public health practice. METHODS Using a case study methodology, semi-structured interviews were conducted with 4 embedded researchers, 9 public health practitioners, and 4 other stakeholders (2 teachers and 2 students) across four case study sites. Sites and individuals were purposively selected. Sites included two local authorities, one secondary school, and one sports organisation. Thematic data analysis was adopted to analyse the qualitative data. RESULTS Four themes were identified: (1) building and maintaining relationships, (2) working with stakeholders, (3) informing practice, and (4) critical reflection. CONCLUSIONS Embedded researchers build and maintain relationships with practitioners and other stakeholders to produce research. Evidence from the co-produced research informs future practice and research to improve service and delivery rendered to the public. Thus, embedded researchers use their role to bridge the research evidence - implementation gap in public health practice.
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Affiliation(s)
- Abisope Akintola
- School of Health and Life Science, Teesside University, Middlesbrough, UK.
- Manchester Institute of Innovation Research, Alliance Manchester Business School, University of Manchester, Manchester, UK.
| | - Dorothy Newbury-Birch
- School of School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
| | - Stephanie Kilinc
- School of School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
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Baxter H, Bearne L, Stone T, Thomas C, Denholm R, Redwood S, Purdy S, Huntley AL. The effectiveness of knowledge-sharing techniques and approaches in research funded by the National Institute for Health and Care Research (NIHR): a systematic review. Health Res Policy Syst 2024; 22:41. [PMID: 38566127 PMCID: PMC10988883 DOI: 10.1186/s12961-024-01127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The National Institute of Health and Care Research (NIHR), funds, enables and delivers world-leading health and social care research to improve people's health and wellbeing. To achieve this aim, effective knowledge sharing (two-way knowledge sharing between researchers and stakeholders to create new knowledge and enable change in policy and practice) is needed. To date, it is not known which knowledge sharing techniques and approaches are used or how effective these are in creating new knowledge that can lead to changes in policy and practice in NIHR funded studies. METHODS In this restricted systematic review, electronic databases [MEDLINE, The Health Management Information Consortium (including the Department of Health's Library and Information Services and King's Fund Information and Library Services)] were searched for published NIHR funded studies that described knowledge sharing between researchers and other stakeholders. One researcher performed title and abstract, full paper screening and quality assessment (Critical Appraisal Skills Programme qualitative checklist) with a 20% sample independently screened by a second reviewer. A narrative synthesis was adopted. RESULTS In total 9897 records were identified. After screening, 17 studies were included. Five explicit forms of knowledge sharing studies were identified: embedded models, knowledge brokering, stakeholder engagement and involvement of non-researchers in the research or service design process and organisational collaborative partnerships between universities and healthcare organisations. Collectively, the techniques and approaches included five types of stakeholders and worked with them at all stages of the research cycle, except the stage of formation of the research design and preparation of funding application. Seven studies (using four of the approaches) gave examples of new knowledge creation, but only one study (using an embedded model approach) gave an example of a resulting change in practice. The use of a theory, model or framework to explain the knowledge sharing process was identified in six studies. CONCLUSIONS Five knowledge sharing techniques and approaches were reported in the included NIHR funded studies, and seven studies identified the creation of new knowledge. However, there was little investigation of the effectiveness of these approaches in influencing change in practice or policy.
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Affiliation(s)
- Helen Baxter
- Evidence and Dissemination, National Institute for Health and Care Research, Twickenham, United Kingdom.
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC WEST), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
| | - Lindsay Bearne
- Evidence and Dissemination, National Institute for Health and Care Research, Twickenham, United Kingdom
- Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Tracey Stone
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC WEST), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Clare Thomas
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC WEST), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- National Institute for Health and Care Research, Health Protection Research Unit in Behaviour Science and Evaluation (NIHR HPRU BSE), University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Rachel Denholm
- National Institute for Health and Care Research, Bristol Biomedical Research Centre (NIHR BRC), University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sabi Redwood
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC WEST), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sarah Purdy
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alyson Louise Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Zhang Z, Lin KY. Applying implementation science to evaluate participatory ergonomics program for continuous improvement: A case study in the construction industry. APPLIED ERGONOMICS 2024; 115:104181. [PMID: 37988875 DOI: 10.1016/j.apergo.2023.104181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/17/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
While participatory ergonomics (PE) presents numerous benefits, its empirical effectiveness remains elusive due to the lack of transparency in implementation contexts and processes. This hinders our ability to discern the reasons behind a program's success or failure and to determine optimization and adaptation strategies. To unravel this "black box," we present a case study using implementation science to evaluate a PE program and illuminate the mechanisms linking process to outcome. The study examines a 4.5-year PE program at a construction company, targeting musculoskeletal disorders (MSDs) from material-cart handling. Using the RE-AIM framework and Implementation Causal Pathway Model, we evaluated implementation process and catalogued contextual factors through worker surveys (n = 106), safety document review (27 training sessions and 7 construction projects), and key informant observations. We assessed the program's impact using a 42-worker survey and an analysis of 8-year injury data, and determined the return-on-investment (ROI) by monetizing the collected data. The program achieved significant impact: Workers' ergonomic knowledge improved from 73% in baseline to 86% in follow-up; 97% of workers reported at least one positive change in their crews; and no cart handling injuries occurred after the first program change, resulting in a ROI rate of 1.99. Implementation process evaluation revealed that seamless integration, tailored intervention, and ongoing adjustments contributed to the success. Five organizational factors necessary for the effective functioning of these three strategies were identified, along with three moderators that amplified their influence. Finally, this case study demonstrates that implementation science offers a coherent structure for evaluating PE programs, uncovering mechanisms of change, and informing future improvements and adaptations. Our research facilitates knowledge transfer from implementation science to ergonomics, eventually leading to more cost-effective PE programs that are faithfully implemented across various industrial settings to prevent MSDs.
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Affiliation(s)
- Zhenyu Zhang
- Department of Construction Science, Texas A&M University, College Station, TX, USA.
| | - Ken-Yu Lin
- Department of Construction Management, University of Washington, Seattle, WA, USA.
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Edwards RC, Kneale D, Stansfield C, Lester S. What are the mechanisms driving the early stages of embedded researcher interventions? A qualitative process evaluation in English local government. Soc Sci Med 2024; 340:116407. [PMID: 38016307 DOI: 10.1016/j.socscimed.2023.116407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/23/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
Improved collaboration and communication between public health practitioners and academia could enhance the flow of research evidence into policy and practice. Embedded researchers present one type of intervention with the potential to bridge the research-implementation gap through their dual affiliations with decision makers and academia. Although embedded researcher posts are garnering increasing attention in public health, there remains a need to understand the mechanisms through which they may promote the translation of evidence into practice. To address this gap, we conducted a processes evaluation incorporating data from seventeen semi-structured interviews with embedded researchers in local government public health teams across England. We aimed to expand theoretical understandings of embedded researchers in public health through providing a detailed conceptualisation of the mechanisms shaping the early stages of their roles. Interviews with embedded researchers were conducted from late 2021 to spring 2022. Our results suggest that the initial months of embedded researcher roles are defined by a lengthy embedding phase centred on building trust and gathering contextual knowledge. This phase forms the foundation on which these interventions are built. We identified seven categories of outputs delivered by embedded researchers which primarily revolved around building research capacity and addressed many of the primary barriers limiting research activity in public health. Improvements in research awareness, interest, and involvement reflected early changes in local research cultures. However, our results align with previous work suggesting that changing an organisational research culture is a long-term process. Expectations for embedded researchers should thus be proportionate to the seniority and scale of the post and we add our voice to calls for sustained investment in these valuable interventions. Further examination of how embedded researcher roles evolve over time in public health is necessary to broaden understandings of the concept of embeddedness in these settings.
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Affiliation(s)
- Rachael C Edwards
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Dylan Kneale
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Claire Stansfield
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Sarah Lester
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
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Bühler F, Leinen A, Schneider-Schelte H, Meyer G, Dichter MN, Köpke S, Wilm S, Bieber A. Exploring stakeholders' perspectives on the adaptation of the Living Lab approach to dementia care: A qualitative study. Geriatr Nurs 2023; 54:184-191. [PMID: 37797546 DOI: 10.1016/j.gerinurse.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023]
Abstract
Collaborative research can promote knowledge translation and help to link care practice and research. Academic-practice partnerships enable joint research projects in collaboration between care professionals, researchers, patients, and other stakeholders. This qualitative study was conducted during the adaptation phase of the Living Lab Dementia, an academic-practice partnership for collaborative research on long-term dementia care. The aim was to explore stakeholders' perspectives on linking care practice and research in a sustainable, research-focused partnership. Data were collected in fifteen qualitative interviews with representatives from three stakeholder groups: nursing care professionals, people with dementia, and nursing researchers. Thematic Framework Analysis resulted in five themes: (1) Access, (2) Expectations, (3) Shaping the collaboration, (4) Linking Pins, and (5) Participation. The findings suggest that care professionals expect support in implementing research results into practice. Researchers should take the lead in shaping the collaboration and create opportunities for stakeholders to get involved.
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Affiliation(s)
- Felix Bühler
- Institute for Health and Nursing Science, University Medicine Halle, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, Halle (Saale) 06112, Germany.
| | - Andrea Leinen
- Institute of Nursing Science, University of Cologne, Medical Faculty and University Hospital Cologne, Gleueler Strasse 176-178, Cologne 50935, Germany
| | | | - Gabriele Meyer
- Institute for Health and Nursing Science, University Medicine Halle, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, Halle (Saale) 06112, Germany
| | - Martin N Dichter
- Institute of Nursing Science, University of Cologne, Medical Faculty and University Hospital Cologne, Gleueler Strasse 176-178, Cologne 50935, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Medical Faculty and University Hospital Cologne, Gleueler Strasse 176-178, Cologne 50935, Germany
| | - Stefan Wilm
- Institute of General Practice, Heinrich Heine University Düsseldorf, Moorenstrasse 5, Düsseldorf 40225, Germany
| | - Anja Bieber
- Institute for Health and Nursing Science, University Medicine Halle, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, Halle (Saale) 06112, Germany
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Lim ELP, Ong RHS, Thor J, Allgurin M, Gäre BA, Thumboo J. An Evaluation of the Relationship between Training of Health Practitioners in a Person-Centred Care Model and their Person-Centred Attitudes. Int J Integr Care 2023; 23:11. [PMID: 38020415 PMCID: PMC10668878 DOI: 10.5334/ijic.7564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The Esther Network (EN) person-centred care (PCC) advocacy training aims to promote person-centred attitudes among health practitioners in Singapore. This study aimed to assess the relationship between the training and practitioners' PCC attributes over a 3-month period, and to explore power sharing by examining the PCC dimensions of "caring about the service user as a whole person" and the "sharing of power, control and information". Methods A repeated-measure study design utilising the Patient-Practitioner Orientation Scale (PPOS), was administered to 437 training participants at three time points - before training (T1), immediately after (T2) and three months after training (T3). A five-statement questionnaire captured knowledge of person-centred care at T1 and T2. An Overall score, Caring and Sharing sub-scores were derived from the PPOS. Scores were ranked and divided into three groups (high, medium and low). Ordinal Generalised Estimating Equation (GEE) model analysed changes in PPOS scores over time. Results A single, short-term training appeared to result in measurable improvements in person-centredness of health practitioners, with slight attenuation at T3. There was greater tendency to "care" than to "share power" with service users across all three time points, but the degree of improvement was larger for sharing after training. The change in overall person-centred scores varied by sex and profession (females score higher than males, allied health showed a smaller attenuation at T3). Conclusion Training as a specific intervention, appeared to have potential to increase health practitioners' person-centredness but the aspect of equalising power was harder to achieve within a hierarchical structure and clinician-centric culture. An ongoing network to build relationships, and a supportive system to facilitate individual and organisational reflexivity can reinforce learning.
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Affiliation(s)
- Esther Li Ping Lim
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Allied Health Division, Singapore General Hospital, Singapore
- Centre for Person-centred Care, Singapore Health Services, Singapore
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore
| | | | - Johan Thor
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Monika Allgurin
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Boel Andersson Gäre
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Futurum, Region Jönköping County, Jönköping, Sweden
| | - Julian Thumboo
- SingHealth Office of Regional Health, Singapore Health Services, Singapore
- SingHealth Centre for Population Health Research and Implementation, Singapore Health Services, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
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Jakobsson CE, Genovesi E, Afolayan A, Bella-Awusah T, Omobowale O, Buyanga M, Kakuma R, Ryan GK. Co-producing research on psychosis: a scoping review on barriers, facilitators and outcomes. Int J Ment Health Syst 2023; 17:25. [PMID: 37644476 PMCID: PMC10466887 DOI: 10.1186/s13033-023-00594-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Co-production is a collaborative approach to service user involvement in which users and researchers share power and responsibility in the research process. Although previous reviews have investigated co-production in mental health research, these do not typically focus on psychosis or severe mental health conditions. Meanwhile, people with psychosis may be under-represented in co-production efforts. This scoping review aims to explore the peer-reviewed literature to better understand the processes and terminology employed, as well as the barriers, facilitators, and outcomes of co-production in psychosis research. METHODS Three databases were searched (MEDLINE, EMBASE, PsycINFO) using terms and headings related to psychosis and co-production. All titles, abstracts and full texts were independently double-screened. Disagreements were resolved by consensus. Original research articles reporting on processes and methods of co-production involving adults with psychosis as well as barriers, facilitators, and/or outcomes of co-production were included. Data was extracted using a standardised template and synthesised narratively. Joanna Briggs Institute and the AGREE Reporting Checklist were used for quality assessment. RESULTS The search returned 1243 references. Fifteen studies were included: five qualitative, two cross-sectional, and eight descriptive studies. Most studies took place in the UK, and all reported user involvement in the research process; however, the amount and methods of involvement varied greatly. Although all studies were required to satisfy INVOLVE (2018) principles of co-production to be included, seven were missing several of the key features of co-production and often used different terms to describe their collaborative approaches. Commonly reported outcomes included improvements in mutual engagement as well as depth of understanding and exploration. Key barriers were power differentials between researchers and service users and stigma. Key facilitators were stakeholder buy-in and effective communication. CONCLUSIONS The methodology, terminology and quality of the studies varied considerably; meanwhile, over-representation of UK studies suggests there may be even more heterogeneity in the global literature not captured by our review. This study makes recommendations for encouraging co-production and improving the reporting of co-produced research, while also identifying several limitations that could be improved upon for a more comprehensive review of the literature.
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Affiliation(s)
- C E Jakobsson
- Department of Psychiatry, Sussex Partnership NHS Foundation Trust, Eastbourne, England, UK.
| | - E Genovesi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - A Afolayan
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - T Bella-Awusah
- Department of Psychiatry & Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - O Omobowale
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - M Buyanga
- SUCCEED Africa, University of Zimbabwe, Harare, Zimbabwe
| | - R Kakuma
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, England, UK.
| | - G K Ryan
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, England, UK.
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Jager A, Wong G, Papoutsi C, Roberts N. The usage of data in NHS primary care commissioning: a realist review. BMC Med 2023; 21:236. [PMID: 37400837 DOI: 10.1186/s12916-023-02949-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Primary care has been described as the 'bedrock' of the National Health Service (NHS) accounting for approximately 90% of patient contacts but is facing significant challenges. Against a backdrop of a rapidly ageing population with increasingly complex health challenges, policy-makers have encouraged primary care commissioners to increase the usage of data when making commissioning decisions. Purported benefits include cost savings and improved population health. However, research on evidence-based commissioning has concluded that commissioners work in complex environments and that closer attention should be paid to the interplay of contextual factors and evidence use. The aim of this review was to understand how and why primary care commissioners use data to inform their decision making, what outcomes this leads to, and understand what factors or contexts promote and inhibit their usage of data. METHODS We developed initial programme theory by identifying barriers and facilitators to using data to inform primary care commissioning based on the findings of an exploratory literature search and discussions with programme implementers. We then located a range of diverse studies by searching seven databases as well as grey literature. Using a realist approach, which has an explanatory rather than a judgemental focus, we identified recurrent patterns of outcomes and their associated contexts and mechanisms related to data usage in primary care commissioning to form context-mechanism-outcome (CMO) configurations. We then developed a revised and refined programme theory. RESULTS Ninety-two studies met the inclusion criteria, informing the development of 30 CMOs. Primary care commissioners work in complex and demanding environments, and the usage of data are promoted and inhibited by a wide range of contexts including specific commissioning activities, commissioners' perceptions and skillsets, their relationships with external providers of data (analysis), and the characteristics of data themselves. Data are used by commissioners not only as a source of evidence but also as a tool for stimulating commissioning improvements and as a warrant for convincing others about decisions commissioners wish to make. Despite being well-intentioned users of data, commissioners face considerable challenges when trying to use them, and have developed a range of strategies to deal with 'imperfect' data. CONCLUSIONS There are still considerable barriers to using data in certain contexts. Understanding and addressing these will be key in light of the government's ongoing commitments to using data to inform policy-making, as well as increasing integrated commissioning.
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Affiliation(s)
- Alexandra Jager
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, Medical Sciences, University of Oxford, Oxford, UK
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Bennett H, Brunner R. Political and ethical dilemmas in multi-agency participatory research: The role of the buffer zone. METHODOLOGICAL INNOVATIONS 2022. [DOI: 10.1177/20597991221129775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ‘buffer zone’ frames the contested space that university researchers must persistently animate and mediate to successfully pursue participatory research with public and third sector partners. This article explores this conceptualisation through a consideration of political and ethical dilemmas in participatory research practice. We contend that participatory researchers must identify, respond to and reflect on everyday and momentous dilemmas by combining technical, relational and political skills. We illustrate this by drawing on extensive collaborative action research conducted with public service partners as part of the What Works Scotland programme (2014–2019). By critically reflecting on university research realities, this article shares insights into complex multi-agency participatory research dilemmas; offers methodological, conceptual, ethical and political evidence to help university researchers navigate such contexts, notably by engaging the buffer zone and finally, considers how universities and research funders should better support participatory research practices.
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Lopes HS, Remoaldo PC, Ribeiro V, Martín-Vide J. Pathways for adapting tourism to climate change in an urban destination - Evidences based on thermal conditions for the Porto Metropolitan Area (Portugal). JOURNAL OF ENVIRONMENTAL MANAGEMENT 2022; 315:115161. [PMID: 35526395 DOI: 10.1016/j.jenvman.2022.115161] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 06/14/2023]
Abstract
The narrative of sustainable tourism transition in a context of adaptation to climate change is very relevant internationally. The availability and sharing of knowledge and information is a basic requirement for the successful planning of the tourism sector regarding this phenomenon. Planning adaptation in the urban tourism sector is widely regarded as a collectively-based process. However, collaborative planning is far from being the standard. This study reports the results of a Modified Delphi Approach (MDA) among experts about the future of urban tourism in a context of adaptation to climate change in Porto Metropolitan Area (Portugal), considering the outdoor thermal conditions perspective. Using an expert panel, the study gathered their opinions to analyze the degrees of responsibility of the main sectorial entities at different territorial levels, the conditions of action in the transformation agenda and the measures to be implemented in the adaptation and mitigation process - according to priority and time horizon. Two rounds were carried out to apply the methodology between January and April 2021. The first questionnaire had the participation of 47 professionals. 34 out of the 47 professionals of the 1st round participated in the second questionnaire. The evidence from different stakeholders demonstrates that there is an ambiguous process of understanding the problem, information needs, and a weak interaction between actors - resources - tasks. The effectiveness and efficiency of collaborative planning and outlined goals by 2050 for adaptation of urban tourism sector to climate change can be hampered. Experts consider the creation of structural (tangible) measures to be fundamental. Among other results, it was found that most participants consider that the intervention is dependent on the guidelines issued by the government and municipal councils when it comes to defining a proposal for adapting the urban tourism sector to climate change. Despite this, the options for more sustainable practices must be based on three axes: (i) solutions based on the energy sector in the hotel industry (e.g., energy certification, prioritization of the use of renewable energy); (ii) improvement and expansion of green infrastructure for tourist enjoyment [e.g., creation of green areas (small additional pockets), namely in the center of Porto; and pedestrianization of central areas of the city] and (iii) network participation through the collaboration of various stakeholders with relevance in tourism and urban planning.
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Affiliation(s)
- Hélder Silva Lopes
- Lab2PT - Landscape, Heritage and Territory Laboratory, Department of Geography/ICS, University of Minho, Guimarães, Portugal; IdRA - Climatology Group, Department of Geography/FGH, University of Barcelona, Barcelona, Spain.
| | - Paula C Remoaldo
- Lab2PT - Landscape, Heritage and Territory Laboratory, Department of Geography/ICS, University of Minho, Guimarães, Portugal.
| | - Vítor Ribeiro
- CIPAF - Paula Frassinetti Research Center, ESE de Paula Frassinetti, Porto, Portugal; Lab2PT - Landscape, Heritage and Territory Laboratory/CIPAF, Department of Geography/ICS, University of Minho, Guimarães, Portugal.
| | - Javier Martín-Vide
- IdRA - Climatology Group, Department of Geography/FGH, University of Barcelona, Barcelona, Spain.
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12
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Piper D, Jorm C, Iedema R, Goodwin N, Searles A, McFayden L. Relational aspects of building capacity in economic evaluation in an Australian Primary Health Network using an embedded researcher approach. BMC Health Serv Res 2022; 22:813. [PMID: 35733164 PMCID: PMC9219146 DOI: 10.1186/s12913-022-08208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Health organisations are increasingly implementing ‘embedded researcher’ models to translate research into practice. This paper examines the impact of an embedded researcher model known as the embedded Economist (eE) Program that was implemented in an Australian Primary Health Network (PHN) located in regional New South Wales, Australia. The site, participants, program aims and design are described. Insights into the facilitators, challenges and barriers to the integration of economic evaluation perspectives into the work of the PHN are provided. Methods The eE Program consisted of embedding a lead health economist on site, supported by offsite economists, part-time, for fifteen weeks to collaborate with PHN staff. Evaluation of the eE at the PHN included qualitative data collection via semi-structured interviews (N= 34), observations (N=8) and a field diary kept by the embedded economists. A thematic analysis was undertaken through the triangulation of this data. Results The eE Program successfully met its aims of increasing PHN staff awareness of the value of economic evaluation principles in decision-making and their capacity to access and apply these principles. There was also evidence that the program resulted in PHN staff applying economic evaluations when commissioning service providers. Evaluation of the eE identified two key facilitators for achieving these results. First, a highly receptive organisational context characterised by a work ethic, and site processes and procedures that were dedicated to improvement. Second was the development of trusted relationships between the embedded economist and PHN staff that was enabled through: the commitment of the economist to bi-directional learning; facilitating access to economic tools and techniques; personality traits (likeable and enthusiastic); and because the eE provided ongoing support for PHN projects beyond the fifteen-week embedding period. Conclusions This study provides the first detailed case description of an embedded health economics program. The results demonstrate how the process, context and relational factors of engaging and embedding the support of a health economist works and why. The findings reinforce international evidence in this area and are of practical utility to the future deployment of such programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08208-7.
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Affiliation(s)
- Donella Piper
- NSW Regional Health Partners, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Christine Jorm
- School of Public Health, University of Sydney, Sydney, Australia
| | - Rick Iedema
- Centre for Team-Based Practice & Learning in Health Care, King's College, London, UK
| | - Nicholas Goodwin
- Central Coast Research Institute for Integrated Care, University of Newcastle & Central Coast Local Health District, Newcastle, Australia
| | - Andrew Searles
- Health Research Economics, Hunter Medical Research Institute, Newcastle, Australia.,University of Newcastle, Newcastle, Australia
| | - Lisa McFayden
- NSW Regional Health Partners, Newcastle, Australia. .,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
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13
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Suutari AM, Nordin A, Kjellström S, Thor J, Areskoug Josefsson K. Using stakeholders' experiences to redesign health services for persons living with heart failure: a case study protocol in a Swedish cardiac care setting. BMJ Open 2022; 12:e058469. [PMID: 35292501 PMCID: PMC8928324 DOI: 10.1136/bmjopen-2021-058469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Clinical guidelines promote recognising persons with heart failure (referred to as PWHF) as coproducers of their own care. Coproduction of healthcare-involving PWHF, families and professionals in care processes-aims to promote the best possible health. Still, it is unclear how to coproduce heart failure (HF) care. This study explores whether and how Experience-Based Co-Design (EBCD) involving PWHF, family members and professionals can be undertaken online, in a Swedish cardiac care setting, to codesign improved experiences of HF care. METHODS AND ANALYSIS In EBCD, stakeholders' experiences are solicited to redesign healthcare services. First, we will undertake a thematic analysis of field notes from consultations and filmed/audio-recorded interviews with PWHF (n=10-12). This analysis will identify 'touchpoints' (emotionally positive/negative events that shape overall service experiences), edited into a 'trigger film'. Next, a thematic analysis of family members' (n=10-12) and professionals' (n=10-12) interviews will identify key themes mirroring their experiences. Separate feedback events with each stakeholder group will confirm identified touchpoints and key themes and identify areas for HF care improvement. At a joint event, prompted by the 'trigger film', stakeholders will agree on one area for HF care improvement. A team including PWHF, family members and professionals, led by an improvement adviser, will then plan, design, implement and evaluate an improvement activity addressing the identified problem area. A deductive thematic analysis of field notes, project documentation and stakeholder focus group interviews, underpinned by MUSIQ, will identify how organisational conditions influence the process. Quantitative measurements, describing the results of the improvement activity, will be integrated with qualitative data to strengthen the case. To reduce resource intensity, we will use online tools during the process. ETHICS AND DISSEMINATION The Swedish Ethical Review Authority approved the study in May 2021. The results will be disseminated through seminars, conference presentations and publications.
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Affiliation(s)
- Anne-Marie Suutari
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Internal Medicine and Geriatrics, the Highland Hospital (Höglandssjukhuset), Region Jönköpings län, Eksjö, Sweden
| | - Annika Nordin
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Sofia Kjellström
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Johan Thor
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Health Services Department, Stockholm County Council, Stockholm, Sweden
| | - Kristina Areskoug Josefsson
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Faculty of Health Studies, VID Specialized University, Oslo, Akershus, Norway
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14
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Reen G, Page B, Oikonomou E. Working as an embedded researcher in a healthcare setting: A practical guide for current or prospective embedded researchers. J Eval Clin Pract 2022; 28:93-98. [PMID: 34121278 DOI: 10.1111/jep.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Gurpreet Reen
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Eirini Oikonomou
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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15
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Mickan S, Coates D. Embedded researchers' purpose and practice: Current perspectives from Australia. Int J Health Plann Manage 2021; 37:133-142. [PMID: 34486737 DOI: 10.1002/hpm.3318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/29/2021] [Accepted: 08/23/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The embedded researcher model proposes that if research is co-produced with academics, clinical staff will have greater engagement with and ownership of the research findings, and they will be able to integrate evidence in practice. This paper describes the role and purpose of embedded researchers in Australian healthcare settings. METHODS A purposive sample of current and former embedded researchers were invited to participate in an exploratory online survey. Embedded researchers were defined as individuals with research qualifications who worked, or had worked, for at least 30% of their time in a healthcare organisation doing research or research capacity building. RESULTS Most embedded researchers described a dual purpose, in building clinicians' capacity for research while also undertaking clinical research. Only a small proportion of respondents described their purpose as supporting and improving clinical practice. Most embedded researchers described working to both traditional academic key performance indicators and a complementary range of clinical performance and healthcare service indicators. CONCLUSION Embedded researchers provide more research development and engagement in health services than is recognised or currently reported. In addition to traditional academic indicators, they described a broad range of clinical and health service indicators which measured capacity building.
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Affiliation(s)
- Sharon Mickan
- Griffith Health, Griffith University, Nathan, Queensland, Australia
| | - Dominiek Coates
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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16
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Anderson R, Booth A, Eastwood A, Rodgers M, Shaw L, Thompson Coon J, Briscoe S, Cantrell A, Chambers D, Goyder E, Nunns M, Preston L, Raine G, Thomas S. Synthesis for health services and policy: case studies in the scoping of reviews. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
For systematic reviews to be rigorous, deliverable and useful, they need a well-defined review question. Scoping for a review also requires the specification of clear inclusion criteria and planned synthesis methods. Guidance is lacking on how to develop these, especially in the context of undertaking rapid and responsive systematic reviews to inform health services and health policy.
Objective
This report describes and discusses the experiences of review scoping of three commissioned research centres that conducted evidence syntheses to inform health and social care organisation, delivery and policy in the UK, between 2017 and 2020.
Data sources
Sources included researcher recollection, project meeting minutes, e-mail correspondence with stakeholders and scoping searches, from allocation of a review topic through to review protocol agreement.
Methods
We produced eight descriptive case studies of selected reviews from the three teams. From case studies, we identified key issues that shape the processes of scoping and question formulation for evidence synthesis. The issues were then discussed and lessons drawn.
Findings
Across the eight diverse case studies, we identified 14 recurrent issues that were important in shaping the scoping processes and formulating a review’s questions. There were ‘consultative issues’ that related to securing input from review commissioners, policy customers, experts, patients and other stakeholders. These included managing and deciding priorities, reconciling different priorities/perspectives, achieving buy-in and engagement, educating the end-user about synthesis processes and products, and managing stakeholder expectations. There were ‘interface issues’ that related to the interaction between the review team and potential review users. These included identifying the niche/gap and optimising value, assuring and balancing rigour/reliability/relevance, and assuring the transferability/applicability of study evidence to specific policy/service user contexts. There were also ‘technical issues’ that were associated with the methods and conduct of the review. These were choosing the method(s) of synthesis, balancing fixed and fluid review questions/components/definitions, taking stock of what research already exists, mapping versus scoping versus reviewing, scoping/relevance as a continuous process and not just an initial stage, and calibrating general compared with specific and broad compared with deep coverage of topics.
Limitations
As a retrospective joint reflection by review teams on their experiences of scoping processes, this report is not based on prospectively collected research data. In addition, our evaluations were not externally validated by, for example, policy and service evidence users or patients and the public.
Conclusions
We have summarised our reflections on scoping from this programme of reviews as 14 common issues and 28 practical ‘lessons learned’. Effective scoping of rapid, responsive reviews extends beyond information exchange and technical procedures for specifying a ‘gap’ in the evidence. These considerations work alongside social processes, in particular the building of relationships and shared understanding between reviewers, research commissioners and potential review users that may be reflective of consultancy, negotiation and co-production models of research and information use.
Funding
This report has been based on work commissioned by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HSDR) programme as three university-based evidence synthesis centres to inform the organisation, delivery and commissioning of health and social care; at the University of Exeter (NIHR 16/47/22), the University of Sheffield (NIHR 16/47/17) and the University of York (NIHR 16/47/11). This report was commissioned by the NIHR HSDR programme as a review project (NIHR132708) within the NIHR HSDR programme. This project was funded by the NIHR HSDR programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rob Anderson
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Andrew Booth
- Sheffield Health Services and Delivery Research Evidence Synthesis Centre, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alison Eastwood
- York Health Service and Delivery Research Evidence Synthesis Centre, Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Rodgers
- York Health Service and Delivery Research Evidence Synthesis Centre, Centre for Reviews and Dissemination, University of York, York, UK
| | - Liz Shaw
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Jo Thompson Coon
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Devon, Cornwall and Somerset, UK
| | - Simon Briscoe
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Anna Cantrell
- Sheffield Health Services and Delivery Research Evidence Synthesis Centre, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- Sheffield Health Services and Delivery Research Evidence Synthesis Centre, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- Sheffield Health Services and Delivery Research Evidence Synthesis Centre, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Michael Nunns
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Louise Preston
- Sheffield Health Services and Delivery Research Evidence Synthesis Centre, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Gary Raine
- York Health Service and Delivery Research Evidence Synthesis Centre, Centre for Reviews and Dissemination, University of York, York, UK
| | - Sian Thomas
- York Health Service and Delivery Research Evidence Synthesis Centre, Centre for Reviews and Dissemination, University of York, York, UK
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Lim S, Morris H, Pizzirani B, Kajewski D, Lee WK, Skouteris H. Evaluating hospital tools and services that were co-produced with patients: A rapid review. Int J Qual Health Care 2021; 32:231-239. [PMID: 32222757 DOI: 10.1093/intqhc/mzaa020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/04/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To describe the process and outcomes of services or products co-produced with patients in hospital settings. DATA SOURCES Database searches on Medline, CINAHL and Business Source between 2008 and 2019. STUDY SELECTION Studies that evaluate the products of co-production in hospital settings. DATA EXTRACTION Primary outcome is the individual and organizational outcomes resulting from co-production. Study characteristics, co-production process, level of engagement and intensity of engagement were also extracted. RESULTS OF DATA SYNTHESIS A total of 13 studies were included. Types of co-produced outputs were health services and care processes, tools and resources, and technology-based products, such as mobile application. Most studies engaged patients at a consultative or involvement level, with only four studies engaging patients as partners. Moderate-to-high acceptability and usability by patients and health services were reported for co-produced outputs. Organizational outcomes were also reported qualitatively as producing various positive effects, such as improved communication and diagnostic process. Positive patient outcomes were reported for co-produced outputs in qualitative (e.g. improved social support) and quantitative results (e.g. reduction of clinic wait time). No patient clinical outcomes were reported. CONCLUSION Co-produced outputs have moderate-to-high acceptability, usability or uptake. There is insufficient evidence on other organizational or patient outcomes due to the lack of reporting of outcomes in co-production. Future research should focus on the outcomes (i.e. effects on patients and health service providers), not just the output of co-production. This is critical to provide feedback to advance the knowledge and implementation of co-production.
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Affiliation(s)
- Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
| | - Heather Morris
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
| | - Bengianni Pizzirani
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
| | - Duncan Kajewski
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
| | - Wai Kit Lee
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, VIC 3168, Australia
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Vashi AA, Orvek EA, Tuepker A, Jackson GL, Amrhein A, Cole B, Asch SM, Gifford AL, Lindquist J, Marshall NJ, Newell S, Smigelsky MA, White BS, White LK, Cutrona SL. The Veterans Health Administration (VHA) Innovators Network: Evaluation design, methods and lessons learned through an embedded research approach. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 8 Suppl 1:100477. [PMID: 34175094 DOI: 10.1016/j.hjdsi.2020.100477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 08/14/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Collaboration between researchers, implementers and policymakers improves uptake of health systems research. In 2018, researchers and VHA Innovators Network (iNET) leadership used an embedded research model to conduct an evaluation of iNET. We describe our evaluation design, early results, and lessons learned. METHODS This mixed-methods evaluation incorporated primary data collection via electronic survey, descriptive analysis using existing VA datasets (examining associations between facility characteristics and iNET participation), and qualitative interviews to support real-time program implementation and to probe perceived impacts, benefits and challenges of participation. RESULTS We developed reporting tools and collected data regarding site participation, providing iNET leadership rapid access to needed information on projects (e.g., target populations reached, milestones achieved, and barriers encountered). Secondary data analyses indicated iNET membership was greater among larger, more complex VA facilities. Of the 37 iNET member sites, over half (n = 22) did not have any of the six major types of VA research centers; thus iNET is supporting VA sites not traditionally served by research innovation pathways. Qualitative findings highlighted enhanced engagement and perceived value of social and informational networks. CONCLUSIONS Working alongside our iNET partners, we supported and influenced iNET's development through our embedded evaluation's preliminary findings. We also provided training and guidance aimed at building capacity among iNET participants. IMPLICATIONS Embedded research can yield successful collaborative efforts between researchers and partners. An embedded research team can help programs pivot to ensure effective use of limited resources. Such models inform program development and expansion, supporting strategic planning and demonstrating value.
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Affiliation(s)
- Anita A Vashi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Emergency Medicine (Affiliated), Stanford University, Stanford, CA, USA.
| | - Elizabeth A Orvek
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; Quantitative Methods Core, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA; Department of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Allison Amrhein
- Department of Veterans Affairs, Veterans Health Administration Innovators Network, USA
| | - Brynn Cole
- Department of Veterans Affairs, Veterans Health Administration Innovators Network, USA
| | - Steven M Asch
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA; Boston University, Boston, MA, USA
| | - Jennifer Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Nell J Marshall
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Summer Newell
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
| | - Melissa A Smigelsky
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA; Veterans Integrated Service Network (VISN) 6 Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Health Care System, Durham, NC, USA
| | - Brandolyn S White
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Lindsay K White
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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19
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Mengshoel AM, Skarbø Å, Hasselknippe E, Petterson T, Brandsar NL, Askmann E, Ildstad R, Løseth L, Sallinen MH. Enabling personal recovery from fibromyalgia - theoretical rationale, content and meaning of a person-centred, recovery-oriented programme. BMC Health Serv Res 2021; 21:339. [PMID: 33853607 PMCID: PMC8045361 DOI: 10.1186/s12913-021-06295-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/18/2021] [Indexed: 12/27/2022] Open
Abstract
Background Fibromyalgia (FM) is a contested, chronic widespread pain syndrome on which recommended therapies have short-lasting, moderate effects. Nevertheless, some patients become symptom-free, and their recovery experiences inspired us to develop a patient-centred recovery-oriented programme (PROP) delivered in a group format. Presently, we describe the theoretical rationale, purpose and content of the PROP, and its meanings for clinicians and patients. Methods A multidisciplinary clinical team, a leader of a rehabilitation unit, and two researchers coproduced the PROP. Five full-day seminars were arranged to bridge research and clinical experiences. Qualitative studies about patients’ illness and recovery experiences and questions by researchers facilitated reflections on clinical experiences. The meaning of the PROP was examined using focus group and individual interviews with patients and clinicians immediately after completing the course and after 1–1.5 years. Results The biopsychosocial model displays the research evidence across biological, mental and social impacts of FM, justifying that life stress can be an illness-maintaining factor in FM. The content addresses enabling patients to heal their own life and self by modifying life stress. Patients engage in making sense of the relationship between FM, themselves, and life through exploring, discovering and creating appropriate solutions for their daily social life. The PROP reduced uncertainties and brought a positive attitude and hope to the groups. After 1 year, patients are still engaged in recovery work, experience more good days, and maintain hope for further recovery. By sharing and reflecting on clinical experiences, a unified clinical team was established that continues to develop their competency. Conclusion To our knowledge, the PROP is the first programme for patients with FM that results from a process of coproducing knowledge, is based on explicit theoretical rationale, and facilitates a personal experiential recovery process. PROP is found to be meaningful and to work by patients and clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06295-6.
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Affiliation(s)
- Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, Box 1089, Blindern, 0317, Oslo, Norway.
| | - Åse Skarbø
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | | | - Tamara Petterson
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Nina Linnea Brandsar
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Ellen Askmann
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Ragnhild Ildstad
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Lena Løseth
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Merja Helena Sallinen
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, Box 1089, Blindern, 0317, Oslo, Norway.,Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
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20
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Wilkinson K, Day J, Thompson-Coon J, Goodwin V, Liabo K, Coxon G, Cox G, Marriott C, Lang IA. A realist evaluation of a collaborative model to support research co-production in long-term care settings in England: the ExCHANGE protocol. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:18. [PMID: 33743827 PMCID: PMC7980357 DOI: 10.1186/s40900-021-00257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Collaborative working between academic institutions and those who provide health and social care has been identified as integral in order to produce acceptable, relevant, and timely research, and for outputs to be useful and practical to implement. The ExCHANGE Collaboration aims to bring together researchers and people working, living in and visiting care homes to build capacity, share and mobilise knowledge, and identify key areas for future research. This paper describes an embedded, formative, realist and theory-driven evaluation which aims to gather information about how successful the ExCHANGE Collaboration is perceived to be in achieving its aims. An existing realist programme theory from the literature - Closer Collaboration - will be supplemented by two substantive theories: Co-production and Knowledge Brokering. This will result in an initial programme theory which will be tested by this formative evaluation to refine understanding of how the ExCHANGE Collaboration works. METHODS The evaluation will employ mixed qualitative methods, including: analysis of documents such as feedback forms, Knowledge Broker journal/diary, event attendance records, risk and issues logs and other relevant paperwork gathered as part of project delivery; observations of events/activities; and interviews with care home providers and staff, care home residents, residents' family members, and researchers who are involved in the project (both project design/delivery, and also attendance or involvement in project activities/events). Framework Analysis will be used to interpret the data collected; analysis will be strategic, by focusing on particular key areas of importance in the developing theory of how the ExCHANGE Collaboration might achieve change. RESULTS The results of this study are expected to be published in 2022. DISCUSSION This evaluation will investigate how successful the ExCHANGE Collaboration is perceived to be in achieving its aims, in what way, in which contexts, and how this may differ for those involved. It will do this by testing an initial programme theory about how the collaboration works, for whom, under which circumstances, and in what way. Findings will be shared through written publication, an end of project learning event for those involved/interested in the project, and a lay summary to be made publically available.
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Affiliation(s)
- K Wilkinson
- University of Exeter, College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - J Day
- University of Exeter, College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - J Thompson-Coon
- University of Exeter, College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - V Goodwin
- University of Exeter, College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - K Liabo
- University of Exeter, College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - G Coxon
- Classic Care Homes (Devon) Ltd, Pottles Court, Days Pottles Lane, Exminster, Devon, EX6 8RL, UK
| | - G Cox
- Southern Healthcare (Wessex) Ltd, Sefton Hall, 11 Plantation Terrace, Dawlish, Devon, EX7 9DS, UK
| | - C Marriott
- The Peninsula Public Engagement Group (PenPEG) member, University of Exeter, College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - I A Lang
- University of Exeter, College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Gilson L, Barasa E, Brady L, Kagwanja N, Nxumalo N, Nzinga J, Molyneux S, Tsofa B. Collective sensemaking for action: researchers and decision makers working collaboratively to strengthen health systems. BMJ 2021; 372:m4650. [PMID: 33593963 PMCID: PMC7879277 DOI: 10.1136/bmj.m4650] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Lucy Gilson and colleagues draw on experiences from Kenya and South Africa to consider the practice, benefits, and challenges of research co-production for strengthening health systems
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Affiliation(s)
- Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
| | - Leanne Brady
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Emergency Medical Services, Department of Health, Western Cape Government, South Africa
| | - Nancy Kagwanja
- Health Systems Research Group, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Nonhlanhla Nxumalo
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Sassy Molyneux
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
- Health Systems Research Group, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Benjamin Tsofa
- Health Systems Research Group, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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22
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van der Graaf P, Cheetham M, Redgate S, Humble C, Adamson A. Co-production in local government: process, codification and capacity building of new knowledge in collective reflection spaces. Workshops findings from a UK mixed methods study. Health Res Policy Syst 2021; 19:12. [PMID: 33514382 PMCID: PMC7844986 DOI: 10.1186/s12961-021-00677-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Co-production of research evidence is valued by local government to improve effective decision-making about public services in times of austerity. However, underlying structural issues of power (so-called ‘dark shadows of co-production’) challenge this ambition with limited evidence on how to embed research use sustainably. In this paper we reflect on mechanisms for increasing co-production in local government. Methods This paper presents findings from a Health Foundation funded research project that explored how a culture of evidence use to improve population health could be embedded in UK local government. Five linked work packages were undertaken using mixed methods. In this paper, we report the views of UK local authority staff who participated in four workshops (n = 54), informed by a rapid literature review and an online scoping survey. Results We identified five themes that facilitate public health evidence use in local government: (1) new governance arrangements to integrate national and local policies, (2) codifying research evidence through local system-wide approaches and (3) ongoing evaluation of programmes, and (4) overcoming political and cultural barriers by increasing absorptive capacity of Local Authorities to embed co-produced knowledge in their cognitive structures. This requires adaptive governance through relationship building between academic researchers and Local Authority staff and shared understanding of fragmented local policy making, which are supported by (5) collective spaces for reflection within local government. Conclusions Creating collective spaces for reflection in between government departments allows for iterative, interactive processes of co-production with external partners that support emergence of new governance structures to socially action the co-produced knowledge in context and build capacity for sustained evidence use.
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Affiliation(s)
- Peter van der Graaf
- Department of Applied Health Professionals, School of Health and Life Sciences, Teesside University, Middlesbrough, UK.
| | - Mandy Cheetham
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Sam Redgate
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Humble
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Newcastle City Council, Newcastle upon Tyne, UK
| | - Ashley Adamson
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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23
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Johnson JK, Stilphen M, Young DL, Friedman M, Marcus RL, Noren CS, Zeleznik H, Freburger JK. Advancing Rehabilitation Practice Using Embedded Learning Health System Researchers. Phys Ther 2021; 101:6123363. [PMID: 33513228 PMCID: PMC8502430 DOI: 10.1093/ptj/pzab029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/10/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA,Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio, USA,Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA,Address all correspondence to Dr Johnson at:
| | - Mary Stilphen
- Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel L Young
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Friedman
- Johns Hopkins Activity and Mobility Promotion, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Robin L Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | | | - Hallie Zeleznik
- Centers for Rehabilitation Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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24
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Coates D, Coppleson D, Travaglia J. Factors supporting the implementation of integrated care between physical and mental health services: an integrative review. J Interprof Care 2021; 36:245-258. [PMID: 33438489 DOI: 10.1080/13561820.2020.1862771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In Australia and internationally there is a strong policy commitment to the redesign of health services toward integrated physical and mental health care. When executed well, integrated care has been demonstrated to improve the access to, clinical outcomes from, and quality of care while reducing overtreatment and duplication. Despite the demonstrated effectiveness and promise of integrated care, exactly how integrated care is best achieved remains less clear. The aim of this review study was to identify factors that support the implementation of integrated care between physical and mental health services. An integrative review was conducted following the framework developed by Whittemore and Knafl, with quantitative and qualitative evidence systematically considered. To identify studies, Medline, PubMed, PsychINFO, CINAHL were searched for the period from 2003 to 2018, and reference lists of included studies and review articles were examined. Nineteen studies were included. Synthesis of study findings identified seven key factors supporting the implementation of integrated care between physical and mental health services: (a) adequate resourcing, (b) shared values, (c) effective communication, (d) information technology (IT) infrastructure, (e) flexible administrative organizations, (f) role clarity and accountability, and (g) staff engagement and training. There was little theoretical development in included studies, with little insight into the contextual factors or underlying mechanism required to support the implementation of integrated care initiatives. This review identified a set of inter-related barriers and facilitators which, if addressed, can improve the implementation and sustainability of truly integrated care.
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Affiliation(s)
- Dominiek Coates
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Danielle Coppleson
- Mental Health Access and Pathways to Care Lead for South Eastern Sydney Local Health District (SESLHD), Sydney, Australia
| | - Jo Travaglia
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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25
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Marston CA, Matthews R, Renedo A, Reed JE. Working together to co-produce better health: The experience of the Collaboration for Leadership in Applied Health Research and Care for Northwest London. J Health Serv Res Policy 2021; 26:28-36. [PMID: 32486987 PMCID: PMC7734957 DOI: 10.1177/1355819620928368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To improve the provision of health care, academics can be asked to collaborate with clinicians, and clinicians with patients. Generating good evidence on health care practice depends on these collaborations working well. Yet such relationships are not the norm. We examine how social science research and health care improvement practice were linked through a programme designed to broker collaborations between clinicians, academics, and patients to improve health care - the UK National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London. We discuss the successes and challenges of the collaboration and make suggestions on how to develop synergistic relationships that facilitate co-production of social science knowledge and its translation into practice. METHODS A qualitative approach was used, including ethnographic elements and critical, reflexive dialogue between members of the two collaborating teams. RESULTS Key challenges and remedies were connected with the risks associated with new ways of working. These risks included differing ideas between collaborators about the purpose, value, and expectations of research, and institutional opposition. Dialogue between collaborators did not mean absence of tensions or clashes. Risk-taking was unpopular - institutions, funders, and partners did not always support it, despite simultaneously demanding 'innovation' in producing research that influenced practice. CONCLUSIONS Our path was made smoother because we had funding to support the creation of a 'potential space' to experiment with different ways of working. Other factors that can enhance collaboration include a shared commitment to dialogical practice, a recognition of the legitimacy of different partners' knowledge, a long timeframe to identify and resolve problems, the maintenance of an enabling environment for collaboration, a willingness to work iteratively and reflexively, and a shared end goal.
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Affiliation(s)
- Cicely A Marston
- Professor of Public Health, London School of Hygiene and Tropical Medicine, UK
| | | | - Alicia Renedo
- Assistant Professor, London School of Hygiene and Tropical Medicine, UK
| | - Julie E Reed
- Strategic Director, CLAHRC NWL, Patient and Public Engagement and Involvement Lead, National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care for Northwest London, Imperial College London, Chelsea and Westminster Hospital, UK
- Visiting Professor in Improvement Science, School of Health and Welfare, Halmstad University, Sweden
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26
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Mbachu CO, Clara Agu I, Onwujekwe O. Collaborating to co-produce strategies for delivering adolescent sexual and reproductive health interventions: processes and experiences from an implementation research project in Nigeria. Health Policy Plan 2020; 35:ii84-ii97. [PMID: 33156942 PMCID: PMC7646732 DOI: 10.1093/heapol/czaa130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 11/27/2022] Open
Abstract
Implementation science embraces collaboration between academic researchers and key stakeholders/implementers for the dual purpose of capacity building and context-adaptation. Co-production ensures that knowledge created with inputs from various groups of stakeholders is more reflective of local contexts. This paper highlights the experiences of academic researchers and non-academic implementers in collaborating to design implementation strategies for improving access to sexual and reproductive information and services for adolescents. Data were collected through primary and secondary sources. Detailed review of project documents such as minutes of research meetings, reports of workshops and outputs of group work activities enabled detailed description of the processes and steps of co-designing implementation strategies. Information on experiences and perspectives of benefits of the collaborative were collected through in-depth interviews of non-academic partners and focus group discussion with academic researchers. Narrative synthesis was done for information extracted through document review. Thematic analysis of qualitative interviews was done. The process of designing implementation strategies happened in three chronological steps of setting up the collaborative, selecting intervention areas and convening partners’ meetings to design strategies. Specific activities include stakeholder engagement, situation analysis, selection of intervention areas, designing the implementation strategies and pre-testing implementation tools. The process of analysing and selecting collaborators was iterative, and facilitated by having an ‘insider’ key informant. Working with key stakeholders enabled knowledge sharing and exchange among partners. Information sharing within the collaborative facilitated shifting of mindsets about adolescent sexual and reproductive health, and contextual adaptation of names and labels given to strategies. Co-producing implementation strategies with non-academic implementers enabled stakeholder ownership of implementation strategies and set the scene for their adoption in implementation settings. Some challenges of co-production of knowledge are that it is time consuming; involves several iterations that may influence coherence of strategies; involves multiple interests and priorities and poses a threat to fidelity.
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Affiliation(s)
| | | | - Obinna Onwujekwe
- Department of Community Medicine, University of Nigeria.,Health Policy Research Group.,Department of Health Administration and Management, University of Nigeria
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27
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Blanchette MA, Saari M, Aubrecht K, Bailey C, Cheng I, Embrett M, Ghandour EK, Haw J, Koval A, Liu RH, Manhas KP, Mawani FN, Mcconnell-Nzunga J, Petricca K, Sim M, Singal D, Syrowatka A, Lai J. Making Contributions and Defining Success: An eDelphi Study of the Inaugural Cohort of CIHR Health System Impact Fellows, Host Supervisors and Academic Supervisors. ACTA ACUST UNITED AC 2020; 15:49-60. [PMID: 31755859 PMCID: PMC7017753 DOI: 10.12927/hcpol.2019.25980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context: The Health System Impact (HSI) Fellowship, an innovative training program developed by the Canadian Institutes of Health Research's Institute of Health Services and Policy Research, provides PhD-trained health researchers with an embedded, experiential learning opportunity within a health system organization. Methods/Design: An electronic Delphi (eDelphi) study was conducted to: (1) identify the criteria used to define success in the program and (2) elucidate the main contributions fellows made to their organizations. Through an iterative, two-round eDelphi process, perspectives were elicited from three stakeholder groups in the inaugural cohort of the HSI Fellowship: HSI fellows, host supervisors and academic supervisors. Discussion: A consensus was reached on many criteria of success for an embedded research fellowship and on several perceived contributions of the fellows to their host organization and academic institutions. This work begins to identify specific criteria for success in the fellowship that can be used to improve future iterations of the program.
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Affiliation(s)
- Marc-André Blanchette
- Département de chiropratique, Université du Québec à Trois-Rivières; Epidemiology, Biostatistics and Occupational Health, McGill University; Institut national d'excellence en santé et services sociaux, Trois-Rivières, QC
| | - Margaret Saari
- SE Research Centre, SE Health and School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Katie Aubrecht
- Nova Scotia Health Authority Continuing Care-Research, Mount Saint Vincent University, Halifax, NS
| | - Chantelle Bailey
- Canadian Nurses Association and the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
| | - Ivy Cheng
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Mark Embrett
- Canada Health Infoway, McMaster University, Toronto, ON
| | | | - Jennie Haw
- Canadian Blood Services, Western University, Ottawa, ON
| | - Andriy Koval
- Observatory for Population and Public Health, University of British Columbia, Vancouver, BC
| | - Rebecca H Liu
- University of Ottawa, Region of Peel Public Health, Toronto, ON
| | | | - Farah N Mawani
- MAP Centre for Urban Health Solutions St. Michael's Hospital; Faculty of Environmental Studies, York University, Toronto, ON
| | | | - Kadia Petricca
- North York General Hospital, Department of Research and Innovation, University of Toronto, IHPME, Toronto, ON
| | - Meaghan Sim
- Nova Scotia Health Authority; Healthy Populations Institute, Dalhousie University, Halifax, NS
| | - Deepa Singal
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
| | - Ania Syrowatka
- Canadian Foundation for Healthcare Improvement, University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON
| | - Jonathan Lai
- Centre for Innovation in Autism and Intellectual Disabilities, Miriam Foundation, co-funded by Mitacs, School of Physical and Occupational Therapy, McGill University, Montreal, QC
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Abstract
PURPOSE The embedded researcher is a healthcare-academic partnership model in which the researcher is engaged as a core member of the healthcare organisation. While this model has potential to support evidence translation, there is a paucity of evidence in relation to the specific challenges and strengths of the model. The aim of this study was to map the barriers and enablers of the model from the perspective of embedded researchers in Australian healthcare settings, and compare the responses of embedded researchers with a primary healthcare versus a primary academic affiliation. DESIGN/METHODOLOGY/APPROACH 104 embedded researchers from Australian healthcare organisations completed an online survey. Both purposive and snowball sampling strategies were used to identify current and former embedded researchers. This paper reports on responses to the open-ended questions in relation to barriers and enablers of the role, the available support, and recommendations for change. Thematic analysis was used to describe and interpret the breadth and depth of responses and common themes. FINDINGS Key barriers to being an embedded researcher in a public hospital included a lack of research infrastructure and funding in the healthcare organisation, a culture that does not value research, a lack of leadership and support to undertake research, limited access to mentoring and career progression and issues associated with having a dual affiliation. Key enablers included supportive colleagues and executive leaders, personal commitment to research and research collaboration including formal health-academic partnerships. RESEARCH LIMITATIONS/IMPLICATIONS To support the embedded researcher model, broader system changes are required, including greater investment in research infrastructure and healthcare-academic partnerships with formal agreements. Significant changes are required, so that healthcare organisations appreciate the value of research and support both clinicians and researchers to engage in research that is important to their local population. ORIGINALITY/VALUE This is the first study to systematically investigate the enablers and challenges of the embedded researcher model.
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29
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Whiteford GE. Sylvia docker memorial lecture: Together we go further-Service co-design, knowledge co-production and radical solidarity. Aust Occup Ther J 2020; 66:682-689. [PMID: 31907942 DOI: 10.1111/1440-1630.12628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM Occupational therapy can be essentially described as enabling social inclusion through occupational participation. How does this best happen? The answer is through working in deeply collaborative, power and knowledge sharing partnerships with individuals, families, communities and populations of people across contextual boundaries. METHODS In this lecture, critical consideration is given to first, ways of working with communities of interest in service co-design, knowledge co-production and as co-researchers and how the philosophical underpinnings of the profession are consistent with such approaches. The second part of the lecture examines epistemic and hegemonic 'blind-spots' of the profession which can act as barriers to such person centred interactions, further reproducing dynamics of exclusion and marginalisation of already vulnerable persons and communities. Finally, the lecture considers the 'next era' in occupational therapy in which, in response to entrenched situations of occupational injustice globally, we may work with people in what has been termed 'radical solidarity' using de-colonising and occupation-centred approaches such as the Participatory Occupational Justice Framework and the Capabilities, Opportunities, Resources and Environments approach. RESULTS Using approaches that represent authentic partnerships between occupational therapists and the people they serve can result in powerful and potentially transformative outcomes. This is because working with people as co-designers of services and as co-researchers in evaluating service effectiveness, means that knowledge is co-produced within specific contexts. This in turn means the traditional evidence/practice gap is closed. CONCLUSIONS Working in authentic, power sharing partnerships with diverse people in diverse settings using diverse approaches, will be the way in which occupational therapy can make its strongest societal contribution. Aligning occupational justice with epistemic and hermeneutic justice is fundamental to this vision, providing a platform in which members of the profession can work collaboratively with people and go further together towards societal change.
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Affiliation(s)
- Gail Elizabeth Whiteford
- Allied Health and Community Wellbeing, Charles Sturt University & Mid North Coast LHD, NSW Health, Port Macquarie, NSW, Australia
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30
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Coates D, Mickan S. The embedded researcher model in Australian healthcare settings: comparison by degree of "embeddedness". Transl Res 2020; 218:29-42. [PMID: 31759948 DOI: 10.1016/j.trsl.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
The embedded researcher model is a health-academic partnership where researchers are core members of a healthcare organization, with an aim to support evidence translation. The purpose of this study was to describe the characteristics and experiences of embedded researchers in Australian healthcare settings, and investigate how the model is experienced differently based on the level of "embeddedness." This exploratory study utilized a purpose-designed online survey. Responses were described using Word and Excel and analyzed using SPSS. To investigate how the model was experienced based on the level of "embeddedness," we tested for differences in responses between respondents with primary academic vs healthcare affiliations. A total of 104 embedded researchers from nursing and midwifery, allied health and medicine completed the survey, with equal numbers reporting a primary academic vs primary healthcare affiliation. Most indicated that research is a strategic objective of the healthcare organization (85.9%) yet almost a third (31%) reported that research outputs were not measured. While 60% agreed that clinical practice informed by research was valued, only 28% reported having adequate resources. Of those with a formal dual affiliation over a quarter reported conflict between expectations of the healthcare and academic organizations. Respondents with a primary academic affiliation were older, more qualified, had more research experience, had been in the role longer, and had more positive perceptions of the research culture of healthcare organizations. This study provides a starting point for healthcare organizations and academic institutions to partner in the further development and implementation of this model.
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Affiliation(s)
- Dominiek Coates
- University of Technology Sydney, Faculty of Health, Sydney, New South Wales, Australia.
| | - Sharon Mickan
- Griffith University, Griffith Health, Brisbane, Australia
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Stuhlfauth S, Knutsen IR, Foss C. Users' and researchers' construction of equity in research collaboration. Health Expect 2020; 23:296-305. [PMID: 31960555 PMCID: PMC7104651 DOI: 10.1111/hex.13026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/26/2019] [Accepted: 12/21/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Equity is described as an ideal in user involvement in research and is mentioned in the health service literature and in several guidelines. However, equity is described as being difficult to obtain and the concept is rarely clarified or concretized. Equity can be socially constructed. OBJECTIVE This study explored users' and researchers' constructions of equity in research processes. DESIGN AND METHOD The study had a qualitative research design. Constructions of equity were analysed through the lens of positioning theory. Two focus group interviews consisting of both users and researchers were conducted. FINDINGS The thirteen users and four researchers considered 'equity' as an important part of user involvement in research. Storylines about norms, responsibility, language, knowledge and usefulness evolved in the discussions. These storylines elucidated unequal access to rights and duties. DISCUSSION AND CONCLUSION Users and researchers constructed equity in user involvement differently, but the difference was masked by an apparent agreement. Users and researchers drew on different storylines. The researchers emphasized the scientific discourse and although users acknowledged this discourse, they attempted to oppose this dominant discourse by drawing on a lay discourse. The identified constructions and negotiations of equity may contribute in new understandings of an equal collaboration in user involvement in research.
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Affiliation(s)
- Susanne Stuhlfauth
- Department of Nursing ScienceFaculty of MedicineUniversity of OsloOsloNorway
| | - Ingrid Ruud Knutsen
- Department of Nursing and Health PromotionFaculty of Health ScienceOslo Metropolitan UniversityKjellerNorway
| | - Christina Foss
- Department of Nursing ScienceFaculty of MedicineUniversity of OsloOsloNorway
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Boulding H, Kamenetzky A, Ghiga I, Ioppolo B, Herrera F, Parks S, Manville C, Guthrie S, Hinrichs-Krapels S. Mechanisms and pathways to impact in public health research: a preliminary analysis of research funded by the National Institute for Health Research (NIHR). BMC Med Res Methodol 2020; 20:34. [PMID: 32075580 PMCID: PMC7031933 DOI: 10.1186/s12874-020-0905-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background The mechanisms and pathways to impacts from public health research in the UK have not been widely studied. Through the lens of one funder (NIHR), our aims are to map the diversity of public health research, in terms of funding mechanisms, disciplinary contributions, and public health impacts, identify examples of impacts, and pathways to impact that existing reporting mechanisms may not otherwise have captured, and provide illustrations of how public health researchers perceive the generation of non-academic impact from their work. Methods A total of 1386 projects were identified as ‘public health research’ by the NIHR and listed in the NIHR Public Health Overview database (2000–2016). From these, a subset of 857 projects were matched as potentially having begun reporting impacts via an external data-gathering platform (Researchfish). Data on the 857 projects were analyzed quantitatively, and nine projects were selected to investigate further through semi-structured interviews with principal investigators. Two workshops took place to validate emerging and final findings and facilitate analysis. Results In addition to the NIHR School for Public Health Research and the NIHR Public Health Research Programme, 89% of projects contained in the NIHR Public Health Overview portfolio as ‘public health research’ are funded via other NIHR research programmes, suggesting significant diversity in disciplines contributing to public health research and outcomes. The pathways to impact observed in our in-depth case studies include contributing to debates on what constitutes appropriate evidence for national policy change, acknowledging local ‘unintended’ impacts, building trusted relationships with stakeholders across health and non-health sectors and actors, collaborating with local authorities, and using non-academic dissemination channels. Conclusions Public health as a discipline contributes substantially to impact beyond academia. To support the diversity of these impacts, we need to recognise localized smaller-scale impacts, and the difference in types of evidence required for community and local authority-based impacts. This will also require building capacity and resources to enable impact to take place from public health research. Finally, support is required for engagement with local authorities and working with non-health sectors that contribute to health outcomes.
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Affiliation(s)
- Harriet Boulding
- The Policy Institute, King's College London, 22 Kingsway, London, WC2B 6LE, UK
| | - Adam Kamenetzky
- The Policy Institute, King's College London, 22 Kingsway, London, WC2B 6LE, UK
| | - Ioana Ghiga
- RAND Europe, Westbrook Centre, Cambridge, CB4 1YG, UK
| | - Becky Ioppolo
- RAND Europe, Westbrook Centre, Cambridge, CB4 1YG, UK
| | | | - Sarah Parks
- RAND Europe, Westbrook Centre, Cambridge, CB4 1YG, UK
| | | | - Susan Guthrie
- RAND Europe, Westbrook Centre, Cambridge, CB4 1YG, UK
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Tabriz AA, Flocke SA, Shires D, Dyer KE, Schreiber M, Elston Lafata J. Logic model framework for considering the inputs, processes and outcomes of a healthcare organisation-research partnership. BMJ Qual Saf 2019; 29:746-755. [PMID: 31826921 DOI: 10.1136/bmjqs-2019-010059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/14/2019] [Accepted: 11/25/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The published literature provides few insights regarding how to develop or consider the effects of knowledge co-production partnerships in the context of delivery system science. OBJECTIVE To describe how a healthcare organisation-university-based research partnership was developed and used to design, develop and implement a practice-integrated decision support tool for patients with a physician recommendation for colorectal cancer screening. DESIGN Instrumental case study. PARTICIPANTS Data were ascertained from project documentation records and semistructured questionnaires sent to 16 healthcare organisation leaders and staff, research investigators and research staff members. RESULTS Using a logic model framework, we organised the key inputs, processes and outcomes of a healthcare organisation-university-based research partnership. In addition to pragmatic researchers, partnership inputs included a healthcare organisation with a supportive practice environment and an executive-level project sponsor, a mid-level manager to serve as the organisational champion and continual access to organisational employees with relevant technical, policy and system/process knowledge. During programme design and implementation, partnership processes included using project team meetings, standing organisational meetings and one-on-one consultancies to provide platforms for shared learning and problem solving. Decision-making responsibility was shared between the healthcare organisation and research team. We discuss the short-term outcomes of the partnership, including how the partnership affected the current research team's knowledge and health system initiatives. CONCLUSION Using a logic model framework, we have described how a healthcare organisation-university-based research team partnership was developed. Others interested in developing, implementing and evaluating knowledge co-production partnerships in the context of delivery system science projects can use the experiences to consider ways to develop, implement and evaluate similar co-production partnerships.
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Affiliation(s)
- Amir Alishahi Tabriz
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Susan A Flocke
- Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Deirdre Shires
- School of Social Work, Michigan State University School of Social Work, East Lansing, Michigan, USA
| | - Karen E Dyer
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Schreiber
- Henry Ford Health System, Detroit, Michigan, USA.,Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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O’Brien MA, Carson A, Barbera L, Brouwers MC, Earle CC, Graham ID, Mittmann N, Grunfeld E. Variable participation of knowledge users in cancer health services research: results of a multiple case study. BMC Med Res Methodol 2018; 18:150. [PMID: 30466391 PMCID: PMC6249816 DOI: 10.1186/s12874-018-0593-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/29/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Integrated knowledge translation (IKT) is a research approach in which knowledge users (KUs) co-produce research. The rationale for IKT is that it leads to research that is more relevant and useful to KUs, thereby accelerating uptake of findings. The aim of the current study was to evaluate IKT activities within a cancer health services research network in Ontario, Canada. METHODS An embedded multiple case study design was used. The cases were 5 individual studies within an overarching cancer health services research network. These studies focused on one of the following topics: case costing of cancer treatment, lung cancer surgery policy analysis, patient and provider-reported outcomes, colorectal cancer screening, and a team approach to women's survivorship. We conducted document reviews and held semi-structured interviews with researchers, KUs, and other stakeholders within a cancer system organization. The analysis examined patterns across and within cases. RESULTS Researchers and their respective knowledge users from 4 of the 5 cases agreed to participate. Eighteen individuals from 4 cases were interviewed. In 3 of 4 cases, there were mismatched expectations between researchers and KUs regarding KU role; participants recommended that expectations be made explicit from the beginning of the collaboration. KUs perceived that frequent KU turnover may have affected both KU engagement and the uptake of study results within the organization. Researchers and KUs found that sharing research results was challenging because the organization lacked a framework for knowledge translation. Uptake of research findings appeared to be related to the researcher having an embedded role in the cancer system organization and/or close alignment of the study with organizational priorities. Document reviews found evidence of planned IKT strategies in 3 of 4 cases; however, actual KU role/engagement on research teams was variable. CONCLUSIONS Barriers to KU co-production of cancer health services research include mismatched expectations of KU role and frequent KU turnover. When a research study directly aligns with organizational priorities, it appears more likely that results will be considered in programming. Research teams that take an IKT approach should consider specific strategies to address barriers to KU engagement.
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Affiliation(s)
- Mary Ann O’Brien
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON M5G 1V7 Canada
| | - Andrea Carson
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Lisa Barbera
- Tom Baker Cancer Centre, Calgary, AB Canada
- University of Calgary, Calgary, AB Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Melissa C. Brouwers
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
- Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Craig C. Earle
- Ontario Institute for Cancer Research, Toronto, ON Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Nicole Mittmann
- Cancer Care Ontario, Toronto, ON Canada
- Sunnybrook Research Institute, Toronto, ON Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON M5G 1V7 Canada
- Ontario Institute for Cancer Research, Toronto, ON Canada
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