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Willcox ML, Okello IA, Maidwell-Smith A, Tura AK, van den Akker T, Knight M, Dumont A, Muller I. Determinants of behaviors influencing implementation of maternal and perinatal death surveillance and response in low- and middle-income countries: A systematic review of qualitative studies. Int J Gynaecol Obstet 2024; 165:586-600. [PMID: 37727893 DOI: 10.1002/ijgo.15132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Maternal and Perinatal Death Surveillance and Review (MPDSR) can reduce mortality but its implementation is often suboptimal, especially in low- and middle-income countries (LMICs). OBJECTIVES To understand the determinants of behaviors influencing implementation of MPDSR in LMICs (through a systematic review of qualitative studies), in order to plan an intervention to improve its implementation. SEARCH STRATEGY Terms for maternal or perinatal death reviews and qualitative studies. SELECTION CRITERIA Qualitative studies regarding implementation of MPDSR in LMICs. DATA COLLECTION AND ANALYSIS We coded the included studies using the Theoretical Domains Framework and COM-B model of behavior change (Capability, Opportunity, Motivation). We developed guiding principles for interventions to improve implementation of MPDSR. MAIN RESULTS Fifty-nine studies met our inclusion criteria. Capabilities required to conduct MPDSR (knowledge and technical/leadership skills) increase cumulatively from community to health facility and leadership levels. Physical and social opportunities depend on adequate data, human and financial resources, and a blame-free environment. All stakeholders were motivated to avoid negative consequences (blame, litigation, disciplinary action). CONCLUSIONS Implementation of MPDSR could be improved by (1) introducing structural changes to reduce negative consequences, (2) strengthening data collection tools and information systems, (3) mobilizing adequate resources, and (4) building capabilities of all stakeholders.
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Affiliation(s)
- Merlin L Willcox
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Immaculate A Okello
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Alice Maidwell-Smith
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | | | - Ingrid Muller
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, UK
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Ngo NT, Flottmann F, Iori F, Bonfanti M, Mandaltsi A, Fiehler J, Bester M. Virtual implantation of Derivo Embolization Devices using PreSize Neurovascular software: Accuracy evaluation and size selection comparison study. Interv Neuroradiol 2023:15910199231202272. [PMID: 37807663 DOI: 10.1177/15910199231202272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Evaluating the deployed length of flow diverting stents (FDs) to select the optimal device size remains a challenging, yet crucial, task in aneurysm treatment. This study reports on the accuracy of PreSize Neurovascular (Oxford Heartbeat Ltd), a visualization and simulation software for FD intervention planning, in predicting FD deployed length, and on its impact on device size selection. METHODS Imaging data from consecutive patients treated with Derivo Embolization Device (Acandis GmbH) were collected from University Medical Center Hamburg-Eppendorf and retrospectively analyzed. Accuracy evaluation: prediction accuracy was calculated by comparing deployed FD lengths measured from imaging data and simulated by PreSize. Size selection comparison: two Interventional Neuroradiologists (INR1, INR2), blinded to the devices deployed, used PreSize to select the optimal device size (diameter and length). Their choices were compared against the deployed devices selected by conventional planning. RESULTS Among 98 implanted devices, PreSize predicted deployed FD length with a mean accuracy of 94.54% (95% confidence interval [93.72%, 95.35%]). Among 98 aneurysm cases, PreSize-informed device lengths were significantly shorter (Wilcoxon signed-rank test, INR1: W = 394, P < .001, INR2: W = 305, P < .001) by 4.13 and 4.18 mm on average, and up to 20 and 25 mm, for INR1 and INR2, respectively, than the conventionally selected FDs. In 32% of cases, PreSize-informed devices resulted in fewer vessel bends covered by the FD while achieving sufficient aneurysm coverage. CONCLUSIONS PreSize retrospectively predicted deployed FD lengths with high accuracy. Moreover, INRs in this study were more inclined to select shorter stent length in the simulation than they would have done conventionally.
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Affiliation(s)
- Ngoc T Ngo
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Grant AK, Felner JK, Castañeda Y, Pratap P, Hebert-Beirne J. Leveraging Key Informant Interviews to Inform Intervention Development: The Greater Lawndale Healthy Work Project. Community Health Equity Res Policy 2023:2752535X231196395. [PMID: 37607529 DOI: 10.1177/2752535x231196395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND The Greater Lawndale Healthy Work project is a sequential mixed methods community based participatory research project that examines work as a structural determinant of health and builds community capacity for healthy work in a predominantly Black and Latinx community in Chicago known as Greater Lawndale (GL). OBJECTIVES We interviewed community leaders in GL as key informants to understand the barriers to healthy work and inform intervention development. METHODS We conducted a directed content analysis of transcripts from 20 key informants and coded the social ecology and type of intervention. RESULTS Every key informant mentioned at least one asset in GL, showing an opportunity to employ a capacity-oriented approach to intervention development. Key informants suggested a variety of interventions to address precarious work across levels of the social ecology, with individual and community level interventions being the most salient. CONCLUSION Through this approach, we were able to navigate tensions and challenges in conducting research for community-wide change. Key informant stakeholder interviews can be leveraged to meaningfully inform intervention development and support the development of multi-level, sustainable, and culturally acceptable interventions that advance health equity.
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Affiliation(s)
| | - Jennifer K Felner
- Institute for Behavioral and Community Health, San Diego State University School of Public Health
| | - Yvette Castañeda
- Environmental and Occupational Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL, USA
| | - Preethi Pratap
- Environmental and Occupational Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL, USA
| | - Jeni Hebert-Beirne
- Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL, USA
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Adkins-Jackson PB, Vázquez E, Henry-Ala FK, Ison JM, Cheney A, Akingbulu J, Starks C, Slay L, Dorsey A, Marmolejo C, Stafford A, Wen J, McCauley MH, Summers L, Bermudez L, Cruz-Roman ZL, Castillo I, Kipke MD, Brown AF. The Role of Anti-Racist Community-Partnered Praxis in Implementing Restorative Circles Within Marginalized Communities in Southern California During the COVID-19 Pandemic. Health Promot Pract 2023; 24:232-243. [PMID: 36419256 PMCID: PMC9703012 DOI: 10.1177/15248399221132581] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has exacerbated the adverse influence of structural racism and discrimination experienced by historically marginalized communities (e.g., Black, Latino/a/x, Indigenous, and transgender people). Structural racism contributes to trauma-induced health behaviors, increasing exposure to COVID-19 and restricting access to testing and vaccination. This intersection of multiple disadvantages has a negative impact on the mental health of these communities, and interventions addressing collective healing are needed in general and in the context of the COVID-19 pandemic. The Share, Trust, Organize, and Partner COVID-19 California Alliance (STOP COVID-19 CA), a statewide collaborative of 11 universities and 75 community partners, includes several workgroups to address gaps in COVID-19 information, vaccine trial participation, and access. One of these workgroups, the Vaccine Hesitancy Workgroup, adopted an anti-racist community-partnered praxis to implement restorative circles in historically marginalized communities to facilitate collective healing due to structural racism and the COVID-19 pandemic. The project resulted in the development of a multilevel pre-intervention restorative process to build or strengthen community-institutional partnerships when procurement of funds has been sought prior to community partnership. This article discusses this workgroup's role in advancing health justice by providing a community-based mental health intervention to marginalized communities in Southern California while using an antiracist praxis tool to develop a successful community-institutional partnership and to live up to the vision of community-based participatory research.
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Affiliation(s)
| | | | | | | | - Ann Cheney
- University of California, Riverside, Riverside, CA, USA
| | | | | | - Lindsay Slay
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Alexander Dorsey
- Mending Minds Professional Clinical Counseling, Inc, Los Angeles, CA, USA
| | | | | | - James Wen
- St. John's Cathedral, Los Angeles, CA, USA
| | | | - Latrese Summers
- St. John's Well Child and Family Center, Inc., Los Angeles, CA, USA
| | | | | | | | | | - Arleen F Brown
- University of California, Los Angeles, Los Angeles, CA, USA
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Namazi S, Dugan AG, Cavallari JM, Rinker RD, Preston JC, Steele VL, El Ghaziri M, Cherniack MG. Participatory design of a sleep intervention with correctional supervisors using a root causes approach. Am J Ind Med 2023; 66:167-177. [PMID: 36537998 DOI: 10.1002/ajim.23452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND After a Design Team (DT) conducted a workforce health assessment of correctional supervisors, they selected sleep as an intervention priority, given its numerous health and work consequences. Existing workplace sleep interventions are designed with little worker input, but participatory solutions that incorporate workers' lived experiences and root causes of poor sleep may be more relevant, appropriate, and acceptable to end-users, resulting in better uptake. METHODS The DT met bi-monthly to complete the Intervention Design and Analysis Scorecard (IDEAS) tool to brainstorm interventions that address root causes of poor sleep, and evaluate, rank, and select interventions for implementation. We conducted a qualitative review of meeting notes and worksheets from each IDEAS step, and present our findings on root causes and prioritized solutions. RESULTS The DT consisted of two university researchers and seven members of a correctional supervisors' union, with 5-9 participants attending each meeting. IDEAS Steps 1-5 were completed in eight meetings over six months. Root causes of poor sleep included mind/body and environmental disruptions, and insufficient time. Three solutions were proposed: training on sleep hygiene, meditation, and sleep debt management; a sleep-tracking smartphone app; and a shared overtime policy based on splitting one 8-hour shift between two supervisors. CONCLUSIONS This is the first known application of IDEAS to address sleep, and targeting root causes may result in more efficacious interventions for sleep improvement. Moreover, because IDEAS guides DTs in selecting solutions with the greatest perceived health benefits, reach, cost-effectiveness, and feasibility, it may result in more successful implementation.
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Affiliation(s)
- Sara Namazi
- Department of Health Sciences, Springfield College, Springfield, Massachusetts, USA
| | - Alicia G Dugan
- Division of Occupational and Environmental Medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Jennifer M Cavallari
- Division of Occupational and Environmental Medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | | | | | | | - Mazen El Ghaziri
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Massachusetts, USA
| | - Martin G Cherniack
- Division of Occupational and Environmental Medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Evans K, Whitehouse AJO, D’Arcy E, Hayden-Evans M, Wallace K, Kuzminski R, Thorpe R, Girdler S, Milbourn B, Bölte S, Chamberlain A. Perceived Support Needs of School-Aged Young People on the Autism Spectrum and Their Caregivers. Int J Environ Res Public Health 2022; 19:15605. [PMID: 36497683 PMCID: PMC9737194 DOI: 10.3390/ijerph192315605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
With increasing demands for health, disability and education services, innovative approaches can help distribute limited resources according to need. Despite an increased focus on support needs within the clinical pathway and policy landscape, the body of research knowledge on this topic is at a relatively early stage. However, there appears to be a sense of unmet support needs and dissatisfaction with the provision of required support following an autism diagnosis amongst caregivers of young people on the spectrum. The primary aim of this study was to explore the perceived support needs of Australian school-aged young people on the spectrum and their caregiver(s). This was achieved using a phenomenographic Support Needs Interview conducted by occupational therapists during home-visits with caregivers of 68 young people on the spectrum (5-17 years). Qualitative data analysis resulted in two hierarchical outcome spaces, one each for young people and their caregivers, indicating interacting levels of support need areas that could be addressed through a combination of suggested supports. These support needs and suggested supports align with almost all chapters within the Body Functions, Activities and Participation and Environmental Factors domains of the International Classification of Functioning, Disability and Health. The overall goals of meeting these complex and interacting support needs were for the young people to optimize their functioning to reach their potential and for caregivers to ensure the sustainability of their caregiving capacity. A series of recommendations for support services, researchers and policy makers have been made to position support needs as central during the assessment, support and evaluation phases.
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Affiliation(s)
- Kiah Evans
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- School of Allied Health, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4068, Australia
- Curtin Autism Research Group and School of Allied Health, Curtin University, Perth 6102, Australia
| | - Andrew J. O. Whitehouse
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4068, Australia
| | - Emily D’Arcy
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4068, Australia
- Curtin Autism Research Group and School of Allied Health, Curtin University, Perth 6102, Australia
- School of Psychological Science, University of Western Australia, Perth 6009, Australia
| | - Maya Hayden-Evans
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4068, Australia
- Curtin Autism Research Group and School of Allied Health, Curtin University, Perth 6102, Australia
- School of Psychological Science, University of Western Australia, Perth 6009, Australia
| | - Kerry Wallace
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
| | - Rebecca Kuzminski
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4068, Australia
- Curtin Autism Research Group and School of Allied Health, Curtin University, Perth 6102, Australia
| | - Rebecca Thorpe
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
| | - Sonya Girdler
- School of Allied Health, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4068, Australia
- Curtin Autism Research Group and School of Allied Health, Curtin University, Perth 6102, Australia
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 171 77 Stockholm, Sweden
| | - Benjamin Milbourn
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4068, Australia
- Curtin Autism Research Group and School of Allied Health, Curtin University, Perth 6102, Australia
| | - Sven Bölte
- Curtin Autism Research Group and School of Allied Health, Curtin University, Perth 6102, Australia
- Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, 171 77 Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, 104 31 Stockholm, Sweden
| | - Angela Chamberlain
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
- Autism CRC, Long Pocket, Brisbane 4068, Australia
- Curtin Autism Research Group and School of Allied Health, Curtin University, Perth 6102, Australia
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Das S, Allston A, Opoku J, Kharfen M. Geographic Core Areas of Coinfections in Washington, District of Columbia: Recommendations for Planning Prevention-Intervention to Mitigate Human Immunodeficiency Virus Burden. Clin Infect Dis 2021; 73:e402-e409. [PMID: 32594140 DOI: 10.1093/cid/ciaa891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/23/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Research suggests that human immunodeficiency virus (HIV)-positive individuals with a sexually transmitted infection (STI) may be at increased risk of transmitting HIV to someone else through unprotected sex. The primary aim of the analysis is to identify the high-risk geographic areas of transmission of coinfections and factors that may be associated with poor outcomes of viral suppression within these higher-risk geographic areas, thus important in transmission prevention. METHODS We used surveillance data reported by all providers and laboratories in the District of Columbia (DC). Applied discrete Poisson scan model in SaTScan to identify the geographic areas. The relative risk (RR) for the scan statistic was calculated based on events inside the cluster, and P values evaluated statistical significance. We used multinomial logistical regression to explore care and demographical characteristics associated with being virally unsuppressed within and outside the geographic areas. RESULTS The coinfected areas (RR, >1; P < .001) were located in the tracts of central and southern DC. Black population (RR, 3.154 [95% confidence interval {CI}, 1.736-5.729]), age 13-19 years (RR, 4.598 [95% CI, 3.176-6.657]), repeat STIs (RR, 1.387 [95% CI, 1.096-1.754]), and not retained in care (RR, 2.546 [95% CI, 1.997-3.245]) were found to be at higher risk of being virally unsuppressed within the coinfected clusters. Those with unknown linkages were found to be at higher risk of being virally unsuppressed outside the coinfected clusters (RR, 5.162 [95% CI, 2.289-11.640]). CONCLUSIONS This is DC's first effort to identify the geographic core areas of coinfections and factors that may be sustaining them. These results will be used by the health department to plan for prevention-intervention strategies. This model be replicated by any local jurisdiction similar.
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Affiliation(s)
- Suparna Das
- Strategic Information Division, HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Government of the District of Columbia, Washington, District of Columbia, USA
| | - Adam Allston
- Strategic Information Division, HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Government of the District of Columbia, Washington, District of Columbia, USA
| | - Jenevieve Opoku
- Strategic Information Division, HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Government of the District of Columbia, Washington, District of Columbia, USA
| | - Michael Kharfen
- Strategic Information Division, HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Government of the District of Columbia, Washington, District of Columbia, USA
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Abstract
This paper examines the implications of intracultural difference for the design and implementation of nutrition interventions. It raises the question of whether small-sample, mixed-method implementation research, using a focused ethnographic approach, has sufficient power to detect meaningful differences in cultural beliefs, values, perceptions, and attitudes that are important for the design and implementation of nutrition interventions. It first presents the theoretical framework that was used to guide the research, followed by a description of the methodology of the Focused Ethnographic Study for Infant and Young Child Feeding. It then uses the findings from recent research in Ghana to address the central question. The findings document strong elements of shared cultural consensus, but intracultural differences of importance, in relation to the planning and content of behavior change communication.
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Affiliation(s)
- Gretel H Pelto
- Division of Nutritional Sciences, Savage Hall, Cornell University, Ithaca, New York, USA
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McWilliam RA, Boavida T, Bull K, Cañadas M, Hwang AW, Józefacka N, Lim HH, Pedernera M, Sergnese T, Woodward J. The Routines-Based Model Internationally Implemented. Int J Environ Res Public Health 2020; 17:E8308. [PMID: 33182740 DOI: 10.3390/ijerph17228308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/10/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022]
Abstract
Professionals from 10 countries are implementing practices from the Routines-Based Model, which has three main components: needs assessment and intervention planning, a consultative approach, and a method for running classrooms. Its hallmark practices are the Routines-Based Interview, support-based visits with families, and a focus on child engagement. Implementers were interested in actual practices for putting philosophy and theory into action in their systems and cultures. We describe implementation challenges and successes and conclude that (a) models have to be adaptable, (b) some principles and practices are indeed universal, (c) we can shape excellent practices for international use, and (d) leadership is vital.
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Cavill N, Richardson D, Faghy M, Bussell C, Rutter H. Using system mapping to help plan and implement city-wide action to promote physical activity. J Public Health Res 2020; 9:1759. [PMID: 32913833 PMCID: PMC7459760 DOI: 10.4081/jphr.2020.1759] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
Background: There is growing interest in conceptualising public health problems such as physical inactivity as the outcome of multiple interacting factors within complex systems. A systems approach includes consideration of the indirect as well as direct impacts of interventions, the contexts within which they take place, the relations between the multiple factors at play, and the ways in which systems adapt in response to changes. This study involved working with stakeholders involved in a city-wide physical activity promotion programme in Derby, UK to investigate whether a conceptual map of the local physical activity system could be a useful tool to help improve the planning and implementation of the programme. Methods: We produced draft conceptual maps of the major modifiable drivers of physical activity in the city, based on the existing literature on determinants and correlates of physical activity, then refined them in a series of stakeholder meetings. The maps were used to explore ways in which the existing programme took a systems approach, and how it might be enhanced. Semistructured interviews were subsequently undertaken with stakeholders to assess their views on the contribution of the mapping approach. Results: Feedback from stakeholders described the mapping as valuable, especially in helping to identify the limitations of the original approach taken in the city. Conclusions: Even a very simple application of systems thinking can be a useful tool for disaggregating the key factors driving a system, helping to identify areas that merit greater attention, and supporting effective action.
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Affiliation(s)
- Nick Cavill
- Cavill Associates Ltd., and Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol
| | - Debra Richardson
- Human Sciences Research Centre, College of Life and Natural Sciences, University of Derby
| | - Mark Faghy
- Human Sciences Research Centre, College of Life and Natural Sciences, University of Derby
| | - Chris Bussell
- Human Sciences Research Centre, College of Life and Natural Sciences, University of Derby
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, UK
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Anderson WG, Parrish M, Kerr K, Kinderman A, Rabow M, Schoen M, Meyers K. Generalist Palliative Care in the California Safety Net: A Structured Assessment to Design Interventions for a Range of Care Settings. Am J Hosp Palliat Care 2020; 38:4-11. [PMID: 32281414 DOI: 10.1177/1049909120915461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND To provide high quality care to all patients who have serious illness, health-care systems must develop effective generalist palliative care strategies. OBJECTIVE To identify palliative care quality gaps within a range of settings in the California safety net and to develop theory-based interventions to address them. DESIGN Structured assessment using the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines and a Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation intervention planning model-based worksheet, which integrates behavior theories to identify factors that predispose, enable, and reinforce clinicians to perform recommended behaviors. SETTING AND PARTICIPANTS Adviser pairs-one from palliative care and one from a partner service line-from 10 California public health-care systems conducted assessments at their sites. A steering committee provided educational webinars, best practices, and assessment tools. MEASUREMENTS Adviser pairs interviewed at least 6 partner service line stakeholders to identify palliative care quality gaps, behaviors clinicians should perform to close gaps, and factors that predispose, enable, and reinforce those behaviors. RESULTS Partner service lines were primary care (n = 4), surgery (n = 3), emergency department (n = 2), and radiation oncology (n = 1). Selected gaps were advance care planning and goals of care communication (n = 6), identifying patients with serious illness (n = 3), and pain management (n = 1). All sites designed multiple interventions to address gaps, based on factors that predispose, enable, and reinforce a target audience to perform a target behavior. Advisers reported that the program strengthened relationships between palliative care and the partner service line. CONCLUSION This structured assessment helped busy clinicians develop theory-based generalist palliative care interventions.
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Affiliation(s)
- Wendy G Anderson
- Supportive & Palliative Service, 36558Zuckerberg San Francisco General, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, CA, USA
| | | | | | - Anne Kinderman
- Supportive & Palliative Service, 36558Zuckerberg San Francisco General, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, CA, USA
| | - Michael Rabow
- Department of Medicine, University of California, San Francisco, CA, USA.,Division of Palliative Medicine, University of California, San Francisco, CA, USA
| | | | - Kate Meyers
- 6153California Health Care Foundation, Oakland, CA, USA
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Affiliation(s)
- Maurizio Domanin
- Department of Clinical and Community Sciences, University of Milan, Italy.,Unit of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Department of Clinical and Community Sciences, University of Milan, Italy.,Unit of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Zhou H, Wang Q, Zhou J, Li T, Medina A, Felt SA, Rozelle S, Openshaw JJ. Structural Equation Modeling (SEM) of Cysticercosis in School-Aged Children in Tibetan Rural Farming Areas of Western China: Implications for Intervention Planning. Int J Environ Res Public Health 2019; 16:ijerph16050780. [PMID: 30836642 PMCID: PMC6427563 DOI: 10.3390/ijerph16050780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 11/17/2022]
Abstract
Neurocysticercosis (NCC) significantly contributes to morbidity in developing countries. We recently published a study of prevalence and risk factors in school-aged children in three mountainous areas in Sichuan province of western China. Using structural equation modeling (SEM) on data from that study to guide intervention planning, here we examine risk factors grouped into three broad interventional categories: sociodemographics, human behavior, and sources of pork and pig husbandry. Because neuroimaging is not easily available, using SEM allows for the use of multiple observed variables (serological tests and symptoms) to represent probable NCC cases. Data collected from 2608 students was included in this analysis. Within this group, seroprevalence of cysticercosis IgG antibodies was 5.4%. SEM results showed that sociodemographic factors (β = 0.33, p < 0.05), sources of pork and pig husbandry (β = 0.26, p < 0.001), and behavioral factors (β = 0.33, p < 0.05) were all directly related to probable NCC in school-aged children. Sociodemographic factors affected probable NCC indirectly via sources of pork and pig husbandry factors (β = 0.07, p < 0.001) and behavioral variables (β = 0.07, p < 0.001). Both sociodemographic factors (β = 0.07, p < 0.05) and sources of pork and pig husbandry factors (β = 0.10, p < 0.01) affected probable NCC indirectly via behavioral variables. Because behavioral variables not only had a large direct effect but also served as a critical bridge to strengthen the effect of sociodemographics and sources of pork and pig husbandry on probable NCC, our findings suggest that interventions targeting behavioral factors may be the most effective in reducing disease.
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Affiliation(s)
- Huan Zhou
- West China School of Public Health, Sichuan University, Chengdu 610041, China.
| | - Qingzhi Wang
- West China School of Public Health, Sichuan University, Chengdu 610041, China.
| | - Junmin Zhou
- West China School of Public Health, Sichuan University, Chengdu 610041, China.
| | - Tiaoying Li
- Institute of Parasitic Diseases, Sichuan Centers for Disease Control and Prevention, Chengdu 610041, China.
| | - Alexis Medina
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA.
| | - Stephen A Felt
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA.
| | - John J Openshaw
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA.
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Escaron AL, Martinez-Donate AP, Riggall AJ, Meinen A, Hall B, Nieto FJ, Nitzke S. Developing and Implementing "Waupaca Eating Smart": A Restaurant and Supermarket Intervention to Promote Healthy Eating Through Changes in the Food Environment. Health Promot Pract 2015; 17:265-77. [PMID: 26546508 DOI: 10.1177/1524839915612742] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Restaurants and food stores are suitable settings for healthy eating interventions. A community-academic partnership developed and implemented "Waupaca Eating Smart" (WES), a healthy eating program in restaurants and supermarkets of a rural, Midwest community. Previous interventions targeted either restaurants or small food stores nearly all in urban areas. Intervention design and implementation is rarely documented, making replication difficult for interested researchers and communities. In this article, we report the activities we undertook to develop and implement WES. METHODS Working with a local nutrition and activity coalition, we used evidence-based strategies guided by the social ecological model and social marketing principles to inform the content of WES. Formative assessment included a review of the literature, statewide key informant interviews and focus groups with restaurant and food store operators and patrons, a local community survey, and interviews with prospective WES businesses. WES was implemented in seven restaurants and two supermarkets and evaluated for feasibility and acceptance using surveys and direct observation of WES implementation. FINDINGS Prior to this intervention, only one of seven restaurants had three or more meals that met WES nutrition criteria. By the end of the program, 38 meals were labeled and promoted to restaurant customers, and the team had staffed four side salad taste tests for supermarket customers. Four and 10 months after intervention launch, the majority of the program's strategies were observed in participating outlets, suggesting that these program's strategies are feasible and can be sustained. Operators reported strong satisfaction overall. CONCLUSIONS A combined restaurant- and supermarket-based healthy eating intervention is feasible and positively valued in rural communities. Further research is needed to better understand how to foster sustainability of these interventions and their impact on customer food choices.
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Affiliation(s)
- Anne L Escaron
- AltaMed Health Services Corporation, Los Angeles, CA, USA
| | - Ana P Martinez-Donate
- University of Wisconsin-Madison, Madison, WI, USA Drexel University, Philadelphia, PA, USA
| | | | - Amy Meinen
- University of Wisconsin-Madison, Madison, WI, USA Wisconsin Obesity Prevention Network in Madison, WI, USA
| | | | | | - Susan Nitzke
- University of Wisconsin-Madison, Madison, WI, USA
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Kulinski KP, Boutaugh M, Smith ML, Ory MG, Lorig K. Setting the stage: measure selection, coordination, and data collection for a national self-management initiative. Front Public Health 2015; 2:206. [PMID: 25964919 PMCID: PMC4410349 DOI: 10.3389/fpubh.2014.00206] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/07/2014] [Indexed: 01/17/2023] Open
Abstract
This paper describes the history and rationale behind the development of a centralized data collection system for the national rollout of the Chronic Disease Self-Management Program (CDSMP) through the American Recovery and Reinvestment Act of 2009 Communities Putting Prevention to Work: CDSMP initiative. In addition to justifying the need for solutions to the burgeoning burden of chronic disease in the United States, this paper provides details about CDSMP and related self-management education programs, including their structure, facilitator training, and effectiveness. These topics set the stage for the processes and procedures to create and manage the database for use at the national, state, and local levels. Furthermore, this paper describes the processes related to selecting variables, coordinating data collection, and utilizing data to inform research and policy.
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Affiliation(s)
| | - Michele Boutaugh
- Administration on Aging, Administration for Community Living , Atlanta, GA , USA
| | - Matthew Lee Smith
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia , Athens, GA , USA
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M Health Science Center , College Station, TX , USA
| | - Kate Lorig
- Stanford Patient Education Research Center, Department of Medicine, Stanford School of Medicine , Palo Alto, CA , USA
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