1
|
Ames ML, Karlsen MC, Sundermeir SM, Durrwachter N, Hemmingson TA, Reznar MM, Staffier KL, Weeks B, Gittelsohn J. Lifestyle Medicine Implementation in 8 Health Systems: Protocol for a Multiple Case Study Investigation. JMIR Res Protoc 2024; 13:e51562. [PMID: 38320320 DOI: 10.2196/51562] [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: 08/03/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Lifestyle medicine (LM) is the use of therapeutic lifestyle changes (including a whole-food, plant-predominant eating pattern; regular physical activity; restorative sleep; stress management; avoidance of risky substances; and positive social connection) to prevent and treat chronic illness. Despite growing evidence, LM is still not widely implemented in health care settings. Potential challenges to LM implementation include lack of clinician training, staffing concerns, and misalignment of LM services with fee-for-service reimbursement, but the full range of factors facilitating or obstructing its implementation and long-term success are not yet understood. To learn important lessons for success and failure, it is crucial to understand the experiences of different LM programs. OBJECTIVE This study aims to describe in depth the protocol used to identify barriers and facilitators impacting the implementation of LM in health systems. METHODS The study team comprises team members at the American College of Lifestyle Medicine (ACLM), including staff and researchers with expertise in public health, LM, and qualitative research. We recruited health systems that were members of the ACLM Health Systems Council. From among 15 self-nominating health systems, we selected 7 to represent a diversity of geographic location, type, size, expertise, funding, patients, and LM services. Partway through the study, we recruited 1 additional contrasting health system to serve as a negative case. For each case, we conducted in-depth interviews, document reviews, site visits (limited due to the COVID-19 pandemic), and study team debriefs. Interviews lasted 45-90 minutes and followed a semistructured interview guide, loosely based on the Consolidated Framework for Implementation Research (CFIR) model. We are constructing detailed case narrative reports for each health system that are subsequently used in cross-case analyses to develop a contextually rich and detailed understanding of various predetermined and emergent topics. Cross-case analyses will draw on a variety of methodologies, including in-depth case familiarization, inductive or deductive coding, and thematic analysis, to identify cross-cutting themes. RESULTS The study team has completed data collection for all 8 participating health systems, including 68 interviews and 1 site visit. We are currently drafting descriptive case narratives, which will be disseminated to participating health systems for member checking and shared broadly as applied vignettes. We are also conducting cross-case analyses to identify critical facilitators and barriers, explore clinician training strategies to facilitate LM implementation, and develop an explanatory model connecting practitioner adoption of LM and experiences of burnout. CONCLUSIONS This protocol paper offers real-world insights into research methods and practices to identify barriers and facilitators to the implementation of LM in health systems. Findings can advise LM implementation across various health system contexts. Methodological limitations and lessons learned can guide the execution of other studies with similar methodologies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51562.
Collapse
Affiliation(s)
- Meghan L Ames
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Micaela C Karlsen
- American College of Lifestyle Medicine, Chesterfield, MO, United States
| | - Samantha M Sundermeir
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Neve Durrwachter
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Melissa M Reznar
- School of Health Sciences, Oakland University, Rochester, MI, United States
| | | | - Bruce Weeks
- American College of Lifestyle Medicine, Chesterfield, MO, United States
| | - Joel Gittelsohn
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
2
|
Schwingrouber J, Bryant-Lukosius D, Kilpatrick K, Mayen S, Colson S. Evaluation of the implementation of advanced practice nursing roles in France: A multiple case study. J Adv Nurs 2024; 80:977-992. [PMID: 37658619 DOI: 10.1111/jan.15840] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 07/24/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023]
Abstract
AIMS The aims of the study were to describe the processes used to introduce advanced practice nursing roles and factors that facilitated or hindered role implementation, examine the time advanced practice nurses (APNs) spend in role activities and how these activities relate to domains of advanced practice nursing and examine how implementation processes influenced APN integration within healthcare teams. DESIGN A multiple case study was conducted. METHODS Five cases were included, representing the four population areas approved for advanced practice nursing in France. Data were collected from January to March 2021 using observation, interview and document analysis methods. Data were examined using thematic analysis. RESULTS Participants included APNs (n = 5), nurses/allied health providers (n = 5), physicians (n = 5), managers (n = 4) and decision-makers (n = 4). Stakeholder engagement and leadership provided by decision-makers, managers, physicians and APNs facilitated role implementation. Poor stakeholder role understanding, uncertain role funding, and the COVID-19 pandemic hindered role implementation. APNs spent the most time in clinical activities. Participants perceived the integration of APNs within the healthcare team and their impact on patient care to be positive. CONCLUSION Stakeholder engagement and organizational and APN leadership facilitated the implementation of the roles, especially related to team-based patient care. Further efforts are needed to strengthen APN involvement in non-clinical activities and address role barriers. IMPLICATIONS FOR NURSING AND PATIENT CARE Systematic and system-wide approaches are needed to improve role clarity, role autonomy and health systems integration of APNs. Research should examine patient perspectives about APNs in France. IMPACT The results highlight how policies can create favourable conditions for advanced practice nursing role implementation in France. Internationally, this study serves as a reminder to APNs and nurse leaders about the strategies for and importance of implementation evaluation to support the optimal development of advanced practice nursing roles. REPORTING METHOD The study reporting followed the Consolidated Criteria for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
Collapse
Affiliation(s)
- Jocelyn Schwingrouber
- Faculté des Sciences Médicales et Paramédicales, Nursing School, CEReSS, Aix-Marseille Université, Marseille, France
| | | | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine, McGill University, Quebec, Canada
| | - Sandrine Mayen
- Faculté des Sciences Médicales et Paramédicales, Nursing School, CEReSS, Aix-Marseille Université, Marseille, France
| | - Sébastien Colson
- Faculté des Sciences Médicales et Paramédicales, Nursing School, CEReSS, Aix-Marseille Université, Marseille, France
| |
Collapse
|
3
|
Short EL, Reynolds Taewon Choi JD, Ponterotto JG. Psychobiography in sociocultural context: the application of culture-based theories of psychology on a culturally diverse historic subject pool. Int Rev Psychiatry 2024; 36:180-191. [PMID: 38557347 DOI: 10.1080/09540261.2023.2248264] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 04/04/2024]
Abstract
In recent years the historical subject base in psychobiography has expanded from a traditional focus on White (Caucasian) subjects to a broader more culturally inclusive population of significant personalities throughout history. A critical component of strong multicultural psychobiography is the inclusion of anchoring theories of psychology that are rooted in socio-cultural-political context. To psychologically profile culturally diverse individuals with only traditional Western theories of psychology and psychiatry (e.g. medical models, psychodynamic, existential, cognitive-behavioral) limits the ability of the research to accurately capture the erlebnis (lived experience) of extraordinary individuals in proper cultural context. This article reviews specific psychological theories that have recently set a foundation for more nuanced and culturally contextualised psychological profiles of historic personalities who represent diverse racial/ethnic/cultural backgrounds. Among the theories covered are the Integrated African Psychology Perspective (IAPP), an Indigenous (Native American) model of psychobiography, as well as theories and models on Psychological Nigrescence (Black racial identity development), Intersectionality, Politicised Collective Identity (PCI), Queered Black Racial Identity Development (QBRID), and Adultification of Black Children, among others. Examples of applications of these culture-centered theories to psychobiography, drawn from the present authors recently completed psychobiographies, as well as from other researchers internationally, are presented.
Collapse
Affiliation(s)
- Ellen L Short
- Group Relations Practitioner, Consultant and Coach in Private Practice, and retired Associate Professor, Department of Counseling and School Psychology, Long Island University, Brooklyn, NY, USA
| | | | - Joseph G Ponterotto
- Division of Psychological & Educational Services, Fordham University, New York City, NY, USA
| |
Collapse
|
4
|
Ghandour EK, Leblond S, Binette S, Rivard J, Joanisse J, Carreau L, Bert L, Boutier V, Fortin JP, Denis JL, Sinha S, Archambault P. Implementation of the Acute Care for Elders Strategy to Improve the Quality of Care Transitions in Quebec and Ontario: a Retrospective Multiple Case Study. Can Geriatr J 2023; 26:444-477. [PMID: 38045881 PMCID: PMC10684303 DOI: 10.5770/cgj.26.679] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Background In 2016, two Canadian hospitals participated in a quality improvement (QI) program, the International Acute Care for Elders (ACE) Collaborative, and sought to adapt and implement a transition coach intervention (TCI). Both hospitals were challenged to provide optimal continuity of care for an increasing number of older adults. The two hospitals received initial funding, coaching, educational materials, and tools to adapt the TCI to their local contexts, but the QI project teams achieved different results. We aimed to compare the implementation of the ACE TCI in these two Canadian hospitals to identify the factors influencing the adaptation of the intervention to the local contexts and to understand their different results. Methods We conducted a retrospective multiple case study, including documentary analysis, 21 semi-structured individual interviews, and two focus groups. We performed thematic analysis using a hybrid inductive-deductive approach. Results Both hospitals met initial organizational goals to varying degrees. Our qualitative analysis highlighted certain factors that were critical to the effective implementation and achievement of the QI project goals: the magnitude of changes and adaptations to the initial intervention; the organizational approaches to the QI project implementation, management, and monitoring; the organizational context; the change management strategies; the ongoing health system reform and organizational restructuring. Our study also identified other key factors for successful care transition QI projects: minimal adaptation to the original evidence-based intervention; use of a collaborative, bottom-up approach; use of a theoretical model to support sustainability; support from clinical and organizational leadership; a strong organizational culture for QI; access to timely quality measures; financial support; use of a knowledge management platform; and involvement of an integrated research team and expert guidance. Conclusion Many of the lessons learned and strategies identified from our analysis will help clinicians, managers, and policymakers better address the issues and challenges of adapting evidence-based innovations in care transitions for older adults to local contexts.
Collapse
Affiliation(s)
- El Kebir Ghandour
- Institut national d'excellence en santé et en services sociaux (INESSS), Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
| | - Sara Leblond
- Hôpital Montfort, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Sébastien Binette
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
| | - Josée Rivard
- Centre intégré de santé et de services sociaux de la Montérégie-Centre, Greenfield Park, QC, Canada
| | - John Joanisse
- Hôpital Montfort, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | | | - Laetitia Bert
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
- Université Laval, Québec, QC, Canada
| | - Véronique Boutier
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Jean-Paul Fortin
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
- Université Laval, Québec, QC, Canada
| | - Jean-Louis Denis
- Département de gestion, d'évaluation et de politique de santé (DGEPS), École de santé publique-Université de Montréal, Montréal, QC, Canada
| | - Samir Sinha
- Sinai Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Institute of Health Policy and Management, University of Toronto, Toronto, ON, Canada
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick Archambault
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
- Université Laval, Québec, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Department of Anesthesiology and Intensive Care Medicine, Université Laval, Québec, QC, Canada
| |
Collapse
|
5
|
Leland NE, Rouch SA, Prusynski RA, Shore AD, Kaufman H, Hoover LP, Mroz TM, Freburger JK, Saliba D. Implementation of US Post-Acute Care Payment Reform and COVID-19 Policies: Examining Experiences of Health System Leaders, Staff, Patients, and Family Caregivers-A Protocol. Int J Environ Res Public Health 2023; 20:6959. [PMID: 37887697 PMCID: PMC10606322 DOI: 10.3390/ijerph20206959] [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] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
In fiscal year 2020, new national Medicare payment models were implemented in the two most common post-acute care settings (i.e., skilled nursing facilities (SNFs) and home health agencies (HHAs)), which were followed by the emergence of COVID-19. Given concerns about the unintended consequence of these events, this study protocol will examine how organizations responded to these policies and whether there were changes in SNF and HHA access, care delivery, and outcomes from the perspectives of leadership, staff, patients, and families. We will conduct a two-phase multiple case study guided by the Institute of Medicine's Model of Healthcare Systems. Phase I will include three cases for each setting and a maximum of fifty administrators per case. Phase II will include a subset of Phase I organizations, which are grouped into three setting-specific cases. Each Phase II case will include a maximum of four organizations. Semi-structured interviews will explore the perspectives of frontline staff, patients, and family caregivers (Phase II). Thematic analysis will be used to examine the impact of payment policy and COVID-19 on organizational operations, care delivery, and patient outcomes. The results of this study intend to develop evidence addressing concerns about the unintended consequences of the PAC payment policy during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Natalie E. Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Stephanie A. Rouch
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
- The Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Rachel A. Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Amanda D. Shore
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Hannah Kaufman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Lorelei P. Hoover
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Tracy M. Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Janet K. Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA;
| | - Debra Saliba
- Veterans Affairs (VA) Greater Los Angeles Geriatrics Research Education and Clinical Center (GRECC), Los Angeles, CA 90095, USA;
- Borun Center, University of California, Los Angeles, CA 90095, USA
| |
Collapse
|
6
|
Singer J, Marsh JA, Menefee-Libey D, Alonso J, Bradley D, Tracy H. The Politics of School Reopening During COVID-19: A Multiple Case Study of Five Urban Districts in the 2020-21 School Year. Educ Adm Q 2023; 59:542-593. [PMID: 38602948 PMCID: PMC10186136 DOI: 10.1177/0013161x231168397] [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: 04/13/2024]
Abstract
Purpose: Nearly all schools in the United States closed in spring 2020, at the onset of the COVID-19 pandemic. We analyze traditional public and charter school reopenings for the 2020-21 school year in five urban districts. We provide a rich and theoretically grounded description of how and why educational leaders made reopening decisions in each of our case districts. Research Methods: We used data from a multiple-case study from March 2020 to July 2021. The research team conducted 56 interviews with school, district, and system-level leaders; triangulated with publicly available data; and also drew on interview data from a subsample of parents and guardians in each of our sites. We analyzed these data through qualitative coding and memo writing and conducted detailed single- and cross-case analyses. Findings: School system leaders in our case sites generally consulted public health authorities, accounted for state-level health and educational guidance, and engaged with and were responsive to the interests of different stakeholders. Districts' adherence to and strategic uses of public health guidance, as well as a combination of union-district relations and labor market dynamics, influenced reopening. Parents, city, and state lawmakers, and local institutional conditions also played a role, helping to explain differences across cases. Implications: In contrast to the "politics or science" framing that has dominated research and public discourse on school reopening, we show that local pandemic conditions and local political dynamics both mattered and in fact were interrelated. Our findings have some implications for how educational leaders might navigate future crises.
Collapse
Affiliation(s)
| | | | | | - Jacob Alonso
- University of Southern California, Los Angeles, CA, USA
| | | | | |
Collapse
|
7
|
Gautier L, Noda S, Chabrol F, David PM, Duhoux A, Hou R, Rosana de Araújo Oliveira S, Traverson L, Zinszer K, Ridde V. Hospital Governance During the COVID-19 Pandemic: A Multiple-Country Case Study. Health Syst Reform 2023; 9:2173551. [PMID: 37253204 DOI: 10.1080/23288604.2023.2173551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/07/2022] [Accepted: 01/24/2023] [Indexed: 06/01/2023] Open
Abstract
In response to the disruptions caused by COVID-19, hospitals around the world proactively or reactively developed and/or re-organized their governance structures to manage the COVID-19 response. Hospitals' governance played a crucial role in their ability to reorganize and respond to the pressing needs of their staff. We discuss and compare six hospital cases from four countries on different continents: Brazil, Canada, France, and Japan. Our study examined how governance strategies (e.g., special task forces, communications management tools, etc.) were perceived by hospital staff. Key findings from a total of 177 qualitative interviews with diverse hospital stakeholders were analyzed using three categories drawn from the European Observatory on Health Systems and Policies framework on health systems resilience during the COVID-19 pandemic: 1) delivering a clear and timely COVID-19 response strategy; 2) coordinating effectively within (horizontally) and across (vertically) levels of decision-making; and 3) communicating clearly and transparently with the hospital's diverse stakeholders. Our study gleaned rich accounts for these three categories, highlighting significant variations across settings. These variations were primarily determined by the hospitals' environment prior to the COVID-19 crisis, namely whether there already existed a culture of managerial openness (including spaces for social interactions among hospital staff) and whether preparedness planning and training had been routinely integrated into their activities.
Collapse
Affiliation(s)
- Lara Gautier
- School of Public Health, Université de Montréal, Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal, and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Shinichiro Noda
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Fanny Chabrol
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | | | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada
| | - Renyou Hou
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | | | - Lola Traverson
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Kate Zinszer
- School of Public Health, Université de Montréal, Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal, and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| |
Collapse
|
8
|
Del Riccio M, Costantini L, Guasconi M, Casella G, Fanfani A, Cosma C, Mindrican P, Bonaccorsi G, Corradini E, Artioli G, Sarli L, Laverack G, Rondini E, Martucci G. Role and challenges to digital technologies in community health promotion programs in Italy during the COVID-19 pandemic: a multiple embedded case study protocol. Acta Biomed 2023; 94:e2023019. [PMID: 36786249 PMCID: PMC9987484 DOI: 10.23750/abm.v94i1.14109] [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] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIM Due to the COVID-19 pandemics, The Italian League Against Cancer (LILT), a national federation of local associations promoting cancer prevention, had to face the challenge to find new ways and technologies to promote health in their territories. This study aims to explore how LILT associations led their health promotion interventions during the COVID-19 pandemic and to understand which interventions had a greater impact, for which population group, and why. METHODS In this descriptive multiple embedded case study, each case will focus on the activities of a local LILT association and their collaborators on the perception and experience of the use of digital technology for health promotion and prevention, through interviews, observations, and a study of products and artifacts. A general overview of each case study will be provided, along with an introduction of the unit(s) of more in-depth analysis. The logical models that emerge from the analysis of each case will be described by using realist analysis, producing a list of possible CMO configurations (Context; Mechanisms; Outcomes). The final report will consist of a cross-case analysis (a comparison between the different case studies). DISCUSSION This multiple case study will help generate a first "theory of the use of digital technology in health promotion in local LILT communities. The observation of what local LILT associations in Italy have done during COVID-19 will help identify new and useful health promotion strategies based on these technologies.
Collapse
Affiliation(s)
- Marco Del Riccio
- University of Florence, Department of Health Sciences, Florence, Italy.
| | - Luigi Costantini
- University of Modena and Reggio Emilia, Department of Medical and Surgical Sciences, School of Specialization in Community Medicine and Primary Care, Italy.
| | - Massimo Guasconi
- Department of Medicine and Surgery, University of Parma, Parma (Italy); Azienda USL (Local Health Service) of Piacenza, Piacenza, Italy .
| | - Giovanna Casella
- University of Parma, Department of Medicine and Surgery, Parma, Italy; Azienda USL (Local Health Service) of Piacenza, Piacenza, Italy.
| | - Alice Fanfani
- University of Florence, School of Specialization in Hygiene and Preventive Medicine, Florence, Italy.
| | - Claudia Cosma
- University of Florence, School of Specialization in Hygiene and Preventive Medicine, Florence, Italy.
| | - Paula Mindrican
- University of Modena and Reggio Emilia, Department of Medical and Surgical Sciences, School of Specialization in Community Medicine and Primary Care, Italy.
| | | | - Elena Corradini
- University of Modena and Reggio Emilia, Department of Medical and Surgical Sciences, School of Specialization in Community Medicine and Primary Care, Italy.
| | - Giovanna Artioli
- University of Parma, Department of Medicine and Surgery, Parma, Italy.
| | - Leopoldo Sarli
- University of Parma, Department of Medicine and Surgery, Parma, Italy.
| | - Glenn Laverack
- University of Trento, Department of Sociology and Social Research, Italy.
| | - Ermanno Rondini
- Italian League Against Cancer (LILT) Local Association of Reggio Emilia, Reggio Emilia, Italy.
| | - Gianfranco Martucci
- Italian League Against Cancer (LILT) Local Association of Reggio Emilia, Reggio Emilia, Italy.
| |
Collapse
|
9
|
Saat JJEH, Naumann E, Fransen GAJ, Voss L, van der Velden K, Assendelft WJJ. Implementation of Combined Lifestyle Interventions for Children with Overweight or Obesity: Experiences of Healthcare Professionals in Multiple Communities. Int J Environ Res Public Health 2023; 20:2156. [PMID: 36767530 PMCID: PMC9915371 DOI: 10.3390/ijerph20032156] [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] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND To counteract children with obesity, different protocols for combined lifestyle interventions (CLIs) are implemented by healthcare providers (HCPs). To understand the effects of CLI, we studied the implementation process, facilitators and barriers experienced by HCPs. METHODS A multiple case study design in which community-based CLIs (n = 4), implemented in a total of ten different communities, are conceptualized as a "case". Qualitative data were collected via group interviews among HCPs (n = 48) regarding their implementation protocol, their network involvement and the adoption of the CLI in a community. Transcripts were coded and analysed using ATLAS.ti. RESULTS Barriers were the absence of a proper protocol, the low emphasis on the construction of the network and difficulty in embedding the CLI into the community. Funding for these activities was lacking. Facilitating factors were the involvement of a coordinator and to have everyone's role regarding signalling, diagnosis, guidance and treatment clearly defined and protocolled. HCPs suggested adding certain professions to their team because they lacked expertise in parenting advice and providing mental support to children. CONCLUSIONS Carrying out and adapting the content of the CLI to the community was experienced as easier compared to the management of the organizational aspects of the CLI. For these aspects, separate funding is essential. In the future, mapping the characteristics of a community will help to clarify this influence on the implementation even better.
Collapse
Affiliation(s)
- Jenneke J. E. H. Saat
- Academic Collaborative Center AMPHI, Department of Primary and Community Care, ELG 117, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Research Group Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, 6503 GL Nijmegen, The Netherlands
- Department of Primary and Community Care, ELG 117, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Elke Naumann
- Research Group Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, 6503 GL Nijmegen, The Netherlands
| | - Gerdine A. J. Fransen
- Academic Collaborative Center AMPHI, Department of Primary and Community Care, ELG 117, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Department of Primary and Community Care, ELG 117, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Lieneke Voss
- Agrotechnology & Food Sciences Group, Chair Group Nutrition and Disease, Division of Human Nutrition and Health, Wageningen University, 6708 PB Wageningen, The Netherlands
| | - Koos van der Velden
- Academic Collaborative Center AMPHI, Department of Primary and Community Care, ELG 117, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Agrotechnology & Food Sciences Group, Chair Group Nutrition and Disease, Division of Human Nutrition and Health, Wageningen University, 6708 PB Wageningen, The Netherlands
| | - Willem J. J. Assendelft
- Department of Primary and Community Care, ELG 117, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|
10
|
Korneta P, Chmiel M. Medical Staff Shortages and the Performance of Outpatient Clinics in Poland during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:14827. [PMID: 36429554 PMCID: PMC9691112 DOI: 10.3390/ijerph192214827] [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] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Unlike many industries, healthcare was simultaneously affected by the COVID-19 pandemic in two opposite ways. On the one hand, the industry faced shortages and overload of many medical representatives such as nurses and infectious disease professionals, but on the other, many medical professionals such as dentists were left with considerably reduced demand. The objective of this paper is to study the efficiency of medical staff allocation and the performance of small and medium sized outpatient clinics in Poland during the COVID-19 pandemic. Owing to the contemporaneity of this problem, we have employed a multiple case study approach. Our sample comprises 5 small and medium-sized outpatient clinics located in Poland in the 3-year period 2019-2021. The results indicate a considerable percentage of medical staff employed in small and medium-sized outpatient clinics remained outside the pandemic, despite their potential provision of healthcare services. Four of the five clinics studied remained passive towards the pandemic. In view of future pandemics, the indications we provide have practical implications for outpatient clinics executives and public health policymakers.
Collapse
Affiliation(s)
- Piotr Korneta
- Faculty of Management, Warsaw University of Technology, 02-524 Warszawa, Poland
| | - Magda Chmiel
- Faculty of Chemical Engineering and Commodity Science, Kazimierz Pułaski University of Technology and Humanities, 26-610 Radom, Poland
| |
Collapse
|
11
|
Ott J, Biller-Andorno N, Glässel A. First Insights into Barriers and Facilitators from the Perspective of Persons with Multiple Sclerosis: A Multiple Case Study. Int J Environ Res Public Health 2022; 19:10733. [PMID: 36078447 PMCID: PMC9518524 DOI: 10.3390/ijerph191710733] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/08/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Multiple Sclerosis (MS) is a complex, lifelong disease. Its effects span across different areas of life and vary strongly. In Switzerland, there is an intense discussion on how to optimize quality of care and patient safety. Patients should be more involved in the management of health care to improve the quality of care from the patient's perspective and form a more comprehensive perspective. This multiple-case study explores the question of how persons with MS experience and describe functioning related barriers, facilitating factors, and ethically relevant conflicts. To address this from a comprehensive perspective, the MS core set of the International Classification for Functioning, Disability, and Health (ICF) is used as theoretical framework. To explore barriers, facilitators, and relevant ethical issues, different narrative sources were used for thematic analysis and ICF coding: (a) MS transcripts from DIPEx interviews and (b) an autobiographical book of persons living with MS. Insights that were meaningful for daily practice and education were identified: (a) understanding the importance of environmental circumstances based on narrative sources; (b) understanding the importance of a person's individual life situation, and the ability to switch perspectives in the medical field; (c) respect for PwMS' individuality in health care settings; (d) creating meaningful relationships for disease management and treatment, as well as building trust.
Collapse
Affiliation(s)
- Joelle Ott
- Institute of Biomedical Ethics and Medical History, University Zurich, Winterthurerstrasse 30, CH-8006 Zurich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and Medical History, University Zurich, Winterthurerstrasse 30, CH-8006 Zurich, Switzerland
| | - Andrea Glässel
- Institute of Biomedical Ethics and Medical History, University Zurich, Winterthurerstrasse 30, CH-8006 Zurich, Switzerland
- Institute of Public Health (IPH), Department of Health Sciences Katharina-Sulzer-Platz 9, Zurich University of Applied Studies (ZHAW), CH-8401 Winterthur, Switzerland
| |
Collapse
|
12
|
Rocco D, Rizzi L, Dell'Arciprete G, Perrella R. The Functional Psychotherapy Approach: A Process-Outcome Multiple Case Study. Front Psychol 2022; 12:727497. [PMID: 35069311 PMCID: PMC8777224 DOI: 10.3389/fpsyg.2021.727497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/18/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: The present work aims to conduct the first naturalistic empirical investigation of the process and outcome assessment of functional psychotherapy (FP) treatment. The FP model of psychotherapy is rooted in psychoanalysis and integrates the verbal communication approach founded on transference and countertransference dynamics with the analysis of bodily processes. Method: The study sample included ten patients recruited on a voluntary basis and treated by clinicians in their private practices. Each patient received FP with an average duration of 40 h (min 35 and max 42). Therapies had weekly sessions, were audio-recorded with the patient’s written consent, and lasted for an average of 10 months (min 9 and max 12). Outcome and process tools included the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Luborsky’s the Core Conflictual Relationship Theme (CCRT), used to assess therapeutic benefit, and the Metacognition Assessment Scale (MAS) and the Italian Discourse Attributes Analysis Program (IDAAP) system, used to evaluate therapeutic benefit and process. The MMPI-2 was used also in the follow-up assessment. Results: Results show that FP had a positive therapeutic outcome on the patients assessed in this study, and that the therapeutic benefits were maintained over time. Some specific features of the FP approach were found to contribute more than others to the observed therapeutic benefits. Conclusion: The current investigation constitutes a first step toward assessment of the therapeutic effectiveness of FP. Future developments should apply the methodology to a larger sample, possibly introducing different methodologies to enable detection of specific bodily oriented processes and techniques.
Collapse
Affiliation(s)
- Diego Rocco
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Luca Rizzi
- Associazione Centro di Psicologia e Psicoterapia Funzionale, Istituto SIF, Padua, Italy
| | - Gaia Dell'Arciprete
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Raffaella Perrella
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| |
Collapse
|
13
|
Kerins C, Kelly C, Reardon CM, Houghton C, Toomey E, Hayes CB, Geaney F, Perry IJ, McSharry J, McHugh S. Factors Influencing Fidelity to a Calorie Posting Policy in Public Hospitals: A Mixed Methods Study. Front Public Health 2021; 9:707668. [PMID: 34485232 PMCID: PMC8414889 DOI: 10.3389/fpubh.2021.707668] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Labelling menus with nutrition information has increasingly become an important obesity policy option. While much research to-date has focused on determining its effectiveness, few studies report the extent to which menu labelling is implemented as designed. The aim of this study was to explore factors influencing fidelity to a calorie posting policy in Irish acute public hospitals. Methods: A mixed methods sequential explanatory study design was employed, with a nested case study for the qualitative component. Quantitative data on implementation fidelity at hospitals were analysed first and informed case sampling in the follow-on qualitative phase. Maximum variation sampling was used to select four hospitals with high and low levels of implementation and variation in terms of geographic location, hospital size, complexity of care provided and hospital type. Data were collected using structured observations, unstructured non-participant observations and in-depth semi-structured interviews. The Consolidated Framework for Implementation Research guided qualitative data collection and analysis. Using framework analysis, factors influencing implementation were identified. A triangulation protocol was used to integrate fidelity findings from multiple sources. Data on influencing factors and fidelity were then combined using joint displays for within and cross-case analysis. Results: Quantitative fidelity data showed seven hospitals were categorised as low implementers and 28 hospitals were high implementers of the policy. Across the four hospitals selected as cases, qualitative analysis revealed factors influencing implementation and fidelity were multiple, and operated independently and in combination. Factors were related to the internal hospital environment (e.g., leadership support, access to knowledge and information, perceived importance of calorie posting implementation), external hospital environment (e.g., national policy, monitoring), features of the calorie posting policy (e.g., availability of supporting materials), and the implementation process (e.g., engaging relevant stakeholders). Integrated analysis of fidelity indicated a pattern of partial adherence to the calorie posting policy across the four hospitals. Across all hospitals, there was a consistent pattern of low adherence to calorie posting across all menu items on sale, low adherence to calorie information displayed per standard portion or per meal, low adherence to standardised recipes/portions, and inaccurate calorie information. Conclusion: Efforts to maximise fidelity require multi-level, multi-component strategies in order to reduce or mitigate barriers and to leverage facilitators. Future research should examine the relative importance of calorie posting determinants and the association between implementation strategies and shifts in fidelity to intervention core components.
Collapse
Affiliation(s)
- Claire Kerins
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Colette Kelly
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Caitlin M Reardon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Elaine Toomey
- Faculty of Education and Health Sciences, School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Catherine B Hayes
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fiona Geaney
- School of Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| |
Collapse
|
14
|
Dębska A, Łuniewska M, Zubek J, Chyl K, Dynak A, Dzięgiel-Fivet G, Plewko J, Jednoróg K, Grabowska A. The cognitive basis of dyslexia in school-aged children: A multiple case study in a transparent orthography. Dev Sci 2021; 25:e13173. [PMID: 34448328 PMCID: PMC9285470 DOI: 10.1111/desc.13173] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Abstract
This study focuses on the role of numerous cognitive skills such as phonological awareness (PA), rapid automatized naming (RAN), visual and selective attention, auditory skills, and implicit learning in developmental dyslexia. We examined the (co)existence of cognitive deficits in dyslexia and assessed cognitive skills’ predictive value for reading. First, we compared school‐aged children with severe reading impairment (n = 51) to typical readers (n = 71) to explore the individual patterns of deficits in dyslexia. Children with dyslexia, as a group, presented low PA and RAN scores, as well as limited implicit learning skills. However, we found no differences in the other domains. We found a phonological deficit in 51% and a RAN deficit in 26% of children with dyslexia. These deficits coexisted in 14% of the children. Deficits in other cognitive domains were uncommon and most often coexisted with phonological or RAN deficits. Despite having a severe reading impairment, 26% of children with dyslexia did not present any of the tested deficits. Second, in a group of children presenting a wide range of reading abilities (N = 211), we analysed the relationship between cognitive skills and reading level. PA and RAN were independently related to reading abilities. Other skills did not explain any additional variance. The impact of PA and RAN on reading skills differed. While RAN was a consistent predictor of reading, PA predicted reading abilities particularly well in average and good readers with a smaller impact in poorer readers.
Collapse
Affiliation(s)
- Agnieszka Dębska
- Laboratory of Language Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Magdalena Łuniewska
- Laboratory of Language Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland.,Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Julian Zubek
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Katarzyna Chyl
- Laboratory of Language Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Agnieszka Dynak
- Laboratory of Language Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland.,Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Gabriela Dzięgiel-Fivet
- Laboratory of Language Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Joanna Plewko
- Laboratory of Language Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Katarzyna Jednoróg
- Laboratory of Language Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Grabowska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| |
Collapse
|
15
|
Lee Y, Kuo BCH, Chen PH, Lai NH. Recovery from Anorexia Nervosa in contemporary Taiwan: A multiple-case qualitative investigation from a cultural-contextual perspective. Transcult Psychiatry 2021; 58:365-378. [PMID: 32429815 DOI: 10.1177/1363461520920327] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Grounded in a cultural and contextual perspective, the current study examined the lived experiences and the recovery pathways of three Taiwanese women diagnosed with various subtypes of anorexia nervosa, at varying stages of their recovery. Specifically, using a multiple-case qualitative method, this study explored the complex, dynamic interactions of sociocultural factors and forces (i.e., cultural, familial, and societal influences) that impinge upon the three Taiwanese female participants in relation to living with anorexia nervosa in contemporary Taiwan. Data were collected based on in-depth, semi-structured interviews with the participants and relevant written materials and journal entries provided by these participants. The data were first analyzed within each case and then again across all cases. Accordingly, we present the results of the study by illustrating each participant's story and narrative of struggling with and recovering from anorexia. We then describe three main culturally-related themes that emerged from the cross-case analysis, which pertain specifically to the recovery process of the participants under the East-West 'biculturalism' in Taiwan: 1) anorexia as a function of the conflictual bicultural self; 2) recovery as a pathway towards an integrated bicultural self; and 3) the paradoxical roles of Chinese cultural heritage in anorexia and recovery. Findings of the study highlight the role of local cultural factors/forces, including Chinese familism, Confucianism, filial piety, face-saving, gender role prescriptions, biculturalism, Westernization, and self-relation-coordination, in affecting and shaping Taiwanese women's struggling with anorexia. Implications and recommendations for future research and clinical interventions are discussed.
Collapse
|
16
|
Mundy IR, Hannant P. Exploring the phonological profiles of children with reading difficulties: A multiple case study. Dyslexia 2020; 26:411-426. [PMID: 32812308 DOI: 10.1002/dys.1667] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 04/29/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
Studies of group differences have established that the phonological profiles of people with reading difficulties contain both strengths and weaknesses. The current study extends this work by exploring individual differences in phonological ability using a multiple case study approach. A heterogeneous sample of 56 children (M age = 9 years) with reading difficulties completed a battery of tasks measuring literacy, phonological processing, expressive vocabulary and general ability. The phonological tasks included measures of phonological awareness (PA), phonological memory (PM), and rapid naming (RAN). A majority-although not all-of the children had phonological processing impairments. However, there was also substantial variability in the nature of children's phonological difficulties. While multiple impairments encompassing two or more phonological domains were most common, impairments that were specific to PA, PM or RAN also occurred frequently. Even within the domain of PA, where children completed three well-matched tasks, individual children were rarely impaired across all three measures and a number of different profiles were observed. Additional, group-level analyses indicated that PA was a significant predictor of decoding while RAN was a significant predictor of automatic word recognition and comprehension. Findings are discussed with reference to conceptual models of phonological processing and implications for assessment.
Collapse
Affiliation(s)
- Ian R Mundy
- School of Social Sciences, Birmingham City University, Birmingham, UK
| | - Penelope Hannant
- Department of Disability Inclusion and Special Needs, University of Birmingham, Birmingham, UK
| |
Collapse
|
17
|
O'Campo P, Freiler A, Muntaner C, Gelormino E, Huegaerts K, Puig-Barrachina V, Mitchell C. Resisting austerity measures to social policies: multiple explanatory case studies. Health Promot Int 2020; 34:1130-1140. [PMID: 30272160 DOI: 10.1093/heapro/day073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/12/2022] Open
Abstract
Since Margaret Thatcher reached power in the United Kingdom, European governments have increasingly turned to neoliberal forms of policy-making, focusing, especially after the 2008 Great Recession on 'austerity policies' rather than investing in social protection policies. We applied a multiple explanatory case studies methodology to examine how and why challenges and resistance to these austerity measures are successful or not in four settings for three different social policy issues: using a gender lens in state budgeting in Andalusia (Spain), maintaining unemployment benefits in Italy and cuts to fuel poverty reduction programs in Northern Ireland and England. In particular, we intended to learn about whether resistance strategies are shared across disparate cases or whether there are unique activities that lead to successful resistance to austerity policies. As our approach drew from realist philosophy of science, we started with initial theories concerning collective action, political ideology and political power of affected populations. Our findings suggest that there are similarities between the cases we studied despite differences in political and policy contexts. We found that joint action between advocacy groups was effective in resisting cuts to social spending. Evidence also indicates that the social construction of target populations is important in resisting changes to social programmes. This was observed in both England and Northern Ireland where pensioners held significant political clout.
Collapse
Affiliation(s)
- Patricia O'Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada
| | - Alix Freiler
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada
| | - Carles Muntaner
- Bloomberg School of Nursing, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada
| | - Elena Gelormino
- ASL Torino 5, Local Public Health Agency, piazza S. Pellico 1, 10023 Chieri, Italy
| | - Kelly Huegaerts
- Interface Demography, Vrije Universiteit Brussel, Pleinlaan 5, 1050 Brussels, Belgium
| | - Vanessa Puig-Barrachina
- Health Information Systems Unit, Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023 Barcelona, Spain
| | - Christiane Mitchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada
| |
Collapse
|
18
|
Brogan P, Hasson F, McIlfatrick S. Lessons learnt: examining the use of case study methodology for nursing research in the context of palliative care. J Res Nurs 2019; 24:446-459. [PMID: 34394560 DOI: 10.1177/1744987119867737] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background An empirical social research approach, facilitating in-depth exploration of complex, contemporary contextualised phenomena, case study research has been used internationally in healthcare studies across clinical settings, to explore systems and processes of care delivery. In the United Kingdom, case study methods have been championed by nurse researchers, particularly in the context of community nursing and palliative care provision, where its applicability is well established. Yet, dogged by conceptual confusion, case study remains largely underutilised as a research approach. Method Drawing on examples from nursing and palliative care studies, this paper clarifies case study research, identifies key concepts and considers lessons learned about its potential for nursing research within the unique and complex palliative and end of life context. Conclusion A case study approach offers nurse researchers the opportunity for in-depth, contextualised understanding of the systems and processes which influence their role in palliative care delivery across settings. However, philosophical and conceptual understandings are needed and further training in case study methodology is required to enable researchers to articulate and conduct case study.
Collapse
Affiliation(s)
- Paula Brogan
- School of Communication and Media, University of Ulster, Northern Ireland, UK
| | - Felicity Hasson
- Institute of Nursing Research, University of Ulster, Northern Ireland, UK
| | | |
Collapse
|
19
|
Holten L, Hollander M, de Miranda E. When the Hospital Is No Longer an Option: A Multiple Case Study of Defining Moments for Women Choosing Home Birth in High-Risk Pregnancies in The Netherlands. Qual Health Res 2018; 28:1883-1896. [PMID: 30101662 PMCID: PMC6154222 DOI: 10.1177/1049732318791535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Some women in a high-risk pregnancy go against medical advice and choose to birth at home with a "holistic" midwife. In this exploratory multiple case study, grounded theory and triangulation were employed to examine 10 cases. The women, their partners, and (regular and holistic) health care professionals were interviewed in an attempt to determine whether there was a pattern to their experiences. Two propositions emerged. The dominant one was a trajectory of trauma, self-education, concern about paternalism, and conflict leading to a negative choice for holistic care. The rival proposition was a path of trust and positive choice for holistic care without conflict. We discuss these two propositions and make suggestions for professionals for building a trusting relationship using continuity of care, true shared decision making, and an alternative risk discourse to achieve the goal of making women perceive the hospital as safe again.
Collapse
Affiliation(s)
- Lianne Holten
- Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | | | | |
Collapse
|
20
|
Abstract
Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis. FINDINGS The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.
Collapse
Affiliation(s)
| | - Pamela Mazzocato
- 2 Department of Learning, informatics, management and ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Stefano Villa
- 3 Department of Management, Catholic University, Rome, Italy; CERISMAS (Research Centre in Health Care Management), Catholic University, Milan, Italy
| | - Marta Marsilio
- 4 Department of economics and management, University of Milan, Italy
| |
Collapse
|
21
|
Bush EJ, Hux K, Guetterman TC, McKelvey M. The diverse vocational experiences of five individuals returning to work after severe brain injury: A qualitative inquiry. Brain Inj 2016; 30:422-436. [PMID: 26910611 DOI: 10.3109/02699052.2015.1131849] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 11/13/2022]
Abstract
OBJECTIVE The researchers explored the return-to-work experiences of five adults with severe traumatic brain injuries (TBIs) and those associated with them by performing a qualitative, multiple case study investigation involving in-depth, semi-structured interviews. Selection of this qualitative methodology allowed for personal, individualized accounts of adults with TBI returning to work. Specifically, this methodology promoted accurate representation of the idiosyncratic nature of each participant's experiences. METHODS The researchers asked individuals to participate based on the diversity of their vocational experiences following TBI. RESULTS Four of the five participants had returned to their pre-injury jobs. Two were subsequently fired and, at the time of research participation, were unemployed. One participant never returned to paid employment; however, he had held two volunteer positions for several years post-injury. Salient content from interview transcripts allowed for the identification of five to eight themes pertinent to each case. CONCLUSIONS Interpretation of the themes led to three main conjectures about return-to-work experiences following TBI: (a) job satisfaction may relate more to involvement in productive activities than monetary compensation; (b) adults with TBI can be successful in holding and maintaining positions with high cognitive demands; and
Collapse
Affiliation(s)
- Erin J Bush
- a Division of Communication Disorders , University of Wyoming , Laramie , WY , USA
| | - Karen Hux
- b Department of Special Education and Communication Disorders , University of Nebraska Lincoln , Lincoln , NE , USA
| | | | - Miechelle McKelvey
- d Department of Communication Disorders , University of Nebraska Kearney , Kearney , NE , USA
| |
Collapse
|
22
|
Abstract
Resilience, or the process of adjusting well to risk, relies on constructive collaboration between youths and their social ecologies. Although the literature details the risks of an intellectual disability (ID), there is little explanation of why some young people cope well despite these risks. Accordingly, we report a multiple case study that affords insight into the resilience of 24 adolescents with ID. Using a draw-and-talk methodology, these young people explained their resilience as enabled primarily by supportive social ecologies (which facilitated behavioral and emotional regulation, encouraged mastery, treated them as agentic beings, and offered safe spaces). Adolescents' positive orientation to their life-worlds co-facilitated their resilience. These insights advance effective ways to champion the resilience of young people with ID.
Collapse
Affiliation(s)
- Anna-Marié Hall
- Anna-Marié Hall, North-West University, Optentia Research Focus Area, Gauteng, South Africa; and
| | - Linda C Theron
- Linda Theron, North-West University, Optentia Research Focus Area, Gauteng, South Africa
| |
Collapse
|
23
|
Glover-Kudon R, DeGroff A, Rohan EA, Preissle J, Boehm JE. Developmental milestones across the programmatic life cycle: implementing the CDC's Colorectal Cancer Screening Demonstration Program. Cancer 2014; 119 Suppl 15:2926-39. [PMID: 23868487 DOI: 10.1002/cncr.28166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 07/11/2012] [Revised: 08/28/2012] [Accepted: 08/31/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND In 2005 through 2009, the Centers for Disease Control and Prevention (CDC) funded 5 sites to implement a colorectal cancer screening program for uninsured, low-income populations. These 5 sites composed a demonstration project intended to explore the feasibility of establishing a national colorectal cancer screening program through various service delivery models. METHODS A longitudinal, multiple case study was conducted to understand and document program implementation processes. Using metaphor as a qualitative analytic technique, evaluators identified stages of maturation across the programmatic life cycle. RESULTS Analysis rendered a working theory of program development during screening implementation. In early stages, program staff built relationships with CDC and local partners around screening readiness, faced real-world challenges putting program policies into practice, revised initial program designs, and developed new professional skills. Midterm implementation was defined by establishing program cohesiveness and expanding programmatic reach. In later stages of implementation, staff focused on sustainability and formal program closeout, which prompted reflection about personal and programmatic accomplishments. CONCLUSIONS Demonstration sites evolved through common developmental stages during screening implementation. Findings elucidate ways to target technical assistance to more efficiently move programs along their maturation trajectory. In practical terms, the time and cost associated with guiding a program to maturity may be potentially shortened to maximize return on investment for both organizations and clients receiving service benefits.
Collapse
|
24
|
Powell BJ, Proctor EK, Glisson CA, Kohl PL, Raghavan R, Brownson RC, Stoner BP, Carpenter CR, Palinkas LA. A mixed methods multiple case study of implementation as usual in children's social service organizations: study protocol. Implement Sci 2013; 8:92. [PMID: 23961701 PMCID: PMC3751866 DOI: 10.1186/1748-5908-8-92] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/19/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Improving quality in children's mental health and social service settings will require implementation strategies capable of moving effective treatments and other innovations (e.g., assessment tools) into routine care. It is likely that efforts to identify, develop, and refine implementation strategies will be more successful if they are informed by relevant stakeholders and are responsive to the strengths and limitations of the contexts and implementation processes identified in usual care settings. This study will describe: the types of implementation strategies used; how organizational leaders make decisions about what to implement and how to approach the implementation process; organizational stakeholders' perceptions of different implementation strategies; and the potential influence of organizational culture and climate on implementation strategy selection, implementation decision-making, and stakeholders' perceptions of implementation strategies. METHODS/DESIGN This study is a mixed methods multiple case study of seven children's social service organizations in one Midwestern city in the United States that compose the control group of a larger randomized controlled trial. Qualitative data will include semi-structured interviews with organizational leaders (e.g., CEOs/directors, clinical directors, program managers) and a review of documents (e.g., implementation and quality improvement plans, program manuals, etc.) that will shed light on implementation decision-making and specific implementation strategies that are used to implement new programs and practices. Additionally, focus groups with clinicians will explore their perceptions of a range of implementation strategies. This qualitative work will inform the development of a Web-based survey that will assess the perceived effectiveness, relative importance, acceptability, feasibility, and appropriateness of implementation strategies from the perspective of both clinicians and organizational leaders. Finally, the Organizational Social Context measure will be used to assess organizational culture and climate. Qualitative, quantitative, and mixed methods data will be analyzed and interpreted at the case level as well as across cases in order to highlight meaningful similarities, differences, and site-specific experiences. DISCUSSION This study is designed to inform efforts to develop more effective implementation strategies by fully describing the implementation experiences of a sample of community-based organizations that provide mental health services to youth in one Midwestern city.
Collapse
Affiliation(s)
- Byron J Powell
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, USA
| | - Enola K Proctor
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, USA
| | - Charles A Glisson
- College of Social Work, University of Tennessee, Knoxville, TN 37996, USA
| | - Patricia L Kohl
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, USA
| | - Ramesh Raghavan
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Ross C Brownson
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, USA
- Department of Surgery and Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Bradley P Stoner
- Department of Anthropology, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Christopher R Carpenter
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Lawrence A Palinkas
- School of Social Work, University of Southern California, Los Angeles, California 90089, USA
| |
Collapse
|
25
|
Van Houdt S, Heyrman J, Vanhaecht K, Sermeus W, De Lepeleire J. Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination. BMC Health Serv Res 2013; 13:296. [PMID: 23919518 PMCID: PMC3750930 DOI: 10.1186/1472-6963-13-296] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 07/31/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care pathways are widely used in hospitals for a structured and detailed planning of the care process. There is a growing interest in extending care pathways into primary care to improve quality of care by increasing care coordination. Evidence is sparse about the relationship between care pathways and care coordination.The multi-level framework explores care coordination across organizations and states that (inter)organizational mechanisms have an effect on the relationships between healthcare professionals, resulting in quality and efficiency of care.The aim of this study was to assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary-hospital care continuum. METHODS This study is an in-depth analysis of five existing local community projects located in four different regions in Flanders (Belgium) to determine whether the available empirical evidence supported or refuted the theoretical expectations from the multi-level framework. Data were gathered using mixed methods, including structured face-to-face interviews, participant observations, documentation and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results. RESULTS The development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, led to the use of existing and newly constructed structures, data monitoring and the development of information tools. The construction and use of these inter-organizational mechanisms had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other's roles, expectations and competences and building qualitative relationships. CONCLUSION Care pathways across the primary-hospital care continuum enhance the components of care coordination.
Collapse
Affiliation(s)
- Sabine Van Houdt
- Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 blok J, box 7001, 3000 Leuven, Belgium
| | - Jan Heyrman
- Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 blok J, box 7001, 3000 Leuven, Belgium
| | - Kris Vanhaecht
- Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
- Western Norway Research Network on Integrated Care, Haugesund, Norway
| | - Walter Sermeus
- Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Jan De Lepeleire
- Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 blok J, box 7001, 3000 Leuven, Belgium
| |
Collapse
|