scholarly journals Facilitating transition from children’s to adult services for young adults with life-limiting conditions (TASYL): Programme theory developed from a mixed methods realist evaluation

2018 ◽  
Vol 86 ◽  
pp. 125-138 ◽  
Author(s):  
Helen Kerr ◽  
Jayne Price ◽  
Honor Nicholl ◽  
Peter O’Halloran
Keyword(s):  
Young Adults ◽  
Mixed Methods ◽  
Realist Evaluation ◽  
Programme Theory ◽  
Adult Services

scholarly journals Youth Access to Cigarettes Across Seven European Countries: A Mixed-Methods Study

2019 ◽  
Vol 22 (11) ◽  
pp. 1989-1996 ◽  
Author(s):  
Paulien A W Nuyts ◽  
Rebecca M F Hewer ◽  
Mirte A G Kuipers ◽  
Vincent Lorant ◽  
Adeline Grard ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Young People ◽  
Realist Evaluation ◽  
Mixed Methods Study ◽  
European Countries ◽  
Programme Theory ◽  
Vending Machines ◽  
Evaluation Approach ◽  
Policy Interventions ◽  
Minimum Age

Abstract Background Despite widespread age-of-sale restrictions on tobacco, adolescents continue to obtain cigarettes and experiment with smoking. This mixed-methods study aimed to understand how European adolescents access cigarettes and how the policy context may influence this process, using a realist evaluation approach. This is the first study to assess access to cigarettes across various European contexts. Methods A survey of 4104 students was combined with qualitative data from focus groups among 319 adolescents aged 14–19 across seven European countries. Data were synthesized to explore mechanisms via which young people obtain cigarettes despite age-of-sale restrictions. Results While purchasing cigarettes from supermarkets was widely regarded as difficult, many participants purchased cigarettes from noncompliant retailers (often in smaller shops or cafes). Other contra-mechanisms included circumventing age checks, proxy purchases, and/or social sources. Dominant forms of access differed across the seven contexts, with direct purchases more common where perceived enforcement was low (eg, Belgium) and proxy purchases more important where perceived enforcement of age-of-sale laws was high (eg, Finland). The effectiveness of age-of-sale restrictions in reducing youth access appears to be influenced by a range of contextual factors including retailer compliance, the availability of vending machines, and the specific minimum age-of-sale. Conclusions Our findings illustrate the relevance of programme theory in understanding the contra-mechanisms that undermine the effectiveness of age-of-sale laws in discouraging youth smoking. Young people’s access to cigarettes could be further limited by addressing these contra-mechanisms, including an increase in the legal sales age (particularly in Belgium), banning vending machines, and strengthening enforcement. Implications Despite widespread implementation of age-of-sale laws, a substantial proportion of minors continue to access cigarettes. Young people use a number of contra-mechanisms to circumvent age-of-sale restrictions. These include accessing cigarettes via social sources, proxy sales or by circumventing age checks. Our findings show that in contexts where perceived enforcement of age-of-sale restrictions is high, young people are more reliant on irregular forms of access such as proxy sales. Young people’s access to cigarettes may be further reduced by policy interventions that address these contra-mechanisms—for example, banning vending machines, strengthening enforcement of age-of-sale laws, and increasing the minimum age-of-sale.

scholarly journals Exploring two distinct gentamicin prescribing protocols in UK hospitals: a mixed-methods realist evaluation

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052697
Author(s):  
Nadine Dyar ◽  
Karen Mattick ◽  
Rob Bethune
Keyword(s):  
Mixed Methods ◽  
Improve Patient Safety ◽  
Aminoglycoside Antibiotic ◽  
Therapeutic Index ◽  
Realist Evaluation ◽  
Programme Theory ◽  
Quantitative And Qualitative Research ◽  
Key Characteristics ◽  
Structured Audio ◽  
The Uk

ObjectivesGentamicin is the aminoglycoside antibiotic of choice in the UK. It has a narrow therapeutic index: underdosing results in inefficacy while overdosing is characterised by nephrotoxicity and ototoxicity. To improve patient safety, hospitals have protocols for the prescription of gentamicin, which vary in complexity and approach. This study aimed to explore two distinct protocols for prescribing gentamicin in hospital settings, in order to understand the mechanisms they trigger and the outcomes they achieve.SettingA mixed-methods realist evaluation explored gentamicin prescribing protocols in two hospital surgical admissions units in South West England between January and August 2018. Site 1 had a traditional, complex protocol, while site 2 took a simplified protocol.ParticipantsTesting the initial programme theory (IPT) involved semi-structured audio-recorded interviews of a volunteer sample of healthcare professionals (HCPs) involved in the prescribing and administering process, alongside a clinical audit reviewing accuracy of gentamicin prescribing.Outcome measuresThree sequential phases were used to identify factors in a successful protocol: IPT generation; testing; refinement of the IPT. The IPT was generated by literature search and analysis of existing protocols of sites 1 and 2. Refinement of the IPT synthesised the results of the quantitative and qualitative research to identify the key characteristics of a successful protocol.ResultsOne hundred gentamicin prescriptions were reviewed, with a mean accuracy of gentamicin prescribing at site 1 of 65.67% and at site 2 of 78.79% (p<0.01). Thirty HCPs were interviewed. Key contexts were identified including prescriptiveness, experience and availability of patient information. These triggered hidden mechanisms including uncertainty, fear, confidence and frustration leading to both intended outcomes but also unintended outcomes such as deviation from protocol and unnecessary gentamicin levels.ConclusionsA simplified prescribing protocol for gentamicin is better accepted by prescribers, leading to better adherence to protocol and more accurate prescribing.

scholarly journals Respite care and short breaks for young adults aged 18–40 with complex health-care needs: mixed-methods systematic review and conceptual framework development

2021 ◽  
Vol 9 (6) ◽  
pp. 1-268
Author(s):  
Katherine Knighting ◽  
Gerlinde Pilkington ◽  
Jane Noyes ◽  
Brenda Roe ◽  
Michelle Maden ◽  
...  
Keyword(s):  
Health Care ◽  
Young Adults ◽  
Mixed Methods ◽  
Cost Effectiveness ◽  
Conceptual Framework ◽  
Respite Care ◽  
Knowledge Map ◽  
Health Care Needs ◽  
Care Needs ◽  
Adult Services

Background The number of young adults with complex health-care needs due to life-limiting conditions/complex physical disability has risen significantly over the last 15 years, as more children now survive into adulthood. The transition from children to adult services may disrupt provision of essential respite/short break care for this vulnerable population, but the impact on young adults, families and providers is unclear. Aim To review the evidence on respite care provision for young adults (aged 18–40 years) with complex health-care needs, provide an evidence gap analysis and develop a conceptual framework for respite care. Design A two-stage mixed-methods systematic review, including a knowledge map of respite care and an evidence review of policy, effectiveness, cost-effectiveness and experience. Data sources Electronic databases and grey/unpublished literature were searched from 2002 to September 2019. The databases searched included Cumulative Index to Nursing and Allied Health Literature, MEDLINE, EMBASE, PsycINFO, Applied Social Sciences Index and Abstracts, Health Management Information Consortium, PROSPERO, Turning Research into Practice, COnNECT+, British Nursing Index, Web of Science, Social Care Online, the National Institute for Health Research Journals Library, Cochrane Effective Practice and Organisation of Care specialist register, databases on The Cochrane Library and international clinical trials registers. Additional sources were searched using the CLUSTER (Citations, Lead authors, Unpublished materials, Scholar search, Theories, Early examples, Related projects) approach and an international ‘call for evidence’. Methods and analysis Multiple independent reviewers used the SPICE (Setting, Perspective, Intervention/phenomenon of interest, Comparison, Evaluation) framework to select and extract evidence for each stage, verified by a third reviewer. Study/source characteristics and outcomes were extracted. Study quality was assessed using relevant tools. Qualitative evidence was synthesised using a framework approach and UK policy was synthesised using documentary content analysis. GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research) was used to assess confidence in the evidence. Logic models developed for each type of respite care constituted the conceptual framework. Results We identified 69 sources (78 records) from 126,267 records. The knowledge map comprised the following types of respite care: residential, home based, day care, community, leisure/social provision, funded holidays and emergency. Seven policy intentions included early transition planning and prioritising respite care according to need. No evidence was found on effectiveness and cost-effectiveness. Qualitative evidence focused largely on residential respite care. Facilitators of accessible/acceptable services included trusted and valued relationships, independence and empowerment of young adults, peer social interaction, developmental/age-appropriate services and high standards of care. Barriers included transition to adult services, paperwork, referral/provision delay and travelling distance. Young adults from black, Asian and minority ethnic populations were under-represented. Poor transition, such as loss of or inappropriate services, was contrary to statutory expectations. Potential harms included stress and anxiety related to safe care, frustration and distress arising from unmet needs, parental exhaustion, and a lack of opportunities to socialise and develop independence. Limitations No quantitative or mixed-methods evidence was found on effectiveness or cost-effectiveness of respite care. There was limited evidence on planned and emergency respite care except residential. Conclusions Policy intentions are more comprehensively met for young people aged < 18 years who are accessing children’s services. Young adults with complex needs often ‘fall off a cliff’ following service withdrawal and this imbalance needs addressing. Future work Research to quantify the effectiveness and cost-effectiveness of respite care to support service development and commissioning. Development of a core set of outcomes measures to support future collation of evidence. Study registration This study is registered as PROSPERO CRD42018088780. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information.

scholarly journals Study protocol: a mixed-methods realist evaluation of the Universal Health Visiting Pathway in Scotland

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042305
Author(s):  
Lawrence Doi ◽  
Kathleen Morrison ◽  
Ruth Astbury ◽  
Jane Eunson ◽  
Margaret A Horne ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Data Analysis ◽  
Routine Data ◽  
Realist Evaluation ◽  
Case Note ◽  
Early Years ◽  
Programme Theory ◽  
Health Visitors ◽  
Universal Health ◽  
Case Note Review

IntroductionThe growing political emphasis on the early years reflects the importance of these formative years of life. Health visitors in the UK are uniquely positioned to improve health outcomes for children and families and to reduce health inequalities. Recently, there has been a policy change in Scotland in an attempt to enhance the delivery of the universal health visiting service. This study aims to examine the extent to which the enhanced Universal Health Visiting Pathway is implemented and delivered across Scotland and to assess any associated impacts.Methods and analysisA mixed-methods study incorporating four methodological components and uses realist evaluation as the overall conceptual framework. It comprises three phases (1) initial programme theory development; (2) programme theory validation and (3) programme theory refinement. The programme theory validation will use interview and focus group data of parents and health visitors, and conduct a case note review at five study sites. It also involves a national survey of parents and health visitors and routine data analysis of existing secondary data. The analyses of the ensuing qualitative and quantitative data will be carried out using a convergent mixed-methods approach to ensure continuous triangulation of multiple data. The findings of the evaluation will provide contextually relevant understanding of how the Universal Health Visiting Pathway works and evidence the impact of increased investments in health visiting in Scotland.Ethics and disseminationThis protocol has been approved by the School of Health in Social Science Research Ethics Committee, University of Edinburgh. Additional approvals have been granted/will be sought from the Public Benefit and Privacy Panel for health and social care in Scotland for the case note review,survey and routine data analysis elements of the evaluation. The findings will be prepared as reports to the funders and presented at conferences. It will be submitted for publication in peer-reviewed journals.

scholarly journals Protocol for a mixed methods realist evaluation of regional District Health Board groupings in New Zealand

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e030076
Author(s):  
Tim Stokes ◽  
Carol Atmore ◽  
Erin Penno ◽  
Lauralie Richard ◽  
Emma Wyeth ◽  
...  
Keyword(s):  
Mixed Methods ◽  
New Zealand ◽  
Health Outcomes ◽  
Health Equity ◽  
Service Integration ◽  
Realist Evaluation ◽  
Health Board ◽  
Programme Theory ◽  
District Health ◽  
The Impact

IntroductionAchieving effective integration of healthcare across primary, secondary and tertiary care is a key goal of the New Zealand (NZ) Health Strategy. NZ’s regional District Health Board (DHB) groupings are fundamental to delivering integration, bringing the country’s 20 DHBs together into four groups to collaboratively plan, fund and deliver health services within their defined geographical regions. This research aims to examine how, for whom and in what circumstances the regional DHB groupings work to improve health service integration, healthcare quality, health outcomes and health equity, particularly for Māori and Pacific peoples.Methods and analysisThis research uses a mixed methods realist evaluation design. It comprises three linked studies: (1) formulating initial programme theory (IPT) through developing programme logic models to describe regional DHB working; (2) empirically testing IPT through both a qualitative process evaluation of regional DHB working using a case study design; and (3) a quantitative analysis of the impact that DHB regional groupings may have on service integration, health outcomes, health equity and costs. The findings of these three studies will allow refinement of the IPT and should lead to a programme theory which will explain how, for whom and in what circumstances regional DHB groupings improve service integration, health outcomes and health equity in NZ.Ethics and disseminationThe University of Otago Human Ethics Committee has approved this study. The embedding of a clinician researcher within a participating regional DHB grouping has facilitated research coproduction, the research has been jointly conceived and designed and will be jointly evaluated and disseminated by researchers and practitioners. Uptake of the research findings by other key groups including policymakers, Māori providers and communities and Pacific providers and communities will be supported through key strategic relationships and dissemination activities. Academic dissemination will occur through publication and conference presentations.

Race and gender differences in attitudes toward help seeking among marginalized young adults with mood disorders: A mixed-methods investigation.

2018 ◽  
Vol 41 (4) ◽  
pp. 277-289 ◽  
Author(s):  
Sarah C. Narendorf ◽  
Michelle R. Munson ◽  
Shelly Ben-David ◽  
Andrea R. Cole ◽  
Lionel D. Scott
Keyword(s):  
Gender Differences ◽  
Young Adults ◽  
Mixed Methods ◽  
Mood Disorders ◽  
Help Seeking ◽  
Race And Gender ◽  
And Gender

scholarly journals Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John Downey ◽  
Katie Shearn ◽  
Nicola Brown ◽  
Ross Wadey ◽  
Jeff Breckon
Keyword(s):  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Developed Countries ◽  
Realist Evaluation ◽  
Service Planning ◽  
Service Development ◽  
Activity Levels ◽  
Programme Theory ◽  
Implementation Framework ◽  
Exercise Referral

Abstract Background Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom. Methods An eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework. Results Three programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice. Conclusions The findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development.

The Path to Adulthood: A Mixed-Methods Approach to the Exploration of the Experiences of Unaccompanied Minors in Portugal

2021 ◽  
Author(s):  
Carla Moleiro ◽  
Sandra Roberto
Keyword(s):  
Young Adults ◽  
Mixed Methods ◽  
Residential Care ◽  
Host Country ◽  
Qualitative Interviews ◽  
Autobiographical Narratives ◽  
Unaccompanied Minors ◽  
Mixed Methods Approach ◽  
Age Of Majority ◽  
The Voice

Abstract Unaccompanied minors who reach the age of majority often experience this transition as a complex stage. Insecurity and helplessness may arise and, in some cases, survival without the support of the institutions and services that previously protected them as minors in the host country may mean becoming at risk for social exclusion. The objective of the present study was to characterize unaccompanied minors in Portugal (N = 67) and understand the processes of transition into the age of majority, using a mixed-methods approach. Quantitative (survey) and qualitative (interviews on autobiographical narratives) methodologies were used as a means of acknowledging the voice of minors/young adults in their trajectories and experiences. Two groups were included, with minors (in residential care) and youths who had already reached adulthood (living independently). Results illustrate diverse reasons for arrival in Portugal and distinct strengths and struggles in the integration experiences, with both positive and negative aspects being identified in the transition to autonomy.

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