scholarly journals Implementation, interrupted: Identifying and leveraging factors that sustain after a program interruption

2021 ◽  
Author(s):  
Rachel Hennein ◽  
Joseph Ggita ◽  
Bashir Ssuna ◽  
Donna Shelley ◽  
Ann R. Akiteng ◽  
...  
Keyword(s):  
Ecological Model ◽  
Implementation Strategies ◽  
Health Centers ◽  
Cascading Effects ◽  
Individual Level ◽  
Clinic Staff ◽  
Outer Setting ◽  
Glucose Test ◽  
The Individual ◽  
Inner Setting

AbstractBackgroundMany implementation efforts experience interruptions, especially in settings with developing health systems. Approaches for evaluating interruptions are needed to inform targeted re-implementation strategies.MethodsThis study took place in two public health centers with tuberculosis (TB) units in Uganda that previously implemented diabetes mellitus (DM) screening in 2017. In 2019, we conducted interviews with clinic staff to determine current DM practices. We mapped themes identified in the interviews to a Social Ecological Model with three levels: outer setting, inner setting, and individuals.ResultsWe conducted nine interviews with clinic staff. Respondents explained that DM screening ceased due to disruptions in the supply chain for glucose test strips. This outer setting interruption had cascading effects on the inner setting and individuals. The lack of screening supplies limited the staff’s opportunities to perform DM screening within the inner setting level, which was associated with diminished self-efficacy within the individual level. However, culture, compatibility and individual beliefs about DM screening sustained throughout the interruption.ConclusionsWe identified factors that diminished and sustained within and between ecological levels during a program interruption. Using this approach, other programs facing interruptions can identify factors and cascading effects of the interruption to target them for re-implementation.

scholarly journals Evaluation of multi-level barriers and facilitators in a large diabetic retinopathy screening program in federally qualified health centers: a qualitative study

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Ana Bastos de Carvalho ◽  
S. Lee Ware ◽  
Tamara Belcher ◽  
Franceska Mehmeti ◽  
Eric B. Higgins ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Qualitative Study ◽  
Underserved Populations ◽  
Implementation Strategies ◽  
Structured Interview ◽  
Health Centers ◽  
Barriers And Facilitators ◽  
Federally Qualified Health Centers ◽  
Multi Level ◽  
Inner Setting

Abstract Background Recommended annual diabetic retinopathy (DR) screening for people with diabetes has low rates in the USA, especially in underserved populations. Telemedicine DR screening (TDRS) in primary care clinics could expand access and increase adherence. Despite this potential, studies have observed high variability in TDRS rates among clinics and over time, highlighting the need for implementation supports. Previous studies of determinants of TDRS focus on patients’ perspectives, with few studies targeting upstream multi-level barriers and facilitators. Addressing this gap, this qualitative study aimed to identify and evaluate multi-level perceived determinants of TDRS in Federally Qualified Health Centers (FQHCs), to inform the development of targeted implementation strategies. Methods We developed a theory-based semi-structured interview tool based on the Consolidated Framework for Implementation Research (CFIR). We conducted 22 key informant interviews with professionals involved in TDRS (administrators, clinicians, staff). The interviews were audio-recorded and transcribed verbatim. Reported barriers and facilitators were organized into emergent themes and classified according to CFIR constructs. Constructs influencing TDRS implementation were rated for each study site and compared across sites by the investigators. Results Professionals identified 21 main barriers and facilitators under twelve constructs of the five CFIR domains. Several identified themes were novel, whereas others corroborated previous findings in the literature (e.g., lack of time and human resources, presence of a champion). Of the 21 identified themes, 13 were classified under the CFIR’s Inner Setting domain, specifically under the constructs Compatibility and Available Resources. Themes under the Outer Setting domain (constructs External Incentives and Cost) were primarily perceived by administrators, whereas themes in other domains were perceived across all professional categories. Two Inner Setting (Leadership Engagement, Goals and Feedback) and two Process (Champion, Engaging) constructs were found to strongly distinguish sites with high versus low TDRS performance. Conclusions This study classified barriers and facilitators to TDRS as perceived by administrators, clinicians, and staff in FQHCs, then identified CFIR constructs that distinguished high- and low-performance clinics. Implementation strategies such as academic detailing and collection and communication of program data and successes to leadership; engaging of stakeholders through involvement in implementation planning; and appointment of intervention champions may therefore improve TDRS implementation and sustainment in resource-constrained settings.

scholarly journals ECOLOGICAL MODEL OF THR STUDENT'S RESILIENCE

2020 ◽  
pp. 218-239
Author(s):  
Ю.В. Постылякова
Keyword(s):  
Risk Factors ◽  
Developmental Psychology ◽  
Family System ◽  
Ecological Model ◽  
Individual Level ◽  
Individual Resilience ◽  
The Family ◽  
The Subject ◽  
The Individual ◽  
The University

В статье в рамках экологического и ресурсного подходов анализируется понятие индивидуальной жизнеспособности как важной характеристики студентов. Рассматриваются индивидуальные навыки жизнеспособности студента, проявляемой им в процессе обучения в университете, анализируются модели жизнеспособности А. Мастен и М. Унгара, созданные в рамках экологической модели развития Ю. Бронфеннбренера. Предложена экологическая модель жизнеспособности студента, которая позволяет учитывать большое число различных факторов риска, прямо или опосредованно оказывающих влияние на студента, и его защитных факторов, к которым он может обращаться для ответа на требования или угрозы, идущие от факторов риска. Факторы риска, действующие на уровне макросистем (актуальная экологическая, эпидемиологическая, экономическая и др. ситуации в стране или мире), в которые включен субъект, взаимодействуют со всеми нижележащими уровнями экологический системы (микро-, мезо- и экзосистемы, например, образовательная система вуза; семейная система и др.), и опосредованно оказывают на них влияние. Все это предъявляет к студенту требования, на которые он вынужден отвечать на основе своих индивидуальных ресурсов, а также ресурсов, заключенных на микро-, мезо- и экзо- уровнях. На любом из уровней, любая из систем может нести в себе как факторы риска, так и факторы защиты, быть ресурсной для отдельного студента. Риски могут возникать как на индивидуальном уровне (на уровне микросистем), так и на уровнях более высокого порядка. Поэтому и проявления жизнеспособности студентом оказываются необходимыми во всех этих системах и на разных уровнях. Развитие и усиление жизнеспособности происходит по мере того, как все уровни (семьи, университета, сообщества) работают вместе, чтобы положительно влиять на индивидуальный уровень жизнеспособности студента. Показано значение экологической модели жизнеспособности студента при использовании ее специалистами в области социальной, педагогической, семейной психологии, психологии развития для анализа факторов риска и жизнеспособности в научных исследованиях, психотерапевтической и консультационной работе. The article analyzes the concept of individual resilience as an important characteristic of students within the framework of environmental and resource approaches. The individual skills of the student's resilience shown by him in the process of studying at the University are considered, the models of resilience by A. Masten and M. Ungar created within the framework of the ecological model of development by Yu. Bronfenbrenner. An ecological model of the student's resilience is proposed, which allows us to take into account a large number of different risk factors that directly or indirectly affect the student, and his protective factors that he can turn to respond to the requirements or threats coming from risk factors. Risk factors operating at the level of macro-systems (current environmental, epidemiological, economic, etc. situations in the country or world), in which the subject is included, interact with all the underlying levels of the ecological system (micro -, meso - and exosystems, for example, the educational system of a university, the family system, etc.), and indirectly influence them. All this makes demands on the student, which he is forced to meet on the basis of his individual resources, as well as resources contained at the micro -, meso - and exo - levels. At any level, any of the systems can carry both risk factors and protection factors, be a resource for a student. Risks can occur both at the individual level (at the level of Microsystems) and at higher-order levels. The manifestations of resilience by the student are necessary in all these systems and at different levels. The development and strengthening of resilience occurs as all levels (family, university, community) work together to positively influence the individual level of the student's resilience. The importance of the ecological model of the student's resilience is shown when it is used by specialists in the field of social, pedagogical, family psychology, developmental psychology for the analysis of risk factors and resilience in scientific research, psychotherapeutic and consulting work.

scholarly journals ‘Hiding their troubles’: a qualitative exploration of suicide in Bhutanese refugees in the USA

2019 ◽  
Vol 6 ◽  
Author(s):  
F. L. Brown ◽  
T. Mishra ◽  
R. L. Frounfelker ◽  
E. Bhargava ◽  
B. Gautam ◽  
...  
Keyword(s):  
Social Ecology ◽  
Ecological Model ◽  
Health Concern ◽  
Language And Literacy ◽  
Bhutanese Refugees ◽  
Individual Level ◽  
Social Ecological ◽  
The Usa ◽  
The Individual ◽  
Past Experiences

Background.Suicide is a major global health concern. Bhutanese refugees resettled in the USA are disproportionately affected by suicide, yet little research has been conducted to identify factors contributing to this vulnerability. This study aims to investigate the issue of suicide of Bhutanese refugee communities via an in-depth qualitative, social-ecological approach.Methods.Focus groups were conducted with 83 Bhutanese refugees (adults and children), to explore the perceived causes, and risk and protective factors for suicide, at individual, family, community, and societal levels. Audio recordings were translated and transcribed, and inductive thematic analysis conducted.Results.Themes identified can be situated across all levels of the social-ecological model. Individual thoughts, feelings, and behaviors are only fully understood when considering past experiences, and stressors at other levels of an individual's social ecology. Shifting dynamics and conflict within the family are pervasive and challenging. Within the community, there is a high prevalence of suicide, yet major barriers to communicating with others about distress and suicidality. At the societal level, difficulties relating to acculturation, citizenship, employment and finances, language, and literacy are influential. Two themes cut across several levels of the ecosystem: loss; and isolation, exclusion, and loneliness.Conclusions.This study extends on existing research and highlights the necessity for future intervention models of suicide to move beyond an individual focus, and consider factors at all levels of refugees’ social-ecology. Simply focusing treatment at the individual level is not sufficient. Researchers and practitioners should strive for community-driven, culturally relevant, socio-ecological approaches for prevention and treatment.

scholarly journals Reducing Sedentary Time among Older Adults in Assisted Living: Perceptions, Barriers, and Motivators

2020 ◽  
Vol 17 (3) ◽  
pp. 717 ◽  
Author(s):  
M. Lauren Voss ◽  
J. Paige Pope ◽  
Jennifer L. Copeland
Keyword(s):  
Older Adults ◽  
Assisted Living ◽  
Sedentary Time ◽  
Ecological Model ◽  
Qualitative Description ◽  
Individual Level ◽  
Challenges And Opportunities ◽  
Four Levels ◽  
The Individual ◽  
Barriers And Motivators

Older adults accumulate more sedentary time (ST) than any other age group, especially those in assisted living residences (ALRs). Reducing prolonged ST could help maintain function among older adults. However, to develop effective intervention strategies, it is important to understand the factors that influence sedentary behavior. The purpose of this study was to explore perceptions of ST as well as barriers and motivators to reducing ST among older adults in assisted living, in the context of the Social Ecological Model (SEM). Using a qualitative description approach, we sought to learn about participants’ perceptions of sedentary time in their daily lives. Semi-structured focus groups were held at six ALRs with 31 participants (84% women, 83.5 ± 6.5 years). Data were transcribed and coded using an inductive thematic approach. Themes were categorized based on four levels of the SEM: individual, social, physical environment, and organization. Many reported barriers were at the individual level (e.g., lack of motivation, pain, fatigue) while others were associated with the organization or social environment (e.g., safety concerns, lack of activities outside of business hours, and social norms). These findings suggest that there are unique challenges and opportunities to consider when designing ST interventions for assisted living.

scholarly journals “This Pandemic Is Making Me More Anxious about My Welfare and the Welfare of Others:” COVID-19 Stressors and Mental Health

2021 ◽  
Vol 18 (11) ◽  
pp. 5680
Author(s):  
Ramey Moore ◽  
Melissa J. Zielinski ◽  
Ronald G. Thompson ◽  
Don E. Willis ◽  
Rachel S. Purvis ◽  
...  
Keyword(s):  
Mental Health ◽  
Depressive Disorders ◽  
Ecological Model ◽  
Social Environments ◽  
Social Phenomena ◽  
Daily Lives ◽  
Social Distancing ◽  
Individual Level ◽  
The Social ◽  
The Individual

COVID-19 and subsequent social distancing guidelines have changed many aspects of people’s daily lives including the way that they interact within their social environment. Pandemics are inherently social phenomena, and public health measures intended to curtail transmission of COVID-19 (e.g., quarantine and social distancing) have consequences for individuals with anxiety and depression. Using qualitative methods, respondents with previously diagnosed anxiety or depression identified ways in which COVID-19 affected their symptoms at multiple levels of the social ecological model (SEM). Key themes reported were organized following the SEM. Emergent themes at the individual level are isolation/loneliness, fear of contracting COVID-19, and uncertainty about the future. Themes at the interpersonal level are: fears of family contracting COVID-19, separation from family members, and domestic relationships. Themes at the level of community and societal stressors are: employment, community and societal systems, media, and the COVID-19 pandemic. Our findings demonstrate the ways that mental health, physical health/safety, and social environments are interrelated in the experience of COVID-19 for individuals diagnosed with anxiety or depression. These findings make a significant contribution to the literature as this is the first article to document mental health stressors related to the COVID-19 pandemic among individuals with diagnosed anxiety and depressive disorders.

Postrzeganie środowiska psychospołecznego szkoły i funkcjonowanie w niej uczniów zdrowych i z chorobami przewlekłymi

2018 ◽  
Vol 63 (1 (247)) ◽  
pp. 179-197
Author(s):  
Agnieszka Małkowska-Szkutnik ◽  
Barbara Woynarowska ◽  
Joanna Mazur
Keyword(s):  
Social Relations ◽  
School Environment ◽  
Chronic Conditions ◽  
Ecological Model ◽  
Chronically Ill ◽  
Special Educational Needs ◽  
School Students ◽  
Individual Level ◽  
The Individual ◽  
Data Collections

The article presents the results of a survey on the perception of the psychosocial school environment and school functioning of lower secondary school students with and without chronic conditions. Students of grades 1–3 (N = 4,058) from randomly selected 234 public lower secondary schools from all voivodships participated in the survey. In this group 3,232 (80%) students were healthy and 798 (20%) had different chronic conditions. The anonymous “Health and school” questionnaire was used as the instrument for data collections with questions from HBSC study (Health Behaviour in School-aged Children) and from CHIP–AE Questionnaire (Child Health and Illness Profile: Adolescent Edition). Based on Urie Bronfenbrenner’s ecological model, dimensions of psychosocial school environment were analysed on the individual level (microsystem) and the social relations level (mesosystem). It was found that healthy students, in comparison with those with chronic conditions, perceived school environment and their functioning at school better. They have: a larger sense of school belonging, higher level of school competencies and achievements, larger sense that their grades are adequate to the results, a higher social position in the class and a higher level of support from peers, teachers and parents. Students with chronic conditions have higher level of workload, stress and problems associated with the school, and they also spend more time on homework. These students (about 20% of the population of school age) have special educational needs which depend on the specificity and the course of the disease. Identification of difficult areas in the functioning of chronically ill students in the school and knowledge of their perception of their school’s psychosocial environment will allow teachers to provide them with appropriate support.

scholarly journals Examining supports and barriers to breastfeeding through a socio-ecological lens: a qualitative study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kailey Snyder ◽  
Emily Hulse ◽  
Holly Dingman ◽  
Angie Cantrell ◽  
Corrine Hanson ◽  
...  
Keyword(s):  
Social Media ◽  
Ecological Model ◽  
Organizational Level ◽  
Breastfeeding Duration ◽  
Theoretical Frameworks ◽  
Individual Level ◽  
Familial Support ◽  
Effective Interventions ◽  
Mother And Child ◽  
The Individual

Abstract Background Early breastfeeding cessation is a societal concern given its importance to the health of mother and child. More effective interventions are needed to increase breastfeeding duration. Prior to developing such interventions more research is needed to examine breastfeeding supports and barriers from the perspective of breastfeeding stakeholders. One such framework that can be utilized is the Socio-Ecological Model which stems from Urie Broffenbrenner’s early theoretical frameworks (1973–1979). The purpose of this study was to examine supports and barriers to breastfeeding across environmental systems. Methods A total of 49 representatives participated in a telephone interview in Nebraska, USA in 2019. Interviewees represented various levels of the model, based on their current breastfeeding experience (i.e., mother or significant other) or occupation. A direct content analysis was performed as well as a constant comparative analysis to determine differences between level representatives. Results At the Individual level, breastfeeding is a valued behavior, however, women are hindered by exhaustion, isolation, and the time commitment of breastfeeding. At the Interpersonal level, social media, peer-to-peer, and family were identified as supports for breastfeeding, however lack of familial support was also identified as a barrier. At the community level, participants were split between identifying cultural acceptance of breastfeeding as support or barrier. At the organizational level, hospitals had supportive breastfeeding friendly policies in place however lacked enough personnel with breastfeeding expertise. At the policy level, breastfeeding legislation is supportive, however, more specific breastfeeding legislation is needed to ensure workplace breastfeeding protections. Conclusion Future efforts should target hospital-community partnerships, family-centered education, evidence-based social media strategies and improved breastfeeding legislation to ensure breastfeeding women receive effective support throughout their breastfeeding journey.

scholarly journals COVID-19 vaccine brand hesitancy and other challenges to vaccination in the Philippines

2021 ◽  
Author(s):  
Arianna Maever L Amit ◽  
Veincent Christian F Pepito ◽  
Lourdes Sumpaico-Tanchanco ◽  
Manuel M Dayrit
Keyword(s):  
Ecological Model ◽  
The Philippines ◽  
Phone Call ◽  
Political Issues ◽  
Individual Level ◽  
Vaccination Uptake ◽  
Marginalised Groups ◽  
Public Health Challenges ◽  
The Media ◽  
The Individual

Abstract Background: COVID-19 vaccines have been developed at a rapid and unprecedented pace to control the spread of the virus, and prevent hospitalisations and deaths. However, there are a series of events and factors that create barriers to vaccination. In this paper, we explore vaccination narratives and challenges experienced and observed by Filipinos during the early vaccination period in the Philippines. Material and methods: We conducted 35 interviews from a subsample of 1,599 survey respondents ages 18 and older in the Philippines. The interviews were conducted in Filipino, Cebuano, and/or English via online platforms such as Zoom or via phone call. All interviews were recorded, transcribed verbatim, translated, and analysed using inductive content analysis. To highlight the complex reasons for delaying and/or refusing COVID-19 vaccines, we embedded our findings within the social ecological model. Results: Our analysis showed that individual perceptions play a major role on the decision to vaccinate. Such perceptions are shaped by exposure to (mis)information amplified by the media, the community, and the health system. Social networks may either positively or negatively impact vaccination uptake, depending on their views on vaccines. Political issues contribute to vaccine brand hesitancy, resulting to vaccination delays and refusals. Perceived inefficiencies and inflexibility of the system also create additional barriers to the vaccine rollout in the country, especially among vulnerable and marginalised groups. Conclusions: Challenges to COVID-19 vaccination may be individual, interpersonal, and structural, which work individually and collectively. Among these barriers, our results suggest that many concerns regarding vaccination operate at the individual level. Vaccine brand hesitancy and misinformation are growing public health challenges in the country that need to be addressed. Recognising and addressing concerns at all levels are critical to solutions aimed at improving COVID-19 vaccination uptake and reach.

scholarly journals STRENGTHENING PERSONAL AND COMMUNITY DISASTER SUPPORT NETWORKS OF OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S584-S584
Author(s):  
Sato Ashida ◽  
Lena Thompson ◽  
Erin L Robinson
Keyword(s):  
Older Adults ◽  
Ecological Model ◽  
State Level ◽  
Network Size ◽  
Community Based ◽  
Individual Level ◽  
Emergency Situations ◽  
Community Based Organizations ◽  
The Individual ◽  
Post Disaster

Abstract The Ecological Model posits a multilevel approach to understanding of and strengthening social networks of community based older adults. We present findings from our intervention, network analysis, and efforts at influencing policy making at the state level to better prepare them for pre and post disaster and emergency situations. At the individual-level, we implemented the Disaster PrepWise program to help community-based older adults develop personal disaster plans. We found increases in personal emergency network size by an average of three non-familial individuals. At the community-level, we evaluated two disaster management networks in Eastern Iowa counties. We found strong collaborations in disaster planning and response among 44 governmental and community-based organizations, but weaker collaborations in supporting older residents, suggesting a need in this area. At the policy-level, we are developing a state-level network of organizations to address policy barriers to effectively support older Iowans.

Using Social Media to Understand Online Social Factors Concerning Obesity: a Systematic Review (Preprint)

2020 ◽  
Author(s):  
Chuqin Li ◽  
Adesoji Ademiluyi ◽  
Yaorong Ge ◽  
Albert Park
Keyword(s):  
Systematic Review ◽  
Social Media ◽  
Social Factors ◽  
Ecological Model ◽  
Healthy Lifestyle ◽  
Eligibility Criteria ◽  
Individual Level ◽  
Obesity Research ◽  
Four Levels ◽  
The Individual

BACKGROUND Evidence in the literature suggests social factors have a substantial role in the spread of obesity. Close social tie with an obese friend increases the probability of becoming obese. However, the role of social factors that exist in social media is underexplored in obesity research. With the rapid proliferation of social media over the past few years, individuals socialize on social media and share their health-related daily routines, including dieting and exercising. Thus, it is timely and imperative to review previous studies focused on social factors in social media and obesity. OBJECTIVE This study aimed to examine online social factors in relation to obesity research. METHODS A systematic review was conducted. We searched PubMed, ACM, and ScienceDirect for articles published by July 5, 2019. RESULTS A total of 1,608 studies were identified from the selected databases. Of these, 50 studies met eligibility criteria. Ten types of online social factors were identified, and a social-ecological model was adopted to explain their potential impact on an individual from varying levels of online social structure to social media users’ connection to the real world. CONCLUSIONS We found four levels of interaction found on social media. Gender is the only factor found at the individual level that affects user’s obesity-related online behaviors. Social support is the most predominant factor among identified factors, which benefits users for their weight loss journey at the interpersonal level. Some factors, such as stigma, are also found associated with a healthy online social environment. Understanding the effectiveness of these factors is essential to help users create and maintain a healthy lifestyle.

Sign in / Sign up

Export Citation Format

Share Document