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 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 Parents’ Active Role and ENgagement in The review of their Stillbirth/perinatal death 2 (PARENTS 2) study: a mixed-methods study of implementation

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044563
Author(s):  
Christy Burden ◽  
Danya Bakhbakhi ◽  
Alexander Edward Heazell ◽  
Mary Lynch ◽  
Laura Timlin ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Review Process ◽  
Parent Engagement ◽  
Improve Patient Safety ◽  
Parental Engagement ◽  
Mixed Methods Study ◽  
Bereaved Parents ◽  
The Uk ◽  
Improve Patient

ObjectiveWhen a formal review of care takes places after the death of a baby, parents are largely unaware it takes place and are often not meaningfully involved in the review process. Parent engagement in the process is likely to be essential for a successful review and to improve patient safety. This study aimed to evaluate an intervention process of parental engagement in perinatal mortality review (PNMR) and to identify barriers and facilitators to its implementation.DesignMixed-methods study of parents’ engagement in PNMR.SettingSingle tertiary maternity unit in the UK.ParticipantsBereaved parents and healthcare professionals (HCPs).InterventionsParent engagement in the PNMR (intervention) was based on principles derived through national consensus and qualitative research with parents, HCPs and stakeholders in the UK.OutcomesRecruitment rates, bereaved parents and HCPs’ perceptions.ResultsEighty-one per cent of bereaved parents approached (13/16) agreed to participate in the study. Two focus groups with bereaved parents (n=11) and HCP (n=7) were carried out postimplementation to investigate their perceptions of the process.Overarching findings were improved dialogue and continuity of care with parents, and improvements in the PNMR process and patient safety. Bereaved parents agreed that engagement in the PNMR process was invaluable and helped them in their grieving. HCP perceived that parent involvement improved the review process and lessons learnt from the deaths; information to understand the impact of aspects of care on the baby’s death were often only found in the parents’ recollections.ConclusionsParental engagement in the PNMR process is achievable and useful for parents and HCP alike, and critically can improve patient safety and future care for mothers and babies. To learn and prevent perinatal deaths effectively, all hospitals should give parents the option to engage with the review of their baby’s death.

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.

Impact of the ‘Learning from Excellence’ programme in NHS trusts: an exploratory study

2020 ◽  
Vol 26 (8) ◽  
pp. 1-10
Author(s):  
Maartje Kletter ◽  
Emma Plunkett ◽  
Adrian Plunkett ◽  
Helen Hunt ◽  
Paul Bird ◽  
...  
Keyword(s):  
Case Studies ◽  
Qualitative Content Analysis ◽  
Contextual Factors ◽  
Realist Evaluation ◽  
Evaluation Methodology ◽  
Organisational Performance ◽  
Programme Theory ◽  
Individual Interviews ◽  
The Uk ◽  
The Impact

Background/Aims The ‘Learning from Excellence’ (LfE) programme aims to provide a means to identify, appreciate, study and learn from episodes of excellence in frontline healthcare. The aim of this study was to explore the impact of LfE on organisational performance in NHS trusts in the United Kingdom (UK), how this impact is achieved and which contextual factors facilitate or hinder impact. Methods A survey and case studies, including individual interviews, were conducted. Data were analysed through qualitative content analysis, informed by realist evaluation methodology. Contextual factors, mechanisms and outcomes were coded, sub-themes were generated and a programme theory was developed. Results There were 47 respondents to the survey (27% response rate) and three case studies were performed. A total of 25 contextual factors were identified, of which 18 acted as a facilitator to uptake or as a barrier if absent. Additionally, 11 mechanisms and 9 outcomes were identified. A programme theory explaining how LfE can impact organisational performance in NHS trusts in the UK, and which contextual factors play a role before design, during design and during implementation, was developed. Conclusions LfE was welcomed by participants, but at the time of this study LfE had not been implemented for long enough for outcomes to be measured. Further research, particularly measuring outcomes and validating mechanisms, as well as exploring the learning based on reported events, is needed.

scholarly journals Mixed-methods process evaluation of SafeTea: a multimedia campaign to prevent hot drink scalds in young children and promote burn first aid

2020 ◽  
pp. injuryprev-2020-043909
Author(s):  
Laura Elizabeth Cowley ◽  
C Verity Bennett ◽  
Isabelle Brown ◽  
Alan Emond ◽  
Alison Mary Kemp
Keyword(s):  
Social Media ◽  
Mixed Methods ◽  
Young Children ◽  
Process Evaluation ◽  
Behavioural Change ◽  
First Aid ◽  
Multifaceted Intervention ◽  
Media Content ◽  
Educational Videos ◽  
The Uk

ObjectivesSafeTea is a multifaceted intervention delivered by community practitioners to prevent hot drink scalds to young children and improve parents’ knowledge of appropriate burn first aid. We adapted SafeTea for a national multimedia campaign, and present a mixed-methods process evaluation of the campaign.MethodsWe used social media, a website hosting downloadable materials and media publicity to disseminate key messages to parents/caregivers of young children and professionals working with these families across the UK. The SafeTea campaign was launched on National Burns Awareness Day (NBAD), October 2019, and ran for 3 months. Process evaluation measurements included social media metrics, Google Analytics, and quantitative and qualitative results from a survey of professionals who requested hard copies of the materials via the website.ResultsFindings were summarised under four themes: ‘reach’, ‘engagement’, ‘acceptability’ and ‘impact/behavioural change’. The launch on NBAD generated widespread publicity. The campaign reached a greater number of the target audience than anticipated, with over 400 000 views of the SafeTea educational videos. Parents and professionals engaged with SafeTea and expressed positive opinions of the campaign and materials. SafeTea encouraged parents to consider how to change their behaviours to minimise the risks associated with hot drinks. Reach and engagement steadily declined after the first month due to reduced publicity and social media promotion.ConclusionThe SafeTea campaign was successful in terms of reach and engagement. The launch on NBAD was essential for generating media interest. Future campaigns could be shorter, with more funding for additional social media content and promotion.

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.

scholarly journals Impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases in the UK: a mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048772
Author(s):  
Toby O Smith ◽  
Pippa Belderson ◽  
Jack R Dainty ◽  
Linda Birt ◽  
Karen Durrant ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Qualitative Study ◽  
Online Survey ◽  
Musculoskeletal Diseases ◽  
Community Dwelling ◽  
Secondary Outcome ◽  
Healthcare Provision ◽  
Social Restriction ◽  
The Uk ◽  
The Impact

ObjectivesTo determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time.DesignMixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study.SettingUK online survey and interviews with community-dwelling individuals in the East of England.ParticipantsPeople in the UK with RMDs were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study.Primary and secondary outcome measuresThe online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant’s perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens and how they experienced changes in their social networks.Results703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs 6% reported a decrease). This was significantly worse for those aged 18–60 years compared with older participants (p=0.017). The qualitative findings from 26 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home.ConclusionsPeople with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK.

scholarly journals Recall, perceptions and determinants of receiving physical activity advice amongst cancer survivors: a mixed-methods survey

2021 ◽  
Author(s):  
Samuel T. Orange ◽  
Stephen E. Gilbert ◽  
Morven C. Brown ◽  
John M. Saxton
Keyword(s):  
Physical Activity ◽  
Mixed Methods ◽  
Cancer Survivors ◽  
Sociodemographic Characteristics ◽  
Physical Activity Guidelines ◽  
Physical Activity Advice ◽  
Exercise Specialist ◽  
Tailored Approach ◽  
The Uk ◽  
Exercise Guidelines

Abstract Purpose This study explored cancer survivors’ views and experiences of receiving physical activity advice post-diagnosis. We also determined the influence of sociodemographic characteristics on the recall of physical activity advice and whether receiving advice was associated with meeting physical activity guidelines. Methods An anonymised, mixed-methods, 27-item survey was distributed to cancer survivors via online cancer communities in the UK. Results Of the 242 respondents, 52% recalled receiving physical activity advice. Of those who recalled receiving advice, only 30% received guidance on type of physical activity and 14% were referred to another source of information or exercise specialist. Advice was most often given after treatment cessation, with only 19% of respondents receiving advice during active treatment. Most respondents (56%) expressed a need for further information. There was no evidence of associations between sociodemographic characteristics and recall of physical activity advice. However, cancer survivors who perceived the physical activity advice they received as being appropriate (odds ratio [OR] 3.8, 95% confidence interval [95% CI]: 1.4–10.7) and those with a higher level of education (OR 3.2, 95% CI: 1.8–5.8) were more likely to meet aerobic exercise guidelines. Females were less likely to meet resistance exercise guidelines than males (OR 0.44, 95% CI: 0.21–0.90). Conclusion There is scope to improve the provision of physical activity advice in cancer care by providing advice in a timely manner after diagnosis, referring patients to a suitable exercise or rehabilitation specialist when indicated, and using a tailored approach to ensure the advice is appropriate for specific sociodemographic groups.

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