scholarly journals The key components of a successful model of midwifery-led continuity of carer, without continuity at birth: findings from a qualitative implementation evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Dharni ◽  
◽  
H. Essex ◽  
M. J. Bryant ◽  
A. Cronin de Chavez ◽  
...  
Keyword(s):  
Postnatal Care ◽  
Administrative Support ◽  
Care Delivery ◽  
Implementation Fidelity ◽  
Standard Approach ◽  
Future Research ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Additional Time ◽  
Continuity Of Carer

Abstract Background Recent UK maternity policy changes recommend that a named midwife supports women throughout their pregnancy, birth and postnatal care. Whilst many studies report high levels of satisfaction amongst women receiving, and midwives providing, this level of continuity of carer, there are concerns some midwives may experience burnout and stress. In this study, we present a qualitative evaluation of the implementation of a midwife-led continuity of carer model that excluded continuity of carer at the birth. Methods Underpinned by the Conceptual Model for Implementation Fidelity, our evaluation explored the implementation, fidelity, reach and satisfaction of the continuity of carer model. Semi-structured interviews were undertaken with midwives (n = 7) and women (n = 15) from continuity of carer team. To enable comparisons between care approaches, midwives (n = 7) and women (n = 10) from standard approach teams were also interviewed. Interviews were recorded, transcribed and analysed using thematic analysis. Results For continuity of carer team midwives, manageable caseloads, extended appointment times, increased team stability, and flexible working patterns facilitated both care provided and midwives’ job satisfaction. Both continuity of carer and standard approach midwives reported challenges in providing postnatal continuity given the unpredictable timing of labour and birth. Time constraints, inadequate staffing and lack of administrative support were reported as additional barriers to implementing continuity of carer within standard approach teams. Women reported continuity was integral to building trust with midwives, encouraged them to disclose mental health issues and increased their confidence in making birth choices. Conclusions Our evaluation highlighted the successful implementation of a continuity of carer model for ante and postnatal care. Despite exclusion of the birth element in the model, both women and midwives expressed high levels of satisfaction in comparison to women and midwives within the standard approach. Implementation successes were largely due to structural and resource factors, particularly the combination of additional time and smaller caseloads of women. However, these resources are not widely available within the resources of maternity unit budgets. Future research should further explore whether a continuity of carer model focusing on antenatal and postnatal care delivery is a feasible and sustainable model of care for all women.

scholarly journals Implementation evaluation of a collective impact initiative to promote adolescent health in Oklahoma County, USA

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Whitney R. Garney ◽  
Sonya Panjwani ◽  
Kelly Wilson ◽  
Kristen E. Garcia ◽  
Sharayah Fore ◽  
...  
Keyword(s):  
Adolescent Health ◽  
Teenage Pregnancy ◽  
Organizational Capacity ◽  
Community Setting ◽  
Implementation Fidelity ◽  
Community Context ◽  
Collective Impact ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Implementation Evaluation

Abstract Background The teenage birth rate in the USA has considerably decreased in recent decades; however, more innovative, collaborative approaches are needed to promote adolescent health and prevent teenage pregnancy at the community level. Despite literature on the promising results of the collective impact (CI) model for health promotion, there is limited literature on the model’s ability to reduce teenage pregnancies in a community. The Central Oklahoma Teen Pregnancy Prevention Collaboration is applying the CI model to foster collaboration among multiple stakeholders with the goal of increasing community and organizational capacity to improve adolescent health outcomes. This paper reports the findings from the initiative’s implementation evaluation, which sought to understand whether the CI model improved collaboration among organizations and understand barriers and facilitators that affected program delivery. Methods Program implementers and evaluators jointly developed research questions to guide the intervention and evaluation design. The Consolidated Framework for Implementation Research (CFIR) was used to assess program components including the intervention characteristics, organization setting, community setting, facilitator characteristics, and the process of implementation. Primary sources of data included performance measures, meeting observations (n = 11), and semi-structured interviews (n = 10). The data was thematically analyzed using CFIR constructs, community capacity domains, and the five constructs of CI. Results Key findings include the need for shortened meeting times for meaningful engagement, opportunities for organizations to take on more active roles in the Collaboration, and enhanced community context expertise (i.e., those with lived experience) in all Collaboration initiatives. We identified additional elements to the core constructs of CI that are necessary for successful implementation: distinct role identification for partner organizations and incorporation of equity and inclusivity into collaboration processes and procedures. Conclusions Results from this implementation evaluation provide valuable insights into implementation fidelity, participant experience, and implementation reach of an innovative, systems-level program. Findings demonstrate the context and requirements needed to successfully implement this innovative program approach and CI overall. Additional core elements for CI are identified and contribute to the growing body of literature on successful CI initiatives.

scholarly journals Breaking the Silence of Mainstream Teachers' Attitude towards Inclusive Education in the Bahamas: High School Teachers' Perceptions

2014 ◽  
Author(s):  
Janelle Cambridge-Johnson ◽  
Yvonne Hunter-Johnson ◽  
Norissa Newton
Keyword(s):  
General Education ◽  
Inclusive Education ◽  
Administrative Support ◽  
Influential Factors ◽  
Successful Implementation ◽  
Structured Interviews ◽  
The Bahamas ◽  
Mainstream Teachers ◽  
Education Data ◽  
Positive Attitudes

There has been a paradigm shift globally regarding the adoption of inclusive education policies and procedures. However, teachers still have varying views, anxieties, and preconceive misconceptions about the successful implementation of inclusive education practices in the general education classroom. This study utilized a qualitative approach to provide an informative exploration of teachers’ attitudes toward inclusive education and its implementation, possible factors that influence teachers' attitude, and recommendations for promoting best practices in inclusive education. Data was collected utilizing semi-structured interviews from eight teachers throughout the New Providence District in the Bahamas. The results of the study revealed that teachers generally had positive attitudes toward inclusion. However, lack of funding, administrative support and minimal opportunities for training and development were identified as negative influential factors regarding teachers’ attitude towards inclusive education.

scholarly journals Challenges in managing urinary tract infection and the potential of a point-of-care test guided care in primary care: an international qualitative study

BJGP Open ◽  
2019 ◽  
Vol 3 (2) ◽  
pp. bjgpopen18X101630 ◽  
Author(s):  
Lucy Brookes-Howell ◽  
Emma Thomas-Jones ◽  
Janine Bates ◽  
Marie-Jet Bekkers ◽  
Curt Brugman ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Care Delivery ◽  
Point Of Care ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Point Of Care Test ◽  
Primary Care Clinicians

BackgroundLittle is known about clinicians’ experiences of using a point-of-care test (POCT) to inform management of urinary tract infection (UTI) in general practice.AimTo explore experiences of using the Flexicult test to inform management of UTI and views on requirements for an optimal POCT to inform successful implementation.Design & settingTelephone interviews with 35 primary care clinicians and healthcare professionals in Wales, England, Spain, and the Netherlands, who had participated in a trial of the Flexicult POCT for UTI based on urine culture.MethodThematic analysis of semi-structured interviews.ResultsMost primary care clinicians interviewed agreed on the need for a POCT in UTI management, and that the Flexicult POCT delivered quicker results than laboratory results used in usual care, reassured patients, boosted their confidence in decision-making, and reminded them about antibiotic stewardship. However, clinicians also reported difficulties in interpreting results, limitations on when the Flexicult could be used, and concerns that testing all patients would strain care delivery and prolong patient discomfort when delaying decisions until a non-rapid POCT result was available. An optimal POCT would produce more rapid results, and be reliable and easy to use. Uptake into routine care would be enhanced by: clear guidance on which patients should be tested; training for interpreting ‘grey area’ results; reiterating that even ‘straightforward’ cases might be better managed with a test; clear messages about stopping unnecessary antibiotics versus completing a course; and better self-management strategies to accompany implementation of delayed, or non-prescription of, antibiotics.ConclusionPrimary care clinicians believe that POCT tests could play a useful role in the management of UTI and gave clear recommendations for successful implementation.

scholarly journals Using the RE-AIM Framework in Formative Evaluation of the EAT Family Style Multilevel Intervention

2020 ◽  
Author(s):  
Dipti A. Dev ◽  
Irene Padasas ◽  
Carly Hillburn ◽  
Virginia Carraway-Stage ◽  
David A. Dzewaltowski
Keyword(s):  
Professional Development ◽  
Performance Monitoring ◽  
Formative Evaluation ◽  
Administrative Support ◽  
A Priori ◽  
Self Regulation ◽  
Implementation Strategies ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Family Style

Abstract Background Ecological Approach To (EAT) Family Style is a 16-week responsive feeding Early Care and Education (ECE) intervention, utilizing a multilevel improvement system of 4 implementation strategies: (a) provision of a 7-lesson, on-line professional development training for administrators and teachers (b) administrative support; (c) performance monitoring, feedback, and assistance through follow-up coaching; and (d) use of incentives. The 7 lessons cover role modeling, peer modeling, sensory exploration, self-regulation, children serve themselves, praise and rewards, and family engagement, each relying on goal setting. The evidence-based practices and implementation system was delivered to ECE administrators and teachers completing one online lesson/week followed by a coaching session with a trained coach. EAT Family Style is guided by the self-determination theory. The objective of this study was to evaluate the EAT Family Style intervention through the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.Methods Center-based ECE administrators (n=8) and teachers (n=17) caring for preschool (3-5 years) children and coaches (n=9) who participated in the EAT Family Style intervention were recruited. Semi-structured interviews were conducted, transcribed verbatim, and coded deductively by 3 coders using RE-AIM dimensions as a priori codes and placed into themes and sub-themes using thematic analysis. Results All participants perceived that EAT Family Style improved children’s nutritional and developmental outcomes and encouraged a positive mealtime environment (Effectiveness). Coaches and administrators reported EAT Family Style aligned with their professional goals and beliefs. Coaches found professional development incentives important, whereas administrators/teachers specifically valued in-service training credit hours (Adoption). Teachers reported successful implementation of EAT Family Style practices in the classroom. Administrators and coaches supported the teachers through administrative and coaching strategies (Implementation). All participants reported they intended to continue using the intervention. Administrators and teachers discussed incorporating EAT Family Style practices into handbook/school policy (Maintenance).Conclusion(s) EAT Family Style was viewed as feasible by participants. Its 4-pronged implementation strategy has the potential to improve the uptake of evidence-informed feeding practices in ECEs.

scholarly journals Factors Influencing Fidelity to a Calorie Posting Policy in Public Hospitals: A Mixed Methods Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Claire Kerins ◽  
Colette Kelly ◽  
Caitlin M. Reardon ◽  
Catherine Houghton ◽  
Elaine Toomey ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Implementation Fidelity ◽  
Public Hospitals ◽  
Hospital Environment ◽  
Future Research ◽  
Integrated Analysis ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Hospital Size ◽  
Factors Influencing

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.

Moving From Interprofessional Education Toward Interprofessional Practice: Bridging the Translation Gap

2019 ◽  
Vol 4 (5) ◽  
pp. 971-976
Author(s):  
Imran Musaji ◽  
Trisha Self ◽  
Karissa Marble-Flint ◽  
Ashwini Kanade
Keyword(s):  
Interprofessional Education ◽  
Interprofessional Collaboration ◽  
Evaluation Model ◽  
Implementation Strategies ◽  
Future Research ◽  
Successful Implementation ◽  
Interprofessional Practice ◽  
Translational Model ◽  
Key Stakeholders ◽  
Clear Identification

Purpose The purpose of this article was to propose the use of a translational model as a tool for identifying limitations of current interprofessional education (IPE) research. Translational models allow researchers to clearly define next-step research needed to translate IPE to interprofessional practice (IPP). Method Key principles, goals, and limitations of current IPE research are reviewed. A popular IPE evaluation model is examined through the lens of implementation research. The authors propose a new translational model that more clearly illustrates translational gaps that can be used to direct future research. Next steps for translating IPE to IPP are discussed. Conclusion Comprehensive reviews of the literature show that the implementation strategies adopted to date have fostered improved buy-in from key stakeholders, as evidenced by improved attitudes and perceptions toward interprofessional collaboration/practice. However, there is little evidence regarding successful implementation outcomes, such as changed clinician behaviors, changed organizational practices, or improved patient outcomes. The authors propose the use of an IPE to IPP translational model to facilitate clear identification of research gaps and to better identify future research targets.

A Qualitative Examination of User Perceptions of User-Driven and App-Controlled Hearing Technologies

2019 ◽  
Vol 28 (4) ◽  
pp. 993-1005 ◽  
Author(s):  
Gitte Keidser ◽  
Nicole Matthews ◽  
Elizabeth Convery
Keyword(s):  
Hearing Aids ◽  
Care Delivery ◽  
Hearing Aid ◽  
New Technology ◽  
Successful Implementation ◽  
Semistructured Interview ◽  
User Perceptions ◽  
Template Analysis ◽  
Training And Support ◽  
And Training

Purpose The aim of this study was to examine how hearing aid candidates perceive user-driven and app-controlled hearing aids and the effect these concepts have on traditional hearing health care delivery. Method Eleven adults (3 women, 8 men), recruited among 60 participants who had completed a research study evaluating an app-controlled, self-fitting hearing aid for 12 weeks, participated in a semistructured interview. Participants were over 55 years of age and had varied experience with hearing aids and smartphones. A template analysis was applied to data. Results Five themes emerged from the interviews: (a) prerequisites to the successful implementation of user-driven and app-controlled technologies, (b) benefits and advantages of user-driven and app-controlled technologies, (c) barriers to the acceptance and use of user-driven and app-controlled technologies, (d) beliefs that age is a significant factor in how well people will adopt new technology, and (e) consequences that flow from the adoption of user-driven and app-controlled technologies. Specifically, suggested benefits of the technology included fostering empowerment and providing cheaper and more discrete options, while challenges included lack of technological self-efficacy among older adults. Training and support were emphasized as necessary for successful adaptation and were suggested to be a focus of audiologic services in the future. Conclusion User perceptions of user-driven and app-controlled hearing technologies challenge the audiologic profession to provide adequate support and training for use of the technology and manufacturers to make the technology more accessible to older people.

Clinical dilemmas of routine outcome monitoring and clinical feedback: a qualitative study of patient experiences

2020 ◽  
Author(s):  
Stig Magne Solstad ◽  
Gøril Kleiven Solberg ◽  
Louis George Castonguay ◽  
Christian Moltu
Keyword(s):  
Mental Health ◽  
Clinical Skill ◽  
Routine Outcome Monitoring ◽  
Future Research ◽  
Successful Implementation ◽  
Basic Training ◽  
Feedback Systems ◽  
Clinical Encounters ◽  
Outcome Monitoring ◽  
Clinical Feedback

Purpose: Routine outcome monitoring (ROM) and clinical feedback systems (CFS) are becoming prevalent in mental health services. The field faces several challenges to successful implementation. The purpose of this study is to gain a better understanding of these challenges by exploring the patient perspective. Method: We report the findings from a qualitative, video assisted interview study of 12 patients from a Norwegian mental health outpatient clinic using ROM/CFS. Results: Our analysis resulted in three pairs of opposing experiences with using ROM/CFS: 1) Explicit vs. implicit use of CFS information, 2) CFS directing focus towards- vs. directing focus away from therapeutic topics and 3) Giving vs. receiving feedback. None of these were intrinsically helpful or hindering. Participants had vastly differing preferences for how to use ROM/CFS in clinical encounters, but all needed the information to be used in a meaningful way by their therapists. If not, ROM/CFS was at risk of becoming meaningless and hindering for therapy. Conclusion: These findings confirm and provide further nuance to previous research. We propose to consider ROM/CFS a clinical skill that should be a part of basic training for therapists. How to use and implement ROM/CFS skillfully should also be the focus of future research.

Stem Cell-Based Therapies: A New Ray of Hope for Diabetic Patients

2019 ◽  
Vol 14 (2) ◽  
pp. 146-151 ◽  
Author(s):  
Junaid Khan ◽  
Amit Alexander ◽  
Mukta Agrawal ◽  
Ajazuddin ◽  
Sunil Kumar Dubey ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Drug Therapy ◽  
Type I Diabetes ◽  
Embryonic Stem ◽  
Health Concern ◽  
Future Research ◽  
Diabetic Patients ◽  
Successful Implementation ◽  
Type I

Diabetes and its complications are a significant health concern throughout the globe. There are physiological differences in the mechanism of type-I and type-II diabetes and the conventional drug therapy as well as insulin administration seem to be insufficient to address the problem at large successfully. Hypoglycemic swings, frequent dose adjustments and resistance to the drug are major problems associated with drug therapy. Cellular approaches through stem cell based therapeutic interventions offer a promising solution to the problem. The need for pancreatic transplants in case of Type- I diabetes can also be by-passed/reduced due to the formation of insulin producing β cells via stem cells. Embryonic Stem Cells (ESCs) and induced Pluripotent Stem Cells (iPSCs), successfully used for generating insulin producing β cells. Although many experiments have shown promising results with stem cells in vitro, their clinical testing still needs more exploration. The review attempts to bring into light the clinical studies favoring the transplantation of stem cells in diabetic patients with an objective of improving insulin secretion and improving degeneration of different tissues in response to diabetes. It also focuses on the problems associated with successful implementation of the technique and possible directions for future research.

scholarly journals Mapping domain characteristics influencing Analytics initiatives: The example of Supply Chain Analytics

2020 ◽  
Vol 13 (1) ◽  
pp. 56
Author(s):  
Tino Herden
Keyword(s):  
Supply Chain ◽  
Supply Chain Management ◽  
Success Factors ◽  
Research Collaboration ◽  
Future Research ◽  
Structured Interviews ◽  
Chain Management ◽  
Domain Specific ◽  
The Status ◽  
The Impact

Purpose: Analytics research is increasingly divided by the domains Analytics is applied to. Literature offers little understanding whether aspects such as success factors, barriers and management of Analytics must be investigated domain-specific, while the execution of Analytics initiatives is similar across domains and similar issues occur. This article investigates characteristics of the execution of Analytics initiatives that are distinct in domains and can guide future research collaboration and focus. The research was conducted on the example of Logistics and Supply Chain Management and the respective domain-specific Analytics subfield of Supply Chain Analytics. The field of Logistics and Supply Chain Management has been recognized as early adopter of Analytics but has retracted to a midfield position comparing different domains.Design/methodology/approach: This research uses Grounded Theory based on 12 semi-structured Interviews creating a map of domain characteristics based of the paradigm scheme of Strauss and Corbin.Findings: A total of 34 characteristics of Analytics initiatives that distinguish domains in the execution of initiatives were identified, which are mapped and explained. As a blueprint for further research, the domain-specifics of Logistics and Supply Chain Management are presented and discussed.Originality/value: The results of this research stimulates cross domain research on Analytics issues and prompt research on the identified characteristics with broader understanding of the impact on Analytics initiatives. The also describe the status-quo of Analytics. Further, results help managers control the environment of initiatives and design more successful initiatives.

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