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 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 Formative process evaluation of a guideline-driven process for improving the cultural responsiveness of alcohol and drug treatment services

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara Farnbach ◽  
Julaine Allan ◽  
Raechel Wallace ◽  
Alexandra Aiken ◽  
Anthony Shakeshaft
Keyword(s):  
Culturally Responsive ◽  
Implementation Fidelity ◽  
Healthcare Services ◽  
Cultural Responsiveness ◽  
Free Text ◽  
Structured Interviews ◽  
Culturally Responsive Practice ◽  
Step Process ◽  
Treatment Services ◽  
Service Staff

Abstract Background To improve Australian Aboriginal and Torres Strait Islander people’s access to, and experience of, healthcare services, including Alcohol and other Drug (AoD) treatment services, principles and frameworks have been developed to optimise cultural responsiveness. Implementing those principles in practice, however, can be difficult to achieve. This study has five aims: i) to describe a five-step process developed to operationalise improvements in culturally responsive practice in AoD services; ii) to evaluate the fidelity of implementation for this five-step process; iii) to identify barriers and enablers to implementation; iv) to assess the feasibility and acceptability of this approach; and v) to describe iterative adaptation of implementation processes based on participant feedback. Methods Participating services were 15 non-Aboriginal AoD services in New South Wales, Australia. Implementation records were used to assess the implementation fidelity of the project. Structured interviews with chief executive officers or senior management were conducted, and interview data were thematically analysed to identify project acceptability, and the key enablers of, and barriers to, project implementation. Quantitative descriptive analyses were performed on the post-implementation workshop survey data, and responses to the free text questions were thematically analysed. Results A high level of implementation fidelity was achieved. Key enablers to improving culturally responsive practice were the timing of the introduction of the five-step process, the active interest of staff across a range of seniority and the availability of resources and staff time to identify and implement activities. Key barriers included addressing the unique needs of a range of treatment sub-groups, difficulty adapting activities to different service delivery models, limited time to implement change in this evaluation (three months) and the varied skill level across staff. The project was rated as being highly acceptable and relevant to service CEOs/managers and direct service staff, with planned changes perceived to be achievable and important. Based on CEO/management feedback after the project was implemented at the initial services, several improvements to processes were made. Conclusion The operationalisation of the five-step process developed to improve cultural responsiveness was feasible and acceptable and may be readily applicable to improving the cultural responsiveness of a wide variety of health and human services.

scholarly journals A systematic approach to context-mapping to prepare for health interventions: development and validation of the SETTING-tool in four countries

2021 ◽  
Vol 6 (1) ◽  
pp. e003221
Author(s):  
Evelyn A Brakema ◽  
Rianne MJJ van der Kleij ◽  
Charlotte C Poot ◽  
Niels H Chavannes ◽  
Ioanna Tsiligianni ◽  
...  
Keyword(s):  
Health Workers ◽  
Rapid Assessment ◽  
Implementation Strategies ◽  
Implementation Fidelity ◽  
Chronic Respiratory Disease ◽  
Health Interventions ◽  
Successful Implementation ◽  
Mapping Tool ◽  
Implementation Failure ◽  
Development And Validation

Effectiveness of health interventions can be substantially impaired by implementation failure. Context-driven implementation strategies are critical for successful implementation. However, there is no practical, evidence-based guidance on how to map the context in order to design context-driven strategies. Therefore, this practice paper describes the development and validation of a systematic context-mapping tool. The tool was cocreated with local end-users through a multistage approach. As proof of concept, the tool was used to map beliefs and behaviour related to chronic respiratory disease within the FRESH AIR project in Uganda, Kyrgyzstan, Vietnam and Greece. Feasibility and acceptability were evaluated using the modified Conceptual Framework for Implementation Fidelity. Effectiveness was assessed by the degree to which context-driven adjustments were made to implementation strategies of FRESH AIR health interventions. The resulting Setting-Exploration-Treasure-Trail-to-Inform-implementatioN-strateGies (SETTING-tool) consisted of six steps: (1) Coset study priorities with local stakeholders, (2) Combine a qualitative rapid assessment with a quantitative survey (a mixed-method design), (3) Use context-sensitive materials, (4) Collect data involving community researchers, (5) Analyse pragmatically and/or in-depth to ensure timely communication of findings and (6) Continuously disseminate findings to relevant stakeholders. Use of the tool proved highly feasible, acceptable and effective in each setting. To conclude, the SETTING-tool is validated to systematically map local contexts for (lung) health interventions in diverse low-resource settings. It can support policy-makers, non-governmental organisations and health workers in the design of context-driven implementation strategies. This can reduce the risk of implementation failure and the waste of resource potential. Ultimately, this could improve health outcomes.

scholarly journals Are rhetorical commitments to adolescents reflected in planning documents? An exploratory content analysis of adolescent sexual and reproductive health in Global Financing Facility country plans

2021 ◽  
Vol 18 (S1) ◽  
Author(s):  
Asha S. George ◽  
Tanya Jacobs ◽  
Mary V. Kinney ◽  
Annie Haakenstad ◽  
Neha S. Singh ◽  
...  
Keyword(s):  
Content Analysis ◽  
Reproductive Health ◽  
Health Services ◽  
Adolescent Health ◽  
Teenage Pregnancy ◽  
Sexual And Reproductive Health ◽  
Democratic Republic Of Congo ◽  
Social Determinant ◽  
Project Appraisal ◽  
School Based

Abstract Background The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health. However, very little work exists examining GFF practice, particularly for adolescent health. As momentum builds for the GFF, we examine initial GFF planning documents to inform future national and multi-lateral efforts to advance adolescent sexual and reproductive health. Methods We undertook a content analysis of the first 11 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. Results While several country documents signal understanding and investment in adolescents as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to indicators to investment. Important contributions include how teenage pregnancy is a universal concern, how adolescent and youth friendly health services and school-based programs are supported in several country documents, how gender is noted as a key social determinant critical for mainstreaming across the health system, alongside the importance of multi-sectoral collaboration, and the acknowledgement of adolescent rights. Weaknesses include the lack of comprehensive analysis of adolescent health needs, inconsistent investments in adolescent friendly health services and school based programs, missed opportunities in not supporting multi-component and multi-level initiatives to change gender norms involving adolescent boys in addition to adolescent girls, and neglect of governance approaches to broker effective multi-sectoral collaboration, community engagement and adolescent involvement. Conclusion There are important examples of how the GFF supports adolescents and their sexual and reproductive health. However, more can be done. While building on service delivery approaches more consistently, it must also fund initiatives that address the main social and systems drivers of adolescent health. This requires capacity building for the technical aspects of adolescent health, but also engaging politically to ensure that the right actors are convened to prioritize adolescent health in country plans and to ensure accountability in the GFF process itself.

scholarly journals Professional perspectives on providing recovery-oriented services in Taiwan: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yen-Ching Chang ◽  
Ling-Hui Chang ◽  
Su-Ting Hsu ◽  
Meng-Wen Huang
Keyword(s):  
Mental Health Professionals ◽  
Organizational Support ◽  
Psychiatric Rehabilitation ◽  
Successful Implementation ◽  
Policy Changes ◽  
Structured Interviews ◽  
Team Collaboration ◽  
Self Confidence ◽  
Professional Perspectives ◽  
Implementation Problems

Abstract Background The experiences of professionals in well-established recovery-oriented programs are valuable for professionals in similar practice settings. This study explored professionals’ experiences with providing recovery-oriented services in community psychiatric rehabilitation organizations. Methods Semi-structured interviews were conducted with 14 professionals from five recovery-oriented psychiatric rehabilitation organizations in Taiwan. The interviews were recorded and transcribed verbatim. Thematic analysis was used for the qualitative data analysis. Results The analyses documented three main themes with 13 subthemes. Recovery-oriented service implementation included seven subthemes: Enabling clients to set their own goals and make decisions, using a strengths-based approach, establishing partnerships with clients, improving individuals’ self-acceptance, encouraging community participation, seeking family, peer, and organizational support, and building team collaboration. Problems with implementing recovery-oriented services included limited policy and organizational support, a lack of understanding of recovery among professionals, stigma, clients’ lack of motivation or self-confidence in their own ability to achieve recovery, and passive or overprotective family members. Strategies to resolve implementation problems included policy changes and organizational support, improving the recovery competence and confidence of professionals, and family and public education. Conclusions To date, this is the first known study examining the perspectives of mental health professionals who have experience implementing recovery-oriented services in Asia. The participants identified family collaboration, anti-stigma efforts, and changes in policy and attitudes as critical to successful implementation and delivery of recovery-oriented services.

Blended learning: Barriers and drawbacks for English language lecturers at Vietnamese universities

2021 ◽  
pp. 204275302110482
Author(s):  
Thi Nguyet Le ◽  
Bill Allen ◽  
Nicola F Johnson
Keyword(s):  
Blended Learning ◽  
Teaching And Learning ◽  
English Language ◽  
English Language Teaching ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Policy And Practice ◽  
Web Based ◽  
Learning Barriers ◽  
Teaching Time

Although blended learning (BL) has emerged as one of the most dominant delivery modes in higher education in the 21st century, there are notable barriers and drawbacks in using BL for English language teaching and learning in Vietnamese universities. This study reports on research into the use of BL, conducted through semi-structured interviews with 30 English as a Foreign Language (EFL) lecturers from 10 different universities across the two major cities of Vietnam. The findings revealed that EFL lecturers identified eight groups of barriers and four groups of drawbacks to the successful implementation of BL. The most significant barriers included: lack of infrastructure and technology, institutional policies and support; lack of knowledge, experience and investment in using BL; lack of technological competence and information technology (IT) skills and lack of teaching time to employ web-based technologies and online resources in classrooms. Meanwhile, the most crucial drawbacks were: lecturers’ workload, ineffective use of BL, time consumption and demotivation. The authors point to the underlying factors contributing to these barriers and drawbacks and make implications for how some of these can be effectively addressed through constructive changes to policy and practice.

scholarly journals Period poverty in rural Uganda; an exploration of the challenges and the need for intervention

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Kennedy ◽  
J Severe
Keyword(s):  
Community Setting ◽  
Female Education ◽  
Structured Interviews ◽  
Intervention Programme ◽  
Cross Sectional ◽  
School Year ◽  
Main Challenge ◽  
The Common ◽  
Women And Girls ◽  
Academic Year

Abstract Background Period poverty refers to a lack of access to safe means of managing menstruation. It affects the education, health and dignity of millions of women and girls globally. This study aims to identify the barriers facing menstruating girls in rural Uganda, investigate the effects of period poverty in this demographic and assess the need to implement a programme to tackle challenges identified. Methods A qualitative study was undertaken in a community setting. 42 Participants were selected in Bududa, Uganda using convenience sampling. School-age girls supported by The Shelo Foundation (charity no.1155142) who had begun menstruating and adults in positions of responsibility in the community were interviewed to gain a cross sectional understanding of the questions posed. Data was collected prospectively in semi-structured interviews over a four-week period in July 2013. Questions focused on access to essential hygiene materials, challenges faced when menstruating (with a focus on accessing education) and possible solutions to the barriers reported. Interview transcripts were analysed; the common concepts were identified, and conclusions drawn from the results. Results Inability to access sanitation products, due to financial poverty and local availability, was the main challenge highlighted throughout the analysis of the interview transcripts. The other common themes included lack of suitable hygiene facilities, absence of education on menstruation and the vulnerability of menstruating girls to abuse and stigma. Analysis found that on average girls were missing three days of school a month due to their periods, equalling 18% of the academic year. Conclusions Period poverty disadvantages school-aged females in Bududa, Uganda. Financial poverty, lack of education and stigma contribute to period poverty. An intervention programme including accessible sanitation products and education is recommended to tackle this gender inequality for girls in this population. Key messages A lack of sanitation products, subpar education and stigma contribute to period poverty in Uganda and negatively impact female education with menstruating students missing up to 18% of a school year. An intervention programme incorporating access to sanitation products alongside education is recommended to tackle period poverty in this population and improve women’s health and female education.

scholarly journals Investigating the barriers and facilitators to implementing mental health first aid in the workplace: a qualitative study

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Melanie Jay Narayanasamy ◽  
Louise Thomson ◽  
Carol Coole ◽  
Fiona Nouri ◽  
Avril Drummond
Keyword(s):  
Mental Health ◽  
Good Practice ◽  
First Aid ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Mental Health First Aid ◽  
Structured Interviews ◽  
Content Type ◽  
Factors Affecting ◽  
Employee Characteristics

Purpose There has been little research into the use and efficacy of Mental Health First Aid (MHFA) across UK workplaces. This paper aims to investigate the implementation of MHFA across six UK organisations, identifying key barriers and facilitators. Design/methodology/approach Twenty-seven workplace representatives were recruited from six organisations through purposive sampling and took part in semi-structured interviews exploring their experiences of workplace MHFA. The data underwent thematic analysis, identifying key themes around implementation. Findings Implementation varied across organisations, including different reasons for initial interest in the programme, and variable ways that MHFA-trained employees operated post-training. Key barriers to successful implementation included negative attitudes around mental health, the perception that MHFA roles were onerous, and employees’ reluctance to engage in the MHFA programme. Successful implementation was perceived to be based on individual qualities of MHFA instructors and good practice demonstrated by trained individuals in the workplace. The role of the inner organisational setting and employee characteristics were further highlighted as barriers and facilitators to effective implementation. Research limitations/implications MHFA is a complex intervention, presenting in different ways when implemented into complex workplace settings. As such, traditional evaluation methods may not be appropriate for gaining insights into its effectiveness. Future evaluations of workplace MHFA must consider the complexity of implementing and operationalising this intervention in the workplace. Originality/value This study is the first to highlight the factors affecting successful implementation of MHFA across a range of UK workplaces.

scholarly journals Socio-economic Determinants of Adolescent Health in Russia

2018 ◽  
Vol 2 (3) ◽  
pp. 70-113
Author(s):  
P. Gazizullina
Keyword(s):  
Adolescent Health ◽  
Structured Interviews ◽  
Economic Determinants ◽  
Promotion Policy ◽  
The Republic ◽  
Definition Of ◽  
Two Stages ◽  
Public Health Promotion ◽  
First Time ◽  
Quantitative And Qualitative Methods

The article presents the results of a comprehensive study of the socio-economic determinants of the health of Russian adolescents, performed using quantitative and qualitative methods. The quantitative analysis was carried out on the basis of the data of the Russian Monitoring of the Economic Situation and Health conducted by the Higher School of Economics for 2010-2016 (19th- 25th waves) using the logistic regression apparatus. Qualitative data are obtained by conducting 39 semi-structured interviews with adolescents aged 14-17 living in the Republic of Udmurtia and the Moscow Region in two stages: in 2010 and 2013. Within the framework of the study, the complex of socio-cultural determinants of health is separately singled out for the first time and its significance is shown for the health of Russian teenagers. The definition of the most significant socio-economic determinants of adolescent health enabled developing a series of recommendations in the area of public health promotion policy.

scholarly journals Effective Factors in the Establishment and Implementation of Patient Electronic Referral System in the Healthcare System: A Qualitative Study

2021 ◽  
Author(s):  
Fatemeh Tajari ◽  
Ghahraman Mahmoudi ◽  
Fatemeh Dabbaghi ◽  
Jamshid Yazdani-Charati
Keyword(s):  
Content Analysis ◽  
Resource Management ◽  
Service Providers ◽  
Referral System ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Health Services Use ◽  
Effective Factors ◽  
Use Of Resources ◽  
Electronic Referral

Background and Purpose: The electronic referral system was established in Iran with the aim of increasing access to care, improving interaction, and efficient use of resources. The purpose of this study was to determine the effective factors in the establishment and implementation of electronic referral system in Iran. Methods: The present study was qualitative with a content analysis approach. In order to collect information, in-depth and semi-structured interviews were used. After interviewing 42 people, the information was saturated. The interviews were transcribed and analyzed, and the main topics were quoted, cited, and coded. The content analysis method was used and all authors participated in the analysis process to avoid bias and agreement. Results: Four main themes and eleven sub-themes were mentioned as effective themes in the implementation of the electronic referral system by the interviewees including resource management (human resource management, financing and equipment, and infrastructure), stewardship (policy-making, inter-sectorial leadership, and intra-sectorial governance), advocacy stakeholders (senior officials and policy-makers related to the program, service providers, community), and social commitment (commitment and accountability of service providers). Conclusions: Successful implementation of electronic referral systems requires the development of an operational plan that correctly identifies the factors affecting the establishment and implementation, as well as the cooperation of all responsible organizations which can help improve the establishment and sustainability of the program. It is suggested that managers and officials active in the field of health services use the results of this study in the establishment and implementation of electronic referral system.

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