scholarly journals ‘Working relationships’ across difference - a realist review of community engagement with malaria research

2022 ◽  
Vol 7 ◽  
pp. 13
Author(s):  
Robin Vincent ◽  
Bipin Adhikari ◽  
Claire Duddy ◽  
Emma Richardson ◽  
Geoff Wong ◽  
...  
Keyword(s):  
Community Engagement ◽  
Health Research ◽  
Access To Health Care ◽  
Evidence Synthesis ◽  
Realist Review ◽  
Evidence Base ◽  
Working Relationships ◽  
Research Paradigm ◽  
Malaria Research ◽  
Conceptual Clarity

Background: Community engagement (CE) is increasingly accepted as a critical aspect of health research, because of its potential to make research more ethical, relevant and well implemented. While CE activities linked to health research have proliferated in Low and Middle Income Countries (LMICs), and are increasingly described in published literature, there is a lack of conceptual clarity around how engagement is understood to ‘work’, and the aims and purposes of engagement are varied and often not made explicit. Ultimately, the evidence base for engagement remains underdeveloped. Methods: To develop explanations for how and why CE with health research contributes to the pattern of outcomes observed in published literature, we conducted a realist review of CE with malaria research – a theory driven approach to evidence synthesis. Results: We found that community engagement relies on the development of provisional ‘working relationships’ across differences, primarily of wealth, power and culture. These relationships are rooted in interactions that are experienced as relatively responsive and respectful, and that bring tangible research related benefits. Contextual factors affecting development of working relationships include the facilitating influence of research organisation commitment to and resources for engagement, and constraining factors linked to the prevailing ‘dominant health research paradigm context’, such as: differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research. Conclusions: The development of working relationships contributes to greater acceptance and participation in research by local stakeholders, who are particularly interested in research related access to health care and other benefits. At the same time, such relationships may involve an accommodation of some ethically problematic characteristics of the dominant health research paradigm, and thereby reproduce this paradigm rather than challenge it with a different logic of collaborative partnership.

scholarly journals A realist review of community engagement with health research

2019 ◽  
Vol 4 ◽  
pp. 87 ◽  
Author(s):  
Bipin Adhikari ◽  
Robin Vincent ◽  
Geoff Wong ◽  
Claire Duddy ◽  
Emma Richardson ◽  
...  
Keyword(s):  
Global Health ◽  
Community Engagement ◽  
Health Research ◽  
Evidence Synthesis ◽  
Realist Review ◽  
Evidence Base ◽  
Programme Theory ◽  
Middle Income ◽  
Middle Income Countries ◽  
Registration Number

Introduction: Community engagement is increasingly recognized as a critical aspect of global health. Recent years have seen an expansion of community engagement activities linked to health research, but debates and inconsistencies remain about the aims of different types of engagement, mechanisms underpinning their implementation and impact, and influential contextual factors. Greater commitment to and consistency around community engagement by health research programs, implementers and funders requires a more coherent evidence base. This realist review is designed to improve our understanding of how and why community engagement contributes to intended and unintended outcomes (including research and ethical outcomes) in different contexts. Given the breadth and diversity of the literature on community engagement in health research, the review will initially focus on malaria research in low- and middle-income countries (LMICs) and draw on wider global health literature where needed. Methods and analysis: Community engagement in practice is often a complex set of interventions. We will conduct a realist review – a theory driven approach to evidence synthesis – to provide explanations for how and why community engagement with health research produces the pattern of outcomes observed across different contexts of application. We will consolidate evidence from a range of documents, including qualitative, quantitative and mixed method studies. The review will follow several stages: devising an initial programme theory, searching evidence, selecting appropriate documents, extracting data, synthesizing and refining the programme theory, and reiteration of these steps as needed. Ethics and dissemination: A formal ethics review is not required for this literature review.  Findings will be disseminated in a peer reviewed journal, through national and international conferences, and through a set of short briefings tailored for audiences with an interest in community engagement. Outputs and presentations will be informed by and feed into our network of community engagement experts. PROSPERO registration number: CRD42019125687

scholarly journals A realist review of community engagement with health research

2019 ◽  
Vol 4 ◽  
pp. 87 ◽  
Author(s):  
Bipin Adhikari ◽  
Robin Vincent ◽  
Geoff Wong ◽  
Claire Duddy ◽  
Emma Richardson ◽  
...  
Keyword(s):  
Global Health ◽  
Community Engagement ◽  
Health Research ◽  
Evidence Synthesis ◽  
Realist Review ◽  
Evidence Base ◽  
Programme Theory ◽  
Middle Income ◽  
Middle Income Countries ◽  
Registration Number

Introduction: Community engagement is increasingly recognized as a critical aspect of global health. Recent years have seen an expansion of community engagement activities linked to health research, but debates and inconsistencies remain about the aims of different types of engagement, mechanisms underpinning their implementation and impact, and influential contextual factors. Greater commitment to and consistency around community engagement by health research programs, implementers and funders requires a more coherent evidence base. This realist review is designed to improve our understanding of how and why community engagement contributes to intended and unintended outcomes (including research and ethical outcomes) in different contexts. Given the breadth and diversity of the literature on community engagement in health research, the review will initially focus on malaria research in low- and middle-income countries (LMICs) and draw on wider global health literature where needed. Methods and analysis: Community engagement in practice is often a complex set of interventions. We will conduct a realist review – a theory driven approach to evidence synthesis – to provide explanations for how and why community engagement with health research produces the pattern of outcomes observed across different contexts of application. We will consolidate evidence from a range of documents, including qualitative, quantitative and mixed method studies. The review will follow several stages: devising an initial programme theory, searching evidence, selecting appropriate documents, extracting data, synthesizing and refining the programme theory, and reiteration of these steps as needed. Ethics and dissemination: A formal ethics review is not required for this literature review.  Findings will be disseminated in a peer reviewed journal, through national and international conferences, and through a set of short briefings tailored for audiences with an interest in community engagement. Outputs and presentations will be informed by and feed into our network of community engagement experts. PROSPERO registration number: CRD42019125687

scholarly journals Remediating doctors’ performance to restore patient safety: a realist review protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e025943 ◽  
Author(s):  
Tristan Price ◽  
Nicola Brennan ◽  
Jennifer Cleland ◽  
Linda Prescott-Clements ◽  
Amanda Wanner ◽  
...  
Keyword(s):  
Patient Safety ◽  
Evidence Synthesis ◽  
Grey Literature ◽  
Realist Review ◽  
Evidence Base ◽  
Stakeholder Group ◽  
Programme Theory ◽  
Dissemination Strategy ◽  
Knowledge To Action ◽  
Patient Representatives

IntroductionUnderperformance by doctors poses a risk to patient safety. Remediation is an intervention designed to remedy underperformance and return a doctor to safe practice. Remediation is widely used across healthcare systems globally, and has clear implications for both patient safety and doctor retention. Yet, there is a poor evidence base to inform remediation programmes. In particular, there is a lack of understanding as to why and how a remedial intervention may work to change a doctor’s practice. The aim of this research is to identify why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to support patient safety.Methods and analysisRealist review is an approach to evidence synthesis that seeks to develop programme theories about how an intervention works to produce its effects. The initial search strategy will involve: database and grey literature searching, citation searching and contacting authors. The evidence search will be extended as the review progresses and becomes more focused on the development of specific aspects of the programme theory. The development of the programme theory will involve input from a stakeholder group consisting of professional experts in the remediation process and patient representatives. Evidence synthesis will use a realist logic of analysis to interrogate data in order to develop and refine the initial programme theory into a more definitive realist programme theory of how remediation works. The study will follow and be reported according to Realist And Meta-narrative Evidence Syntheses—Evolving Standards (RAMESES).Ethics and disseminationEthical approval is not required. Our dissemination strategy will include input from our stakeholder group. Customised outputs will be developed using the knowledge-to-action cycle framework, and will be targeted to: policy-makers; education providers and regulators, the National Health Service, doctors and academics.PROSPERO registration numberCRD42018088779.

scholarly journals Addressing diversity and complexity in the community engagement literature: The rationale for a realist review

2020 ◽  
Vol 5 ◽  
pp. 1
Author(s):  
Emma Z.L. Richardson ◽  
Sunita V.S. Bandewar ◽  
Renaud F. Boulanger ◽  
Rukshan Mehta ◽  
Tinya Lin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Global Health ◽  
Community Engagement ◽  
Health Research ◽  
Realist Review ◽  
Realist Synthesis ◽  
Research Note ◽  
Global Health Research ◽  
Core Elements ◽  
Failed Attempt

In this research note we reflect on our failed attempt to synthesize the community engagement literature through a standard systematic review and explain our rationale for now embarking on a realist synthesis of community engagement in global health research. We believe this paper will be helpful for many who grapple with the lack of clarity about community engagement’s core elements and mechanisms.

scholarly journals Community engagement and involvement in Ghana: conversations with community stakeholders to inform surgical research

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Karolin Kroese ◽  
Bernard Appiah Ofori ◽  
Darling Ramatu Abdulai ◽  
Mark Monahan ◽  
Angela Prah ◽  
...  
Keyword(s):  
Rural Communities ◽  
Community Engagement ◽  
Health Research ◽  
Evidence Base ◽  
Community Leaders ◽  
Advisory Group ◽  
Rural Ghana ◽  
Community Stakeholders ◽  
Public Advisory ◽  
The Uk

Abstract Background Involving patients and communities with health research in low- and middle-income countries (LMICs) contributes to increasing the likelihood that research is relevant in local context and caters to the needs of the population, including vulnerable and marginalised groups. When done right, it can also support empowerment of wider communities in taking ownership of their own health, lead to increased access and uptake of health services and generally improve the wellbeing of individuals. However, the evidence base of how to undertake successful community engagement and involvement (CEI) activities in LMICs is sparse. This paper aims to add to the available literature and describes how the Global Health Research Unit on Global Surgery’s (GSU) team in Ghana worked collaboratively with the Unit’s team in the UK and a UK-based Public Advisory Group to involve community stakeholders in rural Ghana with surgical research. The aim was to explore ways of reaching out to patients and community leaders in rural Ghana to have conversations that inform the relevance, acceptability, and feasibility of a clinical trial, called TIGER. Methods As this kind of larger scale involvement of community stakeholders with research was a novel way of working for the team in Ghana, a reflective approach was taken to outline step-by-step how the GSU team planned and undertook these involvement activities with 31 hernia patients, two Chiefs (community leaders), a community finance officer and a local politician in various locations in Ghana. The barriers that were experienced and the benefits of involving community stakeholders are highlighted with the aim to add to the evidence base of CEI in LMICs. Results GSU members from the UK and Ghana planned and organised successful involvement activities that focused on establishing the best way to talk to patients and other community stakeholders about their experiences of living with hernias and undergoing hernia repairs, and their perceptions of the impact of hernias on the wider community. The Ghanaian team suggested 1:1 conversations in easily accessible locations for rural patient contributors, creating a welcoming environment and addressing contributors in their local dialects. A UK-based Public Advisory Group helped in the initial stages of planning these conversations by highlighting potential barriers when approaching rural communities and advising on how to phrase questions around personal experiences. Conversations mainly focused on understanding the needs of hernia patients in rural Ghana to then incorporate these in the design of the TIGER trial to ensure its relevance, acceptability and feasibility. When talking to patient contributors, the GSU teams found that they were more likely to open up when they knew members of the team and the opportunity to speak to local leaders only arose because of the Ghanaian team members being well-respected amongst communities. The experiences of the patient and community contributors led to changes in the study protocol, such as including women in the patient cohort for the trial, and allowed the GSU teams to confirm the relevance and acceptability of this trial. These conversations also taught the team a lot about perceptions of health in rural communities, allowed the Ghanaian team to establish relationships with community leaders that can be utilised when future studies need input from the public, and has changed the minds of the Ghanaian research team about the importance of involving patients with research. Conclusion This paper contributes to the evidence base on successful CEI activities in LMICs by providing an example of how CEI can be planned and organised, and the benefits this provides. The conversations the teams had with patient contributors in Ghana are an example of successful patient consultations. Even though there are certain limitations to the extent of these involvement activities, a solid foundation has been built for researchers and community stakeholders to establish relationships for ongoing involvement.

scholarly journals Addressing diversity and complexity in the community engagement literature: The rationale for a realist review

2021 ◽  
Vol 5 ◽  
pp. 1
Author(s):  
Emma Z.L. Richardson ◽  
Sunita V.S. Bandewar ◽  
Renaud F. Boulanger ◽  
Rukshan Mehta ◽  
Tinya Lin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Global Health ◽  
Community Engagement ◽  
Health Research ◽  
Realist Review ◽  
Realist Synthesis ◽  
Research Note ◽  
Global Health Research ◽  
Core Elements ◽  
Failed Attempt

In this research note we reflect on our failed attempt to synthesize the community engagement literature through a standard systematic review and explain our rationale for now embarking on a realist synthesis of community engagement in global health research. We believe this paper will be helpful for many who grapple with the lack of clarity about community engagement’s core elements and mechanisms.

Psychological Trauma in the Context of Familial Relationships: A Concept Analysis

2017 ◽  
Vol 20 (4) ◽  
pp. 549-559 ◽  
Author(s):  
Sophie Isobel ◽  
Melinda Goodyear ◽  
Kim Foster
Keyword(s):  
Psychological Trauma ◽  
Evidence Base ◽  
Concept Analysis ◽  
Philosophical Inquiry ◽  
Attachment Trauma ◽  
Trauma Research ◽  
Familial Relationships ◽  
Conceptual Clarity ◽  
Relational Trauma

Many forms of psychological trauma are known to develop interpersonally within important relationships, particularly familial. Within the varying theoretical constructs of psychological traumas, and distinct from the processes of diagnosis, there is a need to refine the scope and definitions of psychological traumas that occur within important familial relationships to ensure a cohesive evidence base and fidelity of the concept in application to practice. This review used a philosophical inquiry methodology of concept analysis to identify the definitions, antecedents, characteristics, and consequences of the varying conceptualizations of psychological trauma occurring within important relationships. Interactions between concepts of interpersonal trauma, relational trauma, betrayal trauma, attachment trauma, developmental trauma, complex trauma, cumulative trauma, and intergenerational trauma are presented. Understanding of the discrete forms and pathways of transmission of psychological trauma between individuals, including transgenerationally within families, creates opportunities for prevention and early intervention within trauma-focused practice. This review found that concepts of psychological trauma occurring within familial relationships are not exclusive of each other but overlap in their encompassment of events and circumstances as well as the effect on individuals of events in the short term and long term. These traumas develop and are transmitted in the space between people, both purposefully and incidentally, and have particularly profound effects when they involve a dependent infant or child. Linguistic and conceptual clarity is paramount for trauma research and practice.

scholarly journals Patient and carer involvement in palliative care research: An integrative qualitative evidence synthesis review

2019 ◽  
Vol 33 (8) ◽  
pp. 969-984 ◽  
Author(s):  
Eleni Chambers ◽  
Clare Gardiner ◽  
Jill Thompson ◽  
Jane Seymour
Keyword(s):  
Palliative Care ◽  
Evidence Synthesis ◽  
Evidence Base ◽  
Qualitative Evidence Synthesis ◽  
Training Support ◽  
Care Research ◽  
Qualitative Evidence ◽  
Health And Social Care ◽  
Facilitators And Barriers ◽  
The Impact

Background: Patient/carer involvement in palliative care research has been reported as complex, difficult and less advanced compared to other areas of health and social care research. There is seemingly limited evidence on impact and effectiveness. Aim: To examine the evidence regarding patient/carer involvement in palliative care research and identify the facilitators, barriers, impacts and gaps in the evidence base. Design: Qualitative evidence synthesis using an integrative review approach and thematic analysis. Data sources: Electronic databases were searched up to March 2018. Additional methods included searching websites and ongoing/unpublished studies, author searching and contacting experts. Eligibility criteria were based on the SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) framework. Two quality assessments on methodology and involvement were undertaken. Results: A total of 93 records were included. Eight main themes were identified, mainly concerning facilitators and barriers to effective patient and carer involvement in palliative care research: definitions/roles, values/principles, organisations/culture, training/support, networking/groups, perspectives/diversity, relationships/communication and emotions/impact. Evidence on the impact of involvement was limited, but when carried out effectively, involvement brought positive benefits for all concerned, improving the relevance and quality of research. Evidence gaps were found in non-cancer populations and collaborative/user-led involvement. Conclusion: Evidence identified suggests that involvement in palliative care research is challenging, but not dissimilar to that elsewhere. The facilitators and barriers identified relate mainly to the conduct of researchers at an individual level; in particular, there exists a reluctance among professionals to undertake involvement, and myths still perpetuate that patients/carers do not want to be involved. A developed infrastructure, more involvement-friendly organisational cultures and a strengthening of the evidence base would also be beneficial.

scholarly journals Contemporary Thyroid Nodule Evaluation and Management

2020 ◽  
Vol 105 (9) ◽  
pp. 2869-2883 ◽  
Author(s):  
Giorgio Grani ◽  
Marialuisa Sponziello ◽  
Valeria Pecce ◽  
Valeria Ramundo ◽  
Cosimo Durante
Keyword(s):  
Thyroid Nodule ◽  
Access To Health Care ◽  
English Language ◽  
Evidence Synthesis ◽  
Low Frequency ◽  
Initial Assessment ◽  
Molecular Testing ◽  
Data Systems ◽  
Sonographic Examination ◽  
Pubmed Search

Abstract Context Approximately 60% of adults harbor 1 or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The widespread use of diagnostic imaging and improved access to health care favor the discovery of small, subclinical nodules and small papillary cancers. Overdiagnosis and overtreatment is associated with potentially excessive costs and nonnegligible morbidity for patients. Evidence Acquisition We conducted a PubMed search for the recent English-language articles dealing with thyroid nodule management. Evidence Synthesis The initial assessment includes an evaluation of clinical risk factors and sonographic examination of the neck. Sonographic risk-stratification systems (e.g., Thyroid Imaging Reporting and Data Systems) can be used to estimate the risk of malignancy and the need for biopsy based on nodule features and size. When cytology findings are indeterminate, molecular analysis of the aspirate may obviate the need for diagnostic surgery. Many nodules will not require biopsy. These nodules and those that are cytologically benign can be managed with long-term follow-up alone. If malignancy is suspected, options include surgery (increasingly less extensive), active surveillance or, in selected cases, minimally invasive techniques. Conclusion Thyroid nodule evaluation is no longer a 1-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients as frankly as possible to identify an approach that best meets their needs.

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