The process evaluation of a pragmatic implementation trial to support self-management for the prevention and management of type 2 diabetes in Uganda, South Africa and Sweden in the SMART2D project

Abstract BackgroundType 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy lifestyle and self-management is paramount, but not adequately implemented in health systems in most countries. Process evaluations facilitate understanding why and how interventions work through analysing the interaction between intervention theory, implementation and context. The SMART2D project implemented and evaluated community-based support interventions for persons at high risk of or having T2D in a rural community in Uganda, an urban township in South Africa, and socio-economically disadvantaged urban communities in Sweden. This study presents comprehensive analyses of the implementation process and interaction with context.MethodsThis paper reports implementation process outcomes across the three sites, guided by the MRC framework for complex intervention process evaluations and focusing on the three community strategies (peer support program; care companion; and link between facility care and community support). Data were collected through observations of peer support group meetings using a structured guide, and semi-structured interviews with project managers, implementers and participants.ResultsThe countries focused their in-depth implementation in accordance with the feasibility and relevance in the context. In Uganda and Sweden, the implementation focused on the peer support intervention whereas in South Africa, it centred around the CC part. The community-facility link received the least attention in the implementation. Continuous capacity building received a lot of attention, but intervention reach, dose delivered and fidelity varied substantially. Intervention- and context-related barriers affected participation. The analysis revealed how context shaped the possibilities of implementation, the delivery and participation and affected the mechanism of impact.ConclusionsIdentification of the key uncertainties and conditions facilitates focus and efficient use of resources in process evaluations, and context relevant findings. The use of an overarching framework allows to collect cross-contextual evidence and a flexibility in evaluation design to adapt to the complex nature of the intervention. When designing an intervention, it is crucial to consider aspects of the implementing organization or structure, absorptive capacity, and to thoroughly assess and discuss implementation feasibility, capacity and organizational context with the implementation team and recipients. These recommendations are important for implementation and scale up.Trial registrationISRCTN 11913581 (Registration 1/10/2017, https://doi.org/10.1186/ISRCTN11913581)

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The Process Evaluation of a Comparative Controlled Trial to Support Self-management for the Prevention and Management of Type 2 Diabetes in Uganda, South Africa and Sweden in the SMART2D Project.

10.21203/rs.3.rs-581101/v1 ◽

2021 ◽

Author(s):

Josefien van Olmen ◽

Pilvikki Absetz ◽

Roy William Mayega ◽

Linda Timm ◽

Peter Delobelle ◽

...

Keyword(s):

South Africa ◽

Type 2 Diabetes ◽

Peer Support ◽

Organizational Context ◽

Implementation Process ◽

Community Support ◽

Self Management ◽

Use Of Resources ◽

Process Evaluations

Abstract Background. Type 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy lifestyle and self-management is paramount, but not adequately implemented in health systems in most countries. Process evaluations facilitate understanding why and how interventions work through analysing the interaction between intervention theory, implementation and context. The SMART2D project implemented and evaluated community-based support interventions for persons at high risk of or having T2D in a rural community in Uganda, an urban township in South Africa, and socio-economically disadvantaged urban communities in Sweden. This study presents comprehensive analyses of the implementation process and interaction with context. Methods. This paper reports implementation process outcomes across the three sites, guided by the MRC framework for complex intervention process evaluations and focusing on the three community strategies (peer support program; care companion; and link between facility care and community support). Data were collected through observations of peer support group meetings using a structured guide, and semi-structured interviews with project managers, implementers and participants. Results. The countries focused their in-depth implementation in accordance with the feasibility and relevance in the context. In Uganda and Sweden, the implementation focused on the peer support intervention whereas in South Africa, it centred around the CC part. The community-facility link received the least attention in the implementation. Continuous capacity building received a lot of attention, but intervention reach, dose delivered and fidelity varied substantially. Intervention- and context-related barriers affected participation. The analysis revealed how context shaped the possibilities of implementation, the delivery and participation and affected the mechanism of impact. Conclusions. Identification of the key uncertainties and conditions facilitates focus and efficient use of resources in process evaluations, and context relevant findings. The use of an overarching framework allows to collect cross-contextual evidence and a flexibility in evaluation design to adapt to the complex nature of the intervention. When designing an intervention, it is crucial to consider aspects of the implementing organization or structure, absorptive capacity, and to thoroughly assess and discuss implementation feasibility, capacity and organizational context with the implementation team and recipients. These recommendations are important for implementation and scale up. Trial registration. ISRCTN 11913581 (Registration 1/10/2017, https://doi.org/10.1186/ISRCTN11913581)

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SMART2D—development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden

Translational Behavioral Medicine ◽

10.1093/tbm/ibz188 ◽

2020 ◽

Vol 10 (1) ◽

pp. 25-34

Author(s):

Pilvikki Absetz ◽

Josefien Van Olmen ◽

David Guwatudde ◽

Thandi Puoane ◽

Helle Mölsted Alvesson ◽

...

Keyword(s):

South Africa ◽

Type 2 Diabetes ◽

Community Support ◽

Self Management ◽

Local Context ◽

Situational Analysis ◽

Socioeconomically Disadvantaged ◽

Increased Risk ◽

Community Strategies

Abstract Type 2 diabetes (T2D) and its complications are increasing rapidly in low- and middle-income countries, as well as among socioeconomically disadvantaged populations in high-income countries. Support for healthy lifestyle and self-management is paramount but not well implemented in health systems, and there is need for knowledge on how to design and implement interventions that are contextualized and patient centered and address special needs of disadvantaged population groups. The SMART2D project implements and evaluates a lifestyle and self-management intervention for participants recently diagnosed with or being at increased risk for T2D in rural communities in Uganda, an urban township in South Africa, and socioeconomically disadvantaged urban communities in Sweden. Our aim was to develop an intervention with shared key functions and a good fit with the local context, needs, and resources. The intervention program design was conducted in three steps facilitated by a coordinating team: (a) situational analysis based on the SMART2D Self-Management Framework and definition of intervention objectives and core strategies; (b) designing generic tools for the strategies; and (c) contextual translation of the generic tools and their delivery. This article focuses on community strategies to strengthen support from the social and physical environment and to link health care and community support. Situational analyses showed that objectives and key functions addressing mediators from the SMART2D framework could be shared. Generic tools ensured retaining of functions, while content and delivery were highly contextualized. Phased, collaborative approach and theoretical framework ensured that key functions were not lost in contextualization, also allowing for cross-comparison despite flexibility with other aspects of the intervention between the sites. The trial registration number of this study is ISRCTN11913581.

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Corporate Social Responsibility Implementation - Lessons from Uganda

Makerere Business Journal ◽

10.33117/512 ◽

2017 ◽

Vol 13 (1) ◽

pp. 47-69

Keyword(s):

Sustainable Development ◽

Corporate Social Responsibility ◽

Social Responsibility ◽

Stakeholder Involvement ◽

Implementation Process ◽

Structured Interviews ◽

Implementation Success ◽

Success Model ◽

Strategic Csr ◽

Corporate Social

Purpose: This paper presents aspects of a Corporate Social Responsibility (CSR) Implementation Success Model to guide CSR engagements. Design/methodology/approach: A qualitative case methodology is used to investigate two CSR companies in Uganda. Semi-structured interviews with managers and stakeholders are conducted. Data triangulation includes reviewing CSR reports and documents, and visiting communities and CSR activities/projects mentioned in the case companies’ reports. Grounded theory guides the data analysis and aggregation. Findings: The findings culminate into a “CSR Implementation Success Model. ” Key aspects of CSR implementation success are identified as: (i) involvement of stakeholders and management (i.e., co-production) at the start and during every stage of CSR implementation; (ii) management of challenges and conflicts arising within/outside of the company itself; and (iii) feedback management or performance assessment—i.e., accountability via CSR communications and reporting. Stakeholder involvement and feedback management (accountability) are pivotal, though all three must be considered equally. Research limitations: The studied companies were large and well-established mature companies, so it is unclear whether newer companies and small and medium-sized enterprises would produce similar findings. Practical implications: Successful CSR implementation starts with a common but strategic understanding of what CSR means to the company. However, CSR implementation should (i) yield benefits that are tangible, and (ii) have a sustainable development impact because these two aspects form implementation benchmarks. Additionally, top management should be involved in CSR implementation, but with clear reasons and means. Originality/value: This paper unearths a CSR Implementation Success Model that amplifies views of “creating shared value” for sustainable development. It guides organizations towards strategic CSR, as opposed to the responsive CSR (returning profits to society) that largely dominates in developing countries. Additionally, it explains how to add value to the resource envelope lubricating the entire CSR implementation process

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The Integration of ERM and Strategy: Implications for Corporate Governance

Accounting Horizons ◽

10.2308/acch-51692 ◽

2017 ◽

Vol 31 (2) ◽

pp. 69-82 ◽

Cited By ~ 10

Author(s):

Therese R. Viscelli ◽

Dana R. Hermanson ◽

Mark S. Beasley

Keyword(s):

Corporate Governance ◽

Boards Of Directors ◽

Implementation Process ◽

Structured Interviews ◽

Executive Management ◽

Strategic Direction ◽

Strategic Value ◽

Enterprise Risk ◽

Leadership Structure ◽

Risk Oversight

SYNOPSIS Since the early 2000s, expectations have increased for organizations to strengthen corporate governance with enterprise risk management (ERM) processes, with the accounting profession playing a major role in these efforts. The ultimate goal of an effective ERM process is to help boards and senior executives to manage risks in the context of strategy so that the organization is more likely to achieve its key objectives. We conduct semi-structured interviews of 15 ERM champions to provide insights about whether the ERM process is integrated with the strategic-planning and execution processes of the firm. We find that while the decision to launch ERM often is based on a desire for ERM to provide strategic value, the integration of ERM with strategy typically is limited. We then examine the ERM implementation process to identify possible ERM implementation practices limiting ERM's integration with strategy. We find that organizations' (1) culture and approach to preparing for ERM's launch, (2) ERM leadership structure, and (3) management of key risks appear to limit the intersection of ERM and strategy. Our summary of key findings highlights important considerations for boards of directors, executive management, and auditors as they assess the effectiveness of their risk oversight efforts in overseeing the strategic direction of the enterprise.

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Gender Differences and Their Influences on T2DM Self-Management Among Spanish-Speaking Latinx Immigrants

Hispanic Health Care International ◽

10.1177/15404153211011727 ◽

2021 ◽

pp. 154041532110117

Author(s):

Cheryl A. Smith-Miller ◽

Diane C. Berry ◽

Cass T. Miller

Keyword(s):

Gender Differences ◽

Health Literacy ◽

English Language ◽

Educational Achievement ◽

Self Management ◽

Structured Interviews ◽

Health Promoting Behaviors ◽

History Of ◽

Health Promoting ◽

Excessive Alcohol

Introduction: Evidence suggests that gender may influence many aspects of type 2 diabetes (T2DM) self-management (SM) and we posit that limited English language–proficient Latinx immigrants face additional challenges. Methods: Instruments and semi-structured interviews were used to examine gender differences on health literacy, diabetes knowledge, health-promoting behaviors, diabetes, eating and exercise self-efficacy (SE), and T2DM SM practices among a cohort of limited English language–proficient Latinx immigrants. Statistical and qualitative analysis procedures were performed comparing males and females. Results: Thirty persons participated. Males tended to be older, have higher educational achievement, and more financial security than females. Physiologic measures tended worse among female participants. Health literacy and exercise SE scores were similar, but females scored lower on Eating and Diabetes SE. Forty-seven percent ( n= 9) of the women reported a history of gestational diabetes mellitus and a majority of men ( n = 7) cited difficulty with excessive alcohol. Consumption: Males appeared to receive more SM support compared to females. Females more frequently noted how family obligations and a lack of support impeded their SM. Work environments negatively influenced SM practices. Conclusion: Men and women have unique SM challenges and as such require individualized strategies and support to improve T2DM management.

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Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽

10.3390/antibiotics10010094 ◽

2021 ◽

Vol 10 (1) ◽

pp. 94

Author(s):

Carolyn Tarrant ◽

Andrew M. Colman ◽

David R. Jenkins ◽

Edmund Chattoe-Brown ◽

Nelun Perera ◽

...

Keyword(s):

South Africa ◽

Sri Lanka ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Low Income ◽

System Level ◽

Comparative Approach ◽

Structured Interviews ◽

Public And Private ◽

The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

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Regulation EU 2017/745 on medical devices – implementation analysis in Portugal by the distributors

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1214 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

H Vilaça

Keyword(s):

Public Health ◽

Medical Devices ◽

Stakeholder Involvement ◽

Implementation Process ◽

Regulatory Framework ◽

Theory And Practice ◽

Structured Interviews ◽

Public Health Action ◽

Study Implementation ◽

Implementation Analysis

Abstract The Regulation responds to legislation failures in the European regulatory framework on medical devices (MD), which in turn led to public health issues. Two media scandals triggered the final actions on the elaboration of this EU Regulation, which was already being thought off in a context of fast MD development, and on the commitment of member-states to harmonize legislation in order to better manage resources. This Regulation is expected to address detected gaps, and contribute to the protection of European citizens' health by ensuring high quality and safety of MD, through advocating for more transparency, vigilance, and traceability. A technique to evaluate policies is the implementation analysis, as it links theory and practice. By understanding it, it is possible to ascertain if, in fact, the Regulation will contribute, as proposed, to improve public health. The implementation analysis framework I developed can be used in other countries affected by this Regulation, and may even be extrapolated to other scenarios. Entry into force 25/05/17.Full application 05/20. This qualitative study uses document analysis and semi-structured interviews to collect data, and literature review to frame the situation and to study implementation analysis. The questions are: identify the facilitators and resistance points of the implementation; explore perceptions of the Portuguese MD distributors; understand the policy implementation pathway; and have a picture of the implementation status in Portugal. The results can be summarized as: implementers are interested in complying with the Regulation; there is stakeholder involvement in policy making and throughout the implementation process; the main points of resistance, difficulties and the facilitators are identified; and the Regulation is being implemented according to the timelines. The public health action brought by the policy is that each economic operator is an active actor on vigilance and patient safety across MD lifecycle. Key messages If we are interested in the extent to which a particular polity is able to solve the problems with which it is confronted, we need to study the way in which the law is executed in practice. Focus on the effective implementation of the new regulatory framework on medical devices to protect patients and ensure it addresses new and emerging challenges.

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A qualitative investigation of LGBTQ+ young people’s experiences and perceptions of self-managing their mental health

European Child & Adolescent Psychiatry ◽

10.1007/s00787-021-01783-w ◽

2021 ◽

Author(s):

Rosa Town ◽

Daniel Hayes ◽

Peter Fonagy ◽

Emily Stapley

Keyword(s):

Mental Health ◽

Young People ◽

Management Strategies ◽

Intervention Development ◽

Community Support ◽

Self Management ◽

Future Research ◽

Youth Groups ◽

Coping Methods ◽

Group A

AbstractThere is evidence that young people generally self-manage their mental health using self-care strategies, coping methods and other self-management techniques, which may better meet their needs or be preferable to attending specialist mental health services. LGBTQ+ young people are more likely than their peers to experience a mental health difficulty and may be less likely to draw on specialist support due to fears of discrimination. However, little is known about LGBTQ+ young people’s experiences and perceptions of self-managing their mental health. Using a multimodal qualitative design, 20 LGBTQ+ young people participated in a telephone interview or an online focus group. A semi-structured schedule was employed to address the research questions, which focussed on LGBTQ+ young people’s experiences and perceptions of self-managing their mental health, what they perceived to stop or help them to self-manage and any perceived challenges to self-management specifically relating to being LGBTQ+ . Reflexive thematic analysis yielded three key themes: (1) self-management strategies and process, (2) barriers to self-management and (3) facilitators to self-management. Participants’ most frequently mentioned self-management strategy was ‘speaking to or meeting up with friends or a partner’. Both barriers and facilitators to self-management were identified which participants perceived to relate to LGBTQ+ identity. Social support, LGBTQ+ youth groups and community support were identified as key facilitators to participants’ self-management of their mental health, which merits further investigation in future research. These findings also have important implications for policy and intervention development concerning LGBTQ+ young people’s mental health.

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Peer support program (P-SUP) to strengthen self-management in patients with chronic conditions

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1122 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

L Giesen ◽

H Könnecke ◽

M Redaèlli ◽

D Simic ◽

M Heßbrügge ◽

...

Keyword(s):

Peer Support ◽

Support Groups ◽

Chronic Conditions ◽

Primary Outcome ◽

Hospital Admissions ◽

Self Management ◽

Artery Disease ◽

Telephone Coaching

Abstract Background Chronic care programmes (CCPs) ensure a standardised, evidence based and structured patient care. In Germany, CCPs are successful in improving quality of care and making care more patient-centred. Regarding self-management support, however, the programs only feature patient education and shared decisions on treatment goals. Peer support has proven to be a successful component in outpatient care to enhance self-management. The aim of this study is to support patients with type 2 diabetes and coronary artery disease in conducting successful self-management through a multimodal program. Methods This randomized controlled trial (RCT) is set up for 27 months and will include a study population of approximately 1800 patients, beginning in summer 2020. The primary outcome (PO) is the reduction of hospital admissions. In addition to the PO, secondary outcomes include motivational and knowledge-based aspects. Furthermore, health-competitive and health-economic data will be collected. The formative evaluation will review the processes for implementation. The central element of the intervention will be peer support groups, in which the group will participate in physical activities and educational lectures on nutrition, exercise or disease related knowledge. Additionally, a specially designed online platform, personalized feedback for patients on medical outcomes from their family doctors, and regular telephone coaching to increase intrinsic motivation and activation will be provided. Results In addition to the primary outcome (reduction of hospital admissions), increased motivation levels, improved quality of life and increased health literacy are expected. Conclusions This project, funded by the Federal Joint Committee (establishment of statutory health insurance funds and medical providers in Germany), can serve as a blueprint for future implementations of public health approaches and accessible care models for patients with chronic conditions. Key messages Peer support as a successful method to enhance self-management in patients with type 2 diabetes and coronary artery disease. A multimodal program, consisting of peer support groups, an online platform, personalized medical feedback and telephone coaching, aiming to improve quality of life in patients with chronic conditions.

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Breastfeeding Experiences of Baccalaureate Nursing Students: A Qualitative Study

Journal of Human Lactation ◽

10.1177/0890334420979981 ◽

2020 ◽

pp. 089033442097998

Author(s):

Cheryl Langford ◽

Marcella Gowan ◽

Monica Haj

Keyword(s):

Nursing Students ◽

Health Care Providers ◽

Baccalaureate Nursing ◽

Community Support ◽

Baccalaureate Nursing Students ◽

Care Providers ◽

Structured Interviews ◽

Breastfeeding Support ◽

Cross Sectional

Background Students returning to school who are breastfeeding face unique challenges. There is limited literature on breastfeeding university students. Several researchers have studied breastfeeding employees in the workplace. Institutions of higher education closely mimic the employment environment. Breastfeeding college students who express their milk while at school share similar challenges to employed mothers. A baccalaureate nursing program is rigorous and little is known about the challenges facing breastfeeding student nurses returning to classes. Research aim To explore the breastfeeding experience of baccalaureate nursing students. Methods Our study was a cross-sectional descriptive qualitative design. Purposive sampling was used to enroll participants ( N = 12). In depth, semi-structured interviews were conducted. Qualitative thematic analysis was used to analyze the data both manually and using Dedoose QDA software. Results An overarching theme of pervasive conflict between the role of the breastfeeding mother and the role of the student nurse surfaced. Three interrelated organizing themes also emerged; challenging, vulnerability, and resilience. Time constraints, self-care versus role demands, and structural accommodations contributed to the challenges. Only one participant indicated a knowledge of her breastfeeding rights. All of the participants expressed gratitude for faculty and community support, regardless of conflicts. Conclusion Breastfeeding participants were both vulnerable and resilient. Faculty may improve experiences through providing specific areas of support. A breastfeeding support policy outlining student rights and faculty responsibilities is needed to educate, guide, and enforce protections. Health care providers may enhance breastfeeding students’ experiences through anticipatory guidance, education, and continued support.

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