The role of contextual factors on participation in the life area of work and employment after rehabilitation: A qualitative study on the views of persons with chronic pain

BACKGROUND: A deeper understanding of how contextual factors affect the ability to participate in the life area of work and employment despite chronic musculoskeletal pain is needed as a basis for interprofessional rehabilitation programs. OBJECTIVE: To investigate which contextual factors influence rehabilitation program clients’ ability to participate in the life area of work and employment, and how they do this. METHODS: Nested case study using a realist evaluation framework of interprofessional interventions. Qualitative content analysis of problem-centered interviews to identify influential context-mechanism-outcome configurations. RESULTS: We identified several important context-mechanism-outcome configurations. In the pre-interventional phase, socioeconomic and environmental factors affected two mechanisms, “exhaustion” and “discrimination”. In the intra-interventional phase, the social skills of health professionals and opportunities for discussion with peers affected the ability of program participants to engage with program content. In the post-intervention phase, volitional competences of the social system affected the sustainable application of program content in everyday life. CONCLUSION: The identified context-mechanism-outcome configurations shows that the ability to participate in the life area of work is interdependent with the ability to participate in other areas of life. In practice and research, assessment and treatment should be carried out based on this understanding.

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A realist evaluation of social prescribing: an exploration into the context and mechanisms underpinning a pathway linking primary care with the voluntary sector

Primary Health Care Research & Development ◽

10.1017/s1463423617000706 ◽

2017 ◽

Vol 19 (03) ◽

pp. 232-245 ◽

Cited By ~ 25

Author(s):

Marcello Bertotti ◽

Caroline Frostick ◽

Patrick Hutt ◽

Ratna Sohanpal ◽

Dawn Carnes

Keyword(s):

Primary Care ◽

Health Inequalities ◽

Contextual Factors ◽

Community Services ◽

Realist Evaluation ◽

Health Interventions ◽

Long Term Conditions ◽

Realist Approach ◽

Social Prescribing ◽

The Social

This article adopts a realist approach to evaluate a social prescribing pilot in the areas of Hackney and City in London (United Kingdom). It unpacks the contextual factors and mechanisms that influenced the development of this pilot for the benefits of GPs, commissioners and practitioners, and reflects on the realist approach to evaluation as a tool for the evaluation of health interventions. Primary care faces considerable challenges including the increase in long-term conditions, GP consultation rates, and widening health inequalities. With its emphasis on linking primary care to non-clinical community services via a social prescribing coordinator (SPC), some models of social prescribing could contribute to reduce the burden on primary care, tackle health inequalities and encourage people to make greater use of non-clinical forms of support. This realist analysis was based on qualitative interviews with users, commissioners, a GP survey, focus groups and learning events to explore stakeholders’ experience. To enable a detailed analysis, we adapted the realist approach by subdividing the social prescribing pathway into stages, each with contextual factors, mechanisms and outcomes. SPCs were pivotal to the effective functioning of the social prescribing service and responsible for the activation and initial beneficial impact on users. Although social prescribing shows significant potential for the benefit of patients and primary care, several challenges need to be considered and overcome, including ‘buy in’ from some GPs, branding, and funding for the third sector in a context where social care cuts are severely affecting the delivery of health care. With its emphasis on context and mechanisms, the realist evaluation approach is useful in understanding how to identify and improve health interventions, and analyse in greater detail the contribution of different stakeholders. As the SPC is central to social prescribing, more needs to be done to understand their role conceptually and practically.

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

British Journal of Healthcare Management ◽

10.12968/bjhc.2020.0003 ◽

2020 ◽

Vol 26 (8) ◽

pp. 1-10

Author(s):

Maartje Kletter ◽

Emma Plunkett ◽

Adrian Plunkett ◽

Helen Hunt ◽

Paul Bird ◽

...

Keyword(s):

Case Studies ◽

Qualitative Content Analysis ◽

Contextual Factors ◽

Realist Evaluation ◽

Evaluation Methodology ◽

Organisational Performance ◽

Programme Theory ◽

Individual Interviews ◽

The Uk ◽

The Impact

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

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Factors associated to functioning and health in relation to home rehabilitation in Sweden: a non-randomized pre-post intervention study

BMC Geriatrics ◽

10.1186/s12877-021-02360-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anette Johansson ◽

Marie Ernsth Bravell ◽

Eleonor I. Fransson ◽

Sofi Fristedt

Keyword(s):

Repeated Measures ◽

Linear Models ◽

Medical Condition ◽

Rehabilitation Program ◽

Community Dwelling ◽

Rehabilitation Service ◽

Post Intervention ◽

Factors Associated ◽

Rehabilitation Outcomes ◽

Self Rated Health

Abstract Background Home rehabilitation is a growing rehabilitation service in many countries, but scientific knowledge of its components and outcomes is still limited. The aim of this study was to investigate; 1) which changes in functioning and self-rated health could be identified in relation to a home rehabilitation program in a population of community-dwelling citizens, and 2) how socio-demographic factors, health conditions and home rehabilitation interventions were associated to change in functioning and self-rated health after the home rehabilitation program. Method The sample consisted of participants in a municipal home rehabilitation project in Sweden and consisted of 165 community-dwelling citizens. General Linear Models (ANOVA repeated measures) was used for identifying changes in rehabilitation outcomes. Logistic regressions analysis was used to investigate associations between rehabilitation outcomes and potential factors associated to outcome. Result Overall improvements in functioning and self-rated health were found after the home rehabilitation program. Higher frequencies of training sessions with occupational therapists, length of home rehabilitation, and orthopaedic conditions of upper extremities and spine as the main health condition, were associated with rehabilitation outcomes. Conclusion The result indicates that the duration of home rehabilitation interventions and intensity of occupational therapy, as well as the main medical condition may have an impact on the outcomes of home rehabilitation and needs to be considered when planning such programs. However, more research is needed to guide practice and policymaking.

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“It was an unexpected bond”: How an emerging participant-driven online social network may be enhancing an eLearning nutrition education & supplemental produce intervention

Digital Health ◽

10.1177/20552076211014978 ◽

2021 ◽

Vol 7 ◽

pp. 205520762110149

Author(s):

Sarah A Stotz ◽

Jung Sun Lee ◽

Jennifer Jo Thompson

Keyword(s):

Nutrition Education ◽

Qualitative Content Analysis ◽

Learning Experience ◽

Online Social Network ◽

Text Message ◽

Safety Net ◽

Text Messages ◽

Support Network ◽

Original Design ◽

Post Intervention

Objective The purpose of this paper is to describe a participant-driven, online text message-based social support network that emerged from an eLearning nutrition education and supplemental produce intervention. Methods Adults (n = 20) who utilized a safety-net clinic for their healthcare participated in a 12-week smartphone-based nutrition education eLearning program using loaned smartphones. Participants also received a box of fresh produce weekly. Participants received weekly text message reminders to collect their produce, and from this researcher-initiated reminder text, a supportive, participant-led, all-group text message thread commenced. Researchers collected all 471 text messages in this all-group thread and included them in the qualitative content analysis of pre and post intervention focus groups. Results The original design of the eLearning nutrition education program was to asynchronously engage learners with nutrition education resources. However, participants themselves initiated a robust group text message support system through which they shared encouragement, recipes, grocery shopping tips, and images of food they prepared with the produce box amongst themselves for the duration of the 12-week intervention. Conclusion The novel nature by which these participants voluntarily engaged in this peer-to-peer nutrition education-focused text message conversation exemplifies participants becoming agents in their own learning experience and will be used to enhance future eLearning nutrition education experiences developed by our team.

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A qualitative framework-based evaluation of radiology clinical decision support initiatives: eliciting key factors to physician adoption in implementation

JAMIA Open ◽

10.1093/jamiaopen/ooz002 ◽

2019 ◽

Vol 2 (1) ◽

pp. 187-196 ◽

Cited By ~ 2

Author(s):

Laura Haak Marcial ◽

Douglas S Johnston ◽

Michael R Shapiro ◽

Sara R Jacobs ◽

Barry Blumenfeld ◽

...

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Contextual Factors ◽

Qualitative Evaluation ◽

Clinical Decision ◽

Evaluation Framework ◽

Key Factors ◽

Clinical Context ◽

Early Term ◽

Near Term

Abstract Objectives To illustrate key contextual factors that may have effects on clinical decision support (CDS) adoption and, ultimately, success. Materials and Methods We conducted a qualitative evaluation of 2 similar radiology CDS innovations for near-term endpoints affecting adoption and present the findings using an evaluation framework. We identified key contextual factors between these 2 innovations and determined important adoption differences between them. Results Degree of electronic health record integration, approach to education and training, key drivers of adoption, and tailoring of the CDS to the clinical context were handled differently between the 2 innovations, contributing to variation in their relative degrees of adoption and use. Attention to these factors had impacts on both near and later-term measures of success (eg, patient outcomes). Discussion CDS adoption is a well-studied early-term measure of CDS success that directly impacts outcomes. Adoption requires attention throughout the design phases of an intervention especially to key factors directly affecting it, including how implementation across multiple sites and systems complicates adoption, which prior experience with CDS matters, and that practice guidelines invariably require tailoring to the clinical context. Conclusion With better planning for the capture of early-term measures of successful CDS implementation, especially adoption, critical adjustments may be made to ensure that the CDS is effectively implemented to be successful.

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A neuropsychological group rehabilitation program with institutionalized elderly

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.588 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s235-s235

Author(s):

L. Lemos ◽

H. Espírito-Santo ◽

S. Simões ◽

F. Silva ◽

J. Galhardo ◽

...

Keyword(s):

Depressive Symptoms ◽

Depressive Symptomatology ◽

Randomized Study ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Rehabilitation Program ◽

Post Intervention ◽

Institutionalized Elderly ◽

Group Rehabilitation ◽

The Impact

IntroductionElderly institutionalization involves an emotional adaptation and the research shows that the risk of depression increases.ObjectivesEvaluate the impact of a neuropsychological group rehabilitation program (NGRP) on depressive symptomatology of institutionalized elderly.AimsNGRP influences the decrease of depressive symptoms.MethodsElderly were assessed pre- and post-intervention with the Geriatric Depression Scale (GDS) and divided into a Rehabilitated Group (RG), a Waiting List Group (WLG), and a Neutral Task Group (NTG).ResultsIn this randomized study, before rehabilitation, 60 elderly people (RG; 80.31 ± 8.98 years of age; 74.2% women) had a mean GDS score of 13.33 (SD = 9.21). Five elderly included in the NTG (80.13 ± 10.84 years; 75.0% women) had a mean GDS score of 10.60 (SD = 4.72). Finally, 29 elderly in the WLG (81.32 ± 6.68 years; 69.0% women) had a mean GDS score of 14.93 (SD = 6.02). The groups were not different in GDS baseline scores (F = 0.74; P = 0.478). ANCOVA has shown significant differences (P < 0.05) in GDS scores between the three groups after 10 weeks. Sidak adjustment for multiple comparisons revealed that elderly in the WLG got worse scores in GDS, comparing with elderly in RG (P < 0.01), and with elderly in NTG (P < 0.05).ConclusionsElderly that are not involved in a task get worse in depressive symptomatology. Being involved in a structured group task means lower depressive symptoms and being in a NGRP means even greater results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The impact of a refurbishment programme on older people living in sheltered housing

Housing Care and Support ◽

10.1108/hcs-02-2021-0004 ◽

2021 ◽

Vol 24 (2) ◽

pp. 54-64

Author(s):

Zeibeda (Zeb) Sattar ◽

Stephanie Wilkie ◽

Jonathan Ling

Keyword(s):

Well Being ◽

Realist Evaluation ◽

Evaluation Framework ◽

Sheltered Housing ◽

Social Activities ◽

Content Type ◽

Social And Emotional ◽

Communal Areas ◽

Physical Changes ◽

The Impact

Purpose This paper aims to explore residents' perceptions of a refurbishment programme to sheltered housing schemes and its impact on their well-being. Design/methodology/approach The methodology draws upon a realist evaluation framework. Four participatory appraisals (PAs) and 19 interviews with residents were conducted in the sheltered housing schemes. Ages of participants ranged from 50 to 99 years. Findings Two categories of residents were identified: healthy active older adults and older frail adults (or over 85+). Residents said their social and emotional well-being improved from the provision of indoor and outdoor communal areas. Older frail residents only accessed the new communal spaces when staff took them in their wheelchairs. The physical changes increased opportunities for social connections for residents. Conservatories and sensory gardens were most popular. Residents felt that structured activities in the new spaces and digital training would improve their social activities. Research limitations/implications The participatory methods spanned over an hour, and some residents felt too tired to complete the full session. Practical implications A practical limitation was that some sensory rooms were not fully completed at the time of the evaluation. Originality/value This paper adds the following: Perceptions of residents of a refurbishment programme in sheltered housing and the impact on their well-being. Perceptions of residents about social activities after a refurbishment programme. Perceptions of residents about the impact of physical changes to their sheltered housing schemes and impact on their internal accessibility to the improvements.

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Upsettling Canada in 140 Characters: race relations in the Twittersphere

10.32920/ryerson.14645526 ◽

2021 ◽

Author(s):

Caroline Carter

Keyword(s):

Content Analysis ◽

Social Networking ◽

Race Relations ◽

Online Discussion ◽

Qualitative Content Analysis ◽

Vital Role ◽

The Social ◽

Colonial Theory ◽

Networking Tool ◽

A Site

This paper is a qualitative content analysis of public tweets made during the Indigenous social movement, Idle No More, containing the #upsettler and #upsettlers hashtags. Using settler colonial theory coupled with previous literature on Twitter during social movements as a guiding framework, this study identifies how settler colonial relations were being constructed on Twitter and how functions of the social networking tool such as the hashtag impacted this process. By examining and analyzing the content of 278 tweets, this study illustrates that Twitter is a site where conversations about race relations in Canada are taking place and that the use of the hashtag function plays a vital role in expanding the reach of this online discussion and creating a sense of solidarity or community among users.

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Midstream social marketing intervention to influence retailers’ compliance with the minimum legal drinking age law

Journal of Social Marketing ◽

10.1108/jsocm-05-2015-0030 ◽

2016 ◽

Vol 6 (2) ◽

pp. 104-120 ◽

Cited By ~ 5

Author(s):

Tanja Kamin ◽

Daša Kokole

Keyword(s):

Social Marketing ◽

Post Intervention ◽

Excessive Alcohol Consumption ◽

Content Type ◽

The Social ◽

Drinking Age ◽

Quasi Experimental ◽

Minimum Legal Drinking Age ◽

Marketing Intervention ◽

Marketing Approach

Purpose Alcohol availability is strongly related to excessive alcohol consumption. This study aims to examine social marketing’s response to concerns about retailers’ noncompliance with the minimum legal drinking age (MLDA) law by proposing and evaluating a social marketing intervention directed at sellers in off-premise stores. Design/methodology/approach The study is based on a non-randomized quasi-experimental design, focusing on an evaluation of the implementation of the “18 rules!” intervention in four cities in Slovenia. Two waves of underage purchase attempts were conducted pre- and post-intervention in 24 off-premise businesses, following a mystery shopping protocol. Findings The initial rate of retailers’ noncompliance with the MLDA law in off-premise establishments was high. After the social marketing intervention, an increase with compliance with the law was observed; the proportion of cashiers selling alcohol to minors after the intervention decreased from 96 to 67 per cent. Qualitative insight suggests an existence of retailers’ dilemma in complying with the MLDA. Research limitations/implications A social marketing approach could contribute to a better understanding of the social working of the MLDA law. Practical implications A social marketing approach could complement the usual enforcement strategies and contribute to a better understanding of the social working of the MLDA law, and encourage deliberate retailers’ compliance with it while developing valuable exchanges among people and stakeholders. Originality/value The paper conceptualizes retailers’ dilemma in complying with the minimal legal drinking age law and offers social marketing response to it. Results of the study show that also solely non-coercive measures have the potential in increasing retailers’ compliance with regulations.

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Quality improvement collaborative aiming for Proactive HEAlthcare of Older People in Care Homes (PEACH): a realist evaluation protocol

BMJ Open ◽

10.1136/bmjopen-2018-023287 ◽

2018 ◽

Vol 8 (11) ◽

pp. e023287 ◽

Cited By ~ 4

Author(s):

Reena Devi ◽

Julienne Meyer ◽

Jay Banerjee ◽

Claire Goodman ◽

John Raymond Fletcher Gladman ◽

...

Keyword(s):

Quality Improvement ◽

Older People ◽

Care Home ◽

Realist Evaluation ◽

Evaluation Framework ◽

Care Homes ◽

Quality Improvement Initiative ◽

Quality Improvement Collaborative ◽

Programme Theory ◽

Health And Social Care

IntroductionThis protocol describes a study of a quality improvement collaborative (QIC) to support implementation and delivery of comprehensive geriatric assessment (CGA) in UK care homes. The QIC will be formed of health and social care professionals working in and with care homes and will be supported by clinical, quality improvement and research specialists. QIC participants will receive quality improvement training using the Model for Improvement. An appreciative approach to working with care homes will be encouraged through facilitated shared learning events, quality improvement coaching and assistance with project evaluation.Methods and analysisThe QIC will be delivered across a range of partnering organisations which plan, deliver and evaluate health services for care home residents in four local areas of one geographical region. A realist evaluation framework will be used to develop a programme theory informing how QICs are thought to work, for whom and in what ways when used to implement and deliver CGA in care homes. Data collection will involve participant observations of the QIC over 18 months, and interviews/focus groups with QIC participants to iteratively define, refine, test or refute the programme theory. Two researchers will analyse field notes, and interview/focus group transcripts, coding data using inductive and deductive analysis. The key findings and linked programme theory will be summarised as context-mechanism-outcome configurations describing what needs to be in place to use QICs to implement service improvements in care homes.Ethics and disseminationThe study protocol was reviewed by the National Health Service Health Research Authority (London Bromley research ethics committee reference: 205840) and the University of Nottingham (reference: LT07092016) ethics committees. Both determined that the Proactive HEAlthcare of Older People in Care Homes study was a service and quality improvement initiative. Findings will be shared nationally and internationally through conference presentations, publication in peer-reviewed journals, a graphical illustration and a dissemination video.

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