scholarly journals Development and Process Evaluation of a Complex Intervention for Improving Nutrition among Hospitalised Patients: A Mixed Methods Study

Healthcare ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 79 ◽  
Author(s):  
Shelley Roberts ◽  
Laurie Grealish ◽  
Lauren T. Williams ◽  
Zane Hopper ◽  
Julie Jenkins ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Process Evaluation ◽  
Complex Intervention ◽  
Intervention Development ◽  
Intervention Strategies ◽  
Nutrition Intervention ◽  
Medical Patients ◽  
Qualitative Approaches ◽  
Hospitalised Patients ◽  
Context Specific

Hospital-acquired malnutrition is a significant issue with complex aetiology, hence nutrition interventions must be multifaceted and context-specific. This paper describes the development, implementation and process evaluation of a complex intervention for improving nutrition among medical patients in an Australian hospital. An integrated knowledge translation (iKT) approach was used for intervention development, informed by previous research. Intervention strategies targeted patients (via a nutrition intake monitoring system); staff (discipline-specific training targeting identified barriers); and the organisation (foodservice system changes). A process evaluation was conducted parallel to implementation assessing reach, dose, fidelity and staff responses to the intervention using a mixed-methods design (quantitative and qualitative approaches). Staff-level interventions had high fidelity and broad reach (61% nurses, 93% foodservice staff and all medical staff received training). Patient and organisation interventions were implemented effectively, but due to staffing issues, only reached around 60% of patients. Staff found all intervention strategies acceptable with benefits to practice. This study found an iKT approach useful for designing a nutrition intervention that was context-specific, feasible and acceptable to staff. This was likely due to engagement of multiple disciplines, identifying and targeting specific areas in need of improvement, and giving staff frequent opportunities to contribute to intervention development/implementation.

scholarly journals Process evaluation protocol for a cluster randomised trial of a complex, nurse-led intervention to improve hypertension management in India

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027841 ◽  
Author(s):  
Nikhil Srinivasapura Venkateshmurthy ◽  
Kevin Mc Namara ◽  
Harriet Koorts ◽  
Sailesh Mohan ◽  
Vamadevan S Ajay ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Process Evaluation ◽  
Randomised Trial ◽  
Intervention Development ◽  
Health Department ◽  
Uncontrolled Hypertension ◽  
Cluster Randomised Trial ◽  
Care Coordinator ◽  
Cluster Randomised ◽  
Number Of Patients

IntroductionIndia has high prevalence of hypertension but low awareness, treatment and control rate. A cluster randomised trial entitled ‘m-Power Heart Project’ is being implemented to test the effectiveness of a nurse care coordinator (NCC) led complex intervention to address uncontrolled hypertension in the community health centres (CHCs). The trial’s process evaluation will assess the fidelity and quality of implementation, clarify the causal mechanisms and identify the contextual factors associated with variation in the outcomes. The trial will use a theory-based mixed-methods process evaluation, guided by the Consolidated Framework for Implementation Research.Methods and analysisThe process evaluation will be conducted in the CHCs of Visakhapatnam (southern India). The key stakeholders involved in the intervention development and implementation will be included as participants. In-depth interviews will be conducted with intervention developers, doctors, NCCs and health department officials and focus groups with patients and their caregivers. NCC training will be evaluated using Kirkpatrick’s model for training evaluation. Key process evaluation indicators (number of patients recruited and retained; concordance between the treatment plans generated by the electronic decision support system and treatment prescribed by the doctor and so on) will be assessed. Fidelity will be assessed using Borrelliet al’s framework. Qualitative data will be analysed using the template analysis technique. Quantitative data will be summarised as medians (IQR), means (SD) and proportions as appropriate. Mixed-methods analysis will be conducted to assess if the variation in the mean reduction of systolic blood pressure between the intervention CHCs is influenced by patient satisfaction, training outcome, attitude of doctors, patients and NCCs about the intervention, process indicators etc.Ethics and disseminationEthical approval for this study was obtained from the ethics committees at Public Health Foundation of India and Deakin University. Findings will be disseminated via peer-reviewed publications, national and international conference presentations.Trial registration numberNCT03164317; Pre-results.

scholarly journals Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 878
Author(s):  
Regina Poss-Doering ◽  
Lukas Kühn ◽  
Martina Kamradt ◽  
Anna Stürmlinger ◽  
Katharina Glassen ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Randomized Trial ◽  
Process Evaluation ◽  
Complex Intervention ◽  
Intervention Program ◽  
Cluster Randomized Trial ◽  
Prescribing Patterns ◽  
Audit And Feedback ◽  
Medical Assistants ◽  
Cluster Randomized

The cluster randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance, 2017–2020) promoted appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation assessed determinants of practice and explored factors associated with antibiotic prescribing patterns. This work describes its findings on uptake and impacts of the complex intervention program and indicates potential implementation into routine care. In a nested mixed-methods approach, a three-wave study-specific survey for participating physicians and medical assistants assessed potential impacts and uptake of the complex intervention program. Stakeholders received a one-time online questionnaire to reflect on network-related aspects. Semi-structured, open-ended interviews, with a purposive sample of physicians, medical assistants and stakeholders, explored program component acceptance for daily practice and perceived sustainability of intervention component effects. Intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for educational components: feedback reports, background information, e-learning modules and disease-specific quality circles (QCs). Participation in PCNs was seen as the motivational factor for guideline-oriented patient care and adoption of new routines. Future approaches to fostering appropriate antibiotics use by targeting health literacy competencies and clinician’s therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.

scholarly journals Protocol for a mixed methods process evaluation of the Smoking Treatment Optimisation in Pharmacies (STOP) trial

2020 ◽  
Author(s):  
Sandra Jumbe ◽  
Vichithranie Madurasinghe ◽  
Colin Houlihan ◽  
Samantha L Jumbe ◽  
Wai-Yee James ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Community Pharmacy ◽  
Process Evaluation ◽  
Complex Intervention ◽  
List Type ◽  
Service Users ◽  
Pharmacy Staff ◽  
Stop Smoking ◽  
Treatment Optimisation ◽  
Stop Trial

AbstractIntroductionAssessing the fidelity of complex behavioural interventions and examining the contextual reasons why such interventions succeed, or fail are important activities but challenging and rarely reported. The Smoking Treatment Optimisation in Pharmacies (STOP) trial is a cluster randomised trial evaluating the effectiveness of a complex intervention to optimise the National Health Service (NHS) Stop Smoking Service delivered in community pharmacies. This complex intervention comprises a training package for pharmacy staff involving motivational interviewing and communication skills aimed at increasing smoking cessation knowledge and proactive client engagement. We report on a process evaluation which was planned alongside the trial to offer findings that will assist in the interpretation of the main trial results and help inform potential implementation in community pharmacy settings on a wider scale.Methods and analysisQuantitative data on recruitment and retention process of pharmacies, pharmacy staff and service users has been collected during the trial along with data on dose and fidelity of the intervention delivery from participating intervention arm pharmacies to identify potential implementation issues. Simulated client data on behaviour change skills and display of intervention materials from both control and intervention pharmacies is being assessed. These data will be combined with qualitative data; including adviser-smoker consultation recordings that provide a snapshot of behaviour skills delivery by stop smoking advisers and semi-structured interviews with pharmacy staff and services users from the intervention arm.DiscussionPublished protocols for process evaluations of complex health interventions are still rare despite increasing funding for this work to facilitate understanding of trial outcomes from an implementation perspective. This mixed methods protocol will contribute to the developing literature around the conduct of process evaluation and the value they add to health services research.Trial registration numberISRCTN16351033.Strengths and limitations of this studyA planned mixed methods process evaluation that draws together data from different sources to help explain the trial results and establish the feasibility of scaling this complex intervention up in community pharmacy settings.A strength is the use of a previously tested mystery shopping method to assess fidelity of skills performance at the pharmacy counterThe process evaluation relies on willing pharmacy staff and service users involved in the trial to collect some of the data, which may introduce bias.This paper also provides a detailed example of how to use the MRC framework for process evaluation of complex interventions to design an extensive process evaluation within trial settings.

scholarly journals Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena

2020 ◽  
Author(s):  
Regina Poss-Doering ◽  
Lukas Kühn ◽  
Martina Kamradt ◽  
Anna Stürmlinger ◽  
Katharina Glassen ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Randomized Trial ◽  
Process Evaluation ◽  
Complex Intervention ◽  
Cluster Randomized Trial ◽  
Prescribing Patterns ◽  
Audit And Feedback ◽  
Appropriate Use ◽  
Medical Assistants ◽  
Cluster Randomized

The cluster randomized trial ARena (Sustainable reduction of antibiotic-induced antimicrobial resistance, 2017-2020) promoted the appropriate use of antibiotics for acute non-complicated infections in primary care networks (PCNs) in Germany. A process evaluation aimed to provide insights into determinants of practice and explored factors associated with antibiotic prescribing patterns. In a nested mixed-methods approach, a three-waves survey used study-specific questionnaires for participating physicians and medical assistants to assess potential impacts and uptake of the complex intervention program. Stakeholders received a one-time online questionnaire to reflect on network-related aspects. Semi-structured, open-ended interviews with a purposive sample of physicians, medical assistants and stakeholders explored aspects regarding the acceptance of the program components for daily practice and the perceived sustainability of intervention component effects. The intervention components were perceived to be smoothly integrable into practice routines. The highest uptake was reported for the educational components: feedback reports, background information, e-learning modules, and disease specific quality circles. Participation in PCNs was seen as motivational factor for guideline-oriented patient care and the adoption of new routines Future approaches to fostering appropriate use of antibiotics by targeting health literacy competencies and clinician’s therapy decisions should combine evidence-based information sources, audit and feedback reports and QCs.

scholarly journals Mixed-methods process evaluation of SafeTea: a multimedia campaign to prevent hot drink scalds in young children and promote burn first aid

2020 ◽  
pp. injuryprev-2020-043909
Author(s):  
Laura Elizabeth Cowley ◽  
C Verity Bennett ◽  
Isabelle Brown ◽  
Alan Emond ◽  
Alison Mary Kemp
Keyword(s):  
Social Media ◽  
Mixed Methods ◽  
Young Children ◽  
Process Evaluation ◽  
Behavioural Change ◽  
First Aid ◽  
Multifaceted Intervention ◽  
Media Content ◽  
Educational Videos ◽  
The Uk

ObjectivesSafeTea is a multifaceted intervention delivered by community practitioners to prevent hot drink scalds to young children and improve parents’ knowledge of appropriate burn first aid. We adapted SafeTea for a national multimedia campaign, and present a mixed-methods process evaluation of the campaign.MethodsWe used social media, a website hosting downloadable materials and media publicity to disseminate key messages to parents/caregivers of young children and professionals working with these families across the UK. The SafeTea campaign was launched on National Burns Awareness Day (NBAD), October 2019, and ran for 3 months. Process evaluation measurements included social media metrics, Google Analytics, and quantitative and qualitative results from a survey of professionals who requested hard copies of the materials via the website.ResultsFindings were summarised under four themes: ‘reach’, ‘engagement’, ‘acceptability’ and ‘impact/behavioural change’. The launch on NBAD generated widespread publicity. The campaign reached a greater number of the target audience than anticipated, with over 400 000 views of the SafeTea educational videos. Parents and professionals engaged with SafeTea and expressed positive opinions of the campaign and materials. SafeTea encouraged parents to consider how to change their behaviours to minimise the risks associated with hot drinks. Reach and engagement steadily declined after the first month due to reduced publicity and social media promotion.ConclusionThe SafeTea campaign was successful in terms of reach and engagement. The launch on NBAD was essential for generating media interest. Future campaigns could be shorter, with more funding for additional social media content and promotion.

scholarly journals A Combined Impact-Process Evaluation of a Program Promoting Active Transport to School: Understanding the Factors That Shaped Program Effectiveness

2013 ◽  
Vol 2013 ◽  
pp. 1-14 ◽  
Author(s):  
S. Crawford ◽  
J. Garrard
Keyword(s):  
Mixed Methods ◽  
Process Evaluation ◽  
Active Transport ◽  
Primary Schools ◽  
Quantitative Data ◽  
Program Effectiveness ◽  
Primary School Children ◽  
Second Phase ◽  
Program Staff ◽  
Impact Process

This mixed methods study was a comprehensive impact-process evaluation of the Ride2School program in metropolitan and regional areas in Victoria, Australia. The program aimed to promote transport to school for primary school children. Qualitative and quantitative data were collected at baseline and followup from two primary schools involved in the pilot phase of the program and two matched comparison schools, and a further 13 primary schools that participated in the implementation phase of the program. Classroom surveys, structured and unstructured observations, and interviews with Ride2School program staff were used to evaluate the pilot program. For the 13 schools in the second phase of the program, parents and students completed questionnaires at baseline (N= 889) and followup (N= 761). Based on the quantitative data, there was little evidence of an overall increase in active transport to school across participating schools, although impacts varied among individual schools. Qualitative data in the form of observations, interviews, and focus group discussions with students, school staff, and program staff provided insight into the reasons for variable program impacts. This paper highlights the benefits of undertaking a mixed methods approach to evaluating active transport to school programs that enables both measurement and understanding of program impacts.

Sign in / Sign up

Export Citation Format

Share Document