scholarly journals Using Group Model Building to Capture the Complex Dynamics of Scaling Up District-Level Surgery in Arusha Region, Tanzania

2020 ◽  
Author(s):  
Henk Broekhuizen ◽  
Monic Lansu ◽  
Jakub Gajewski ◽  
Chiara Pittalis ◽  
Martilord Ifeanyichi ◽  
...  
Keyword(s):  
Model Building ◽  
Complex Dynamics ◽  
Scale Up ◽  
Nominal Group Technique ◽  
Scaling Up ◽  
Feedback Loops ◽  
District Level ◽  
Nominal Group ◽  
Group Model ◽  
Arusha Region

Background: Scaling up surgery at district hospitals (DHs) is the critical challenge if the Tanzanian national Surgical, Obstetric, and Anesthesia Plan (NSOAP) objectives are to be achieved. Our study aims to address this challenge by taking a dynamic view of surgical scale-up at the district level using a participatory research approach. Methods: A group model building (GMB) workshop was held with 18 professionals from three hospitals in the Arusha region. They built a graphical representation of the local system of surgical services delivery through a facilitated discussion that employed the nominal group technique. This resulted in a causal loop diagram (CLD) from which the participants identified the requirements for scaling-up surgery and the stakeholders who could satisfy these. After the GMB sessions, we identified clusters of related variables using inductive thematic analysis and the main feedback loops driving the model. Results: The CLD consists of 57 variables. These include the 48 variables that were obtained through the nominal group technique and those that participants added later. We identified 6 themes: patient benefits, financing of surgery, cost sharing, staff motivation, communication, and effects on referral hospital. There are 5 self-reinforcing feedback loops: training, learning, meeting demand, revenues, and willingness to work in a good hospital. There are four self-correcting feedback loops or ‘resistors to change:’ recurrent costs, income lost, staff stress, and brain drain. Conclusion: This study provides a systems view on the scaling up of surgery from a district level perspective. Its results enable a critical appraisal of the feasibility of implementing the NSOAP. Our results suggest that policy-makers should be wary of ‘quick fixes’ that have short term gains only. Long term policy that considers the complex dynamics of surgical systems and that allows for periodic evaluation and adaption is needed to scale up surgery in a sustainable manner.

Using nominal group technique among clinical providers to identify barriers and prioritize solutions to scaling up opioid agonist therapies in Ukraine

2017 ◽  
Vol 49 ◽  
pp. 48-53 ◽  
Author(s):  
Lynn Madden ◽  
Martha J. Bojko ◽  
Scott Farnum ◽  
Alyona Mazhnaya ◽  
Tatiana Fomenko ◽  
...  
Keyword(s):  
Nominal Group Technique ◽  
Scaling Up ◽  
Nominal Group ◽  
Opioid Agonist ◽  
Group Technique

scholarly journals Policy options for surgical mentoring: Lessons from Zambia based on stakeholder consultation and systems science

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257597
Author(s):  
Henk Broekhuizen ◽  
Martilord Ifeanyichi ◽  
Mweene Cheelo ◽  
Grace Drury ◽  
Chiara Pittalis ◽  
...  
Keyword(s):  
Model Building ◽  
District Hospital ◽  
District Level ◽  
Systems Science ◽  
Group Model ◽  
Policy Options ◽  
Surgical Performance ◽  
Stakeholder Consultation ◽  
Provincial Level ◽  
Surgical Teams

Background Supervision by surgical specialists is beneficial because they can impart skills to district hospital-level surgical teams. The SURG-Africa project in Zambia comprises a mentoring trial in selected districts, involving two provincial-level mentoring teams. The aim of this paper is to explore policy options for embedding such surgical mentoring in existing policy structures through a participatory modeling approach. Methods Four group model building workshops were held, two each in district and central hospitals. Participants worked in a variety of institutions and had clinical and/or administrative backgrounds. Two independent reviewers compared the causal loop diagrams (CLDs) that resulted from these workshops in a pairwise fashion to construct an integrated CLD. Graph theory was used to analyze the integrated CLD, and dynamic system behavior was explored using the Method to Analyse Relations between Variables using Enriched Loops (MARVEL) method. Results The establishment of a provincial mentoring faculty, in collaboration with key stakeholders, would be a necessary step to coordinate and sustain surgical mentoring and to monitor district-level surgical performance. Quarterly surgical mentoring reviews at the provincial level are recommended to evaluate and, if needed, adapt mentoring. District hospital administrators need to closely monitor mentee motivation. Conclusions Surgical mentoring can play a key role in scaling up district-level surgery but its implementation is complex and requires designated provincial level coordination and regular contact with relevant stakeholders.

scholarly journals Investigating the Socio-Economic and Livelihoods Impacts of African Swine Fever in Timor-Leste: An Application of Spatial Group Model Building

2021 ◽  
Vol 8 ◽  
Author(s):  
Jared Berends ◽  
Joanita Bendita da Costa Jong ◽  
Tarni Louisa Cooper ◽  
Kanar Dizyee ◽  
Olavio Morais ◽  
...  
Keyword(s):  
Model Building ◽  
African Swine Fever ◽  
Feedback Loops ◽  
Small Scale ◽  
Group Model ◽  
Group Model Building ◽  
Concept Model ◽  
Pig Farming ◽  
Starting Point ◽  
Timor Leste

Small-scale pig farming is highly important to the economic and social status of households in Timor-Leste. The presence of an African Swine Fever (ASF) outbreak in Timor-Leste was confirmed in 2019, a major concern given that around 70% of agricultural households practice pig farming. This research used a virtual spatial group model building process to construct a concept model to better understand the main feedback loops that determine the socio-economic and livelihood impacts of the ASF outbreak. After discussing the interaction of reinforcing and balancing feedback loops in the concept model, potential leverage points for intervention are suggested that could reduce the impacts of ASF within socio-economic spheres. These include building trust between small-scale farmers and veterinary technicians, strengthening government veterinary services, and the provision of credit conditional on biosecurity investments to help restock the industry. This conceptual model serves as a starting point for further research and the future development of a quantitative system dynamics (SD) model which would allow ex-ante scenario-testing of various policy and technical mitigation strategies of ASF outbreaks in Timor-Leste and beyond. Lessons learned from the blended offline/online approach to training and workshop facilitation are also explored in the paper.

scholarly journals Current Practices and Future Pathways towards Competencies in Education for Sustainable Development

2021 ◽  
Vol 13 (16) ◽  
pp. 8733
Author(s):  
Gisela Cebrián ◽  
Mercè Junyent ◽  
Ingrid Mulà
Keyword(s):  
Sustainable Development ◽  
Informal Education ◽  
Model Building ◽  
Education For Sustainable Development ◽  
Project Based Learning ◽  
Assessment Tools ◽  
Educational Institutions ◽  
Group Model ◽  
Recent Developments ◽  
Competencies Development

The 2030 Agenda for Sustainable Development reflects the urgency to embed the principles of education for sustainable development (ESD) into all levels of education. ESD, understood as an integral part of quality education and where all educational institutions, from preschool to higher education and in non-formal and informal education, can and should foster the development of sustainability competencies. This Special Issue entitled “Competencies in Education for Sustainable Development II” responds to this urgency and the papers presented deliver recent developments in the field of sustainability and ESD competencies. They focus on various perspectives: systematic literature reviews and conceptual contributions; curriculum developments and pedagogical approaches to explore competencies’ development, such as action research, serious games, augmented reality, multi-course project-based learning and group model building processes; testing and validation of assessment tools and processes for linking sustainability competencies to employability and quality assurance processes. The contributions show how the field of sustainability and ESD competencies has become a major focus in recent years and present emerging research developments. Further research efforts need to be put into operationalizing sustainability competencies and developing tools that help measure and assess students’ and educators’ competencies development.

scholarly journals Barriers to implementing motivational interviewing in addiction treatment: A nominal group technique process evaluation

2021 ◽  
Vol 2 ◽  
pp. 263348952110184
Author(s):  
Melissa R Hatch ◽  
Kristine Carandang ◽  
Joanna C Moullin ◽  
Mark G Ehrhart ◽  
Gregory A Aarons
Keyword(s):  
Motivational Interviewing ◽  
Process Evaluation ◽  
Nominal Group Technique ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Nominal Group ◽  
Management Level ◽  
Implementation Program ◽  
Ebp Implementation ◽  
Staff Level

Background: The successful implementation of evidence-based practices (EBPs) in real-world settings requires an adaptive approach and ongoing process evaluation and tailoring. Although conducting a needs assessment during the preparation phase of implementation is beneficial, it is challenging to predict all barriers to EBP implementation that may arise over the course of implementation and sustainment. This article describes a process evaluation that identified emergent and persistent barriers that impacted the implementation of an EBP across multiple behavioral health organizations and clinics. Methods: This study was conducted during the first cohort of a cluster randomized controlled trial testing the effectiveness of the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI) in substance use disorder treatment agencies and clinics. We used a modified nominal group technique (NGT) in which clinic leaders identified barriers faced during the implementation process. Barriers were categorized, then ranked and rated according to leaders’ perceptions of each barrier’s influence on implementation. The barriers were then contextualized through individual qualitative interviews. Results: Fifteen barriers were identified, grouped into staff-level barriers, management-level barriers, and implementation program barriers. Time and resistance to MI were rated as the most influential staff-level barriers. Among management-level barriers, time was also rated highest, followed by turnover and external contractual constraints. The most influential implementation barrier was client apprehension of recording for fidelity assessment and feedback. Individual interviews supported these findings and provided suggested adaptations for future implementation efforts. Conclusion: EBP implementation is an ongoing process whereby implementation strategies must be proactively and strategically tailored to address emergent barriers. This research described a process evaluation that was used to identify 15 emergent and/or persistent barriers related to staff, management, and the implementation program. Using implementation strategies that can be tailored and/or adapted to such emergent barriers is critical to implementation effectiveness. Plain Language Summary Unforeseen barriers often arise during the course of implementation. Conducting evaluations during implementation allows for tailoring the implementation strategy. As part of a larger study using the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI), we collected data from the first cohort of LOCI clinic leaders to identify barriers to MI implementation that persisted despite advanced planning and to understand unanticipated barriers that arose during implementation. Leaders identified 15 barriers faced during the implementation process that fell into three categories: staff-level barriers, management-level barriers, and implementation program barriers. The leaders ranked time as the most influential barrier at both the staff and management levels. Staff apprehension, resistance to MI implementation, and staff turnover were also of significant concern to leaders. Future implementation efforts may benefit from conducting a similar process evaluation during the implementation phase.

scholarly journals Strategies for involving patients and the public in scaling-up initiatives in health and social services: protocol for a scoping review and Delphi survey

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Ali Ben Charif ◽  
◽  
Karine V. Plourde ◽  
Sabrina Guay-Bélanger ◽  
Hervé Tchala Vignon Zomahoun ◽  
...  
Keyword(s):  
Social Services ◽  
Scoping Review ◽  
Delphi Study ◽  
Public Involvement ◽  
Scale Up ◽  
Scaling Up ◽  
Delphi Survey ◽  
The Public ◽  
Health And Social Services ◽  
Scoping Reviews

Abstract Background The scale-up of evidence-based innovations is required to reduce waste and inequities in health and social services (HSS). However, it often tends to be a top-down process initiated by policy makers, and the values of the intended beneficiaries are forgotten. Involving multiple stakeholders including patients and the public in the scaling-up process is thus essential but highly complex. We propose to identify relevant strategies for meaningfully and equitably involving patients and the public in the science and practice of scaling up in HSS. Methods We will adapt our overall method from the RAND/UCLA Appropriateness Method. Following this, we will perform a two-prong study design (knowledge synthesis and Delphi study) grounded in an integrated knowledge translation approach. This approach involves extensive participation of a network of stakeholders interested in patient and public involvement (PPI) in scaling up and a multidisciplinary steering committee. We will conduct a systematic scoping review following the methodology recommended in the Joanna Briggs Institute Reviewers Manual. We will use the following eligibility criteria: (1) participants—any stakeholder involved in creating or testing a strategy for PPI; (2) intervention—any PPI strategy proposed for scaling-up initiatives; (3) comparator—no restriction; (4) outcomes: any process or outcome metrics related to PPI; and (5) setting—HSS. We will search electronic databases (e.g., Medline, Web of Science, Sociological Abstract) from inception onwards, hand search relevant websites, screen the reference lists of included records, and consult experts in the field. Two reviewers will independently select and extract eligible studies. We will summarize data quantitatively and qualitatively and report results using the PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist. We will conduct an online Delphi survey to achieve consensus on the relevant strategies for PPI in scaling-up initiatives in HSS. Participants will include stakeholders from low-, middle-, and high-income countries. We anticipate that three rounds will allow an acceptable degree of agreement on research priorities. Discussion Our findings will advance understanding of how to meaningfully and equitably involve patients and the public in scaling-up initiatives for sustainable HSS. Systematic review registration We registered this protocol with the Open Science Framework on August 19, 2020 (https://osf.io/zqpx7/).

scholarly journals Photograph Based Evaluation of Consumer Expectation on Healthiness, Fullness, and Acceptance of Sandwiches as Convenience Food

Foods ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 1102
Author(s):  
Purificación García-Segovia ◽  
Mª Jesús Pagán-Moreno ◽  
Amparo Tárrega ◽  
Javier Martínez-Monzó
Keyword(s):  
Interaction Effect ◽  
Online Survey ◽  
Age Groups ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Visual Appearance ◽  
Consumer Expectation ◽  
Preference Mapping ◽  
Consumer Experiences ◽  
And Cluster Analysis

Sandwiches are the most common “casual-food” consumed by all age groups in Spain. Due to the importance of visual appearance to promote unplanned or impulse buying, foodservice and hospitality companies focus on improving the visual impression of their food menus to create an expectation that satisfies both sensory and hedonic consumer experiences. To provide a list of attributes about the visual appearance of sandwiches, 25 students were recruited from a university and were invited to participate in two nominal group technique (NGT) sessions. To understand whether a sandwiches’ appearance can influence the expectation of consumers, 259 participants completed an online survey specially designed from the results of the NGT sessions. Data were analyzed using conjoint, internal preference mapping and cluster analysis; the interaction effect by gender was also studied. The conjoint results indicate that visual perception about the filling (vegetal or pork based) plays the most key role overall in consumer expectation. When consumers choose vegetables as the filling, the consumers’ perceived sandwiches as healthier, but the pork filling was perceived as more attractive and satiating. Interaction effect by gender was observed in filling when females perceived pork filling as less healthy than vegetable. By acceptance, consumers were segmented into three groups. The first cluster (n = 80) selected the pork filling. The smaller group (cluster 3, n = 36) prioritized the vegetal filling, and the most numerous cluster 2 (n = 140) liked sandwiches with multigrain bread. These results may help companies to build tailor-made marketing strategies to satisfy consumer segments.

scholarly journals Promoting Scale-Up Across a Global Project Platform: Lessons from the Evidence to Action Project

2021 ◽  
Author(s):  
Laura Ghiron ◽  
Eric Ramirez-Ferrero ◽  
Rita Badiani ◽  
Regina Benevides ◽  
Alexis Ntabona ◽  
...  
Keyword(s):  
Family Planning ◽  
Scale Up ◽  
Scaling Up ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
Country Level ◽  
Look Ahead ◽  
Republic Of The Congo ◽  
Sub Saharan ◽  
Multi Stakeholder

AbstractThe USAID-funded flagship family planning service delivery project named Evidence to Action (E2A) worked from 2011 to 2021 to improve family planning and reproductive health for women and girls across seventeen nations in sub-Saharan Africa using a “scaling-up mindset.” The paper discusses three key lessons emerging from the project’s experience with applying ExpandNet’s systematic approach to scale up. The methodology uses ExpandNet/WHO’s scaling-up framework and guidance tools to design and implement pilot or demonstration projects in ways that look ahead to their future scale-up; develop a scaling-up strategy with local stakeholders; and then strategically manage the scaling-up process. The paper describes how a scaling-up mindset was engendered, first within the project’s technical team in Washington and then how they subsequently sought to build capacity at the country level to support scale-up work throughout E2A’s portfolio of activities. The project worked with local multi-stakeholder resource teams, often led by government officials, to equip them to lead the scale-up of family planning and health system strengthening interventions. Examples from project experience in the Democratic Republic of the Congo, Kenya, Nigeria, and Uganda illustrating key concepts are discussed. E2A also established a community of practice on systematic approaches to scale up as a platform for sharing learning across a variety of technical agencies engaged in scale-up work and to create learning opportunities for interacting with thought leaders around critical scale-up issues.

scholarly journals Parent engagement in co-design of clinical trials: the PARENT trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Leigh M. Vanderloo ◽  
Shelley M. Vanderhout ◽  
Erika Tavares ◽  
Jonathon Maguire ◽  
Sharon Straus ◽  
...  
Keyword(s):  
Focus Group ◽  
Patient Engagement ◽  
Parent Engagement ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Future Research ◽  
Potential Barriers ◽  
Patient Engagement In Research ◽  
Diverse Individual ◽  
Parent Trial

AbstractEvidence generated from partnering with parents to design and conduct research together may be used to refine, adjust, and modify future research approaches. This study aimed to describe the initial approaches to parent engagement in the design of the PARENT trial as well as understand parent perspectives on the acceptability and relevance of the PARENT trial and potential barriers and facilitators to participation.Parents participating in the TARGet Kids! cohort were invited to participate in a focus group, called the PARENT panel, to co-design the PARENT trial. This focus group was conducted to capture diverse individual and collective parents’ experiences. Overall methodological approaches for the PARENT panel were informed by the CIHR Strategy for Patient Oriented Research (SPOR) guiding principles (mutual respect, co-building, inclusiveness, and support) for patient engagement in research, and facilitated through the Knowledge Translation Program in the Li Ka Shing Knowledge Institute at Unity Health Toronto. Using a Nominal Group Technique, the PARENT panel provided feedback on the feasibility, relevance, and acceptability of the proposed intervention. Findings from this work will be used to further refine, adjust, and modify the next iteration of the PARENT trial, which will also serve as an opportunity to discuss the efforts made by researchers to incorporate parent suggestions and what additional steps are required for improved patient engagement.

scholarly journals Prioritization Of Research Under National Aids Control Programme In India Using Nominal Group Technique

1970 ◽  
Vol 8 (1) ◽  
pp. 20-30
Author(s):  
R Sogarwal ◽  
D Bachani
Keyword(s):  
Nominal Group Technique ◽  
Research Priorities ◽  
Control Programme ◽  
Pediatric Hiv ◽  
Nominal Group ◽  
Phase Iii ◽  
Hiv Care ◽  
Policy Makers ◽  
Research Questions ◽  
Group Technique

Introduction: During the fi rst 2 years of the fi ve year plan of India’s National AIDS Control Programme Phase-III (NACP-III; 2007-12), various interactive consultative workshops were organized in collaboration with development partners with the objective of identifying priority areas for operational research and further development of research protocols adopting mentorship approach. Methodology: This article is an attempt to present the Nominal Group Technique (NGT) which was used to identify a set of fundable and practically feasible research priorities under NACP-III specifi cally focusing on Prevention of Parent to Child Transmission (PPTCT) and Pediatric HIV Care in India. The activity was undertaken with support of UNICEF in the year 2010. A total of 110 persons participated in the consultation clustering into 37, 36 and 37 members in Group A, B and C, respectively. The participants refl ected the mix of policy makers / decision makers (8), programme managers (12), implementers (36), subject experts / researchers (28), other stakeholders (16). Results: A total of nine highest priority research questions were identifi ed by all the groups in the assigned themes. The value of Kendall’s W coeffi cient of concordance was 0.68, which shows signifi cant agreement among raters on priority research questions (chi-square=16.35; p=0.03). Conclusion: Based on our experience, we can conclude that NGT was found to be an important tool for setting research priorities that is more democratic and transparent than the traditional methods. By applying various stages of the group sessions, participants can experience the rethinking process with reference information to enhance their judgment. The results of our experience may help programme managers / policy makers to plan similar and more improved method in other element of NACP as well as other health programmes. DOI: http://dx.doi.org/10.3126/saarctb.v8i1.5888 SAARCTB 2011; 8(1): 20-30

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