Enhancing engagement in meaningful occupation in a dementia town: A qualitative evaluation of MOED – The meaningful occupational engagement intervention for people with dementia

Introduction Engagement in meaningful everyday life occupations is linked to well-being. However, people with dementia are often deprived of engagement. As a response, a Danish Dementia Town was established with the intention of transforming care services to improve opportunities for meaningful engagement. The evidence-based The meaningful occupational engagement intervention for people with dementia (MOED) intervention was developed and implemented in dementia town to enhance meaningful occupational engagement. The purpose of this paper is to evaluate the content, impact and implementation process of MOED. Method To evaluate MOED, we applied a program theory-based qualitative approach, building on participant observations and informal conversations with people with dementia ( n = 7) and staff ( n = 9). Data were analysed from a hermeneutic approach to gain an in-depth understanding of how MOED influenced meaningful occupational engagement and to evaluate the implementation process. Findings The main theme ‘Engagement in meaningful occupations – a conditional and fragile process’ emerged along with three subthemes: ‘Creating an everyday space of meaning: Conditions of the intervention’, ‘Occupational engagement as an opportunity to blossom: Impact of the intervention’ and ‘Professional identity, culture and reflections: Contextual barriers to changes to working practice’. Together, the subthemes illustrate how engagement in meaningful occupations arose. However, opportunities to engage in meaningful occupations were fragile, as they depended on various factors within the context. Conclusion Engagement in meaningful occupations emerged when MOED was applied in accordance with the program theory, as it seemed to create spaces where people with dementia could engage in meaningful occupations and they could blossom over time. However, MOED was only partially implemented in accordance with the developed program theory, as several contextual barriers influenced the sustainability of the intervention. MOED showed potential to support improvement in dementia care activity programmes to enhance opportunities to engage in meaningful occupations in everyday life for people living with dementia.

Health care professionals’ perspectives on self-management for people with Parkinson’s: qualitative findings from a UK study

Background Parkinson’s disease is a long-term, complex health condition. To improve or maintain quality of life, people with Parkinson’s can have an active involvement in their care through self-management techniques. Given the complexity and individualization of self-management, people with Parkinson’s will need support and encouragement from their healthcare professionals (HCPs). Despite the key role HCPs have in this, research has seldom explored their perspectives and understanding of self-management for people with Parkinson’s. Methods Multi-disciplinary teams providing care for people with Parkinson’s across London, Coventry and Hertfordshire were approached and took part in either one of four focus groups or individual interviews. Forty-two HCPs, including a range of specialist doctors, general practitioners, allied health professionals, nurses, and social workers, took part in this study. Interviews were transcribed and analysed using thematic analysis to identify themes. Results Four themes were developed from the data: 1) Empowerment of patients through holistic care and being person-centred; 2) Maximising motivation and capability for patients, for example using asset based approaches and increasing opportunities; 3) importance of empowerment of carers to support self-management and 4) contextual barriers to self-management such as the social context. Conclusions This study is the first to explore the perspectives of HCPs on self-management in people with Parkinson’s. Our findings have identified important considerations surrounding empowerment, motivation, carers and contextual barriers to better understand how we enable effective self-management techniques in people with Parkinson’s. Research should build on these findings on to develop acceptable and effective self-management tools for use in practice with people affected by Parkinson’s.

Rural entrepreneurship and the context: navigating contextual barriers through women's groups

PurposeThis study aims to examine how women's groups help women to navigate context-related barriers to their engagement in rural entrepreneurship. The paper combines the contextualisation of entrepreneurship framework and the feminist separatist theory to describe how women's groups in patriarchal rural communities enable women to circumvent context-related barriers and actively engage in rural entrepreneurship.Design/methodology/approachBased on a case study of 12 women's groups engaged in paddy farming, rice processing and marketing in rural Tanzania, this study draws on semi-structured interviews with 46 women, four focus group discussions, four in-depth key informant interviews and non-participant observation.FindingsRural women face unique context-related challenges that hinder them from effectively participating in rural entrepreneurship. Specifically, limited access to farmlands and profitable markets, lack of business networks, limited time, poverty and insufficient financial resources constrain women's engagement in entrepreneurship. To overcome these contextual barriers, rural women have organised themselves into groups to gain access to business services, business-related training, grants and business networks.Research limitations/implicationsThis study contributes to the existing literature on contextualising entrepreneurship by focussing on how rural contexts may constrain women's entrepreneurial engagement while showing how women respond to contextual barriers that enable them to participate in rural entrepreneurship.Practical implicationsThis study shows that women with low education can pursue rural entrepreneurship if they are supported through training and access to networks. This will support the performance of these groups of women.Originality/valueThis study offers new insights into the role of women's groups in navigating gender-related constraints that hinder women from participating in rural entrepreneurship within the patriarchal context of low-income countries. Thus, new perceptions for the gender and rural entrepreneurship theory and the policy implications thereof are proffered.

Implementation, Mechanisms and Context of the MAMAACT Intervention to Reduce Ethnic and Social Disparity in Stillbirth and Infant Health

The MAMAACT intervention aimed to address ethnic and social disparity in stillbirth and infant health by improving management of pregnancy complications. This process evaluation of the intervention was guided by the British Medical Research Council’s framework. We examined implementation through dose, reach, and fidelity, important mechanisms and the influence of contextual factors. The intervention included a six-hour training session for antenatal care (ANC) midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials (leaflet and app) on warning signs of severe pregnancy complications and how to respond for pregnant women. A mixed-methods approach was applied. Cross-sectional survey data and administrative data were used to assess intervention reach and dose. Qualitative data (records from dialogue meetings with midwives, participant observations and field notes from ANC visits, focus group interviews with midwives, and individual interviews with non-Western immigrant women) evaluated intervention fidelity, mechanisms, and contextual barriers. More than 80% of women received the MAMAACT leaflet and many found the content useful. The app was used more selectively. Midwives described being more aware and reflective in their communication with women from various cultural backgrounds. Organizational factors in ANC (time pressure, lack of flexibility in visits, poor interpreter services), barriers in women’s everyday life (lack of social network, previous negative experiences/lack of trust and domestic responsibilities), and habitual interaction patterns among midwives served as contextual barriers. The reach of the intervention was high and it was evaluated positively by both pregnant women and midwives. Organizational factors hindered changes towards more needs-based communication in ANC potentially hindering the intended mechanisms of the intervention. When interpreting the intervention effects, attention should be drawn to both organizational and interpersonal factors in the clinic as well as the pregnant women’s life situations.

Process evaluation of co-designed interventions to improve communication of positive newborn bloodspot screening results

ObjectiveTo implement and evaluate co-designed interventions to improve communication of positive newborn bloodspot screening results and make recommendations for future research and practice.DesignA process evaluation underpinned by Normalisation Process Theory.SettingThree National Health Service provider organisations in England.ParticipantsTwenty-four healthcare professionals (7 newborn screening laboratory staff and 24 clinicians) and 18 parents were interviewed.InterventionsThree co-designed interventions were implemented in practice: standardised laboratory proformas, communication checklists and an email/letter template.Primary outcome measuresAcceptability and feasibility of the co-designed interventions.ResultsAuditing the implementation of these interventions revealed between 58%–76% of the items on the laboratory proforma and 43%–80% of items on the communication checklists were completed. Interviews with healthcare professionals who had used the interventions in practice provided positive feedback in relation to the purpose of the interventions and the ease of completion both of which were viewed as enhancing communication of positive newborn bloodspot screening results. Interviews with parents highlighted the perceived benefit of the co-designed interventions in terms of consistency, pacing and tailoring of information as well as providing reliable information to families following communication of the positive newborn bloodspot screening result. The process evaluation illuminated organisational and contextual barriers during implementation of the co-designed interventions in practice.ConclusionVariations in communication practices for positive newborn bloodspot screening results continue to exist. The co-designed interventions could help to standardise communication of positive newborn screening results from laboratories to clinicians and from clinicians to parents which in turn could improve parents’ experience of receiving a positive newborn bloodspot screening result. Implementation highlighted some organisational and contextual barriers to effective adoption of the co-designed interventions in practice.Trial registration numberISRCTN15330120.

Échale Neurona and contextual barriers to sex and sexuality education in Mexico

Background: Developing sex and sexuality education programmes for adolescents has proved challenging in many parts of the world, especially in contexts where the importance of these programmes is not valued. In such settings, educating about sex and sexuality may also require dealing with detractors who are active in spreading misinformation. Objective: This article identifies contextual barriers encountered by those involved in developing the Échale Neurona programme in Mexico. Team members associated with the programme have been teaching about sex and sexuality in public secondary and high schools since 2016. Methods and design: Grounded theory approach using semi-structured interviews. Interviews took place with 10 participants including health promotion experts and programme officials. The main focus of the interviews was on the contextual limitations encountered when implementing sex and sexuality education workshops. Results: Findings reveal at least three types of barriers hindering the comprehensive sex and sexuality education developed by the programme: institutional, cultural and socio-educational barriers. Conclusion: Contextual barriers associated with family and school environments posed a significant challenge to implementation. Such barriers may facilitate or hinder sex and sexuality education programmes affecting the way young people develop their sex lives and live their sexuality.

Barriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services

Background Stroke is a leading cause of disability worldwide. Visual impairments (VIs) affect 60% of stroke survivors, and have negative consequences for rehabilitation and post-stroke life. VIs after stroke are often overlooked and undertreated due to lack of structured routines for visual care after stroke. This study aims to identify and assess barriers and facilitators to the implementation of structured visual assessment after stroke in municipal health care services. The study is part of a larger knowledge translation project. Methods Eleven leaders and municipal interdisciplinary health care professionals participated in qualitative interviews. During two workshops, results from the interviews were discussed with 26 participants from municipal health care services and user representatives. Data from interviews and workshops were collected before the intervention was implemented and analyzed using content analysis. Results The analysis identified individual and contextual barriers and facilitators. The individual barriers were related to the participants' experiences of having low competence of visual functions and vision assessment skills. They considered themselves as generalists, not stroke experts, and some were reluctant of change because of previous experiences of unsuccessful implementation projects. Individual facilitators were strong beliefs that including vision in stroke care would improve health care services. If experienced as useful and evidence based, the new vision routine would implement easier. Contextual barriers were experiences of unclear responsibility for vision care, lack of structured interdisciplinary collaboration and lack of formal stroke routines. Time constraints and practical difficulties with including the vision tool in current medical records were also expressed barriers. Contextual facilitators were leader support and acknowledgement, in addition to having a flexible work schedule. Conclusions This study shows that improving competence about VIs after stroke and skills in assessing visual functions are particularly important to consider when planning implementation of new vision routines in municipal health care services. Increased knowledge about the consequences of living with VIs after stroke, and the motivation to provide best possible care, were individual facilitators for changing clinical practice. Involving knowledge users, solutions for integrating new knowledge in existing routines, along with easily accessible supervision in own practise, are essential facilitators for promoting a successful implementation.