A Sociomaterial Perspective of the Challenges of Implementing the Communicative Approach in Saudi State Schools

Despite its dominance in the field of teaching English as a second/foreign language, the implementation of the Communicative Language Teaching (CLT) approach continues to be challenging and problematic. A similar set of constraints – including but not limited to challenges related to educational cultures, contextual and conceptual factors, and lack of authentic materials and facilities – have been reported as factors hindering CLT implementations in many contexts. Language teaching and learning materials and facilities are crucial elements that have been found to affect communicative language teaching implementation. However, the issue of how those material elements can affect CLT implementation has rarely been the focus of research in CLT implementation studies. In this paper, the researcher examines the effect of language teaching and learning materials on teachers’ ability to teach communicatively. Thus, informed by sociomateriality this paper attends to a gap in the literature about how material elements of the curriculum hinder the implementation of the communicative language teaching approach in the Saudi context. The data examined in this study were collected through classroom observations and semi-structured interviews. The analysis of the findings indicated that material elements in the curriculum exerted agency and power, hindering teachers’ ability to teach communicatively and learners’ ability to improve their learning experiences. The report concludes with practical implications related to the complexity of curriculum development and implementation and the emergent nature of such processes as webs of entangled human/nonhuman relations that give rise to education.

Comprehensive Sex Education Addressing Gender and Power: A Systematic Review to Investigate Implementation and Mechanisms of Impact

Background Delivered globally to promote adolescents’ sexual and reproductive health, comprehensive sex education (CSE) is rights-based, holistic, and seeks to enhance young people’s skills to foster respectful and healthy relationships. Previous research has demonstrated that CSE programmes that incorporate critical content on gender and power in relationships are more effective in achieving positive sexual and reproductive health outcomes than programmes without this content. However, it is not well understood how these programmes ultimately affect behavioural and biological outcomes. We therefore sought to investigate underlying mechanisms of impact and factors affecting implementation and undertook a systematic review of process evaluation studies reporting on school-based sex education programmes with a gender and power component. Methods We searched six scientific databases in June 2019 and screened 9375 titles and abstracts and 261 full-text articles. Two distinct analyses and syntheses were conducted: a narrative review of implementation studies and a thematic synthesis of qualitative studies that examined programme characteristics and mechanisms of impact. Results Nineteen articles met the inclusion criteria of which eleven were implementation studies. These studies highlighted the critical role of the skill and training of the facilitator, flexibility to adapt programmes to students’ needs, and a supportive school/community environment in which to deliver CSE to aid successful implementation. In the second set of studies (n = 8), student participation, student-facilitator relationship-building, and open discussions integrating student reflection and experience-sharing with critical content on gender and power were identified as important programme characteristics. These were linked to empowerment, transformation of gender norms, and meaningful contextualisation of students’ experiences as underlying mechanisms of impact. Conclusion and policy implications Our findings emphasise the need for CSE programming addressing gender and power that engages students in a meaningful, relatable manner. Our findings can inform theories of change and intervention development for such programmes.

A Sociomaterial Perspective of the Challenges of Implementing the Communicative Approach in Saudi State Schools

Despite its dominance in the field of teaching English as a second/foreign language, the implementation of the Communicative Language Teaching (CLT) approach continues to be challenging and problematic. A similar set of constraints – including but not limited to challenges related to educational cultures, contextual and conceptual factors, and lack of authentic materials and facilities – have been reported as factors hindering CLT implementations in many contexts. Language teaching and learning materials and facilities are crucial elements that have been found to affect communicative language teaching implementation. However, the issue of how those material elements can affect CLT implementation has rarely been the focus of research in CLT implementation studies. In this paper, the researcher examines the effect of language teaching and learning materials on teachers’ ability to teach communicatively. Thus, informed by sociomateriality this paper attends to a gap in the literature about how material elements of the curriculum hinder the implementation of the communicative language teaching approach in the Saudi context. The data examined in this study were collected through classroom observations and semi-structured interviews. The analysis of the findings indicated that material elements in the curriculum exerted agency and power, hindering teachers’ ability to teach communicatively and learners’ ability to improve their learning experiences. The report concludes with practical implications related to the complexity of curriculum development and implementation and the emergent nature of such processes as webs of entangled human/nonhuman relations that give rise to education.

Strategies for implementing music-based interventions for people with dementia: A systematic review

Previous research has found that music-based interventions are effective at improving several outcomes related to dementia for nursing home residents. Some studies have investigated the implementation of music-based interventions. However, to date, there is no synthesis available regarding strategies and outcomes of these implementation studies. This study aims to synthesize available evidence regarding implementation strategies and outcomes of music-based interventions for nursing home residents with dementia. We conducted a systematic literature search in PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. A total of 8 studies were included for the qualitative synthesis. Of the eight studies, half were studies of music therapy and the other half were on individualized music. We identified 49 implementation strategies. The most frequently reported category of strategies was planning (34.7%), followed by education (24.5%), quality management (24.5%), restructuring (12.2%), and finance (4.1%). No strategies under the category of attending to the policy context were reported. We identified 21 implementation outcomes. The most frequently reported category was adoption (33.3%), followed by fidelity (28.6%), appropriateness (19.0%), sustainability (9.5%), acceptability (4.8%), and cost (4.8%). No studies measured feasibility or penetration. Although various implementation strategies have been utilized, most of them are under the categories related to intervention methods. Less attention has been paid to strategies that aim at structural changes of intervention delivery systems. Future studies should investigate facilitators and barriers of implementing music-based interventions especially focusing on organizational and structural aspects.

A scoping review of de-implementation frameworks and models

Background Reduction or elimination of inappropriate, ineffective, or potentially harmful healthcare services and public health programs can help to ensure limited resources are used effectively. Frameworks and models (FM) are valuable tools in conceptualizing and guiding the study of de-implementation. This scoping review sought to identify and characterize FM that can be used to study de-implementation as a phenomenon and identify gaps in the literature to inform future model development and application for research. Methods We searched nine databases and eleven journals from a broad array of disciplines (e.g., healthcare, public health, public policy) for de-implementation studies published between 1990 and June 2020. Two raters independently screened titles and abstracts, and then a pair of raters screened all full text records. We extracted information related to setting, discipline, study design, methodology, and FM characteristics from included studies. Results The final search yielded 1860 records, from which we screened 126 full text records. We extracted data from 27 articles containing 27 unique FM. Most FM (n = 21) were applicable to two or more levels of the Socio-Ecological Framework, and most commonly assessed constructs were at the organization level (n = 18). Most FM (n = 18) depicted a linear relationship between constructs, few depicted a more complex structure, such as a nested or cyclical relationship. Thirteen studies applied FM in empirical investigations of de-implementation, while 14 articles were commentary or review papers that included FM. Conclusion De-implementation is a process studied in a broad array of disciplines, yet implementation science has thus far been limited in the integration of learnings from other fields. This review offers an overview of visual representations of FM that implementation researchers and practitioners can use to inform their work. Additional work is needed to test and refine existing FM and to determine the extent to which FM developed in one setting or for a particular topic can be applied to other contexts. Given the extensive availability of FM in implementation science, we suggest researchers build from existing FM rather than recreating novel FM. Registration Not registered

On-farm culture and pathogen identification: risks and benefits

Selective treatment of clinical mastitis cases based on the results of on-farm culture (OFC) has been suggested by several international experts. It is based on the theory that mastitis cases caused by Gram-negative species has high resolution rates, and those that do not resolve respond poorly to therapy. Several peer-reviewed studies have evaluated the accuracy of different OFC test kits, which are between 60–85% accurate at identifying Gram-positive pathogens. Implementation studies consistently show a reduction in antimicrobial use, although further research across larger populations is needed to assess the impact on mastitis cure. Any OFC protocol should be regularly reviewed with the herd veterinarian. Herds with a high bulk cell count, a high prevalence of Gram-positive pathogens (e.g. Streptococcus uberis), or with a high prevalence of Klebsiella spp. should carefully consider the impact of deferred or withholding treatment on mastitis cure.

The use of patient-reported measures in epilepsy care: the Calgary Comprehensive Epilepsy Program experience

The regular use of patient-reported measures (PRMs) has been associated with greater patient satisfaction and outcomes. In this article, we will review the Calgary Comprehensive Epilepsy Program's successful experience with PRMs in both clinical and research settings, as well as our current challenges and future directions. Our experience will illustrate that is feasible and convenient to implement PRMs, and especially electronic PRMs (ePRMs), into epilepsy clinics. These PRMs have direct clinical and research applications. They inform clinical decision making through readily interpretable scales to which clinicians can expeditiously respond. Equally, they are increasingly forming an integral and central component of intervention and outcomes-based research. However, implementation studies are necessary to address knowledge gaps and facilitate adoption and dissemination of this approach. A natural symbiosis of the clinical and research realms is precision medicine. The foundations of precision-based interventions are now being set whereby we can maximize the quality of life and psychosocial functioning on an individual level. As illustrated in this article, this exciting prospect crucially depends on the routine use of ePRMs in the everyday care of people with epilepsy. Increasing ePRMs uptake will clearly be a catalyst propelling precision epilepsy from aspiration to clinical reality.

Challenges of Antibiotic Stewardship in the Pediatric and Neonatal Intensive Care Units

The goals of antimicrobial stewardship programs (ASPs) are to optimize antimicrobial prescribing habits in order to improve patient outcomes, reduce antimicrobial resistance, and reduce hospital costs. Multiple society-endorsed guidelines and government policies reinforce the importance of ASP implementation. Effective antimicrobial stewardship can impact unique patients, hospitals, and societal antibiotic-resistance burden. The role and subsequent success of these programs has largely been reported in the adult population. Pediatric and neonatal intensive care units present unique challenges for traditional antimicrobial stewardship approaches. The purpose of this review article is to explore the challenges of appropriate antibiotic use in the pediatric and neonatal intensive care units and to summarize strategies ASPs can use to overcome these challenges. These problems include non-specific disease presentations, limited evidence for definitive treatment durations in many pediatric infections, fewer pediatric-trained infectious disease physicians, and applicability of intensive laboratory obtainment, collection, and interpretation. Additionally, many ASP implementation studies evaluating the efficacy of ASPs exclude the PICU and NICU. Areas of focus for pediatric ASPs should likely include appropriate antibiotic initiation, appropriate antibiotic duration, and appropriate antibiotic de-escalation.

Evaluating Implementation Contexts, Mechanisms, and Outcomes: A Normalization Process Theory Coding Manual for Qualitative Research and Instrument Development

Background. Qualitative studies, especially those conducted by teams of researchers, may benefit from clearly structured, parsimonious, coding manuals. The process of creating rigorous and robust coding manuals for individual studies is rarely described, and generalizable coding manuals are rare. Normalization Process Theory (NPT) provides conceptual tools to facilitate understanding of the dynamics of adoption, implementation, and sustainment of socio-technical and organizational innovations. As a widely used theory, a generalizable coding manual would be of utility to implementation researchersObjectives. To make the application of NPT simple for the user, to describe the development of a coding manual for qualitative content analytic studies using NPT, and present this for wider use.Method. Concept Selection and Structuring. Qualitative Content Analysis of selected published papers and interview transcripts. Results. All identifiable theoretical concepts (n=149) embedded in papers and chapters that developed NPT between 2006 and 2020 were identified and extracted from their texts. Overlapping, ambiguous, and duplicate versions of concepts were eliminated, as were concepts derived from other theories. This left 38 core concept definitions. These were piloted in coding of qualitative transcripts collected in two implementation studies, and by collaboratively coding papers collected for a systematic review of implementation studies. At the end of this process, a further process of elimination of overlapping or ambiguous concepts was undertaken leaving 12 primary NPT concepts. Conclusion. The process of coding manual resulted in the presentation of NPT concepts according to the Context-Mechanism-Outcomes configuration of realist evaluation research. A coding manual for NPT that is in accordance with realistic evaluation research was successfully produced and is now freely available to researchers who wish to use NPT in primary and secondary research that employs qualitative methods.