Remembering Elizabeth Ann Manhart Barrett, RN; PhD; FAAN, Her Life and Legacy

This is a tribute to Dr. Elizabeth Ann Manhart Barrett, creator of the Power as Knowing Participation in Change theory and research tool. Her life is described in her own words via the obituaries she wrote for her family to share in various venues. This is followed by a tribute from Dr. Violet Malinski, a friend and colleague of Dr. Barrett.

Vaccine hesitancy and behavior change theory-based social media interventions: a systematic review

It is widely acknowledged that vaccine hesitancy is a multifaceted problem that cannot be addressed by a single strategy. Behavior change theories and social media tools may together help to guide the design of interventions aimed at improving vaccination uptake. This systematic review aims to identify the breadth and effectiveness of such theories and tools. The systematic review search was performed in PubMed, Scopus, ACM, Cochrane Library, ProQuest, and Web of Science databases for studies between January 2011 and January 2021 that applied social media tools to increase vaccine confidence or improve vaccination uptake. The literature search yielded a total of 3,065 publications. Twenty articles met the eligibility criteria, 12 of which were theory-based interventions. The result shows that the Health Belief Model was the most frequently deployed theory, and the most common social media tool was educational posts, followed by dialogue-based groups, interactive websites, and personal reminders. Theory-based interventions were generally more measurable and comparable and had more evidence to trigger the positive behavior change. Fifteen studies reported the effectiveness in knowledge gain, intention increase, or behavior change. Educational messages were proved to be effective in increasing knowledge but less helpful in triggering behavior change. Dialogue-based social media intervention performed well in improving people’s intention to vaccinate. Interventions informed by behavior change theory and delivered via social media platforms offer an important opportunity for addressing vaccine hesitancy. This review highlights the need to use a multitheory framework and tailoring social media interventions to the specific circumstances and needs of the target audience in future interventions. The results and insights gained from this review will be of assistance to future studies.

Development of a self-management intervention for stroke survivors with aphasia using co-production and behaviour change theory: An outline of methods and processes

Background Self-management is a promising approach to improve quality of life after stroke. However, evidence for the appropriateness and effectiveness of self-management for stroke survivors with aphasia is limited. This article reports on the process used to develop a supported self-management intervention for stroke survivors with aphasia (SSWA) using co-production and behaviour change theory. Preparatory research included systematic reviews, and qualitative interviews and focus groups with SSWA, family members and speech and language therapists (SLTs). Materials and methods We conducted six, 2 hour long intervention development workshops with key stakeholders. The workshops were informed by principles of co-production and the intervention development process outlined by the Behaviour Change Wheel (BCW). We also incorporated the findings of our preparatory research within workshops. Each workshop included an introduction, 1–2 co-production tasks and time for feedback at the end of the session. Data were analysed on an ongoing basis so that findings could be used to feed in to subsequent workshops and intervention development. Results Workshop participants (n = 12) included; SSWA (n = 5), family members (n = 3) and SLTs (n = 4). Together, participants engaged with accessible and participatory co-production tasks which aligned with the BCW framework. Participants engaged in discussion to define self-management in behavioural terms (behavioural diagnosis) and to identify what needed to change to support self-management. Participant’s co-produced solutions for supporting self-management and discussed options to implement these in practice. Prototype materials were generated by the research team and evaluated by participants. Intervention functions and behaviour change techniques (BCTs) were mapped to the solutions generated by participants by the research team, after the final workshop. A supported self-management intervention for SSWA was developed which will be delivered by SLTs through community stroke services. Conclusions This paper reports the process we used to integrate co-production work with behaviour change theory to develop a complex self-management intervention. This is of relevance for researchers looking to harness the strengths of co-production methods and theory in intervention design. Future research will feasibility test the supported self-management intervention developed. This paper provides transparency to our intervention development process which will help others to better interpret the findings of our feasibility work.

E-Learning in Information Management (IM) Education in Sri Lanka: An examination of contextual issues

<p>Information is considered a fundamental resource for improving the quality of governance and promoting socio-economic development in developing countries. In Sri Lanka, under the government’s vision of higher education, Information Management (IM) education is seen as important for fostering the development of a high quality market-oriented and knowledge-based society. However, a number of barriers currently restrict access to IM education by Sri Lankan information workers: the provision of education is limited to face-to-face teaching at three institutions in the Colombo (capital city) area, and the country’s physical infrastructure makes it difficult for full-time workers to attend classes without missing substantial work time. This results in IM employer reluctance to support education. Hence there is a growing need to provide equity of access to IM education. In response to World Bank reports (2007, 2009) the Quality Assurance and Accreditation Council (QAAC) of Sri Lanka aims to foster transformative change in IM education with the goal of increasing equality of access to IM education through the use of e-learning. A number of early attempts to implement e-learning in Sri Lanka have already failed (Anderson, 2008). There is no rigorous research that investigates what factors have an impact on the introduction and use of e-learning in tertiary-level IM education in the Sri Lankan context and what the barriers or enablers to doing so might be. Understanding of the cultural context is known to be critical for the success of e-learning (Siritongthaworn et al., 2006). This research fills these gaps in the literature. It was guided by two questions: (i) what are the contextual factors that affect the introduction and use of e-learning in tertiary-level IM education in Sri Lanka? and (ii) how do these factors affect the introduction and use of e-learning? An interpretive case study research was conducted. Thirty semi-structured interviews were conducted with information management education providers, existing e-learning providers and relevant stakeholders, and three focus group discussions were conducted with information workers and academics. Relevant documents were also analysed: (i) official government documents, e.g. policies, reports, and announcements; (ii) official documents from private sources, e.g. administrative documents, proposals, progress reports, and other internal records; and (iii) relevant internet resources. Fullan’s (1991) educational change theory and Hofstede, Hofstede, and Minkov’s (2010) cultural dimensions provided a basis for a conceptual model to guide the process of data collection and analysis in this study to gain an understanding of factors affecting the introduction and use of e-learning in tertiary-level IM education in Sri Lanka. Factors that are perceived to have an impact on the introduction and use of e-learning in tertiary-level IM education in Sri Lanka were found at different levels. Macro-level factors included social and cultural factors, governmental factors, and technological factors. Meso-level factors included resistance to pedagogical change, lack of human and other resources, lack of collaboration/partnership among stakeholders and collective perception of e-learning acceptance. A key outcome of this study is the development of a contextual framework to guide the introduction and use of e-learning in tertiary-level IM education in Sri Lanka. This study extends education and sociology research (including socio-technological innovation research) involving Fullan’s educational change theory and Hofstede, Hofstede, and Minkov’s cultural dimensions into a developing country context. In addition to the study contributing to theoretical understanding in education and sociology research, the findings of this study have implications for IM educators and practice in the forms of development of policies, implementation of e-learning, and prioritization and allocation of resources.</p>

E-Learning in Information Management (IM) Education in Sri Lanka: An examination of contextual issues

<p>Information is considered a fundamental resource for improving the quality of governance and promoting socio-economic development in developing countries. In Sri Lanka, under the government’s vision of higher education, Information Management (IM) education is seen as important for fostering the development of a high quality market-oriented and knowledge-based society. However, a number of barriers currently restrict access to IM education by Sri Lankan information workers: the provision of education is limited to face-to-face teaching at three institutions in the Colombo (capital city) area, and the country’s physical infrastructure makes it difficult for full-time workers to attend classes without missing substantial work time. This results in IM employer reluctance to support education. Hence there is a growing need to provide equity of access to IM education. In response to World Bank reports (2007, 2009) the Quality Assurance and Accreditation Council (QAAC) of Sri Lanka aims to foster transformative change in IM education with the goal of increasing equality of access to IM education through the use of e-learning. A number of early attempts to implement e-learning in Sri Lanka have already failed (Anderson, 2008). There is no rigorous research that investigates what factors have an impact on the introduction and use of e-learning in tertiary-level IM education in the Sri Lankan context and what the barriers or enablers to doing so might be. Understanding of the cultural context is known to be critical for the success of e-learning (Siritongthaworn et al., 2006). This research fills these gaps in the literature. It was guided by two questions: (i) what are the contextual factors that affect the introduction and use of e-learning in tertiary-level IM education in Sri Lanka? and (ii) how do these factors affect the introduction and use of e-learning? An interpretive case study research was conducted. Thirty semi-structured interviews were conducted with information management education providers, existing e-learning providers and relevant stakeholders, and three focus group discussions were conducted with information workers and academics. Relevant documents were also analysed: (i) official government documents, e.g. policies, reports, and announcements; (ii) official documents from private sources, e.g. administrative documents, proposals, progress reports, and other internal records; and (iii) relevant internet resources. Fullan’s (1991) educational change theory and Hofstede, Hofstede, and Minkov’s (2010) cultural dimensions provided a basis for a conceptual model to guide the process of data collection and analysis in this study to gain an understanding of factors affecting the introduction and use of e-learning in tertiary-level IM education in Sri Lanka. Factors that are perceived to have an impact on the introduction and use of e-learning in tertiary-level IM education in Sri Lanka were found at different levels. Macro-level factors included social and cultural factors, governmental factors, and technological factors. Meso-level factors included resistance to pedagogical change, lack of human and other resources, lack of collaboration/partnership among stakeholders and collective perception of e-learning acceptance. A key outcome of this study is the development of a contextual framework to guide the introduction and use of e-learning in tertiary-level IM education in Sri Lanka. This study extends education and sociology research (including socio-technological innovation research) involving Fullan’s educational change theory and Hofstede, Hofstede, and Minkov’s cultural dimensions into a developing country context. In addition to the study contributing to theoretical understanding in education and sociology research, the findings of this study have implications for IM educators and practice in the forms of development of policies, implementation of e-learning, and prioritization and allocation of resources.</p>

Sustainability in Quality Improvement (SusQI): challenges and strategies for translating undergraduate learning into clinical practice

Background The healthcare sector is a major contributor to climate change and there are international calls to mitigate environmental degradation through more sustainable forms of clinical care. The UK healthcare sector has committed to net zero carbon by 2040 and sustainable healthcare is a nationally mandated outcome for all UK graduating doctors who must demonstrate their ability to address social, economic, and environmental challenges. Bristol Medical School piloted successful Sustainability in Quality Improvement (SusQI) workshop, but identified challenges translating classroom learning into clinical practice. This paper aims to identify and address those challenges. Methods We conducted five focus groups that identified and iteratively explored barriers and facilitators to practice among medical students, comparing a range of experiences to generate a conceptual model. We then combined our findings with behaviour change theory to generate educational recommendations. Results Students that applied their learning to the clinical workplace were internally motivated and self-determined but needed time and opportunity to complete projects. Other students were cautious of disrupting established hierarchies and practices or frustrated by institutional inertia. These barriers impacted on their confidence in suggesting or achieving change. A minority saw sustainable healthcare as beyond their professional role. Conclusions We present a series of theoretically informed recommendations. These include wider curricular engagement with concepts of sustainable clinical practice; supportive workplace enablement strategies such as workplace champions and co-creation of improvement goals; and time and headspace for students to engage through structured opportunities for credit-bearing project work.

Development of a secondary school-based digital behaviour change intervention to improve tooth brushing

Background Dental caries in adolescents remains a significant public health problem with few oral health promotion interventions aimed at reducing dental caries in secondary school-aged students. Previous oral health and mobile health (mHealth) research has suggested the need for the development of a school-based behaviour change intervention incorporating a digital component. This study aimed to describe the development process of a behaviour change intervention to improve the oral health of students aged 11–16 years attending secondary schools in the UK. Methods A six-step process was used to develop the complex intervention informed by behaviour change theory and involving students, young people, parents and teachers in the process. The steps were: (1) identifying the target behaviours, namely tooth brushing with a fluoride toothpaste (2) identifying the theoretical basis and developing the causal model (3) reviewing the relevant literature and developing the logic model (4) designing the intervention with young people, parents and school staff (5) specifying the intervention content and (6) translating this content into features of the intervention and piloting. Results The resultant intervention included a quality-assured classroom-based session (CBS) (guided by a lesson plan and teaching resources), delivered by school teachers which was embedded within the school curriculum. This CBS was followed by a series of (Short Message Service) SMS texts delivered twice daily to student’s mobile telephones with the content, duration and timing of the messages informed by involvement of students and young people. Conclusions An intervention to improve the oral health of secondary school students through improved tooth brushing was rigorously developed based on behaviour change theory and work with young people, parents and school staff. Further research is needed to evaluate the outcomes and processes involved following the delivery of this intervention. BRIGHT Trial Trial Registration ISRCTN12139369.