What Happened in ‘The HERizon Project’?—Process Evaluation of a Multi-Arm Remote Physical Activity Intervention for Adolescent Girls

This mixed-methods process evaluation examines the reach, recruitment, fidelity, adherence, acceptability, mechanisms of impact, and context of remote 12-week physical activity (PA) interventions for adolescent girls named The HERizon Project. The study was comprised of four arms—a PA programme group, a behaviour change support group, a combined group, and a comparison group. Data sources included intervention deliverer and participant logbooks (100 and 71% respective response rates, respectively), exit surveys (72% response rate), and semi-structured focus groups/interviews conducted with a random subsample of participants from each of the intervention arms (n = 34). All intervention deliverers received standardised training and successfully completed pre-intervention competency tasks. Based on self-report logs, 99% of mentors adhered to the call guide, and 100% of calls and live workouts were offered. Participant adherence and intervention receipt were also high for all intervention arms. Participants were generally satisfied with the intervention components; however, improvements were recommended for the online social media community within the PA programme and combined intervention arms. Autonomy, sense of accomplishment, accountability, and routine were identified as factors facilitating participant willingness to adhere to the intervention across all intervention arms. Future remote interventions should consider structured group facilitation to encourage a genuine sense of community among participants.

How Does Participatory Action Research Generate Innovation? Findings from a Rapid Realist Review

This Emerging Evidence Report shares evidence of how, for whom, and under what circumstances, Participatory Action Research (PAR) leads to innovative actions. A rapid realist review was undertaken to develop programme theories that explain how PAR generates innovation. The methodology included peer-reviewed and grey literature and moments of engagement with programme staff, such that their input supported the development and refinement of three resulting initial programme theories (IPTs) that we present in this report. Across all three IPTs, safe relational space, group facilitation, and the abilities of facilitators, are essential context and intervention components through which PAR can generate innovation. Implications from the three IPTs for evaluation design of the CLARISSA programme are identified and discussed. The report finishes with opportunities for the CLARISSA programme to start building an evidence base of how PAR works as an intervention modality, such as evidencing group-level conscientisation, the influence of intersecting inequalities, and influence of diverse perspectives coming together in a PAR process.

A descriptive video analysis of interactions during inpatient brain injury rehabilitation groups

Introduction An advantage of using groups in rehabilitation is the opportunity for peer learning and support. This study aimed to describe and understand the nature of interactions occurring in inpatient occupational therapy brain injury rehabilitation groups, using video-recorded group interactions, to inform recommendations for group facilitation. Method Video recordings of four occupational therapy rehabilitation groups were taken. Twelve adults with brain injury who participated in the groups and four facilitators consented to the study. The data were analysed using a qualitative descriptive approach. Results Interactions were predominantly facilitated by facilitators and shaped by the nature of the group activities. Facilitators used a number of strategies to encourage interaction including knowledge of group participants, activity choice and physical positioning of group members. Conclusion Group facilitators utilise a number of strategies to encourage peer interactions. However, during structured activity-based rehabilitation groups, participants with a brain injury may focus predominantly on achieving the goal of the group rather than initiating peer interactions.

Group Facilitation on Societal Disruption and Collapse: Insights from Deep Adaptation

This article synthesises the practice and rationale behind ways of facilitating gatherings on topics of societal disruption and collapse, which is argued to be useful for lessening damaging responses. The authors draw on first-person inquiry as facilitators of gatherings, both online and in person, in the post-sustainability field of ‘Deep Adaptation,’ particularly since 2018. This term describes an agenda and framework for people who believe in the probable, inevitable or unfolding collapse of industrial consumer societies, due to the direct and indirect impacts of human-caused climate change and environmental degradation. Some of the principles of Deep Adaptation facilitation are summarised, such as containment, to enable co-responsibility for a safe enough space for difficult conversations. Another key principle is welcoming radical uncertainty in response to the anxieties that people feel from their anticipation of collapse. A third principle is making space for difficult emotions, which are welcomed as a natural and ongoing response to our predicament. A fourth aspect is a curiosity about processes of othering and separation. This paper provides a review of the theories that a reason for environmental destruction is the process of othering people and nature as being less significant or meaningful. One particular modality called Deep Relating is outlined.

Becoming the Unseen Helmsman - Game facilitator competencies for novice, experienced, and non-game facilitators

Background. To facilitate game sessions for purposes beyond mere entertainment a facilitator needs to act like an ‘Unseen Helmsman’: steering their ship clear from rocks and storms without the players in the ship realizing. Previous work laid down a competency model for game facilitation. It reviewed several competency models for facilitators of generic (non-game) group sessions. Since no such model comprehensively provided guidelines to facilitate game sessions in particular, a new competency model was proposed using a bottom-up approach with the participation of game facilitation experts. The question remains what lessons may be drawn from this model. Methods. This contribution elaborates on the competency model for game facilitation and draws lessons from it. Thus it aims to empower both novice and experienced game facilitators to become an Unseen Helmsman. Also, it presents learnings for people who are experienced in facilitating groups in general, but who are new to facilitating game sessions. Conclusions. First, lessons for novice game facilitators include familiarising themselves with the core notions of the competency model: the characteristics of a complex systems game (session), and the attitudes, knowledge, and skills for successful game facilitation. Second, experienced game facilitators may learn from existing competency models for generic (non-game) group facilitation. Third, facilitators of generic (non-game) group sessions are encouraged to study the characteristics of game sessions in addition to the specific competencies contained in the competency model for game facilitators.

Collaborative improvement in Scottish GP clusters after the Quality and Outcomes Framework: a qualitative study

Background: Scotland abolished the Quality and Outcomes Framework (QOF) in April 2016, prior to implementing a new Scottish GP contract in April 2018. Since 2016, groups of practices (GP clusters) have been incentivised to meet regularly, to plan and organise quality improvement (QI) as part of this new direction in primary care policy. Aim: To understand the organisation and perceived impact of GP clusters, including how they use quantitative data for improvement. Design/Setting/Methods: Thematic analysis, of semi-structured interviews with key stakeholders (n=17) and observations of GP cluster meetings (n=6) in two clusters. Results: There was uncertainty whether GP clusters should focus on activities generated internally or externally by the wider healthcare system (e.g. from Scottish Health Boards), although the two clusters we observed generally generated their own ideas and issues. Clusters operated with variable administrative/managerial and data support, and variable baseline leadership experience and QI skills. Qualitative approaches formed the focus of collaborative learning in cluster meetings, through sharing and discussion of member practices’ own understandings and experiences. We observed less evidence of data analytics being championed in these meetings, partly because of barriers accessing the analytics data and existing data quality. Conclusion: Cluster development would benefit from more consistent training and support for cluster leads in small group facilitation, leadership and QI expertise, and data analytics access and capacity. Whilst GP clusters are up and running, their impact is likely to be limited without further investment in developing capacity in these areas.