If we can imagine it, we can build it: Developing Complexity Theory-Informed Methodologies

Seemingly intractable or ‘wicked’ problems are often characterised by the complexity and uncertainty involved. However, these characteristics are not always accounted for within research design. How health care systems may effectively respond to intimate partner violence presents a complex research problem. Researchers have been challenged to account for contextual influences when responding to intimate partner violence. However, theoretical perspectives and methodologies have not sufficiently evolved to account for the multi-layered complexity and uncertainty involved. Recognising and responding to this challenge offers opportunities to innovate methodologies and methods capable of evolving alongside learning. We present a complexity-led research design to study improving primary care service delivery to those impacted by intimate partner violence in Aotearoa New Zealand.

Contextual influences on implementation of online behavioral obesity treatment in primary care: formative evaluation guided by the consolidated framework for implementation research

Online behavioral obesity treatment is a promising first-line approach to weight management in primary care. However, little is known about contextual influences on implementation. Understand qualitative contextual factors that affect the implementation process, as experienced by key primary care stakeholders implementing the program. Online behavioral obesity treatment was implemented across a 60-clinic primary care practice network. Patients were enrolled by nurse care managers (NCMs; N = 14), each serving 2–5 practices. NCMs were randomized to one of two implementation conditions—“Basic” (standard implementation) or “Enhanced” (i.e., with added patient tracking features and more implementation strategies employed). NCMs completed qualitative interviews guided by the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed and analyzed via directed content analysis. Emergent categories were summarized by implementation condition and assigned a valence according to positive/negative influence. Individuals in the Enhanced condition viewed two aspects of the intervention as more positively influencing than Basic NCMs: Design Quality & Packaging (i.e., online program aesthetics), and Cost (i.e., no-cost program, clinician time savings). In both conditions, strongly facilitating factors included: Compatibility between intervention and clinical context; Intervention Source (from a trusted local university); and Evidence Strength & Quality supporting effectiveness. Findings highlight the importance of considering stakeholders’ perspectives on the most valued types of evidence when introducing a new intervention, ensuring the program aligns with organizational priorities, and considering how training resources and feedback on patient progress can improve implementation success for online behavioral obesity treatment in primary care.

Individual-level Evaluation of the Exposure Notification Cascade in the SwissCovid Digital Proximity Tracing App: An Observational Study (Preprint)

BACKGROUND Digital proximity tracing (DPT) aims to complement manual contact tracing (MCT) in identifying exposed contacts and preventing further transmission of SARS-CoV-2 in the population. While several DPT apps, including SwissCovid, have shown to have promising effects on mitigating the pandemic, several challenges have impeded them from fully achieving the desired results. A key question now relates to how the effectiveness of DPT can be improved which requires better understanding of factors influencing its processes. OBJECTIVE In this study, we aimed to provide a detailed examination of the exposure notification (EN) cascade and to evaluate potential contextual influences for successful receipt of EN and subsequent actions taken by cases and contacts in different exposure settings. METHODS We used data from 285 pairs of SARS-CoV-2-infected cases and their contacts within an observational cohort study of cases and contacts identified by MCT and enrolled between 06 August and 17 January 2021 in the Canton of Zurich, Switzerland. We surveyed participants with electronic questionnaires. Data were summarized descriptively and stratified by exposure setting. RESULTS We found that only 60% of contacts using the app whose corresponding case reported to have triggered the EN also received one. Among those, 23% received the EN before being contacted by MCT. Compared to those receiving an EN after MCT, we observed that a higher proportion of contacts receiving an EN before MCT were exposed in non-household settings (67% versus 56%) and their corresponding cases had more frequently reported mild to moderate symptoms (78% versus 69%). Among the 18 contacts receiving an EN before MCT, 14 (78%) took preventive measures: 12 (67%) were tested for SARS-CoV-2 and 7 (39%) called the SwissCovid Infoline. In non-household settings, the proportion of contacts taking preventive actions after receiving an EN was higher compared to same-household settings (82% versus 67%). One in eleven ENs received before MCT led to the identification of a SARS-CoV-2-infected case by prompting the contact to get tested. This corresponds to one in 85 exposures of a contact to a case in a non-household setting, in which both were app users and the case triggered the EN. CONCLUSIONS Our descriptive evaluation of the DPT notification cascade provides further evidence that DPT is an important complementary tool in pandemic mitigation, especially in non-household exposure settings. However, the effect of DPT apps can only be exerted if code generation processes are efficient and exposed contacts are willing to undertake preventive actions. This highlights the need to focus efforts on keeping barriers to efficient code generation as low as possible and promoting not only app adoption but also compliance with the recommended measures upon EN. CLINICALTRIAL ISRCTN14990068

Vagal flexibility to negative emotions moderates the relations between environmental risk and adjustment problems in childhood

Neurobiological and social-contextual influences shape children’s adjustment, yet limited biopsychosocial studies have integrated temporal features when modeling physiological regulation of emotion. This study explored whether a common underlying pattern of non-linear change in respiratory sinus arrhythmia (RSA) across emotional scenarios characterized 4–6 year-old children’s parasympathetic reactivity (N = 180). Additionally, we tested whether dynamic RSA reactivity was an index of neurobiological susceptibility or a diathesis in the association between socioeconomic status, authoritarian parenting, and the development of externalizing problems (EP) and internalizing problems over two years. There was a shared RSA pattern across all emotions, characterized by more initial RSA suppression and a subsequent return toward baseline, which we call vagal flexibility (VF). VF interacted with parenting to predict EP. More authoritarian parenting predicted increased EP two years later only when VF was low; conversely, when VF was very high, authoritarian mothers reported that their children had fewer EP. Altogether, children’s patterns of dynamic RSA change to negative emotions can be characterized by a higher order factor, and the nature by which VF contributes to EP depends on maternal socialization practices, with low VF augmenting and high VF buffering children against the effects of authoritarian parenting.

Dynamic contextual influences on social motivation and behavior in schizophrenia: a case-control network analysis

Contextual influences on social behavior and affective dynamics are not well understood in schizophrenia. We examined the role of social context on emotions, and the motivation to interact in the future, using dynamic network analysis of ecological momentary assessment (EMA) data. Participants included 105 outpatients with schizophrenia or schizoaffective disorder (SZ) and 76 healthy comparators (HC) who completed 7 days, 7 times a day of EMA. Dynamic networks were constructed using EMA data to visualize causal interactions between emotional states, motivation, and context (e.g., location, social interactions). Models were extended to include the type and frequency of interactions and the motivation to interact in the near future. Results indicated SZ networks were generally similar to HC but that contextual influences on emotion and social motivation were more evident in SZ. Further, feedback loops in HC were likely adaptive (e.g., positive emotions leading to social motivation), but most were likely maladaptive in SZ (e.g., sadness leading to reduced happiness leading to increased sadness). Overall, these findings indicate that network analyses may be useful in specifying emotion regulation problems in SZ and that instability related to contextual influences may be a central aspect of aberrant regulation.

Cultural and contextual considerations in designing programs to support the incorporation of early childhood development within ongoing national nutrition programmes: A focus on the Baby-Friendly Community Initiative (BFCI) in a rural African context

The Baby Friendly Community Initiative (BFCI) offers a unique platform for integration of counselling on early childhood development (ECD) with existing maternal and child health and nutrition messages. To understand how to efficiently deliver such a program, this study determined the feasibility of integrating counselling on child stimulation into the Kenyan BFCI activities. Qualitative interviews (N=97) among female (aged 15-49 years) and male users, stakeholders, and services providers in Koibatek sub-County (mainly inhabited by the Tugen people, a Nilotic group in sub-Saharan Africa) provided extensive information on understanding regarding ECD, caregiving beliefs, needs at different levels and barriers and facilitators. Contextual influences and existing health system infrastructure are important considerations when designing integrated interventions to improve nurturing care of children.

Contextual Influences on the Perception of Bullying Behaviours for Youth in New Zealand

<p>Bullying has gained a lot of attention in the public and academic spheres over the past two decades (Carrera, DePalma, & Lameiras, 2011; Monks et al., 2009) and is considered to be a very serious international issue (Due et al., 2005; Mullis, Martin, Foy, & Arora, 2012). There is extensive research based on the experiences of bullying, which has examined prevalence rates (Green, Harcourt, Mattioni, & Prior, 2013), distinctions between different types of bullying (Rivers & Smith, 1994; Smokowski & Kopasz, 2005) as well as the short and long term impacts (Coggan, Bennett, Hooper, & Dickinson, 2003). Through this, a strong research based understanding of bullying has been developed and a consistent definition established (Canty, Stubbe, Steers, & Collings, 2014; Carroll-Lind, 2009). However, previous research has primarily focused on the experiences of bullying, and few studies have examined how bullying is understood from the perspectives of young people. The present study aimed to bridge this gap by exploring young people’s understanding of bullying behaviour in New Zealand. Twenty participants completed a short questionnaire and structured interview, where they discussed four hypothetical scenarios, each describing a different type of bullying in a different setting. Results demonstrated that young people maintain a much broader conception of bullying than what is currently defined by academia. The academic criteria of intention to harm, repetition and an imbalance of power were not central to young people’s definitions of bullying. Rather, factors such as, the reaction of the victim, how public the behaviour was and the role of friendship were more instrumental in shaping young people’s bullying perceptions and definitions. Furthermore, it was found that the perceived relationship between bullies, victims and bystanders as well as gender differences, also influenced participants’ understanding of bullying behaviours. These findings yield important implications for the development and efficacy of intervention programs. Limitations and avenues of future research are also discussed.</p>