Strengthening facility-based integrated emergency care services for time sensitive emergencies at all levels of healthcare in India: An implementation research study protocol.

BACKGROUND: The healthcare system in India is tiered and has primary, secondary and tertiary levels of facilities depending on the complexity and severity of health challenges at these facilities. Evidence suggests that emergency services in the country is fragmented. This study aims to identify the barriers and facilitators of emergency care delivery for patients with time-sensitive conditions, and develop and implement a contextually relevant model, and measure its impact using implementation research outcomes. METHODS: We will study 85 healthcare facilities across five zones of the country and focus on emergency care delivery for 11 time-sensitive conditions. This implementation research will include seven phases: the preparatory phase, formative assessment, co-design of Model "Zero", co-implementation, model optimization, end-line evaluation and consolidation phase. The "preparatory phase" will involve stakeholder meetings, approval from health authorities and the establishment of a research ecosystem. The "formative assessment" will include quantitative and qualitative evaluations of the existing healthcare facilities and personnel to identify gaps, barriers and facilitators of emergency care services for time-sensitive conditions. On the basis of the results of the formative assessment, context-specific implementation strategies will be developed through meetings with stakeholders, providers and experts. The "co-design of Model 'Zero'" phase will help develop the initial Model "Zero", which will be pilot tested on a small scale (co-implementation). In the "model optimization" phase, iterative feedback loops of meetings and testing various strategies will help develop and implement the final context-specific model. End-line evaluation will assess implementation research outcomes such as acceptability, adoption, fidelity and penetration. The consolidation phase will include planning for the sustenance of the interventions. DISCUSSION: In a country such as India, where resources are scarce, this study will identify the barriers and facilitators to delivering emergency care services for time-sensitive conditions across five varied zones of the country. Stakeholder and provider participation in developing consensus-based implementation strategies, along with iterative cycles of meetings and testing, will help adapt these strategies to local needs. This approach will ensure that the developed models are practical, feasible and tailored to the specific challenges and requirements of each region.

Evaluation of research co-design in health: a systematic overview of reviews and development of a framework.

BACKGROUND: Co-design with consumers and healthcare professionals is widely used in applied health research. While this approach appears to be ethically the right thing to do, a rigorous evaluation of its process and impact is frequently missing. Evaluation of research co-design is important to identify areas of improvement in the methods and processes, as well as to determine whether research co-design leads to better outcomes. We aimed to build on current literature to develop a framework to assist researchers with the evaluation of co-design processes and impacts. METHODS: A multifaceted, iterative approach, including three steps, was undertaken to develop a Co-design Evaluation Framework: 1) A systematic overview of reviews; 2) Stakeholder panel meetings to discuss and debate findings from the overview of reviews and 3) Consensus meeting with stakeholder panel. The systematic overview of reviews included relevant papers published between 2000 and 2022. OVID (Medline, Embase, PsycINFO), EBSCOhost (Cinahl) and the Cochrane Database of Systematic reviews were searched for papers that reported co-design evaluation or outcomes in health research. Extracted data was inductively analysed and evaluation themes were identified. Review findings were presented to a stakeholder panel, including consumers, healthcare professionals and researchers, to interpret and critique. A consensus meeting, including a nominal group technique, was applied to agree upon the Co-design Evaluation Framework. RESULTS: A total of 51 reviews were included in the systematic overview of reviews. Fifteen evaluation themes were identified and grouped into the following seven clusters: People (within co-design group), group processes, research processes, co-design context, people (outside co-design group), system and sustainment. If evaluation methods were mentioned, they mainly included qualitative data, informal consumer feedback and researchers' reflections. The Co-Design Evaluation Framework used a tree metaphor to represent the processes and people in the co-design group (below-ground), underpinning system- and people-level outcomes beyond the co-design group (above-ground). To evaluate research co-design, researchers may wish to consider any or all components in the tree. CONCLUSIONS: The Co-Design Evaluation Framework has been collaboratively developed with various stakeholders to be used prospectively (planning for evaluation), concurrently (making adjustments during the co-design process) and retrospectively (reviewing past co-design efforts to inform future activities).

The continuity psychiatric nursing care model to enhance medication adherence in schizophrenia patients in Indonesia: Participatory action research.

OBJECTIVE: To develop a continuity of psychiatric nursing care model to enhance medication adherence in schizophrenia patients. METHODS: The Participatory Action Research study was conducted from 2017 to 2018 in Pekanbaru, Riau, Indonesia, after approval form the ethics review committee of the Faculty of Nursing, Prince of Songkla University, Thailand. The sample included schizophrenia inpatients at a mental hospital, their family members and nursing staff. Qualitative data were gathered through in-depth interviews, observations, field notes, and photo records. Data was subjected to content analysis, while trustworthiness of the model was also determined. RESULTS: Of the 57 subjects, 22(38.6%) were schizophrenia patients, 22(38.6%) were family members, and 13(22.8%) were nurses. The continuity of psychiatric nursing care model consisted of three components: preparing for readiness to live a normal way of life; creating a supportive environment; and, sustaining the continuity of care until the community level care. CONCLUSIONS: The continuity of psychiatric nursing care model facilitated holistic nursing care aspects.

Targeting emotion dysregulation in depression: an intervention mapping protocol augmented by participatory action research.

BACKGROUND: Depression is a highly prevalent and often recurrent condition; however, treatment is not always accessible or effective in addressing abnormalities in emotional processing. Given the high prevalence of depression worldwide, identifying and mapping out effective and sustainable interventions is crucial. Emotion dysregulation in depression is not readily amenable to improvement due to the complex, time-dynamic nature of emotion; however, systematic planning frameworks for programs addressing behavioral changes can provide guidelines for the development of a rational intervention that tackles these difficulties. This study proposes an empirical and theoretical art-based emotion regulation (ER) intervention using an integrated approach that combines intervention mapping (IM) with participatory action research (PAR). METHODS: We used the IM protocol to identify strategies and develop an intervention for patients with major depressive disorder (MDD). As applied in this study, IM comprises six steps: (a) determining the need for new treatments and determinants of risk; (b) identifying changeable determinants and assigning specific intervention targets; (c) selecting strategies to improve ER across relevant theories and research disciplines; (d) creating a treatment program and refining it based on consultations with an advisory group; (e) developing the implementation plan and conducting a PAR study to pilot-test it; and (f) planning evaluation strategies and conducting a PAR study for feedback on the initial testing. RESULTS: Following the steps of IM, we developed two frameworks for an art-based ER intervention: an individual and an integrative framework. The programs include four theory- and evidence-based ER strategies aimed mainly at decreasing depressive symptoms and improving ER in patients with MDD. We also developed a plan for evaluating the proposed intervention. Based on our preliminary PAR studies, the intervention was feasible and acceptable for adoption and implementation in primary care settings. CONCLUSION: The application of IM incorporated with PAR has resulted in an intervention for improving ER in depression. While changing behavior is perceived as a challenging and elaborate task, this method can be useful in offering a clear structure for developing rational interventions. Further refinement is necessary through rigorous research.

What Do We Know About Sharing Power in Co-Production in Mental Health Research? A Systematic Review and Thematic Synthesis.

BACKGROUND: Guidance on co-production between researchers and people with lived experience was published in 2018 by the National Institute for Health and Care Research (NIHR) advisory group, previously known as INVOLVE. This guidance described sharing power as a key principle within co-production. Authentic sharing of power within co-produced mental health research does not always occur however and remains a challenge to achieve within many projects. OBJECTIVES: To explore what has been learned about the sharing of power in co-production within mental health research since the publication of these guidelines, by synthesising qualitative literature relating to power within co-produced mental health research. METHODS: We carried out a systematic review with thematic synthesis. We searched CINHAL, Embase and PubMed databases to identify qualitative or mixed-method studies relating to power within co-produced mental health research. Studies were independently screened by two reviewers for inclusion and appraised using the Critical Appraisal Skills Programme tool (CASP) for qualitative research. RESULTS: We identified nine papers that met the criteria for inclusion and were included in the synthesis. Three themes were generated: (1) Battling to share power against a more powerful system, (2) Empowerment through relationships and (3) The journey is turbulent, but it is not supposed to be smooth. CONCLUSIONS: Results highlight that power is pervasive, especially within the hierarchical systems research is often conducted within. Sharing power within co-produced mental health research is an ongoing complex process that is not intended to be easy. Respectful trusting relationships can help facilitate power sharing. However, ultimately meaningful change needs to come from research funders, universities and NHS providers. PATIENT OR PUBLIC CONTRIBUTION: The study authors include a lived experience researcher who contributed to the review design, analysis and write-up.

"I am there just to get on with it": a qualitative study on the labour of the patient and public involvement workforce.

BACKGROUND: Workers tasked with specific responsibilities around patient and public involvement (PPI) are now routinely part of the organizational landscape for applied health research in the United Kingdom. Even as the National Institute for Health and Care Research (NIHR) has had a pioneering role in developing a robust PPI infrastructure for publicly funded health research in the United Kingdom, considerable barriers remain to embedding substantive and sustainable public input in the design and delivery of research. Notably, researchers and clinicians report a tension between funders' orientation towards deliverables and the resources and labour required to embed public involvement in research. These and other tensions require further investigation. METHODS: This was a qualitative study with participatory elements. Using purposive and snowball sampling and attending to regional and institutional diversity, we conducted 21 semi-structured interviews with individuals holding NIHR-funded formal PPI roles across England. Interviews were analysed through reflexive thematic analysis with coding and framing presented and adjusted through two workshops with study participants. RESULTS: We generated five overarching themes which signal a growing tension between expectations put on staff in PPI roles and the structural limitations of these roles: (i) the instability of support; (ii) the production of invisible labour; (iii) PPI work as more than a job; (iv) accountability without control; and (v) delivering change without changing. CONCLUSIONS: The NIHR PPI workforce has enabled considerable progress in embedding patient and public input in research activities. However, the role has led not to a resolution of the tension between performance management priorities and the labour of PPI, but rather to its displacement and - potentially - its intensification. We suggest that the expectation to "deliver" PPI hinges on a paradoxical demand to deliver a transformational intervention that is fundamentally divorced from any labour of transformation. We conclude that ongoing efforts to transform health research ecologies so as to better respond to the needs of patients will need to grapple with the force and consequences of this paradoxical demand.

The scope and sustainability of, and data about, utilization of embedded research: qualitative evidence from Latin America and the Caribbean / Alcance, sostenibilidad y datos sobre la utilización de la investigación incorporada: evidencia cualitativa procedente de América Latina y el Caribe / Escopo, sustentabilidade e dados da utilização de pesquisa com implementação incorporada: evidências qualitativas da América Latina e do Caribe

[ABSTRACT]. Objectives. This paper describes and analyzes embedded implementation research and the empirical processes of planning for utilization, strategies to promote utilization and the sustainability of utilization of results from research led by decision-makers in Latin America and the Caribbean. Methods. This qualitative, descriptive and interpretive study is based on the findings from semistructured interviews with members of teams working under the Embedding Research for the Sustainable Development Goals initiative (2018–2019) as well as their responses to a self-assessment follow-up questionnaire 1 year after the project was completed. Results. Altogether 13 teams from 11 countries participated in the Initiative. Nine teams had a core team composed of a decision-maker as the principal investigator assisted by a researcher as co-principal investigator. Four teams included more than one co-principal investigator; and in five teams, the originally assigned principal investigator was replaced. There was an interesting relationship between the expected utilization of research results, the utilization strategies, the sustainability of research uptake and the teams’ collaboration modalities. When decision-makers and co-principal investigators were active participants, the intention to use the results and strategies for utilization were clearly oriented to improve implementation. In teams with basically a formal collaboration between the two principals, plans for utilization were unclear or focused on producing academic knowledge. The participation of implementers below the rank of principal investigator decision-maker may be relevant. Conclusions. Embedded implementation research is an innovative tool that may foster the utilization of research and strengthen health programs and services. Considering the internal dynamics of such research teams will enhance planning and strategies for research utilization as well as the sustainability of practical and actionable findings.

[RESUMEN]. Objetivos. En este artículo se describe y analiza la incorporación de la investigación sobre implementación y los procesos empíricos de planificación de su utilización, las estrategias para promoverla y la sostenibilidad de la utilización de los resultados de la investigación dirigida por los responsables de la toma de decisiones en América Latina y el Caribe. Métodos. Este estudio cualitativo, descriptivo e interpretativo se basa en los resultados de entrevistas semiestructuradas a miembros de equipos que trabajan en el marco de la iniciativa Incorporación de la investigación para avanzar en el cumplimiento de los Objetivos de Desarrollo Sostenible (2018-2019), así como en sus respuestas a un cuestionario de autoevaluación de seguimiento un año después de la finalización del proyecto. Resultados. En la iniciativa participaron un total de 13 equipos de 11 países. Nueve equipos disponían de un equipo central formado por un responsable de la toma de decisiones como investigador principal, que contaba con la colaboración de un investigador como coinvestigador principal. Cuatro equipos tenían más de un coinvestigador principal, y en cinco equipos se sustituyó al investigador principal asignado inicialmente. Se observó una relación interesante entre la utilización prevista de los resultados de la investigación, las estrategias de utilización, la sostenibilidad de la adopción de la investigación y las modalidades de colaboración de los equipos. Cuando había una participación activa de los responsables de la toma de decisiones y los coinvestigadores principales, el objetivo del uso de los resultados y las estrategias de utilización estaban claramente orientados a la mejora de su implementación. En los equipos en los que había una colaboración básicamente formal entre los dos directores, los planes de utilización no eran claros o se centraban en la producción de conocimiento académico. La participación de responsables de la puesta en práctica con cargos inferiores a los de investigador principal con capacidad de decisión puede ser un factor de interés. Conclusiones. La incorporación de la investigación sobre implementación es una herramienta innovadora que puede fomentar la utilización de la investigación y fortalecer los programas y servicios de salud. La consideración de la dinámica interna de estos equipos de investigación mejorará la planificación y las estrategias para su utilización, así como la sostenibilidad de los resultados prácticos y aplicables.

[RESUMO]. Objetivos. Este artigo descreve e analisa a pesquisa com implementação incorporada e processos empíricos de planejamento da aplicação, estratégias de promoção do uso e sustentabilidade da utilização dos resultados de pesquisas lideradas por tomadores de decisão da América Latina e do Caribe. Métodos. Este estudo qualitativo, descritivo e interpretativo baseia-se nos achados de entrevistas semiestruturadas com membros de equipes que trabalharam no âmbito da iniciativa “Incorporação de Pesquisas para os Objetivos de Desenvolvimento Sustentável” (2018–2019), além de suas respostas a um questionário de autoavaliação aplicado um ano após a conclusão do projeto. Resultados. Treze equipes de 11 países participaram da iniciativa. Nove equipes contavam com uma equipe central composta por um tomador de decisão como investigador principal, auxiliado por um pesquisador como coinvestigador principal. Quatro equipes incluíram mais de um coinvestigador principal; e cinco equipes substituíram o investigador principal designado inicialmente. Houve uma relação interessante entre a aplicação esperada dos resultados da pesquisa, as estratégias de uso, a sustentabilidade da adoção da pesquisa e as modalidades de colaboração das equipes. Quando os tomadores de decisão e os coinvestigadores principais eram participantes ativos, a intenção de usar os resultados e as estratégias de utilização estavam claramente orientadas para o aprimoramento da implementação. Nas equipes em que a colaboração entre os dois investigadores principais era basicamente uma formalidade, os planos de utilização não estavam claros ou se concentravam na produção de conhecimento acadêmico. A participação de implementadores abaixo da posição de tomador de decisão do pesquisador principal pode ser importante. Conclusões. A pesquisa com implementação incorporada é uma ferramenta inovadora que pode promover a aplicação das pesquisas e fortalecer os programas e serviços de saúde. Levar em conta a dinâmica interna dessas equipes de pesquisa aprimorará o planejamento e as estratégias de utilização da pesquisa, bem como a sustentabilidade de achados práticos e implementáveis.

Improving spatial accessibility to health care services in Cali, Colombia: stakeholder assessment of an innovative platform / Mejora de la accesibilidad espacial a los servicios de atención de salud en Cali, Colombia: evaluación de una plataforma innovadora por las partes interesadas / Melhoria da acessibilidade espacial aos serviços de saúde em Cali, Colômbia: avaliação de uma plataforma inovadora pelas partes interessadas

[ABSTRACT]. Objectives. To (i) ascertain stakeholders’ perceptions of the contextual factors and resources necessary to successfully implement the AMORE platform, a tool that provides accessibility assessments for health care services, considering factors such travel time and traffic conditions, and (ii) identify potential barriers to and facilitators for enhancing spatial accessibility to health care services within the Colombian urban context. Methods. In this qualitative study, semi-structured interviews were conducted with a purposive sample of seven key stakeholders. The sample was drawn from individuals involved in development of policies in Colombia, service providers, and users, among others, who had expertise in the field. Interviews were conducted until saturation was reached. Results. The participants had positive views on the appearance of the AMORE platform, highlighting its user-friendly visualization. Suggestions were made about the variables used in the dashboard, the implementation of the platform, potential usage areas, and barriers and facilitators to implementation and use. Barriers included economic, political, and personnel challenges, while facilitators included creating a minimum viable product at a low cost and building interinstitutional and international cooperation. Conclusions. Innovations such as the AMORE platform have the potential to support decision-making processes across various sectors, including public policies and internal processes within private organizations, academia, and the community. However, implementing such a tool has financial, contextual and environmental challenges. The study identified key factors that were considered prerequisites for successfully implementing the AMORE platform in Colombian cities.

[RESUMEN]. Objetivos. i) Determinar las percepciones de las partes interesadas sobre los factores contextuales y los recursos necesarios para implementar con éxito la plataforma AMORE, una herramienta que proporciona evaluaciones de accesibilidad para los servicios de atención de salud, teniendo en cuenta factores como el tiempo de desplazamiento y el estado del tráfico; y ii) determinar los posibles factores que obstaculizan o favorecen las mejoras en la accesibilidad espacial a los servicios de atención de salud en el contexto urbano en Colombia. Métodos. En este estudio cualitativo, se realizaron entrevistas semiestructuradas en una muestra intencional de siete partes interesadas. La muestra se obtuvo a partir de responsables del diseño de políticas en Colombia, prestadores de servicios y usuarios, entre otras personas, con conocimientos en la materia. Las entrevistas se llevaron a cabo hasta llegar al punto de saturación. Resultados. Los participantes tenían una opinión favorable sobre el aspecto de la plataforma AMORE, de la que resaltaban su fácil visualización. Se formularon sugerencias sobre las variables utilizadas en el panel de información, la implementación de la plataforma, las posibles áreas de uso y los elementos que podrían obstaculizar o favorecer su implementación y uso. Los obstáculos incluían desafíos económicos, políticos y de personal, mientras que entre los elementos facilitadores estaban la creación de un producto mínimo viable a bajo costo y el establecimiento de lazos de cooperación interinstitucional e internacional. Conclusiones. Innovaciones como la plataforma AMORE tienen el potencial de brindar apoyo para los procesos de toma de decisiones en diversos sectores, como las políticas públicas y los procesos internos en las organizaciones privadas, el sector académico y la comunidad. Sin embargo, la implementación de una herramienta de este tipo plantea desafíos económicos, contextuales y ambientales. El estudio determinó los factores clave que se consideran requisitos previos para implementar con éxito la plataforma AMORE en las ciudades colombianas.

[RESUMO]. Objetivos. Os objetivos do estudo foram: i) avaliar as percepções das partes interessadas sobre os fatores contextuais e os recursos necessários para implementação bem-sucedida da plataforma AMORE, uma ferramenta que fornece avaliações sobre a acessibilidade dos serviços de saúde considerando fatores como tempo de deslocamento e condições de trânsito; e ii) identificar possíveis barreiras e facilitadores para melhorar a acessibilidade espacial a serviços de saúde no contexto urbano da Colômbia. Métodos. Neste estudo qualitativo, foram realizadas entrevistas semiestruturadas com uma amostra intencional de sete partes interessadas principais. A amostra foi composta por indivíduos envolvidos na elaboração de políticas na Colômbia, prestadores de serviços e usuários, entre outros, que tinham conhecimento especializado na área. As entrevistas foram realizadas até se alcançar a saturação. Resultados. Os participantes tiveram opiniões positivas sobre a aparência da plataforma AMORE, destacando a visualização fácil de usar. Foram feitas sugestões sobre as variáveis usadas no painel, a implementação da plataforma, potenciais áreas de uso e barreiras e facilitadores para sua implementação e utilização. As barreiras englobavam dificuldades econômicas, políticas e relacionadas ao pessoal. Já os facilitadores incluíam a criação de um produto mínimo viável de baixo custo e o desenvolvimento de cooperação interinstitucional e internacional. Conclusões. Inovações como a plataforma AMORE têm o potencial de apoiar processos decisórios em vários setores, incluindo políticas públicas e processos internos em organizações privadas, no meio acadêmico e na comunidade. No entanto, a implementação dessa ferramenta envolve desafios financeiros, contextuais e ambientais. O estudo identificou os principais fatores que foram considerados pré-requisitos para o sucesso da implementação da plataforma AMORE em cidades colombianas.

Development and evaluation of scenario-based e-simulation for humanitarian health training: a mixed-methods action research study.

OBJECTIVES: This study aimed to develop and evaluate a scenario-based e-simulation (SBES) to address the limited avilability of accessible and practical training for humanitarian public health responders. The objectives included SBES customisation, effectiveness evaluation, and identifying learning-enhancing design elements. DESIGN: A university-based, mixed-methods action research design. SETTING: The study was conducted at an international university's academic centre in Italy, and at a university-based master's programme in Yemen. PARTICIPANTS: The study involved 20 multidisciplinary global health and education experts and 66 international medical and health sciences students. RESULTS: Between September 2020 and July 2022, four SBES modules were developed, implemented and evaluated using a rapid prototype model. The modules, which targeted health professionals new to or with limited experience in the humanitarian field, included health needs assessment, essential health services, communicable diseases and health system. Formative evaluation improved the design and implementation of the SBES, which was found to be effective in the summative evaluation, evident from positive student reactions (the overall mean satisfaction rate was 6.03 out of 7, 95% CI 5.95 to 6.47) and the significant improvement in knowledge scores (p<0.001, effect size: 1.179). The identified effective design of SBES includes overlapping elements among content, strategy and technology. Poor internet access was recognised as a potential barrier to delivering the training in the humanitarian context, highlighting the need to develop an offline version in the next phase. CONCLUSION: The developed SBES met the training needs of the academic institution involved. The study findings will contribute to advancing future SBES training initiatives for disaster medicine and global health. Further studies are recommended to evaluate and address the challenges associated with SBES implementation beyond the study setting.

Research Coproduction: An Underused Pathway to Impact.

Knowledge translation and implementation science have made many advances in the last two decades. However, research is still not making expedient differences to practice, policy, and service delivery. It is time to evolve our approach to knowledge production and implementation. In this editorial we advance research coproduction as a neglected pathway to impact. Our starting point is that research impact is a function of how research is done and who is involved, arguing that researchers and non-researchers have an equal voice and role to play. We outline principles of coproduction including sharing power, valuing different sources of knowledge and viewpoints, equality, open communication, inclusivity, and mutuality. We consider implications at micro, meso, and macro system levels. In calling for this shift in the way knowledge is produced and applied, we anticipate it leading to inclusive research that more rapidly translates to better, more equitable health and care for all.

Identifying health and healthcare priorities in rural areas: A concept mapping study informed by consumers, health professionals and researchers.

BACKGROUND: It is vital that health service delivery and health interventions address patients' needs or preferences, are relevant for practice and can be implemented. Involving those who will use or deliver healthcare in priority-setting can lead to health service delivery and research that is more meaningful and impactful. This is particularly crucial in rural communities, where limited resources and disparities in healthcare and health outcomes are often more pronounced. The aim of this study was to determine the health and healthcare priorities in rural communities using a region-wide community engagement approach. METHODS: This multi-methods study was conducted in five rural communities in the Grampians region, Western Victoria, Australia. It involved six concept mapping steps: (1) preparation, (2) generation (brainstorming statements and identifying rating criteria), (3) structuring statements (sorting and rating statements), (4) representation of statements, (5) interpretation of the concept map and (6) utilization. Community forums, surveys and stakeholder consultations with community members and health professionals were used in Step 2. An innovative online group concept mapping platform, involving consumers, health professionals and researchers was used in Step 3. RESULTS: Overall, 117 community members and 70 health professionals identified 400 health and healthcare issues. Six stakeholder consultation sessions (with 16 community members and 16 health professionals) identified three key values for prioritizing health issues: equal access for equal need, effectiveness and impact (number of people affected). Actionable priorities for healthcare delivery were largely related to access issues, such as the challenges navigating the healthcare system, particularly for people with mental health issues; the lack of sufficient general practitioners and other health providers; the high travel costs; and poor internet coverage often impacting technology-based interventions for people in rural areas. CONCLUSIONS: This study identified actionable health and healthcare priorities from the perspective of healthcare service users and providers in rural communities in Western Victoria. Issues related to access, such as the inequities in healthcare costs, the perceived lack of quality and availability of services, particularly in mental health and disability, were identified as priorities. These insights can guide future research, policy-making and resource allocation efforts to improve healthcare access, quality and equity in rural communities.

Health policy and systems research priority-setting exercise in Ethiopia: a collaborative approach.

INTRODUCTION: Health policy and systems research (HPSR) is a multi-disciplinary approach of generating health system and policy-level evidence. Setting HPSR agendas is considered as an efficient strategy to map and identify policy and cost-effective research topics, but its practice in developing countries is limited. This paper aimed to conduct a collaborative health policy and system research priority-setting exercise in Ethiopia. METHOD: The WHO's plan, implement, publish, and evaluate (PIPE) framework and the Delphi technique were used to conduct the priority-setting exercise. The PIPE model was used to lead the priority-setting process from planning to evaluation, while the Delphi technique was used to run the rating and ranking exercise with the aim of reaching a consensus. Two rounds of expert panel workshops supplemented with an online survey were used for the HPSR agenda setting, rating and ranking purposes. Groups were formed using the WHO health system building blocks as a base framework to identify and prioritize the HPSR topics. RESULT: Under 8 themes, 32 sub-themes and 182 HPSR topics were identified. The identified research themes include leadership management and governance, health policy, health information system, healthcare financing, human resource for health, medical products and supply, service delivery and cross-cutting issues. CONCLUSIONS: Priority HPSR topics focussing on national health priority issues were identified. The identified topics were shared with policymakers and academic and research institutions. Evidence generation on the identified priority topics will guide future research endeavours and improve evidence-informed decision-making practice, health system performance and national health goals and targets.

International declaration on rural mental health research: 10 guiding principles and standards.

Rural communities have unique mental health needs and challenges which are often related to the uniqueness of the community itself. On a per-capita basis, the investment in rural mental health research is far less than that in urban communities. Added to this, rural communities are often at risk of researchers, based in large urban universities, visiting, conducting the research with minimal engagement with local stakeholders and limited understanding of the community's social-service-environmental context. Often this research leaves no visible benefit to the community with respect to increased knowledge, resources or community capacity. This commentary is based on the insights of a panel of authors from 9 countries, each with extensive experience of rural mental health research and work. And it seeks to stimulate the discourse on responsible rural mental health practice. The aim of this commentary is to provide a reference on research practice for novice and experienced researchers on rural mental health research and practice, to assist policymakers, government and funding bodies to establish appropriate standards and guidelines for rural mental health research, and support rural communities to advocate for equity of funding and sustainable research as they engage with researchers, funders and governments. The 10 standards in this declaration will help guide researchers toward research that is beneficial to rural communities and also help develop the local community's research capability, which ultimately will serve to enhance the mental health and well-being of rural communities.

Building Cross-sectoral Collaborations to Address Perinatal Health Inequities: Insights From the Dutch Healthy Pregnancy 4 All-3 Program.

BACKGROUND: Addressing perinatal health inequities is the joint responsibility of professionals working for local governments, the medical, social, and public health sector. Cross-sectoral collaboration between these professionals is challenging. For such collaborations to succeed, a transition, ie, a fundamental shift in the dominant structure, culture, and practices at the systems level, is necessary. We investigated facilitators and barriers for cross-sectoral collaborations, when addressing perinatal health inequities in the Netherlands. Additionally, we studied how cross-sectoral collaborations can be facilitated by action research. METHODS: We used interview and questionnaire data of the Healthy Pregnancy 4 All-3 (HP4All-3) program, which resulted from action research in six Dutch municipalities. All interviews were coded using open codes related to facilitators and barriers for cross-sectoral collaboration and categorized into three subgroups: structural, cultural, or practical. The answers to the questionnaire were analyzed and summarized quantitatively. RESULTS: We conducted 53 interviews with a total of 81 professionals. The most important ingredients for cross-sectoral collaborations mentioned by the interviewees were: (1) structural: having a solid network with a clear overview of professionals working in the different sectors, (2) cultural: having a joint vision/goal, and (3) practical: short lines of communication and timely sharing of information. A total of 85 professionals filled in (parts of) the questionnaire. Two-thirds to over 80 percent replied that the HP4All-3 program had an added value in building cross-sectoral collaborations. CONCLUSION: Our research shows that cross-sectoral collaborations in the context of perinatal health are hampered by structural, cultural, and practical barriers. Analyzing facilitators and barriers at these three levels helps to identify bottlenecks in cross-sectoral collaboration. Action researchers can be of great advantage in facilitating collaboration, as they can offer an open setting for reflection and instigate a sense of urgency for building collaborations.

Knowledge and training among nursing students regarding the conspiracy of silence in palliative care: A participatory action research.

AIM: To develop and implement specific training based on the knowledge and management of conspiracy of silence among nursing students. BACKGROUND: Conspiracy of silence refers to the concealment of information from a patient on the family's request, under the influence of a paternalistic culture that seeks to protect the patient. DESIGN: Participatory action research. METHODS: Was conducted in the following stages: reconnaissance (focus groups); planning, action and observation (theoretical sessions); and reflection (analysis of care plans). The focus group consisted of six fourth year and eight second-year students. The intervention was conducted with 42 s-year students and a total of 93 s-year students participated in the resolution of the clinical case. The study was conducted between October 2022 and June 2023 at the Faculty of Nursing, University of Valencia. For data analysis, the process described by Carrillo et al. (2011) was followed, involving coding and the creation of categories and subcategories. RESULTS: The focus group deficiencies were detected in the students' learning of palliative care competence, breaking bad news and the conspiracy of silence (reconnaissance stage). Therefore, an intervention was conducted to reinforce these knowledge areas, specifically addressing the conspiracy of silence (planning, action and observation stages). The resolution of the case showed how students with training approached the situation more comprehensively, including the family and proposed activities that were consistent with managing the situation (reflection stage). CONCLUSIONS: An active feedback process was successfully established, where the students' feedback helped create specific training on oncological palliative care and provided the students with tools to manage the conspiracy of silence. The results underscore the importance of providing students with training in palliative care and managing conspiracy of silence, through therapeutic communication training, active training or enhancing emotional intelligence. This training is essential for cultivating the attitudes and skills required to deliver high-quality palliative care.

The impact of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response: an action research study.

INTRODUCTION: Hospitals as the main providers of healthcare services play an essential role in the management of disasters and emergencies. Nurses are one of the important and influential elements in increasing the surge capacity of hospitals. Accordingly, the present study aimed to assess the effect of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response. METHODS: All nursing managers employed at Motahari Hospital in Tehran took part in this interventional pre- and post-test action research study. Ultimately, a total of 20 nursing managers were chosen through a census method and underwent training in hospital capacity fluctuations. The Iranian version of the "Hospital Emergency Response Checklist" was used to measure hospital disaster preparedness and response before and after the intervention. RESULTS: The overall hospital disaster preparedness and response score was 184 (medium level) before the intervention and 216 (high level) after the intervention. The intervention was effective in improving the dimensions of hospital disaster preparedness, including "command and control", "triage", "human resources", "communication", "surge capacity", "logistics and supply", "safety and security", and "recovery", but had not much impact on the "continuity of essential services" component. CONCLUSION: The research demonstrated that enhancing the disaster preparedness of hospitals can be achieved by training nursing managers using an action research approach. Encouraging their active participation in identifying deficiencies, problems, and weaknesses related to surge capacity, and promoting the adoption and implementation of suitable strategies, can enhance overall hospital disaster preparedness.

Living labs for migrant health research: the challenge of cocreating research with migrant population and policy makers.

The need for the public to take an active role in scientific research is becoming increasingly important, particularly in health-related research. However, the coexistence and alignment of scientific and citizen interests, needs, knowledge and timing is not straightforward, especially when involving migrant populations. To conduct impactful research, it becomes also essential to consider the perspectives of policymakers, thereby adding a layer of complexity to the processes.In this article we address the experience of a living lab created in a research institution and supported by the city council and a local foundation, in which we developed three experiences of patient and public involvement (PPI): (1) accessing to comprehensive care for people at risk of Chagas disease; (2) strategies towards improving access and quality of mental healthcare services in migrants; (3) promoting healthy and safe school environments in vulnerable urban settings.These three challenges provided an opportunity to delve into diverse strategies for involving key stakeholders, including migrant populations, expert researchers and political actors in health research. This article offers insights into the successes, challenges, and valuable lessons learnt from these endeavours, providing a vision that can be beneficial for future initiatives. Each living lab experience crafted its unique governance system and agenda tailored to specific challenge scenarios, giving rise to diverse methods and study designs.We have found that the management of the cocreation of the research question and the institutional support are key to building robust PPI processes with migrant groups.

Reflecting on the quality of a methodologically pluralist evaluation of a large-scale Indigenous health research collaboration in Australia.

BACKGROUND: Indigenous communities worldwide lead calls for all evaluations of research, programmes and policies affecting their communities to reflect the values, priorities and perspectives of the Indigenous peoples and communities involved. Tools, such as the Quality Appraisal Tool (QAT), are available to assess research quality through an Indigenous cultural lens. Good evaluation requires that evaluation efforts be evaluated. We found that critical reflection on the quality of evaluations from an Indigenous perspective is largely absent from the published literature. To ensure that we strive for quality in evaluation as determined by Indigenous people with whom we work, we examined the quality of our own evaluation of an Indigenous health research collaboration by conducting a reflexive dialogue. METHODS: The QAT was used to assess our evaluation according to Indigenous health research principles. Our qualitative study used analytical coautoethnography to generate data through a series of reflexive dialogue sessions with Indigenous and non-Indigenous members of the research collaboration, using the QAT criteria as discussion prompts. Our ideas and reflections were compared and contrasted through a collaborative and iterative writing process, multiple review cycles and discussions. RESULTS: We documented our findings against the QAT framework. We found examples that each QAT principle had, to some extent, been adhered to, but constantly needed to assess whether the principles were fully achieved to our satisfaction. Strengths of the evaluation included being adaptable and responsive to emerging issues for the research collaboration, while areas for improvement included more Indigenous leadership of, and involvement in, evaluation. CONCLUSIONS: Although reflexive evaluation practice is not always comfortable, it does provide an opportunity to generate insights for improvement. Reflecting as we did-in a partnership between Indigenous and non-Indigenous colleagues-enabled deeper insights and meaning. We anticipate that our process models how other research in Indigenous contexts might better advance ethical, quality Indigenous research through working in collaboration with Indigenous researchers and communities.