The impact of train-the-trainer programs on the continued professional development of nurses: a systematic review.

BACKGROUND: Train-the-trainer (TTT) programs are widely applied to disseminate knowledge within healthcare systems, but evidence of the effectiveness of this educational model remains unclear. We systematically reviewed studies evaluating the impact of train-the-trainer models on the learning outcomes of nurses. METHODS: The reporting of our systematic review followed PRISMA 2020 checklist. Records identified from MEDLINE, Embase, CINAHL, and ERIC were independently screened by two researchers and deemed eligible if studies evaluated learning outcomes of a train-the-trainer intervention for trainers or trainees targeting nurses. Study quality was assessed with Joanna Briggs Institute's critical appraisal tools and data of study characteristics extracted (objective, design, population, outcomes, results). Heterogeneity of outcomes ruled out meta-analysis; a narrative synthesis and vote counting based on direction of effects (p < 0.05) synthesized the results. All records were uploaded and organized in EPPI-Reviewer. RESULTS: Of the 3800 identified records 11 studies were included. The included studies were published between 1998 and 2021 and mostly performed in the US or Northern Europe. Nine studies had quasi-experimental designs and two were randomized controlled trials. All evaluated effects on nurses of which two also included nurses' assistants. The direction of effects of the 13 outcomes (knowledge, n = 10; skills, n = 2; practice, n = 1) measured in the 11 included studies were all beneficial. The statistical analysis of the vote counting showed that train-the-trainer programs could significantly (p < 0.05) improve trainees' knowledge, but the number of outcomes measuring impact on skills or practice was insufficient for synthesis. CONCLUSIONS: Train-the-trainer models can successfully disseminate knowledge to nurses within healthcare systems. Considering the nurse shortages faced by most Western healthcare systems, train-the-trainer models can be a timesaving and sustainable way of delivering education. However, new comparative studies that evaluate practice outcomes are needed to conclude whether TTT programs are more effective, affordable and timesaving alternatives to other training programs. TRIAL REGISTRATION: The protocol was registered in Research Registry ( https://www.researchregistry.com , unique identifying number 941, 29 June 2020).

Calibrating logics: How adolescents and young adults calibrate often-competing logics in their daily self-management of type 1 diabetes.

Adolescents and young adults with type 1 diabetes must manage a demanding chronic condition in their daily lives, but adequate self-management remains a major challenge. In this article, we explore the logics invoked in shaping daily type 1 diabetes self-management among adolescents and young adults and propose an analytical view of self-management as a matter of 'calibrating logics'. Drawing on Annemarie Mol's concept of logic, our analysis of in-depth interviews with 21 adolescents and young adults with type 1 diabetes suggested that three main logics collectively shaped their self-management: biomedical, embodied and social. Biomedical logics appeared in the form of routinised insulin therapy, frequent blood glucose testing, and carbohydrate counting, all of which emphasise controlling blood glucose levels. Embodied logics emerged as refined practices such as 'thinking insulin units' and 'listening' to blood glucose fluctuations. Finally, social logics were at play when discreet or postponed self-management practices were used to adjust to social situations. While these logics may complement each other, study participants invoked how these logics often competed in daily life, generating tensions. We therefore propose viewing self-management as a matter of calibrating logics in which often-competing logics are at play. This can provide nuanced insights into the effort and challenges related to the daily self-management of type 1 diabetes for adolescents and young adults, in contrast to the prevailing dichotomy of adherence versus nonadherence to prescribed treatment regimens.

When People With Chronic Conditions Turn to Peers on Social Media to Obtain and Share Information: Systematic Review of the Implications for Relationships With Health Care Professionals.

BACKGROUND: People living with chronic conditions such as diabetes turn to peers on social media to obtain and share information. Although social media use has grown dramatically in the past decade, little is known about its implications for the relationships between people with chronic conditions and health care professionals (HCPs). OBJECTIVE: We aimed to systematically review the content and quality of studies examining what the retrieval and sharing of information by people with chronic conditions on social media implies for their relationships with HCPs. METHODS: We conducted a search of studies in MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO). Eligible studies were primary studies; examined social media use; included adults with any type of diabetes, cardiovascular diseases that are closely linked with diabetes, obesity, hypertension, or dyslipidemia; and reported on the implications for people with chronic conditions-HCP relationships when people with chronic conditions access and share information on social media. We used the Mixed Methods Appraisal Tool version 2018 to assess the quality of the studies, and the included studies were narratively synthesized. RESULTS: Of the 3111 screened studies, 17 (0.55%) were included. Most studies (13/17, 76%) were of low quality. The narrative synthesis identified implications for people with chronic conditions-HCP relationships when people with chronic conditions access and share information on social media, divided into 3 main categories with 7 subcategories. These categories of implications address how the peer interactions of people with chronic conditions on social media can influence their communication with HCPs, how people with chronic conditions discuss advice and medical information from HCPs on social media, and how relationships with HCPs are discussed by people with chronic conditions on social media. The implications are illustrated collectively in a conceptual model. CONCLUSIONS: More evidence is needed to draw conclusions, but the findings indicate that the peer interactions of people with chronic conditions on social media are implicated in the ways in which people with chronic conditions equip themselves for clinical consultations, evaluate the information and advice provided by HCPs, and manage their relationships with HCPs. Future populations with chronic conditions will be raised in a digital world, and social media will likely remain a strategy for obtaining support and information. However, the generally low quality of the studies included in this review points to the relatively immature state of research exploring social media and its implications for people with chronic conditions-HCP relationships. Better study designs and methods for conducting research on social media are needed to generate robust evidence.

From 'parallel world' to 'trading zone': How diabetes-related information from social media is (not) discussed in clinical consultations.

In today's digital world, people with type 1 and 2 diabetes turn to peers on social media to access and share information. Some studies have addressed how such information is discussed in clinical consultations, but conceptual nuances are needed to account for the different ways information is discussed. In this article, we draw on semi-structured interviews with 19 clinicians and 25 people with diabetes to examine how diabetes-related information from social media is discussed in Danish outpatient clinical consultations. The data were collected from September 2020 to January 2021. We conceptualise how these discussions fall on a continuum of (dis)engagement with social media information represented by three metaphorical concepts: parallel world, border zone, and trading zone. On one end, social media resembles a parallel world disconnected from clinical consultations: people with diabetes do not bring up social media information and clinicians do not invite them to discuss it. The middle of the continuum is represented by a border zone in which people with diabetes present social media information and clinicians' reactions can either push back, maintaining social media as a parallel world, or support the formation of a trading zone. On the other end, clinical consultations resemble a trading zone: clinicians are open to social media information, invite people with diabetes to discuss it and acknowledge the value of social media. Furthermore, these discussions are often characterised by negotiation in which different perspectives are exchanged. We discuss the benefits and challenges of moving from the parallel world to the trading zone, arguing that discussions about social media information may help clinicians learn what people with diabetes gain from online peer interactions and enable them to offer their expertise to support people with diabetes as they navigate a complex world of online information.