A realist evaluation of a support and training program for family caregivers in the municipality of Envigado: A research protocol.

AIMS: In Envigado, Colombia, the Secretariat of Health has implemented, since 2011, an interprofessional program involving nurses to support and train relatives to improve the quality of life of people with a loss of autonomy and their family caregivers. The objectives of this study are to assess the outcomes of this program and to explore the contextual elements and mechanisms that can explain these outcomes. DESIGN: This article presents the research protocol for a realist evaluation that will be carried out to gather the perspectives of various local stakeholders involved. METHODS: Four outcomes on family caregivers will be measured quantitatively using self-administered questionnaires and numerical scales. Contextual elements and mechanisms will then be explored qualitatively through focus groups and individual interviews. An iterative analysis will enable the refinement of a program theory. RESULTS: The results will inform a program theory that underlies the outcomes of the family caregiver support and training program. PATIENT OR PUBLIC CONTRIBUTION: Community stakeholders, family caregivers, people with a loss of autonomy and their relatives will be involved in data collection and/or in the validation of the program theory.

Characteristics, barriers and facilitators of initiatives to develop interprofessional collaboration in rural and remote primary healthcare facilities: a scoping review.

INTRODUCTION: Despite strong evidence supporting interprofessional collaboration (IPC) and the documented need for collaborative practice in primary health care (PHC), initiatives to promote IPC in rural and remote PHC facilities have not been extensively studied. The purpose of this article is to map interprofessional education (IPE) and interprofessional practice (IPP) initiatives implemented to promote IPC in rural and remote PHC facilities, and identify barriers and facilitators to their implementation. METHODS: A scoping review was conducted. After two reviewers filtered titles and abstracts, 94 retained articles were subsequently screened. Finally, 23 articles were selected and analyzed using a directed content analysis approach in NVivo v12. RESULTS: Only 10 articles focused on the implementation of initiatives to improve IPC, while the majority reported barriers and facilitators. The most common IPE initiatives were workshops, courses, discussion groups and simulations, while IPP initiatives fell into two main categories: clinical or technological tools. Limited human resources, understanding of roles, and knowledge of context as well as traditional roles, were identified as barriers. Team size, past experience and relationships, connection to community, flexibility and openness, and financial support were facilitators to developing IPC. CONCLUSION: Deployment of IPC in rural and remote PHC facilities is critical given the various challenges faced in these clinical settings. The facilitators identified in this literature review are specific to rural and remote clinical settings and provide hope that new initiatives more tailored to rural and remote settings will be implemented and evaluated in the future to improve IPC and care delivery.

An ounce of prevention is worth a pound of cure-the arts as a vehicle for knowledge translation and exchange (KTE) in public health during a pandemic: a realist-informed developmental evaluation research protocol.

INTRODUCTION: The COVID-19 crisis has led to the adoption of strict and coercive preventive measures. The implementation of these measures has generated negative impacts for many communities. The situation is especially worrisome for Indigenous communities in Peru. Therefore, it is necessary to recognise the contribution of the experiential knowledge of Indigenous communities and to implement innovative approaches. The use of art can be a promising avenue for working in partnership with Indigenous communities.The goal of this research is to (1) develop an intervention promoting barrier measures and vaccination to limit the transmission of COVID-19 among Indigenous communities using an arts-based and community-based knowledge translation and exchange (ACKTE) model; and (2) understand the contextual elements and mechanisms associated with the process of developing a preventive intervention using the ACKTE model. METHODOLOGY AND ANALYSIS: This research will take place in Indigenous communities in Peru and will be based on a developmental evaluation guided by the principles of realist evaluation. Members of two Indigenous communities, local authorities, health professionals and artists will participate in the intervention development process as well as in the developmental evaluation. For data collection, we will conduct modified talking circles and semistructured individual interviews with stakeholders as well as an analysis of documents and artistic works produced. ETHICS AND DISSEMINATION OF RESULTS: This research received the approval of the Université du Québec à Rimouski's research ethics board. In addition to scientific articles, the results of this research will be disseminated through videos and during an artistic performance.

Current issues and options for improving influenza vaccination rates in rural areas / Enjeux actuels et pistes de solution pour améliorer les couvertures vaccinales antigrippales dans les milieux ruraux

INTRODUCTION: Despite the positive impact of vaccination on health, influenza vaccination rates worldwide remain low for certain population groups. In Quebec, vaccination rates among populations with chronic diseases remain below what is expected by public health. Since this situation is also noticeable in rural areas, it is necessary to reflect on the current issues associated with low vaccination rates in the rural population. PURPOSE OF RESEARCH: The purpose of this commentary is to explore the importance of obtaining a multifactorial understanding of the problem raised in order to propose possible solutions to increase influenza vaccination rates among people living in rural areas.

Introduction: Malgré l'impact positif de la vaccination sur la santé, les couvertures vaccinales antigrippales au niveau mondial demeurent faibles pour certains groupes de population. Au Québec, les couvertures vaccinales chez les populations atteintes de maladies chroniques demeurent en deçà de ce qui est attendu par la santé publique. Cette situation étant aussi perceptible en région rurale, il s'avère nécessaire de réfléchir sur les enjeux actuels associés aux faibles couvertures vaccinales au sein de cette population spécifique. But de l'étude: Ce commentaire a pour but d'explorer l'importance d'obtenir une compréhension multifactorielle du problème soulevé afin de proposer des pistes de solution visant à augmenter les couvertures vaccinales antigrippales auprès des personnes vivant en région rurale.

Oral Health Status of Schoolchildren Living in Remote Rural Andean Communities: A Cross-Sectional Study.

OBJECTIVE: Oral health promotion (OHP) was introduced in Peruvian primary schools in 2013, and no evaluation has been undertaken in rural areas since then. To measure OHP outcomes, this cross-sectional study aimed to assess the oral health (OH) status of schoolchildren living in a remote rural area of the Cusco region. MATERIALS AND METHODS: Sixty-six children were recruited in three remote rural communities and in a rural district capital. Six dimensions of OH (knowledge, attitudes, behaviors, dental plaque, dental caries, and quality of life related to OH) were measured using self-administered questionnaires and dental examinations. Wilcoxon-Mann-Whitney tests were conducted to compare outcomes between two types of settings (remote rural community and district capital). Multiple linear regression models were fit to identify which variables can explain the variance observed in the decayed, missing, and filled teeth (DMFT) index. RESULTS: The median percentage of dental plaque in remote rural communities was 78.7+ (interquartile range [IQR] 71.5-82.8) and 78.6+ (IQR 72.7-82.2) in the district capital (P = 0.90). The prevalence of dental caries was estimated to be 94.1+ (95+ confidence interval [CI] 71.1->99.9) in the district capital and 98.0+ (95+ CI 88.3->99.9) in remote rural communities (P = 0.43). CONCLUSION: These results suggested that OHP interventions had not reached their full potential. Identifying different factors that influence the reported outcomes would provide a more comprehensive understanding and help to tailor OHP interventions.

Intersectoral oral health promotion interventions for schoolchildren living in remote rural Andean communities: a realist evaluation.

BACKGROUND: Intersectoral oral health promotion entails the participation of local communities. IOHP interventions were introduced in Peru in primary schools in 2013 but oral health among schoolchildren living in rural Andean communities remains suboptimal. OBJECTIVES: To understand the contextual elements and the underlying mechanisms associated with intersectoral oral health promotion interventions' current effects on schoolchildren living in remote rural Andean communities. METHOD: A realist evaluation was carried out in three rural Andean communities where intersectoral oral health promotion interventions aimed at schoolchildren have been implemented. Following an evaluation of the effects among schoolchildren, contextual elements and mechanisms were explored with various stakeholders involved in intersectoral oral health promotion through focus groups and semi-structured interviews. Subsequently, an iterative data analysis and a validation process resulted in the identification of context-mechanism configurations. RESULTS: Previous positive experiences of collaboration, a focus on communication, feelings of being respected and considered, and development of leadership and trust among stakeholders involved in intersectoral oral health promotion were elements of configurations that positively influence intersectoral oral health promotion. On the other hand, unfavorable physical, social and political environments, previous negative health experiences, feelings of not being respected or considered, demotivation, development of mistrust and insufficient leadership were shown to negatively influence outcomes. CONCLUSION: This research highlights the complexity associated with the deployment of intersectoral oral health promotion interventions in rural communities. Local stakeholders should be further involved to build trust, to facilitate coordination processes among remote rural communities and oral health professionals, and to optimize deployment of intersectoral oral health promotion interventions.

Traducción y adaptación de la versión al español del Questionnaire on Knowledge, Attitudes and Behaviors related to Oral Health (QKAB-OH) / Translation and Adaptation of Questionnaire on Knowledge, Attitudes and Behaviors related to Oral Health (QKAB-OH) Spanish Version

Objetivos: Efectuar la traducción y la adaptación transcultural al español del Questionnaire on Knowledge, At- titudes and Behaviors related to Oral Health (QKAB-OH) y estudiar la coherencia interna de esta versión del cuestionario. Material y métodos: El proceso de traducción, adaptación y validación del QKAB-OH se realizó en base a la síntesis de varias líneas directrices relacionadas con el proceso de traducción y adaptación de cues- tionarios. La coherencia interna de la versión traducida de este cuestionario se evaluó mediante una muestra no probabilística de niños de 9 a 13 años que viven en distritos o comunidades rurales andinas. Resultados: La coherencia interna se evaluó mediante una muestra de 70 niños. Para el conjunto de las secciones de la versión al español del QKAB-OH, el alfa de Cronbach es de 0,73. Conclusiones: Este proceso proporciona validez al con- tenido del cuestionario y una coherencia interna satisfactoria. Puede utilizarse para evaluar los comportamientos, las actitudes y los conocimientos relacionados con la salud bucodental de los niños peruanos (9 a 13 años) que viven en el área rural alto andino.

Objectives: To carry out the translation, cross-cultural adaptation and internal coherence of the Questionnaire on Knowledge, Attitudes and Behaviors related to Oral Health (QKAB-OH) Spanish version. Material and methods: The translation, adaptation and preliminary validation process of QKAB-OH was carried out based on a synthesis of several guidelines related to the process of translation and adaptation of questionnaires. The internal consistency of the translated version of the questionnaire was evaluated using a non-probabilistic sam- ple of children aged 9 to 13 years old living in rural Andean districts or communities. Results: Seventy children were recruited for the study. Cronbach's alpha of the QKAB-OH Spanish version (all sections included) was 0.73. Conclusions: This questionnaire adaptation appears to have a good face validity and a satisfactory internal consistency. It could therefore be used to evaluate behaviors, attitudes and knowledge related to oral health with Peruvian children (aged 9-13) living in high Andean rural area.

Translation and Validation of the Toronto Pain Management Index, French-Canadian Version.

Background To provide effective pain management, nurses must have sufficient knowledge and adequate beliefs about pain management. In Quebec, however, nurses seem to be generally uninvolved in pain management, and there is little significant evidence shedding light on nurses' pain management knowledge and beliefs in postoperative settings. To perform such studies, a valid questionnaire in French to assess nurses' knowledge and beliefs is required. Some valid questionnaires are available in English, but none are available in French. Purpose This article describes the process of translation, adaptation, and preliminary validation of the Toronto Pain Management Index into French. Results For temporal stability of the Toronto Pain Management Index, French-Canadian version, the result of intraclass correlation coefficient for the total score of this questionnaire is 0.59 (CI: 0.44-0.72). Conclusion Following this process, the French version of this questionnaire has suitable face and content validity and can be used to evaluate nurses' knowledge and beliefs about pain management in postoperative settings.

Realist evaluation of intersectoral oral health promotion interventions for schoolchildren living in rural Andean communities: a research protocol.

BACKGROUND: Intersectoral collaboration, known to promote more sustainable change within communities, will be examined in an oral health promotion program (OHPP). In Peru, an OHPP was implemented by the Ministry of Health, to reduce the incidence of caries in schoolchildren. In rural Andean communities, however, these initiatives achieved limited success. The objectives of this project are: (1) to understand the context and the underlying mechanisms associated with Peruvian OHPP's current effects among school children living in rural Andean communities and (2) to validate a theory explaining how and under which circumstances OHP intersectoral interventions on schoolchildren living in rural Andean communities produce their effects. METHODS AND ANALYSIS: Through a realist evaluation, the context, underlying mechanisms and programme outcomes will be identified. This process will involve five different steps. In the first and second steps, a logic model and an initial theory are developed. In the third step, data collection will permit measurement of the OHHP's outcomes with quantitative data, and exploration of the elements of context and the mechanisms with qualitative data. In the fourth and fifth steps, iterative data analysis and a validation process will allow the identification of Context-Mechanism-Outcome configuration, and validate or refine the initial theory. ETHICS AND DISSEMINATION: This research project has received approval from the Comité d'éthique de la recherche en santé chez l'humain du Centre hospitalier universitaire de Sherbrooke. The initial theory and research results will be published in relevant journals in public health and oral health. They will also be presented at realist evaluation and health promotion international conferences.

Knowledge and Beliefs about Chronic Non Cancer Pain Management for Family Medicine Group Nurses.

To provide effective care for chronic pain sufferers, nurses must have a knowledge of chronic pain management. In Quebec, nurses working in Family Medicine Groups (FMGs) could play a major role in helping patients with chronic noncancer pain (CNCP); however, the extent of their knowledge about CNCP management is unknown. The primary goal of this study was to explore the knowledge and beliefs of FMG nurses about CNCP management. The secondary goal was to explore the obstacles seen by these nurses as preventing them from performing CNCP management. We used a mixed-methods design with quantitative preponderance. Fifty-three FMG nurses answered a self-administered mail-in questionnaire. A rigorous data collection method was used. FMG nurses have suboptimal knowledge about CNCP management. They identify their lack of training and lack of knowledge as major obstacles to conducting pain management interventions. There is a need for pain management training specifically designed around the realities of FMG nursing.

[Nursing activities in family medicine groups for patients with chronic pain]. / Gestion de la douleur chronique par les infirmières des Groupes de médecine de famille.

INTRODUCTION: Thousands of people treated in primary care are currently experiencing chronic pain (CP), for which management is often inadequate. In Quebec, nurses in family medicine groups (FMGs) play a key role in the management of chronic health problems. OBJECTIVE: The present study aimed to describe the activities performed by FMG nurses in relation to CP management and to describe barriers to those activities. METHOD: A descriptive correlational cross-sectional postal survey was used. The accessible population includes FMG nurses on the Ordre des infirmières et infirmiers du Québec list. All nurses on the list who provided consent to be contacted at home for research purposes were contacted. A self-administered postal questionnaire (Pain Management Activities Questionnaire) was completed by 53 FMG nurses. RESULTS: Three activities most often performed by nurses were to establish a therapeutic relationship with the client; discuss the effectiveness of therapeutic measures with the physician; and conduct personalized teaching for the patient. The average number of individuals seen by interviewed nurses that they believe suffer from CP was 2.68 per week. The lack of knowledge of possible interventions in pain management (71.7%) and the nonavailability of information on pain management (52.8%) are the main barriers perceived by FMG nurses. CONCLUSION: FMG nurses are currently performing few activities in CP management. The nonrecognition of CP may explain this situation.

[Descriptive study of the postoperative pain assessment and documentation process in a university hospital]. / Étude descriptive du processus d'évaluation et de documentation de la douleur postopératoire dans un hôpital universitaire.

Several studies have shown that patients often receive inadequate treatment of postoperative pain. The aim of the present descriptive study was to examine and analyze various data related to the postoperative pain assessment of 40 patients who underwent elective surgery. Pain journals were to be completed by patients during every waking hour for the first three postoperative days to assess both pain intensity and pain unpleasantness. A post hoc analysis of patient records permitted verification of pain assessment by nurses for each patient. The results showed that not only was postoperative pain rarely assessed using a valid scale, it was also poorly documented. In addition, when nurses assessed and documented postoperative pain using a numerical scale, their results were very different from patients' assessments. For the first postoperative day, the mean (± SD) pain intensity documented by nurses on a 0 to 10 numerical scale was 1.57±0.23, while the mean pain intensity noted by patients using the same scale was 3.82±0.41. Statistical analysis showed that there was no significant correlation between mean pain intensity documented by nurses and the mean pain intensity noted by patients.