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1.
BMC Health Serv Res ; 21(1): 577, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34126980

RESUMO

BACKGROUND: To describe the ethical issues and experiences of scientists conducting mixed methods health services research and to advance empirical and conceptual discussion on ethical integrity in mixed methods health research. METHODS: The study was conducted with 64 scholars, faculty and consultants from the NIH-funded Mixed Methods Research Training Program (MMRTP) for the Health Sciences. This was a cross-sectional study. Survey results were analyzed using descriptive statistics to characterize responses and open coding to summarize strategies about eight ethical mixed methods research issues. Respondents completed an online survey to elicit experiences related to eight ethical issues (informed consent, confidentiality, data management, burden, safety, equitable recruitment, communication, and dissemination) and strategies for addressing them. RESULTS: Only about one-third of respondents thought their research ethics training helped them plan, conduct, or report mixed methods research. The most frequently occurring ethical issues were participant burden, dissemination and equitable recruitment (> 70% endorsement). Despite occurring frequently, < 50% of respondents rated each ethical issue as challenging. The most challenging ethical issues were related to managing participant burden, communication, and dissemination. Strategies reported to address ethical issues were largely not specific or unique to mixed methods with the exception of strategies to mitigate participant burden and, to a lesser degree, to facilitate equitable recruitment and promote dissemination of project results. CONCLUSIONS: Mixed methods health researchers reported encountering ethical issues often yet varying levels of difficulty and effectiveness in the strategies used to mitigate ethical issues. This study highlights some of the unique challenges faced by mixed methods researchers to plan for and appropriately respond to arising ethical issues such as managing participant burden and confidentiality across data sources and utilizing effective communication and dissemination strategies particularly when working with a multidisciplinary research team. As one of the first empirical studies to examine mixed methods research ethics, our findings highlight the need for greater attention to ethics in health services mixed methods research and training.


Assuntos
Confidencialidade , Ética em Pesquisa , Estudos Transversais , Pesquisa sobre Serviços de Saúde , Humanos , Consentimento Livre e Esclarecido
2.
BMC Health Serv Res ; 21(1): 533, 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059042

RESUMO

BACKGROUND: The NHS pledges to give all patients access to clinical research. In England, 32% of General Practices are research active and only 14% of patients engage in research. This project aimed to evaluate consent-for-contact and communication in primary care patients. METHODS: An explanatory mixed methods study of patients and staff within a single general practice. The study included all patients over the age of 18 years, and excluded those on the palliative care register and those unable to give informed consent. The questionnaire asked recipients to indicate their preferred contact method and data-sharing permissions with three organisations: NHS, Universities and Commercial Companies. Survey recipients and staff were invited to take part in a semi-structured interview. Interviews explored project acceptability, feasibility and reasoning behind choices made. Statistical data were triangulated with interview data. RESULTS: The target patient population was 4678, 24% (n = 1148) responded. Seven hundred and three gave permission for at least one of the organisations to contact them. Older people were more likely to respond than young people, (p < 0.001). There was a trend for more women than men to give permissions however, in the 70 years plus age group this was reversed. Short message service was the preferred method of communication (48% n = 330), but those aged 70 years and over, preferred letter (p = 0.001). Interviews suggested patients felt the project was primarily about improving communication and secondly access to research. Patients trusted the NHS and university researchers. Staff interviewees found the project was less onerous than expected. Barriers to wider rollout included workload and the fragmented nature of NHS digital systems. CONCLUSIONS: A registry of patients was established; however, the response rate of 24% needs increasing before wider adoption. Health promotion and chronic disease-based research may recruit better when based in primary health care. Older demographics would be more likely to volunteer for research. NHS and academic researchers are trusted, commercial organisations less so. The move to digitalise communication methods has the potential to marginalise older women. Findings were used to drive forward two novel developments: a consent registry (Research+Me) and a federation-wide participant identification process.


Assuntos
Pesquisa sobre Serviços de Saúde , Atenção Primária à Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra/epidemiologia , Feminino , Humanos , Consentimento Livre e Esclarecido , Pessoa de Meia-Idade , Sistema de Registros
3.
Front Public Health ; 9: 615474, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33996710

RESUMO

Background: D/deaf and hard of hearing populations are at higher risk for experiencing physical and mental health problems compared to hearing populations. In addition, they commonly encounter barriers to accessing and benefiting from health services, which largely stem from challenges they face in communicating with healthcare providers. Healthcare providers commonly lack tailored communication skills in caring for D/deaf and hard of hearing populations, which lead to difficulties and dissatisfaction for both staff and D/deaf and hard of hearing communities. This research project aims to develop and evaluate a capacity-building intervention for healthcare providers with the goal of increasing their awareness of D/deaf and hard of hearing individuals' experiences with the healthcare system, their distinct needs, and improving their capacity to communicate effectively with this patient population. Methods: This research project features a participative action research design using qualitative and quantitative methods. Consistent with participative action research, the study will actively involve the target populations, key stakeholders and representative associations. The intervention will be developed and tested through iterative phases. The Integrated Model of Training Evaluation and Effectiveness will guide prospective evaluation of the intervention. The latter will involve qualitative and quantitative assessments in participants before and after the intervention and at 6-months follow-up. Discussion: Results will contribute to research aimed at decreasing barriers to accessing and benefiting from healthcare services for D/deaf and hard of hearing individuals. Findings will be presented to representative associations and political authorities, as well as disseminated at research conferences and in peer-reviewed journals.


Assuntos
Pessoal de Saúde , Pesquisa sobre Serviços de Saúde , Comunicação , Audição , Humanos , Estudos Prospectivos
4.
Front Public Health ; 9: 639192, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33996719

RESUMO

In implementation science (IS), conducting well-targeted and reproducible literature searches is challenging due to non-specific and varying terminology that is fragmented over multiple disciplines. A list of journals that publish IS-relevant content for use in search strings can support this process. We conducted a cross-sectional online survey of 56 Australian, European, and North American IS experts to identify and prioritize relevant journals that publish IS articles. Journals' relevance was assessed by providing each with a list of 12 journals, to which they were encouraged to add additional journal names and comments as free text. We also assessed which journals had published special IS-focused issues-identified via PubMed and Google searches-over the last 20 years. Data were analyzed descriptively. Between February 28 and March 15, 2020, a purposive sample of 34/56 experts participated in the survey (response rate: 60.7%). Implementation Science and BMC Health Services Research were perceived as relevant by 97.1% of participants; other journals' relevance varied internationally. Experts proposed 50 additional journals from various clinical fields and health science disciplines. We identified 12 calls and 53 special issues on IS published within various journals and research fields. Experts' comments confirmed the described challenges in identifying IS literature. This report presents experts' ratings of IS journals, which can be included in strategies supporting searches of IS evidence. However, challenges in identifying IS evidence remain geographically and interdisciplinary. Further investment is needed to develop reproducible search strings to capture IS evidence as an important step in improving IS research quality.


Assuntos
Ciência da Implementação , Publicações Periódicas como Assunto , Austrália , Estudos Transversais , Pesquisa sobre Serviços de Saúde , Humanos
5.
Stud Health Technol Inform ; 281: 18-22, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042697

RESUMO

Metadata management is an essential condition to follow the FAIR principles. Therefore, metadata management was one asset of an accompanying project within a funding scheme for registries in health services research. The metadata of the funded projects were acquired, combined in a database compatible with the metamodel of ISO/IEC 11179 "Information technology - Metadata registries" third edition (ISO/IEC 11179-3), and analyzed in order to support the development and the operation of the registries. In the second phase of the funding scheme, six registries delivered a complete update of their metadata. The mean number of data elements increased from 245.7 to 473.5 and the mean number of values from 569.5 to 1,306.0. The conceptual core of the database had to be extended by one third to cover the new elements. The reason for this increase remained unclear. Constraints from the grant might be causal, a deviation from an evidence-based development process as well. It is questionable, whether the revealed quality of the metadata is sufficient to fulfill the FAIR principles. The extension of the metamodel of ISO/IEC 11179-3 is in agreement with the literature. However, further research is needed to find workable solutions for metadata management.


Assuntos
Pesquisa sobre Serviços de Saúde , Metadados , Bases de Dados Factuais , Tecnologia da Informação , Sistema de Registros
6.
BMC Health Serv Res ; 21(1): 483, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34016114

RESUMO

BACKGROUND: There seems to be a consensus that a vision for an organization is a valuable thing for organizations to have. However, research on organizational vision has predominantly been studied from a leadership perspective. In contrast to previous research, organizational vision in this paper takes an employee perspective. Specifically, the purpose is to examine factors associated with the integration of organizational vision among employees in hospital organizations. Consequently, it focuses on a relatively neglected domain within health services research. METHODS: A conceptual model, centred on the concept of organizational vision integration, was developed and tested on a sample (N = 1008) consisting of hospital employees. Partial least-squares structural equation modelling (PLS-SEM) was used to test the hypotheses, using SmartPLS 3 software. Furthermore, a bootstrapping test was used to inspect potential mediating effects. Specifically, the test assessed whether the proposed direct and indirect effects were statistically significant, and at the same time revealed the nature of the mediation effect. RESULTS: The results from the empirical study reveal three key findings: i) organizational vision integration among employees is directly and positively related to creative performance in their respective work role (ß = 0.16). Organizational vision integration and employees' psychological capital explains almost 40% (R2 = 0.36) in employees' creative performance, ii) psychological capital and employees' perception of organizational attractiveness are directly and positively related to employees' organizational vision integration (ß = 0.19 and ß = 0.40, respectively) and explains about 30% (R2 = 0.29) of employees' organizational vision integration, iii) employees' organizational vision integration mediates the relationship between employees' psychological capital, perception of organizational attractiveness and employees' creative performance. CONCLUSIONS: Taking an employee perspective, this study contributes to revealing whether and how organizational vision matters and its impact on hospital employees' work performance. To achieve organizational vision integration among hospital employees successfully, this study shows that it is important for hospital leaders to be aware of the pattern of impact of both personal as well as environmental-related factors.


Assuntos
Organizações , Recursos Humanos em Hospital , Pesquisa sobre Serviços de Saúde , Hospitais , Humanos , Liderança
7.
Front Public Health ; 9: 604796, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33981658

RESUMO

Background: Contemporary public health problems connect to the social determinants of health, with a growing recognition of social inclusion as imperative to sustainable development. In this quest for social inclusion, early childhood and families are of particular interest. Although co-creation is suggested as viable path to support well-being, less is known how social inclusion might be co-created in practice. The aim of this study was to explore how Participatory Action Research (PAR) can be a tool for transformative practices in a local community, pointing to kindergartens as meeting places for recognizing social inclusion as a common value in early childhood. Methods: A qualitative PAR study was embedded in a Norwegian municipality as an integrated part of their local public health work. The study involved a wide range of participants and stakeholders in three kindergartens and the wider community. Together, we explored potentials for co-creating social inclusion to achieve well-being through cycles of transformative actions and reflections. Reflexive thematic analysis was applied to generate patterns and themes in the data. Results: The participants formulated and took on ownership to an inclusive agenda through the PAR-process. Acts of inclusion was framed by an intersection between political aims of achieving health and well-being for all and public value co-creation unfolding at the level of the place, in the context of the Norwegian welfare regime. To feel valued and adding value was seen as important aspects for social inclusion. Four themes were generated from analysis; (1) Co-creating a shared vision of inclusive communities, (2) Becoming aware and empowered through caring, sharing and collaboration, (3) Places and spaces of inclusiveness in kindergartens and beyond, and (4) Valuing and practicing inclusion, and signs of transformative change. Conclusions: Through the PAR process, parents, kindergartens employees, community members and policy makers appear to have opened a creative toolbox for inclusive and transformational change through formulating and co-creating inclusion and well-being as public values. The results suggest that local actors might support adaptive social systems to taking on relational responsibility for inclusive processes and outcomes in the pursuit of well-being for all.


Assuntos
Instituições Acadêmicas , Inclusão Social , Pré-Escolar , Pesquisa sobre Serviços de Saúde , Humanos , Saúde Pública , Projetos de Pesquisa
8.
BMJ Open ; 11(5): e040043, 2021 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-34031107

RESUMO

INTRODUCTION: Asset-based community development (ABCD) is a strategy aimed at strengthening communities of interest through the identification and enhancement of those protective resources (also called 'health assets') that contribute to improve population health. Although primary care is specially well placed to contribute to ABCD by facilitating patients' access to community health assets, the implementation of ABCD approaches is limited, in part due to training deficiencies amongst general practitioners. In this study, we will develop a training programme on ABCD aimed at general practice trainees and evaluate its implementation and scale-up in Andalusia, Spain. We will also investigate whether the programme may contribute to strengthen the community orientation of the primary care practices involved in the study. METHODS AND ANALYSIS: We will undertake a mixed methods, multilevel and multicentric action research study drawing on theoretical frameworks relevant to learning (pedagogy) and community health promotion. The intervention will be implemented and evaluated in eight different study areas over 48 months. It will comprise a classroom-based session and a practical exercise, which will involve general practice trainees producing a map of community health assets relevant to common health conditions. In each study area, we will set up a stakeholder group to guide our study. We will run the intervention sequentially across the eight study areas, and modify and refine it iteratively by incorporating the findings from the evaluation. We will employ qualitative (interviews and focus groups with general practice trainees, primary care workers, members of the teaching units and policymakers) and quantitative methods (self-administered questionnaires with an approximate sample of 157 general practice trainees and 502 primary care workers). ETHICS AND DISSEMINATION: Ethics approval from the Andalusian Regional Health Council has been granted (6/2020). It is envisaged that this research will provide relevant, evidence-based guidance on how best to incorporate learning on ABCD into the general practice training curriculum. Findings will be disseminated in an ongoing manner and will target the following audiences: (1) general practice trainees, primary care workers and members of the teaching units, (2) policymakers and strategic decision makers and (3) the academic community.


Assuntos
Medicina Geral , Currículo , Medicina de Família e Comunidade , Medicina Geral/educação , Pesquisa sobre Serviços de Saúde , Humanos , Espanha
9.
BMJ Open ; 11(5): e047943, 2021 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-34035107

RESUMO

OBJECTIVES: To explore and explain success and limiting factors in UK health service innovation. DESIGN: Mixed methods evaluation of a series of health service innovations involving a survey and interviews, with theory-generating analysis. SETTING: The research explored innovations supported by one of the UK's Academic Health Science Networks which provides small grants, awards and structural support to health service innovators including clinical academics, health and social care professionals and third-sector organisations. PARTICIPANTS: All recipients of funding or support 2014-2018 were invited to participate. We analysed survey responses relating to 56 innovation projects. RESULTS: Responses were used to conceptualise success along two axes: value creation for the intended beneficiaries and expansion beyond its original pilot. An analysis of variance between categories of success indicated that participation, motivation and evaluation were critical to value generation; organisational, educational and administrative support were critical to expansion; and leadership and collaborative expertise were critical to both value creation and expansion. Additional limiting factors derived from qualitative responses included difficulties navigating the boundaries and intersections between organisations, professions, sectors and cultures; a lack of support for innovation beyond the start-up phase; a lack of protected time; and staff burn-out and turnover. CONCLUSIONS: A nested hierarchy of innovation needs has been derived via an analysis of these factors, providing targeted suggestions to enhance the success of future innovations.


Assuntos
Pesquisa sobre Serviços de Saúde , Liderança , Serviços de Saúde , Humanos , Reino Unido
10.
Rev Bras Enferm ; 74(suppl 3): e20200405, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34037174

RESUMO

OBJECTIVE: to describe the implementation of workshops on the approach of people in psychological distress with suicidal behavior for Primary Health Care workers and managers. METHODS: this is an action research developed for Primary Health Care professionals in a city in the countryside of São Paulo. Charles Maguerez's Arch methodology was used as a theoretical framework to construct the workshops. RESULTS: through active strategies and the exercise of reflection-action, the workshops enabled participants to raise awareness on the topic, articulation between professionals and managers, and the co-responsibility required to care for users with suicidal behavior assisted in Primary Health Care. FINAL CONSIDERATIONS: the workshops broadened knowledge, facilitating skill development to qualify Primary Health Care professionals in caring for people with suicidal behavior.


Assuntos
Atenção à Saúde/normas , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Atenção Primária à Saúde , Angústia Psicológica , Ideação Suicida , Adulto , Brasil , Congressos como Assunto , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade
11.
PLoS One ; 16(5): e0251685, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34048459

RESUMO

BACKGROUND: Black, Asian and minority ethnic communities suffer from disproportionately poorer health than the general population. This issue has been recently exemplified by the large numbers of infection rates and deaths caused by covid-19 in BAME populations. Future research has the potential to improve health outcomes for these groups. High quality research priority setting is crucial to effectively consider the needs of the most vulnerable groups of the population. OBJECTIVE: The purpose of this systematic review is to identify existing research priority studies conducted for BAME health and to determine the extent to which they followed good practice principles for research priority setting. METHOD: Included studies were identified by searching Medline, Cinnahl, PsychINFO, Psychology and Behavioral Sciences Collection, as well as searches in grey literature. Search terms included "research priority setting", "research prioritisation", "research agenda", "Black and minority ethnic", "ethnic group". Studies were included if they identified or elicited research priorities for BAME health and if they outlined a process of conducting a research prioritisation exercise. A checklist of Nine Common Themes of Good Practice in research priority setting was used as a methodological framework to evaluate the research priority processes of each study. RESULTS: Out of 1514 citations initially obtained, 17 studies were included in the final synthesis. Topic areas for their research prioritisation exercise included suicide prevention, knee surgery, mental health, preterm birth, and child obesity. Public and patient involvement was included in eleven studies. Methods of research prioritisation included workshops, Delphi techniques, surveys, focus groups and interviews. The quality of empirical evidence was diverse. None of the exercises followed all good practice principles as outlined in the checklist. Areas that were lacking in particular were: the lack of a comprehensive approach to guide the process; limited use of criteria to guide discussion around priorities; unequal or no representation from ethnic minorities, and poor evaluation of their own processes. CONCLUSIONS: Research priority setting practices were found to mostly not follow good practice guidelines which aim to ensure rigour in priority setting activities and support the inclusion of BAME communities in establishing the research agenda. Research is unlikely to deliver useful findings that can support relevant research and positive change for BAME communities unless they fulfil areas of good practice such as inclusivity of key stakeholders' input, planning for implementation of identified priorities, criteria for deciding on priorities, and evaluation of their processes in research priority setting.


Assuntos
Afro-Americanos , Americanos Asiáticos , COVID-19 , Pesquisa sobre Serviços de Saúde , Grupos Minoritários , SARS-CoV-2 , Humanos
12.
BMJ Open ; 11(5): e045018, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952550

RESUMO

INTRODUCTION: Qualitative methods have become integral in health services research, and Andersen's behavioural model of health services use (BMHSU) is one of the most commonly employed models of health service utilisation. The model focuses on three core factors to explain healthcare utilisation: predisposing, enabling and need factors. A recent overview of the application of the BMHSU is lacking, particularly regarding its application in qualitative research. Therefore, we provide (1) a descriptive overview of the application of the BMHSU in health services research in general and (2) a qualitative synthesis on the (un)suitability of the model in qualitative health services research. METHODS: We searched five databases from March to April 2019, and in April 2020. For inclusion, each study had to focus on individuals ≥18 years of age and to cite the BMHSU, a modified version of the model, or the three core factors that constitute the model, regardless of study design, or publication type. We used MS Excel to perform descriptive statistics, and applied MAXQDA 2020 as part of a qualitative content analysis. RESULTS: From a total of 6319 results, we identified 1879 publications dealing with the BMSHU. The main methodological approach was quantitative (89%). More than half of the studies are based on the BMHSU from 1995. 77 studies employed a qualitative design, the BMHSU was applied to justify the theoretical background (62%), structure the data collection (40%) and perform data coding (78%). Various publications highlight the usefulness of the BMHSU for qualitative data, while others criticise the model for several reasons (eg, its lack of cultural or psychosocial factors). CONCLUSIONS: The application of different and older models of healthcare utilisation hinders comparative health services research. Future research should consider quantitative or qualitative study designs and account for the most current and comprehensive model of the BMHSU.


Assuntos
Pesquisa sobre Serviços de Saúde , Psiquiatria , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa
13.
J Couns Psychol ; 68(3): 344-356, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34043378

RESUMO

Building on the conceptual foundation of articles published in the 2005 volume of the Journal of Counseling Psychology on the qualitative turn in Counseling Psychology, we write to introduce and reflect on Critical Participatory Action Research (CPAR) as an intersectional approach to knowledge production by psychologists researching alongside individuals, communities, and movements dedicated to social justice. We open with a brief review of the origins of CPAR and the epistemological commitments of this approach to inquiry. We then explore why and how participation matters, and the delicate dynamics of CPAR through various phases of research: putting together a research team, crafting research questions and design, selecting methods, sampling, participatory analyses of qualitative and quantitative material, and figuring out how to produce and circulate findings in ways accountable to the community/movement of interest. The second half of the article offers a slow journey into one CPAR project, What's Your Issue?, a multigenerational, national, participatory survey designed by and for LGBTQIA+ youth, with an emphasis on the participation and representation of youth of color. We write this article for scholars, practitioners, activists, educators, and students to make visible why participation is so crucial to social justice research; that "no research on us, without us" is both scientifically and ethically valid, and how mixed methods research with LGBTQIA+ and gender-expansive youth can open new horizons for theory, methods, and action. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Pesquisa sobre Serviços de Saúde , Conhecimento , Projetos de Pesquisa , Justiça Social , Adolescente , Adulto , Idoso , Pesquisa Participativa Baseada na Comunidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Rev Esp Salud Publica ; 952021 May 24.
Artigo em Espanhol | MEDLINE | ID: mdl-34024903

RESUMO

OBJECTIVE: In Catalonia, the variety of the provision of Primary Healthcare has sparked intense debates over the last 20 years regarding the efficiency of the various management models. Our study analyzed the differences in the three existing management models of primary healthcare in Catalonia (the Catalan Health Institute, public consortiums and associative base entities). METHODS: The primary data were obtained from the reports of the Results Center of The Observatory of the Health System of Catalonia. Representative indicators were selected and compared with the Kruskall-Wallis test. They were later adjusted for confounding factors. RESULTS: There were differences in the average number of visits per population attended, the percentage of the population attended in the subgroup of population over 75 years of age, the percentage of patients over 74 years with more than twelve appointments, the rate of potentially avoidable hospitalizations (total and in the subgroup of patients with chronic obstructive pulmonary disease (COPD)), polypharmacy, the use of lipid-lowering drugs and the detection of prostate-specific antigen (PSA). When adjusting for confounding variables, the differences disappeared in all of them except for the indicator on the detection of PSA. CONCLUSIONS: The differences favoured mainly the associative base entities disappear when they are corrected for confounding variables. The legal status of each provider does not significantly influence the health outcomes.


Assuntos
Modelos Organizacionais , Atenção Primária à Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Humanos , Espanha
15.
Gesundheitswesen ; 83(6): 470-480, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34020493

RESUMO

The evaluation of intervention effects is an important domain of health services research. The ad hoc commission for the use of routine practice data of the German Network for Health Services Research (DNVF) therefore provides this second part of its manual focusing on the use of routine practice data for the evaluation of intervention effects. First, we discuss definition issues and the importance of contextual factors. Subsequently, general requirements for planning, data collection and analysis as well as concrete examples for the evaluation of intervention effects for the 3 fields of application regarding pharmacotherapy, nonpharmaceutical interventions as well as complex interventions are elaborated. We consider scenarios in which no information from randomized controlled trials (RCTs) comparing the two groups directly is yet available or in which RCTs are already available but an extension of the research question is required. In all examples either with or without randomization, the first and foremost question is always whether the data source is suitable for the specific research question. Most of the examples chosen are from oncology trials, because the necessary data are already available for Germany, at least in some form. Finally, the manual discusses possible challenges for future use of these data.


Assuntos
Pesquisa sobre Serviços de Saúde , Armazenamento e Recuperação da Informação , Coleta de Dados , Alemanha
16.
Epilepsia Open ; 6(2): 331-338, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34033243

RESUMO

OBJECTIVE: To determine whether the portable Ceribell® electroencephalograph (EEG) (Mountain View, CA) used for suspected status epilepticus (SE) can reduce time to diagnosis and on-call workforce demands and whether it can be applied to patients in respiratory isolation. METHODS: A multidisciplinary team developed a protocol for the use of the Ceribell EEG. The staff deploying the device, the attending physician, and the interpreting neurologist completed evaluation tools for each patient. Data maintained for quality and resource planning of 18-channel electroencephalography ordered for suspected SE were used as controls. Times to diagnosis were compared by application of Welch-Satterthwaite tests and workforce call-in demands by Fisher's exact t test. We evaluated qualitative data related to the use of the EEG in COVID-19 isolation rooms and on its technical aspects and acceptance by staff members. RESULTS: The Ceribell EEG reduced diagnosis time (P = .0000006) and on-call workforce demand (P = .02). The device can be used at any time of day in any hospital care area and has advantages in respiratory isolation rooms. SIGNIFICANCE: Compared with a standard 18-channel EEG, the Ceribell device allowed earlier diagnosis of SE and non-SE conditions and reduced workforce demands. Due to the ease of its use and its simple components, which can be readily disinfected, it is advantageous for COVID-19 patients in isolation.


Assuntos
COVID-19 , Eletroencefalografia , Serviços Médicos de Emergência , Controle de Infecções , Estado Epiléptico/diagnóstico , Tempo para o Tratamento/normas , Serviços de Atendimento/instrumentação , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/terapia , Diagnóstico Precoce , Eletroencefalografia/instrumentação , Eletroencefalografia/métodos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Pesquisa sobre Serviços de Saúde , Mão de Obra em Saúde , Hospitalização , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Estudo de Prova de Conceito , Melhoria de Qualidade , SARS-CoV-2 , Gestão da Segurança , Estado Epiléptico/terapia
17.
BMC Public Health ; 21(1): 889, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-33971852

RESUMO

BACKGROUND: Health volunteers act as the link between the society and the healthcare system and are a symbol of people's participation in the health maintenance and promotion. Despite the important role of health volunteers in the health system, it seems that they experience several problems. The aim of this study was empowering health volunteers through an action research. METHODS: This participatory action research was conducted through two continuous cycles of reflection and acting for change over 20 months, in a comprehensive health center in Southern of Fars province in Iran. Participants included 25 health volunteers; two instructors and an academic researcher as facilitator. In the first cycle the participants discovered the challenges of health volunteers, prioritized them, designed an action plan, and implemented it. At the end of this cycle, evaluation was done with the participants' cooperation. The second cycle began with reflecting on the results of the first cycle and then after designing and implementing second action plan, final evaluation was done. RESULTS: Qualitative content analysis in the first phase led to the emergence of four categories, including role confusion, inadequate volunteer training, deficits in attracting and keeping volunteers, and being unfamiliar to the public. After the implementation of the action plan the participants learned through reflection and immersing in action. Finally, quantitative and qualitative data showed improvement of knowledge and performance, satisfaction, effectiveness of programs and improvement in volunteer's competence. CONCLUSIONS: Clarification of volunteers' roles, supporting volunteers to improve their knowledge and skills with coherent planning based on their educational needs, are appropriate management plans to attract and retain volunteers. By presenting their services to the society, they will be empowered and motivated to continue.


Assuntos
Pesquisa sobre Serviços de Saúde , Voluntários , Assistência Integral à Saúde , Humanos , Irã (Geográfico) , Poder Psicológico
18.
Hu Li Za Zhi ; 68(3): 33-43, 2021 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-34013504

RESUMO

BACKGROUND: Obstetric nursing laboratory courses typically involve both time and credit limitations. Using traditional teaching methods such as "teacher demonstrate, students imitate" in these courses provides insufficient opportunities for students to develop the ideal level of maternity nursing expertise. Lack of sufficient familiarity with the relevant techniques, procedures, and clinical scenarios prior to participation in internships reduces the level of safety in clinical care environments. PURPOSES: (1) To explore the effectiveness as perceived by baccalaureate nursing students of an obstetric nursing laboratory classes based on a flipped teaching model; (2) To examine the application of a flipped teaching model in obstetric nursing laboratory classes as well as the problems encountered and the actions necessary to resolve these problems. The findings may be used as a reference for future teaching and guidance. METHODS: This study used an action research framework as a guide and employed focus groups and questionnaires to collect student perceptions of the flipped teaching model. RESULTS: The feedback of students was highly positive because the classes involved repeated practice, were integrated into the clinical context, and allowed active learning independent of time and space restrictions. These attributes affected learning efficiency positively. The following four themes emerged from the focus group analysis: helps improve self-directed learning, helps integrate into the clinical context, helps peers learn from each other, and helps bring teachers and students closer. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study demonstrated an actual implementation of the flipped teaching model in obstetric nursing laboratory classes as well as assessed the learning perceptions of students. This teaching method provides opportunities for teachers and students to discuss and practice nursing skills, strengthen students' self-directed learning capabilities, and improve students' learning motivation. The author recommends that this innovative teaching strategy may be used to teach various subjects and different disciplines in nursing.


Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Currículo , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Laboratórios , Enfermagem Obstétrica , Gravidez , Aprendizagem Baseada em Problemas , Ensino
19.
BMC Health Serv Res ; 21(1): 397, 2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910551

RESUMO

BACKGROUND: Primary health care is the entry point to the health-care system and regarded as an essential step to achieving universal health coverage. The present study aimed at evaluating the quality of health-care services provided in health centers in Mashhad, Iran. METHODS: This was a cross-sectional study implemented among 200 health service users who were referring to four health centers in Mashhad during January to June 2019. The quality of services in health centers was evaluated with the SERVQUAL and HEALTHQUAL models. Data was analyzed by employing paired t-test and independent sample t-test using SPSS version 16 software. The Levene test was used for examining the equality of variance (homogeneity). Significance level of all the tests was considered when p ≤ 0.05. RESULTS: According to the results of SERVQUAL questionnaire, the average scores of health service users' expectations and perceptions were 4.97 and 3.26, respectively, and the quality gap in the provided services was equal to - 1.7. Based on HEALTHQUAL questionnaire, the average scores of health service users' perception and expectations were 4.72 and 3.25, respectively, and the quality gap in the provided services was equal to - 1.16. Empathy was the highest quality dimension (- 2.019) based on SERVQUAL model, and efficiency dimension was the highest based on HEALTHQUAL model (- 1.761). CONCLUSIONS: The findings of the current study showed a negative gap between the service users' expectations and perceptions in both models. Therefore, the results of this study helps the health managers and policymakers to plan effective interventions for improving the provided services emphasizing the dimensions with the wider gaps.


Assuntos
Satisfação do Paciente , Qualidade da Assistência à Saúde , Estudos Transversais , Pesquisa sobre Serviços de Saúde , Humanos , Irã (Geográfico)/epidemiologia , Inquéritos e Questionários
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