A comparison of policy and direct practice stakeholder perceptions of factors affecting evidence-based practice implementation using concept mapping

PubMed Central

2011-01-01

Background The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States. Methods Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and t-tests were used to analyze the data. Results A total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding) were rated among the most important and least likely to change by both groups. Conclusions EBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light. PMID:21899754

A comparison of policy and direct practice stakeholder perceptions of factors affecting evidence-based practice implementation using concept mapping.

PubMed

Green, Amy E; Aarons, Gregory A

2011-09-07

The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States. Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and t-tests were used to analyze the data. A total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding) were rated among the most important and least likely to change by both groups. EBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light.

Strengthening organizations to implement evidence-based clinical practices.

PubMed

VanDeusen Lukas, Carol; Engle, Ryann L; Holmes, Sally K; Parker, Victoria A; Petzel, Robert A; Nealon Seibert, Marjorie; Shwartz, Michael; Sullivan, Jennifer L

2010-01-01

Despite recognition that implementation of evidence-based clinical practices (EBPs) usually depends on the structure and processes of the larger health care organizational context, the dynamics of implementation are not well understood. This project's aim was to deepen that understanding by implementing and evaluating an organizational model hypothesized to strengthen the ability of health care organizations to facilitate EBPs. CONCEPTUAL MODEL: The model posits that implementation of EBPs will be enhanced through the presence of three interacting components: active leadership commitment to quality, robust clinical process redesign incorporating EBPs into routine operations, and use of management structures and processes to support and align redesign. In a mixed-methods longitudinal comparative case study design, seven medical centers in one network in the Department of Veterans Affairs participated in an intervention to implement the organizational model over 3 years. The network was selected randomly from three interested in using the model. The target EBP was hand-hygiene compliance. Measures included ratings of implementation fidelity, observed hand-hygiene compliance, and factors affecting model implementation drawn from interviews. Analyses support the hypothesis that greater fidelity to the organizational model was associated with higher compliance with hand-hygiene guidelines. High-fidelity sites showed larger effect sizes for improvement in hand-hygiene compliance than lower-fidelity sites. Adherence to the organizational model was in turn affected by factors in three categories: urgency to improve, organizational environment, and improvement climate. Implementation of EBPs, particularly those that cut across multiple processes of care, is a complex process with many possibilities for failure. The results provide the basis for a refined understanding of relationships among components of the organizational model and factors in the organizational context affecting them. This understanding suggests practical lessons for future implementation efforts and contributes to theoretical understanding of the dynamics of the implementation of EBPs.

Policy Implementation: Implications for Evaluation

ERIC Educational Resources Information Center

DeGroff, Amy; Cargo, Margaret

2009-01-01

Policy implementation reflects a complex change process where government decisions are transformed into programs, procedures, regulations, or practices aimed at social betterment. Three factors affecting contemporary implementation processes are explored: networked governance, sociopolitical context and the democratic turn, and new public…

The Integration of Technology into School Curriculum in Saudi Arabia: Factors Affecting Technology Implementation in the Classroom

ERIC Educational Resources Information Center

Barri, Moatasim A.

2013-01-01

There are a number of factors that influence technology implementation in the classroom including teachers' concerns; barriers; and intrinsic incentives. These factors give classroom teachers a chance to make a shift in their thinking and practice to help them properly integrate technology across the curriculum. This study was designed to assess:…

Factors Affecting the Full Use of Library and Information Management Systems by Library Personnel

ERIC Educational Resources Information Center

Skretas, Georgios

2005-01-01

Purpose: To provide a general list of factors that affects and determines the full use of library information management systems (LIMS) by library staff. Design/methodology/approach: The factors, which were identified mainly during participation in the implementation of automation projects in Greece, are listed and briefly analysed in categories…

Business process re-engineering in the logistics industry: a study of implementation, success factors, and performance

NASA Astrophysics Data System (ADS)

Shen, Chien-wen; Chou, Ching-Chih

2010-02-01

As business process re-engineering (BPR) is an important foundation to ensure the success of enterprise systems, this study would like to investigate the relationships among BPR implementation, BPR success factors, and business performance for logistics companies. Our empirical findings show that BPR companies outperformed non-BPR companies, not only on information processing, technology applications, organisational structure, and co-ordination, but also on all of the major logistics operations. Comparing the different perceptions of the success factors for BPR, non-BPR companies place greater emphasis on the importance of employee involvement while BPR companies are more concerned about the influence of risk management. Our findings also suggest that management attitude towards BPR success factors could affect performance with regard to technology applications and logistics operations. Logistics companies which have not yet implemented the BPR approach could refer to our findings to evaluate the advantages of such an undertaking and to take care of those BPR success factors affecting performance before conducting BPR projects.

Private primary care physicians' perspectives on factors affecting the adoption of electronic medical records: a qualitative pre-implementation study.

PubMed

Or, Calvin; Wong, Katie; Tong, Ellen; Sek, Antonio

2014-01-01

Use of electronic medical records (EMR) has the potential to offer quality and safety benefits, but without the adoption of the technology, the benefits will not be realized. This study aimed to identify the factors perceived as relevant by private physicians when considering EMR adoption. A qualitative pre-implementation study was conducted using semi-structured, face to face interviews to explore the perspectives of physicians (n=16) operating in private clinics on the factors affecting their adoption of EMR. A multilevel, work system approach and the immersion/crystallization data analysis technique guided the researchers in examining the data, identifying patterns and key themes, and extracting representative quotes to illustrate these themes. The major factors associated with EMR adoption, which relate to the five categories of a work system, were system usefulness; user interface design; technical support; cost; system reliability; the privacy, confidentiality, and security of patient information; physical space in the clinic; data migration process; adverse work-related factors; and the computer and systems skills of physicians. Pre-implementation identification of factors important to adoption can allow system developers to focus proactively on these factors when developing the system and its implementation strategies, to maximize the likelihood of successful introduction.

Primary Care Physicians' Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment

PubMed Central

Ludwick, D. A.; Doucette, John

2009-01-01

Our aging population has exacerbated strong and divergent trends between health human resource supply and demand. One way to mitigate future inequities is through the adoption of health information technology (HIT). Our previous research showed a number of risks and mitigating factors which affected HIT implementation success. We confirmed these findings through semistructured interviews with nine Alberta clinics. Sociotechnical factors significantly affected physicians' implementation success. Physicians reported that the time constraints limited their willingness to investigate, procure, and implement an EMR. The combination of antiquated exam room design, complex HIT user interfaces, insufficient physician computer skills, and the urgency in patient encounters precipitated by a fee-for-service remuneration model and long waitlists compromised the quantity, if not the quality, of the information exchange. Alternative remuneration and access to services plans might be considered to drive prudent behavior during physician office system implementation. PMID:19081787

An Analysis of Some Factors That Affect Curriculum Implementation in Upper Volta.

ERIC Educational Resources Information Center

Ouedraogo, Mathieu R.

Proposed reforms in the educational system of Upper Volta have brought to the surface a variety of opposing and negative reactions against implementing suggested changes. Factors that have emerged to hamper change are: (1) language of instruction (French vs Voltaic); (2) concentration on productive instruction (e.g., animal husbandry) gives rise…

Making Sense, Making Do: Local District Implementation of a New State Induction Policy

ERIC Educational Resources Information Center

Ellis, Chad D.

2016-01-01

Connecticut's Teacher Education and Mentoring (TEAM) program is in its early stages of implementation. This study examined how local school districts implemented TEAM and identified factors that affected implementation. It was based on interviews with twenty-two participants at the state, district, and local school levels. The intentions of the…

Critical factors of implementing Industrialised Building System in Sarawak: A research on SMEs

NASA Astrophysics Data System (ADS)

Hadi, N. A.; Muhamad, W. M. N. W.; Othman, M. K. F.

2017-05-01

Industrialised Building System (IBS) have been adopted in Malaysia for over five decades and is expected to grow consistent with Malaysia's economic development. In promoting the adoption of IBS in construction projects, the government has taken several steps such as levy exemption for contractors and developers. Despite its numerous advantages and efforts pulled by the government, the implementation and adoption of IBS are still below the expected figure. Many researchers investigated readiness, setbacks and issues related to the implementation of IBS in Malaysia's construction projects. However, most of the research mainly for projects located in urban areas of West Malaysia. Therefore, this paper aims to close the gap on factors affecting the implementation of IBS for SMEs in Sarawak, where the level urbanisation is low. A semi-structured interview was conducted with 10 SME's contractors to get better insight view. The study found that logistics and infrastructure problems, a limited number of the manufacturer, lack of incentive, conventional payment methods, lack of financial supports are among critical factors affecting the implementation of IBS. Therefore, it was concluded that government plays major role in providing supports, incentives and facilitating the improvement of infrastructure to successfully implementing IBS in Sarawak.

Implementing Cooperative Learning in Australian Primary Schools: Generalist Teachers' Perspectives

ERIC Educational Resources Information Center

Hennessey, Angela; Dionigi, Rylee A.

2013-01-01

To implement cooperative learning successfully in practice, teachers require knowledge of cooperative learning, its features and terms, and how it functions in classrooms. This qualitative study examined 12 Australian generalist primary teachers', understandings of cooperative learning and perceived factors affecting its implementation. Using…

Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures

PubMed Central

2013-01-01

Background Two of the current methodological barriers to implementation science efforts are the lack of agreement regarding constructs hypothesized to affect implementation success and identifiable measures of these constructs. In order to address these gaps, the main goals of this paper were to identify a multi-level framework that captures the predominant factors that impact implementation outcomes, conduct a systematic review of available measures assessing constructs subsumed within these primary factors, and determine the criterion validity of these measures in the search articles. Method We conducted a systematic literature review to identify articles reporting the use or development of measures designed to assess constructs that predict the implementation of evidence-based health innovations. Articles published through 12 August 2012 were identified through MEDLINE, CINAHL, PsycINFO and the journal Implementation Science. We then utilized a modified five-factor framework in order to code whether each measure contained items that assess constructs representing structural, organizational, provider, patient, and innovation level factors. Further, we coded the criterion validity of each measure within the search articles obtained. Results Our review identified 62 measures. Results indicate that organization, provider, and innovation-level constructs have the greatest number of measures available for use, whereas structural and patient-level constructs have the least. Additionally, relatively few measures demonstrated criterion validity, or reliable association with an implementation outcome (e.g., fidelity). Discussion In light of these findings, our discussion centers on strategies that researchers can utilize in order to identify, adapt, and improve extant measures for use in their own implementation research. In total, our literature review and resulting measures compendium increases the capacity of researchers to conceptualize and measure implementation-related constructs in their ongoing and future research. PMID:23414420

Implementing bicycle improvements at the local level

DOT National Transportation Integrated Search

1998-09-01

This implementational manual is intended for local governments who want to make improvements to existing conditions that affect bicycling. Thirteen of the most typical situations or factors that impact bicycle use are considered.

Factors affecting the implementation of clinical pharmacy services in China.

PubMed

Penm, Jonathan; Moles, Rebekah; Wang, Holly; Li, Yan; Chaar, Betty

2014-03-01

New policies in China have recently led to the implementation of clinical pharmacy services in hospitals. We explored the views of hospital administrators, pharmacy directors, clinical pharmacists, and dispensing pharmacists about the factors affecting clinical pharmacy services in China, using the framework approach and organizational theory. We conducted 30 interviews with 130 participants at 29 hospitals (both secondary and tertiary) in Beijing, Zhengzhou, Luoyang, and Shanghai. We found that the barriers to and facilitators of implementation of clinical pharmacy services slotted into the environment and participant dimensions of Scott's adapted version of Leavitt's organizational model. External support from government was perceived as crucial to promoting pharmacy services. It is proposed that the internationally recognized Basel Statements of the International Pharmaceutical Federation also provide a strong foundation for guiding China in implementing clinical pharmacy services.

Organizational factors affecting safety implementation in food companies in Thailand.

PubMed

Chinda, Thanwadee

2014-01-01

Thai food industry employs a massive number of skilled and unskilled workers. This may result in an industry with high incidences and accident rates. To improve safety and reduce the accident figures, this paper investigates factors influencing safety implementation in small, medium, and large food companies in Thailand. Five factors, i.e., management commitment, stakeholders' role, safety information and communication, supportive environment, and risk, are found important in helping to improve safety implementation. The statistical analyses also reveal that small, medium, and large food companies hold similar opinions on the risk factor, but bear different perceptions on the other 4 factors. It is also found that to improve safety implementation, the perceptions of safety goals, communication, feedback, safety resources, and supervision should be aligned in small, medium, and large companies.

What are key factors influencing malnutrition screening in community-dwelling elderly populations by general practitioners? A large cross-sectional survey in two areas of France.

PubMed

Gaboreau, Y; Imbert, P; Jacquet, J-P; Marchand, O; Couturier, P; Gavazzi, G

2013-11-01

Malnutrition is associated with a high morbi-mortality in elderly populations and their institutionalization at an early stage. The incidence is well known despite being often under-diagnosed in primary care. General practitioners (GPs) have a key role in home care. What are the factors affecting malnutrition-screening implementation by French GPs? We conducted a cross-sectional survey in two areas in the southeast of France (Savoie and Isère). In May 2008, an anonymized survey was sent by e-mail and/or post to all GPs with a large clinical practice. Two months later, reminder letters were sent. Potential barriers were measured by dichotomous scale. On GPs' characteristics (socio-demographic, medical training, geriatric practice and knowledge), multiple regression logistic was performed to identify others factors affecting malnutrition screening. In all, 493 GPs (26.85%) answered and 72.2% felt that malnutrition screening was useful although only 26.6% implemented it each year and 11.9% every 2-5 years. The main barriers to the implementation were patient selection (60.4%) and forgetting to screen (26.6%). Minor barriers were lack of knowledge (19.5%) or time (15%). New factors were identified: unsuitable working conditions (19.1%), insufficient motivation (6.8%) or technical support (7.2%). The quality of malnutrition information received was found to be the only promoter of annual screening (odds ratio=1.44 (1.087-1.919); P=0.011). This survey is the first in France to reveal GPs' factors affecting malnutrition implementation. New obstacles were identified in this survey. The hope of implementing regular malnutrition screening by GPs seems to lie with the quality of malnutrition information received.

Association of School Characteristics and Implementation in the X:IT Study--A School-Randomized Smoking Prevention Program

ERIC Educational Resources Information Center

Bast, Lotus S.; Due, Pernille; Ersbøll, Annette K.; Damsgaard, Mogens T.; Andersen, Anette

2017-01-01

Background: Assessment of implementation is essential for the evaluation of school-based preventive activities. Interventions are more easily implemented in schools if detailed instructional manuals, lesson plans, and materials are provided; however, implementation may also be affected by other factors than the intervention itself--for example,…

Factors associated with implementation of a multicomponent responsible beverage service program – results from two surveys in 290 Swedish municipalities

PubMed Central

2013-01-01

Background The purpose of this study was to investigate which factors affected the implementation of a multicomponent Responsible Beverage Service (RBS) program in 290 Swedish municipalities and whether the amount of such factors influenced the level of implementation of the program. Methods This study used variation in the presence of implementation-promoting factors to predict the level of implementation of the RBS program in municipalities throughout Sweden. The presence of such factors and the level of implementation of the program were studied by means of two surveys in all Swedish municipalities (N=290). Logistic regression and Spearman’s correlation analyses were used to analyze the relationship between implementation-promoting factors and the level of implementation of the RBS program. Results The response rates of the two surveys were 96% and 98%, respectively. One main finding was that program fidelity was low. Only 13% of the municipalities surveyed had implemented the RBS program as a whole, as stated in the specification of requirements. In municipalities reporting a higher amount of implementation-promoting factors, a significantly higher level of implementation of the program was shown. Evaluation and feedback was the only factor that correlated significantly with the level of implementation of the RBS program as a whole. Conclusion Evaluation and feedback constitutes an important implementation-promoting factor also in complex programs like the RBS program. Program fidelity is significant for the outcome of an intervention and must be a major focus of the implementation processes. PMID:23497692

Health care professionals implementing a smoke-free policy at inpatient psychiatric units.

PubMed

Grant, Lyle G; Oliffe, John L; Johnson, Joy L; Bottorff, Joan L

2014-12-01

Smoke-free grounds policies (SFGPs) were introduced to inpatient psychiatric hospital settings to improve health among patients, staff, and visitors. We conducted an ethnographic study in Northern British Columbia, Canada, to describe how the implementation of SFGPs is affected by institutional cultures. Data reported here included participant observation, document review, informal discussions (n = 11), and interviews with health care professionals (HCPs; n = 19) and staff (n = 2) at two hospitals. We used iterative and inductive processes to derive thematic findings. Findings related to HCPs illustrate how local contexts and cultural factors affect SFGP implementation. These factors included individual beliefs and attitudes, the influence of group norms, leadership and consensus building, and locale-specific norms. Strong, consultative leadership, in which leaders solicited input from and long-term support of people most directly responsible for policy implementation, was key to success. © The Author(s) 2014.

The Role of Practitioner Self-Efficacy, Training, Program and Workplace Factors on the Implementation of an Evidence-Based Parenting Intervention in Primary Care

ERIC Educational Resources Information Center

Turner, Karen M. T.; Nicholson, Jan M.; Sanders, Matthew R.

2011-01-01

This study examines factors affecting the implementation by primary care practitioners (nursing, education, allied health, and medical) of a brief parenting and family support intervention (the Primary Care Triple P--Positive Parenting Program) following professional training. It assesses the impact of prior experience, self-efficacy, program…

Toward Digital Citizenship: Examining Factors Affecting Participation and Involvement in the Internet Society among Higher Education Students

ERIC Educational Resources Information Center

Al-Zahrani, Abdulrahman

2015-01-01

The current study aims to understand digital citizenship, based on the assumptions of Ribble (2014), by examining factors affecting participation and involvement in the Internet virtual societies among higher education students. A quantitative approach using a survey questionnaire was implemented. The participants were 174 students from the…

Implementing large-scale programmes to optimise the health workforce in low- and middle-income settings: a multicountry case study synthesis.

PubMed

Gopinathan, Unni; Lewin, Simon; Glenton, Claire

2014-12-01

To identify factors affecting the implementation of large-scale programmes to optimise the health workforce in low- and middle-income countries. We conducted a multicountry case study synthesis. Eligible programmes were identified through consultation with experts and using Internet searches. Programmes were selected purposively to match the inclusion criteria. Programme documents were gathered via Google Scholar and PubMed and from key informants. The SURE Framework - a comprehensive list of factors that may influence the implementation of health system interventions - was used to organise the data. Thematic analysis was used to identify the key issues that emerged from the case studies. Programmes from Brazil, Ethiopia, India, Iran, Malawi, Venezuela and Zimbabwe were selected. Key system-level factors affecting the implementation of the programmes were related to health worker training and continuing education, management and programme support structures, the organisation and delivery of services, community participation, and the sociopolitical environment. Existing weaknesses in health systems may undermine the implementation of large-scale programmes to optimise the health workforce. Changes in the roles and responsibilities of cadres may also, in turn, impact the health system throughout. © 2014 John Wiley & Sons Ltd.

Resistance to Change among Veteran Teachers: Providing Voice for More Effective Engagement

ERIC Educational Resources Information Center

Snyder, Richard R.

2017-01-01

Effective implementation of change remains a crucial concern for educational leaders in the 21st Century. One of the factors affecting effective implementation of reform is resistance to change. Veteran teachers in particular present unique challenges, and stereotypically the greatest resistance, for effective implementation of change. This study…

Scaling up a School-Based Sexual and Reproductive Health Intervention in Rural Tanzania: A Process Evaluation Describing the Implementation Realities for the Teachers

ERIC Educational Resources Information Center

Renju, Jenny; Nyalali, Kija; Andrew, Bahati; Kishamawe, Coleman; Kimaryo, Micheal; Remes, Pieter; Changalucha, John; Obasi, Angela

2010-01-01

Little is known about the nature and mechanisms of factors that facilitate or inhibit the scale-up and subsequent implementation of school-based adolescent sexual and reproductive health (ASRH) interventions. We present process evaluation findings examining the factors that affected the 10-fold scale-up of such an intervention, focussing on…

A Study of the Physiological Factors Affecting the Nature of the Adult Learner in the Phoenix Air National Guard.

ERIC Educational Resources Information Center

Torbert, James Brison

An investigation reviewed current literature in the field of physiological factors affecting the adult learning environment. These findings were compared to the academic learning environment at the Phoenix Air National Guard. The end product was a set of recommendations for management to implement in order to improve the learning climate for the…

Philosophies of Policy Development and Implementation in Technical and Vocational Education. Report on UNESCO/UNEVOC Regional Expert Group Meeting (Auckland, New Zealand, April 2-9, 1995).

ERIC Educational Resources Information Center

Auckland Inst. of Tech. (New Zealand).

This report begins with an outline of key issues in policy development and implementation in technical and vocational education (TVE). It sets forth the bases of policy development and implementation, the purpose of TVE, contextual factors that affect policy development and implementation. The following values significant in policy determination…

Implementation of the Better Jobs Better Care Demonstration: Lessons for Long-Term Care Workforce Initiatives

ERIC Educational Resources Information Center

Kemper, Peter; Brannon, Diane; Barry, Teta; Stott, Amy; Heier, Brigitt

2008-01-01

Purpose: Better Jobs Better Care (BJBC) was a long-term care workforce demonstration that sought to improve recruitment and retention of direct care workers by changing public policy and management practice. The purpose of this article is to document and assess BJBC's implementation, analyze factors affecting implementation, and draw lessons from…

Innovation implementation in the public sector: an integration of institutional and collective dynamics.

PubMed

Choi, Jin Nam; Chang, Jae Yoon

2009-01-01

The present study integrates institutional factors and employee-based collective processes as predictors of 2 key implementation outcomes: implementation effectiveness and innovation effectiveness (Klein, Conn, & Sorra, 2001). Specifically, the authors proposed that institutional factors shape employees' collective implementation efficacy and innovation acceptance. The authors further hypothesized that these employee-based collective processes mediate the effects of institutional factors on implementation outcomes. This integrative framework was examined in the context of 47 agencies and ministries of the Korean Government that were implementing a process innovation called E-Government. Three-wave longitudinal data were collected from 60 external experts and 1,732 government employees. The results reveal the importance of management support for collective implementation efficacy, which affected employees' collective acceptance of the innovation. As hypothesized, these collective employee dynamics mediated the effects of institutional enablers on successful implementation as well as the amount of long-term benefit that accrued to the agencies and ministries. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Strategic implementation of integrated water resources management in Mozambique: An A’WOT analysis

NASA Astrophysics Data System (ADS)

Gallego-Ayala, Jordi; Juízo, Dinis

The Integrated Water Resources Management (IWRM) paradigm has become an important framework in development and management of water resources. Many countries in the Southern Africa region have begun water sector reforms to align the sector with the IWRM concepts. In 2007 the Mozambican Government started to update the policy and the legal framework of the water sector to foster the application of IWRM concept as a basis for achieving sustainable development. However the steps towards the implementation of this national framework are still in preparation. This research aims to identify and establish a priority ranking of the fundamental factors likely to affect the outcome of the IWRM reforms in Mozambique. This study uses the hybrid multi-criteria decision method A’WOT, a methodology coined by Kurttila et al. (2000). This method relies on the combination of the Strengths, Weaknesses, Opportunities, and Threats (SWOT) technique and the Analytic Hierarchy Process (AHP) technique. Using this procedure it is possible to identify and rank the factors affecting the functioning of a system. The key factors affecting the implementation of the IWRM, analysed in this study, were identified through an expert group discussion. These factors have been grouped into different categories of SWOT. Subsequently, the AHP methodology was applied to obtain the relative importance of each factor captured in the SWOT analysis; to this end the authors interviewed a panel of water resources management experts and practitioners. As a result, of this study and the application of the A’WOT methodology, the research identified and ranked the fundamental factors for the success of the IWRM strategy in Mozambique. The results of this study suggest that in Mozambique a planning strategy for the implementation of the IWRM should be guided mainly by combination of interventions in factors falling under opportunity and weakness SWOT groups.

Interventions to provide culturally-appropriate maternity care services: factors affecting implementation.

PubMed

Jones, Eleri; Lattof, Samantha R; Coast, Ernestina

2017-08-31

The World Health Organization recently made a recommendation supporting 'culturally-appropriate' maternity care services to improve maternal and newborn health. This recommendation results, in part, from a systematic review we conducted, which showed that interventions to provide culturally-appropriate maternity care have largely improved women's use of skilled maternity care. Factors relating to the implementation of these interventions can have implications for their success. This paper examines stakeholders' perspectives and experiences of these interventions, and facilitators and barriers to implementation; and concludes with how they relate to the effects of the interventions on care-seeking outcomes. We based our analysis on 15 papers included in the systematic review. To extract, collate and organise data on the context and conditions from each paper, we adapted the SURE (Supporting the Use of Research Evidence) framework that lists categories of factors that could influence implementation. We considered information from the background and discussion sections of papers included in the systematic review, as well as cost data and qualitative data when included. Women's and other stakeholders' perspectives on the interventions were generally positive. Four key themes emerged in our analysis of facilitators and barriers to implementation. Firstly, interventions must consider broader economic, geographical and social factors that affect ethnic minority groups' access to services, alongside providing culturally-appropriate care. Secondly, community participation is important in understanding problems with existing services and potential solutions from the community perspective, and in the development and implementation of interventions. Thirdly, respectful, person-centred care should be at the core of these interventions. Finally, cohesiveness is essential between the culturally-appropriate service and other health care providers encountered by women and their families along the continuum of care through pregnancy until after birth. Several important factors should be considered and addressed when implementing interventions to provide culturally-appropriate care. These factors reflect more general goals on the international agenda of improving access to skilled maternity care; providing high-quality, respectful care; and community participation.

Motivational Factors Affecting Athletes in Selecting the Sport Branches of Athletics, Ski and Tennis

ERIC Educational Resources Information Center

Akyüz, Murat; Agar, Muharrem; Akyüz, Öznur; Dogru, Yeliz

2016-01-01

The aim of this study is to research the motivational factors affecting athletes to select the branches of athletics, ski and tennis. Within the scope of the research, the survey developed by H. Sunay in 1996 was implemented and solution for the problem of the research was searched through the findings that were obtained from the survey. SPSS…

A mixed methods study of individual and organizational factors that affect implementation of interventions for children with autism in public schools.

PubMed

Locke, Jill; Beidas, Rinad S; Marcus, Steven; Stahmer, Aubyn; Aarons, Gregory A; Lyon, Aaron R; Cannuscio, Carolyn; Barg, Frances; Dorsey, Shannon; Mandell, David S

2016-10-10

The significant lifelong impairments associated with autism spectrum disorder (ASD), combined with the growing number of children diagnosed with ASD, have created urgency in improving school-based quality of care. Although many interventions have shown efficacy in university-based research, few have been effectively implemented and sustained in schools, the primary setting in which children with ASD receive services. Individual- and organizational-level factors have been shown to predict the implementation of evidence-based interventions (EBIs) for the prevention and treatment of other mental disorders in schools, and may be potential targets for implementation strategies in the successful use of autism EBIs in schools. The purpose of this study is to examine the individual- and organizational-level factors associated with the implementation of EBIs for children with ASD in public schools. We will apply the Domitrovich and colleagues (2008) framework that examines the influence of contextual factors (i.e., individual- and organizational-level factors) on intervention implementation in schools. We utilize mixed methods to quantitatively test whether the factors identified in the Domitrovich and colleagues (2008) framework are associated with the implementation of autism EBIs, and use qualitative methods to provide a more comprehensive understanding of the factors associated with successful implementation and sustainment of these interventions with the goal of tailoring implementation strategies. The results of this study will provide an in-depth understanding of individual- and organizational-level factors that influence the successful implementation of EBIs for children with ASD in public schools. These data will inform potential implementation targets and tailoring of strategies that will help schools overcome barriers to implementation and ultimately improve the services and outcomes for children with ASD.

The GUIDES checklist: development of a tool to improve the successful use of guideline-based computerised clinical decision support.

PubMed

Van de Velde, Stijn; Kunnamo, Ilkka; Roshanov, Pavel; Kortteisto, Tiina; Aertgeerts, Bert; Vandvik, Per Olav; Flottorp, Signe

2018-06-25

Computerised decision support (CDS) based on trustworthy clinical guidelines is a key component of a learning healthcare system. Research shows that the effectiveness of CDS is mixed. Multifaceted context, system, recommendation and implementation factors may potentially affect the success of CDS interventions. This paper describes the development of a checklist that is intended to support professionals to implement CDS successfully. We developed the checklist through an iterative process that involved a systematic review of evidence and frameworks, a synthesis of the success factors identified in the review, feedback from an international expert panel that evaluated the checklist in relation to a list of desirable framework attributes, consultations with patients and healthcare consumers and pilot testing of the checklist. We screened 5347 papers and selected 71 papers with relevant information on success factors for guideline-based CDS. From the selected papers, we developed a 16-factor checklist that is divided in four domains, i.e. the CDS context, content, system and implementation domains. The panel of experts evaluated the checklist positively as an instrument that could support people implementing guideline-based CDS across a wide range of settings globally. Patients and healthcare consumers identified guideline-based CDS as an important quality improvement intervention and perceived the GUIDES checklist as a suitable and useful strategy. The GUIDES checklist can support professionals in considering the factors that affect the success of CDS interventions. It may facilitate a deeper and more accurate understanding of the factors shaping CDS effectiveness. Relying on a structured approach may prevent that important factors are missed.

Causes and remedies for the dominant risk factors in Enterprise System implementation projects: the consultants' perspective.

PubMed

Lech, Przemysław

2016-01-01

The purpose of this research was to investigate the causes of the dominant risk factors, affecting Enterprise System implementation projects and propose remedies for those risk factors from the perspective of implementation consultants. The study used a qualitative research strategy, based on e-mail interviews, semi-structured personal interviews with consultants and participant observation during implementation projects. The main contribution of this paper is that it offers viable indications of how to mitigate the dominant risk factors. These indications were grouped into the following categories: stable project scope, smooth communication supported by the project management, dedicated, competent and decision-making client team, competent and engaged consultant project manager, schedule and budget consistent with the project scope, use of methodology and procedures, enforced and enabled by the project managers, competent and dedicated consultants. A detailed description is provided for each category.

Ergonomics in the development and implementation of organisational strategy for sustainability.

PubMed

Ryan, Brendan; Wilson, John R

2013-01-01

This is the first phase of an ergonomics study of sustainability in a rail organisation, particularly environmental sustainability. The main emphasis has been on the use of a qualitative approach to carry out in-depth consultation with those in influential and policy setting roles in the organisation, collecting and analysing perceptions on sustainability policy and related business processes. The study identified factors affecting implementation of policy on sustainability and these have been developed to produce a list of requirements for implementing the policy. The findings are valuable in understanding the range of attitudes, aspirations and perceived constraints, from the perspective of those in senior roles in the company, and development of a sustainability strategy for a rail infrastructure owner. There is need for wider consultation, both within the organisation and externally, to validate and refine the understanding of barriers to the implementation of the policy. The role of ergonomics in supporting the work on sustainability is discussed. The study collects in-depth views from senior managers on the challenges of implementing a policy on sustainability in a rail organisation. Outputs include a list of factors affecting implementation of policy and requirements for better implementation of policy in this area. Potential contributions of ergonomics to sustainability in organisational contexts are discussed.

From EDI to Internet Commerce: The BHP Steel Experience.

ERIC Educational Resources Information Center

Chan, Caroline; Swatman, Paula M. C.

2000-01-01

Discusses the issue of business-to-business electronic commerce implementation and the factors affecting it. Discusses electronic data interchange technology, describes the results of a case study of BHP Steel (Australia), and considers paradigm shifts in implementation issues related to electronic commerce that occur over time. (Author/LRW)

Making the Indian Child Welfare Act Work: Missing Social and Governmental Linkages.

ERIC Educational Resources Information Center

Sink, David

1982-01-01

The Indian Child Welfare Act places responsibility for implementing Indian welfare legislation onto Indian tribes themselves, rather than on the government bureaucracy. Successful implementation poses challenges concerning the establishment of comprehensive tribal courts, in view of sociocultural and environmental factors that have affected the…

Sustainability of teacher implementation of school-based mental health programs.

PubMed

Han, Susan S; Weiss, Bahr

2005-12-01

Evidence-based prevention and intervention programs are increasingly being implemented in schools and it therefore is becoming increasingly important to understand the complexities of program implementation under real-world conditions. Much research has focused on the contextual factors that influence program implementation but less work has attempted to provide an integrated understanding of mechanisms (e.g., teacher-training processes) that affect teachers' program implementation. In this paper, we review literature on factors related to teachers' implementation of school-based prevention and intervention programs, then from this review abstract what we believe are four basic ingredients that characterize potentially sustainable teacher-implemented classroom programs. Finally, we present a sequential model, based on these ingredients, of the naturalistic processes underlying sustainability of teachers' program implementation and describe how this sustainability can be enhanced through provision of teacher training and performance feedback from a classroom consultant.

Programmes for advance distribution of misoprostol to prevent post-partum haemorrhage: a rapid literature review of factors affecting implementation.

PubMed

Smith, Helen J; Colvin, Christopher J; Richards, Esther; Roberson, Jeffrey; Sharma, Geeta; Thapa, Kusum; Gülmezoglu, A Metin

2016-02-01

Recent efforts to prevent post-partum haemorrhage (PPH) in low-income countries have focused on providing women with access to oral misoprostol during home birth. The WHO recommends using lay health workers (LHWs) to administer misoprostol in settings where skilled birth attendants are not available. This review synthesizes current knowledge about the barriers and facilitators affecting implementation of advance community distribution of misoprostol to prevent PPH, where misoprostol may be self-administered or administered by an LHW.We searched for and summarized available empirical evidence, and collected primary data from programme stakeholders about their experiences of programme implementation.We present key outcomes and features of advanced distribution programmes that are in operation or have been piloted globally. We categorized factors influencing implementation into those that operate at the health system level, factors related to the community and policy context and those factors more closely connected to the end user.Debates around advance distribution have centred on the potential risks and benefits of making misoprostol available to pregnant women and community members during pregnancy for administration in the home. However, the risks of advance distribution appear manageable and the benefits of self-administration, especially for women who have little chance of expert care for PPH, are considerable. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Affective Outcomes of Schooling: Full-Information Item Factor Analysis of a Student Questionnaire.

ERIC Educational Resources Information Center

Muraki, Eiji; Engelhard, George, Jr.

Recent developments in dichotomous factor analysis based on multidimensional item response models (Bock and Aitkin, 1981; Muthen, 1978) provide an effective method for exploring the dimensionality of questionnaire items. Implemented in the TESTFACT program, this "full information" item factor analysis accounts not only for the pairwise joint…

Factors That Affect a School District's Ability to Successfully Implement the Use of Data Warehouse Applications in the Data Driven Decision Making Process

ERIC Educational Resources Information Center

DeLoach, Robin

2012-01-01

The purpose of this study was to explore the factors that influence the ability of teachers and administrators to use data obtained from a data warehouse to inform instruction. The mixed methods study was guided by the following questions: 1) What data warehouse application features affect the ability of an educator to effectively use the…

A path analysis study of retention of healthcare professionals in urban India using health information technology.

PubMed

Bhattacharya, Indrajit; Ramachandran, Anandhi

2015-07-31

Healthcare information technology (HIT) applications are being ubiquitously adopted globally and have been indicated to have effects on certain dimensions of recruitment and retention of healthcare professionals. Retention of healthcare professionals is affected by their job satisfaction (JS), commitment to the organization and intention to stay (ITS) that are interlinked with each other and influenced by many factors related to job, personal, organization, etc. The objectives of the current study were to determine if HIT was one among the factors and, if so, propose a probable retention model that incorporates implementation and use of HIT as a strategy. This was a cross-sectional survey study covering 20 hospitals from urban areas of India. The sample (n = 586) consisted of doctors, nurses, paramedics and hospital administrators. Data was collected through a structured questionnaire. Factors affecting job satisfaction were determined. Technology acceptance by the healthcare professionals was also determined. Interactions between the factors were predicted using a path analysis model. The overall satisfaction rate of the respondents was 51 %. Based on factor analysis method, 10 factors were identified for JS and 9 factors for ITS. Availability and use of information technology was one factor that affected JS. The need for implementing technology influenced ITS through work environment and career growth. Also, the study indicated that nearly 70 % of the respondents had awareness of HIT, but only 40 % used them. The importance of providing training for HIT applications was stressed by many respondents. The results are in agreement with literature studies exploring job satisfaction and retention among healthcare professionals. Our study documented a relatively medium level of job satisfaction among the healthcare professionals in the urban area. Information technology was found to be one among the factors that can plausibly influence their job satisfaction and intention to stay. Based on the results of the study, a retention strategy has been suggested that utilizes implementation of HIT and provision of training to influence the retention of healthcare workers.

Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care

PubMed Central

2012-01-01

Background Prior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people. Methods The intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity. Results A total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity. Discussion The Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time. Trial registration ClinicalTrials.gov, NCT01260493. PMID:22436121

Key ingredients for implementing intensive outpatient programs within patient-centered medical homes: A literature review and qualitative analysis.

PubMed

Breland, Jessica Y; Asch, Steven M; Slightam, Cindie; Wong, Ava; Zulman, Donna M

2016-03-01

Intensive outpatient programs aim to transform care while conserving resources for high-need, high-cost patients, but little is known about factors that influence their implementation within patient-centered medical homes (PCMHs). In this mixed-methods study, we reviewed the literature to identify factors affecting intensive outpatient program implementation, then used semi-structured interviews to determine how these factors influenced the implementation of an intensive outpatient program within the Veterans Affairs' (VA) PCMH. Interviewees included facility leadership and clinical staff who were involved in a pilot Intensive Management Patient Aligned Care Team (ImPACT) intervention for high-need, high-cost VA PCMH patents. We classified implementation factors in the literature review and qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). The literature review (n=9 studies) and analyses of interviews (n=15) revealed key implementation factors in three CFIR domains. First, the Inner Setting (i.e., the organizational and PCMH environment), mostly enabled implementation through a culture of innovation, good networks and communication, and positive tension for change. Second, Characteristics of Individuals, including creativity, flexibility, and interpersonal skills, allowed program staff to augment existing PCMH services. Finally, certain Intervention Characteristics (e.g., adaptability) enabled implementation, while others (e.g., complexity) generated implementation barriers. Resources and structural features common to PCMHs can facilitate implementation of intensive outpatient programs, but program success is also dependent on staff creativity and flexibility, and intervention adaptations to meet patient and organizational needs. Established PCMHs likely provide resources and environments that permit accelerated implementation of intensive outpatient programs. V. Published by Elsevier Inc.

The Implementation of Interactive Multimedia Learning Materials in Teaching Listening Skills

ERIC Educational Resources Information Center

Ampa, Andi Tenri

2015-01-01

One of the factors that may affect the success of the learning process is the use of learning media. Therefore, this research aimed to implement and evaluate the interactive multimedia learning materials using Wondershare Quizcreator program and audio materials in teaching "English listening skills". The research problem was whether or…

Infrastructure and Resources of Private Schools in Cali and the Implementation of the Bilingual Colombia Program

ERIC Educational Resources Information Center

Miranda, Norbella; Echeverry, Ángela Patricia

2010-01-01

Institutional factors affect the implementation of educational policies. Physical school infrastructure and the availability of resources determine to a certain extent whether a policy may be successfully transformed into practice. This article provides a description and analysis of school infrastructure and resources of private institutions of…

Implementation considerations when expanding health worker roles to include safe abortion care: a five-country case study synthesis.

PubMed

Glenton, Claire; Sorhaindo, Annik M; Ganatra, Bela; Lewin, Simon

2017-09-21

Allowing a broader range of trained health workers to deliver services can be an important way of improving access to safe abortion care. However, the expansion of health worker roles may be challenging to implement. This study aimed to explore factors influencing the implementation of role expansion strategies for non-physician providers to include the delivery of abortion care. We conducted a multi-country case study synthesis in Bangladesh, Ethiopia, Nepal, South Africa and Uruguay, where the roles of non-physician providers have been formally expanded to include the provision of abortion care. We searched for documentation from each country related to non-physician providers, abortion care services and role expansion through general internet searches, Google Scholar and PubMed, and gathered feedback from 12 key informants. We carried out a thematic analysis of the data, drawing on categories from the SURE Framework of factors affecting the implementation of policy options. Several factors appeared to affect the successful implementation of including non-physician providers to provide abortion care services. These included health workers' knowledge about abortion legislation and services; and health workers' willingness to provide abortion care. Health workers' willingness appeared to be influenced by their personal views about abortion, the method of abortion and stage of pregnancy and their perceptions of their professional roles. While managers' and co-workers' attitudes towards the use of non-physician providers varied, the synthesis suggests that female clients focused less on the type of health worker and more on factors such as trust, privacy, cost, and closeness to home. Health systems factors also played a role, including workloads and incentives, training, supervision and support, supplies, referral systems, and monitoring and evaluation. Strategies used, with varying success, to address some of these issues in the study countries included values clarification workshops, health worker rotation, access to emotional support for health workers, the incorporation of abortion care services into pre-service curricula, and in-service training strategies. To increase the likelihood of success for role expansion strategies in the area of safe abortion, programme planners must consider how to ensure motivation, support and reasonable working conditions for affected health workers.

Understanding and avoiding potential problems in implementing automation

NASA Astrophysics Data System (ADS)

Rouse, W. B.; Morris, N. M.

1985-11-01

Technology-driven efforts to implement automation often encounter problems due to lack of acceptance or begrudging acceptance by the personnel involved. It is argued in this paper that the level of automation perceived by an individual heavily influences whether or not the automation is accepted by that individual. The factors that appear to affect perceived level of automation are discussed. Issues considered include the impact of automation on the system and the individual, correlates of acceptance, problems and risks of automation, and factors influencing alienation. Based on an understanding of these issues, a set of eight guidelines is proposed as a possible means of avoiding problems in implementing automation.

Understanding and avoiding potential problems in implementing automation

NASA Technical Reports Server (NTRS)

Rouse, W. B.; Morris, N. M.

1985-01-01

Technology-driven efforts to implement automation often encounter problems due to lack of acceptance or begrudging acceptance by the personnel involved. It is argued in this paper that the level of automation perceived by an individual heavily influences whether or not the automation is accepted by that individual. The factors that appear to affect perceived level of automation are discussed. Issues considered include the impact of automation on the system and the individual, correlates of acceptance, problems and risks of automation, and factors influencing alienation. Based on an understanding of these issues, a set of eight guidelines is proposed as a possible means of avoiding problems in implementing automation.

An accelerated subspace iteration for eigenvector derivatives

NASA Technical Reports Server (NTRS)

Ting, Tienko

1991-01-01

An accelerated subspace iteration method for calculating eigenvector derivatives has been developed. Factors affecting the effectiveness and the reliability of the subspace iteration are identified, and effective strategies concerning these factors are presented. The method has been implemented, and the results of a demonstration problem are presented.

Translational Research in South Africa: Evaluating Implementation Quality Using a Factorial Design

PubMed Central

Smith, Edward A.; Collins, Linda M.; Graham, John W.; Lai, Mary; Wegner, Lisa; Vergnani, Tania; Matthews, Catherine; Jacobs, Joachim

2012-01-01

Background HealthWise South Africa: Life Skills for Adolescents (HW) is an evidence-based substance use and sexual risk prevention program that emphasizes the positive use of leisure time. Since 2000, this program has evolved from pilot testing through an efficacy trial involving over 7,000 youth in the Cape Town area. Beginning in 2011, through 2015, we are undertaking a new study that expands HW to all schools in the Metro South Education District. Objective This paper describes a research study designed in partnership with our South African collaborators that examines three factors hypothesized to affect the quality and fidelity of HW implementation: enhanced teacher training; teacher support, structure and supervision; and enhanced school environment. Methods Teachers and students from 56 schools in the Cape Town area will participate in this study. Teacher observations are the primary means of collecting data on factors affecting implementation quality. These factors address the practical concerns of teachers and schools related to likelihood of use and cost-effectiveness, and are hypothesized to be “active ingredients” related to high-quality program implementation in real-world settings. An innovative factorial experimental design was chosen to enable estimation of the individual effect of each of the three factors. Results Because this paper describes the conceptualization of our study, results are not yet available. Conclusions The results of this study may have both substantive and methodological implications for advancing Type 2 translational research. PMID:22707870

Devising and Implementing a Business Proposal Module: Constraints and Compromises

ERIC Educational Resources Information Center

Flowerdew, Lynne

2010-01-01

This article describes the design and implementation of a business proposal module for final-year science students at a tertiary institution in Hong Kong. It is argued that in the needs analysis process, the present situation analysis (PSA), that is, personal information about the learners and factors which may affect their learning, is just as if…

Factors Influencing the Implementation of Training and Learning in the Workplace.

ERIC Educational Resources Information Center

Ridoutt, Lee; Dutneall, Ralph; Hummel, Kevin; Smith, Chris Selby

The quantitative relationship between factors previously identified as affecting the extent and intensity of training within organizations was explored through a survey of companies in Australia's entertainment and process manufacturing sectors. A self-completion questionnaire was mailed first to a sample of 446 companies across Australia (112 of…

Organizational Barriers to Adopting an Alcohol Screening and Brief Intervention in Community-Based Mental Health Organizations.

PubMed

Patterson, David A; Wolf Adelv Unegv Waya, Silver; Dulmus, Catherine N

2012-06-01

This paper examines two factors related to successfully implementing a brief alcohol screening throughout all community-based mental health organizations. The first issue is related to an organization's internal structures, such as culture and climate that can impede evidenced-based practice implementation. There is literature suggesting that organizational culture and climate affect decisions about whether evidence-based practices are adopted and implemented within health care agencies. Following this literature review on organizational barriers, the history and successes of adopting an alcohol screening and brief intervention are reviewed. Studying, identifying, and understanding the organizational factors associated with the successful dissemination and implementation of best practices throughout community-based mental health organizations would contribute to increasing the likelihood that an alcohol screening and brief intervention are implemented throughout mental health organizations.

Organizational Barriers to Adopting an Alcohol Screening and Brief Intervention in Community-Based Mental Health Organizations

PubMed Central

Patterson, David A.; Wolf (Adelv unegv Waya), Silver; Dulmus, Catherine N.

2012-01-01

This paper examines two factors related to successfully implementing a brief alcohol screening throughout all community-based mental health organizations. The first issue is related to an organization’s internal structures, such as culture and climate that can impede evidenced-based practice implementation. There is literature suggesting that organizational culture and climate affect decisions about whether evidence-based practices are adopted and implemented within health care agencies. Following this literature review on organizational barriers, the history and successes of adopting an alcohol screening and brief intervention are reviewed. Studying, identifying, and understanding the organizational factors associated with the successful dissemination and implementation of best practices throughout community-based mental health organizations would contribute to increasing the likelihood that an alcohol screening and brief intervention are implemented throughout mental health organizations. PMID:24634639

Factors affecting speech pathologists' implementation of stroke management guidelines: a thematic analysis.

PubMed

Miao, Melissa; Power, Emma; O'Halloran, Robyn

2015-01-01

Although clinical practice guidelines can facilitate evidence-based practice and improve the health outcomes of stroke patients, they continue to be underutilised. There is limited research into the reasons for this, especially in speech pathology. This study provides the first in-depth, qualitative examination of the barriers and facilitators that speech pathologists perceive and experience when implementing guidelines. A maximum variation sample of eight speech pathologists participated in a semi-structured interview concerning the implementation of the National Stroke Foundation's Clinical Guidelines for Stroke Management 2010. Interviews were transcribed, thematically analysed and member checked before overall themes were identified. Three main themes and ten subthemes were identified. The first main theme, making implementation explicit, reflected the necessity of accessing and understanding guideline recommendations, and focussing specifically on implementation in context. In the second theme, demand versus ability to change, the size of changes required was compared with available resources and collaboration. The final theme, Speech pathologist motivation to implement guidelines, demonstrated the influence of individual perception of the guidelines and personal commitment to improved practice. Factors affecting implementation are complex, and are not exclusively barriers or facilitators. Some potential implementation strategies are suggested. Further research is recommended. In most Western nations, stroke remains the single greatest cause of disability, including communication and swallowing disabilities. Although adherence to stroke clinical practice guidelines improves stroke patient outcomes, guidelines continue to be underutilised, and the reasons for this are not well understood. This is the first in-depth qualitative study identifying the complex barriers and facilitators to guideline implementation as experienced by speech pathologists in stroke care. Suggested implementation strategies include local monitoring of guideline implementation (e.g. team meetings, audits), increasing collaboration on implementation projects (e.g. managerial involvement, networking), and seeking speech pathologist input into guideline development.

A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa.

PubMed

Silumbwe, Adam; Zulu, Joseph Mumba; Halwindi, Hikabasa; Jacobs, Choolwe; Zgambo, Jessy; Dambe, Rosalia; Chola, Mumbi; Chongwe, Gershom; Michelo, Charles

2017-05-22

Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa. A systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation. The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution. Mass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.

Implementation of national guidelines for the prevention and treatment of overweight and obesity in children and adolescents: a phenomenographic analysis of public health nurses' perceptions.

PubMed

Nordstrand, Aina; Fridlund, Bengt; Sollesnes, Ragnhild

2016-01-01

To explore and describe how public health nurses (PHNs) perceive the implementation of national guidelines for the prevention and treatment of overweight and obesity among children and adolescents in well-baby clinics and school health services. An explorative descriptive design was carried out through individual interviews with 18 PHNs and analysed according to the phenomenographic tradition. Four implementation strategies were described and assigned a metaphor: the structured PHN, pragmatic PHN, critical PHN, and the resigned PHN. Competence, patient receptiveness, internal consensus, interdisciplinary collaboration, resources, and organizational embedding were the determinants identified that most frequently affect implementation, and these determinants were distributed at different levels of the organization. The extent of facilitation seemed to determine which implementation strategy would be used. How PHNs implemented the guidelines for overweight and obesity were affected by determinants at different organizational levels. Contextual facilitation of implementation seemed better in larger organizations, but factors such as leadership, drive, and experience compensated in smaller municipalities. The implementation of guidelines was hindered when the barriers exceeded the benefits.

Exploring multi-level system factors facilitating educator training and implementation of evidence-based practices (EBP): a study protocol.

PubMed

Stahmer, Aubyn C; Suhrheinrich, Jessica; Schetter, Patricia L; McGee Hassrick, Elizabeth

2018-01-08

This study examines how system-wide (i.e., region, district, and school) mechanisms such as leadership support, training requirements, structure, collaboration, and education affect the use of evidence-based practices (EBPs) in schools and how this affects the outcomes for students with autism spectrum disorder (ASD). Despite growing evidence for the positive effects of EBPs for ASD, these practices are not consistently or effectively used in schools. Although special education programs are mandated to use EBPs, there are very few evidence-based methods for selecting, implementing, and sustaining EBPs. Research focuses primarily on teacher training, without attention to contextual factors (e.g., implementation climate, attitudes toward EBPs, resource allocation, and social networks) that may impact outcomes. Using an implementation science framework, this project will prospectively examine relations between system-wide factors and teachers' use of EBPs and student education outcomes. Survey data will be collected from approximately 85 regional special education directors, 170 regional program specialists, 265 district special education directors, 265 behavior specialists, 925 school principals, 3538 special education teachers, and 2700 paraprofessionals. Administrative data for the students with ASD served by participating teachers will be examined. A total of 79 regional-, district-, and school-level personnel will also participate in social network interviews. Mixed methods, including surveys, administrative data, and observational checklists, will be used to gather in-depth information about system-wide malleable factors that relate to positive teacher implementation of EBPs and student outcomes. Multi-level modeling will be used to assess system-wide malleable factors related to EBP implementation which will be linked to the trainer, teacher, and student outcomes and examined based on moderators (e.g., district size, Special Education Local Plan Area structure, teachers' ASD experience). Finally, a dynamic social network approach will be used to map EBP-related connectivity across all levels of the system for selected regions. Dynamic network analysis will be used to gauge the degree to which and ways that EBP trainings, resources, and interventions are shared (or not shared) among school staff. Results are expected to inform the development of system-wide interventions to improve the school-based implementation of EBPs for students with ASD.

Effects of organizational context on Lean implementation in five hospital systems.

PubMed

Harrison, Michael I; Paez, Kathryn; Carman, Kristin L; Stephens, Jennifer; Smeeding, Lauren; Devers, Kelly J; Garfinkel, Steven

2016-01-01

Despite broad agreement among researchers about the value of examining how context shapes implementation of improvement programs and projects, limited attention has been paid to contextual effects on implementation of Lean. To help reduce gaps in knowledge of effects of intraorganizational context, we researched Lean implementation initiatives in five organizations and examined 12 of their Lean rapid improvement projects. All projects aimed at improving clinical care delivery. On the basis of the literature on Lean, innovation, and quality improvement, we developed a framework of factors likely to affect Lean implementation and outcomes. Drawing on the framework, we conducted semistructured interviews and applied qualitative codes to the transcribed interviews. Available documents, data, and observations supplemented the interviews. We constructed case studies of Lean implementation in each organization, compared implementation across organizations, and compared the 12 projects. Intraorganizational characteristics affecting organization-wide Lean initiatives and often also shaping project outcomes included CEO commitment to Lean and active support for it, prior organizational capacity for quality improvement-based performance improvement, alignment of the Lean initiative with the organizational mission, dedication of resources and experts to Lean, staff training before and during projects, establishment of measurable and relevant project targets, planning of project sequences that enhance staff capabilities and commitment without overburdening them, and ensuring communication between project members and other affected staff. Dependence of projects on inputs of new information technology was a barrier to project success. Incremental implementation of Lean produced reported improvements in operational efficiency and occasionally in care quality. However, even under the relatively favorable circumstances prevailing in our study sites, incremental implementation did not readily change organizational culture. This study should alert researchers, managers, and teachers of management to ways that contexts shape Lean implementation and may affect other types of process redesign and quality improvement.

Lean healthcare in developing countries: evidence from Brazilian hospitals.

PubMed

Costa, Luana Bonome Message; Filho, Moacir Godinho; Rentes, Antonio Freitas; Bertani, Thiago Moreno; Mardegan, Ronaldo

2017-01-01

The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Applying a contingency model of strategic decision making to the implementation of smoking bans: a case study.

PubMed

Willemsen, M C; Meijer, A; Jannink, M

1999-08-01

A model of strategic decision making was applied to study the implementation of worksite smoking policy. This model assumes there is no best way of implementing smoking policies, but that 'the best way' depends on how decision making fits specific content and context factors. A case study at Wehkamp, a mail-order company, is presented to illustrate the usefulness of this model to understand how organizations implement smoking policies. Interview data were collected from representatives of Wehkamp, and pre- and post-ban survey data were collected from employees. After having failed to solve the smoking problem in a more democratic way, Wehkamp's top management choose a highly confrontational and decentralized decision-making approach to implement a complete smoking ban. This resulted in an effective smoking ban, but was to some extent at the cost of employees' satisfaction with the policy and with how the policy was implemented. The choice of implementation approach was contingent upon specific content and context factors, such as managers' perception of the problem, leadership style and legislation. More case studies from different types of companies are needed to better understand how organizational factors affect decision making about smoking bans and other health promotion innovations.

Federal Programs Supporting Educational Change, Vol. VII: Factors Affecting Implementation and Continuation.

ERIC Educational Resources Information Center

Berman, Paul; And Others

This report is one of three volumes that describe the second phase of a study that examined the implementation of four federal change agent programs related to education. Phase 2 of the study focused on what happens to local projects in the two largest change agent programs--ESEA Title III and ESEA Title VII--when federal funding stops. This…

Academic Accountability in Texas Public Schools: 2003-2007

ERIC Educational Resources Information Center

Jaska, Patrick; Hogan, Patrick; Wen, Zhezhu

2009-01-01

This study examines factors affecting test scores in a sample of thirty-seven Texas public high schools from 2003 to 2007 since the implementation of the No Child Left Behind (NCLB) Act of 2001. The schools were chosen based upon similar tax rates and district sizes. The Texas Assessment of Knowledge and Skills (TAKS) test was implemented in 2003…

Utilizing an Early Childhood Science Curriculum: Factors Influencing Implementation and How Variations Affect Students' Skills and Attitudes

ERIC Educational Resources Information Center

Shamas-Brandt, Ellen

2012-01-01

Early childhood is a ripe time for students to begin learning science, but due to certain constraints, this instruction is not happening as frequently as it should. This mixed-methods, multiple case study examined how two teachers implemented an early childhood science curriculum, the "Young Scientist Series." The teacher participants…

Washington State Traffic Safety Education Curriculum Guide. A Master Guide for Implementing a Performance-Based Curriculum.

ERIC Educational Resources Information Center

Washington Office of the State Superintendent of Public Instruction, Olympia. Div. of Vocational-Technical and Adult Education Services.

This guide for implementing performance-based curriculum is intended to teach students decision-making driving. Heavy emphasis is put on the tasks and concepts involving traffic flow tasks (interacting with other highway users) and the functions and factors that affect that interaction. It is a "90-hour" guide, that is, the average student needs…

An evaluation of factors which can affect the implementation of a health promotion programme under the Schools for Health in Europe framework.

PubMed

Bennett, Annemarie E; Cunningham, Cara; Johnston Molloy, Charlotte

2016-08-01

The Health Promoting Schools concept helps schools to promote health in a sustainable and long-term fashion. However, developing the capacity to promote health in this way can be challenging when a busy teaching curriculum must be fulfilled. This study aimed to identify factors which affect the acceptability of health promotion programmes to the everyday school environment. Semi-structured qualitative interviews were audio-taped with primary school teachers in one Irish county and transcribed verbatim. The resulting transcripts were analysed using content analysis. Thirty-one teachers were interviewed. The factors which may adversely affect the acceptability of health promotion programmes include the: attitude of teachers towards an additional extra-curricular workload; lack of confidence amongst teachers to lead health promotion; and different organisational cultures between schools. When health promotion programmes under the Health Promoting Schools concept are being implemented, it's important to consider: the readiness for change amongst teachers; the resources available to increase staff capacity to promote health; and the ability of a programme to adapt to the different organisational cultures between schools. Copyright © 2016 Elsevier Ltd. All rights reserved.

Factors Affecting the Implementation of Sheltered Instruction Observation Protocols for English Language Learners

ERIC Educational Resources Information Center

Calderon, Carlos Trevino

2012-01-01

The purpose of this sequential mixed methods case study was to explore the role of a teacher's attitude towards Sheltered Instruction Observation Protocols (SIOP) and how those attitudes affect the program's effectiveness. SIOP is a program designed to mitigate the effects of limited English proficiency and promote equal access to the curriculum…

Key Informants' Perceptions on the Implementation of a National Program for Improving Nutritional Status of Children in Iran.

PubMed

Ghodsi, Delaram; Omidvar, Nasrin; Rashidian, Arash; Raghfar, Hossein; Eini-Zinab, Hassan; Ebrahimi, Marziyeh

2016-01-01

Childhood malnutrition is a major public health issue. Multidisciplinary approach for Improvement of Nutritional Status of Children in Iran was implemented in order to reduce malnutrition among children. This study aimed to evaluate the implementation aspect of the program and to explore key informants' perceptions and experience regarding the factors affected its implementation. Data were collected through the review of secondary data and semistructured interviews at national, province, and local levels. Four layers of key informants were selected purposefully for interviewing, including policymakers, senior nutrition officers, head of Hygiene, Remedy and Insurance Affairs in Imam Khomeini Relief Foundation, and community health workers. Qualitative content analysis was carried out based on Supporting the Use of Research Evidence framework and Tailored Implementation for Chronic Diseases' checklist to interpret the viewpoints of the study participants. Results showed that the program had successes in improving mother's knowledge on health, nutrition, and child care through health system and increased families' access to food, but there were some aspects that affected program's implementation. Some of these factors are the lack of clarity in the program's protocol and indicators, human shortage and inadequate financial resources, poor facilities, inattention to staff motivation, insufficient commitment among different sections, poor communication and supervision among different executive sections, and program protocols designing regardless of practical condition. Based on the results, top-down approach in policymaking and inadequate financial and human resources were responsible for most of the challenges encountered in the implementation.

Relationship between Multiple Intelligence, Reading Proficiency, and Implementing Motivational Strategies: A Study of Iranian Secondary Students

ERIC Educational Resources Information Center

Fayazi-Nasab, Ensieh; Ghafournia, Narjes

2016-01-01

There exist many factors, affecting reading ability. Multiple intelligence and motivational strategies are among the factors that seem to make significant contribution to the reading process. Thus, the present study probed the probable significant relation between Iranian language learners' multiple intelligences and reading ability. The study…

A Quantitative Assessment of the Factors that Influence Technology Acceptance in Emergency Response

ERIC Educational Resources Information Center

Seiter, Thomas C.

2012-01-01

Traditional models for studying user acceptance and adoption of technology focused on the factors that identify and tested the relationships forged between the user and the technology in question. In emergency response, implementing technology without user acceptance may affect the safety of the responders and citizenry. Integrating the factors…

Factors Affecting the Use of an E-Learning Portal at University

ERIC Educational Resources Information Center

Cegarra-Navarro, Juan-Gabriel; Rodriguez, Francisco Javier Canovas

2012-01-01

Electronic learning (e-learning) portals can be defined as websites that store and present materials for online learning, training, performance assessment, and certification. Few, if any, studies have investigated the factors that might contribute to the integration or implementation of e-learning portals in universities. With the development of…

Age-Related Differences in Emotion Regulation Strategies: Examining the Role of Contextual Factors

ERIC Educational Resources Information Center

Schirda, Brittney; Valentine, Thomas R.; Aldao, Amelia; Prakash, Ruchika Shaurya

2016-01-01

Increasing age is characterized by greater positive affective states. However, there is mixed evidence on the implementation of emotion regulation strategies across the life span. To clarify the discrepancies in the literature, we examined the modulating influence of contextual factors in understanding emotion regulation strategy use in older and…

Factors Affecting the Implementation of Communicative Language Teaching in Taiwanese College English Classes

ERIC Educational Resources Information Center

Chang, Ming; Goswami, Jaya S.

2011-01-01

Foreign language teaching in many Asian-Pacific countries in recent decades has shifted toward communicative-focused instruction. However, researchers have reported a gap between policy and practice. To incorporate teachers' voices in adopting the communicative approach in the curriculum, this study explores factors that promote or hinder EFL…

Affecting Factors on Local Waste Management in Penyangkringan Village, Weleri: an Identification

NASA Astrophysics Data System (ADS)

Puspita Adriyanti, Nadia; Candra Dewi, Ova; Gamal, Ahmad; Joko Romadhon, Mohammad; Raditya

2018-03-01

Villages in Indonesia usually does not have proper waste management and it is affecting the environmental and social condition in those places. Local governments have been trying to implement many kinds of solid waste management systems and yet many of them does not bear fruit. We argue that the failure of the waste management implementation in Indonesian villages is due to several aspects: the geographic condition of the villages, the social conditions, and the availability of facilities and infrastructures in those villages. Waste management should be modeled in accordance to those three aspects.

Citizen's Charter in a primary health-care setting of Nepal: An accountability tool or a "mere wall poster"?

PubMed

Gurung, Gagan; Gauld, Robin; Hill, Philip C; Derrett, Sarah

2018-02-01

Despite some empirical findings on the usefulness of citizen's charters on awareness of rights and services, there is a dearth of literature about charter implementation and impact on health service delivery in low-income settings. To gauge the level of awareness of the Charter within Nepal's primary health-care (PHC) system, perceived impact and factors affecting Charter implementation. Using a case study design, a quantitative survey was administered to 400 participants from 22 of 39 PHC facilities in the Dang District to gauge awareness of the Charter. Additionally, qualitative interviews with 39 key informants were conducted to explore the perceived impact of the Charter and factors affecting its implementation. Few service users (15%) were aware of the existence of the Charter. Among these, a greater proportion were literate, and there were also differences according to ethnicity and occupational group. The Charter was usually not properly displayed and had been implemented with no prior public consultation. It contained information that provided awareness of health facility services, particularly the more educated public, but had limited potential for increasing transparency and holding service providers accountable to citizens. Proper display, consultation with stakeholders, orientation or training and educational factors, follow-up and monitoring, and provision of sanctions were all lacking, negatively influencing the implementation of the Charter. Poor implementation and low public awareness of the Charter limit its usefulness. Provision of sanctions and consultation with citizens in Charter development are needed to expand the scope of Charters from information brochures to tools for accountability. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Best Practices for the Identification of Elder Abuse and Neglect in Home Health.

PubMed

Pickering, Carolyn E Z; Ridenour, Kimberly; Salaysay, Zachary

2016-04-01

Elder abuse and neglect (EA/N) affects over 1 million older adults each year, and disproportionately affects persons with dementia and older women. Home healthcare professionals are in an advantageous position to assess for, identify, and report EA/N. Lack of knowledge on EA/N risk factors, assessment tools, and mandatory reporting guidelines often prevent professionals from identifying and reporting EA/N. This article provides practical guidance on EA/N risk factors, assessment tools, and reporting responsibilities that can easily be implemented in practice.

Exploring Multi-Level System Factors Facilitating Educator Training and Implementation of Evidence-Based Practices (EBP): A Study Protocol

ERIC Educational Resources Information Center

Stahmer, Aubyn C.; Suhrheinrich, Jessica; Schetter, Patricia L.; Hassrick, Elizabeth McGee

2018-01-01

This study examines how system-wide (i.e., region, district, and school) mechanisms such as leadership support, training requirements, structure, collaboration, and education affect the use of evidence-based practices (EBPs) in schools and how this affects the outcomes for students with autism spectrum disorder (ASD). Despite growing evidence for…

Paving the Road to Success: A Framework for Implementing the "Success Tutoring" Approach

ERIC Educational Resources Information Center

Spark, Linda; De Klerk, Danie; Maleswena, Tshepiso; Jones, Andrew

2017-01-01

The exponential growth of higher education enrolment in South Africa has resulted in increased diversity of the student body, leading to a proliferation of factors that affect student performance and success. Various initiatives have been adopted by tertiary institutions to mitigate the negative impact these factors may have on student success,…

Implementing e-Learning in the Jordanian Higher Education System: Factors Affecting Impact

ERIC Educational Resources Information Center

Al-adwan, Ahmad; Smedley, Jo

2012-01-01

The increased involvement of technology in all aspects of our lives places educational institutions under pressure to include these aspects at the heart of their learning. This ensures that they continue to be competitive in a constantly changing market with international and cultural links. This study explores the factors that influenced the…

To develop effective strategies for mainstreaming intelligent transportation systems (ITS).

DOT National Transportation Integrated Search

2002-11-01

This report investigates factors affecting ITS implementation as a mainstream transportation planning activity. It draws upon a detailed literature review, interviews with fifty-one leaders from a cross-section of jurisdictions and agencies in ...

A Concept Mapping Approach to Guide and Understand Dissemination and Implementation

PubMed Central

Green, Amy E.; Fettes, Danielle L.; Aarons, Gregory A.

2013-01-01

Many efforts to implement evidence-based programs do not reach their full potential or fail due to the variety of challenges inherent in dissemination and implementation. This article describes the use of concept mapping—a mixed method strategy—to study implementation of behavioral health innovations and evidence-based practice (EBP). The application of concept mapping to implementation research represents a practical and concise way to identify and quantify factors affecting implementation, develop conceptual models of implementation, target areas to address as part of implementation readiness and active implementation, and foster communication among stakeholders. Concept mapping is described and a case example is provided to illustrate its use in an implementation study. Implications for the use of concept mapping methods in both research and applied settings towards the dissemination and implementation of behavioral health services are discussed. PMID:22892987

A concept mapping approach to guide and understand dissemination and implementation.

PubMed

Green, Amy E; Fettes, Danielle L; Aarons, Gregory A

2012-10-01

Many efforts to implement evidence-based programs do not reach their full potential or fail due to the variety of challenges inherent in dissemination and implementation. This article describes the use of concept mapping-a mixed method strategy-to study implementation of behavioral health innovations and evidence-based practice (EBP). The application of concept mapping to implementation research represents a practical and concise way to identify and quantify factors affecting implementation, develop conceptual models of implementation, target areas to address as part of implementation readiness and active implementation, and foster communication among stakeholders. Concept mapping is described and a case example is provided to illustrate its use in an implementation study. Implications for the use of concept mapping methods in both research and applied settings towards the dissemination and implementation of behavioral health services are discussed.

Factors affecting the implementation of health legislation and its impact on the rural poor in China: a case study of implementation of the maternal and infant health care law in two poor counties.

PubMed

Tolhurst, Rachel; Zhang, Tuohong; Yang, Hui; Gao, Jun; Tang, Shenglan

2004-01-01

This paper presents and discusses a case study of health legislation in China. In the transition to a market economy, legislation has been developed to offset the weakening in the central planning mechanism and political control that have historically influenced the behaviour of institutions and individuals in the Ministry of Health. There has been relatively little empirical examination of the implementation and impact of legislation as a tool for influencing health service provision in low-income countries. The study aimed to contribute towards filling this gap by exploring the factors affecting the implementation and impact of the Maternal and Infant Health Care Law, through a case study of two poor, rural counties in Chongqing municipality, China. The study found that key local actors perceive health legislation to be an important tool for safeguarding access to essential health care. However, the implementation of health legislation is inevitably a political process. The study illustrates the difficulties involved in efforts to influence provider behaviour through a national level legislative framework in a situation of decentralization of control over those providers, due to extreme regional variation in economic situations and limited resource inputs from the centre. Lessons are drawn for Chinese and international policy makers.

Team-Based Learning in US Colleges and Schools of Pharmacy

PubMed Central

Copeland, Jeffrey; Franks, Andrea S.; Karimi, Reza; McCollum, Marianne; Riese, David J.; Lin, Anne Y.F.

2013-01-01

Objective. To characterize the use of team-based learning (TBL) in US colleges and schools of pharmacy, including factors that may affect implementation and perceptions of faculty members regarding the impact of TBL on educational outcomes. Methods. Respondents identified factors that inhibit or enable TBL use and its impact on student learning. Results were stratified by type of institution (public/private), class size, and TBL experience. Results. Sixty-nine of 100 faculty members (69%) representing 43 (86%) institutions responded. Major factors considered to enable TBL implementation included a single campus and student and administration buy-in. Inhibiting factors included distant campuses, faculty resistance, and lack of training. Compared with traditional lectures, TBL is perceived to enhance student engagement, improve students’ preparation for class, and promote achievement of course outcomes. In addition, TBL is perceived to be more effective than lectures at fostering learning in all 6 domains of Bloom’s Taxonomy. Conclusions. Despite potential implementation challenges, faculty members perceive that TBL improves student engagement and learning. PMID:23966718

Walking the tightrope-perspectives on local politicians' role in implementing a national social care policy on evidence-based practice.

PubMed

Bäck, A; Ståhl, C; von Thiele Schwarz, U; Richter, A; Hasson, H

2016-01-01

Despite national policy recommending evidence-based practice (EBP), its application in social care has been limited. While local politicians can affect the process, little is known about their knowledge, attitudes and roles regarding EBP. The aim here is twofold: to explore the role of local politicians in the implementation of EBP in social care from both their own and a management perspective; and to examine factors politicians perceive as affecting their decisions and actions concerning the implementation of EBP policy. Local politicians (N = 13) and managers (N = 22) in social care were interviewed. Qualitative thematic analysis with both inductive and deductive codes was used. Politicians were rather uninformed regarding EBP and national policy. The factors limiting their actions were, beside the lack of awareness, lack of ability to question existing working methods, and a need for support in the steering of EBP. Thus, personal interest played a significant part in what role the politicians assumed. This resulted in some politicians taking a more active role in steering EBP while others were not involved. From the managers' perspective, a more active steering by politicians was desired. Setting budget and objectives, as well as active follow-up of work processes and outcomes, were identified as means to affect the implementation of EBP. However, the politicians seemed unaware of the facilitating effects of these actions. Local politicians had a possibility to facilitate the implementation of EBP, but their role was unclear. Personal interest played a big part in determining what role was taken. The results imply that social care politicians might need support in the development of their steering of EBP. Moving the responsibility for EBP facilitation upwards in the political structure could be an important step in developing EBP in social care.

Can Protection Motivation Theory explain farmers'adaptation to Climate change/variability decision making in the Gambia?

NASA Astrophysics Data System (ADS)

Bagagnan, A. R.

2016-12-01

In the Gambia, Changes in the climate pattern has affected and continue to affect the agriculture sector and therefore calling for effective adaptation policies. The present study aimed to explain farmers' adoption of climate change adaptation measure through the protection motivation theory in The Central River Region of The Gambia. Primary data were collected in all the eight communities of the study area. A transect walk was conducted first followed by a survey with 283 informants. The perception variables were referring to the past 20 years while the stated implementation was addressing the current adaptation practices. Results showed that on one hand, most of the perception variables such as severity, ability to withstand, and internal barriers are significantly correlated to protection motivation and on the other hand Protection motivation and stated implementation for water conservation technique are strongly correlated. Structural Equation Modeling confirms the mediation role of Protection motivation between Farmers stated implementation and their perception of climate variability. Decrease in soil water storage capacity, degradation of the quality of soil surface structure, decrease of the length of the growing season are factors that motivate farmers to implement an adaptation measure. Cost of the implementation and farmers' vulnerability are factors that prevent farmers to implement an adaptation measure. The cost of the implementation is the main barrier to farmers `protection motivation. Therefore the study suggested that farmers' awareness about climate change/variability should be increased through farmers' field school and awareness campaigns, farmers' resilience should be improved and adaptation measures should be made accessible to farmers through loans facilities and subsidizes application.

Barriers and Facilitators Affecting Patient Portal Implementation from an Organizational Perspective: Qualitative Study.

PubMed Central

Kooij, Laura; Groen, Wim G

2018-01-01

Background The number of patient portals is rising, and although portals can have positive effects, their implementation has major impacts on the providing health care institutions. However, little is known about the organizational factors affecting successful implementation. Knowledge of the specific barriers to and facilitators of various stakeholders is likely to be useful for future implementations. Objective The objective of this study was to identify the barriers to and facilitators of patient portal implementation facing various stakeholders within hospital organizations in the Netherlands. Methods Purposive sampling was used to select hospitals of various types. A total of 2 university medical centers, 3 teaching hospitals, and 2 general hospitals were included. For each, 3 stakeholders were interviewed: (1) medical professionals, (2) managers, and (3) information technology employees. In total, 21 semistructured interviews were conducted using the Grol and Wensing model, which describes barriers to and facilitators of change in health care practice at 6 levels: (1) innovation; (2) individual professional; (3) patient; (4) social context; (5) organizational context; and (6) economic and political context. Two researchers independently selected and coded quotes by applying this model using a (deductive) directed content approach. Additional factors related to technical and portal characteristics were added using the model of McGinn et al, developed for implementation of electronic health records. Results In total, we identified 376 quotes, 26 barriers, and 28 facilitators. Thirteen barriers and 12 facilitators were common for all stakeholder groups. The facilitators’ perceived usefulness (especially less paperwork) was mentioned by all the stakeholders, followed by subjects’ positive attitude. The main barriers were lack of resources (namely, lack of staff and materials), financial difficulties (especially complying with high costs, lack of reimbursements), and guaranteeing privacy and security (eg, strict regulations). Both similarities and differences were found between stakeholder groups and hospital types. For example, managers and information technology employees mainly considered guaranteeing privacy and security as a predominant barrier. Financial difficulties were particularly mentioned by medical professionals and managers. Conclusions Patient portal implementation is a complex process and is not only a technical process but also affects the organization and its staff. Barriers and facilitators occurred at various levels and differed among hospital types (eg, lack of accessibility) and stakeholder groups (eg, sufficient resources) in terms of several factors. Our findings underscore the importance of involving multiple stakeholders in portal implementations. We identified a set of barriers and facilitators that are likely to be useful in making strategic and efficient implementation plans. PMID:29752253

Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review.

PubMed

Francke, Anneke L; Smit, Marieke C; de Veer, Anke J E; Mistiaen, Patriek

2008-09-12

Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect the implementation of guidelines, and secondly, to provide insight into the "state-of-the-art" regarding research within this field. A search of five literature databases and one website was performed to find relevant existing systematic reviews or meta-reviews. Subsequently, a two-step inclusion process was conducted: (1) screening on the basis of references and abstracts and (2) screening based on full-text papers. After that, relevant data from the included reviews were extracted and the methodological quality of the reviews was assessed by using the Quality Assessment Checklist for Reviews. Twelve systematic reviews met our inclusion criteria. No previous systematic meta-reviews meeting all our inclusion criteria were found. Two of the twelve reviews scored high on the checklist used, indicating only "minimal" or "minor flaws". The other ten reviews scored in the lowest of middle ranges, indicating "extensive" or "major" flaws. A substantial proportion (although not all) of the reviews indicates that effective strategies often have multiple components and that the use of one single strategy, such as reminders only or an educational intervention, is less effective. Besides, characteristics of the guidelines themselves affect actual use. For instance, guidelines that are easy to understand, can easily be tried out, and do not require specific resources, have a greater chance of implementation. In addition, characteristics of professionals - e.g., awareness of the existence of the guideline and familiarity with its content - likewise affect implementation. Furthermore, patient characteristics appear to exert influence: for instance, co-morbidity reduces the chance that guidelines are followed. Finally, environmental characteristics may influence guideline implementation. For example, a lack of support from peers or superiors, as well as insufficient staff and time, appear to be the main impediments. Existing reviews describe various factors that influence whether guidelines are actually used. However, the evidence base is still thin, and future sound research - for instance comparing combinations of implementation strategies versus single strategies - is needed.

Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review

PubMed Central

2013-01-01

Background An ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities? Methods We conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption. Results Of the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption. Conclusions Rural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”). PMID:23311452

[Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses].

PubMed

Citolino, Clairton Marcos Filho; Santos, Eduesley Santana; Silva, Rita de Cassia Gengo E; Nogueira, Lilia de Souza

2015-12-01

To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR) in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. The majority of nurses reported that the high number of professionals in the scenario (75.5%), the lack of harmony (77.6%) or stress of any member of staff (67.3%), lack of material and/or equipment failure (57.1%), lack of familiarity with the emergency trolleys (98.0%) and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1%) are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.

Multilevel dynamic systems affecting introduction of HIV/STI prevention innovations among Chinese women in sex work establishments.

PubMed

Weeks, Margaret R; Li, Jianghong; Liao, Susu; Zhang, Qingning; Dunn, Jennifer; Wang, Yanhong; Jiang, Jingmei

2013-10-01

Social and public health scientists are increasingly interested in applying system dynamics theory to improve understanding and to harness the forces of change within complex, multilevel systems that affect community intervention implementation, effects, and sustainability. Building a system dynamics model based on ethnographic case study has the advantage of using empirically documented contextual factors and processes of change in a real-world and real-time setting that can then be tested in the same and other settings. System dynamics modeling offers great promise for addressing persistent problems like HIV and other sexually transmitted epidemics, particularly in complex rapidly developing countries such as China. We generated a system dynamics model of a multilevel intervention we conducted to promote female condoms for HIV/sexually transmitted infection (STI) prevention among Chinese women in sex work establishments. The model reflects factors and forces affecting the study's intervention, implementation, and effects. To build this conceptual model, we drew on our experiences and findings from this intensive, longitudinal mixed-ethnographic and quantitative four-town comparative case study (2007-2012) of the sex work establishments, the intervention conducted in them, and factors likely to explain variation in process and outcomes in the four towns. Multiple feedback loops in the sex work establishments, women's social networks, and the health organization responsible for implementing HIV/STI interventions in each town and at the town level directly or indirectly influenced the female condom intervention. We present the conceptual system dynamics model and discuss how further testing in this and other settings can inform future community interventions to reduce HIV and STIs.

Multilevel Dynamic Systems Affecting Introduction of HIV/STI Prevention Innovations among Chinese Women in Sex-work Establishments

PubMed Central

Weeks, Margaret R.; Li, Jianghong; Liao, Susu; Zhang, Qingning; Dunn, Jennifer; Wang, Yanhong; Jiang, Jingmei

2015-01-01

Social and public health scientists are increasingly interested in applying system dynamics theory to improve understanding and to harness the forces of change within complex, multilevel systems that affect community intervention implementation, effects, and sustainability. Building a system dynamics model based on ethnographic case study has the advantage of using empirically documented contextual factors and processes of change in a real world and real time setting that can then be tested in the same and other settings. System dynamics modeling offers great promise for addressing persistent problems like HIV and other sexually transmitted epidemics, particularly in complex rapidly developing countries like China. We generated a system dynamics model of a multilevel intervention we conducted to promote female condoms (FC) for HIV/STI prevention among Chinese women in sex-work establishments. The model reflects factors and forces affecting the study’s intervention implementation and effects. To build this conceptual model, we drew on our experiences and findings from this intensive, longitudinal mixed ethnographic and quantitative four-town comparative case study (2007–2012) of the sex-work establishments, the intervention conducted in them, and factors likely to explain variation in process and outcomes in the four towns. Multiple feedback loops in the sex-work establishments, women’s social networks, and the health organization responsible for implementing HIV/STI interventions in each town and at the town level directly or indirectly influenced the FC intervention. We present the conceptual system dynamics model and discuss how further testing in this and other settings can inform future community interventions to reduce HIV and STIs. PMID:24084394

Invisible Obstacles on the Implementation of Multiple Intelligences Theory in K-8 Classrooms in Turkey

ERIC Educational Resources Information Center

Kaya, Osman Nafiz; Ebenezer, Jazlin

2006-01-01

The aim of this study was to investigate the factors affecting the implementation of Multiple Intelligences (MI) Theory in K-8 classrooms in Turkey. First, it was made meetings in small groups (3 or 4) with 38 teachers in one of the first MI schools in Turkey during the first semesters. They were 22 elementary teachers from Grades 1 to 5 and 16…

Creative Mathematical Games: The Enhancement of Number Sense of Kindergarten Children Through Fun Activities

NASA Astrophysics Data System (ADS)

Mirawati

2017-02-01

The research departed from an issue found regarding the number sense of kindergarten children and as a solution to this problem, the research proposes the use of creative mathematical games in the teaching and learning. Departing from the issue and the offered solution, the following problems are about Children’s ability of number sense before and after the implementation of creative mathematical games; the forms of creative mathematical games in improving children’s number sense; the implementation of creative mathematical games in improving children’s number sense; and the factors possibly affecting the implementation of creative mathematical games. This study use action research method. The data were collected through observation, interview, and documentation and then qualitatively analysed using thematic analysis technique. The findings show that children respond positively to the creative mathematical games. They demonstrate fairly high enthusiasm and are able to understand number as well as its meaning in various ways. Children’s number sense has also improved in terms of one-on-one correspondence and mentioning and comparing many objects. The factors possibly affecting the implementation of these creative mathematical games are the media and the stages of teaching and learning that should be in accordance with the level of kindergarten children’s number sense.

Factors Influencing Implementation of a Physical Activity Intervention in Residential Children's Homes.

PubMed

Lau, Erica Y; Saunders, Ruth P; Pate, Russell R

2016-11-01

The Environmental Intervention in Children's Homes (ENRICH) study was the first published physical activity intervention undertaken in residential children's homes (RCHs). The study revealed differences in implementation across the homes, which may be a key factor that affects program effectiveness. The purpose of this study was to examine the direct and indirect effects of organizational capacity, provider characteristics, and quality of prevention support system on level of implementation of the ENRICH intervention. This study analyzed the ENRICH process evaluation data collected from 24 RCHs. Bayesian Path analysis was used to examine the direct and indirect effects of organizational capacity, provider characteristics, and quality of prevention support system on level of implementation. Level of implementation across RCHs was variable, ranging from 38 to 97 % (M = 68.3, SD = 14.45). Results revealed that organizational capacity and provider characteristics had significant direct associations with level of implementation. Neither direct nor indirect associations between quality of prevention support system and level of implementation reached statistical significance. Conducting formative assessments on organizational capacity and provider characteristics and incorporating such information in implementation planning may increase the likelihood of achieving higher levels of implementation in future studies.

Implementing quality initiatives in healthcare organizations: drivers and challenges.

PubMed

Abdallah, Abdallah

2014-01-01

Various quality initiatives seem to have successful implementation in some healthcare organizations yet fail in others. This paper sets out to study the literature trying to understand drivers and challenges facing quality initiatives implementation in healthcare organizations then compare findings from literature with those of a structured questionnaire answered by 60 representatives from 18 hospitals. Finally it proposes a framework that mitigates challenges and utilizes drivers to ensure best implementation results. Literature regarding implementing various quality initiatives in the healthcare sector was reviewed. Representatives from several healthcare organizations were surveyed. Results from both approaches are compared to highlight the key challenges and drivers facing implementers. This research reveals that internal factors related to leadership and employees greatly affect quality initiative success or failure. Design and relevance play a major role in successful implementation. PRACTICAL IMPLICATIONs: This research offers healthcare professionals greater success when implementing certain quality initiatives by taking success/failure factors into consideration. A general framework for successful implementation in the healthcare sector is provided. This article uncovers reasons behind success or failure in a comprehensive and practical way. It also explores how most popular quality initiatives are applied in hospitals.

Implementation Science Supports Core Clinical Competencies: An Overview and Clinical Example.

PubMed

Kirchner, JoAnn E; Woodward, Eva N; Smith, Jeffrey L; Curran, Geoffrey M; Kilbourne, Amy M; Owen, Richard R; Bauer, Mark S

2016-12-08

Instead of asking clinicians to work faster or longer to improve quality of care, implementation science provides another option. Implementation science is an emerging interdisciplinary field dedicated to studying how evidence-based practice can be adopted into routine clinical care. This article summarizes principles and methods of implementation science, illustrates how they can be applied in a routine clinical setting, and highlights their importance to practicing clinicians as well as clinical trainees. A hypothetical clinical case scenario is presented that explains how implementation science improves clinical practice. The case scenario is also embedded within a real-world implementation study to improve metabolic monitoring for individuals prescribed antipsychotics. Context, recipient, and innovation (ie, the evidence-based practice) factors affected improvement of metabolic monitoring. To address these factors, an external facilitator and a local quality improvement team developed an implementation plan involving a multicomponent implementation strategy that included education, performance reports, and clinician follow-up. The clinic remained compliant with recommended metabolic monitoring at 1-year follow up. Implementation science improves clinical practice by addressing context, recipient, and innovation factors and uses this information to develop and utilize specific strategies that improve clinical practice. It also enriches clinical training, aligning with core competencies by the Accreditation Council for Graduate Medical Education and American Boards of Medical Specialties. By learning how to change clinical practice through implementation strategies, clinicians are more able to adapt in complex systems of practice. © Copyright 2016 Physicians Postgraduate Press, Inc.

Managing the initiation and early implementation of health promotion interventions: a study of a parental support programme in primary care.

PubMed

Westerlund, Anna; Garvare, Rickard; Nyström, Monica E; Eurenius, Eva; Lindkvist, Marie; Ivarsson, Anneli

2017-03-01

Mental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed. This study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors' views on factors likely to affect implementation and the strategies used to manage them. A case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used. Eighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors. Interviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices. Implementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these insights might help increase the rate of adoption and the use of such programmes and thereby increase their effectiveness. © 2016 Nordic College of Caring Science.

Long Live Love+: evaluation of the implementation of an online school-based sexuality education program in the Netherlands.

PubMed

van Lieshout, Sanne; Mevissen, Fraukje; de Waal, Esri; Kok, Gerjo

2017-06-01

Schools are a common setting for adolescents to receive health education, but implementation of these programs with high levels of completeness and fidelity is not self-evident. Programs that are only partially implemented (completeness) or not implemented as instructed (fidelity) are unlikely to be effective. Therefore, it is important to identify which determinants affect completeness and fidelity of program implementation. As part of the launch of Long Live Love+ (LLL+), an online school-based sexuality education program for adolescents aged 15-17, we performed a process evaluation among teachers and students to measure the levels of completeness and fidelity, identify factors influencing teachers' implementation, and to evaluate the students' response. Sixteen Biology teachers from nine secondary schools throughout the Netherlands who implemented LLL+ were interviewed and 60 students participated in 13 focus group discussions. Results showed that teachers' completeness ranged between 22-100% (M = 75%). Fidelity was high, but many teachers added elements. Teachers and students enjoyed LLL+, particularly the diversity in the exercises and its interactive character. The most important factors that influenced implementation were time and organizational constraints, lack of awareness on the impact of completeness and fidelity, and student response. These factors should be taken into account when developing school-based prevention programs. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Influences on the implementation of TQM in health care organizations: professional bureaucracies, ownership and complexity.

PubMed

Badrick, T; Preston, A

2001-01-01

TQM is introduced into many organisations in an attempt to improve productivity and quality. There are a number of organisational variables that have been recognised as influencing the success of TQM implementation including leadership, teamwork, and suppliers. This paper presents findings of a study of the implementation of TQM in Australian health care organisations. Structural factors were observed to affect the progress of TQM. Professional bureaucracies were less successful than machine bureaucracies. Private organisations were more successful than their public counterparts.

ERP system implementation in SMEs: exploring the influences of the SME context

NASA Astrophysics Data System (ADS)

Zach, Ondrej; Munkvold, Bjørn Erik; Håkon Olsen, Dag

2014-03-01

Small and medium-sized enterprises (SMEs) are increasingly implementing enterprise resource planning (ERP) systems. Compared to large enterprises, SMEs differ in a number of inherent characteristics, which are likely to impact the ERP system implementations. The purpose of this study is to explore these influences of the SME context on the ERP system implementation process. SME characteristics are synthesised from relevant literature and the influences of the contextual factors on various activities across the ERP life cycle are investigated. The study presents findings from a multiple case study of four SMEs. The ownership type of the companies and limited resources were identified as the most influential contextual factors. Among the ERP life-cycle phases, the implementation phase was affected most by the SME context. The case studies also illustrate the need for a more nuanced view on what should be considered general characteristics of SMEs; for example, regarding the level of IS knowledge, business processes, and market characteristics.

Framework for culturally competent decisionmaking in child welfare.

PubMed

Cohen, Elena P

2003-01-01

This article provides a framework to understand the cultural, social, political, and economic factors that affect decisionmaking when working with ethnically and racially diverse families in the child welfare system. The article describes external factors affecting the decisionmaking process, including community environment, agency structure, and family characteristics. It then reviews the core stages of the casework process, describing key decisions during intake, assessment, service planning, implementation, evaluation, and closure. Although the framework is based on casework process in the child welfare system, it can be adapted to other child-serving systems, including education, mental health, and juvenile justice.

Factors affecting construction performance: exploratory factor analysis

NASA Astrophysics Data System (ADS)

Soewin, E.; Chinda, T.

2018-04-01

The present work attempts to develop a multidimensional performance evaluation framework for a construction company by considering all relevant measures of performance. Based on the previous studies, this study hypothesizes nine key factors, with a total of 57 associated items. The hypothesized factors, with their associated items, are then used to develop questionnaire survey to gather data. The exploratory factor analysis (EFA) was applied to the collected data which gave rise 10 factors with 57 items affecting construction performance. The findings further reveal that the items constituting ten key performance factors (KPIs) namely; 1) Time, 2) Cost, 3) Quality, 4) Safety & Health, 5) Internal Stakeholder, 6) External Stakeholder, 7) Client Satisfaction, 8) Financial Performance, 9) Environment, and 10) Information, Technology & Innovation. The analysis helps to develop multi-dimensional performance evaluation framework for an effective measurement of the construction performance. The 10 key performance factors can be broadly categorized into economic aspect, social aspect, environmental aspect, and technology aspects. It is important to understand a multi-dimension performance evaluation framework by including all key factors affecting the construction performance of a company, so that the management level can effectively plan to implement an effective performance development plan to match with the mission and vision of the company.

Alcohol safety action projects evaluation of operations : data, table of results, and formulation

DOT National Transportation Integrated Search

1979-06-01

This volume contains the data used in the evaluation of 35 Alcohol Safety Action Projects implemented throughout the country. Historical background, discussion of analytic results and factors affecting impact detecion are contained in the document ti...

Chinese Students' Perceptions of a Collaborative E-Learning Environment and Factors Affecting Their Performance: Implementing a Flemish E-Learning Course in a Chinese Educational Context

ERIC Educational Resources Information Center

Zhu, Chang; Valcke, Martin; Schellens, Tammy; Li, Yifei

2009-01-01

This study was set up in a Chinese university in Beijing by implementing a Flemish e-learning course in a Chinese setting. A main feature of the e-learning environment is the asynchronous "task-based" online group discussion. The purpose of the study is to understand Chinese students' perceptions of a collaborative e-learning environment…

Use of electronic medical records and quality of patient data: different reaction patterns of doctors and nurses to the hospital organization.

PubMed

Lambooij, Mattijs S; Drewes, Hanneke W; Koster, Ferry

2017-02-10

As the implementation of Electronic Medical Records (EMRs) in hospitals may be challenged by different responses of different user groups, this paper examines the differences between doctors and nurses in their response to the implementation and use of EMRs in their hospital and how this affects the perceived quality of the data in EMRs. Questionnaire data of 402 doctors and 512 nurses who had experience with the implementation and the use of EMRs in hospitals was analysed with Multi group Structural equation modelling (SEM). The models included measures of organisational factors, results of the implementation (ease of use and alignment of EMR with daily routine), perceived added value, timeliness of use and perceived quality of patient data. Doctors and nurses differ in their response to the organisational factors (support of IT, HR and administrative departments) considering the success of the implementation. Nurses respond to culture while doctors do not. Doctors and nurses agree that an EMR that is easier to work with and better aligned with their work has more added value, but for the doctors this is more pronounced. The doctors and nurses perceive that the quality of the patient data is better when EMRs are easier to use and better aligned with their daily routine. The result of the implementation, in terms of ease of use and alignment with work, seems to affect the perceived quality of patient data more strongly than timeliness of entering patient data. Doctors and nurses value bottom-up communication and support of the IT department for the result of the implementation, and nurses respond to an open and innovative organisational culture.

Contextual factors affecting task distribution in two participatory ergonomic interventions: a qualitative study.

PubMed

Dixon, Shane Michael; Theberge, Nancy

2011-11-01

This article provides an analysis of the evolution of the division of labour in participatory ergonomics (PE) programmes in two worksites. The analysis is based on interviews and field observations in the worksites. In both settings there was meaningful participation by both worker and management members of ergonomic change teams (ECTs) in the hazard assessment and solution identification stages, but as the teams moved to the implementation stage, worker representatives were marginalised and the participatory nature of the programmes was severely curtailed. The removal of workers from the process was the outcome of the interplay among the type of activities pursued in the implementation stage, the skills and knowledge required to carry out those activities, and workers' limited influence in the organisational hierarchies. Findings highlight the salience of the social context in which participatory programmes are located and the importance of examining participatory programmes as they evolve over time. STATEMENT OF RELEVANCE: This article contributes to a growing literature on the process and implementation of PE programmes. The article's focus on social and organisational factors that affect the division of labour and attention to the evolution of involvement over time extend current understandings of participation in ergonomics programmes.

New Science Teachers' Descriptions of Inquiry Enactment

ERIC Educational Resources Information Center

Dreon, Oliver, Jr.

2008-01-01

This phenomenological study demonstrates the influence that affective factors have on beginning teachers' ability to enact instructional practices. Through narratives shared in interviews and web log postings, two beginning science teachers' emotional engagement with their instructional practices, especially that of implementing inquiry-based…

Effects of seed production, seedbed condition, and overstory basal area on the establishment of shortleaf pine seedlings in the Ouachita Mountains

Treesearch

Michael G. Shelton

1995-01-01

Some of the factors affecting the establishment of shortleaf pine regeneration after the initial treatments implementing uneven-aged silviculture in shortleaf pine-hardwood stands are quantitatively described in this publication.

Social relations and healthcare utilisation among middle-aged and older people: study protocol for an implementation and register-based study in Denmark.

PubMed

Mikkelsen, Anne Sophie Bech; Lund, Rikke; Kristiansen, Maria

2017-11-15

While previous research establishes an association between social relations, health and use of healthcare services among older people, how to implement this knowledge in real-life settings has received much less attention. This study will explore the relationship between social relations, health and use of healthcare services in a Danish mid-life population sample. In addition, the study will explore individual and contextual factors affecting the implementation of a group-based life story intervention aimed at establishing and strengthening social relations among older people at nursing homes in Denmark. A combined quantitative register-based approach and a qualitative implementation approach will be applied in this study. First, we will quantitatively analyse the relationship between social relations, health status and use of healthcare services among middle-aged people in Denmark by linking survey data on social relations, loneliness, self-perceived health and disease status from the Copenhagen Aging and Midlife Biobank (CAMB) (n = 7191) with national registries through the Public Health Database on use of healthcare services and demographic and socioeconomic factors. Second, we will qualitatively analyse individual and contextual factors affecting the implementation process of the group-based life story intervention based on semi-structured interviews (n = 16), observations and field notes with and among intervention stakeholders, i.e., participants and group leaders facilitating the intervention. The results of this study are expected to improve knowledge about mechanisms through which social relations are associated with health status and use of healthcare services and to inform the implementation of future interventions targeting social relations among older people at nursing homes. The study has been registered and approved by the Danish Data Protection Agency. Seperate approvals have been attained for the qualitative data (Approval No. SUND-2016-08), and for the quantitative data in the CAMB database which has also received approval from the local ethical committee (approval No.H-A-2008-126 and No. 2013-41-1814, respectively).

Power effects on cognitive control: Turning conflict into action.

PubMed

Schmid, Petra C; Kleiman, Tali; Amodio, David M

2015-06-01

Power is known to promote effective goal pursuit, especially when it requires one to overcome distractions or bias. We proposed that this effect involves the ability to engage and implement cognitive control. In Study 1, we demonstrated that power enhances behavioral performance on a response conflict task and that it does so by enhancing controlled processing rather than by reducing automatic processing. In Study 2, we used an event-related potential index of anterior cingulate activity to test whether power effects on control were due to enhanced conflict sensitivity or action implementation. Power did not significantly affect neural sensitivity to conflict; rather, high power was associated with a stronger link between conflict processing and intended action, relative to low power. These findings suggest a new perspective on how social factors can affect controlled processing and offer new evidence regarding the transition between conflict detection and the implementation of action control. (c) 2015 APA, all rights reserved).

Security in the management of information systems.

PubMed

Huston, T L; Huston, J L

1998-06-01

Although security technology exists in abundance in health information management systems, the implementation of that technology is often lacking. This lack of implementation can be heavily affected by the attitudes and perceptions of users and management, the "people part" of systems. Particular operational, organizational, and economic factors must be addressed along with employment of security objectives and accountability. Unique threats, as well as controls, pervade the use of microcomputer-based systems as these systems permeate health care information management.

Acceptance of Health Information Technologies, Acceptance of Mobile Health: A Review Article.

PubMed

Garavand, A; Samadbeik, M; Kafashi, M; Abhari, Sh

2017-12-01

Mobile health is one of the new technologies for the utilization of health information. For its successful implementation as well as any other system, we must primarily measure the adoption and use of its factors. The purpose of this study was to systematically investigate published articles about the factors affecting the adoption of mobile health and categorizing the factors affecting the adoption of this system. This study is a comprehensive review done by searching major databases such as Google Scholar, Emerald, Science Direct, Iran Medex, SID, Magiran, Pub med, etc. In addition, we use Mobile, mobile Health + adoption, mobile Health + TAM, Health + TAM keywords in the range of 2004 to 2015. Among the studies that use information technology theories to survey the factors affecting the adoption of mobile health, TAM model was used more than other models. Factors such as perceived ease of use, perceived usefulness and facilitating condition form TUATU are the most effective in the adoption of mobile health. Results showed that by considering factors such as perceived ease of use, perceived usefulness and facilitating condition can increase the adoption of mobile health system. Consequently, these factors are recommended to be considered in planning to run systems.

Barriers and Facilitators Affecting Patient Portal Implementation from an Organizational Perspective: Qualitative Study.

PubMed

Kooij, Laura; Groen, Wim G; van Harten, Wim H

2018-05-11

The number of patient portals is rising, and although portals can have positive effects, their implementation has major impacts on the providing health care institutions. However, little is known about the organizational factors affecting successful implementation. Knowledge of the specific barriers to and facilitators of various stakeholders is likely to be useful for future implementations. The objective of this study was to identify the barriers to and facilitators of patient portal implementation facing various stakeholders within hospital organizations in the Netherlands. Purposive sampling was used to select hospitals of various types. A total of 2 university medical centers, 3 teaching hospitals, and 2 general hospitals were included. For each, 3 stakeholders were interviewed: (1) medical professionals, (2) managers, and (3) information technology employees. In total, 21 semistructured interviews were conducted using the Grol and Wensing model, which describes barriers to and facilitators of change in health care practice at 6 levels: (1) innovation; (2) individual professional; (3) patient; (4) social context; (5) organizational context; and (6) economic and political context. Two researchers independently selected and coded quotes by applying this model using a (deductive) directed content approach. Additional factors related to technical and portal characteristics were added using the model of McGinn et al, developed for implementation of electronic health records. In total, we identified 376 quotes, 26 barriers, and 28 facilitators. Thirteen barriers and 12 facilitators were common for all stakeholder groups. The facilitators' perceived usefulness (especially less paperwork) was mentioned by all the stakeholders, followed by subjects' positive attitude. The main barriers were lack of resources (namely, lack of staff and materials), financial difficulties (especially complying with high costs, lack of reimbursements), and guaranteeing privacy and security (eg, strict regulations). Both similarities and differences were found between stakeholder groups and hospital types. For example, managers and information technology employees mainly considered guaranteeing privacy and security as a predominant barrier. Financial difficulties were particularly mentioned by medical professionals and managers. Patient portal implementation is a complex process and is not only a technical process but also affects the organization and its staff. Barriers and facilitators occurred at various levels and differed among hospital types (eg, lack of accessibility) and stakeholder groups (eg, sufficient resources) in terms of several factors. Our findings underscore the importance of involving multiple stakeholders in portal implementations. We identified a set of barriers and facilitators that are likely to be useful in making strategic and efficient implementation plans. ©Laura Kooij, Wim G Groen, Wim H van Harten. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 11.05.2018.

Regional and geographical variations in infertility: effects of environmental, cultural, and socioeconomic factors.

PubMed Central

Leke, R J; Oduma, J A; Bassol-Mayagoitia, S; Bacha, A M; Grigor, K M

1993-01-01

Fertility is affected by many different cultural, environmental, and socioeconomic factors, especially in developing countries where poverty and infections are commonplace. Environmental factors play a major role in infertility in Africa. One of the most important health problems in sub-Saharan Africa is the high rate of infertility and childlessness. The African society has a strong traditional heritage, and the study of the patterns of infertility in this part of the world would be incomplete without consideration of the sociocultural and environmental factors. The most cost-effective approach to solving the infertility problems in Africa is prevention and education. In Mexico, problems of reproductive health are associated with pregnancy in adolescents, sexually transmitted diseases and genitourinary neoplasms. Infertility affects 10% of couples, usually as a result of asymptomatic infection. Education, poverty, nutrition, and pollution are problems that must be tackled. The government has taken positive action in the State of São Paulo in Brazil, where gender discrimination is a major factor affecting women's health and reproductive outcomes. The implementation of new policies with adequate funding has resulted in marked improvements. PMID:8243409

Ontario's emergency department process improvement program: the experience of implementation.

PubMed

Rotteau, Leahora; Webster, Fiona; Salkeld, Erin; Hellings, Chelsea; Guttmann, Astrid; Vermeulen, Marian J; Bell, Robert S; Zwarenstein, Merrick; Rowe, Brian H; Nigam, Amit; Schull, Michael J

2015-06-01

In recent years, Lean manufacturing principles have been applied to health care quality improvement efforts to improve wait times. In Ontario, an emergency department (ED) process improvement program based on Lean principles was introduced by the Ministry of Health and Long-Term Care as part of a strategy to reduce ED length of stay (LOS) and to improve patient flow. This article aims to describe the hospital-based teams' experiences during the ED process improvement program implementation and the teams' perceptions of the key factors that influenced the program's success or failure. A qualitative evaluation was conducted based on semistructured interviews with hospital implementation team members, such as team leads, medical leads, and executive sponsors, at 10 purposively selected hospitals in Ontario, Canada. Sites were selected based, in part, on their changes in median ED LOS following the implementation period. A thematic framework approach as used for interviews, and a standard thematic coding framework was developed. Twenty-four interviews were coded and analyzed. The results are organized according to participants' experience and are grouped into four themes that were identified as significantly affecting the implementation experience: local contextual factors, relationship between improvement team and support players, staff engagement, and success and sustainability. The results demonstrate the importance of the context of implementation, establishing strong relationships and communication strategies, and preparing for implementation and sustainability prior to the start of the project. Several key factors were identified as important to the success of the program, such as preparing for implementation, ensuring strong executive support, creation of implementation teams based on the tasks and outcomes of the initiative, and using multiple communication strategies throughout the implementation process. Explicit incorporation of these factors into the development and implementation of future similar interventions in health care settings could be useful. © 2015 by the Society for Academic Emergency Medicine.

[Risk factors negatively affecting on the formation of musculoskeletal system in children and adolescents in the present conditions].

PubMed

Mirskaya, N B

2013-01-01

Identifying risk factors affecting the formation of the musculoskeletal system (MSS) in children and adolescents is considered by the author as a necessary condition for the implementation of prevention, timely diagnosis and adequate correction of the MSS disorders and diseases. Introduction in the educational process developed by the author for the first time a conceptual model of prevention and correction of the MSS disorders and diseases in schoolchildren allowed significantly reduce the prevalence of functional disorders and early forms of the MSS diseases in students of a number of comprehensive schools in Moscow by 50%.

Factors Affecting the Implementation of Argument in the Elementary Science Classroom. A Longitudinal Case Study

NASA Astrophysics Data System (ADS)

Martin, Anita M.; Hand, Brian

2009-01-01

This longitudinal case study describes the factors that affect an experienced teacher’s attempt to shift her pedagogical practices in order to implement embedded elements of argument into her science classroom. Research data was accumulated over 2 years through video recordings of science classes. The Reformed Teacher Observation Protocol (RTOP) is an instrument designed to quantify changes in classroom environments as related to reform as defined by the National Research Council ( National science education standards. Washington, DC: National Academy Press, 1996b) and the National Research Council ( Fulfilling the promise: Biology education in the nation’s schools, Washington, DC: National Academy Press, 1990) and was used to analyze videotaped science lessons. Analysis of the data shows that there was a significant shift in the areas of teacher questioning, and student voice. Several levels of subsequent analysis were completed related to teacher questioning and student voice. The data suggests a relationship between these areas and the implementation of scientific argument. Results indicate that the teacher moved from a traditional, teacher-centered, didactic teaching style to instructional practices that allowed the focus and direction of the lesson to be affected by student voice. This was accomplished by a change in teacher questioning that included a shift from factual recall to more divergent questioning patterns allowing for increased student voice. As student voice increased, students began to investigate ideas, make statements or claims and to support these claims with strong evidence. Finally, students were observed refuting claims in the form of rebuttals. This study informs professional development related to experienced teachers in that it highlights pedagogical issues involved in implementing embedded elements of argument in the elementary classroom.

Relationships between core factors of knowledge management in hospital nursing organisations and outcomes of nursing performance.

PubMed

Lee, Eun Ju; Kim, Hong Soon; Kim, Hye Young

2014-12-01

The study was conducted to investigate the levels of implementation of knowledge management and outcomes of nursing performance, to examine the relationships between core knowledge management factors and nursing performance outcomes and to identify core knowledge management factors affecting these outcomes. Effective knowledge management is very important to achieve strong organisational performance. The success or failure of knowledge management depends on how effectively an organisation's members share and use their knowledge. Because knowledge management plays a key role in enhancing nursing performance, identifying the core factors and investigating the level of knowledge management in a given hospital are priorities to ensure a high quality of nursing for patients. The study employed a descriptive research procedure. The study sample consisted of 192 nurses registered in three large healthcare organisations in South Korea. The variables demographic characteristics, implementation of core knowledge management factors and outcomes of nursing performance were examined and analysed in this study. The relationships between the core knowledge management factors and outcomes of nursing performance as well as the factors affecting the performance outcomes were investigated. A knowledge-sharing culture and organisational learning were found to be core factors affecting nursing performance. The study results provide basic data that can be used to formulate effective knowledge management strategies for enhancing nursing performance in hospital nursing organisations. In particular, prioritising the adoption of a knowledge-sharing culture and organisational learning in knowledge management systems might be one method for organisations to more effectively manage their knowledge resources and thus to enhance the outcomes of nursing performance and achieve greater business competitiveness. The study results can contribute to the development of effective and efficient knowledge management systems and strategies for enhancing knowledge-sharing culture and organisational learning that can improve both the productivity and competitiveness of healthcare organisations. © 2014 John Wiley & Sons Ltd.

Barriers to the implementation of research perceived by nurses from Osakidetza.

PubMed

Cidoncha-Moreno, M Ángeles; Ruíz de Alegría-Fernandez de Retana, Begoña

To understand the barriers to implementing nursing research findings into practice, as perceived by the nurses working in Osakidetza and to analyze if the workplace factor and time worked affect the perception of these barriers. Cross-sectional study. BARRIERS Scale questionnaire was given to a representative sample of 1,572 Basque Health Service nurses, stratified and randomized, according to scope of work and job responsibility (response rate: 43.76%). According to the research results, the first important barrier was "insufficient time on the job to implement new ideas". Nurses have perceived the organizational factor as the most important barrier in their practice. Nurses in "Special hospital departments" perceived more barriers in the "quality of research" factor than those working in "Primary Care". Years of service showed a slight influence. The nurses stated that external factors related to the organization principally interfered in implementing results into clinical practice. They placed lack of critical reading training second. Working environment and seniority mark differences in the perception of barriers. This study may help to develop strategies for planning training programs to facilitate the use of research in clinical practice, in order to provide quality care. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

The intellectual core of enterprise information systems: a co-citation analysis

NASA Astrophysics Data System (ADS)

Shiau, Wen-Lung

2016-10-01

Enterprise information systems (EISs) have evolved in the past 20 years, attracting the attention of international practitioners and scholars. Although literature reviews and analyses have been conducted to examine the multiple dimensions of EISs, no co-citation analysis has been conducted to examine the knowledge structures involved in EIS studies; thus, the current study fills this research gap. This study investigated the intellectual structures of EISs. All data source documents (1083 articles and 24,090 citations) were obtained from the Institute for Scientific Information Web of Knowledge database. A co-citation analysis was used to analyse EIS data. By using factor analysis, we identified eight critical factors: (a) factors affecting the implementation and success of information systems (ISs); (b) the successful implementation of enterprise resource planning (ERP); (c) IS evaluation and success, (d) system science studies; (e) factors influencing ERP success; (f) case research and theoretical models; (g) user acceptance of information technology; and (h) IS frameworks. Multidimensional scaling and cluster analysis were used to visually map the resultant EIS knowledge. It is difficult to implement an EIS in an enterprise and each organisation exhibits specific considerations. The current findings indicate that managers must focus on ameliorating inferior project performance levels, enabling a transition from 'vicious' to 'virtuous' projects. Successful EIS implementation yields substantial organisational advantages.

Risk Analysis of Underestimate Cost Offer to The Project Quality in Aceh Province

NASA Astrophysics Data System (ADS)

Rani, Hafnidar A.

2016-11-01

The possibility of errors in the process of offer price determination could be enormous, so it can affect the possibility of project underestimate cost which can impact and reduce the profit if being implementing. Government Equipment/Service Procurement Policy Institution (LKPP) assesses that the practices of cheaper price in the government equipment/service procurement are still highly found and can be potential to decrease the project quality. This study aimed to analyze the most dominant factors happened in underestimate cost offer practice, to analyze the relationship of underestimate cost offer risk factors to road construction project quality in Aceh Province and to analyze the most potential factors of underestimate cost offer risk affecting road construction project quality in Aceh Province. Road construction projects observed the projects which have been implemented in Aceh Province since 2013 - 2015. This study conducted by interviewing Government Budget Authority (KPA), and distributing the questionnaire to the road construction contractors with the qualification of K1, K2, K3, M1, M2 and B1. Based on the data from Construction Service Development Institution (LPJK) of Aceh Province on 2016, the populations obtained are 2,717 constructors. By using Slovin Equation, the research samples obtained are 97 contractors. The most dominant factors in underestimate cost offer risk of the road construction projects in Aceh Province is Contingency Cost Factor which the mean is 4.374.

Factors affecting registered nurses' use of medication administration technology in acute care settings: A systematic review.

PubMed

San, Tay Hui; Lin, Serena Koh Siew; Fai, Chan Moon

Information technology to aid reduction in medication errors has been encouraged over the years and one of them is the medication administration technology. It consists of the electronic Medication Administration Record, Bar-Code Medication Administration system and Automated Medication Dispensing system. Studies had examined the effectiveness and impact of this technology to reduce medication error. However, user's acceptance towards this technology has often been neglected. To date, no systematic review has been undertaken to examine the possible factors that affect nurses' use of this technology in the acute care settings. The objective of this systematic review was to explore and determine the factors that affect nurses' use of medication administration technology in the acute care settings. All quantitative studies published in English which examined factors affecting nurses' use of the medication administration technology were considered.Primary focus was on registered nurses with experience of operating medication administration technology in the acute care settings. Other healthcare personnel were excluded.This review considered studies that evaluated factors affecting nurses' use of the medication administration technology.The outcome measures of interest were the factors that affect nurses' use of the medication administration technology in the acute care settings. The search was conducted across published and unpublished databases. A search was conducted in JBI Library of Systematic Reviews, The Cochrane Library, CINAHL, MEDLINE, Scopus, ScienceDirect, Wiley InterScience, SpringerLink, PsycINFO (ovid), Web of science, ProQuest Dissertations and Theses, and MedNar. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review, using the standardised critical appraisal instruments developed by the Joanna Briggs Institute. Quantitative data were extracted from papers included in the review using a standardised data extraction tool developed by the JBI. Findings were presented in narrative summary due to heterogeneity of the study designs. Six descriptive studies were included in this review. Nurses' use of the technology can be influenced by a combination of complex and inter-related factors, such as organisational factors, and user and system characteristics. In order to successfully implement medication administration technology, system, user and organisational factors have to be collaborated concurrently.Users' needs should be accommodated when designing the system features. Prior to system implementation, institutions should consider the users' demographical characteristics and provide adequate preparations and training. A supportive culture from the institution and colleagues is also important.There is a significant need for further research in this field. Further research to discover potential factors in different settings, locations and countries are suggested. Studies to evaluate nurses' use of the technology at regular intervals are also required.

Factors Influencing Worker Morale: Evaluating Provider Demographics, Workplace Environment and Using ESTs

ERIC Educational Resources Information Center

Patterson-Silver Wolf, David A.; Dulmus, Catherine N.; Maguin, Eugene; Cristalli, Maria

2013-01-01

Objectives: Mental health organizations are strongly encouraged to implement empirically supported treatments (ESTs); however, little is known about their working environments. The present study investigated how provider demographics, workplace environment, and whether ESTs were used affected the worker morale. Method: Frontline workers…

Bilingual Education: A Reference Handbook. Contemporary Education Issues.

ERIC Educational Resources Information Center

Feinberg, Rosa Castro

This book describes the evolution of bilingual education in the United States, emphasizing its relationship to educational and civil rights reform. Federal, state, and district policies affecting the implementation of bilingual programs are identified, along with related legal, political, demographic, and economic factors and controversies.…

Factors Affecting Third Culture Kids' (TCKs) Transition

ERIC Educational Resources Information Center

Morales, Antonio

2015-01-01

(TCKs) transition becomes challenging for both the student and the school. The programs implemented, or lack thereof, are imperative to the successful transition of TCKs into their new, diverse, multicultural environment. Research has been written on the positive effects and challenges faced by TCKs' transient lifestyle. Although international…

Factors affecting sustainability of rural water schemes in Swaziland

NASA Astrophysics Data System (ADS)

Peter, Graciana; Nkambule, Sizwe E.

The Millennium Development Goal (MDG) target to reduce the proportion of people without sustainable access to safe drinking water by the year 2015 has been met as of 2010, but huge disparities exist. Some regions, particularly Sub-Saharan Africa are lagging behind it is also in this region where up to 30% of the rural schemes are not functional at any given time. There is need for more studies on factors affecting sustainability and necessary measures which when implemented will improve the sustainability of rural water schemes. The main objective of this study was to assess the main factors affecting the sustainability of rural water schemes in Swaziland using a Multi-Criteria Analysis Approach. The main factors considered were: financial, social, technical, environmental and institutional. The study was done in Lubombo region. Fifteen functional water schemes in 11 communities were studied. Data was collected using questionnaires, checklist and focused group discussion guide. A total of 174 heads of households were interviewed. Statistical Package for Social Sciences (SPSS) was used to analyse the data and to calculate sustainability scores for water schemes. SPSS was also used to classify sustainability scores according to sustainability categories: sustainable, partially sustainable and non-sustainable. The averages of the ratings for the different sub-factors studied and the results on the sustainability scores for the sustainable, partially sustainable and non-sustainable schemes were then computed and compared to establish the main factors influencing sustainability of the water schemes. The results indicated technical and social factors as most critical while financial and institutional, although important, played a lesser role. Factors which contributed to the sustainability of water schemes were: functionality; design flow; water fetching time; ability to meet additional demand; use by population; equity; participation in decision making on operation and maintenance; existence of fund for operation and maintenance; willingness to contribute money; existence of a user’s committee; participation in the initial planning and design of the water scheme; and coordination between the local leaders and user’s committee. The main factors which made the schemes unsustainable were: long fetching time; non-involvement in decision making; lack of willingness to contribute funds; absence of users committee; and lack of cooperation between local leaders and the users committee. Water service providers should address the technical, social, financial and institutional factors identified affecting sustainability in their planning and implementation of rural water schemes.

Stage is a prognostic factor for surgically treated patients with early-stage lip cancer for whom a 'wait and see' policy in terms of neck status has been implemented.

PubMed

Eskiizmir, G; Ozgur, E; Karaca, G; Temiz, P; Yanar, N Hacioglu; Ozyurt, B Cengiz

2017-10-01

To determine the locoregional control and survival rates (in terms of risk factors) of patients who underwent surgical resection of early-stage lip cancer and for whom a 'wait and see' policy in terms of neck status had been implemented. The sociodemographic data, tumour stage, tumour characteristics and histopathological features of 41 patients with early-stage lip cancer were evaluated. Factors predictive of survival and locoregional recurrence were analysed. The five-year overall survival and disease-free survival rates were determined, and the prognostic risk factors were compared. The mean follow-up period was 60.5 months (range, 4-92 months). Age, sex, tumour stage, tumour thickness and volume, and perineural involvement were not predictive of locoregional recurrence or survival. Pathological tumour stage (T1 vs T2) was a prognostic factor for both five-year overall survival (87.3 vs 65.6 per cent, p = 0.042) and disease-free survival (88.6 vs 65.6 per cent, p = 0.037). Tumour stage was clearly a major factor affecting the prognosis of surgically treated patients with early-stage lip cancer for whom a 'wait and see' policy in terms of neck status had been implemented.

A computer simulation of Skylab dynamics and attitude control for performance verification and operational support

NASA Technical Reports Server (NTRS)

Buchanan, H.; Nixon, D.; Joyce, R.

1974-01-01

A simulation of the Skylab attitude and pointing control system (APCS) is outlined and discussed. Implementation is via a large hybrid computer and includes those factors affecting system momentum management, propellant consumption, and overall vehicle performance. The important features of the flight system are discussed; the mathematical models necessary for this treatment are outlined; and the decisions involved in implementation are discussed. A brief summary of the goals and capabilities of this tool is also included.

Wall interference assessment and corrections

NASA Technical Reports Server (NTRS)

Newman, P. A.; Kemp, W. B., Jr.; Garriz, J. A.

1989-01-01

Wind tunnel wall interference assessment and correction (WIAC) concepts, applications, and typical results are discussed in terms of several nonlinear transonic codes and one panel method code developed for and being implemented at NASA-Langley. Contrasts between 2-D and 3-D transonic testing factors which affect WIAC procedures are illustrated using airfoil data from the 0.3 m Transonic Cryogenic Tunnel and Pathfinder 1 data from the National Transonic Facility. Initial results from the 3-D WIAC codes are encouraging; research on and implementation of WIAC concepts continue.

Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives.

PubMed

Byron, Gerard; Ziedonis, Douglas M; McGrath, Caroline; Frazier, Jean A; deTorrijos, Fernando; Fulwiler, Carl

2015-08-01

Occupational stress and burnout adversely impacts mental health care staff well-being and patient outcomes. Mindfulness training reduces staff stress and may improve patient care. However, few studies explore mental health setting implementation. This qualitative study used focus groups to evaluate stakeholders' perceptions of organizational factors affecting implementation of an adapted version of Mindfulness-Based Stress Reduction (MBSR) for staff on adolescent mental health units. Common facilitators included leadership securing buy-in with staff, allocating staff time to participate, and quiet space for training and practice. Other facilitators were past staff knowledge of mindfulness, local champions, and acculturating staff with mindfulness through a non-mandatory training attendance policy. Common barriers were limited staff time to attend training sessions and insufficient training coverage for some staff. Staff also reported improved focus when interacting with adolescents and improved social cohesion on the units. We conclude that a mindfulness-based program for reducing occupational stress can be successfully implemented on adolescent mental health units. Implementation appeared to change the social context of the units, including staff and patient interactions. More broadly, our findings highlight the importance of environmental factors in shaping attitudes, diffusion of innovation, and acculturation of wellness program implementations.

Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives

PubMed Central

Byron, Gerard; Ziedonis, Douglas M.; McGrath, Caroline; Frazier, Jean A.; deTorrijos, Fernando

2014-01-01

Occupational stress and burnout adversely impacts mental health care staff well-being and patient outcomes. Mindfulness training reduces staff stress and may improve patient care. However, few studies explore mental health setting implementation. This qualitative study used focus groups to evaluate stakeholders’ perceptions of organizational factors affecting implementation of an adapted version of Mindfulness-Based Stress Reduction (MBSR) for staff on adolescent mental health units. Common facilitators included leadership securing buy-in with staff, allocating staff time to participate, and quiet space for training and practice. Other facilitators were past staff knowledge of mindfulness, local champions, and acculturating staff with mindfulness through a non-mandatory training attendance policy. Common barriers were limited staff time to attend training sessions and insufficient training coverage for some staff. Staff also reported improved focus when interacting with adolescents and improved social cohesion on the units. We conclude that a mindfulness-based program for reducing occupational stress can be successfully implemented on adolescent mental health units. Implementation appeared to change the social context of the units, including staff and patient interactions. More broadly, our findings highlight the importance of environmental factors in shaping attitudes, diffusion of innovation, and acculturation of wellness program implementations. PMID:26500708

The future of transportation in society: Forces of change

NASA Technical Reports Server (NTRS)

Richardson, Barbara C.

1996-01-01

The transportation system is a critical element of the social / political / economic system of the United States. Factors influencing the use of transportation technology include technology push, market pull, and external factors. In order for new transportation technology to be successful, it must meet the needs of the market. These needs are diverse and vary almost by individual. Historical trends show great changes in transportation use by mode and origins and destinations of trips. Other important changes in society affecting transportation use include changes in the composition of society by gender, age, national origin, family composition, land use, income, and residential distribution. Changes of these factors in the future and how technology is deployed to meet the changing needs of society will affect the success of transportation technology implementation over the next twenty years.

Teaching an Integrated Science Curriculum: Linking Teacher Knowledge and Teaching Assignments

ERIC Educational Resources Information Center

Harrell, Pamela Esprivalo

2010-01-01

A number of factors affect successful implementation of an integrated science curriculum, including various outputs and inputs related to teacher quality such as professional development experiences, adequate planning periods, and adequate content preparation of teachers with regard to content knowledge associated with the curriculum taught. This…

Teacher Perceptions of an Online Tutoring Program for Elementary Mathematics

ERIC Educational Resources Information Center

Whetstone, Patti; Clark, Amy; Flake, Mari Wheeler

2014-01-01

This study explores elementary teacher perceptions related to the implementation of an online tutoring program. Teachers were surveyed regarding factors that affected use of the online tutoring program as a supplement to mathematics instruction. Results indicated that teachers overwhelmingly reported positive views of the training and support…

A Systems Dynamics Model of Implementation of an Innovation.

ERIC Educational Resources Information Center

Gaynor, Alan K.; And Others

The research presented in this report investigated the critical factors that affected the decision to abandon or replace a curricular innovation in one elementary school. The specific innovation examined in this research is called developing mathematical processes, which emphasizes process and induction rather than computational skills. Although…

Factors Affecting Faculty Acceptance and Use of Institutional Repositories in Thailand

ERIC Educational Resources Information Center

Ammarukleart, Sujira

2017-01-01

Institutional repositories have been introduced as an innovative and alternative technology for scholarly communication and have received considerable attention from scholars across disciplines and around the globe. While some universities in Thailand have developed and implemented institutional repositories for nearly a decade, knowledge of the…

Effectiveness Information and Institutional Change: An Exploratory Analysis.

ERIC Educational Resources Information Center

Ewell, Peter T.

Factors that affect the implementation of information-based improvements in college instruction and decision-making are considered, based on a conceptual scheme for comparing information-based change efforts. Based on a student outcomes project, eight brief case studies of public colleges illustrate different patterns leading to successful use of…

Mechanisms of Change in COMPASS Consultation for Students with Autism

ERIC Educational Resources Information Center

Ruble, Lisa A.; McGrew, John H.; Toland, Michael D.

2013-01-01

More than a decade has passed since the National Research Council described the common elements of effective educational programs for young children with autism. Since that time, few studies have attempted to understand the mechanisms of change and factors affecting the effectiveness of research supported interventions implemented in community…

Factors Affecting Student Success with a Google Earth-Based Earth Science Curriculum

ERIC Educational Resources Information Center

Blank, Lisa M.; Almquist, Heather; Estrada, Jen; Crews, Jeff

2016-01-01

This study investigated to what extent the implementation of a Google Earth (GE)-based earth science curriculum increased students' understanding of volcanoes, earthquakes, plate tectonics, scientific reasoning abilities, and science identity. Nine science classrooms participated in the study. In eight of the classrooms, pre- and post-assessments…

Eastern Adult, Continuing, and Distance Education Research Conference Proceedings (University Park, Pennsylvania, October 24-26, 1996).

ERIC Educational Resources Information Center

Pennsylvania State Univ., University Park. Coll. of Education.

Includes the following among 52 papers: "Accelerated Degree Programs" (Anderson et al.); "Basic Skills in the Workplace" (Askov); "Breaking All the Rules" (Baird); "Data Mining for Factors Affecting the Implementation of Interactive, Computer-Mediated Instructional Techniques for Students at a Distance"…

Implementation factors affecting the large-scale deployment of digital health and well-being technologies: A qualitative study of the initial phases of the 'Living-It-Up' programme.

PubMed

Agbakoba, Ruth; McGee-Lennon, Marilyn; Bouamrane, Matt-Mouley; Watson, Nicholas; Mair, Frances S

2016-12-01

Little is known about the factors which facilitate or impede the large-scale deployment of health and well-being consumer technologies. The Living-It-Up project is a large-scale digital intervention led by NHS 24, aiming to transform health and well-being services delivery throughout Scotland. We conducted a qualitative study of the factors affecting the implementation and deployment of the Living-It-Up services. We collected a range of data during the initial phase of deployment, including semi-structured interviews (N = 6); participant observation sessions (N = 5) and meetings with key stakeholders (N = 3). We used the Normalisation Process Theory as an explanatory framework to interpret the social processes at play during the initial phases of deployment.Initial findings illustrate that it is clear - and perhaps not surprising - that the size and diversity of the Living-It-Up consortium made implementation processes more complex within a 'multi-stakeholder' environment. To overcome these barriers, there is a need to clearly define roles, tasks and responsibilities among the consortium partners. Furthermore, varying levels of expectations and requirements, as well as diverse cultures and ways of working, must be effectively managed. Factors which facilitated implementation included extensive stakeholder engagement, such as co-design activities, which can contribute to an increased 'buy-in' from users in the long term. An important lesson from the Living-It-Up initiative is that attempting to co-design innovative digital services, but at the same time, recruiting large numbers of users is likely to generate conflicting implementation priorities which hinder - or at least substantially slow down - the effective rollout of services at scale.The deployment of Living-It-Up services is ongoing, but our results to date suggest that - in order to be successful - the roll-out of digital health and well-being technologies at scale requires a delicate and pragmatic trade-off between co-design activities, the development of innovative services and the efforts allocated to widespread marketing and recruitment initiatives. © The Author(s) 2015.

Factors affecting adoption and implementation of AHRQ health literacy tools in pharmacies.

PubMed

Shoemaker, Sarah J; Staub-DeLong, Leah; Wasserman, Melanie; Spranca, Mark

2013-01-01

Pharmacies are key sources of medication information for patients, yet few effectively serve patients with low health literacy. The Agency for Healthcare Research and Quality (AHRQ) supported the development of four health literacy tools for pharmacists to address this problem, and to help assess and improve pharmacies' health literacy practices. This study aimed to understand the facilitators and barriers to the adoption and implementation of AHRQ's health literacy tools, particularly a tool to assess a pharmacy's health literacy practices. We conducted a comparative, multiple-case study of eight pharmacies, guided by an adaptation of Rogers's Diffusion of Innovations model. Data were collected and triangulated through interviews, site visit observations, and the review of documents, and analyzed on the factors affecting pharmacies' adoption decisions and implementation of the tools. Factors important to pharmacies' decision to adopt the health literacy tools included awareness of health literacy; a culture of innovation; a change champion; the relative advantage and compatibility of the tools; and an invitation to utilize and receive support to use the tools. The barriers included a lack of leadership support, limited staff time, and a perception of the tools as complex with limited value. For implementation, the primary facilitators were buy-in from leadership, qualified staff, college-affiliated change champions, the adaptability and organization of the tool, and support. Barriers to implementation were limited leadership buy-in, prioritization of other activities, lack of qualified staff, and tool complexity. If pharmacists are provided tools that could ultimately improve their health literacy practices and patient-centered services; and the tools have a clear relative advantage, are simple as well adaptable, and the pharmacists are supported in their efforts - either by colleagues or by collaborating with colleges of pharmacy-then there could be important progress toward achieving the goals of the National Action Plan for Health Literacy. Copyright © 2013 Elsevier Inc. All rights reserved.

Implementing National System of Health Research Ethics Regulations: The Nigerian Experience

PubMed Central

Adebamowo, Clement A.

2013-01-01

Efforts by Nigerian authorities to institutionalize health research dates back to the early 70's with the establishment of the Medical Research Council. Subsequently efforts to strengthen a national health research system in line with the concept of Essential National Health Research (ENHR) were made but albeit un-successfully. This may have been as a result of poor political support, and lack of regulations to promote health research in the country. However little is known about health research regulations and their implementation in Nigeria. Health and health research in Nigeria is not regulated via a set of clearly defined legislation. While the country has developed a regulation document for health research ethics, compliance to this document is likely to be affected by the lack of legislation in for the health system as an entity. In this paper we narrate the developments in health, health research, and health regulations; we describe process for, and extent of implementation of the National Code of Health Research Ethics. We conclude that several factors affect the extent of implementation of the ethics code amongst which legislation is an important one. PMID:24324978

Implementing National System of Health Research Ethics Regulations: The Nigerian Experience.

PubMed

Yakubu, Aminu; Adebamowo, Clement A

2012-01-01

Efforts by Nigerian authorities to institutionalize health research dates back to the early 70's with the establishment of the Medical Research Council. Subsequently efforts to strengthen a national health research system in line with the concept of Essential National Health Research (ENHR) were made but albeit un-successfully. This may have been as a result of poor political support, and lack of regulations to promote health research in the country. However little is known about health research regulations and their implementation in Nigeria. Health and health research in Nigeria is not regulated via a set of clearly defined legislation. While the country has developed a regulation document for health research ethics, compliance to this document is likely to be affected by the lack of legislation in for the health system as an entity. In this paper we narrate the developments in health, health research, and health regulations; we describe process for, and extent of implementation of the National Code of Health Research Ethics. We conclude that several factors affect the extent of implementation of the ethics code amongst which legislation is an important one.

A socio-ecological perspective of access to and acceptability of HIV/AIDS treatment and care services: a qualitative case study research.

PubMed

Yakob, Bereket; Ncama, Busisiwe Purity

2016-02-16

Access to healthcare is an essential element of health development and a fundamental human right. While access to and acceptability of healthcare are complex concepts that interact with different socio-ecological factors (individual, community, institutional and policy), it is not known how these factors affect HIV care. This study investigated the impact of socio-ecological factors on access to and acceptability of HIV/AIDS treatment and care services (HATCS) in Wolaita Zone of Ethiopia. Qualitative case study research was conducted in six woredas (districts). Focus group discussions (FGDs) were conducted with 68 participants in 11 groups (six with people using antiretroviral therapy (ART) and five with general community members). Key informant interviews (KIIs) were conducted with 28 people involved in HIV care, support services and health administration at different levels. Individual in-depth interviews (IDIs) were conducted with eight traditional healers and seven defaulters from (ART). NVIVO 10 was used to assist qualitative content data analysis. A total of 111 people participated in the study, of which 51 (45.9%) were male and 60 (54.1%) were female, while 58 (53.3%) and 53 (47.7%) were urban and rural residents, respectively. The factors that affect access to and acceptability of HATCS were categorized in four socio-ecological units of analysis: client-based factors (awareness, experiences, expectations, income, employment, family, HIV disclosure and food availability); community-based factors (care and support, stigma and discrimination and traditional healing); health facility-based factors (interactions with care providers, availability of care, quality of care, distance, affordability, logistics availability, follow up and service administration); and policy and standards (healthcare financing, service standards, implementation manuals and policy documents). A socio-ecological perspective provides a useful framework to investigate the interplay among multilevel and interactive factors that impact on access to and acceptability of HATCS such as clients, community, institution and policy. Planners, resource allocators and implementers could consider these factors during planning, implementation and evaluation of HATCS. Further study is required to confirm the findings.

The transcatheter aortic valve implementation (TAVI)--a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure.

PubMed

Merkel, Sebastian; Eikermann, Michaela; Neugebauer, Edmund A; von Bandemer, Stephan

2015-10-06

The transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure to treat patients with severe symptomatic aortic stenosis, showed a rapid diffusion in Germany compared to the international level. The aim of this study is to identify and analyze factors affecting the implementation and diffusion of the procedure in hospitals using a qualitative application of the diffusion of innovations theory. We conducted problem-centered interviews with cardiologists and cardiac surgeons working in German hospitals. The multi-level model "diffusion of innovations in health services organizations" developed by Greenhalgh et al. was used to guide the research. Data was analyzed using content and a thematic analysis. Among the ten participants who were interviewed, we found both barriers and facilitators related to the innovation itself, system readiness and antecedents, communication and influence, and the outer context. Key issues were the collaboration between cardiologists and cardiac surgeons, reimbursement policies, requirements needed to conduct the procedure, and medical advantages of the method. The findings show that there are multiple factors influencing the diffusion of TAVI that go beyond the reimbursement and cost issues. The diffusion of innovations model proved to be helpful in understanding the different aspects of the uptake of the procedure. A central theme that affected the implementation of TAVI was the collaboration and competition between involved medical departments: cardiology and cardiac surgery. Against this background, it seems especially important to moderate and coordinate the cooperation of the different medical disciplines.

Acceptance of Health Information Technologies, Acceptance of Mobile Health: A Review Article

PubMed Central

Garavand, A.; Samadbeik, M.; Kafashi, M.; Abhari, Sh.

2017-01-01

Background: Mobile health is one of the new technologies for the utilization of health information. For its successful implementation as well as any other system, we must primarily measure the adoption and use of its factors. The purpose of this study was to systematically investigate published articles about the factors affecting the adoption of mobile health and categorizing the factors affecting the adoption of this system. Methods: This study is a comprehensive review done by searching major databases such as Google Scholar, Emerald, Science Direct, Iran Medex, SID, Magiran, Pub med, etc. In addition, we use Mobile, mobile Health + adoption, mobile Health + TAM, Health + TAM keywords in the range of 2004 to 2015. Results: Among the studies that use information technology theories to survey the factors affecting the adoption of mobile health, TAM model was used more than other models. Factors such as perceived ease of use, perceived usefulness and facilitating condition form TUATU are the most effective in the adoption of mobile health. Conclusion: Results showed that by considering factors such as perceived ease of use, perceived usefulness and facilitating condition can increase the adoption of mobile health system. Consequently, these factors are recommended to be considered in planning to run systems. PMID:29445717

Exploring Factors Affecting Voluntary Adoption of Electronic Medical Records Among Physicians and Clinical Assistants of Small or Solo Private General Practice Clinics.

PubMed

Or, Calvin; Tong, Ellen; Tan, Joseph; Chan, Summer

2018-05-29

The health care reform initiative led by the Hong Kong government's Food and Health Bureau has started the implementation of an electronic sharing platform to provide an information infrastructure that enables public hospitals and private clinics to share their electronic medical records (EMRs) for improved access to patients' health care information. However, previous attempts to convince the private clinics to adopt EMRs to document health information have faced challenges, as the EMR adoption has been voluntary. The lack of electronic data shared by private clinics carries direct impacts to the efficacy of electronic record sharing between public and private healthcare providers. To increase the likelihood of buy-in, it is essential to proactively identify the users' and organizations' needs and capabilities before large-scale implementation. As part of the reform initiative, this study examined factors affecting the adoption of EMRs in small or solo private general practice clinics, by analyzing the experiences and opinions of the physicians and clinical assistants during the pilot implementation of the technology, with the purpose to learn from it before full-scale rollout. In-depth, semistructured interviews were conducted with 23 physicians and clinical assistants from seven small or solo private general practice clinics to evaluate their experiences, expectations, and opinions regarding the deployment of EMRs. Interview transcripts were content analyzed to identify key factors. Factors affecting the adoption of EMRs to record and manage health care information were identified as follows: system interface design; system functions; stability and reliability of hardware, software, and computing networks; financial and time costs; task and outcome performance, work practice, and clinical workflow; physical space in clinics; trust in technology; users' information technology literacy; training and technical support; and social and organizational influences. The factors are interrelated with the others. The adoption factors identified are multifaceted, ranging from technological characteristics, clinician-technology interactions, skills and knowledge, and the user-workflow-technology fit. Other findings, which have been relatively underrepresented in previous studies, contribute unique insights about the influence of work and social environment on the adoption of EMRs, including limited clinic space and the effects of physicians' decision to use the technology on clinical staffs' adoption decisions. Potential strategies to address the concerns, overcome adoption barriers, and define relevant policies are discussed.

Experiments to Evaluate and Implement Passive Tracer Gas Methods to Measure Ventilation Rates in Homes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lunden, Melissa; Faulkner, David; Heredia, Elizabeth

2012-10-01

This report documents experiments performed in three homes to assess the methodology used to determine air exchange rates using passive tracer techniques. The experiments used four different tracer gases emitted simultaneously but implemented with different spatial coverage in the home. Two different tracer gas sampling methods were used. The results characterize the factors of the execution and analysis of the passive tracer technique that affect the uncertainty in the calculated air exchange rates. These factors include uncertainties in tracer gas emission rates, differences in measured concentrations for different tracer gases, temporal and spatial variability of the concentrations, the comparison betweenmore » different gas sampling methods, and the effect of different ventilation conditions.« less

Factors affecting electronic health record adoption in long-term care facilities.

PubMed

Cherry, Barbara; Carter, Michael; Owen, Donna; Lockhart, Carol

2008-01-01

Electronic health records (EHRs) hold the potential to significantly improve the quality of care in long-term care (LTC) facilities, yet limited research has been done on how facilities decide to adopt these records. This study was conducted to identify factors that hinder and facilitate EHR adoption in LTC facilities. Study participants were LTC nurses, administrators, and corporate executives. Primary barriers identified were costs, the need for training, and the culture change required to embrace technology. Primary facilitators were training programs, well-defined implementation plans, government assistance with implementation costs, evidence that EHRs will improve care outcomes, and support from state regulatory agencies. These results offer a framework of action for policy makers, LTC Leaders, and researchers.

A transformative perspective on learning and professional development of Afghan physiotherapists.

PubMed

Wickford, Jenny; Edwards, Ian; Rosberg, Susanne

2012-05-01

The aim of this article is to explore factors that impacted learning of Afghan physiotherapists in a development project to improve the physiotherapy services in a disability programme implemented by a Swedish nongovernmental organisation in Afghanistan. Participant observation, recorded as field notes, was used to document the process, to gain a better understanding of professional development of physiotherapists in Afghanistan. Field notes were analysed and factors affecting learning were interpreted from a perspective inspired by transformative learning. Various factors were identified: a pattern approach to treatment, linear thinking, and socially oriented decision making affected how new things learned were put into practice; concrete representations and an instrumental view of knowledge characterised learning approaches; language barriers, different interpretations of meaning, and cultural codes challenged communication; and a prescriptive, encouraging approach of the expatriate physiotherapy development worker affected teaching and learning. Working with professional development across cultural borders is challenging, and the identified factors impacting learning can help expatriate physiotherapists in adapting training to the Afghan context. Exploring meaning perspectives and communicative learning could enhance understanding of these factors for both expatriate and Afghan physiotherapists and should be a focus in future development activities.

Implementation of a clinical innovation: the case of advanced clinic access in the Department of Veterans Affairs.

PubMed

Lukas, Carol VanDeusen; Meterko, Mark M; Mohr, David; Seibert, Marjorie Nealon; Parlier, Renee; Levesque, Odette; Petzel, Robert A

2008-01-01

Healthcare organizations seeking to improve clinical practices often have disappointing results because the planned innovations are not successfully implemented. To increase the understanding of implementation, we analyzed the national spread of an ambulatory innovation in the Department of Veterans Affairs. This study provides support for a conceptual model that posits that the extent to which a clinical innovation is implemented will be affected by factors in 3 domains: (1) intentional activities to introduce, spread, and support the innovation; (2) the attitudes and capabilities of clinic staff responsible for implementing the innovation; and (3) the context of the facility in which the innovation is being introduced. Among the strongest predictors of successful implementation, management support for the innovation and clinic team knowledge and skills to make changes successfully were significant across both primary care and specialty clinics.

Voices of Worth-Listening to Teachers: A Phenomenological Study of Professional Development and Instructional Change

ERIC Educational Resources Information Center

Roberts, Jennifer A.

2009-01-01

The purpose of this phenomenological study was to describe and explain teachers' perceptions about effective professional development as well as to identify the environmental factors that affect the teacher participants' ability to engage in and implement various behaviors and beliefs transferred from the professional development experience. Four…

Understanding How Institutional Leadership Affects Civic Engagement on University Campuses

ERIC Educational Resources Information Center

Burgess, Prairie Leigh

2011-01-01

Higher education in America has a long tradition of civic engagement education. Although there is theoretical and rhetorical support, many institutions still struggle with implementing effective civic engagement on their campuses. The aim of this study was to provide an understanding of factors that contribute to successful civic engagement,…

Balancing Parenthood and Employment: Factors Affecting Company Receptiveness to Family-Related Innovations in the Workplace.

ERIC Educational Resources Information Center

McNeeley, R. L.; Fogarty, Barbe A.

1988-01-01

Examined employer reluctance to consider and/or implement innovations by assessing the relationship between selected demographic features of companies and the receptiveness of these companies to the introduction of innovative changes, as reported by company officials. Found demographic and other features influenced company officials' willingness…

First Year Teachers Technology Use: Perceptions of Factors Affecting Technology Integration

ERIC Educational Resources Information Center

Jones, Elodie J.

2013-01-01

For decades, technology integration into the classroom and curriculum has been at the forefront of education. Although public perception and technology funding assumes that teachers are integrating technology into the curriculum, research shows that actual integration is still far from being fully implemented. This study detailed how first-year…

Educational Factors and Experiences in English Language Learner Reading Fluency Development

ERIC Educational Resources Information Center

Weber, Christina J. T.

2013-01-01

Reading fluency has been an area of struggle for students. Certain populations of students, such as English language learners (ELLs), have struggled even more so, affecting their overall achievement. Interventions have been implemented and studied regarding the reading fluency of ELLs, yet reading fluency has continued to be problematic in this…

University Students' Behavioral Intention to Use Mobile Learning: Evaluating the Technology Acceptance Model

ERIC Educational Resources Information Center

Park, Sung Youl; Nam, Min-Woo; Cha, Seung-Bong

2012-01-01

As many Korean universities have recommended the implementation of mobile learning (m-learning) for various reasons, the number of such tertiary learning opportunities has steadily grown. However, little research has investigated the factors affecting university students' adoption and use of m-learning. A sample of 288 Konkuk university students…

An Analysis of Factors Affecting Student Perceptions in a Blended Learning Environment

ERIC Educational Resources Information Center

Peruso, Florence Mary

2012-01-01

The current quantitative study measured the perceptions of students towards online-only learning and towards blended-hybrid learning. Descriptive statistics were implemented to analyze the data from a Likert-type survey, administered to students in degree-seeking programs at an institution of higher learning. A "t"-test and…

Being in the Hot Spot: A Phenomenological Study of Two Beginning Teachers' Experiences Enacting Inquiry Science Pedagogy

ERIC Educational Resources Information Center

Dreon, Oliver; McDonald, Scott

2012-01-01

This phenomenological study demonstrates the influence that affective factors have on beginning teachers' ability to enact inquiry science pedagogy. Through narratives shared in interviews and weblog postings, two beginning science teachers' emotional engagement with their teaching practices, especially that of implementing inquiry-based…

Organizational Factors Affecting the Continuation of an Instructional Innovation for Heterogeneous Populations.

ERIC Educational Resources Information Center

Dahl, Rene Fukuhara

This paper investigates the elementary school principal's role in helping to sustain implementation of a complex math and science program designed to foster the development of higher order thinking skills, particularly for language minority students. The study predicted a positive relationship between coordination and program continuation; if the…

Factors Affecting the Adoption of an E-Assessment System

ERIC Educational Resources Information Center

McCann, Ann L.

2010-01-01

A case study was conducted in 2006-07 to explore how one US campus implemented a centralised e-assessment system. The study specifically measured the extent of adoption by faculty members, identified their reasons for adoption and evaluated the impact on teaching and learning. The purposes of the system, entitled researching learning (REAL, a…

What Influences Physical Activity Provision in After-School Childcare in the Absence of Policy Guidance? A Qualitative Exploration

ERIC Educational Resources Information Center

MacFarlane, Kendra; Wharf Higgins, Joan; Naylor, Patti-Jean

2018-01-01

Objective: This study explored factors affecting the implementation of good-quality physical activity provision in after-school childcare delivered in a Canadian jurisdiction without specific policy, standards or active interventions aimed at increasing physical activity underway. Design: Case study design theoretically guided by the…

Coping Power Dissemination Study: Intervention and Special Education Effects on Academic Outcomes

ERIC Educational Resources Information Center

Lochman, John E.; Boxmeyer, Caroline L.; Powell, Nicole P.; Qu, Lixin; Wells, Karen; Windle, Michael

2012-01-01

This study examines whether a school-based preventive intervention for children with aggressive behavior affects children's academic outcomes when it is implemented by school counselors in a dissemination field trial. The Coping Power program targets empirical risk factors for aggressive behavior and focuses primarily on teaching social and…

Upper Illinois River basin

USGS Publications Warehouse

Friedel, Michael J.

1998-01-01

During the past 25 years, industry and government made large financial investments that resulted in better water quality across the Nation; however, many water-quality concerns remain. Following a 1986 pilot project, the U.S. Geological Survey began implementation of the National Water-Quality Assessment (NAWQA) Program in 1991. This program differs from other national water-quality assessment studies in that the NAWQA integrates monitoring of surface- and ground-water quality with the study of aquatic ecosystems. The goals of the NAWQA Program are to (1) describe current water-quality conditions for a large part of the Nation's freshwater streams and aquifers (water-bearing sediments and rocks), (2) describe how water quality is changing over time, and (3) improve our understanding of the primary natural and human factors affecting water quality.The Upper Illinois River Basin National Water- Quality Assessment (NAWQA) study will increase the scientific understanding of surface- and ground-water quality and the factors that affect water quality in the basin. The study also will provide information needed by water-resource managers to implement effective water-quality management actions and evaluate long-term changes in water quality.

Electronic health records implementation: an evaluation of information system impact and contingency factors.

PubMed

Nguyen, Lemai; Bellucci, Emilia; Nguyen, Linh Thuy

2014-11-01

This paper provides a review of EHR (electronic health record) implementations around the world and reports on findings including benefits and issues associated with EHR implementation. A systematic literature review was conducted from peer-reviewed scholarly journal publications from the last 10 years (2001-2011). The search was conducted using various publication collections including: Scopus, Embase, Informit, Medline, Proquest Health and Medical Complete. This paper reports on our analysis of previous empirical studies of EHR implementations. We analysed data based on an extension of DeLone and McLean's information system (IS) evaluation framework. The extended framework integrates DeLone and McLean's dimensions, including information quality, system quality, service quality, intention of use and usage, user satisfaction and net benefits, together with contingent dimensions, including systems development, implementation attributes and organisational aspects, as identified by Van der Meijden and colleagues. A mix of evidence-based positive and negative impacts of EHR was found across different evaluation dimensions. In addition, a number of contingent factors were found to contribute to successful implementation of EHR. This review does not include white papers or industry surveys, non-English papers, or those published outside the review time period. This review confirms the potential of this technology to aid patient care and clinical documentation; for example, in improved documentation quality, increased administration efficiency, as well as better quality, safety and coordination of care. Common negative impacts include changes to workflow and work disruption. Mixed observations were found on EHR quality, adoption and satisfaction. The review warns future implementers of EHR to carefully undertake the technology implementation exercise. The review also informs healthcare providers of contingent factors that potentially affect EHR development and implementation in an organisational setting. Our findings suggest a lack of socio-technical connectives between the clinician, the patient and the technology in developing and implementing EHR and future developments in patient-accessible EHR. In addition, a synthesis of DeLone and McLean's framework and Van der Meijden and colleagues' contingent factors has been found useful in comprehensively understanding and evaluating EHR implementations. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

Maternity Care Services and Culture: A Systematic Global Mapping of Interventions

PubMed Central

Coast, Ernestina; Jones, Eleri; Portela, Anayda; Lattof, Samantha R.

2014-01-01

Background A vast body of global research shows that cultural factors affect the use of skilled maternity care services in diverse contexts. While interventions have sought to address this issue, the literature on these efforts has not been synthesised. This paper presents a systematic mapping of interventions that have been implemented to address cultural factors that affect women's use of skilled maternity care. It identifies and develops a map of the literature; describes the range of interventions, types of literature and study designs; and identifies knowledge gaps. Methods and Findings Searches conducted systematically in ten electronic databases and two websites for literature published between 01/01/1990 and 28/02/2013 were combined with expert-recommended references. Potentially eligible literature included journal articles and grey literature published in English, French or Spanish. Items were screened against inclusion and exclusion criteria, yielding 96 items in the final map. Data extracted from the full text documents are presented in tables and a narrative synthesis. The results show that a diverse range of interventions has been implemented in 35 countries to address cultural factors that affect the use of skilled maternity care. Items are classified as follows: (1) service delivery models; (2) service provider interventions; (3) health education interventions; (4) participatory approaches; and (5) mental health interventions. Conclusions The map provides a rich source of information on interventions attempted in diverse settings that might have relevance elsewhere. A range of literature was identified, from narrative descriptions of interventions to studies using randomised controlled trials to evaluate impact. Only 23 items describe studies that aim to measure intervention impact through the use of experimental or observational-analytic designs. Based on the findings, we identify avenues for further research in order to better document and measure the impact of interventions to address cultural factors that affect use of skilled maternity care. PMID:25268940

[Evaluation of Contextual Factors in Psychosomatic Rehabilitation].

PubMed

Bülau, N I; Kessemeier, F; Petermann, F; Bassler, M; Kobelt, A

2016-12-01

Objectives: Although individualized and ICF-oriented implementation of rehabilitation treatment requires knowledge of relevant contextual factors, there is a lack of operationalized documentation and measurement tools to evaluate these factors. Therefore, an ICF-oriented semi-structured interview was designed. Methods: 20 contextual factors were externally assessed whether they negatively affected mental functioning and participation of psychosomatic patients. Additionally, psychometric scales were applied. Results: Six relevant impairing contextual factors were identified. Contextual factors significantly correlated with psychometric scales. Patients with higher contextual impairment showed significantly higher psychological stress levels. Conclusions: Anamnesis of contextual factors at the beginning of psychosomatic rehabilitation yields important information for therapy planning. Further research on contextual factors in medical rehabilitation is needed. © Georg Thieme Verlag KG Stuttgart · New York.

Factors affecting adoption, implementation fidelity, and sustainability of the Redesigned Community Health Fund in Tanzania: a mixed methods protocol for process evaluation in the Dodoma region

PubMed Central

Kalolo, Albino; Radermacher, Ralf; Stoermer, Manfred; Meshack, Menoris; De Allegri, Manuela

2015-01-01

Background Despite the implementation of various initiatives to address low enrollment in voluntary micro health insurance (MHI) schemes in sub-Saharan Africa, the problem of low enrollment remains unresolved. The lack of process evaluations of such interventions makes it difficult to ascertain whether their poor results are because of design failures or implementation weaknesses. Objective In this paper, we describe a process evaluation protocol aimed at opening the ‘black box’ to evaluate the implementation processes of the Redesigned Community Health Fund (CHF) program in the Dodoma region of Tanzania. Design The study employs a cross-sectional mixed methods design and is being carried out 3 years after the launch of the Redesigned CHF program. The study is grounded in a conceptual framework which rests on the Diffusion of Innovation Theory and the Implementation Fidelity Framework. The study utilizes a mixture of quantitative and qualitative data collection tools (questionnaires, focus group discussions, in-depth interviews, and document review), and aligns the evaluation to the Theory of Intervention developed by our team. Quantitative data will be used to measure program adoption, implementation fidelity, and their moderating factors. Qualitative data will be used to explore the responses of stakeholders to the intervention, contextual factors, and moderators of adoption, implementation fidelity, and sustainability. Discussion This protocol describes a systematic process evaluation in relation to the implementation of a reformed MHI. We trust that the theoretical approaches and methodologies described in our protocol may be useful to inform the design of future process evaluations focused on the assessment of complex interventions, such as MHI schemes. PMID:26679408

Predictors of Success for Electronic Health Record Implementation in Small Physician Practices

PubMed Central

Ancker, J.S.; Singh, M.P.; Thomas, R.; Edwards, A.; Snyder, A.; Kashyap, A.; Kaushal, R.

2013-01-01

Background The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 – 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them. PMID:23650484

Newborn screening 50 years later: access issues faced by adults with PKU

PubMed Central

Berry, Susan A.; Brown, Christine; Grant, Mitzie; Greene, Carol L.; Jurecki, Elaina; Koch, Jean; Moseley, Kathryn; Suter, Ruth; van Calcar, Sandra C.; Wiles, Judy; Cederbaum, Stephen

2013-01-01

Fifty years after the implementation of universal newborn screening programs for phenylketonuria, the first disease identified through newborn screening and considered a success story of newborn screening, a cohort of adults with phenylketonuria treated from birth provides valuable information about effects of long-term treatment for inborn errors of metabolism in general, and phenylketonuria specifically. For phenylketonuria, newborn screening allows early implementation of the phenylalanine-restricted diet, eliminating the severe neurocognitive and neuromotor impairment associated with untreated phenylketonuria. However, executive function impairments and psychiatric problems are frequently reported even for those treated early and continuously with the phenylalanine-restricted diet alone. Moreover, a large percentage of adults with phenylketonuria are reported as lost to follow-up by metabolic clinics. While a group of experts identified by the National Institutes of Health convenes to update treatment guidelines for phenylketonuria, we explore individual patient, social, and economic factors preventing >70% of adult phenylketonuria patients in the United States from accessing treatment. As more conditions are identified through newborn screening, factors affecting access to treatment grow in importance, and we must continue to be vigilant in assessing and addressing factors that affect patient treatment outcomes and not just celebrate amelioration of the most severe manifestations of disease. Genet Med 2013:15(8):591–599 PMID:23470838

Newborn screening 50 years later: access issues faced by adults with PKU.

PubMed

Berry, Susan A; Brown, Christine; Grant, Mitzie; Greene, Carol L; Jurecki, Elaina; Koch, Jean; Moseley, Kathryn; Suter, Ruth; van Calcar, Sandra C; Wiles, Judy; Cederbaum, Stephen

2013-08-01

Fifty years after the implementation of universal newborn screening programs for phenylketonuria, the first disease identified through newborn screening and considered a success story of newborn screening, a cohort of adults with phenylketonuria treated from birth provides valuable information about effects of long-term treatment for inborn errors of metabolism in general, and phenylketonuria specifically. For phenylketonuria, newborn screening allows early implementation of the phenylalanine-restricted diet, eliminating the severe neurocognitive and neuromotor impairment associated with untreated phenylketonuria. However, executive function impairments and psychiatric problems are frequently reported even for those treated early and continuously with the phenylalanine-restricted diet alone. Moreover, a large percentage of adults with phenylketonuria are reported as lost to follow-up by metabolic clinics. While a group of experts identified by the National Institutes of Health convenes to update treatment guidelines for phenylketonuria, we explore individual patient, social, and economic factors preventing >70% of adult phenylketonuria patients in the United States from accessing treatment. As more conditions are identified through newborn screening, factors affecting access to treatment grow in importance, and we must continue to be vigilant in assessing and addressing factors that affect patient treatment outcomes and not just celebrate amelioration of the most severe manifestations of disease.

Senior managers' viewpoints toward challenges of implementing clinical governance: a national study in iran.

PubMed

Ravaghi, Hamid; Heidarpour, Peigham; Mohseni, Maryam; Rafiei, Sima

2013-11-01

Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government's intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers' viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers' attitude toward CG and ultimately affected the success of quality improvement activities.

Changing the use of electronic fetal monitoring and labor support: a case study of barriers and facilitators.

PubMed

Graham, Ian D; Logan, Jo; Davies, Barbara; Nimrod, Carl

2004-12-01

Decreasing the use of continuous electronic fetal monitoring and increasing professional labor support for low-risk pregnancies are recommended by the Society of Obstetricians and Gynecologists of Canada. This study explored factors influencing the successful (and unsuccessful) introduction of an evidence-based fetal health surveillance guideline. This qualitative case study was conducted at two tertiary and one community hospital. Data were collected in 14 clinician focus groups (51 nurses), followed by 8 interviews with nurse administrators and educators. Analysis of verbatim transcripts and unit records included coding and categorizing data to form profiles that were compared across hospitals. Implementation of the guideline recommendations in the hospital settings was affected by many different factors originating in the practice environment, with the potential adopters, and related to the characteristics of the guideline. The influences of these diverse factors interacted sometimes to magnify or counteract each other's effect. The physical setting, adopter concerns, and the medicolegal issues surrounding the guideline played critical roles in uptake. In addition, changes preceding the introduction of the recommendations, the institution's agenda, and nursing and medical leadership influenced the uptake of guideline recommendations. The number and experience of nurses in each setting and availability of equipment also affected guideline acceptance and use. When implementing best practice, it is important to identify organizational barriers to the change that will need managing by the appropriate level of administration in the organization. Careful tailoring of implementation interventions to the barriers originating with the potential adopters is also necessary. Be prepared for unanticipated effects.

What determines successful implementation of inpatient information technology systems?

PubMed

Spetz, Joanne; Burgess, James F; Phibbs, Ciaran S

2012-03-01

To identify the factors and strategies that were associated with successful implementation of hospital-based information technology (IT) systems in US Department of Veterans Affairs (VA) hospitals, and how these might apply to other hospitals. Qualitative analysis of 118 interviews conducted at 7 VA hospitals. The study focused on the inpatient setting, where nurses are the main patient-care providers; thus, the research emphasized the impact of Computerized Patient Record System and Bar Code Medication Administration on nurses. Hospitals were selected to represent a range of IT implementation dates, facility sizes, and geography. The subjects included nurses, pharmacists, physicians, IT staff, and managers. Interviews were guided by a semi-structured interview protocol, and a thematic analysis was conducted, with initial codes drawn from the content of the interview guides. Additional themes were proposed as the coding was conducted. Five broad themes arose as factors which affected the process and success of implementation: (1) organizational stability and implementation team leadership, (2) implementation timelines, (3) equipment availability and reliability, (4) staff training, and (5) changes in work flow Overall IT implementation success in the VA depended on: (1) whether there was support for change from both leaders and staff, (2) development of a gradual and flexible implementation approach, (3) allocation of adequate resources for equipment and infrastructure, hands-on support, and deployment of additional staff, and (4) how the implementation team planned for setbacks, and continued the process to achieve success. Problems that developed in the early stages of implementation tended to become persistent, and poor implementation can lead to patient harm.

Modeling a hierarchical structure of factors influencing exploitation policy for water distribution systems using ISM approach

NASA Astrophysics Data System (ADS)

Jasiulewicz-Kaczmarek, Małgorzata; Wyczółkowski, Ryszard; Gładysiak, Violetta

2017-12-01

Water distribution systems are one of the basic elements of contemporary technical infrastructure of urban and rural areas. It is a complex engineering system composed of transmission networks and auxiliary equipment (e.g. controllers, checkouts etc.), scattered territorially over a large area. From the water distribution system operation point of view, its basic features are: functional variability, resulting from the need to adjust the system to temporary fluctuations in demand for water and territorial dispersion. The main research questions are: What external factors should be taken into account when developing an effective water distribution policy? Does the size and nature of the water distribution system significantly affect the exploitation policy implemented? These questions have shaped the objectives of research and the method of research implementation.

New technology planning and approval: critical factors for success.

PubMed

Haselkorn, Ateret; Rosenstein, Alan H; Rao, Anil K; Van Zuiden, Michele; Coye, Molly J

2007-01-01

The steady evolution of technology, with the associated increased costs, is a major factor affecting health care delivery. In the face of limited capital resources, it is important for hospitals to integrate technology management with the strategic plan, mission, and resource availability of the organization. Experiences in technology management have shown that having a well-organized, consistent approach to technology planning, assessment, committee membership, approval, evaluation, implementation, and monitoring are key factors necessary to ensure a successful program. We examined the results of a survey that assessed the structure, processes, and cultural support behind hospital committees for new technology planning and approval.

Broadcasting satellite service synthesis using gradient and cyclic coordinate search procedures

NASA Technical Reports Server (NTRS)

Reilly, C. H.; Mount-Campbell, C. A.; Gonsalvez, D. J.; Martin, C. H.; Levis, C. A.; Wang, C. W.

1986-01-01

Two search techniques are considered for solving satellite synthesis problems. Neither is likely to find a globally optimal solution. In order to determine which method performs better and what factors affect their performance, we design an experiment and solve the same problem under a variety of starting solution configuration-algorithm combinations. Since there is no randomization in the experiment, we present results of practical, rather than statistical, significance. Our implementation of a cyclic coordinate search procedure clearly finds better synthesis solutions than our implementation of a gradient search procedure does with our objective of maximizing the minimum C/I ratio computed at test points on the perimeters of the intended service areas. The length of the available orbital arc and the configuration of the starting solution are shown to affect the quality of the solutions found.

Broadcasting satellite service synthesis using gradient and cyclic coordinate search procedures

NASA Technical Reports Server (NTRS)

Reilly, C. H.; Mount-Campbell, C. A.; Gonsalvez, D. J.; Martin, C. H.; Levis, C. A.

1986-01-01

Two search techniques are considered for solving satellite synthesis problems. Neither is likely to find a globally optimal solution. In order to determine which method performs better and what factors affect their performance, an experiment is designed and the same problem is solved under a variety of starting solution configuration-algorithm combinations. Since there is no randomization in the experiment, results of practical, rather than statistical, significance are presented. Implementation of a cyclic coordinate search procedure clearly finds better synthesis solutions than implementation of a gradient search procedure does with the objective of maximizing the minimum C/I ratio computed at test points on the perimeters of the intended service areas. The length of the available orbital arc and the configuration of the starting solution are shown to affect the quality of the solutions found.

The Buck Stops Here: Tying What Students Learn to What Educators Earn

ERIC Educational Resources Information Center

Slotnik, William J.

2010-01-01

Performance pay can be implemented in ways that are helpful to students and teachers, or it can repeat the mistakes of the past. To avoid these mistakes, initiatives must address the district factors that affect schools. There are six cornerstones for compensation reform: 1) Performance-based compensation is a systemic reform; 2) Compensation…

Students' Intention to Take Online Courses in High School: A Structural Equation Model of Causality and Determinants

ERIC Educational Resources Information Center

Badri, Masood; Al Rashedi, Asma; Yang, Guang; Mohaidat, Jihad; Al Hammadi, Arif

2016-01-01

Offering an online integrated high-school course or subject for the first time involves many challenges. Better understanding the factors that affect students' willingness to participate in the experience could provide support for better implementation of such a strategic initiative. In addition, it is important to understand how personal factors…

An Empirical Study of the Factors Affecting Weblog Success in Higher Education

ERIC Educational Resources Information Center

Zhang, Sonya

2013-01-01

The use of classroom blogs in higher education serves to engage and motivate students as well as to help them build a professional online profile and connect with fellow classmates. Although many studies have focused on the implementation and benefits of blogging in education, few have investigated best practices in design, which can have a…

Curriculum Integration in Context: An Exploration of How Structures and Circumstances Affect Design and Implementation.

ERIC Educational Resources Information Center

Johnson, Amy Bell; Charner, Ivan; White, Robin

In order to obtain firsthand information about different approaches and strategies for curriculum integration, case studies of curriculum integration models were conducted in seven sites across the United States. It was concluded that the presence or lack of certain contextual factors related to structure and operations had implications for the…

Reading Strategy Instruction and Teacher Change: Implications for Teacher Training

ERIC Educational Resources Information Center

Klapwijk, Nanda M.

2012-01-01

I report on teacher change in the context of a reading strategy instruction intervention. Reading Strategy Instruction (RSI) was implemented by three teachers, new to the concept, over a period of 15 weeks. Observations of these teachers showed that a multitude of factors affect the uptake of RSI as part of everyday teaching practice, and that…

Factors Affecting Innovation Within Aeronautical Systems Center (ASC) Organizations - An inductive Study

DTIC Science & Technology

2003-03-01

device…” (Freeman, 1982: 5). Amabile and Conti also support this definition; they believe that innovation is the successful implementation of...creative ideas within organizations ( Amabile and Conti, 1996: 1154). A large proportion of the available literature supports the definition that...organization. This area is for general comments. 70 Bibliography Amobile, Teresa M. and Conti

How Do the Different Types of Computer Use Affect Math Achievement?

ERIC Educational Resources Information Center

Flores, Raymond; Inan, Fethi; Lin, Zhangxi

2013-01-01

In this study, the National Educational Longitudinal Study (ELS:2002) dataset was used and a predictive data mining technique, decision tree analysis, was implemented in order to examine which factors, in conjunction to computer use, can be used to predict high or low probability of success in high school mathematics. Specifically, this study…

Improving the Achievement of Second Year Natural Resource Management Students of Madawalabu University through Cooperative Learning

ERIC Educational Resources Information Center

Abdulahi, Mohammed Mussa; Hashim, Hakim; Kawo, Mohammed

2017-01-01

The purpose of this action research is to improve the achievement of students in general and, to examine the perception of students and teachers about cooperative learning, to identify major factors affecting the implementation of cooperative learning and to identify the possible strategies used to improve cooperative learning in Madawalabu…

M-Readiness Assessment Model Development and Validation: Investigation of Readiness Index and Factors Affecting Readiness

ERIC Educational Resources Information Center

Bakhsh, Muhammad; Mahmood, Amjad; Sangi, Nazir Ahmed

2018-01-01

It is important for distance learning institutions to be well prepared before designing and implementing any new technology based learning system to justify the investment and minimize failure risk. It can be achieved by systematically assessing the readiness of all stakeholders. This paper first proposes an m-readiness assessment process and…

Factors affecting student achievement in science: A study of teacher beliefs

NASA Astrophysics Data System (ADS)

Hayes, Jonathan

This study employed a mixed methods and mixed model research design to explore secondary science teachers' beliefs. Specifically, this study focused on factors that secondary science teachers believe affect student achievement in science, and the extent to which teacher beliefs transfer to teacher practice. This study is significant because the outcomes may inform professional development and policy decisions at the school, district, and provincial level. Results from self-reporting data of 82 secondary science teachers indicate that teacher beliefs in each of the fourteen topics surveyed (Classroom Management, Learning Styles, Inclusion, Equity, Science-Technology-Society (STS), Formative Assessment, Summative Assessment, Constructivism, Thematic Approach, Hands-On/Minds-On Activities, The Nature of Science, Science Subject Matter, Electronic Learning and Cooperative Learning) are positive for most Prince Edward Island (P.E.I.) secondary science teachers. Furthermore, secondary science teachers reported having strong beliefs in their ability to affect student learning (self-efficacy beliefs). However, it is apparent from the survey and interview data that teachers believe there are other influential factors that are preventing some students from learning despite the teachers' best efforts and ability. Regarding implementation, this study indicates that beliefs and the enactment of beliefs in classroom practice are positively correlated. The data also shows that at least seventy percent of teachers reported that they implement practices consistent with all but two topics -- The Nature of Science and Electronic Learning -- at least once a week. The findings of this study are discussed in the context of the P.E.I. secondary science setting. Limitations and implications of this study are also addressed.

Factors affecting student success in a first-year mathematics course: a South African experience

NASA Astrophysics Data System (ADS)

Kizito, Rita; Munyakazi, Justin; Basuayi, Clement

2016-01-01

In spite of sustained efforts tertiary institutions implement to try and improve student academic performance, the number of students succeeding in first-year mathematics courses remains disturbingly low. For most students, the gap between their mathematical capability and the competencies they are expected and need to develop to function effectively in these courses persists even after course instruction. In this study, an instrument for identifying and examining factors affecting student performance and success in a first-year Mathematics university course was developed and administered to 86 students. The overall Cronbach's Alpha coefficient for the questionnaire was found to be 0.916. Having identified variables from prior research known to affect student performance, factor analysis was used to identify variables exhibiting the greatest impact on student performance. The variables included prior academic knowledge, workload, student approaches to learning, assessment, student support teaching quality, methods and resources. From the analysis, students' perceptions of their workload emerged as the factor having the greatest impact on student's performance, followed by the matriculation examination score. The findings are discussed and strategies that can be used to improve teaching and contribute to student success in a first-year mathematics course in a South African context are presented.

Investigation on influence of Wurster coating process parameters for the development of delayed release minitablets of Naproxen.

PubMed

Shah, Neha; Mehta, Tejal; Aware, Rahul; Shetty, Vasant

2017-12-01

The present work aims at studying process parameters affecting coating of minitablets (3 mm in diameter) through Wurster coating process. Minitablets of Naproxen with high drug loading were manufactured using 3 mm multi-tip punches. The release profile of core pellets (published) and minitablets was compared with that of marketed formulation. The core formulation of minitablets was found to show similarity in dissolution profile with marketed formulation and hence was further carried forward for functional coating over it. Wurster processing was implemented to pursue functional coating over core formulation. Different process parameters were screened and control strategy was applied for factors significantly affecting the process. Modified Plackett Burman Design was applied for studying important factors. Based on the significant factors and minimum level of coating required for functionalization, optimized process was executed. Final coated batch was evaluated for coating thickness, surface morphology, and drug release study.

The effects of pay-for-performance on tuberculosis treatment in Taiwan.

PubMed

Li, Ya-Hsin; Tsai, Wen-Chen; Khan, Mahmud; Yang, Wen-Ta; Lee, Tsuey-Fong; Wu, Yi-Chun; Kung, Pei-Tseng

2010-07-01

In order to make tuberculosis (TB) treatment more effective and to lower the transmission rate of the disease, the Bureau of National Health Insurance (BNHI) in Taiwan implemented the 'Pay-for-Performance on Tuberculosis' programme (P4P on TB) in 2004. This study investigates the effectiveness of the P4P system in terms of cure rate and length of treatment. This retrospective study obtained information on all TB cases in the national data sets of Taiwan for the years 2002 to 2005. The number of cases in pre-P4P years (2002 and 2003) was 25 754, compared with 33 536 in the post-P4P implementation years (2004 and 2005). The effectiveness of the programme was evaluated by comparing the TB cure rate and length of treatment before and after the implementation of the P4P programme, and between participating and non-participating hospitals. Logistic regression analysis was conducted to explore the factors affecting TB patients' cure rate within a 12-month treatment period. The cure rate and the average length of treatment before the implementation of P4P were 46.9% and 256.24 days, respectively, compared with 63.0% and 249.74 days after implementation of P4P. The cure rate and length of treatment in P4P hospitals were 68.1% and 249.13 days, respectively, compared with 42.4% and 53.71 days in non-P4P hospitals. This study found that both the cure rate and average length of treatment for cured cases improved significantly after the implementation of the P4P on TB programme in Taiwan. Compared with non-P4P hospitals, P4P hospitals had significantly better treatment outcomes. Patients' age, income level, the physician density of a patient's place of residence, and whether the hospital has joined the P4P on TB programme are factors affecting the treatment outcomes of TB patients in Taiwan.

Investigating healthcare IT innovations: a "conceptual blending" approach.

PubMed

Cranfield, Steven; Hendy, Jane; Reeves, Barnaby; Hutchings, Andrew; Collin, Simon; Fulop, Naomi

2015-01-01

The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS). To analyse these multi-level dynamics, the authors blend Rogers' diffusion of innovations theory (DoIT) with Webster's sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts. Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application - in particular speed, ease of use, reliability and flexibility and levels of readiness - were highly relevant but their influence was modulated through interaction with complex structural and relational issues. Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of "co-construction" between designers and end-users. The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes.

Identification of major factors in Australian primary care pharmacists' practice environment that have a bearing on the implementation of professional models of practice.

PubMed

Jackson, John K; Hussainy, Safeera Y; Kirkpatrick, Carl M J

2017-08-01

Objective The aim of the present study was to describe an environmental framework for pharmacists in primary care in Australia and determine the major factors within that environment that have the greatest bearing on their capacity to implement patient-focused models of professional practice. Methods A draft framework for pharmacists' practice was developed by allocating structures, systems and related factors known to the researchers or identified from the literature as existing within pharmacists' internal, operational and external environments to one of five domains: Social, Technological, Economic, Environmental or Political [STEEP]. Focus groups of pharmacists used an adapted nominal group technique to assess the draft and add factors where necessary. Where applicable, factors were consolidated into groups to establish a revised framework. The three major factors or groups in each domain were identified. The results were compared with the enabling factors described in the profession's vision statement. Results Seventy-eight individual factors were ultimately identified, with 86% able to be grouped. The three dominant groups in each of the five domains that had a bearing on the implementation of professional models of practice were as follows: (1) Social: the education of pharmacists, their beliefs and the capacity of the pharmacist workforce; (2) Technological: current and future practice models, technology and workplace structures; (3) Economic: funding of services, the viability of practice and operation of the Pharmaceutical Benefits Scheme; (4) Environmental: attitudes and expectations of stakeholders, including consumers, health system reform and external competition; and (5) Political: regulation of practice, representation of the profession and policies affecting practice. Conclusions The three dominant groups of factors in each of the five STEEP environmental domains, which have a bearing on pharmacists' capacity to implement patient-focused models of practice, correlate well with the enabling factors identified in the profession's vision statement, with the addition of three factors in the Environmental domain of stakeholder attitudes, health system reform and external competition. What is known about the topic? The extensive range of patient-focused professional programs developed for application by pharmacists in primary care in Australia has yet to be widely implemented. What does this paper add? Factors both within and beyond the pharmacists' immediate practice environment that have a bearing on the uptake of professional programs have been identified and prioritised using a structured thematic approach. What are the implications for practitioners? The results demonstrate the need for a multifactorial approach to the implementation of professional models of practice in this setting.

Bio-psycho-social factors affecting sexual self-concept: A systematic review.

PubMed

Potki, Robabeh; Ziaei, Tayebe; Faramarzi, Mahbobeh; Moosazadeh, Mahmood; Shahhosseini, Zohreh

2017-09-01

Nowadays, it is believed that mental and emotional aspects of sexual well-being are the important aspects of sexual health. Sexual self-concept is a major component of sexual health and the core of sexuality. It is defined as the cognitive perspective concerning the sexual aspects of 'self' and refers to the individual's self-perception as a sexual creature. The aim of this study was to assess the different factors affecting sexual self-concept. English electronic databases including PubMed, Scopus, Web of Science and Google Scholar as well as two Iranian databases including Scientific Information Database and Iranmedex were searched for English and Persian-language articles published between 1996 and 2016. Of 281 retrieved articles, 37 articles were finally included for writing this review article. Factors affecting sexual self-concept were categorized to biological, psychological and social factors. In the category of biological factors, age gender, marital status, race, disability and sexual transmitted infections are described. In the psychological category, the impact of body image, sexual abuse in childhood and mental health history are present. Lastly, in the social category, the roles of parents, peers and the media are discussed. As the development of sexual self-concept is influenced by multiple events in individuals' lives, to promotion of sexual self-concept, an integrated implementation of health policies is recommended.

Using an interdisciplinary approach to identify factors that affect clinicians' compliance with evidence-based guidelines.

PubMed

Gurses, Ayse P; Marsteller, Jill A; Ozok, A Ant; Xiao, Yan; Owens, Sharon; Pronovost, Peter J

2010-08-01

Our objective was to identify factors that affect clinicians' compliance with the evidence-based guidelines using an interdisciplinary approach and develop a conceptual framework that can provide a comprehensive and practical guide for designing effective interventions. A literature review and a brainstorming session with 11 researchers from a variety of scientific disciplines were used to identify theoretical and conceptual models describing clinicians' guideline compliance. MEDLINE, EMBASE, CINAHL, and the bibliographies of the papers identified were used as data sources for identifying the relevant theoretical and conceptual models. Thirteen different models that originated from various disciplines including medicine, rural sociology, psychology, human factors and systems engineering, organizational management, marketing, and health education were identified. Four main categories of factors that affect compliance emerged from our analysis: clinician characteristics, guideline characteristics, system characteristics, and implementation characteristics. Based on these findings, we developed an interdisciplinary conceptual framework that specifies the expected interrelationships among these four categories of factors and their impact on clinicians' compliance. An interdisciplinary approach is needed to improve clinicians' compliance with evidence-based guidelines. The conceptual framework from this research can provide a comprehensive and systematic guide to identify barriers to guideline compliance and design effective interventions to improve patient safety.

[Factors affecting the control of blood pressure and lipid levels in patients with cardiovascular disease: the PREseAP Study].

PubMed

Orozco-Beltrán, Domingo; Brotons, Carlos; Moral, Irene; Soriano, Nuria; Del Valle, María A; Rodríguez, Ana I; Pepió, Josep M; Pastor, Ana

2008-03-01

The aim of this observational study was to identify factors influencing the control of blood pressure (i.e., <140/90 mmHg, or <130/80 mmHg in diabetic patients) and low-density lipoprotein (LDL) cholesterol level (<100 mg/dL) in 1223 patients with cardiovascular disease. Overall, 70.2% of patients were men, and their mean age was 66.4 years. Blood pressure was poorly controlled in 50.9% (95% confidence interval [CI], 46.9%-54.8%) and the LDL cholesterol level was poorly controlled in 60.1% (95% CI, 56.3%-63.9%). Determinants of poor blood pressure control were diabetes, hypertension, no previous diagnosis of heart failure, previous diagnosis of peripheral artery disease or stroke, obesity, and no lipid-lowering treatment. Determinants of poor LDL cholesterol control were no lipid-lowering treatment, no previous diagnosis of ischemic heart disease, no antihypertensive treatment, and dyslipidemia. The factors affecting blood pressure control were different from those affecting LDL cholesterol control, an observation that should be taken into account when implementing treatment recommendations for achieving therapeutic objectives in secondary prevention.

Confronting the realities of implementing contextual learning ideas in a biology classroom

NASA Astrophysics Data System (ADS)

Akers, Julia B.

1999-10-01

The purpose of this study was to describe the implementation of contextual learning practices in a biology class. Research contends that contextual learning classrooms are active learning environments where students are involved in "hands-on" team projects and the teacher assumes a facilitator role. In this student-centered classroom, students take ownership and responsibility for their own learning. This study examined these assertions and other factors that emerged as the study developed. The research methods used were qualitative. The subject for this study was a biology teacher with twenty-six years of experience who implemented contextual learning practices in two of her biology classes in the 1997--98 school year. As the teacher confronted contextual learning, we engaged in collaborative research that included fourteen interviews transcribed verbatim for analysis, classroom observations and the teacher's written reports. Throughout the study, factors developed that adversely affected contextual learning practices. These factors were discipline, curriculum, and administrative decisions over which the teacher had no control. These are examined along with their consequences for implementing a contextual classroom. Successful practices that worked in the teacher's classroom were also determined and included the teacher's "failure is not an option" policy, mandatory tutoring, behavior contracts, high expectations and teamed projects. Besides contextual learning, a key component of the study was the collaborative research process and its meaning to the subject, the researcher and future researchers who attempt this collaborative approach. The study's conclusion indicate that scheduling, multiple repeaters, discipline and the state Standards of Learning moved the teacher away from contextual learning practices to a more teacher-directed classroom. Two recommendations of this study are that further research is needed to study how the state Standards of Learning have affected instructional practices and the effect of administrative decisions that influence the level of teacher success in the classroom.

Determinant Factors in Applying Picture Archiving and Communication Systems (PACS) in Healthcare.

PubMed

Abdekhoda, Mohammadhiwa; Salih, Kawa Mirza

2017-01-01

Meaningful use of picture archiving and communication systems (PACS) can change the workflow for accessing digital images, lead to faster turnaround time, reduce tests and examinations, and increase patient throughput. This study was carried out to identify determinant factors that affect the adoption of PACS by physicians. This was a cross-sectional study in which 190 physicians working in a teaching hospital affiliated with Tehran University of Medical Sciences were randomly selected. Physicians' perceptions concerning the adoption of PACS were assessed by the conceptual path model of the Unified Theory of Acceptance and Use of Technology (UTAUT). Collected data were analyzed with regression analysis. Structural equation modeling was applied to test the final model that was developed. The results show that the UTAUT model can explain about 61 percent of the variance on in the adoption of PACS ( R 2 = 0.61). The findings also showed that performance expectancy, effort expectancy, social influences, and behavior intention have a direct and significant effect on the adoption of PACS. However, facility condition showed to have no significant effect on physicians' behavior intentions. Implementation of new technology such as PACS in the healthcare sector is unavoidable. Our study clearly identified significant and nonsignificant factors that may affect the adoption of PACS. Also, this study acknowledged that physicians' perception is a key factor to manage the implementation of PACS optimally, and this fact should be considered by healthcare managers and policy makers.

Determinant Factors in Applying Picture Archiving and Communication Systems (PACS) in Healthcare

PubMed Central

Abdekhoda, Mohammadhiwa; Salih, Kawa Mirza

2017-01-01

Objectives Meaningful use of picture archiving and communication systems (PACS) can change the workflow for accessing digital images, lead to faster turnaround time, reduce tests and examinations, and increase patient throughput. This study was carried out to identify determinant factors that affect the adoption of PACS by physicians. Methods This was a cross-sectional study in which 190 physicians working in a teaching hospital affiliated with Tehran University of Medical Sciences were randomly selected. Physicians’ perceptions concerning the adoption of PACS were assessed by the conceptual path model of the Unified Theory of Acceptance and Use of Technology (UTAUT). Collected data were analyzed with regression analysis. Structural equation modeling was applied to test the final model that was developed. Results The results show that the UTAUT model can explain about 61 percent of the variance on in the adoption of PACS (R2 = 0.61). The findings also showed that performance expectancy, effort expectancy, social influences, and behavior intention have a direct and significant effect on the adoption of PACS. However, facility condition showed to have no significant effect on physicians’ behavior intentions. Conclusions Implementation of new technology such as PACS in the healthcare sector is unavoidable. Our study clearly identified significant and nonsignificant factors that may affect the adoption of PACS. Also, this study acknowledged that physicians’ perception is a key factor to manage the implementation of PACS optimally, and this fact should be considered by healthcare managers and policy makers. PMID:28855856

Factors influencing physicians' choice of workplace: systematic review of drivers of attrition and policy interventions to address them.

PubMed

El Koussa, Maria; Atun, Rifat; Bowser, Diana; Kruk, Margaret E

2016-12-01

The movement of skilled physicians from the public to the private sector is a key constraint to achieving universal health coverage and is currently affecting health systems worldwide. This systematic review aims to assess factors influencing physicians' choice of workplace, and policy interventions for retaining physicians in the public sector. Five literature databases were searched. Studies were included in the review if they focused on at least one of the following criteria: (i) incentives or motivators for retaining physicians in the public sector, (ii) pull factors that encouraged physicians to move to the private sector, (iii) push factors that forced physicians to leave the public sector, (iv) policy interventions or case studies that addressed physician retention in the public sector, and (v) qualitative reviews of policy interventions that were implemented in different health system settings. Nineteen articles met the inclusion criteria. Six major themes that affected physicians' choice of workplace were identified including: financial incentives, career development, infrastructure and staffing, professional work environment, workload and autonomy. The majority of the studies suggested that the use of financial incentives was a motivator in retaining physicians in the public sector. The review also identified policy interventions including: regulatory controls, incentives and management reforms. Regulatory controls and incentives were the two most frequently reported policy interventions. While factors affecting physicians' choice of workplace are country specific, financial incentives and professional development are core factors. Other factors are highly influenced by context, and thus, it would be useful for future cross-country research to use standardized data collection tools, allowing comparison of contextual factors as well as the examination of how context affects physician retention in the public sector.

Factors influencing physicians’ choice of workplace: systematic review of drivers of attrition and policy interventions to address them

PubMed Central

El Koussa, Maria; Atun, Rifat; Bowser, Diana; Kruk, Margaret E

2016-01-01

Objectives The movement of skilled physicians from the public to the private sector is a key constraint to achieving universal health coverage and is currently affecting health systems worldwide. This systematic review aims to assess factors influencing physicians’ choice of workplace, and policy interventions for retaining physicians in the public sector. Methods Five literature databases were searched. Studies were included in the review if they focused on at least one of the following criteria: (i) incentives or motivators for retaining physicians in the public sector, (ii) pull factors that encouraged physicians to move to the private sector, (iii) push factors that forced physicians to leave the public sector, (iv) policy interventions or case studies that addressed physician retention in the public sector, and (v) qualitative reviews of policy interventions that were implemented in different health system settings. Results Nineteen articles met the inclusion criteria. Six major themes that affected physicians’ choice of workplace were identified including: financial incentives, career development, infrastructure and staffing, professional work environment, workload and autonomy. The majority of the studies suggested that the use of financial incentives was a motivator in retaining physicians in the public sector. The review also identified policy interventions including: regulatory controls, incentives and management reforms. Regulatory controls and incentives were the two most frequently reported policy interventions. Conclusion While factors affecting physicians’ choice of workplace are country specific, financial incentives and professional development are core factors. Other factors are highly influenced by context, and thus, it would be useful for future cross–country research to use standardized data collection tools, allowing comparison of contextual factors as well as the examination of how context affects physician retention in the public sector. PMID:27648254

Physical activity and metabolic disease among people with affective disorders: Prevention, management and implementation.

PubMed

Vancampfort, Davy; Stubbs, Brendon

2017-12-15

One in ten and one in three of people with affective disorders experience diabetes and metabolic syndrome respectively. Physical activity (PA) and sedentary behaviour (SB) are key risk factors that can ameliorate the risk of metabolic disease among this population. However, PA is often seen as luxury and/or a secondary component within the management of people with affective disorders. The current article provides a non-systematic best-evidence synthesis of the available literature, detailing a number of suggestions for the implementation of PA into clinical practice. Whilst the evidence is unequivocal for the efficacy of PA to prevent and manage metabolic disease in the general population, it is in its infancy in this patient group. Nonetheless, action must be taken now to ensure that PA and reducing SB are given a priority to prevent and manage metabolic diseases and improve wider health outcomes. PA should be treated as a vital sign and all people with affective disorders asked about their activity levels and if appropriate advised to increase this. There is a need for investment in qualified exercise specialists in clinical practice such as physiotherapists to undertake and oversee PA in practice. Behavioural strategies such as the self-determined theory should be employed to encourage adherence. Funding is required to develop the evidence base and elucidate the optimal intervention characteristics. PA interventions should form an integral part of the multidisciplinary management of people with affective disorders and our article outlines the evidence and strategies to implement this in practice. Copyright © 2016 Elsevier B.V. All rights reserved.

Assessing ERP SAP implementation in the small and medium enterprises (SMEs) in Indonesia

NASA Astrophysics Data System (ADS)

Yohannes; Gunawan, W.; Ikhsan, R. B.; Aries

2018-03-01

The consistent growth of Indonesian SMEs has received attention of global IT vendors. One of major ERP player in Indonesian market such as SAP, has introduced ERP solutions for SMEs through SAP Business One. Due to its fast growth, unfortunately, there are still very few articles can be found to understand the ERP implementation in Indonesian SMEs. The article addressed the common factors that affect the successful of the ERP implementation at SMEs. They are: identifying vendor quality, opening balance data migration, and A-SAP methodology. The article applied case study method to examine the fast growth companies owned by same owners, such as: GRK, MMM, and KM25; with the objectives to identify the practical pattern of ERP implementation in SMEs that will be useful for SAP project manager and consultants.

Design of training programs for a positive youth development program: Project P.A.T.H.S. in Hong Kong.

PubMed

Shek, Daniel T L; Chak, Yammy L Y

2010-01-01

To facilitate the implementation of the Secondary 1 to Secondary 3 program of the Project P.A.T.H.S. in Hong Kong, systematic training programs are designed for the potential program implementers. The rationales, objectives and design of the Secondary 1 to Secondary 3 training programs are outlined in this paper. The training programs cover theories of adolescent development, positive youth development, background and curricula of the Project P.A.T.H.S., factors affecting program implementation quality and evaluation of the project. Besides introducing the curriculum units, the training programs also focus on nature of learning and related theories (particularly experiential learning), teaching methods and instructional techniques, motivating students, and classroom management.

Overcoming Molehills and Mountains Implementing a New Program

NASA Technical Reports Server (NTRS)

Salute, Joan; McDougal, John; Stephens, Karen

2011-01-01

This slide presentation reviews some of the challenges and accomplishments of implementing a new program. The purpose of the presentation is to: (1) Share the challenges that were encountered formulating a new program concurrent with formulating & implementing new spacecraft development projects: (a) Immature mission concepts put on the fast track (b) Need to reconcile ambitious objectives with cost and budget reality (c) Changes of major stakeholders (d) Timing, timing, timing (e) Changing ground rules, assumptions, and risk tolerance (f) The role of centers, (2) Share the successes to date despite the challenges (3) Demonstrate how interdependencies between the program, projects, NASA HQ environment, and external political forces affect the process, and how expectations must be managed while dealing with external factors and great change.

Could autonomous motivation hold the key to successfully implementing lifestyle changes in affective disorders? A multicentre cross sectional study.

PubMed

Vancampfort, Davy; Madou, Tomas; Moens, Herman; De Backer, Tanja; Vanhalst, Patrick; Helon, Chris; Naert, Pieter; Rosenbaum, Simon; Stubbs, Brendon; Probst, Michel

2015-07-30

There is a need for theoretically-based research on the motivational processes linked to the adoption and maintenance of an active lifestyle in people with affective disorders. Within the Self-Determination Theory (SDT) framework, we investigated the SDT tenets in people with major depressive disorder or bipolar disorder by examining the factor structure of the Behavioural Regulation in Exercise Questionnaire-2 (BREQ-2) and by investigating associations between motivation, the Positive and Negative Affect Scale (PANAS) and International Physical Activity Questionnaire (IPAQ) scores. A total of 165 patients (105 ♀) (45.6 ± 14.2 years) agreed to participate. An exploratory factor analysis demonstrated sufficient convergence with the original factor for amotivation, and external and introjected regulation. The items of identified and intrinsic regulation loaded on the same factor, which was labelled autonomous regulation. Significant correlations were found between the total IPAQ score and the subscales amotivation, external regulation, introjected regulation and autonomous regulation. The relative autonomy index (RAI) was associated with the PANAS scores. Differences in RAI were found between physically inactive and active participants. Our results suggest that in people with affective disorders the level of autonomous motivation may play an important role in the adoption and maintenance of health promoting behaviours. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

An analytical hierarchy process-based study on the factors affecting legislation on plastic bags in the USA.

PubMed

Li, Zhongguo; Zhao, Fu

2017-08-01

Annually, a large number of used plastic shopping bags are released into the environment, posing significant threats to public health and wildlife. Owing to these concerns, many local, regional, and national governments around the world have passed legislation to ban or restrict the use of plastic shopping bags. However, in the USA there are only 18 states that have approved plastic bag bans/fees, and even within these states these regulations do not cover all cities or counties. There are many factors that could affect the development and implementation of these regulations. This article employs an analytical hierarchy process to analyse the factors that could impact the enactment of plastic bag regulations. Five impact factors are identified based on statistical data, that is, geographical location, interest of industry achievable, cost of living, level of economic development, and educational level of population. The weights of the five impact factors are determined and it is found that the possibility of banning or restricting plastic bags in general follows a certain pattern among all states.

Ferroelectrics for semiconductor devices

NASA Astrophysics Data System (ADS)

Sayer, M.; Wu, Z.; Vasant Kumar, C. V. R.; Amm, D. T.; Griswold, E. M.

1992-11-01

The technology for the implementation of the integration of thin film ferroelectrics with silicon processing for various devices is described, and factors affecting the integration of ferroelectric films with semiconductor processing are discussed. Consideration is also given to film properties, the properties of electrode materials and structures, and the phenomena of ferroelectric fatigue and aging. Particular attention is given to the nonmemory device application of ferroelectrics.

Managing Threat, Cost, and Incentive to Kill: The Short- and Long-Term Effects of Intervention in Mass Killings

ERIC Educational Resources Information Center

Kathman, Jacob D.; Wood, Reed M.

2011-01-01

How do third-party interventions affect the severity of mass killings? The authors theorize that episodes of mass killing are the consequence of two factors: (1) the threat perceptions of the perpetrators and (2) the cost of implementing genocidal policies relative to other alternatives. To reduce genocidal hostilities, interveners must address…

Implementation of Low-Fat, Low-Sugar, and Portion-Controlled Nutrition Guidelines in Competitive Food Venues of Maine Public High Schools

ERIC Educational Resources Information Center

Whatley Blum, Janet E.; Davee, Anne-Marie; Devore, Rachel L.; Beaudoin, Christina M.; Jenkins, Paul L.; Kaley, Lori A.; Wigand, Debra A.

2007-01-01

Background: The prevalence of childhood "overweight" and "at risk for overweight" has become a major public health concern. School food environments can affect key nutritional risk factors, especially in high schools where foods of poor nutrient value are pervasive in a la carte and vending programs. This study examines a la…

Teacher Factors Affecting the Implementation of Early Childhood Development Education in Kericho Municipality, Kericho County

ERIC Educational Resources Information Center

Mutindi, Koech Zipporah; Chepngeno, Kabwos Rebecca; Jeruto, Beatrice

2016-01-01

Childhood education is crucial in the life of a child because it lays the foundation of intellectual and physical development. Concerns have been raised over the state of the ECDE programmes with regard to the negative teacher attitudes towards selection and use of instructional resources due to low remuneration, lack of time and demotivation. The…

Factors Affecting the Distribution and Access to Athletic Opportunities for New Jersey High School Students

ERIC Educational Resources Information Center

Casarico, Paul

2013-01-01

The requirement for continuous improvements and the lack of funds for schools to properly implement all the mandates puts schools in the inevitable position of having to make tough decisions with regards to programs. The central theme of NCLB requires states to adopt a plan for accountability that will lead to increased achievement for all…

Teacher Expectations of Students: A Self-Fulfilling Prophecy? The Progress of Education Reform. Volume 13, Number 6

ERIC Educational Resources Information Center

Workman, Emily

2012-01-01

Teachers are the single most important in-school factor that affects student achievement. As a result, over the last decade state leaders have taken aim at increasing educator effectiveness, including requiring the implementation of new teacher evaluation systems. A growing body of research suggests that the expectations a teacher sets for an…

Performance Analysis and Optimization on the UCLA Parallel Atmospheric General Circulation Model Code

NASA Technical Reports Server (NTRS)

Lou, John; Ferraro, Robert; Farrara, John; Mechoso, Carlos

1996-01-01

An analysis is presented of several factors influencing the performance of a parallel implementation of the UCLA atmospheric general circulation model (AGCM) on massively parallel computer systems. Several modificaitons to the original parallel AGCM code aimed at improving its numerical efficiency, interprocessor communication cost, load-balance and issues affecting single-node code performance are discussed.

Senior Managers’ Viewpoints Toward Challenges of Implementing Clinical Governance: A National Study in Iran

PubMed Central

Ravaghi, Hamid; Heidarpour, Peigham; Mohseni, Maryam; Rafiei, Sima

2013-01-01

Background: Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government’s intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. Methods: A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Results: Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers’ viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Conclusion: Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers’ attitude toward CG and ultimately affected the success of quality improvement activities. PMID:24596887

Strengthening decentralized primary healthcare planning in Nigeria using a quality improvement model: how contexts and actors affect implementation.

PubMed

Eboreime, Ejemai Amaize; Nxumalo, Nonhlanhla; Ramaswamy, Rohit; Eyles, John

2018-05-08

Quality improvement models have been applied across various levels of health systems with varying success leading to scepticisms about effectiveness. Health systems are complex, influenced by contexts and characterized by numerous interests. Thus, a shift in focus from examining whether improvement models work, to understanding why, when and where they work most effectively is essential. Nigeria introduced DIVA (Diagnose-Intervene-Verify-Adjust) as a model to strengthen decentralized PHC planning. However, implementation has been poorly sustained. This article explores the role of actors and context in implementation and sustainability of DIVA in two local government areas (LGAs) in Nigeria. We employed an integrated mixed method approach in which qualitative data was used in conjunction with quantitative to understand effects of actors and contexts on implementation outcomes. We analysed policy documents and conducted interviews with PHC managers. Then using the Model for Understanding Success in Quality (MUSIQ), we measured contextual factors affecting implementation of DIVA in the selected LGAs. The LGAs scored 117.42 and 104.67 out of 168 points on the MUSIQ scale, respectively, indicating contextual barriers exist. Both have strong DIVA team attributes, but these could not independently ensure quality implementation. Although external support accounted for the greatest contextual disparities, the utmost implementation challenges relate to subnational government leadership, management, financial and technical support. Although higher levels of government may set visionary goals for PHC, interventions are potentially skewed towards donor interests at lower (implementation) levels. Thus, subnational political will is a key determinant of quality implementation. Consequently, advocacy for responsible and accountable political governance is essential in comparable decentralized contexts.

How organizational escalation prevention potential affects success of implementation of innovations: electronic medical records in hospitals.

PubMed

Lambooij, Mattijs S; Koster, Ferry

2016-05-20

Escalation of commitment is the tendency that (innovation) projects continue, even if it is clear that they will not be successful and/or become extremely costly. Escalation prevention potential (EPP), the capability of an organization to stop or steer implementation processes that do not meet their expectations, may prevent an organization of losing time and money on unsuccessful projects. EPP consists of a set of checks and balances incorporated in managerial practices that safeguard management against irrational (but very human) decisions and may limit the escalation of implementation projects. We study whether successful implementation of electronic medical records (EMRs) relates to EPP and investigate the organizational factors accounting for this relationship. Structural equation modelling (SEM), using questionnaire data of 427 doctors and 631 nurses who had experience with implementation and use of EMRs in hospitals, was applied to study whether formal governance and organizational culture mediate the relationship between EPP and the perceived added value of EMRs. Doctors and nurses in hospitals with more EPP report more successful implementation of EMR (in terms of perceived added value of the EMR). Formal governance mediates the relation between EPP and implementation success. We found no evidence that open or innovative culture explains the relationship between EPP and implementation success. There is a positive relationship between the level of EPP and perceived added value of EMRs. This relationship is explained by formal governance mechanisms of organizations. This means that management has a set of tangible tools to positively affect the success of innovation processes. However, it also means that management needs to be able to critically reflect on its (previous) actions and decisions and is willing to change plans if elements of EPP signal that the implementation process is hampered.

Effects of Platform Design on the Customer Experience in an Online Solar PV Marketplace

DOE Office of Scientific and Technical Information (OSTI.GOV)

OShaughnessy, Eric J; Margolis, Robert M; Leibowicz, Benjamin

Residential solar photovoltaic (PV) customers are increasingly buying PV systems in online marketplaces, where customers can compare multiple quotes from several installers on quote platforms. In this study, we use data from an online marketplace to explore how quote platform design affects customer experiences. We analyze how four design changes affected customer experiences in terms of factors such as prices. We find that three of the four design changes are associated with statistically significant and robust price reductions, even though none of the changes were implemented specifically to reduce prices. The results suggest that even seemingly small platform design changesmore » can affect PV customer experiences in online marketplaces.« less

The conception of the alternative and the decision to divorce.

PubMed

Kalb, M

1983-07-01

Despite soaring divorce rates and the effect of divorce on the individual, family, and society, professional scientific literature examining the factors governing the decision to divorce has been scant. The author suggests that the key variable affecting the decision to divorce can best be understood through an exploration of the individual's conception of the alternative. The factors that comprise the conception of the alternative are discussed and the problems inherent in its valid construction by the patient are examined. The therapeutic implementation of this conception is outlined.

Health information technology and dynamic capabilities.

PubMed

Leung, Ricky C

2012-01-01

Health information technology (HIT) purports to increase quality and efficiency in health care organizations. However, health care organizations are situated in constantly changing environments. They need dynamic capabilities to implement HIT effectively. This article builds on the dynamic capabilities perspective and generates propositions about implementing HIT in dynamic environments. Specifically, I identify the (1) the necessary resources and capabilities for organizations to implement HIT; (2) the organizational capabilities and benefits that can be enhanced by HIT; and (3) the similarities and differences between three distinct forms of HIT. I synthesized the literature on dynamic capabilities and HIT to identify dynamic capabilities that are associated with (1) electronic medical records, (2) telemedicine, and (3) social media. In addition, I discuss the benefits of these HITs for improving the dynamic capabilities of health care organizations. PROPOSITIONS/FINDINGS: This article generates three sets of propositions that can be tested empirically. First, I am concerned with how organizational size and human resources affect successful implementation of HIT. In addition, I argue that three technology-specific factors--hospital type, medical specialty, and socially desirable technical features--may affect the implementation of HIT. To cope with constantly changing environmental pressures, health administrators need to deploy, modify, and/or acquire organizational resources skillfully. Practitioners need to identify dynamic capabilities to support specific forms of HIT and understand how HIT enables health care organizations in turn. The concept of evolutionary fitness in the dynamic capabilities perspective may be developed to measure HIT implementation.

A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol.

PubMed

Gordon, Elisa J; Lee, Jungwha; Kang, Raymond H; Caicedo, Juan Carlos; Holl, Jane L; Ladner, Daniela P; Shumate, Michelle D

2018-05-16

The shortage of organs for kidney transplantation for patients with end-stage renal disease (ESRD) is magnified in Hispanics/Latin Americans in the United States. Living donor kidney transplantation (LDKT) is the treatment of choice for ESRD. However, compared to their representation on the transplant waitlist, fewer Hispanics receive a LDKT than non-Hispanic whites. Barriers to LDKT for Hispanics include: lack of knowledge, cultural concerns, and language barriers. Few interventions have been designed to reduce LDKT disparities. This study aims to reduce Hispanic disparities in LDKT through a culturally targeted intervention. Using a prospective effectiveness-implementation hybrid design involving pre-post intervention evaluation with matched controls, we will implement a complex culturally targeted intervention at two transplant centers in Dallas, TX and Phoenix, AZ. The goal of the study is to evaluate the effect of Northwestern Medicine's® Hispanic Kidney Transplant Program's (HKTP) key culturally targeted components (outreach, communication, education) on Hispanic LDKT rates over five years. The main hypothesis is that exposure to the HKTP will reduce disparities by increasing the ratio of Hispanic to non-Hispanic white LDKTs and the number of Hispanic LDKTs. We will also examine other process and outcome measures including: dialysis patient outreach, education session attendance, marketing efforts, Hispanic patients added to the waitlist, Hispanic potential donors per potential recipient, and satisfaction with culturally competent care. We will use mixed methods based on the Promoting Action on Research Implementation in Health Services (revised PARIHS) and the Consolidated Framework for Implementation Research (CFIR) frameworks to formatively evaluate the fidelity and innovative adaptations to HKTP's components at both study sites, to identify moderating factors that most affect implementation fidelity, and to identify adaptations that positively and negatively affect outcomes for patients. Our study will provide new knowledge about implementing culturally targeted interventions and their impact on reducing health disparities. Moreover, the study of a complex organizational-level intervention's implementation over five years is rare in implementation science; as such, this study is poised to contribute new knowledge to the factors influencing how organizational-level interventions are sustained over time. (ClinicalTrials.gov registration # NCT03276390 , date of registration: 9-7-17, retrospectively registered).

Pathways to Medical Home Recognition: A Qualitative Comparative Analysis of the PCMH Transformation Process.

PubMed

Mendel, Peter; Chen, Emily K; Green, Harold D; Armstrong, Courtney; Timbie, Justin W; Kress, Amii M; Friedberg, Mark W; Kahn, Katherine L

2017-12-15

To understand the process of practice transformation by identifying pathways for attaining patient-centered medical home (PCMH) recognition. The CMS Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration was designed to help FQHCs achieve NCQA Level 3 PCMH recognition and improve patient outcomes. We used a stratified random sample of 20 (out of 503) participating sites for this analysis. We developed a conceptual model of structural, cultural, and implementation factors affecting PCMH transformation based on literature and initial qualitative interview themes. We then used conventional cross-case analysis, followed by qualitative comparative analysis (QCA), a cross-case method based on Boolean logic algorithms, to systematically identify pathways (i.e., combinations of factors) associated with attaining-or not attaining-Level 3 recognition. Site-level indicators were derived from semistructured interviews with site leaders at two points in time (mid- and late-implementation) and administrative data collected prior to and during the demonstration period. The QCA results identified five distinct pathways to attaining PCMH recognition and four distinct pathways to not attaining recognition by the end of the demonstration. Across these pathways, one condition (change leader capacity) was common to all pathways for attaining recognition, and another (previous improvement or recognition experience) was absent in all pathways for not attaining recognition. In general, sites could compensate for deficiencies in one factor with capacity in others, but they needed a threshold of strengths in cultural and implementation factors to attain PCMH recognition. Future efforts at primary care transformation should take into account multiple pathways sites may pursue. Sites should be assessed on key cultural and implementation factors, in addition to structural components, in order to differentiate interventions and technical assistance. © Health Research and Educational Trust.

Establishing partnership with traditional birth attendants for improved maternal and newborn health: a review of factors influencing implementation.

PubMed

Miller, Tina; Smith, Helen

2017-10-19

Recent World Health Organization recommendations recognize the important role Traditional Birth Attendants (TBAs) can play in supporting the health of women and newborns. This paper provides an analysis of key factors that affect the implementation of interventions to develop partnerships with TBAs to promote improved access to skilled care at birth. We conducted a secondary analysis of 20 papers identified through two systematic reviews that examined the effectiveness of interventions to find new roles for TBAs on maternal and newborn health outcomes, as well as papers identified through a systematic mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and implementation barriers and facilitators, as well as other contextual issues. This analysis identified countries that have implemented interventions to support the transition from birth with a TBA to birth with a skilled birth attendant. Drawing on the experiences of these countries, the analysis highlights factors that are important to consider when designing and implementing such interventions. Barriers to implementation included resistance to change in more traditional communities, negative attitudes between TBAs and skilled attendants and TBAs concerns about the financial implications of assuming new roles. Facilitating factors included stakeholder involvement in devising and implementing interventions, knowledge sharing between TBAs and skilled birth attendants, and formalised roles and responsibilities and remuneration for TBAs. The implementation barriers identified in this analysis could, if not addressed, prevent or discourage TBAs from carrying out newly defined roles supporting women in pregnancy and childbirth and linking them to the formal health system. This paper also identifies the factors that seem critical to success, which new programmes could consider adopting from the outset. In most cases a multi-faceted approach is needed to prepare TBAs and others for new roles, including the training of TBAs to strengthen their knowledge and skills to enable them to be able to assume new roles, alongside the sensitization of healthcare providers, communities, women and their families. Further research is required to map the transition process and stakeholder experiences in more detailed ways and to provide longer-term monitoring of existing interventions.

Structural and process factors affecting the implementation of antimicrobial resistance prevention and control strategies in U.S. hospitals.

PubMed

Chou, Ann F; Yano, Elizabeth M; McCoy, Kimberly D; Willis, Deanna R; Doebbeling, Bradley N

2008-01-01

To address increases in the incidence of infection with antimicrobial-resistant pathogens, the National Foundation for Infectious Diseases and Centers for Disease Control and Prevention proposed two sets of strategies to (a) optimize antibiotic use and (b) prevent the spread of antimicrobial resistance and control transmission. However, little is known about the implementation of these strategies. Our objective is to explore organizational structural and process factors that facilitate the implementation of National Foundation for Infectious Diseases/Centers for Disease Control and Prevention strategies in U.S. hospitals. We surveyed 448 infection control professionals from a national sample of hospitals. Clinically anchored in the Donabedian model that defines quality in terms of structural and process factors, with the structural domain further informed by a contingency approach, we modeled the degree to which National Foundation for Infectious Diseases and Centers for Disease Control and Prevention strategies were implemented as a function of formalization and standardization of protocols, centralization of decision-making hierarchy, information technology capabilities, culture, communication mechanisms, and interdepartmental coordination, controlling for hospital characteristics. Formalization, standardization, centralization, institutional culture, provider-management communication, and information technology use were associated with optimal antibiotic use and enhanced implementation of strategies that prevent and control antimicrobial resistance spread (all p < .001). However, interdepartmental coordination for patient care was inversely related with antibiotic use in contrast to antimicrobial resistance spread prevention and control (p < .0001). Formalization and standardization may eliminate staff role conflict, whereas centralized authority may minimize ambiguity. Culture and communication likely promote internal trust, whereas information technology use helps integrate and support these organizational processes. These findings suggest concrete strategies for evaluating current capabilities to implement effective practices and foster and sustain a culture of patient safety.

Establishing support groups for HIV-infected women: using experiences to develop guiding principles for project implementation.

PubMed

Visser, Maretha J; Mundell, Jonathan P

2008-07-01

HIV-infected women need support to deal with their diagnosis as well as with the stigma attached to HIV. As part of their practical training, Master's-level psychology students negotiated with the staff of four clinics in townships in Tshwane, South Africa, to establish support groups for HIV+ women and offered to assist them in facilitating the groups. This study aimed to understand why the implementation of groups was successful in one clinic and not other clinics. The student reports on their experiences and interaction with clinic staff and clients were used as sources of data. Using qualitative data analysis, different dynamics and factors that could affect project implementation were identified in each clinic. The socio-ecological and systems theories were used to understand implementation processes and obstacles in implementation. The metaphor of building a bridge over a gorge was used to describe the different phases in and obstacles to the implementation of the intervention. Valuable lessons were learnt, resulting in the development of guiding principles for the implementation of support groups in community settings.

Mental Health Problems in a School Setting in Children and Adolescents.

PubMed

Schulte-Körne, Gerd

2016-03-18

10-20% of children and adolescents have a mental health problem of some type. Manifestations such as attention deficits, cognitive disturbances, lack of motivation, and negative mood all adversely affect scholastic development. It is often unclear what factors associated with school affect children's mental development and what preventive measures and interventions at school might be effective. This review is based on systematic reviews, meta-analyses, and randomized and non-randomized controlled trials that were retrieved by a selective search in the PubMed, PsycInfo, and Google Scholar databases. The prevalence of hyperkinetic disorder is 1-6%. Its main manifestations are motor hyperactivity, an attention deficit, and impulsive behavior. Learning disorders such as dyscalculia and dyslexia affect 4-6% of children each, while 4-5% of children and adolescents suffer from depression, which is twice as prevalent in girls as in boys. Mental health problems increase the risk of repeating a grade, truancy, and dropping out of school. The risk of developing an internalizing or externalizing mental health problem can be lessened by changes in the school environment and by the implementation of evidencebased school programs. Physicians, in collaboration with school social workers and psychologists, should help teachers recognize and contend with mental health problems among the children and adolescents whom they teach, to enable the timely detection of stress factors at school and the initiation of the necessary measures and aids. In particular, the school-entrance examination and screening for risk factors at school can make a positive contribution. Evidence-based preventive programs should be implemented in schools, and beneficial changes of the school environment should be a further goal.

Using the Systems-Practice Framework to Understand Food Allergen Management Practices at College Catering Operations: A Qualitative Study.

PubMed

Verstappen, Jennie; Mirosa, Miranda; Thomson, Carla

2018-03-01

The number of individuals with food allergies or intolerances attending catered university residential colleges is increasing, and safe dining options are required to minimize the risk of allergic reactions and food-induced death. This qualitative research study sought to advance professional knowledge of the factors affecting allergen management practices, particularly pertaining to college foodservices. Three catered residential colleges affiliated with a major university in New Zealand were selected as research sites. The study used an ethnographic approach and systems-practice theory as a framework for data collection and organizing results. Data collection techniques included document analyses (3 hours per site), observations (6 to 8 hours per site), focus groups with foodservice workers (30 to 45 minutes per site, n=16), and interviews with foodservice managers (45 to 90 minutes per interview, n=5). Notes and transcripts were coded through the process of thematic analysis using NVivo for Mac software, version 11.1.1, to identify factors affecting allergen management practices. The main factors affecting allergen management practices at college foodservices included information provided by residents about dietary requirements; communication between residents and foodservice staff; systems for allergen management; attitude of foodservice staff; and college size. Detailed dietary information, effective communication with residents, sufficient resources, clarification of responsibilities, and thorough systems are required for staff to perform safe allergen management practices. Ultimately, successful implementation was predominantly determined by staff attitude. Foodservice managers are advised to identify motivators and address barriers of staff attitudes toward allergen management practices to promote successful implementation. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Challenges During Implementation of a Patient-Facing Mobile App for Surgical Rehabilitation: Feasibility Study

PubMed Central

Piper, Kalman; Bokor, Desmond; Martin, Paige; Lau, Victor SL; Coiera, Enrico

2017-01-01

Background Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in health care settings. Objective The aim of this study was to report challenges experienced when implementing mobile apps for patients to support their postsurgical rehabilitation in an orthopedic setting. Methods A mobile app was tailored to the needs of patients undergoing rotator cuff repair. A 30-min usability session and a 12-week feasibility study were conducted with patients to evaluate the app in routine care. Implementation records (observation reports, issues log, and email correspondence) explored factors that hindered or facilitated patient acceptance. Interviews with clinicians explored factors that influenced app integration in routine care. Results Participant completion was low (47%, 9/19). Factors that affected patient acceptance included digital literacy, health status, information technology (IT) infrastructure at home, privacy concerns, time limitations, the role of a caregiver, inconsistencies in instruction received from clinicians and the app, and app advice not reflective of patient progress over time. Factors that negatively influenced app integration in routine care included competing demands among clinicians, IT infrastructure in health care settings, identifying the right time to introduce the app to patients, user interface complexity for older patients, lack of coordination among multidisciplinary clinicians, and technical issues with app installation. Conclusions Three insights were identified for mobile app implementation in routine care: (1) apps for patients need to reflect their journey over time and in particular, postoperative apps ought to be introduced as part of preoperative care with opportunities for patients to learn and adopt the app during their postoperative journey; (2) strategies to address digital literacy issues among patients and clinicians are essential; and (3) impact of the app on patient outcomes and clinician workflow needs to be communicated, monitored, and reviewed. Lastly, digital health interventions should supplement but not replace patient interaction with clinicians. PMID:29217504

A qualitative study of contextual factors' impact on measures to reduce surgery cancellations.

PubMed

Hovlid, Einar; Bukve, Oddbjørn

2014-05-13

Contextual factors influence quality improvement outcomes. Understanding this influence is important when adapting and implementing interventions and translating improvements into new settings. To date, there is limited knowledge about how contextual factors influence quality improvement processes. In this study, we explore how contextual factors affected measures to reduce surgery cancellations, which are a persistent problem in healthcare. We discuss the usefulness of the theoretical framework provided by the model for understanding success in quality (MUSIQ) for this kind of research. We performed a qualitative case study at Førde Hospital, Norway, where we had previously demonstrated a reduction in surgery cancellations. We interviewed 20 clinicians and performed content analysis to explore how contextual factors affected measures to reduce cancellations of planned surgeries. We identified three common themes concerning how contextual factors influenced the change process: 1) identifying a need to change, 2) facilitating system-wide improvement, and 3) leader involvement and support. Input from patients helped identify a need to change and contributed to the consensus that change was necessary. Reducing cancellations required improving the clinical system. This improvement process was based on a strategy that emphasized the involvement of frontline clinicians in detecting and improving system problems. Clinicians shared information about their work by participating in improvement teams to develop a more complete understanding of the clinical system and its interdependencies. This new understanding allowed clinicians to detect system problems and design adequate interventions. Middle managers' participation in the improvement teams and in regular work processes was important for successfully implementing and adapting interventions. Contextual factors interacted with one another and with the interventions to facilitate changes in the clinical system, reducing surgery cancellations. The MUSIQ framework is useful for exploring how contextual factors influence the improvement process and how they influence one another. Discussing data in relation to a theoretical framework can promote greater uniformity in reporting findings, facilitating knowledge-building across studies.

Potential safety issues and other factors that may affect the introduction and uptake of rotavirus vaccines

PubMed Central

Aliabadi, N.; Tate, J.E.; Parashar, U.D.

2018-01-01

Rotavirus vaccines have demonstrated significant impact in reducing the burden of morbidity and mortality from childhood diarrhoea in countries that have implemented routine vaccination to date. Despite this success, in many countries, rotavirus vaccine coverage remains lower than that of other routine childhood vaccines. Several issues may potentially affect vaccine uptake, namely safety concerns related to intussusception with consequent age restrictions on rotavirus vaccination, contamination with porcine circovirus, vaccine-derived reassortant strains and hospitalization in newborn nurseries at time of administration of live oral rotavirus vaccine. In addition to these safety concerns, other factors may also affect uptake, including lower vaccine efficacy in the developing world, potential emergence of strains escaping from vaccine protection resulting in lower overall impact of a vaccination programme and sustainable vaccine financing. Although further work is needed to address some of these concerns, global policy bodies have reaffirmed that the benefits of rotavirus vaccination outweigh the risks, and vaccine use is recommended globally. PMID:27129416

Potential safety issues and other factors that may affect the introduction and uptake of rotavirus vaccines.

PubMed

Aliabadi, N; Tate, J E; Parashar, U D

2016-12-01

Rotavirus vaccines have demonstrated significant impact in reducing the burden of morbidity and mortality from childhood diarrhoea in countries that have implemented routine vaccination to date. Despite this success, in many countries, rotavirus vaccine coverage remains lower than that of other routine childhood vaccines. Several issues may potentially affect vaccine uptake, namely safety concerns related to intussusception with consequent age restrictions on rotavirus vaccination, contamination with porcine circovirus, vaccine-derived reassortant strains and hospitalization in newborn nurseries at time of administration of live oral rotavirus vaccine. In addition to these safety concerns, other factors may also affect uptake, including lower vaccine efficacy in the developing world, potential emergence of strains escaping from vaccine protection resulting in lower overall impact of a vaccination programme and sustainable vaccine financing. Although further work is needed to address some of these concerns, global policy bodies have reaffirmed that the benefits of rotavirus vaccination outweigh the risks, and vaccine use is recommended globally. Published by Elsevier Ltd.

Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults.

PubMed

Shuman, Clayton J; Xie, Xian-Jin; Herr, Keela A; Titler, Marita G

2017-11-01

Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.

A common evaluation framework for the African Health Initiative.

PubMed

Bryce, Jennifer; Requejo, Jennifer Harris; Moulton, Lawrence H; Ram, Malathi; Black, Robert E

2013-01-01

The African Health Initiative includes highly diverse partnerships in five countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia), each of which is working to improve population health by strengthening health systems and to evaluate the results. One aim of the Initiative is to generate cross-site learning that can inform implementation in the five partnerships during the project period and identify lessons that may be generalizable to other countries in the region. Collaborators in the Initiative developed a common evaluation framework as a basis for this cross-site learning. This paper describes the components of the framework; this includes the conceptual model, core metrics to be measured in all sites, and standard guidelines for reporting on the implementation of partnership activities and contextual factors that may affect implementation, or the results it produces. We also describe the systems that have been put in place for data management, data quality assessments, and cross-site analysis of results. The conceptual model for the Initiative highlights points in the causal chain between health system strengthening activities and health impact where evidence produced by the partnerships can contribute to learning. This model represents an important advance over its predecessors by including contextual factors and implementation strength as potential determinants, and explicitly including equity as a component of both outcomes and impact. Specific measurement challenges include the prospective documentation of program implementation and contextual factors. Methodological issues addressed in the development of the framework include the aggregation of data collected using different methods and the challenge of evaluating a complex set of interventions being improved over time based on continuous monitoring and intermediate results.

Staff development and secondary science teachers: Factors that affect voluntary participation

NASA Astrophysics Data System (ADS)

Corley, Theresa Roebuck

2000-10-01

A researcher-designed survey assessed the perceptions of Alabama secondary science public school teachers toward the need for staff development and toward certain staff development strategies and programs. Factors that encouraged or discouraged attendance at voluntary staff development programs and opinions regarding effective and ineffective features of programs were identified. Data were analyzed using descriptive techniques. Percentages and frequencies were noted. Average rankings were computed for the staff development techniques considered most and least effective and for the preferred designs of future staff development offerings. Chi squares were computed to respond to each of the 4 research hypotheses. Narrative discussions and tables were utilized to report the data and provide clarification. This study related demographic information to the research hypotheses. Analysis of the research hypotheses revealed that experienced teachers agree more strongly about the features of staff development programs that they consider effective and about the factors that may affect participation in staff development programs. Analysis of the research questions revealed that secondary science teachers in Alabama agree that staff development is a personal responsibility but that the school systems are responsible for providing staff development opportunities. Teachers believe that staff development is needed annually in both science content and teaching strategies and favor lengthening the school year for staff development. Teachers identified interest level, graduate credit, ability to implement material, scheduling factors, and the reputation of the organizer as the most important factors in determining participation in voluntary staff development programs. Hands-on workshops were identified as the most effective type of voluntary staff development and teachers requested that future staff development experiences include hands-on workshops, networking, curriculum development, mentoring, support groups, training trainers, cooperative learning groups, coaching, implementing changes, and collecting resources.

Surface or Deep Change? How Is a Curriculum Change Implemented at Ground Level?

ERIC Educational Resources Information Center

Sng, Bee Bee

2008-01-01

Purpose: The purpose of this paper is to find out how organizational and contextual factors affect a curriculum change in a University in Singapore. There is a need to research the processes of educational change in Singapore as rapid changes can result in complex problems. The university is chosen as it is at the forefront of the government's…

Lessons learned from the application of a participatory evaluation methodology to healthy municipalities, cities and communities initiatives in selected countries of the Americas.

PubMed

Rice, Marilyn; Franceschini, Maria Cristina

2007-01-01

Health promotion has made significant strides in the past few decades in the Americas. Creating a healthy and supportive setting, also known as the settings approach, continues to be one of the most widely used health promotion strategies. Interest in evaluating the effectiveness of these strategies has been increasing greatly in the past few years. Participatory evaluation holds great promise for helping to generate this evidence and promote understanding of the factors that affect, positively or negatively, the advances of health promotion in the Region. During 2004-2006, a Participatory Evaluation methodology was introduced into several countries in the Americas through formal trainings conducted by the Pan American Health Organization (PAHO) in collaboration with country partners. This article summarizes the main lessons learned from the application of the participatory evaluation methodology in various countries in Latin America and the Caribbean. Factors affecting the evaluation of the initiatives were identified at multiple levels (individual, community, organizational, political, economic, etc.). Specific issues that were addressed included the political context, turnover of personnel in key institutions, concerns related to the effectiveness of participatory processes, and the existence of strong and sustained leadership at the country level. These factors are intertwined and affect each other in very complex ways, a fact that was reflected in the municipalities' experiences with participatory evaluation. Challenges included the ability to secure resources for the evaluation, the time needed to conclude the process, and working in an intersectoral manner. However, participating municipalities reported that the process of implementing a participatory evaluation and working with various stakeholders had an empowering effect: communities and stakeholders were more willing and interested in participating in health promotion initiatives in a sustained manner; alliances and intersectoral collaboration were strengthened; communication channels were opened; and municipalities were stimulated to review their planning and implementation processes in order to more appropriately incorporate health promotion principles. The article concludes with recommendations to improve the planning and implementation process of participatory evaluation efforts.

Bio-psycho-social factors affecting sexual self-concept: A systematic review

PubMed Central

Potki, Robabeh; Ziaei, Tayebe; Faramarzi, Mahbobeh; Moosazadeh, Mahmood; Shahhosseini, Zohreh

2017-01-01

Background Nowadays, it is believed that mental and emotional aspects of sexual well-being are the important aspects of sexual health. Sexual self-concept is a major component of sexual health and the core of sexuality. It is defined as the cognitive perspective concerning the sexual aspects of ‘self’ and refers to the individual’s self-perception as a sexual creature. Objective The aim of this study was to assess the different factors affecting sexual self-concept. Methods English electronic databases including PubMed, Scopus, Web of Science and Google Scholar as well as two Iranian databases including Scientific Information Database and Iranmedex were searched for English and Persian-language articles published between 1996 and 2016. Of 281 retrieved articles, 37 articles were finally included for writing this review article. Results Factors affecting sexual self-concept were categorized to biological, psychological and social factors. In the category of biological factors, age gender, marital status, race, disability and sexual transmitted infections are described. In the psychological category, the impact of body image, sexual abuse in childhood and mental health history are present. Lastly, in the social category, the roles of parents, peers and the media are discussed. Conclusion As the development of sexual self-concept is influenced by multiple events in individuals’ lives, to promotion of sexual self-concept, an integrated implementation of health policies is recommended. PMID:29038693

A game of Chinese whispers in Malaysia: contextual analysis of child road safety education.

PubMed

Puvanachandra, Prasanthi; Kulanthayan, Subramaniam; Hyder, Adnan A

2012-11-01

In 2006, the Malaysian government began implementing road safety education (RSE) programs in primary schools, involving numerous stakeholders. We interviewed 19 stakeholders. Thematic analysis led to the identification of four themes: road traffic injuries (RTIs) among children in Malaysia, the role of RSE, factors affecting successful implementation, and intersectoral involvement. The latter was identified as a significant strength of the overall approach to implementation, and is one of the first examples in Malaysia and in the region of such an approach. Lack of official documentation surrounding ownership, funding responsibilities, and roles among the various sectors led to resistance from some groups. Although we know from scientific studies what works in terms of reducing RTIs, the more important question is how such interventions can be successfully and sustainably implemented, particularly in low- and middle-income countries (LMIC). The results of this study permit stronger understanding of issues surrounding the implementation of RTI interventions in LMIC.

Practical Framework: Implementing OEE Method in Manufacturing Process Environment

NASA Astrophysics Data System (ADS)

Maideen, N. C.; Sahudin, S.; Mohd Yahya, N. H.; Norliawati, A. O.

2016-02-01

Manufacturing process environment requires reliable machineries in order to be able to satisfy the market demand. Ideally, a reliable machine is expected to be operated and produce a quality product at its maximum designed capability. However, due to some reason, the machine usually unable to achieved the desired performance. Since the performance will affect the productivity of the system, a measurement technique should be applied. Overall Equipment Effectiveness (OEE) is a good method to measure the performance of the machine. The reliable result produced from OEE can then be used to propose a suitable corrective action. There are a lot of published paper mentioned about the purpose and benefit of OEE that covers what and why factors. However, the how factor not yet been revealed especially the implementation of OEE in manufacturing process environment. Thus, this paper presents a practical framework to implement OEE and a case study has been discussed to explain in detail each steps proposed. The proposed framework is beneficial to the engineer especially the beginner to start measure their machine performance and later improve the performance of the machine.

Optimisation of a parallel ocean general circulation model

NASA Astrophysics Data System (ADS)

Beare, M. I.; Stevens, D. P.

1997-10-01

This paper presents the development of a general-purpose parallel ocean circulation model, for use on a wide range of computer platforms, from traditional scalar machines to workstation clusters and massively parallel processors. Parallelism is provided, as a modular option, via high-level message-passing routines, thus hiding the technical intricacies from the user. An initial implementation highlights that the parallel efficiency of the model is adversely affected by a number of factors, for which optimisations are discussed and implemented. The resulting ocean code is portable and, in particular, allows science to be achieved on local workstations that could otherwise only be undertaken on state-of-the-art supercomputers.

Clinical and economic impact of an antibiotics stewardship programme in a regional hospital in Hong Kong.

PubMed

Ng, C K; Wu, T C; Chan, W M J; Leung, Y S W; Li, C K P; Tsang, D N C; Leung, G M

2008-10-01

Inappropriate use of antibiotics is one of the important factors attributing to emergence of drug-resistant pathogens. Infection with multidrug-resistant pathogens adversely affects quality of medical care. Queen Elizabeth Hospital, an 1800-bed acute service hospital in Hong Kong. Antibiotics are commonly prescribed for treating acute infections. Reduce inappropriate prescription of broad-spectrum antibiotics and overall antibiotic prescription through implementation of a multidisciplinary antibiotics stewardship programme (ASP). A multidisciplinary programme involving policy and guideline formulation, education and feedback, monthly antibiotic consumption and cost monitoring, antimicrobial susceptibility pattern reporting and concurrent feedbacks for commonly prescribed broad-spectrum antibiotics was implemented in 2004. Predefined logistics to prescribe "restricted" antibiotics were formulated and implemented with collaborative efforts from clinical and non-clinical departments. The programme was supported by management at department and hospital levels. Broad-spectrum antibiotics were prescribed inappropriately in 28.9% (n = 192) clinical scenarios. The ASP reduced the restricted and total antibiotic consumption as well as the antibiotics-related costs. Predefined clinical outcomes were not adversely affected. Economic analysis suggested that the extra human cost in running ASP could be offset by savings from antibiotic expenditure. It is cost-effective to implement a multidisciplinary ASP in acute service hospitals as the programme reduces antibiotic consumption and results in overall cost savings. The quality of medical care is not jeopardized as the important clinical outcomes are not adversely affected. The generalisability and sustainability of ASPs in other clinical contexts warrant further studies to ensure the continuous success of this programme.

'It is not a quick fix' structural and contextual issues that affect implementation of integrated health and well-being services: a qualitative study from North East England.

PubMed

Cheetham, M; Visram, S; Rushmer, R; Greig, G; Gibson, E; Khazaeli, B; Wiseman, A

2017-11-01

The objective of this article is to examine the factors affecting the design, commissioning and delivery of integrated health and well-being services (IHWSs), which seek to address multiple health-related behaviours, improve well-being and tackle health inequalities using holistic approaches. Qualitative studies embedded within iterative process evaluations. Semi-structured interviews conducted with 16 key informants as part of two separate evaluations of IHWSs in North East England, supplemented by informal observations of service delivery. Transcripts and fieldnotes were analysed thematically. The study findings identify a challenging organisational context in which to implement innovative service redesign, as a result of budget cuts and changes in NHS and local authority capacity. Pressures to demonstrate outcomes affected the ability to negotiate the practicalities of joint working. Progress is at risk of being undermined by pressures to disinvest before the long-term benefits to population health and well-being are realised. The findings raise important questions about contract management and relationships between commissioners and providers involved in implementing these new ways of working. These findings provide useful learning in terms of the delivery and commissioning of similar IHWSs, contributing to understanding of the benefits and challenges of this model of working. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Analysis on the restriction factors of the green building scale promotion based on DEMATEL

NASA Astrophysics Data System (ADS)

Wenxia, Hong; Zhenyao, Jiang; Zhao, Yang

2017-03-01

In order to promote the large-scale development of the green building in our country, DEMATEL method was used to classify influence factors of green building development into three parts, including green building market, green technology and macro economy. Through the DEMATEL model, the interaction mechanism of each part was analyzed. The mutual influence degree of each barrier factor that affects the green building promotion was quantitatively analysed and key factors for the development of green building in China were also finally determined. In addition, some implementation strategies of promoting green building scale development in our country were put forward. This research will show important reference value and practical value for making policies of the green building promotion.

Institutional Readiness for Interprofessional Education Among Nutrition and Dietetics and Athletic Training Education Programs.

PubMed

Eliot, Kathrin; Breitbach, Anthony; Wilson, Mardell; Chushak, Maria

2017-01-01

Organizations recommend interprofessional education (IPE) as a means of promoting collaborative patient-centered care. In turn, various external accreditors in the health professions have integrated IPE competencies into their standards. However, little is known about how athletic training (AT) and nutrition and dietetics (ND) have incorporated IPE into their educational programs. This study examined institutional factors that affect the level of IPE participation within ND and AT programs in the United States. The Interprofessional Education Assessment and Planning Instrument for Academic Institutions was distributed electronically to directors of accredited programs in ND and AT. In addition to gathering demographic information, survey questions addressed the institutions' level of involvement and commitment to IPE. Differences emerged between ND and AT programs for several items in the instrument. Factors that affected the differences included program level and academic unit in which the program resides. Results also suggest that ND and AT programs have similar levels of IPE participation, but there are great opportunities for growth. Institutional factors such resource commitment, academic unit type, and level of program may affect implementation and contribute to the development and success of IPE initiatives.

Factors influencing the adoption of health information technologies: a systematic review

PubMed Central

Garavand, Ali; Mohseni, Mohammah; Asadi, Heshmatollah; Etemadi, Manal; Moradi-Joo, Mohammad; Moosavi, Ahmad

2016-01-01

Introduction The successful implementation of health information technologies requires investigating the factors affecting the acceptance and use of them. The aim of this study was to determine the most important factors affecting the adoption of health information technologies by doing a systematic review on the factors affecting the acceptance of health information technology. Methods This systematic review was conducted by searching the major databases, such as Google Scholar, Emerald, Science Direct, Web of Science, Pubmed, and Scopus. We used various keywords, such as adoption, use, acceptance of IT in medicine, hospitals, and IT theories in health services, and we also searched on the basis of several important technologies, such as Electronic Health Records (HER), Electronic Patient Records (EPR), Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), Hospital Information System (HIS), Picture Archiving and Communication System (PACS), and others in the 2004–2014 period. Results The technology acceptance model (TAM) is the most important model used to identify the factors influencing the adoption of information technologies in the health system; also, the unified theory of acceptance and use of technology (UTAUT) model has had a lot of applications in recent years in the health system. Ease of use, usefulness, social impact, facilitating conditions, attitudes and behavior of users are effective in the adoption of health information technologies. Conclusion By considering various factors, including ease of use, usefulness, and social impact, the rate of the adoption of health information technology can be increased. PMID:27757179

Factors influencing the adoption of health information technologies: a systematic review.

PubMed

Garavand, Ali; Mohseni, Mohammah; Asadi, Heshmatollah; Etemadi, Manal; Moradi-Joo, Mohammad; Moosavi, Ahmad

2016-08-01

The successful implementation of health information technologies requires investigating the factors affecting the acceptance and use of them. The aim of this study was to determine the most important factors affecting the adoption of health information technologies by doing a systematic review on the factors affecting the acceptance of health information technology. This systematic review was conducted by searching the major databases, such as Google Scholar, Emerald, Science Direct, Web of Science, Pubmed, and Scopus. We used various keywords, such as adoption, use, acceptance of IT in medicine, hospitals, and IT theories in health services, and we also searched on the basis of several important technologies, such as Electronic Health Records (HER), Electronic Patient Records (EPR), Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), Hospital Information System (HIS), Picture Archiving and Communication System (PACS), and others in the 2004-2014 period. The technology acceptance model (TAM) is the most important model used to identify the factors influencing the adoption of information technologies in the health system; also, the unified theory of acceptance and use of technology (UTAUT) model has had a lot of applications in recent years in the health system. Ease of use, usefulness, social impact, facilitating conditions, attitudes and behavior of users are effective in the adoption of health information technologies. By considering various factors, including ease of use, usefulness, and social impact, the rate of the adoption of health information technology can be increased.

Factors affecting knowledge transfer from continuing professional education to clinical practice: Development and psychometric properties of a new instrument.

PubMed

Vasli, Parvaneh; Dehghan-Nayeri, Nahid; Khosravi, Laleh

2018-01-01

Despite the emphasis placed on the implementation of continuing professional education programs in Iran, researchers or practitioners have not developed an instrument for assessing the factors that affect the knowledge transfer from such programs to clinical practice. The aim of this study was to design and validate such instrument for the Iranian context. The research used a three-stage mix method. In the first stage, in-depth interviews with nurses and content analysis were conducted, after which themes were extracted from the data. In the second stage, the findings of the content analysis and literature review were examined, and preliminary instrument options were developed. In the third stage, qualitative content validity, face validity, content validity ratio, content validity index, and construct validity using exploratory factor analysis was conducted. The reliability of the instrument was measured before and after the determination of construct validity. Primary tool instrument initially comprised 53 items, and its content validity index was 0.86. In the multi-stage factor analysis, eight questions were excluded, thereby reducing 11 factors to five and finally, to four. The final instrument with 43 items consists of the following dimensions: structure and organizational climate, personal characteristics, nature and status of professionals, and nature of educational programs. Managers can use the Iranian instrument to identify factors affecting knowledge transfer of continuing professional education to clinical practice. Copyright © 2017. Published by Elsevier Ltd.

Determination of injection molding process windows for optical lenses using response surface methodology.

PubMed

Tsai, Kuo-Ming; Wang, He-Yi

2014-08-20

This study focuses on injection molding process window determination for obtaining optimal imaging optical properties, astigmatism, coma, and spherical aberration using plastic lenses. The Taguchi experimental method was first used to identify the optimized combination of parameters and significant factors affecting the imaging optical properties of the lens. Full factorial experiments were then implemented based on the significant factors to build the response surface models. The injection molding process windows for lenses with optimized optical properties were determined based on the surface models, and confirmation experiments were performed to verify their validity. The results indicated that the significant factors affecting the optical properties of lenses are mold temperature, melt temperature, and cooling time. According to experimental data for the significant factors, the oblique ovals for different optical properties on the injection molding process windows based on melt temperature and cooling time can be obtained using the curve fitting approach. The confirmation experiments revealed that the average errors for astigmatism, coma, and spherical aberration are 3.44%, 5.62%, and 5.69%, respectively. The results indicated that the process windows proposed are highly reliable.

Factors affecting science reform: Bridging the gap between reform initiatives and teaching practices

NASA Astrophysics Data System (ADS)

Pensak, Karl John

In response to the perceived deficiencies in science education today, and to the expressed need for research into the culture of schools (due primarily to the failure of many science reforms in the past), this study used a broad based approach to study the gap between science education research and science education practice. This study identified 47 factors that may encourage or inhibit science curriculum reform. A survey was conducted to determine which factors were perceived to be important by local and national K-12 classroom teachers, science supervisors/coordinators, and college/university professors. Continual staff development (scheduled as part of teachers' work day/week/month), funding (for long-term staff development, teacher training and support, science laboratory facilities and materials), teacher motivation and "ownership" of the reform, the need for collaborative opportunities for classroom teachers, teachers' college preparation, textbook reform, community support, and reform initiatives that are "in tune" with assessment, are major factors identified as having a substantial affect on the successful adoption, implementation, and institutionalization of science reforms.

Eating habits and factors affecting food choice of adolescents living in rural areas.

PubMed

Bargiota, Alexandra; Pelekanou, Maria; Tsitouras, Andreas; Koukoulis, Georgios N

2013-01-01

To establish factors that affect food choices among adolescents living in rural areas and to identify their food choices. A random sample of adolescents living in a Greek rural area (n=382) aged 12-18 years were individually interviewed. Food consumption was assessed by a semi-quantitative food-frequency questionnaire and adherence to the Mediterranean diet was evaluated using the KIDMED questionnaire. Information was collected regarding self-perceived body size, dieting, dietary knowledge, parental control, meal and snack frequency, eating out of home, eating takeaways and precooked meals, eating from the school canteen. Body image concerns, dieting, education about food, parental control, maternal education level and eating with family and peers are factors that were found to affect food choices in this group of Greek adolescents. The adherence to the Mediterranean diet was low (KIDMED index was 4.5±2.7). Regular family meals at home were frequent in this group and 99% of the adolescents ate lunch daily at home. Eating out with peers and eating from the school canteen was related with higher consumption of 'junk type of food'. Girls and younger adolescents and those whose mothers had a higher education level seem to make healthier choices. Factors such as personal issues, family and peer pressure significantly affect food choices among adolescents living in a Greek rural area and highlight the importance of implementing multilevel strategies to promote healthy eating among adolescents.

Implementing Role-Changing Versus Time-Changing Innovations in Health Care: Differences in Helpfulness of Staff Improvement Teams, Management, and Network for Learning.

PubMed

Nembhard, Ingrid M; Morrow, Christopher T; Bradley, Elizabeth H

2015-12-01

Health care organizations often fail in their effort to implement care-improving innovations. This article differentiates role-changing innovations, altering what workers do, from time-changing innovations, altering when tasks are performed or for how long. We examine our hypothesis that the degree to which access to groups that can alter organizational learning--staff, management, and external network--facilitates implementation depends on innovation type. Our longitudinal study using ordinal logistic regression and survey data on 517 hospitals' implementation of evidence-based practices for treating heart attack confirmed our thesis for factors granting access to each group: improvement team's representativeness (of affected staff), senior management engagement, and network membership. Although team representativeness and network membership were positively associated with implementing role-changing practices, senior management engagement was not. In contrast, senior management engagement was positively associated with implementing time-changing practices, whereas team representativeness was not, and network membership was not unless there was limited management engagement. These findings advance implementation science by explaining mixed results across past studies: Nature of change for workers alters potential facilitators' effects on implementation. © The Author(s) 2015.

Development of a Tailored Intervention With Computerized Clinical Decision Support to Improve Quality of Care for Patients With Knee Osteoarthritis: Multi-Method Study.

PubMed

Van de Velde, Stijn; Kortteisto, Tiina; Spitaels, David; Jamtvedt, Gro; Roshanov, Pavel; Kunnamo, Ilkka; Aertgeerts, Bert; Vandvik, Per Olav; Flottorp, Signe

2018-06-11

Clinical practice patterns greatly diverge from evidence-based recommendations to manage knee osteoarthritis conservatively before resorting to surgery. This study aimed to tailor a guideline-based computerized decision support (CDS) intervention that facilitates the conservative management of knee osteoarthritis. Experts with backgrounds in clinical medicine, research, implementation, or health informatics suggested the most important recommendations for implementation, how to develop an implementation strategy, and how to form the CDS algorithms. In 6 focus group sessions, 8 general practitioners and 22 patients from Norway, Belgium, and Finland discussed the suggested CDS intervention and identified factors that would be most critical for the success of the intervention. The focus group moderators used the GUideline Implementation with DEcision Support checklist, which we developed to support consideration of CDS success factors. The experts prioritized 9 out of 22 recommendations for implementation. We formed the concept for 6 CDS algorithms to support implementation of these recommendations. The focus group suggested 59 unique factors that could affect the success of the presented CDS intervention. Five factors (out of the 59) were prioritized by focus group participants in every country, including the perceived potential to address the information needs of both patients and general practitioners; the credibility of CDS information; the timing of CDS for patients; and the need for personal dialogue about CDS between the general practitioner and the patient. The focus group participants supported the CDS intervention as a tool to improve the quality of care for patients with knee osteoarthritis through shared, evidence-based decision making. We aim to develop and implement the CDS based on these study results. Future research should address optimal ways to (1) provide patient-directed CDS, (2) enable more patient-specific CDS within the context of patient complexity, and (3) maintain user engagement with CDS over time. ©Stijn Van de Velde, Tiina Kortteisto, David Spitaels, Gro Jamtvedt, Pavel Roshanov, Ilkka Kunnamo, Bert Aertgeerts, Per Olav Vandvik, Signe Flottorp. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 11.06.2018.

Present and future of desertification in Spain: Implementation of a surveillance system to prevent land degradation.

PubMed

Martínez-Valderrama, Jaime; Ibáñez, Javier; Del Barrio, Gabriel; Sanjuán, Maria E; Alcalá, Francisco J; Martínez-Vicente, Silvio; Ruiz, Alberto; Puigdefábregas, Juan

2016-09-01

Mitigation strategies are crucial for desertification given that once degradation starts, other solutions are extremely expensive or unworkable. Prevention is key to handle this problem and solutions should be based on spotting and deactivating the stressors of the system. Following this topic, the Spanish Plan of Action to Combat Desertification (SPACD) created the basis for implementing two innovative approaches to evaluate the threat of land degradation in the country. This paper presents tools for preventing desertification in the form of a geomatic approach to enable the periodic assessments of the status and trends of land condition. Also System Dynamics modelling has been used to integrate bio-physical and socio-economic aspects of desertification to explain and analyse degradation in the main hot spots detected in Spain. The 2dRUE procedure was implemented to map the land-condition status by comparing potential land productivity according to water availability, the limiting factor in arid lands, with plant-biomass data. This assessment showed that 20% of the territory is degraded and an additional 1% is actively degrading. System Dynamics modelling was applied to study the five desertification landscapes identified by the SPACD. The risk analysis, implemented on these models, concluded that 'Herbaceous crops affected by soil erosion' is the landscape most at risk, while the Plackett-Burman sensitivity analysis used to rank the factors highlighted the supremacy of climatic factors above socioeconomic drivers. Copyright © 2016 Elsevier B.V. All rights reserved.

Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities

PubMed Central

Carey, Gemma; Friel, Sharon

2015-01-01

Many of the societal level factors that affect health – the ‘social determinants of health (SDH)’ – exist outside the health sector, across diverse portfolios of government, and other major institutions including non-governmental organisations (NGOs) and the private sector. This has created growing interest in how to create and implement public policies which will drive better and fairer health outcomes. While designing policies that can improve the SDH is critical, so too is ensuring they are appropriately administered and implemented. In this paper, we draw attention to an important area for future public health consideration – how policies are managed and implemented through complex administrative layers of ‘the state.’ Implementation gaps have long been a concern of public administration scholarship. To precipitate further work in this area, in this paper, we provide an overview of the scholarly field of public administration and highlight its role in helping to understand better the challenges and opportunities for implementing policies and programs to improve health equity. PMID:26673462

Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities.

PubMed

Carey, Gemma; Friel, Sharon

2015-10-11

Many of the societal level factors that affect health - the 'social determinants of health (SDH)' - exist outside the health sector, across diverse portfolios of government, and other major institutions including non-governmental organisations (NGOs) and the private sector. This has created growing interest in how to create and implement public policies which will drive better and fairer health outcomes. While designing policies that can improve the SDH is critical, so too is ensuring they are appropriately administered and implemented. In this paper, we draw attention to an important area for future public health consideration - how policies are managed and implemented through complex administrative layers of 'the state.' Implementation gaps have long been a concern of public administration scholarship. To precipitate further work in this area, in this paper, we provide an overview of the scholarly field of public administration and highlight its role in helping to understand better the challenges and opportunities for implementing policies and programs to improve health equity. © 2015 by Kerman University of Medical Sciences.

Mixed-method study of a conceptual model of evidence-based intervention sustainment across multiple public-sector service settings.

PubMed

Aarons, Gregory A; Green, Amy E; Willging, Cathleen E; Ehrhart, Mark G; Roesch, Scott C; Hecht, Debra B; Chaffin, Mark J

2014-12-10

This study examines sustainment of an EBI implemented in 11 United States service systems across two states, and delivered in 87 counties. The aims are to 1) determine the impact of state and county policies and contracting on EBI provision and sustainment; 2) investigate the role of public, private, and academic relationships and collaboration in long-term EBI sustainment; 3) assess organizational and provider factors that affect EBI reach/penetration, fidelity, and organizational sustainment climate; and 4) integrate findings through a collaborative process involving the investigative team, consultants, and system and community-based organization (CBO) stakeholders in order to further develop and refine a conceptual model of sustainment to guide future research and provide a resource for service systems to prepare for sustainment as the ultimate goal of the implementation process. A mixed-method prospective and retrospective design will be used. Semi-structured individual and group interviews will be used to collect information regarding influences on EBI sustainment including policies, attitudes, and practices; organizational factors and external policies affecting model implementation; involvement of or collaboration with other stakeholders; and outer- and inner-contextual supports that facilitate ongoing EBI sustainment. Document review (e.g., legislation, executive orders, regulations, monitoring data, annual reports, agendas and meeting minutes) will be used to examine the roles of state, county, and local policies in EBI sustainment. Quantitative measures will be collected via administrative data and web surveys to assess EBI reach/penetration, staff turnover, EBI model fidelity, organizational culture and climate, work attitudes, implementation leadership, sustainment climate, attitudes toward EBIs, program sustainment, and level of institutionalization. Hierarchical linear modeling will be used for quantitative analyses. Qualitative analyses will be tailored to each of the qualitative methods (e.g., document review, interviews). Qualitative and quantitative approaches will be integrated through an inclusive process that values stakeholder perspectives. The study of sustainment is critical to capitalizing on and benefiting from the time and fiscal investments in EBI implementation. Sustainment is also critical to realizing broad public health impact of EBI implementation. The present study takes a comprehensive mixed-method approach to understanding sustainment and refining a conceptual model of sustainment.

[Risk factors for the spine: nursing assessment and care].

PubMed

Bringuente, M E; de Castro, I S; de Jesus, J C; Luciano, L dos S

1997-01-01

The present work aimed at studying risk factor that affect people with back pain, identifying them and implementing an intervention proposal of a health education program based on self-care teaching, existential humanist philosophical projects and stress equalization approach line, skeletal-muscle reintegration activities, basic techniques on stress equalization and massage. It has been developed for a population of 42 (forty-two) clients. Two instruments which integrate nursing consultation protocol have been used in data collection. The results showed the existence of associated risk factors which are changeable according to health education programs. The assessment process has contributed for therapeutic measures focus, using non-conventional care methods for this approach providing an improvement to these clients life quality.

Classroom characteristics and implementation of a substance use prevention curriculum in European countries.

PubMed

Caria, Maria Paola; Faggiano, Fabrizio; Bellocco, Rino; Galanti, Maria Rosaria

2013-12-01

Partial implementation may explain modest effectiveness of many school-based preventive programmes against substance use. We studied whether specific characteristics of the class could predict the level of implementation of a curriculum delivered by class teachers in schools from some European countries. Secondary analysis of data from an evaluation trial. In seven European countries, 78 schools (173 classes) were randomly assigned to a 12-unit, interactive, standardized programme based on the comprehensive social influence model. Curriculum completeness, application fidelity, average unit duration and use of role-play were monitored using structured report forms. Predictors of implementation were measured by aggregating at class level information from the baseline student survey. Class size, gender composition, mean age, factors related to substance use and to affection to school were analysed, with associations estimated by multilevel regression models. Implementation was not significantly predicted by mean age, proportion of students with positive academic expectation or liking school. Proportion of boys was associated with a shorter time devoted to each unit [β = -0.19, 95% confidence intervals (CI) -0.32 to -0.06]. Class size was inversely related to application fidelity [Odds ratio (OR) 0.92, 95% CI 0.85 to 0.99]. Prevalence of substance use was associated with a decreased odds of implementing all the curriculum units (OR 0.81, 95% CI 0.65 to 0.99). Students' connectedness to their class was associated with increased odds of teachers using role-play (OR 1.52, 95% CI 1.03 to 2.29). Teachers' implementation of preventive programmes may be affected by structural and social characteristics of classes and therefore benefit from organizational strategies and teachers' training in class management techniques.

Factors affecting the stability of reverse shoulder arthroplasty: a biomechanical study.

PubMed

Clouthier, Allison L; Hetzler, Markus A; Fedorak, Graham; Bryant, J Tim; Deluzio, Kevin J; Bicknell, Ryan T

2013-04-01

Despite the success of reverse shoulder arthroplasty (RSA) in treating patients with painful pseudoparalytic shoulders, instability is a common complication and currently the factors affecting stability are not well understood. The objective of this study was to investigate a number of factors as well as the interactions between factors to determine how they affect the stability of the prosthesis. These factors included: active arm posture (abduction and abduction plane angles), loading direction, glenosphere diameter and eccentricity, and humeral socket constraint. Force required to dislocate the joint, determined using a biomechanical shoulder simulator, was used as a measure of stability. A factorial design experiment was implemented to examine the factors and interactions. Actively increasing the abduction angle by 15° leads to a 30% increase in stability and use of an inferior-offset rather than a centered glenosphere improved stability by 17%. Use of a more constrained humeral socket also increased stability; but the effect was dependent on loading direction, with a 88% improvement for superior loading, 66% for posterior, 36% for anterior, and no change for inferior loading. Abduction plane angle and glenosphere diameter had no effect on stability. Increased glenohumeral abduction and the use of an inferior-offset glenosphere were found to increase the stability of RSA. Additionally, use of a more constrained humeral socket increased stability for anterior, posterior, and superior loading. These identified factor effects have the potential to decrease the risk of dislocation following RSA. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Implementation Plan for Flexible Automation in U.S. Shipyards

DTIC Science & Technology

1985-01-01

process steps, cramped work sites, interrupted geometries , irregular or novel shapes, and other factors that affect automatability. We also try to...held by 2 hands in awkward places. Interrupt geometry of plates and beams. Cannot predict outcome. Creates need to measure and recut. Automation, if...of standard. enough over time I every job. I Rearrange work.Redefine work units. Too many interruptions Time, space, geometry only a little work gets

State of the States 2009: Renewable Energy Development and the Role of Policy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Doris, E.; McLaren, J.; Healey, V.

2009-10-01

As U.S. states increasingly focus on developing renewable energy resources, there is a need to track the progress of development, as well as the policies and support mechanisms being implemented to encourage this development. Beyond tracking, the evaluation of policy measures is necessary to determine their effectiveness, guide future efforts, and efficiently allocate resources. This report addresses each of these needs. It provides a detailed picture of the status of renewable energy development in each of the U.S. states using a variety of metrics and discusses the policies being used to encourage this development. The report then explores the contextmore » in which renewable energy development occurs by discussing the factors that can affect the uptake of power generation technologies. The analysis offers suggestions on how policies can be used to address these variables, which leads to tailored policy support that considers the specific circumstances within each state. The analysis presents results of several quantitative evaluation methods that have been designed to explore the link between policy implementation and actual development. Finally, the report discusses contextual factors, aside from policy, that affect renewable energy development. The report concludes with a summary of the main points from each chapter, discussion of next steps, and a list of resources.« less

Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature.

PubMed

Soukup, Tayana; Lamb, Benjamin W; Arora, Sonal; Darzi, Ara; Sevdalis, Nick; Green, James Sa

2018-01-01

In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs - including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don'ts) when setting up MDT-driven cancer care.

Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature

PubMed Central

Soukup, Tayana; Lamb, Benjamin W; Arora, Sonal; Darzi, Ara; Sevdalis, Nick; Green, James SA

2018-01-01

In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs – including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don’ts) when setting up MDT-driven cancer care. PMID:29403284

Identification of key factors affecting the water pollutant concentration in the sluice-controlled river reaches of the Shaying River in China via statistical analysis methods.

PubMed

Dou, Ming; Zhang, Yan; Zuo, Qiting; Mi, Qingbin

2015-08-01

The construction of sluices creates a strong disturbance in water environmental factors within a river. The change in water pollutant concentrations of sluice-controlled river reaches (SCRRs) is more complex than that of natural river segments. To determine the key factors affecting water pollutant concentration changes in SCRRs, river reaches near the Huaidian Sluice in the Shaying River of China were selected as a case study, and water quality monitoring experiments based on different regulating modes were implemented in 2009 and 2010. To identify the key factors affecting the change rates for the chemical oxygen demand of permanganate (CODMn) and ammonia nitrogen (NH3-N) concentrations in the SCRRs of the Huaidian Sluice, partial correlation analysis, principal component analysis and principal factor analysis were used. The results indicate four factors, i.e., the inflow quantity from upper reaches, opening size of sluice gates, water pollutant concentration from upper reaches, and turbidity before the sluice, which are the common key factors for the CODMn and NH3-N concentration change rates. Moreover, the dissolved oxygen before a sluice is a key factor for the permanganate concentration from CODMn change rate, and the water depth before a sluice is a key factor for the NH3-N concentration change rate. Multiple linear regressions between the water pollutant concentration change rate and key factors were established via multiple linear regression analyses, and the quantitative relationship between the CODMn and NH3-N concentration change rates and key affecting factors was analyzed. Finally, the mechanism of action for the key factors affecting the water pollutant concentration changes was analyzed. The results reveal that the inflow quantity from upper reaches, opening size of sluice gates, permanganate concentration from CODMn from upper reaches and dissolved oxygen before the sluice have a negative influence and the turbidity before the sluice has a positive influence on the permanganate concentration from CODMn change rates and that the opening size of sluice gates, NH3-N concentration from upper reaches, and water depth before the sluice have a negative influence and the inflow quantity from upper reaches and turbidity before the sluice have a positive influence on the NH3-N concentration change rates, which provides a scientific grounding for pollution control and sluice operations in SCRRs.

Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers.

PubMed

Amemori, Masamitsu; Michie, Susan; Korhonen, Tellervo; Murtomaa, Heikki; Kinnunen, Taru H

2011-05-26

Tobacco use adversely affects oral health. Clinical guidelines recommend that dental providers promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented, however. To improve guideline adherence and to develop effective interventions, it is essential to understand provider behaviour and challenges to implementation. This study aimed to develop a theoretically informed measure for assessing among dental providers implementation difficulties related to tobacco use prevention and cessation (TUPAC) counselling guidelines, to evaluate those difficulties among a sample of dental providers, and to investigate a possible underlying structure of applied theoretical domains. A 35-item questionnaire was developed based on key theoretical domains relevant to the implementation behaviours of healthcare providers. Specific items were drawn mostly from the literature on TUPAC counselling studies of healthcare providers. The data were collected from dentists (n = 73) and dental hygienists (n = 22) in 36 dental clinics in Finland using a web-based survey. Of 95 providers, 73 participated (76.8%). We used Cronbach's alpha to ascertain the internal consistency of the questionnaire. Mean domain scores were calculated to assess different aspects of implementation difficulties and exploratory factor analysis to assess the theoretical domain structure. The authors agreed on the labels assigned to the factors on the basis of their component domains and the broader behavioural and theoretical literature. Internal consistency values for theoretical domains varied from 0.50 ('emotion') to 0.71 ('environmental context and resources'). The domain environmental context and resources had the lowest mean score (21.3%; 95% confidence interval [CI], 17.2 to 25.4) and was identified as a potential implementation difficulty. The domain emotion provided the highest mean score (60%; 95% CI, 55.0 to 65.0). Three factors were extracted that explain 70.8% of the variance: motivation (47.6% of variance, α = 0.86), capability (13.3% of variance, α = 0.83), and opportunity (10.0% of variance, α = 0.71). This study demonstrated a theoretically informed approach to identifying possible implementation difficulties in TUPAC counselling among dental providers. This approach provides a method for moving from diagnosing implementation difficulties to designing and evaluating interventions.

Reducing eating disorder risk factors: A pilot effectiveness trial of a train-the-trainer approach to dissemination and implementation.

PubMed

Greif, Rebecca; Becker, Carolyn Black; Hildebrandt, Tom

2015-12-01

Impediments limit dissemination and implementation of evidence-based interventions (EBIs), including lack of sufficient training. One strategy to increase implementation of EBIs is the train-the-trainer (TTT) model. The Body Project is a peer-led body image program that reduces eating disorder (ED) risk factors. This study examined the effectiveness of a TTT model at reducing risk factors in Body Project participants. Specifically, this study examined whether a master trainer could train a novice trainer to train undergraduate peer leaders to administer the Body Project such that individuals who received the Body Project (i.e., participants) would evidence comparable outcomes to previous trials. We hypothesized that participants would evidence reductions in ED risk factors, with effect sizes similar to previous trials. Utilizing a TTT model, a master trainer trained a novice trainer to train undergraduate peer leaders to administer the Body Project to undergraduate women. Undergraduate women aged 18 years or older who received the Body Project intervention participated in the trial and completed measures at baseline, post-treatment, and five-month follow-up. Primary outcomes included body dissatisfaction, thin ideal internalization, negative affect, and ED pathology. Participants demonstrated significant reductions in thin ideal internalization, ED pathology and body dissatisfaction at post-treatment and 5-month follow-up. At 5 months, using three different strategies for managing missing data, effect sizes were larger or comparable to earlier trials for 3 out of 4 variables. Results support a TTT model for Body Project implementation and the importance of utilizing sensitivity analyses for longitudinal datasets with missing data. © 2015 Wiley Periodicals, Inc.

How does race/ethnicity influence pharmacological response to asthma therapies?

PubMed

Cazzola, Mario; Calzetta, Luigino; Matera, Maria Gabriella; Hanania, Nicola A; Rogliani, Paola

2018-04-01

Our understanding of whether and/or how ethnicity influences pharmacological response to asthma therapies is still very scarce. A possible explanation for the increased asthma treatment failures observed in ethnic and racial minorities receiving asthma therapies is that some of these groups may have a pharmacogenomic predisposition to either nonresponse or to adverse response with a specific class of drugs. However, the effects of ethnicity on pharmacological response to asthma therapies are also, and mainly, determined by socioeconomic and environmental factors to a varying extent, depending on the ethnic groups. Areas covered: Genetic, socioeconomic and environmental factors that can affect the pharmacotherapeutic responses to asthma medications and their link(s) to race/ethnicity have been examined and critically discussed. Expert opinion: Differences in genetic ancestry are definitely non-modifiable factors, but socioeconomic and environmental disadvantages are all factors that can be modified. It is likely that improved outcomes may be achieved when tailored and multifaceted approaches that include home, school, and clinician-based interventions are implemented. Consequently, it is critical to determine if a clinical intervention programme combined with implementation strategies that attempt to reduce inequalities can reduce asthma disparities, including the influence of ethnicity and race on pharmacological response to asthma therapies.

Mobile computing acceptance factors in the healthcare industry: a structural equation model.

PubMed

Wu, Jen-Her; Wang, Shu-Ching; Lin, Li-Min

2007-01-01

This paper presents a revised technology acceptance model to examine what determines mobile healthcare systems (MHS) acceptance by healthcare professionals. Conformation factor analysis was performed to test the reliability and validity of the measurement model. The structural equation modeling technique was used to evaluate the causal model. The results indicated that compatibility, perceived usefulness and perceived ease of use significantly affected healthcare professional behavioral intent. MHS self-efficacy had strong indirect impact on healthcare professional behavioral intent through the mediators of perceived usefulness and perceived ease of use. Yet, the hypotheses for technical support and training effects on the perceived usefulness and perceived ease of use were not supported. This paper provides initial insights into factors that are likely to be significant antecedents of planning and implementing mobile healthcare to enhance professionals' MHS acceptance. The proposed model variables explained 70% of the variance in behavioral intention to use MHS; further study is needed to explore extra significant antecedents of new IT/IS acceptance for mobile healthcare. Such as privacy and security issue, system and information quality, limitations of mobile devices; the above may be other interesting factors for implementing mobile healthcare and could be conducted by qualitative research.

Lean production and work-related musculoskeletal disorders: overviews of international and Swedish studies.

PubMed

Brännmark, Mikael; Håkansson, Malin

2012-01-01

This paper aimed at summarizing the knowledge of the relationship between Lean and work related musculoskeletal disorders (WMSD), and WMSD risk factors, in manufacturing companies. Literature search processes identified 23 publications studying this, in scientific journals. Eight included measurements of WMSD; three were mostly negative, two showed mixed results, one showed no results and two were mostly positive. Eighteen publications included measurements of WMSD risk factors; seven showed mostly negative results, eight showed mixed results, two showed mostly positive results and one was inconclusive. Three literature reviews were identified, which studied this question; two were mostly negative, while the third was inconclusive. Also, 12 publications of grey literature studying Lean and WMSD risk factors in Swedish organizations were identified; nine showed mixed results, two showed mostly positive results and one showed mostly negative results. Due to the varying quality and study design of the publications, together with the few identified studies, it is difficult to compare them. The context and the implementation also likely affect the results. The general conclusion was that a Lean implementation may increase the risk of WMSD and risk factors for WMSD, if it is not accompanied with an ergonomic intervention.

Higher Education Institutional Agents as Policy Implementers: The Case of Policies That Affect Undocumented and DACAmented Students

ERIC Educational Resources Information Center

Nienhusser, H. Kenny

2018-01-01

This study examines 45 community college institutional agents across four states in their role as implementer of policies that affected undocumented and DACAmented students. The findings delve into the role of changing implementation landscape, policy vagueness, implementation burden, and institutional support in this implementation environment.…

A common evaluation framework for the African Health Initiative

PubMed Central

2013-01-01

Background The African Health Initiative includes highly diverse partnerships in five countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia), each of which is working to improve population health by strengthening health systems and to evaluate the results. One aim of the Initiative is to generate cross-site learning that can inform implementation in the five partnerships during the project period and identify lessons that may be generalizable to other countries in the region. Collaborators in the Initiative developed a common evaluation framework as a basis for this cross-site learning. Methods This paper describes the components of the framework; this includes the conceptual model, core metrics to be measured in all sites, and standard guidelines for reporting on the implementation of partnership activities and contextual factors that may affect implementation, or the results it produces. We also describe the systems that have been put in place for data management, data quality assessments, and cross-site analysis of results. Results and conclusions The conceptual model for the Initiative highlights points in the causal chain between health system strengthening activities and health impact where evidence produced by the partnerships can contribute to learning. This model represents an important advance over its predecessors by including contextual factors and implementation strength as potential determinants, and explicitly including equity as a component of both outcomes and impact. Specific measurement challenges include the prospective documentation of program implementation and contextual factors. Methodological issues addressed in the development of the framework include the aggregation of data collected using different methods and the challenge of evaluating a complex set of interventions being improved over time based on continuous monitoring and intermediate results. PMID:23819778

Considerations for the design of safe and effective consumer health IT applications in the home.

PubMed

Zayas-Cabán, Teresa; Dixon, Brian E

2010-10-01

Consumer health IT applications have the potential to improve quality, safety and efficiency of consumers' interactions with the healthcare system. Yet little attention has been paid to human factors and ergonomics in the design of consumer health IT, potentially limiting the ability of health IT to achieve these goals. This paper presents the results of an analysis of human factors and ergonomics issues encountered by five projects during the design and implementation of home-based consumer health IT applications. Agency for Healthcare Research and Quality-funded consumer health IT research projects, where patients used the IT applications in their homes, were reviewed. Project documents and discussions with project teams were analysed to identify human factors and ergonomic issues considered or addressed by project teams. The analysis focused on system design and design processes used as well as training, implementation and use of the IT intervention. A broad range of consumer health IT applications and diverse set of human factors and ergonomics issues were identified. The design and implementation processes used resulted in poor fit with some patients' healthcare tasks and the home environment and, in some cases, resulted in lack of use. Clinician interaction with patients and the information provided through health IT applications appeared to positively influence adoption and use. Consumer health IT application design would benefit from the use of human factors and ergonomics design and evaluation methods. Considering the context in which home-based consumer health IT applications are used will likely affect the ability of these applications to positively impact the quality, safety and efficiency of patient care.

Barriers to the success of an electronic pharmacovigilance reporting system in Kenya: an evaluation three years post implementation.

PubMed

Agoro, Oscar O; Kibira, Sarah W; Freeman, Jenny V; Fraser, Hamish S F

2018-06-01

Electronic pharmacovigilance reporting systems are being implemented in many developing countries in an effort to improve reporting rates. This study sought to establish the factors that acted as barriers to the success of an electronic pharmacovigilance reporting system in Kenya 3 years after its implementation. Factors that could act as barriers to using electronic reporting systems were identified in a review of literature and then used to develop a survey questionnaire that was administered to pharmacists working in government hospitals in 6 counties in Kenya. The survey was completed by 103 out of the 115 targeted pharmacists (89.5%) and included free-text comments. The key factors identified as barriers were: unavailable, unreliable, or expensive Internet access; challenges associated with a hybrid system of paper and electronic reporting tools; and system usability issues. Coordination challenges at the national pharmacovigilance center and changes in the structure of health management in the country also had an impact on the success of the electronic reporting system. Different personal, organizational, infrastructural, and reporting system factors affect the success of electronic reporting systems in different ways, depending on the context. Context-specific formative evaluations are useful in establishing the performance of electronic reporting systems to identify problems and ensure that they achieve the desired objectives. While several factors hindered the optimal use of the electronic pharmacovigilance reporting system in Kenya, all were considered modifiable. Effort should be directed toward tackling the identified issues in order to facilitate use and improve pharmacovigilance reporting rates.

The science of quality improvement implementation: developing capacity to make a difference.

PubMed

Alexander, Jeffrey A; Hearld, Larry R

2011-12-01

Quality improvement (QI) holds promise to improve quality of care; however, organizations often struggle with its implementation. It has been recommended that practitioners, managers, and researchers attempt to increase systematic understanding of the structure, practices, and context of organizations that facilitate or impede the implementation of QI innovations. To critically review the empirical research on QI implementation in health care organizations. A literature review of 107 studies that examined the implementation of QI innovations in health care organizations. Studies were classified into 4 groups based on the types of predictors that were assumed to affect implementation (content of QI innovation, organizational processes, internal context, and external context). Internal context and organizational processes were the most frequently studied categories. External context and organizational process categories exhibited the highest rate of positive effects on QI implementation. The review revealed several important gaps in the QI implementation literature. Studies often lacked clear conceptual frameworks to guide the research, which may hinder efforts to compare relationships across studies. Studies also tended to adopt designs that were narrowly focused on independent effects of predictors and did not include holistic frameworks to capture interactions among the many factors involved in implementation. Other design limitations included the use of cross-sectional designs, single-source data collection, and potential selection bias among study participants.

Role of school teachers in identifying attention deficit hyperactivity disorder among primary school children in Mansoura, Egypt.

PubMed

Awadalla, N J; Ali, O F; Elshaer, S; Eissa, M

2016-11-02

There is a knowledge gap in primary school teachers that affects their ability to detect attention deficit hyperactivity disorder (ADHD). This study measured primary school teachers' knowledge about ADHD, and implemented a training programme to improve early detection of ADHD. The prevalence and risk factors of ADHD were also studied. The training programme was implemented through a 2-day workshop for 39 primary school teachers who completed a validated Arabic version of the ADHD Rating Scale for 873 primary school children. The children's parents completed the questionnaire to explore ADHD risk factors. The teachers' pre-training knowledge scores of ADHD ranged from 17.9 to 46.2%. Post-training, their scores improved significantly to 69.2-94.9%. Prevalence rate of ADHD was 12.60%. On logistic regression, independent predictors of ADHD were female gender, unemployed fathers and rural residence. In conclusion, ADHD is a significant health problem among primary school children in Mansoura, Egypt. Efforts should be made to improve teachers' knowledge about ADHD and control modifiable risk factors.

Effect of quantum noise on deterministic joint remote state preparation of a qubit state via a GHZ channel

NASA Astrophysics Data System (ADS)

Wang, Ming-Ming; Qu, Zhi-Guo

2016-11-01

Quantum secure communication brings a new direction for information security. As an important component of quantum secure communication, deterministic joint remote state preparation (DJRSP) could securely transmit a quantum state with 100 % success probability. In this paper, we study how the efficiency of DJRSP is affected when qubits involved in the protocol are subjected to noise or decoherence. Taking a GHZ-based DJRSP scheme as an example, we study all types of noise usually encountered in real-world implementations of quantum communication protocols, i.e., the bit-flip, phase-flip (phase-damping), depolarizing and amplitude-damping noise. Our study shows that the fidelity of the output state depends on the phase factor, the amplitude factor and the noise parameter in the bit-flip noise, while the fidelity only depends on the amplitude factor and the noise parameter in the other three types of noise. And the receiver will get different output states depending on the first preparer's measurement result in the amplitude-damping noise. Our results will be helpful for improving quantum secure communication in real implementation.

Stakeholder approach for evaluating organizational change projects.

PubMed

Peltokorpi, Antti; Alho, Antti; Kujala, Jaakko; Aitamurto, Johanna; Parvinen, Petri

2008-01-01

This paper aims to create a model for evaluating organizational change initiatives from a stakeholder resistance viewpoint. The paper presents a model to evaluate change projects and their expected benefits. Factors affecting the challenge to implement change were defined based on stakeholder theory literature. The authors test the model's practical validity for screening change initiatives to improve operating room productivity. Change initiatives can be evaluated using six factors: the effect of the planned intervention on stakeholders' actions and position; stakeholders' capability to influence the project's implementation; motivation to participate; capability to change; change complexity; and management capability. The presented model's generalizability should be explored by filtering presented factors through a larger number of historical cases operating in different healthcare contexts. The link between stakeholders, the change challenge and the outcomes of change projects needs to be empirically tested. The proposed model can be used to prioritize change projects, manage stakeholder resistance and establish a better organizational and professional competence for managing healthcare organization change projects. New insights into existing stakeholder-related understanding of change project successes are provided.

Examining sustainability in a hospital setting: case of smoking cessation.

PubMed

Campbell, Sharon; Pieters, Karen; Mullen, Kerri-Anne; Reece, Robin; Reid, Robert D

2011-09-14

The Ottawa Model of Smoking Cessation (OMSC) is a hospital-based smoking cessation program that is expanding across Canada. While the short-term effectiveness of hospital cessation programs has been documented, less is known about long-term sustainability. The purpose of this exploratory study was to understand how hospitals using the OMSC were addressing sustainability and determine if there were critical factors or issues that should be addressed as the program expanded. Six hospitals that differed on OMSC program activities (identify and document smokers, advise quitting, provide medication, and offer follow-up) were intentionally selected, and two key informants per hospital were interviewed using a semi-structured interview guide. Key informants were asked to reflect on the initial decision to implement the OMSC, the current implementation process, and perceived sustainability of the program. Qualitative analysis of the interview transcripts was conducted and themes related to problem definition, stakeholder influence, and program features emerged. Sustainability was operationalized as higher performance of OMSC activities than at baseline. Factors identified in the literature as important for sustainability, such as program design, differences in implementation, organizational characteristics, and the community environment did not explain differences in program sustainability. Instead, key informants identified factors that reflected the interaction between how the health problem was defined by stakeholders, how priorities and concerns were addressed, features of the program itself, and fit within the hospital context and resources as being influential to the sustainability of the program. Applying a sustainability model to a hospital smoking cessation program allowed for an examination of how decisions made during implementation may impact sustainability. Examining these factors during implementation may provide insight into issues affecting program sustainability, and foster development of a sustainability plan. Based on this study, we suggest that sustainability plans should focus on enhancing interactions between the health problem, program features, and stakeholder influence.

Examining sustainability in a hospital setting: Case of smoking cessation

PubMed Central

2011-01-01

Background The Ottawa Model of Smoking Cessation (OMSC) is a hospital-based smoking cessation program that is expanding across Canada. While the short-term effectiveness of hospital cessation programs has been documented, less is known about long-term sustainability. The purpose of this exploratory study was to understand how hospitals using the OMSC were addressing sustainability and determine if there were critical factors or issues that should be addressed as the program expanded. Methods Six hospitals that differed on OMSC program activities (identify and document smokers, advise quitting, provide medication, and offer follow-up) were intentionally selected, and two key informants per hospital were interviewed using a semi-structured interview guide. Key informants were asked to reflect on the initial decision to implement the OMSC, the current implementation process, and perceived sustainability of the program. Qualitative analysis of the interview transcripts was conducted and themes related to problem definition, stakeholder influence, and program features emerged. Results Sustainability was operationalized as higher performance of OMSC activities than at baseline. Factors identified in the literature as important for sustainability, such as program design, differences in implementation, organizational characteristics, and the community environment did not explain differences in program sustainability. Instead, key informants identified factors that reflected the interaction between how the health problem was defined by stakeholders, how priorities and concerns were addressed, features of the program itself, and fit within the hospital context and resources as being influential to the sustainability of the program. Conclusions Applying a sustainability model to a hospital smoking cessation program allowed for an examination of how decisions made during implementation may impact sustainability. Examining these factors during implementation may provide insight into issues affecting program sustainability, and foster development of a sustainability plan. Based on this study, we suggest that sustainability plans should focus on enhancing interactions between the health problem, program features, and stakeholder influence. PMID:21917156

A Study of Quality of Service Communication for High-Speed Packet-Switching Computer Sub-Networks

NASA Technical Reports Server (NTRS)

Cui, Zhenqian

1999-01-01

In this thesis, we analyze various factors that affect quality of service (QoS) communication in high-speed, packet-switching sub-networks. We hypothesize that sub-network-wide bandwidth reservation and guaranteed CPU processing power at endpoint systems for handling data traffic are indispensable to achieving hard end-to-end quality of service. Different bandwidth reservation strategies, traffic characterization schemes, and scheduling algorithms affect the network resources and CPU usage as well as the extent that QoS can be achieved. In order to analyze those factors, we design and implement a communication layer. Our experimental analysis supports our research hypothesis. The Resource ReSerVation Protocol (RSVP) is designed to realize resource reservation. Our analysis of RSVP shows that using RSVP solely is insufficient to provide hard end-to-end quality of service in a high-speed sub-network. Analysis of the IEEE 802.lp protocol also supports the research hypothesis.

A review on disaster risk mitigation in the oil and gas project

NASA Astrophysics Data System (ADS)

Rodhi, N. N.; Anwar, N.; Wiguna, I. P. A.

2018-01-01

In addition to the very complex risks, hazards potentially lead to disasters in the oil and gas projects. These risks can certainly be anticipated with the application of risk management, but an unsystematic and ineffective implementation of risk management will still bring adverse impacts. According to the eleven risk management principles in ISO 31000:2009, the application of risk management must pay attention to all aspects, both internal and external factors. Thus, this paper aims to identify variables that could affect the disaster mitigation efforts of oil and gas projects. This research began with literature study to determine the problems of risk management in oil and gas projects, so the affecting variables as the study objectives can be specified subsequently based on the literature review as well. The variables that must be considered in the efforts of disaster risk mitigation of oil and gas project are the risk factors and sustainability aspect.

Factors Affecting Patient Satisfaction with Community Health Service under the Gatekeeper System: A Cross-sectional Study in Nanjing, China.

PubMed

Li, Wen Zhen; Gan, Yong; Zhou, Yan Feng; Chen, Ya Wen; Li, Jing; Kkandawire, Naomiem; Hu, Sai; Qiao, Yan; Lu, Zu Xun

2017-09-01

The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service (CHS) under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor-patient relationships, information and support, organization of care, and accessibility (P < 0.001). One or more factors such as gender and self-perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients' satisfaction with CHS by strengthening their awareness of the gatekeeper policy. Copyright © 2017 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

Indigenous HIV Prevention Beliefs and Practices Among Low-Earning Chinese Sex Workers as Context for Introducing Female Condoms and Other Novel Prevention Options.

PubMed

Dunn, Jennifer; Zhang, Qingning; Weeks, Margaret R; Li, Jianghong; Liao, Susu; Li, Fei

2017-07-01

New interventions to reduce HIV and sexually transmitted infections (STI) among female sex workers are introduced into the context of women's existing prevention beliefs and practices. These indigenous practices affected implementation of our program to introduce female condoms to women in sex-work establishments in southern China. We used ethnographic field observations and in-depth interviews to document common prevention methods women reported using to protect themselves before and during intervention implementation. Individual, sex-work establishment, and other contextual factors, including sources of information and social and economic pressures to use or reject prevention options, shaped their perceptions and selection of these methods and affected adoption of female condoms as an additional tool. Efforts to improve uptake of effective prevention methods among low-income sex workers require attention to the context and spectrum of women's HIV/STI prevention practices when introducing innovations such as female condoms, microbicides, pre-exposure prophylaxis pills, and others, as they become available.

The effects of biotic and abiotic factors on the spatial heterogeneity of alpine grassland vegetation at a small scale on the Qinghai-Tibet Plateau (QTP), China.

PubMed

Wen, Lu; Dong, Shi Kui; Li, Yuan Yuan; Sherman, Ruth; Shi, Jian Jun; Liu, De Mei; Wang, Yan Long; Ma, Yu Shou; Zhu, Lei

2013-10-01

Understanding the complex effects of biotic and abiotic factors on the composition of vegetation is very important for developing and implementing strategies for promoting sustainable grassland development. The vegetation-disturbance-environment relationship was examined in degraded alpine grasslands in the headwater areas of three rivers on the Qinghai-Tibet Plateau in this study. The investigated hypotheses were that (1) the heterogeneity of the vegetation of the alpine grassland is due to a combination of biotic and abiotic factors and that (2) at a small scale, biotic factors are more important for the distribution of alpine vegetation. On this basis, four transects were set along altitudinal gradients from 3,770 to 3,890 m on a sunny slope, and four parallel transects were set along altitudinal gradients on a shady slope in alpine grasslands in Guoluo Prefecture of Qinghai Province, China. It was found that biological disturbances were the major forces driving the spatial heterogeneity of the alpine grassland vegetation and abiotic factors were of secondary importance. Heavy grazing and intensive rat activity resulted in increases in unpalatable and poisonous weeds and decreased fine forages in the form of sedges, forbs, and grasses in the vegetation composition. Habitat degradation associated with biological disturbances significantly affected the spatial variation of the alpine grassland vegetation, i.e., more pioneer plants of poisonous or unpalatable weed species, such as Ligularia virgaurea and Euphorbia fischeriana, were found in bare patches. Environmental/abiotic factors were less important than biological disturbances in affecting the spatial distribution of the alpine grassland vegetation at a small scale. It was concluded that rat control and light grazing should be applied first in implementing restoration strategies. The primary vegetation in lightly grazed and less rat-damaged sites should be regarded as a reference for devising vegetation restoration measures in alpine pastoral regions.

Factors associated with intern fatigue.

PubMed

Friesen, Lindsay D; Vidyarthi, Arpana R; Baron, Robert B; Katz, Patricia P

2008-12-01

Prior data suggest that fatigue adversely affects patient safety and resident well-being. ACGME duty hour limitations were intended, in part, to reduce resident fatigue, but the factors that affect intern fatigue are unknown. To identify factors associated with intern fatigue following implementation of duty hour limitations. Cross-sectional confidential survey of validated questions related to fatigue, sleep, and stress, as well as author-developed teamwork questions. Interns in cognitive specialties at the University of California, San Francisco. Univariate statistics characterized the distribution of responses. Pearson correlations elucidated bivariate relationships between fatigue and other variables. Multivariate linear regression models identified factors independently associated with fatigue, sleep, and stress. Of 111 eligible interns, 66 responded (59%). In a regression analysis including gender, hours worked in the previous week, sleep quality, perceived stress, and teamwork, only poorer quality of sleep and greater perceived stress were significantly associated with fatigue (p < 0.001 and p = 0.02, respectively). To identify factors that may affect sleep, specifically duty hours and stress, a secondary model was constructed. Only greater perceived stress was significantly associated with diminished sleep quality (p = 0.04), and only poorer teamwork was significantly associated with perceived stress (p < 0.001). Working >80 h was not significantly associated with perceived stress, quality of sleep, or fatigue. Simply decreasing the number of duty hours may be insufficient to reduce intern fatigue. Residency programs may need to incorporate programmatic changes to reduce stress, improve sleep quality, and foster teamwork in order to decrease intern fatigue and its deleterious consequences.

Exploring the challenges of the Iranian parliament about passing laws for resource allocation in healthcare: a qualitative study

PubMed Central

Mohsenpour, Seyed Ramezan; Arab, Mohammad; Razavi, Seyed Hasan Emami; Sari, Ali Akbari

2017-01-01

Background Awareness about the process of law making and the factors that affect the legislative process have an important role in improving legislations that are approved by parliaments. Objective This study aimed to explore and analyze the process of development and enactment of law in Iran’s parliament, and factors that might affect the enactment of laws that are related to the allocation and distribution of health sector resources in Iran. Methods In this case study, data were collected through review of literature and national documents, and experts’ interviews. Interviews were performed with selected members of parliament (MPs), ex members of parliament and professionals from the Ministry of Health and Medical Education (MOHME) (15 persons). MAX QDA 10 was used for coding and constructing themes. Data were analyzed in five steps (familiarization, developing a conceptual framework, coding, indexing, and interpretation) using a content analysis with inductive and deductive approaches. Results The main factors that could affect the approval and enactment of legislations related to allocation of healthcare resources in the Iranian parliament were categorized in seven themes including: Importance of issue, resource availability, legislator’s awareness about the topic, lobbying and unofficial relations with influential officials, mentioning strong reasons by MOHME, weakness of previous laws, and positive feedback related to the same laws. Conclusion Although the process of law making in parliament, and implementation of them in health organizations have legal stages, the study showed that several key factors affect this trend. In fact, it is suggested the health policy makers and MPs consider extending a range of factors to improve the process of law making and the efficiency of legislation related to allocation of healthcare resources. PMID:29238478

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers--a qualitative study.

PubMed

Espeland, Ansgar; Baerheim, Anders

2003-03-24

General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group. The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations. Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed.

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers – a qualitative study

PubMed Central

Espeland, Ansgar; Baerheim, Anders

2003-01-01

Background General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. Methods Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group. Results The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations. Conclusions Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed. PMID:12659640

Exploring the challenges of the Iranian parliament about passing laws for resource allocation in healthcare: a qualitative study.

PubMed

Mohsenpour, Seyed Ramezan; Arab, Mohammad; Razavi, Seyed Hasan Emami; Sari, Ali Akbari

2017-10-01

Awareness about the process of law making and the factors that affect the legislative process have an important role in improving legislations that are approved by parliaments. This study aimed to explore and analyze the process of development and enactment of law in Iran's parliament, and factors that might affect the enactment of laws that are related to the allocation and distribution of health sector resources in Iran. In this case study, data were collected through review of literature and national documents, and experts' interviews. Interviews were performed with selected members of parliament (MPs), ex members of parliament and professionals from the Ministry of Health and Medical Education (MOHME) (15 persons). MAX QDA 10 was used for coding and constructing themes. Data were analyzed in five steps (familiarization, developing a conceptual framework, coding, indexing, and interpretation) using a content analysis with inductive and deductive approaches. The main factors that could affect the approval and enactment of legislations related to allocation of healthcare resources in the Iranian parliament were categorized in seven themes including: Importance of issue, resource availability, legislator's awareness about the topic, lobbying and unofficial relations with influential officials, mentioning strong reasons by MOHME, weakness of previous laws, and positive feedback related to the same laws. Although the process of law making in parliament, and implementation of them in health organizations have legal stages, the study showed that several key factors affect this trend. In fact, it is suggested the health policy makers and MPs consider extending a range of factors to improve the process of law making and the efficiency of legislation related to allocation of healthcare resources.

Promoting fit bodies, healthy eating and physical activity among Indigenous Australian men: a study protocol.

PubMed

Ricciardelli, Lina A; Mellor, David; McCabe, Marita P; Mussap, Alexander J; Hallford, David J; Tyler, Matthew

2012-01-11

Overall the physical health of Indigenous men is among the worst in Australia. Research has indicated that modifiable lifestyle factors, such as poor nutrition and physical inactivity, appear to contribute strongly to these poor health conditions. To effectively develop and implement strategies to improve the health of Australia's Indigenous peoples, a greater understanding is needed of how Indigenous men perceive health, and how they view and care for their bodies. Further, a more systematic understanding of how sociocultural factors affect their health attitudes and behaviours is needed. This article presents the study protocol of a community-based investigation into the factors surrounding the health and body image of Indigenous Australian men. The study will be conducted in a collaborative manner with Indigenous Australian men using a participatory action research framework. Men will be recruited from three locations around Australia (metropolitan, regional, and rural) and interviewed to understand their experiences and perspectives on a number of issues related to health and health behaviour. The information that is collected will be analysed using modified grounded theory and thematic analysis. The results will then be used to develop and implement community events in each location to provide feedback on the findings to the community, promote health enhancing strategies, and determine future action and collaboration. This study will explore both risk and protective factors that affect the health of Indigenous Australian men. This knowledge will be disseminated to the wider Indigenous community and can be used to inform future health promotion strategies. The expected outcome of this study is therefore an increased understanding of health and health change in Indigenous Australian men, the development of strategies that promote healthy eating and positive patterns of physical activity and, in the longer term, more effective and culturally-appropriate interventions to improve health.

Analyzing implementation dynamics using theory-driven evaluation principles: lessons learnt from a South African centralized chronic dispensing model.

PubMed

Magadzire, Bvudzai Priscilla; Marchal, Bruno; Mathys, Tania; Laing, Richard O; Ward, Kim

2017-12-04

Centralized dispensing of essential medicines is one of South Africa's strategies to address the shortage of pharmacists, reduce patients' waiting times and reduce over-crowding at public sector healthcare facilities. This article reports findings of an evaluation of the Chronic Dispensing Unit (CDU) in one province. The objectives of this process evaluation were to: (1) compare what was planned versus the actual implementation and (2) establish the causal elements and contextual factors influencing implementation. This qualitative study employed key informant interviews with the intervention's implementers (clinicians, managers and the service provider) [N = 40], and a review of policy and program documents. Data were thematically analyzed by identifying the main influences shaping the implementation process. Theory-driven evaluation principles were applied as a theoretical framework to explain implementation dynamics. The overall participants' response about the CDU was positive and the majority of informants concurred that the establishment of the CDU to dispense large volumes of medicines is a beneficial strategy to address healthcare barriers because mechanical functions are automated and distribution of medicines much quicker. However, implementation was influenced by the context and discrepancies between planned activities and actual implementation were noted. Procurement inefficiencies at central level caused medicine stock-outs and affected CDU activities. At the frontline, actors were aware of the CDU's implementation guidelines regarding patient selection, prescription validity and management of non-collected medicines but these were adapted to accommodate practical realities and to meet performance targets attached to the intervention. Implementation success was a result of a combination of 'hardware' (e.g. training, policies, implementation support and appropriate infrastructure) and 'software' (e.g. ownership, cooperation between healthcare practitioners and trust) factors. This study shows that health system interventions have unpredictable paths of implementation. Discrepancies between planned and actual implementation reinforce findings in existing literature suggesting that while tools and defined operating procedures are necessary for any intervention, their successful application depends crucially on the context and environment in which implementation occurs. We anticipate that this evaluation will stimulate wider thinking about the implementation of similar models in low- and middle-income countries.

Implementation Science for the Environment.

PubMed

Hering, Janet G

2018-05-15

The establishment of the field of implementation science was motivated by the understanding that medical and health research alone is insufficient to generate better health outcomes. With strong support from funding agencies for medical research, implementation science promotes the application of a structured framework or model in the implementation of research-based results, specifically evidence-based practices (EBPs). Furthermore, explicit consideration is given to the context of EBP implementation (i.e., socio-economic, political, cultural, and institutional factors that could affect the implementation process). Finally, implementation is monitored in a robust and rigorous way. Today, the field of implementation science supports conferences and professional societies as well as one dedicated journal and numerous others with related content. The goal of these various activities is to reduce the estimated, average "bench to bedside" time lag of 17 years for uptake of EBPs from health research into routine practice. Despite similar time lags and impediments to uptake in the environmental domain, a parallel field of implementation science for the environment has not (yet) emerged. Although some parallels in needs and opportunities can easily be drawn between the health and environmental domains, a detailed mapping exercise is needed to understand which aspects of implementation science could be applied in the environmental domain either directly or in a modified form. This would allow an accelerated development of implementation science for the environment.

Challenges in Patient Recruitment, Implementation, and Fidelity in a Mobile Telehealth Study.

PubMed

Baron, Justine; Hirani, Shashivadan; Newman, Stanton

2016-05-01

Mobile telehealth (MTH) evaluations in diabetes have been conducted, but few report details and issues related to recruitment, implementation (intervention delivery), fidelity, and context. These have important implications on the interpretation of the findings and effectiveness of the intervention. This article reports these data from an MTH study and describes the challenges experienced in running an intervention such as this in an active clinical environment. We conducted a mixed-methods MTH study that included a 9-month randomized controlled trial in people with poorly controlled diabetes. Detailed recruitment data were recorded during the study. Data on contacts between MTH participants and the MTH team were collected and used to report on intervention delivery and fidelity. Meeting and field notes, as well as communications between research team members during the study, were used to report on the contextual factors that affected recruitment, implementation, and fidelity. The recruited sample size represented 6% of the total clinic population (n = 1,360) and 10.7% of the number of potentially eligible people at the clinic (n = 802) identified at the beginning of the study. Contextual factors related to patients, healthcare providers, the institution, or the recruitment protocol contributed to influence access to study participants and the number of participants randomized (n = 81). Technical and device-related aspects of the MTH intervention were delivered successfully, but the expected education and clinical feedback by the MTH nurse were not delivered according to the protocol. Although 92.5% of introductory calls were made by the MTH nurses, only 13.3% of expected educational calls were performed. Changes to the MTH nursing staff affected intervention participants differently and contributed to the low fidelity of intervention delivery. The current article presents data on the influence of contextual factors on the conduct of this MTH study and underlines the need for these processes to be assessed and reported adequately in future MTH research.

The "Universal" in UHC and Ghana's National Health Insurance Scheme: policy and implementation challenges and dilemmas of a lower middle income country.

PubMed

Agyepong, Irene Akua; Abankwah, Daniel Nana Yaw; Abroso, Angela; Chun, ChangBae; Dodoo, Joseph Nii Otoe; Lee, Shinye; Mensah, Sylvester A; Musah, Mariam; Twum, Adwoa; Oh, Juwhan; Park, Jinha; Yang, DoogHoon; Yoon, Kijong; Otoo, Nathaniel; Asenso-Boadi, Francis

2016-09-21

Despite universal population coverage and equity being a stated policy goal of its NHIS, over a decade since passage of the first law in 2003, Ghana continues to struggle with how to attain it. The predominantly (about 70 %) tax funded NHIS currently has active enrolment hovering around 40 % of the population. This study explored in-depth enablers and barriers to enrolment in the NHIS to provide lessons and insights for Ghana and other low and middle income countries (LMIC) into attaining the goal of universality in Universal Health Coverage (UHC). We conducted a cross sectional mixed methods study of an urban and a rural district in one region of Southern Ghana. Data came from document review, analysis of routine data on enrolment, key informant in-depth interviews with local government, regional and district insurance scheme and provider staff and community member in-depth interviews and focus group discussions. Population coverage in the NHIS in the study districts was not growing towards near universal because of failure of many of those who had ever enrolled to regularly renew annually as required by the NHIS policy. Factors facilitating and enabling enrolment were driven by the design details of the scheme that emanate from national level policy and program formulation, frontline purchaser and provider staff implementation arrangements and contextual factors. The factors inter-related and worked together to affect client experience of the scheme, which were not always the same as the declared policy intent. This then also affected the decision to enrol and stay enrolled. UHC policy and program design needs to be such that enrolment is effectively compulsory in practice. It also requires careful attention and responsiveness to actual and potential subscriber, purchaser and provider (stakeholder) incentives and related behaviour generated at implementation levels.

Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial.

PubMed

Amemori, Masamitsu; Korhonen, Tellervo; Kinnunen, Taru; Michie, Susan; Murtomaa, Heikki

2011-02-14

Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on intervention effects, as well as on the validity and feasibility of the theoretical-domain approach. The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers. Current Controlled Trials ISRCTN15427433.

Learning Evaluation: blending quality improvement and implementation research methods to study healthcare innovations.

PubMed

Balasubramanian, Bijal A; Cohen, Deborah J; Davis, Melinda M; Gunn, Rose; Dickinson, L Miriam; Miller, William L; Crabtree, Benjamin F; Stange, Kurt C

2015-03-10

In healthcare change interventions, on-the-ground learning about the implementation process is often lost because of a primary focus on outcome improvements. This paper describes the Learning Evaluation, a methodological approach that blends quality improvement and implementation research methods to study healthcare innovations. Learning Evaluation is an approach to multi-organization assessment. Qualitative and quantitative data are collected to conduct real-time assessment of implementation processes while also assessing changes in context, facilitating quality improvement using run charts and audit and feedback, and generating transportable lessons. Five principles are the foundation of this approach: (1) gather data to describe changes made by healthcare organizations and how changes are implemented; (2) collect process and outcome data relevant to healthcare organizations and to the research team; (3) assess multi-level contextual factors that affect implementation, process, outcome, and transportability; (4) assist healthcare organizations in using data for continuous quality improvement; and (5) operationalize common measurement strategies to generate transportable results. Learning Evaluation principles are applied across organizations by the following: (1) establishing a detailed understanding of the baseline implementation plan; (2) identifying target populations and tracking relevant process measures; (3) collecting and analyzing real-time quantitative and qualitative data on important contextual factors; (4) synthesizing data and emerging findings and sharing with stakeholders on an ongoing basis; and (5) harmonizing and fostering learning from process and outcome data. Application to a multi-site program focused on primary care and behavioral health integration shows the feasibility and utility of Learning Evaluation for generating real-time insights into evolving implementation processes. Learning Evaluation generates systematic and rigorous cross-organizational findings about implementing healthcare innovations while also enhancing organizational capacity and accelerating translation of findings by facilitating continuous learning within individual sites. Researchers evaluating change initiatives and healthcare organizations implementing improvement initiatives may benefit from a Learning Evaluation approach.

The factors affecting Nigeria's success toward implementation of global public health priorities.

PubMed

Echebiri, Vitalis C

2015-06-01

This paper examines the challenges facing the Nigerian government toward the implementation of global public health priories. The Nigerian government recognizes the need to implement these priorities by putting in place the necessary policy framework, but political instability, poor infrastructural development and inadequate funding have remained barriers toward the achievement of success in implementing these priorities. The rest of the paper elucidates the fact that despite leadership and influence from the World Health Organization and other United Nations agencies, and some responses from the Nigerian government, tackling these public health problems requires much more fundamental reform to primary health services and a reduction in poverty. Although the government has shown enough political will to tackle these problems, it is expected that a better result will be achieved through injecting more funds into the Nigerian health sector, and deploying astute health administrators to manage the sector rather than pure health professionals without managerial acumen. © The Author(s) 2014.

Understanding the implementation of interventions to improve the management of chronic kidney disease in primary care: a rapid realist review.

PubMed

Tsang, Jung Yin; Blakeman, Tom; Hegarty, Janet; Humphreys, John; Harvey, Gill

2016-04-04

Chronic kidney disease (CKD) is common and a significant marker of morbidity and mortality. Its management in primary care is essential for maintenance of cardiovascular health, avoidance of acute kidney injury (AKI) and delay in progression to end-stage renal disease. Although many guidelines and interventions have been established, there is global evidence of an implementation gap, including variable identification rates and low patient communication and awareness. The objective of this study is to understand the factors enabling and constraining the implementation of CKD interventions in primary care. A rapid realist review was conducted that involved a primary literature search of three databases to identify existing CKD interventions in primary care between the years 2000 and 2014. A secondary search was performed as an iterative process and included bibliographic and grey literature searches of reference lists, authors and research groups. A systematic approach to data extraction using Normalisation Process Theory (NPT) illuminated key mechanisms and contextual factors that affected implementation. Our primary search returned 710 articles that were narrowed down to 18 relevant CKD interventions in primary care. Our findings suggested that effective management of resources (encompassing many types) was a significant contextual factor enabling or constraining the functioning of mechanisms. Three key intervention features were identified from the many that contributed to successful implementation. Firstly, it was important to frame CKD interventions appropriately, such as within the context of cardiovascular health and diabetes. This enabled buy-in and facilitated an understanding of the significance of CKD and the need for intervention. Secondly, interventions that were compatible with existing practices or patients' everyday lives were readily accepted. In contrast, new systems that could not be integrated were abandoned as they were viewed as inconvenient, generating more work. Thirdly, ownership of the feedback process allowed users to make individualised improvements to the intervention to suit their needs. Our rapid realist review identified mechanisms that need to be considered in order to optimise the implementation of interventions to improve the management of CKD in primary care. Further research into the factors that enable prolonged sustainability and cost-effectiveness is required for efficient resource utilisation.

Evaluating implementation of the World Health Organization's Strategic Approach to strengthening sexual and reproductive health policies and programs to address unintended pregnancy and unsafe abortion.

PubMed

Rashid, Shusmita; Moore, Julia E; Timmings, Caitlyn; Vogel, Joshua P; Ganatra, Bela; Khan, Dina N; Sayal, Radha; Metin Gülmezoglu, A; Straus, Sharon E

2017-11-21

We conducted a process evaluation to assess how the World Health Organization's (WHO) Strategic Approach to strengthening sexual and reproductive health policies and programs ("the SA") was used in 15 countries that requested WHO's technical support in addressing unintended pregnancy and unsafe abortion. The SA is a three-stage planning, policy, and program implementation process. We used the social ecological model (SEM) to analyze the contextual factors that influenced SA implementation. We used a two-phased sequential approach to data collection and analysis. In Phase A, we conducted a document and literature review and synthesized data thematically. In Phase B, we conducted interviews with stakeholders who used the SA in the countries of interest. We used a qualitative method triangulation technique to analyze and combine data from both phases to understand how the SA was implemented in each country. Data from 145 documents and 19 interviews described the SA process and activities in each country. All 15 countries completed Stage 1 activities. The activities of Stage 1 determined activities in subsequent stages and varied across countries. Following Stage 1, some countries focused on reforming policies to improve access to sexual and reproductive health (SRH) services whereas others focused on improving provider-level capacity to enhance SRH service quality and improving community-level SRH education. We identified factors across SEM levels that affected SA implementation, including individual- and community-level perceptions of using the SA and the recommendations that emerged from its use, organizational capacity to conduct SA activities, and how well these activities aligned with the existing political climate. Stakeholders perceived SA implementation to be country-driven and systematic in bringing attention to important SRH issues in their countries. We identified key success factors for influencing the individual, organization, and system change required for implementing the SA. These include sustaining stakeholder engagement for all SA stages, monitoring and reporting on activities, and leveraging activities and outputs from each SA stage to obtain technical and financial support for subsequent stages. Results may be used to optimize ongoing implementation efforts to improve access to and the quality of SRH services.

Factors influencing recovery and restoration following a chemical incident.

PubMed

Peña-Fernández, A; Wyke, S; Brooke, N; Duarte-Davidson, R

2014-11-01

Chemicals are an important part of our society. A wide range of chemicals are discharged into the environment every day from residential, commercial and industrial sources. Many of these discharges do not pose a threat to public health or the environment. However, global events have shown that chemical incidents or accidents can have severe consequences on human health, the environment and society. It is important that appropriate tools and technical guidance are available to ensure that a robust and efficient approach to developing a remediation strategy is adopted. The purpose of remediation is to protect human health from future exposure and to return the affected area back to normal as soon as possible. There are a range of recovery options (techniques or methods for remediation) that are applicable to a broad range of chemicals and incidents. Recovery options should be evaluated according to their appropriateness and efficacy for removing contaminants from the environment; however economic drivers and social and political considerations often influence decision makers on which remedial actions are implemented during the recovery phase of a chemical incident. To date, there is limited information in the literature on remediation strategies and recovery options that have been implemented following a chemical incident, or how successful they have been. Additional factors that can affect the approach taken for recovery are not well assessed or understood by decision makers involved in the remediation and restoration of the environment following a chemical incident. The identification of this gap has led to the development of the UK Recovery Handbook for Chemical Incidents to provide a framework for choosing an effective recovery strategy. A compendium of practical evidence-based recovery options (techniques or methods for remediation) for inhabited areas, food production systems and water environments has also been developed and is included in the chemical handbook. This paper presents the key factors that should be considered when developing a recovery strategy with respect to how these may impact on its effectiveness. The paper also highlights the importance of these factors through an evaluation of recovery strategies implemented following real chemical incidents that have been reported in the literature. Copyright © 2014 Elsevier Ltd. All rights reserved.

Implementation and dissemination of a transition of care program for rural veterans: a controlled before and after study.

PubMed

Leonard, Chelsea; Lawrence, Emily; McCreight, Marina; Lippmann, Brandi; Kelley, Lynette; Mayberry, Ashlea; Ladebue, Amy; Gilmartin, Heather; Côté, Murray J; Jones, Jacqueline; Rabin, Borsika A; Ho, P Michael; Burke, Robert

2017-10-23

Adapting promising health care interventions to local settings is a critical component in the dissemination and implementation process. The Veterans Health Administration (VHA) rural transitions nurse program (TNP) is a nurse-led, Veteran-centered intervention designed to improve transitional care for rural Veterans funded by VA national offices for dissemination to other VA sites serving a predominantly rural Veteran population. Here, we describe our novel approach to the implementation and evaluation = the TNP. This is a controlled before and after study that assesses both implementation and intervention outcomes. During pre-implementation, we assessed site context using a mixed method approach with data from diverse sources including facility-level quantitative data, key informant and Veteran interviews, observations of the discharge process, and a group brainstorming activity. We used the Practical Robust Implementation and Sustainability Model (PRISM) to inform our inquiries, to integrate data from all sources, and to identify factors that may affect implementation. In the implementation phase, we will use internal and external facilitation, paired with audit and feedback, to encourage appropriate contextual adaptations. We will use a modified Stirman framework to document adaptations. During the evaluation phase, we will measure intervention and implementation outcomes at each site using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). We will conduct a difference-in-differences analysis with propensity-matched Veterans and VA facilities as a control. Our primary intervention outcome is 30-day readmission and Emergency Department visit rates. We will use our findings to develop an implementation toolkit that will inform the larger scale-up of the TNP across the VA. The use of PRISM to inform pre-implementation evaluation and synthesize data from multiple sources, coupled with internal and external facilitation, is a novel approach to engaging sites in adapting interventions while promoting fidelity to the intervention. Our application of PRISM to pre-implementation and midline evaluation, as well as documentation of adaptations, provides an opportunity to identify and address contextual factors that may impede or enhance implementation and sustainability of health interventions and inform dissemination.

Nonalcoholic steatohepatitis in precision medicine: Unraveling the factors that contribute to individual variability.

PubMed

Clarke, John D; Cherrington, Nathan J

2015-07-01

There are numerous factors in individual variability that make the development and implementation of precision medicine a challenge in the clinic. One of the main goals of precision medicine is to identify the correct dose for each individual in order to maximize therapeutic effect and minimize the occurrence of adverse drug reactions. Many promising advances have been made in identifying and understanding how factors such as genetic polymorphisms can influence drug pharmacokinetics (PK) and contribute to variable drug response (VDR), but it is clear that there remain many unidentified variables. Underlying liver diseases such as nonalcoholic steatohepatitis (NASH) alter absorption, distribution, metabolism, and excretion (ADME) processes and must be considered in the implementation of precision medicine. There is still a profound need for clinical investigation into how NASH-associated changes in ADME mediators, such as metabolism enzymes and transporters, affect the pharmacokinetics of individual drugs known to rely on these pathways for elimination. This review summarizes the key PK factors in individual variability and VDR and highlights NASH as an essential underlying factor that must be considered as the development of precision medicine advances. A multifactorial approach to precision medicine that considers the combination of two or more risk factors (e.g. genetics and NASH) will be required in our effort to provide a new era of benefit for patients. Copyright © 2015 Elsevier Inc. All rights reserved.

The influence of social challenges when implementing information systems in a Swedish health-care organisation.

PubMed

Nilsson, Lina; Eriksén, Sara; Borg, Christel

2016-09-01

To describe and obtain a deeper understanding of social challenges and their influence on the implementation process when implementing Information systems in a Swedish health-care organisation. Despite positive effects when implementing Information systems in health-care organisations, there are difficulties in the implementation process. Nurses' experiences of being neglected have been dismissed as reasons for setbacks in implementation. An Institutional Ethnography design was used. A deductive content analysis was made influenced by empirically identified social challenges of power, professional identity and encounters. An abstraction was made of the analysis. Nineteen nurses at macro, meso and micro levels were interviewed in focus groups. Organisational levels are lost in different ways in how to control the reformation, how to introduce Information systems as reformation strategies and in how to translate new tools and assumptions that do not fit traditional ways of working in shaping professional identities. Different focus may affect the reformation of health-care organisations and implementation and knowledge processes. An implementation climate is needed where the system standards fit the values of the users. Nursing management needs to be visionary, engaged and work with risk factors in order to reform the hierarchical health-care organisation. © 2016 John Wiley & Sons Ltd.

[Factors affecting the recovery in the intensive care unit].

PubMed

Turkov, P N; Nikitin, V V; Antsupova, M A; Podkopaev, V N; Panfilova, R P; Ivanova, I N; Nesterova, L I

2013-01-01

Urgency of the problem is defined by economical, regulatory and legislative acts, regional social and moral factors. There is critical situation in Russian Pediatric Healthcare system. This situation is due to inadequate funding, high medical technologies inaccessibility for some Russian children, their adverse health state. The article presents a retrospective analysis of intensive therapy and resuscitation outcomes with technical equipment and work environment assessment in the intensive care unit of Tushinskaya city pediatric clinic for the period from 2007 to 2011. Anaesthetic and emergency care quality and safety depend on several factors: permanent equipment improvement, comprehensive analysis of every fatal case and full implementation of "Anti-epidemic (prophylactic) actions plan" and "Program of monitoring compliance with the sanitary norms".

Success in health information exchange projects: solving the implementation puzzle.

PubMed

Sicotte, Claude; Paré, Guy

2010-04-01

Interest in health information exchange (HIE), defined as the use of information technology to support the electronic transfer of clinical information across health care organizations, continues to grow among those pursuing greater patient safety and health care accessibility and efficiency. In this paper, we present the results of a longitudinal multiple-case study of two large-scale HIE implementation projects carried out in real time over 3-year and 2-year periods in Québec, Canada. Data were primarily collected through semi-structured interviews (n=52) with key informants, namely implementation team members and targeted users. These were supplemented with non-participants observation of team meetings and by the analysis of organizational documents. The cross-case comparison was particularly relevant given that project circumstances led to contrasting outcomes: while one project failed, the other was a success. A risk management analysis was performed taking a process view in order to capture the complexity of project implementations as evolving phenomena that are affected by interdependent pre-existing and emergent risks that tend to change over time. The longitudinal case analysis clearly demonstrates that the risk factors were closely intertwined. Systematic ripple effects from one risk factor to another were observed. This risk interdependence evolved dynamically over time, with a snowball effect that rendered a change of path progressively more difficult as time passed. The results of the cross-case analysis demonstrate a direct relationship between the quality of an implementation strategy and project outcomes. Copyright 2010 Elsevier Ltd. All rights reserved.

Implementing the Integrated Strategy for the Cultural Adaptation of Evidence-Based Interventions: An Illustration.

PubMed

Sidani, Souraya; Ibrahim, Sarah; Lok, Jana; Fan, Lifeng; Fox, Mary

2018-01-01

Background Persons' cultural beliefs about a health problem can affect their perceived acceptability of evidence-based interventions, undermining evidence-based interventions' adherence, and uptake to manage the problem. Cultural adaptation has the potential to enhance the acceptability, uptake, and adherence to evidence-based interventions. Purpose To illustrate the implementation of the first two phases of the integrated strategy for cultural adaptation by examining Chinese Canadians' perceptions of chronic insomnia and evidence-based behavioral therapies for insomnia. Methods Chinese Canadians ( n = 14) with chronic insomnia attended a group session during which they completed established instruments measuring beliefs about sleep and insomnia, and their perceptions of factors that contribute to chronic insomnia. Participants rated the acceptability of evidence-based behavioral therapies and discussed their cultural perspectives regarding chronic insomnia and its treatment. Results Participants actively engaged in the activities planned for the first two phases of the integrated strategy and identified the most significant factor contributing to chronic insomnia and the evidence-based intervention most acceptable for their cultural group. Conclusions The protocol for implementing the two phases of the integrated strategy for cultural adaptation of evidence-based interventions was feasible, acceptable, and useful in identifying culturally relevant evidence-based interventions.

Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies.

PubMed

O'Connor, Siobhan; Hanlon, Peter; O'Donnell, Catherine A; Garcia, Sonia; Glanville, Julie; Mair, Frances S

2016-09-15

Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts. PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 - 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. 'telemedicine', 'mobile applications', 'personal health record', 'social networking'). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results. Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature. This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them. International Prospective Register of Systematic Reviews CRD42015029846.

Catchment process affecting drinking water quality, including the significance of rainfall events, using factor analysis and event mean concentrations.

PubMed

Cinque, Kathy; Jayasuriya, Niranjali

2010-12-01

To ensure the protection of drinking water an understanding of the catchment processes which can affect water quality is important as it enables targeted catchment management actions to be implemented. In this study factor analysis (FA) and comparing event mean concentrations (EMCs) with baseline values were techniques used to asses the relationships between water quality parameters and linking those parameters to processes within an agricultural drinking water catchment. FA found that 55% of the variance in the water quality data could be explained by the first factor, which was dominated by parameters usually associated with erosion. Inclusion of pathogenic indicators in an additional FA showed that Enterococcus and Clostridium perfringens (C. perfringens) were also related to the erosion factor. Analysis of the EMCs found that most parameters were significantly higher during periods of rainfall runoff. This study shows that the most dominant processes in an agricultural catchment are surface runoff and erosion. It also shows that it is these processes which mobilise pathogenic indicators and are therefore most likely to influence the transport of pathogens. Catchment management efforts need to focus on reducing the effect of these processes on water quality.

Analysis of Complaints from Patients During Mechanical Ventilation After Cardiac Surgery: A Retrospective Study.

PubMed

Wang, Yi; Li, Hua; Zou, Honglin; Li, Yaxiong

2015-08-01

This study analyzed major complaints from patients during mechanical ventilation after cardiac surgery and identified the most common complaints to reduce adverse psychologic responses. Retrospective. A single tertiary university hospital. Patients with heart disease who were on mechanical ventilation after cardiac surgery (N = 800). The major complaints of the patients during mechanical ventilation after cardiac surgery were analyzed. Patients' comfort was evaluated using a visual analog scale, and the factors affecting comfort were analyzed. The average visual analog scale score in all patients was 5.8±2.0, and most patients presented moderate discomfort. The factors affecting comfort included dry mouth, thirst, tracheal intubation, aspiration of sputum, communication barriers, limited mobility, fear/anxiety, patient-ventilator dyssynchrony, and poor environmental conditions. Of these factors, 8 were independent predictors of the visual analog scale score. Patients considered mechanical ventilation to be the worst part of their hospitalization. The study identified 8 independent factors causing discomfort in patients during mechanical ventilation after cardiac surgery. Clinicians should take appropriate measures and implement nursing interventions to reduce suffering, physical and psychologic trauma, and adverse psychologic responses and to promote recovery. Copyright © 2015 Elsevier Inc. All rights reserved.

[Analysis on barriers of urban sustainable development based on DEMATEL: a case of Shenyang City].

PubMed

Li, Chun-Rong; Geng, Yong; Xue, Bing; Ren, Wan-Xia; Dong, Hui-Juan

2012-10-01

To scientifically identify the key barriers which the urban sustainable development is facing and to analyze the interrelationships among the barriers are of significance to promote urban sustainable development. Through literature review, site investigation and structural interview, 21 factors affecting the Shenyang City's sustainable development were recognized, and based on questionnaire survey and statistics analysis, 12 main factors were screened. Further, by employing decision-making and trial evaluation laboratory (DEMATEL) method, the interrelationships among these factors were analyzed. The key factors affecting the Shenyang's sustainable development included the lack of leaders' attention, the economy-oriented governmental performance evaluation system, the lower public awareness on sustainable development, and the lack of academic understanding on regional eco-carrying capacity and related key projects. It was suggested that the local government should pay more attention on sustainable development, increase propaganda activities, reform governmental performance evaluation system, establish a reward-punishment system for promoting sustainable development and an effective monitoring mechanism, and enhance the implementation of related regulations, the local enterprises should establish research and development funds to support the researches of key technologies and introduce key projects, and general publics should improve their awareness on sustainable development and actively participate in related activities.

Genetic factors affecting dental caries risk.

PubMed

Opal, S; Garg, S; Jain, J; Walia, I

2015-03-01

This article reviews the literature on genetic aspects of dental caries and provides a framework for the rapidly changing disease model of caries. The scope is genetic aspects of various dental factors affecting dental caries. The PubMed database was searched for articles with keywords 'caries', 'genetics', 'taste', 'diet' and 'twins'. This was followed by extensive handsearching using reference lists from relevant articles. The post-genomic era will present many opportunities for improvement in oral health care but will also present a multitude of challenges. We can conclude from the literature that genes have a role to play in dental caries; however, both environmental and genetic factors have been implicated in the aetiology of caries. Additional studies will have to be conducted to replicate the findings in a different population. Identification of genetic risk factors will help screen and identify susceptible patients to better understand the contribution of genes in caries aetiopathogenesis. Information derived from these diverse studies will provide new tools to target individuals and/or populations for a more efficient and effective implementation of newer preventive measures and diagnostic and novel therapeutic approaches in the management of this disease. © 2015 Australian Dental Association.

Analyzing and Predicting Effort Associated with Finding and Fixing Software Faults

NASA Technical Reports Server (NTRS)

Hamill, Maggie; Goseva-Popstojanova, Katerina

2016-01-01

Context: Software developers spend a significant amount of time fixing faults. However, not many papers have addressed the actual effort needed to fix software faults. Objective: The objective of this paper is twofold: (1) analysis of the effort needed to fix software faults and how it was affected by several factors and (2) prediction of the level of fix implementation effort based on the information provided in software change requests. Method: The work is based on data related to 1200 failures, extracted from the change tracking system of a large NASA mission. The analysis includes descriptive and inferential statistics. Predictions are made using three supervised machine learning algorithms and three sampling techniques aimed at addressing the imbalanced data problem. Results: Our results show that (1) 83% of the total fix implementation effort was associated with only 20% of failures. (2) Both safety critical failures and post-release failures required three times more effort to fix compared to non-critical and pre-release counterparts, respectively. (3) Failures with fixes spread across multiple components or across multiple types of software artifacts required more effort. The spread across artifacts was more costly than spread across components. (4) Surprisingly, some types of faults associated with later life-cycle activities did not require significant effort. (5) The level of fix implementation effort was predicted with 73% overall accuracy using the original, imbalanced data. Using oversampling techniques improved the overall accuracy up to 77%. More importantly, oversampling significantly improved the prediction of the high level effort, from 31% to around 85%. Conclusions: This paper shows the importance of tying software failures to changes made to fix all associated faults, in one or more software components and/or in one or more software artifacts, and the benefit of studying how the spread of faults and other factors affect the fix implementation effort.

The Effects of Dietary Factors on Blood Pressure.

PubMed

Appel, Lawrence J

2017-05-01

Evidence supports that multiple dietary factors affect blood pressure (BP). Dietary changes that effectively lower BP are weight loss, reduced sodium intake, increased potassium intake, moderation of alcohol intake, and Dietary Approaches to Stop Hypertension-style and vegetarian dietary patterns. In view of the increasing levels of BP in children and adults and the continuing epidemic of BP-related cardiovascular and renal diseases, efforts to reduce BP in both nonhypertensive and hypertensive individuals are warranted. The challenge to health care providers, researchers, government officials, and the general public is developing and implementing clinical and public health strategies that lead to sustained dietary changes. Copyright © 2016 Elsevier Inc. All rights reserved.

Type 1 diabetes mellitus: psychosocial factors and adjustment of pediatric patient and his/her family. Review.

PubMed

Pérez-Marín, Marián; Gómez-Rico, Irene; Montoya-Castilla, Inmaculada

2015-04-01

Type 1 diabetes mellitus is the most common chronic endocrine disease in children, with a very low incidence in the first months of life and reaching its peak during puberty (10-15 years old is the age group with the highest incidence at the time of onset). Based on the review of the scientific literature, our objective is to study the main psychosocial factors associated with the adjustment of these pediatric patients and their families. Research underscore the following risk factors: situational (stressful life events), personal (additional physical diseases, low self-esteem, emotional disturbances), and interpersonal (family breakdown and conflicts), and also protection factors (coping strategies, social support, fluent communication). There is a pressing need to deal with the disturbances that affect these diabetic patients and their families, by implementing effective health care psychological interventions that take into account psychosocial factors associated with the course of type 1 diabetes mellitus.

National Human Trafficking Initiatives: Dimensions of Policy Diffusion1

PubMed Central

Yoo, Eun-hye; Boyle, Elizabeth Heger

2014-01-01

The implementation of criminal law involves formal law enforcement, education and public outreach aimed at preventing criminal activity, and providing services for victims. Historically, quantitative research on global trends has tended to focus on a single policy dimension, potentially masking the unique factors that affect the diffusion of each policy dimension independently. Using an ordered-probit model to analyze new human trafficking policy data on national prosecution, prevention, and victim-protection efforts, we find that global ties and domestic interest groups matter more in areas where international law is less defined. While prosecution, officially mandated by the Trafficking Protocol, was relatively impervious to global ties and domestic interest groups, both trafficking prevention and victim protection were associated with these factors. Our findings also suggest that fear of repercussions is not a major driver of state actions to combat trafficking—neither ratification of the Trafficking Protocol nor levels of United States aid were associated with greater implementation of anti-trafficking measures. PMID:26538806

National Human Trafficking Initiatives: Dimensions of Policy Diffusion.

PubMed

Yoo, Eun-Hye; Boyle, Elizabeth Heger

2015-01-01

The implementation of criminal law involves formal law enforcement, education and public outreach aimed at preventing criminal activity, and providing services for victims. Historically, quantitative research on global trends has tended to focus on a single policy dimension, potentially masking the unique factors that affect the diffusion of each policy dimension independently. Using an ordered-probit model to analyze new human trafficking policy data on national prosecution, prevention, and victim-protection efforts, we find that global ties and domestic interest groups matter more in areas where international law is less defined. While prosecution, officially mandated by the Trafficking Protocol, was relatively impervious to global ties and domestic interest groups, both trafficking prevention and victim protection were associated with these factors. Our findings also suggest that fear of repercussions is not a major driver of state actions to combat trafficking-neither ratification of the Trafficking Protocol nor levels of United States aid were associated with greater implementation of anti-trafficking measures.

An enhanced methodology for spacecraft correlation activity using virtual testing tools

NASA Astrophysics Data System (ADS)

Remedia, Marcello; Aglietti, Guglielmo S.; Appolloni, Matteo; Cozzani, Alessandro; Kiley, Andrew

2017-11-01

Test planning and post-test correlation activity have been issues of growing importance in the last few decades and many methodologies have been developed to either quantify or improve the correlation between computational and experimental results. In this article the methodologies established so far are enhanced with the implementation of a recently developed procedure called Virtual Testing. In the context of fixed-base sinusoidal tests (commonly used in the space sector for correlation), there are several factors in the test campaign that affect the behaviour of the satellite and are not normally taken into account when performing analyses: different boundary conditions created by the shaker's own dynamics, non-perfect control system, signal delays etc. All these factors are the core of the Virtual Testing implementation, which will be thoroughly explained in this article and applied to the specific case of Bepi-Colombo spacecraft tested on the ESA QUAD Shaker. Correlation activity will be performed in the various stages of the process, showing important improvements observed after applying the final complete methodology.

Rural long-term care work, gender, and restructuring.

PubMed

Leach, Belinda; Joseph, Gillian

2011-06-01

Restructuring--the introduction of changes that alter the way health care is delivered for maximum efficiency and least cost--layered with rurality and with rural gender ideologies and practices, results in rural long-term care settings that have particular consequences for the women working in them, and for the residents and communities that they serve. This research investigated how rurality affects the implementation of patient classification in Ontario long-term care homes. Methods involved interviews and focus groups with front-line long-term care workers, administrators, and key participants. The findings revealed that rural long-term care delivery takes place when a restructured work environment intersects with gender ideologies and practices that take on particular characteristics when developed and sustained in a rural context. These factors shape the labor market and working conditions for rural women. We argue that this produces a uniquely rural experience for long-term care workers and conclude that those implementing classification systems must consider contextual factors as well as practical and financial exigencies.

Examining Adoption of e-Procurement in Public Sector Using the Perceived Characteristics of Innovating: Indonesian Perspective

NASA Astrophysics Data System (ADS)

Wahid, Fathul

This study aims to examine factors affecting adoption of e-procurement in public sector with special reference to Indonesian context. The Perceived Characteristics of Innovating defined by Moore and Benbasat [1] used as the framework. Based on a survey to 87 contractors/suppliers in the city of Yogyakarta, the study finds that only trialability that affects use intention of e-procurement among the contractors/suppliers. The survey conducted in the early stage of e-procurement implementation is of the possible explanations. Government policy that forces the contractors/suppliers to use the e-procurement also partakes in this context. Practical implication of the findings are also discussed in the paper.

Thrombocalc: implementation and uptake of personalized postpartum venous thromboembolism risk assessment in a high-throughput obstetric environment.

PubMed

O'Shaughnessy, Fergal; Donnelly, Jennifer C; Cooley, Sharon M; Deering, Mary; Raman, Ajita; Gannon, Geraldine; Hickey, Jane; Holland, Alan; Hayes, Niamh; Bennett, Kathleen; Ní Áinle, Fionnuala; Cleary, Brian J

2017-11-01

Venous thromboembolism risk assessment (VTERA) is recommended in all pregnant and postpartum women. Our objective was to develop, pilot and implement a user-friendly electronic VTERA tool. We developed "Thrombocalc", an electronic VTERA tool using Microsoft EXCEL ™ . Thrombocalc was designed as a score-based tool to facilitate rapid assessment of all women after childbirth. Calculation of a total score estimated risk of venous thromboembolism in line with consensus guidelines. Recommendations for thromboprophylaxis were included in the VTERA output. Implementation was phased. Uptake of the VTERA tool was assessed prospectively by monitoring the proportion of women who gave birth in our institution and had a completed risk assessment. Factors affecting completion and accuracy of risk assessments were also assessed. Thrombocalc was used prospectively to risk-assess 8380 women between September 2014 and December 2015. Compliance with this tool increased dramatically throughout the study period; over 92% of women were risk-assessed in the last quarter of data collection. Compliance was not adversely affected if delivery took place out of working hours [adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 0.93-1.14]. Risk assessment was less likely in the case of cesarean deliveries (aOR 0.66, 95% CI 0.60-0.73) and stillborn infants (aOR 0.48, 95% CI 0.29-0.79). Misclassification of risk factors led to approximately 207 (2.5%) inaccurate thromboprophylaxis recommendations. Our electronic, score-based VTERA tool provides a highly effective mechanism for rapid assessment of individual postpartum venous thromboembolism risk in a high-throughput environment. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

The elimination of fox rabies from Europe: determinants of success and lessons for the future

PubMed Central

Freuling, Conrad M.; Hampson, Katie; Selhorst, Thomas; Schröder, Ronald; Meslin, Francois X.; Mettenleiter, Thomas C.; Müller, Thomas

2013-01-01

Despite perceived challenges to controlling an infectious disease in wildlife, oral rabies vaccination (ORV) of foxes has proved a remarkably successful tool and a prime example of a sophisticated strategy to eliminate disease from wildlife reservoirs. During the past three decades, the implementation of ORV programmes in 24 countries has led to the elimination of fox-mediated rabies from vast areas of Western and Central Europe. In this study, we evaluated the efficiency of 22 European ORV programmes between 1978 and 2010. During this period an area of almost 1.9 million km² was targeted at least once with vaccine baits, with control taking between 5 and 26 years depending upon the country. We examined factors influencing effort required both to control and eliminate fox rabies as well as cost-related issues of these programmes. The proportion of land area ever affected by rabies and an index capturing the size and overlap of successive ORV campaigns were identified as factors having statistically significant effects on the number of campaigns required to both control and eliminate rabies. Repeat comprehensive campaigns that are wholly overlapping much more rapidly eliminate infection and are less costly in the long term. Disproportionally greater effort is required in the final phase of an ORV programme, with a median of 11 additional campaigns required to eliminate disease once incidence has been reduced by 90 per cent. If successive ORV campaigns span the entire affected area, rabies will be eliminated more rapidly than if campaigns are implemented in a less comprehensive manner, therefore reducing ORV expenditure in the longer term. These findings should help improve the planning and implementation of ORV programmes, and facilitate future decision-making by veterinary authorities and policy-makers. PMID:23798690

The elimination of fox rabies from Europe: determinants of success and lessons for the future.

PubMed

Freuling, Conrad M; Hampson, Katie; Selhorst, Thomas; Schröder, Ronald; Meslin, Francois X; Mettenleiter, Thomas C; Müller, Thomas

2013-08-05

Despite perceived challenges to controlling an infectious disease in wildlife, oral rabies vaccination (ORV) of foxes has proved a remarkably successful tool and a prime example of a sophisticated strategy to eliminate disease from wildlife reservoirs. During the past three decades, the implementation of ORV programmes in 24 countries has led to the elimination of fox-mediated rabies from vast areas of Western and Central Europe. In this study, we evaluated the efficiency of 22 European ORV programmes between 1978 and 2010. During this period an area of almost 1.9 million km² was targeted at least once with vaccine baits, with control taking between 5 and 26 years depending upon the country. We examined factors influencing effort required both to control and eliminate fox rabies as well as cost-related issues of these programmes. The proportion of land area ever affected by rabies and an index capturing the size and overlap of successive ORV campaigns were identified as factors having statistically significant effects on the number of campaigns required to both control and eliminate rabies. Repeat comprehensive campaigns that are wholly overlapping much more rapidly eliminate infection and are less costly in the long term. Disproportionally greater effort is required in the final phase of an ORV programme, with a median of 11 additional campaigns required to eliminate disease once incidence has been reduced by 90 per cent. If successive ORV campaigns span the entire affected area, rabies will be eliminated more rapidly than if campaigns are implemented in a less comprehensive manner, therefore reducing ORV expenditure in the longer term. These findings should help improve the planning and implementation of ORV programmes, and facilitate future decision-making by veterinary authorities and policy-makers.

Vulnerability assessment in a participatory approach to design and implement community based adaptation to drought in the Peruvian Andes

NASA Astrophysics Data System (ADS)

Lasage, Ralph; Muis, Sanne; Sardella, Carolina; van Drunen, Michiel; Verburg, Peter; Aerts, Jeroen

2015-04-01

The livelihoods of people in the Andes are expected to be affected by climate change due to their dependence on glacier meltwater during the growing season. The observed decrease in glacier volume over the last few decades is likely to accelerate during the current century, which will affect water availability in the region. This paper presents the implementation of an approach for the participatory development of community-based adaptation measures to cope with the projected impacts of climate change, which was implemented jointly by the local community and by a team consisting of an NGO, Peruvian ministry of environment, research organisations and a private sector organisation. It bases participatory design on physical measurements, modelling and a vulnerability analysis. Vulnerability to drought is made operational for households in a catchment of the Ocoña river basin in Peru. On the basis of a household survey we explore how a vulnerability index (impacts divided by the households' perceived adaptive capacity) can be used to assess the distribution of vulnerability over households in a sub catchment. The socio-economic factors water entitlement, area of irrigated land, income and education are all significantly correlate with this vulnerability to drought. The index proved to be appropriate for communicating about vulnerability to climate change and its determining factors with different stakeholders. The water system research showed that the main source of spring water is local rainwater, and that water use efficiency in farming is low. The adaptation measures that were jointly selected by the communities and the project team aimed to increase water availability close to farmland, and increase water use efficiency, and these will help to reduce the communities vulnerability to drought.

An Assessment of the Factors in Office Automation Systems Affecting Air Force Middle Managers and Clerical Workers in the Information Management Career Field

DTIC Science & Technology

1990-12-01

Implementation..........14 Advantages of OA ............... 20 Social Impact of CA. ........... Effect of OA on Users ............. 25 Conclusion...discussed include social impacts , specific Air Force studies, job skills, supervision, and changes in employment. 10 Chapter III contains the... social impact of OA on managers and clerical workers. The final area examined effects of OA on users in their environments. General Review Review of

Method of Testing and Predicting Failures of Electronic Mechanical Systems

NASA Technical Reports Server (NTRS)

Iverson, David L.; Patterson-Hine, Frances A.

1996-01-01

A method employing a knowledge base of human expertise comprising a reliability model analysis implemented for diagnostic routines is disclosed. The reliability analysis comprises digraph models that determine target events created by hardware failures human actions, and other factors affecting the system operation. The reliability analysis contains a wealth of human expertise information that is used to build automatic diagnostic routines and which provides a knowledge base that can be used to solve other artificial intelligence problems.

Factors affecting the concussion knowledge of athletes, parents, coaches, and medical professionals

PubMed Central

Cusimano, Michael D; Zhang, Stanley; Topolovec-Vranic, Jane; Hutchison, Michael G; Jing, Rowan

2017-01-01

Objectives: To determine the predictors of knowledge and awareness of concussion symptoms and outcomes through a survey of athletes, parents of players and coaches in sports settings in Canada. Methods: A cross-sectional survey of athletic communities in Canada was conducted. Respondents’ concussion knowledge score consists of responses to questions about the symptoms, diagnosis, and treatment of a concussion and the timing of return-to-sport post-concussion. The percentage of correct responses was defined as the “identification rate.” The extent to which participant factors affected the scores was examined by univariate and multivariate analyses. Results: Respondents were able to identify a mean of 80.6% of symptoms. Cognitive symptoms were most commonly known, and mental health symptoms associated with concussion were least known, and health professionals, coaches, and those with a personal history of concussion had the highest levels of overall knowledge. Language, age, educational level, annual household income, and traumatic brain injury history were good predictors of better concussion knowledge. Conclusion: Those designing and implementing interventions aimed at concussion management and prevention should ensure that younger, lower income, lower educational, non-English-speaking persons, and those without experience of traumatic brain injury or concussion be specifically accounted for in the design and implementation of interventions to prevent and treat concussion and mild traumatic brain injury. PMID:28540042

Cardiovascular diseases and diabetes as economic and developmental challenges in Africa.

PubMed

Kengne, Andre Pascal; June-Rose McHiza, Zandile; Amoah, Albert George Baidoe; Mbanya, Jean-Claude

2013-01-01

Current estimates and projections suggest that the burden of cardiovascular diseases (CVDs), diabetes and related risk factors in African countries is important, somewhat unique and rapidly growing. Various segments of the population are affected; however, the group mostly affected is young adults residing in urban areas, and increasingly those in the low socioeconomic strata. The African milieu/environment is compounded by weak health systems, which are unable to cope with the looming double burden of communicable and chronic non-communicable diseases. This review discusses the economic and developmental challenges posed by CVDs and diabetes in countries in Africa. Using several lines of evidence, we demonstrate that the cost of care for major CVDs and diabetes is beyond the coping capacities of individuals, households, families and governments in most African countries. We have reviewed modeling studies by the International Diabetes Federation (IDF) and other major international agencies on the current and projected impact that CVDs and diabetes have on the economy and development of countries in the region. Locally, appropriate strategies to limit the impact of the conditions on the economies and development of countries in Africa are suggested and discussed. These include monitoring diseases and risk factors, and primordial, primary and secondary preventions implemented following a life-course perspective. Structural, logistic, human capacity and organizational challenges to be surmounted during the implementations of these strategies will be reviewed. © 2013.

The effectiveness of risk communication regarding drug safety information: a nationwide survey by the Japanese public health insurance claims data.

PubMed

Hagiwara, Hiromi; Nakano, Shun; Ogawa, Yoshihiro; Tohkin, Masahiro

2015-06-01

We evaluated the effectiveness of warning letters published by the pharmaceutical regulatory agency in Japan on communication of drug safety and risk by quantitative analysis of the national health insurance claims database (NHICD). We then explored what factors may have affected risk communication. We measured the implementation rate of the hepatitis virus-monitoring test among methotrexate (MTX)-treated patients; a warning letter had been issued regarding the use of MTX, as it apparently activates the hepatitis virus. Data from the NHICD, which include 99·3% of Japanese residents, were used. A total of 4,933,481 patients with rheumatoid arthritis (RA) (January-June, 2010) were the focus of this study. The implementation rate of the hepatitis virus-monitoring test increased from 1·4% before to 1·8% after the warning letter announcement. Logistic regression analysis suggested that the installation of a drug information management room is one of the important factors affecting risk communication. Further analysis revealed that the hepatitis virus monitoring rates in hospitals without drug information management rooms increased from 2·3% to 4·1% due to the issue of the warning letter. The warning letter from the regulatory agency plays an important role in risk communication in hospitals without drug information management rooms. © 2015 John Wiley & Sons Ltd.

Designing Caregiver-Implemented Shared-Reading Interventions to Overcome Implementation Barriers

PubMed Central

Logan, Jessica R.; Damschroder, Laura

2015-01-01

Purpose This study presents an application of the theoretical domains framework (TDF; Michie et al., 2005), an integrative framework drawing on behavior-change theories, to speech-language pathology. Methods A multistep procedure was used to identify barriers affecting caregivers' implementation of shared-reading interventions with their children with language impairment (LI). The authors examined caregiver-level data corresponding to implementation issues from two randomized controlled trials and mapped these to domains in the TDF as well as empirically validated behavior-change techniques. Results Four barriers to implementation were identified as potentially affecting caregivers' implementation: time pressures, reading difficulties, discomfort with reading, and lack of awareness of benefits. These were mapped to 3 TDF domains: intentions, beliefs about capabilities, and skills. In turn, 4 behavior-change techniques were identified as potential vehicles for affecting these domains: reward, feedback, model, and encourage. An ongoing study is described that is determining the effects of these techniques for improving caregivers' implementation of a shared-reading intervention. Conclusions A description of the steps to identifying barriers to implementation, in conjunction with an ongoing experiment that will explicitly determine whether behavior-change techniques affect these barriers, provides a model for how implementation science can be used to identify and overcome implementation barriers in the treatment of communication disorders. PMID:26262941

Designing Caregiver-Implemented Shared-Reading Interventions to Overcome Implementation Barriers.

PubMed

Justice, Laura M; Logan, Jessica R; Damschroder, Laura

2015-12-01

This study presents an application of the theoretical domains framework (TDF; Michie et al., 2005), an integrative framework drawing on behavior-change theories, to speech-language pathology. A multistep procedure was used to identify barriers affecting caregivers' implementation of shared-reading interventions with their children with language impairment (LI). The authors examined caregiver-level data corresponding to implementation issues from two randomized controlled trials and mapped these to domains in the TDF as well as empirically validated behavior-change techniques. Four barriers to implementation were identified as potentially affecting caregivers' implementation: time pressures, reading difficulties, discomfort with reading, and lack of awareness of benefits. These were mapped to 3 TDF domains: intentions, beliefs about capabilities, and skills. In turn, 4 behavior-change techniques were identified as potential vehicles for affecting these domains: reward, feedback, model, and encourage. An ongoing study is described that is determining the effects of these techniques for improving caregivers' implementation of a shared-reading intervention. A description of the steps to identifying barriers to implementation, in conjunction with an ongoing experiment that will explicitly determine whether behavior-change techniques affect these barriers, provides a model for how implementation science can be used to identify and overcome implementation barriers in the treatment of communication disorders.

A qualitative study of factors affecting mental health amongst low-income working mothers in Bangalore, India.

PubMed

Travasso, Sandra Mary; Rajaraman, Divya; Heymann, Sally Jody

2014-02-07

Low-income urban working mothers face many challenges in their domestic, environmental, and working conditions that may affect their mental health. In India, a high prevalence of mental health disorders has been recorded in young women, but there has been little research to examine the factors that affect their mental health at home and work. Through a primarily qualitative approach, we studied the relationship between work, caring for family, spousal support, stress relief strategies and mental health amongst forty eight low-income working mothers residing in urban slums across Bangalore, India. Participants were construction workers, domestic workers, factory workers and fruit and vegetable street vendors. Qualitative data analysis themes included state of mental health, factors that affected mental health positively or negatively, manifestations and consequences of stress and depression, and stress mitigators. Even in our small sample of women, we found evidence of extreme depression, including suicidal ideation and attempted suicide. Women who have an alcoholic and/or abusive husband, experience intimate partner violence, are raising children with special needs, and lack adequate support for child care appear to be more susceptible to severe and prolonged periods of depression and suicide attempts. Factors that pointed towards reduced anxiety and depression were social support from family, friends and colleagues and fulfilment from work. This qualitative study raises concerns that low-income working mothers in urban areas in India are at high risk for depression, and identifies common factors that create and mitigate stress in this population group. We discuss implications of the findings for supporting the mental health of urban working women in the Indian context. The development of the national mental health policy in India and its subsequent implementation should draw on existing research documenting factors associated with negative mental health amongst specific population groups in order to ensure greater impact.

A qualitative study of factors affecting mental health amongst low-income working mothers in Bangalore, India

PubMed Central

2014-01-01

Background Low-income urban working mothers face many challenges in their domestic, environmental, and working conditions that may affect their mental health. In India, a high prevalence of mental health disorders has been recorded in young women, but there has been little research to examine the factors that affect their mental health at home and work. Methods Through a primarily qualitative approach, we studied the relationship between work, caring for family, spousal support, stress relief strategies and mental health amongst forty eight low-income working mothers residing in urban slums across Bangalore, India. Participants were construction workers, domestic workers, factory workers and fruit and vegetable street vendors. Qualitative data analysis themes included state of mental health, factors that affected mental health positively or negatively, manifestations and consequences of stress and depression, and stress mitigators. Results Even in our small sample of women, we found evidence of extreme depression, including suicidal ideation and attempted suicide. Women who have an alcoholic and/or abusive husband, experience intimate partner violence, are raising children with special needs, and lack adequate support for child care appear to be more susceptible to severe and prolonged periods of depression and suicide attempts. Factors that pointed towards reduced anxiety and depression were social support from family, friends and colleagues and fulfilment from work. Conclusion This qualitative study raises concerns that low-income working mothers in urban areas in India are at high risk for depression, and identifies common factors that create and mitigate stress in this population group. We discuss implications of the findings for supporting the mental health of urban working women in the Indian context. The development of the national mental health policy in India and its subsequent implementation should draw on existing research documenting factors associated with negative mental health amongst specific population groups in order to ensure greater impact. PMID:24502531

European hospital managers' perceptions of patient-centred care.

PubMed

Taylor, Angelina; Groene, Oliver

2015-01-01

The spotlight has recently been placed on managers' responsibility for patient-centred care as a result of Mid Staffordshire NHS Foundation Trust failings. In previous research, clinicians reported that managers do not have an adequate structured plan for implementing patient-centred care. The purpose of this paper is to assess the perceptions of European hospital management with respect to factors affecting the implementation of a patient-centred approach. In total, 15 semi-structured interviews were conducted with hospital managers (n=10), expert country informants (n=2), patient organisations (n=2) and a user representative (n=1) from around Europe. Participants were purposively and snowball sampled. Interviews were analysed using framework analysis. Most participants felt that current levels of patient-centred care are inadequate, but accounted that there were a number of macro, meso and micro challenges they faced in implementing this approach. These included budget constraints, political and historical factors, the resistance of clinicians and other frontline staff. Organisational culture emerged as a central theme, shaped by these multi-level factors and influencing the way in which patient-centred care was borne out in the hospital. Participants proposed that the needs of patients might be better met through increasing advocacy by patient organisations and greater staff contact with patients. This study is the first of its kind to obtain management views from around Europe. It offers an insight into different models of how patient-centred care is realised by management. It indicates that managers see the value of a patient-centred approach but that they feel restricted by a number of factors at multiple levels.

Energy performance standards for new buildings: Economic analysis

NASA Astrophysics Data System (ADS)

1980-01-01

The major economic impacts of the implementations of the standards on affected groups were assessed and the effectiveness of the standards as an investment in energy conservation was evaluated. The methodology used to evaluate the standards for the various building types and perspectives is described. The net economic effect of changes in building cost and energy use are discussed for three categories of buildings: single family residential, commercial and multifamily residential, and mobile homes. Forecasts of energy savings and national costs and benefits both with and without implementation of the standards are presented. The effects of changes in energy consumption and construction of new buildings on the national economy, including such factors as national income, investment, employment, and balance of trade are assessed.

Factors affecting job satisfaction and retention of medical laboratory professionals in seven countries of Sub-Saharan Africa

PubMed Central

2013-01-01

Effective implementation and sustainability of quality laboratory programmes in Sub-Saharan Africa relies on the development of appropriate staff retention strategies. Assessing the factors responsible for job satisfaction and retention is key for tailoring specific interventions aiming at improving the overall impact of health programmes. A survey was developed to assess these factors among 224 laboratorians working in the laboratory programme the University of Maryland implemented in seven Sub-Saharan African countries. Lack of professional development was the major reason for leaving the previous job for 28% of interviewees who changed jobs in the past five years. Professional development/training opportunities was indicated by almost 90% (195/224) of total interviewees as the most important or a very important factor for satisfaction at their current job. Similarly, regular professional development/opportunities for training was the highest rated incentive to remain at their current job by 80% (179/224). Laboratory professionals employed in the private sector were more likely to change jobs than those working in the public sector (P = 0.002). The findings were used for developing specific strategies for human resources management, in particular targeting professional development, aiming at improving laboratory professionals within the University of Maryland laboratory programme and hence its long-term sustainability. PMID:23958152

Factors affecting job satisfaction and retention of medical laboratory professionals in seven countries of Sub-Saharan Africa.

PubMed

Marinucci, Francesco; Majigo, Mtebe; Wattleworth, Matthew; Paterniti, Antonio Damiano; Hossain, Mian Bazle; Redfield, Robert

2013-08-17

Effective implementation and sustainability of quality laboratory programmes in Sub-Saharan Africa relies on the development of appropriate staff retention strategies. Assessing the factors responsible for job satisfaction and retention is key for tailoring specific interventions aiming at improving the overall impact of health programmes. A survey was developed to assess these factors among 224 laboratorians working in the laboratory programme the University of Maryland implemented in seven Sub-Saharan African countries. Lack of professional development was the major reason for leaving the previous job for 28% of interviewees who changed jobs in the past five years. Professional development/training opportunities was indicated by almost 90% (195/224) of total interviewees as the most important or a very important factor for satisfaction at their current job. Similarly, regular professional development/opportunities for training was the highest rated incentive to remain at their current job by 80% (179/224). Laboratory professionals employed in the private sector were more likely to change jobs than those working in the public sector (P = 0.002). The findings were used for developing specific strategies for human resources management, in particular targeting professional development, aiming at improving laboratory professionals within the University of Maryland laboratory programme and hence its long-term sustainability.

Factors Associated with Intern Fatigue

PubMed Central

Vidyarthi, Arpana R.; Baron, Robert B.; Katz, Patricia P.

2008-01-01

ABSTRACT BACKGROUND Prior data suggest that fatigue adversely affects patient safety and resident well-being. ACGME duty hour limitations were intended, in part, to reduce resident fatigue, but the factors that affect intern fatigue are unknown. OBJECTIVE To identify factors associated with intern fatigue following implementation of duty hour limitations. DESIGN Cross-sectional confidential survey of validated questions related to fatigue, sleep, and stress, as well as author-developed teamwork questions. SUBJECTS Interns in cognitive specialties at the University of California, San Francisco. MEASUREMENTS Univariate statistics characterized the distribution of responses. Pearson correlations elucidated bivariate relationships between fatigue and other variables. Multivariate linear regression models identified factors independently associated with fatigue, sleep, and stress. RESULTS Of 111 eligible interns, 66 responded (59%). In a regression analysis including gender, hours worked in the previous week, sleep quality, perceived stress, and teamwork, only poorer quality of sleep and greater perceived stress were significantly associated with fatigue (p < 0.001 and p = 0.02, respectively). To identify factors that may affect sleep, specifically duty hours and stress, a secondary model was constructed. Only greater perceived stress was significantly associated with diminished sleep quality (p = 0.04), and only poorer teamwork was significantly associated with perceived stress (p < 0.001). Working >80 h was not significantly associated with perceived stress, quality of sleep, or fatigue. CONCLUSIONS Simply decreasing the number of duty hours may be insufficient to reduce intern fatigue. Residency programs may need to incorporate programmatic changes to reduce stress, improve sleep quality, and foster teamwork in order to decrease intern fatigue and its deleterious consequences. PMID:18807096

From Classification to Causality: Advancing Understanding of Mechanisms of Change in Implementation Science.

PubMed

Lewis, Cara C; Klasnja, Predrag; Powell, Byron J; Lyon, Aaron R; Tuzzio, Leah; Jones, Salene; Walsh-Bailey, Callie; Weiner, Bryan

2018-01-01

The science of implementation has offered little toward understanding how different implementation strategies work. To improve outcomes of implementation efforts, the field needs precise, testable theories that describe the causal pathways through which implementation strategies function. In this perspective piece, we describe a four-step approach to developing causal pathway models for implementation strategies. First, it is important to ensure that implementation strategies are appropriately specified. Some strategies in published compilations are well defined but may not be specified in terms of its core component that can have a reliable and measureable impact. Second, linkages between strategies and mechanisms need to be generated. Existing compilations do not offer mechanisms by which strategies act, or the processes or events through which an implementation strategy operates to affect desired implementation outcomes. Third, it is critical to identify proximal and distal outcomes the strategy is theorized to impact, with the former being direct, measurable products of the strategy and the latter being one of eight implementation outcomes (1). Finally, articulating effect modifiers, like preconditions and moderators, allow for an understanding of where, when, and why strategies have an effect on outcomes of interest. We argue for greater precision in use of terms for factors implicated in implementation processes; development of guidelines for selecting research design and study plans that account for practical constructs and allow for the study of mechanisms; psychometrically strong and pragmatic measures of mechanisms; and more robust curation of evidence for knowledge transfer and use.

Technical issues affecting the implementation of US Environmental Protection Agency's proposed fish tissue-based aquatic criterion for selenium.

PubMed

Lemly, A Dennis; Skorupa, Joseph P

2007-10-01

The US Environmental Protection Agency is developing a national water quality criterion for selenium that is based on concentrations of the element in fish tissue. Although this approach offers advantages over the current water-based regulations, it also presents new challenges with respect to implementation. A comprehensive protocol that answers the "what, where, and when" is essential with the new tissue-based approach in order to ensure proper acquisition of data that apply to the criterion. Dischargers will need to understand selenium transport, cycling, and bioaccumulation in order to effectively monitor for the criterion and, if necessary, develop site-specific standards. This paper discusses 11 key issues that affect the implementation of a tissue-based criterion, ranging from the selection of fish species to the importance of hydrological units in the sampling design. It also outlines a strategy that incorporates both water column and tissue-based approaches. A national generic safety-net water criterion could be combined with a fish tissue-based criterion for site-specific implementation. For the majority of waters nationwide, National Pollution Discharge Elimination System permitting and other activities associated with the Clean Water Act could continue without the increased expense of sampling and interpreting biological materials. Dischargers would do biotic sampling intermittently (not a routine monitoring burden) on fish tissue relative to the fish tissue criterion. Only when the fish tissue criterion is exceeded would a full site-specific analysis including development of intermedia translation factors be necessary.

Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers

PubMed Central

2011-01-01

Background Tobacco use adversely affects oral health. Clinical guidelines recommend that dental providers promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented, however. To improve guideline adherence and to develop effective interventions, it is essential to understand provider behaviour and challenges to implementation. This study aimed to develop a theoretically informed measure for assessing among dental providers implementation difficulties related to tobacco use prevention and cessation (TUPAC) counselling guidelines, to evaluate those difficulties among a sample of dental providers, and to investigate a possible underlying structure of applied theoretical domains. Methods A 35-item questionnaire was developed based on key theoretical domains relevant to the implementation behaviours of healthcare providers. Specific items were drawn mostly from the literature on TUPAC counselling studies of healthcare providers. The data were collected from dentists (n = 73) and dental hygienists (n = 22) in 36 dental clinics in Finland using a web-based survey. Of 95 providers, 73 participated (76.8%). We used Cronbach's alpha to ascertain the internal consistency of the questionnaire. Mean domain scores were calculated to assess different aspects of implementation difficulties and exploratory factor analysis to assess the theoretical domain structure. The authors agreed on the labels assigned to the factors on the basis of their component domains and the broader behavioural and theoretical literature. Results Internal consistency values for theoretical domains varied from 0.50 ('emotion') to 0.71 ('environmental context and resources'). The domain environmental context and resources had the lowest mean score (21.3%; 95% confidence interval [CI], 17.2 to 25.4) and was identified as a potential implementation difficulty. The domain emotion provided the highest mean score (60%; 95% CI, 55.0 to 65.0). Three factors were extracted that explain 70.8% of the variance: motivation (47.6% of variance, α = 0.86), capability (13.3% of variance, α = 0.83), and opportunity (10.0% of variance, α = 0.71). Conclusions This study demonstrated a theoretically informed approach to identifying possible implementation difficulties in TUPAC counselling among dental providers. This approach provides a method for moving from diagnosing implementation difficulties to designing and evaluating interventions. PMID:21615948

Implementing the LifeSkills Training drug prevention program: factors related to implementation fidelity.

PubMed

Mihalic, Sharon F; Fagan, Abigail A; Argamaso, Susanne

2008-01-18

Widespread replication of effective prevention programs is unlikely to affect the incidence of adolescent delinquency, violent crime, and substance use until the quality of implementation of these programs by community-based organizations can be assured. This paper presents the results of a process evaluation employing qualitative and quantitative methods to assess the extent to which 432 schools in 105 sites implemented the LifeSkills Training (LST) drug prevention program with fidelity. Regression analysis was used to examine factors influencing four dimensions of fidelity: adherence, dosage, quality of delivery, and student responsiveness. Although most sites faced common barriers, such as finding room in the school schedule for the program, gaining full support from key participants (i.e., site coordinators, principals, and LST teachers), ensuring teacher participation in training workshops, and classroom management difficulties, most schools involved in the project implemented LST with very high levels of fidelity. Across sites, 86% of program objectives and activities required in the three-year curriculum were delivered to students. Moreover, teachers were observed using all four recommended teaching practices, and 71% of instructors taught all the required LST lessons. Multivariate analyses found that highly rated LST program characteristics and better student behavior were significantly related to a greater proportion of material taught by teachers (adherence). Instructors who rated the LST program characteristics as ideal were more likely to teach all lessons (dosage). Student behavior and use of interactive teaching techniques (quality of delivery) were positively related. No variables were related to student participation (student responsiveness). Although difficult, high implementation fidelity by community-based organizations can be achieved. This study suggests some important factors that organizations should consider to ensure fidelity, such as selecting programs with features that minimize complexity while maximizing flexibility. Time constraints in the classroom should be considered when choosing a program. Student behavior also influences program delivery, so schools should train teachers in the use of classroom management skills. This project involved comprehensive program monitoring and technical assistance that likely facilitated the identification and resolution of problems and contributed to the overall high quality of implementation. Schools should recognize the importance of training and technical assistance to ensure quality program delivery.

Evaluation of Effective Factors on the Clinical Performance of General Surgeons in Tehran University of Medical Science, 2015.

PubMed

Farzianpour, Fereshteh; Mohamadi, Efat; Najafpour, Zhila; Yousefinezhadi, Taraneh; Forootan, Sara; Foroushani, Abbas Rahimi

2016-09-01

Existence of doctors with high performance is one of the necessary conditions to provide high quality services. There are different motivations, which could affect their performance. Recognizing Factors which effect the performance of doctors as an effective force in health care centers is necessary. The aim of this article was evaluate the effective factors which influence on clinical performance of general surgery of Tehran University of Medical Sciences in 2015. This is a cross-sectional qualitative-quantitative study. This research conducted in 3 phases-phases I: (use of library studies and databases to collect data), phase II: localization of detected factors in first phase by using the Delphi technique and phase III: prioritizing the affecting factors on performance of doctors by using qualitative interviews. 12 articles were analyzed from 300 abstracts during the evaluation process. The output of assessment identified 23 factors was sent to surgeons and their assistants for obtaining their opinions. Quantitative analysis of the findings showed that "work qualification" (86.1%) and "managers and supervisors style" (50%) have respectively the most and the least impact on the performance of doctors. Finally 18 effective factors were identified and prioritized in the performance of general surgeons. The results showed that motivation and performance is not a single operating parameter and it depends on several factors according to cultural background. Therefore it is necessary to design, implementation and monitoring based on key determinants of effective interventions due to cultural background.

Factors influencing parents' decision-making when sending children with respiratory tract infections to nursery.

PubMed

Carroll, Fran E; Rooshenas, Leila; Owen-Smith, Amanda; Al-Janabi, Hareth; Hollinghurst, Sandra; Hay, Alastair D

2016-06-01

Many families rely on formal day care provision, which can be problematic when children are unwell. Attendance in these circumstances may impact on the transmission of infections in both day care and the wider community. Thirty-one semi-structured interviews were conducted to investigate how parents make decisions about nursery care when children are unwell. Topics for discussion included: illness attitudes, current practice during childhood illness and potential nursery policy changes that could affect decision-making. A combination of illness perceptions and external factors affected decision-making. Parents: (i) considered the severity of respiratory and non-respiratory symptoms differently, and stated that while most other contagious illnesses required nursery exclusion, coughs/colds did not; (ii) said decisions were not solely based on nursery policy, but on practical challenges such as work absences, financial penalties and alternative care availability; (iii) identified modifiable nursery policy factors that could potentially help parents keep unwell children at home, potentially reducing transmission of infectious illness. Decision-making is a complex interaction between the child's illness, personal circumstance and nursery policy. Improving our understanding of the modifiable aspects of nursery policies and the extent to which these factors affect decision-making could inform the design and implementation of interventions to reduce the transmission of infectious illness and the associated burden on NHS services. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Cancer education and effective dissemination: information access is not enough.

PubMed

Ousley, Anita L; Swarz, Jeffrey A; Milliken, Erin L; Ellis, Steven

2010-06-01

Education is the main avenue for disseminating new research findings into clinical practice. Understanding factors that affect translation of research into practice may help cancer educators design programs that facilitate the time it takes for research-indicated practices to become standard care. To understand various factors, the National Cancer Institute (NCI) Office of Education and Special Initiatives (OESI)(1) with individual cooperation from Oncology Nursing Society (ONS), American Society of Clinical Oncology (ASCO), and Association of Oncology Social Work (AOSW) administered a Practitioner Information Needs survey to five different types of practitioners involved in cancer care. While most of the 2,864 practitioners (83%) agreed they had access to current practice information, practitioners in large practice settings were more likely to report having access to research than those small practice settings. However, only 33% indicated that they had adequate time to access the information. Colleagues or experts within the organization were cited as the most frequently relied on information resource (60%), and peer-reviewed journals were cited as second (57%). Overall, 66% strongly or somewhat agreed that their organizations exhibit effective change management practices. A majority (69%) agreed that implementation of new practices is hindered by the lack of available staff time. Financial factors and the characteristics of the information presented were also believed to be factors contributing to research implementation. Group differences were observed among practitioner groups and practice settings for some factors.

Factors that influence nurses' job satisfaction.

PubMed

Ma, Chen-Chung; Samuels, Michael E; Alexander, Judith W

2003-05-01

To examine factors affecting the job satisfaction of registered nurses (RNs). A growing recognition of job dissatisfaction among RNs in South Carolina hospitals has contributed to current problems with recruitment and retention. If administrators identify factors influencing RNs' job satisfaction in hospitals and implement strategies to address these factors, RN turnover rates will decrease and recruiting and retention rates will increase. A cross-sectional study of secondary data was designed to identify the individual, work, and geographic factors that impact nursing job satisfaction at the state level. A 27-question self-administered survey was sent to 17,500 RNs in South Carolina with postage-paid envelopes for their responses. Surveys from 3472 nurses were completed anonymously. Univariate statistics were used to describe the study sample. One-way and multivariable Analysis of Variance were used to determine which variables contributed the most to job satisfaction. For about two thirds of the RNs, job satisfaction remained the same or had lessened over the past 2 years. In addition, statistically significant differences were found between job satisfaction and years of service, job position, hospital retirement plan, and geographic area. The findings have implications for nurse managers and hospital administrators for planning and implementing effective health policies that will meet the unique needs of their staffs and organizations. Such research is particularly relevant in this difficult time of nursing shortages throughout the healthcare industry.

What is access to radiation therapy? A conceptual framework and review of influencing factors.

PubMed

Sundaresan, Puma; Stockler, Martin R; Milross, Christopher G

2016-02-01

Optimal radiation therapy (RT) utilisation rates (RURs) have been defined for various cancer indications through extensive work in Australia and overseas. These benchmarks remain unrealised. The gap between optimal RUR and actual RUR has been attributed to inadequacies in 'RT access'. We aimed to develop a conceptual framework for the consideration of 'RT access' by examining the literature for existing constructs and translating it to the context of RT services. We further aimed to use this framework to identify and examine factors influencing 'RT access'. Existing models of health care access were reviewed and used to develop a multi-dimensional conceptual framework for 'RT access'. A review of the literature was then conducted to identify factors reported to affect RT access and utilisation. The electronic databases searched, the host platform and date range of the databases searched were Ovid MEDLINE, 1946 to October 2014 and PsycINFO via OvidSP,1806 to October 2014. The framework developed demonstrates that 'RT access' encompasses opportunity for RT as well as the translation of this opportunity to RT utilisation. Opportunity for RT includes availability, affordability, adequacy (quality) and acceptability of RT services. Several factors at the consumer, referrer and RT service levels affect the translation of this opportunity for RT to actual RT utilisation. 'Access' is a term that is widely used in the context of health service related research, planning and political discussions. It is a multi-faceted concept with many descriptions. We propose a conceptual framework for the consideration of 'RT access' so that factors affecting RT access and utilisation may be identified and examined. Understanding these factors, and quantifying them where possible, will allow objective evaluation of their impact on RT utilisation and guide implementation of strategies to modify their effects.

Factors Affecting Time to Sputum Culture Conversion in Adults with Pulmonary Tuberculosis: A Historical Cohort Study without Censored Cases.

PubMed

Kanda, Rie; Nagao, Taishi; Tho, Nguyen Van; Ogawa, Emiko; Murakami, Yoshitaka; Osawa, Makoto; Saika, Yoshinori; Doi, Kenji; Nakano, Yasutaka

2015-01-01

In patients with pulmonary tuberculosis (TB), shortening the time to sputum culture conversion is desirable to reduce the likelihood of mycobacterial transmission. A persistent positive sputum culture after 2 months of treatment is reported to be associated with the presence of cavitation and the extent of disease on chest X-ray, high colony count, diabetes mellitus, and smoking. However, little is known about factors affecting the time to sputum culture conversion. This study was conducted to evaluate factors affecting the time to sputum culture conversion throughout the course of treatment in adults with pulmonary TB. This study was performed using a database of the medical records of patients with active pulmonary TB who were treated at Hirakata Kohsai Hospital in Hirakata City, Osaka, Japan, from October 2000 to October 2002. Cox proportional-hazards analysis was used to evaluate factors affecting the time to sputum culture conversion after adjusting for potential confounders. The data of 86 patients with pulmonary TB were analyzed. The median time to sputum culture conversion was 39 days, and the maximum time was 116 days. The Cox proportional-hazards analysis showed that a higher smear grading (HR, 0.40; 95%CI, 0.23-0.71) and a history of ever smoking (HR, 0.48; 95%CI, 0.25-0.94) were associated with delayed sputum culture conversion. High smear grading and smoking prolonged the time to sputum culture conversion in adults with pulmonary TB. To effectively control TB, measures to decrease the cigarette smoking rate should be implemented, in addition to early detection and timely anti-TB treatment.

Water demand management in times of drought: What matters for water conservation

NASA Astrophysics Data System (ADS)

Maggioni, Elena

2015-01-01

Southern California is subject to long droughts and short wet spells. Its water agencies have put in place voluntary, mandatory, and market-based conservation strategies since the 1980s. By analyzing water agencies' data between 2006 and 2010, this research studies whether rebates for water efficient fixtures, water rates, or water ordinances have been effective, and tests whether structural characteristics of water agencies have affected the policy outcome. It finds that mandates to curb outdoor water uses are correlated with reductions in residential per capita water usage, while water rates and subsidies for water saving devices are not. It also confirms that size is a significant policy implementation factor. In a policy perspective, the transition from a water supply to a water demand management-oriented strategy appears guided by mandates and by contextual factors such as the economic cycle and the weather that occur outside the water governance system. Three factors could improve the conservation effort: using prices as a conservation tool, not only as a cost recovering instrument; investing in water efficient tools only when they provide significant water savings; supporting smaller agencies in order to give them opportunities to implement conservation strategies more effectively or to help them consolidate.

Evaluating the sustainability, scalability, and replicability of an STH transmission interruption intervention: The DeWorm3 implementation science protocol.

PubMed

Means, Arianna Rubin; Ajjampur, Sitara S R; Bailey, Robin; Galactionova, Katya; Gwayi-Chore, Marie-Claire; Halliday, Katherine; Ibikounle, Moudachirou; Juvekar, Sanjay; Kalua, Khumbo; Kang, Gagandeep; Lele, Pallavi; Luty, Adrian J F; Pullan, Rachel; Sarkar, Rajiv; Schär, Fabian; Tediosi, Fabrizio; Weiner, Bryan J; Yard, Elodie; Walson, Judd

2018-01-01

Hybrid trials that include both clinical and implementation science outcomes are increasingly relevant for public health researchers that aim to rapidly translate study findings into evidence-based practice. The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions. The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. DeWorm3 will use stakeholder mapping to identify individuals who influence or are influenced by school-based or community-wide mass drug administration (MDA) for STH and to evaluate network dynamics that may affect study outcomes and future policy development. Individual interviews and focus groups will generate the qualitative data needed to identify factors that shape, contextualize, and explain DeWorm3 trial outputs and outcomes. Structural readiness surveys will be used to evaluate the factors that drive health system readiness to implement novel interventions, such as community-wide MDA for STH, in order to target change management activities and identify opportunities for sustaining or scaling the intervention. Process mapping will be used to understand what aspects of the intervention are adaptable across heterogeneous implementation settings and to identify contextually-relevant modifiable bottlenecks that may be addressed to improve the intervention delivery process and to achieve intervention outputs. Lastly, intervention costs and incremental cost-effectiveness will be evaluated to compare the efficiency of community-wide MDA to standard-of-care targeted MDA both over the duration of the trial and over a longer elimination time horizon.

The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints

PubMed Central

Martins, João Soares; Zwi, Anthony B; Hobday, Karen; Bonaparte, Fernando; Kelly, Paul M

2012-01-01

Background Timor-Leste changed its malaria treatment protocol in 2007, replacing the first-line for falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. This study explored the factors affecting the implementation of the revised treatment protocol, with an emphasis on identifying key constraints. Methods A mixed method approach drew on both qualitative and quantitative data. The study included data from District Health Services in seven districts, community health centres in 14 sub-districts, four hospitals, five private clinics, one private pharmacy and the country's autonomous medical store. In-depth interviews with 36 key informants, five group interviews and 15 focus group discussions were conducted. A survey was also undertaken at community health centres and hospitals to assess the availability of a physical copy of the Malaria Treatment Protocol, as well as the availability and utilization of artemether-lumefantrine and sulphadoxine-pyrimethamine. Results Many factors impeded the implementation of the new malaria protocol. These included: inadequate introduction and training around the revised treatment protocol; unclear phasing out of sulphadoxine-pyrimethamine and phasing in of the revised treatment, artemether-lumefantrine, and the rapid diagnostic test (RDT); lack of supervision; lack of adherence to the revised guidelines by foreign health workers; lack of access to the new drug by the private sector; obstacles in the procurement process; and the use of trade names rather than generic drug description. Insufficient understanding of the rapid diagnostic test and the untimely supply of drugs further hampered implementation. Conclusion To effectively implement a revised malaria treatment protocol, barriers should be identified during the policy formulation process and those emerging during implementation should be recognized promptly and addressed. PMID:22460007

Understanding Motivation to Implement Smoking Bans among Mothers with a Hospitalized Infant

PubMed Central

Stotts, Angela L.; Klawans, Michelle R.; Northrup, Thomas F.; Villarreal, Yolanda; Hovell, Melbourne F.

2016-01-01

Objective Secondhand smoke exposure (SHSe) poses risks to hospitalized children upon discharge and no uniformly effective interventions have been identified. Understanding change-related processes and social-contextual factors related to motivation for implementing home and car smoking bans may inform interventions to reduce infant SHSe among mothers with a hospitalized infant. Methods In this cross-sectional, secondary analysis, mothers of neonatal ICU infants who reported smoking or living with a smoker (N=205) were assigned to stages of change (pre-contemplation, contemplation, preparation, or action) based on behaviors and intentions for establishing smoking bans in their homes and cars. Processes of change (POC) for SHSe reduction practices, self-efficacy, depressive symptoms, generalized anxiety, and social support for not smoking in the home were examined across all four stages. Results The majority of mothers were in the action stage for having a home smoking ban in place (55%); only 35% of participants were in action for a car smoking ban. POC use differed across the stages of change for having a home ban (p=0.004) and car ban (p=0.02), with earlier stages using fewer overall and relatively fewer cognitive/affective processes. Earlier stage women also reported lower self-efficacy to change, less familial and partner support for in-home smoking bans, and more depressive symptoms. Conclusions Novel intervention targets were identified, including cognitive/affective change processes, mental health, and familial/social contingencies for implementing SHSe protective practices. Creative ways in which to affect change at the individual and household level are needed in order to fully address the complexity of child SHSe. PMID:26914262

Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.

PubMed

Knowles, Serena; Lam, Lawrence T; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy

2015-01-01

Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians' behaviour intentions related to bowel management for intensive care patients.

Optimizing the implementation of the target motion sampling temperature treatment technique - How fast can it get?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tuomas, V.; Jaakko, L.

This article discusses the optimization of the target motion sampling (TMS) temperature treatment method, previously implemented in the Monte Carlo reactor physics code Serpent 2. The TMS method was introduced in [1] and first practical results were presented at the PHYSOR 2012 conference [2]. The method is a stochastic method for taking the effect of thermal motion into account on-the-fly in a Monte Carlo neutron transport calculation. It is based on sampling the target velocities at collision sites and then utilizing the 0 K cross sections at target-at-rest frame for reaction sampling. The fact that the total cross section becomesmore » a distributed quantity is handled using rejection sampling techniques. The original implementation of the TMS requires 2.0 times more CPU time in a PWR pin-cell case than a conventional Monte Carlo calculation relying on pre-broadened effective cross sections. In a HTGR case examined in this paper the overhead factor is as high as 3.6. By first changing from a multi-group to a continuous-energy implementation and then fine-tuning a parameter affecting the conservativity of the majorant cross section, it is possible to decrease the overhead factors to 1.4 and 2.3, respectively. Preliminary calculations are also made using a new and yet incomplete optimization method in which the temperature of the basis cross section is increased above 0 K. It seems that with the new approach it may be possible to decrease the factors even as low as 1.06 and 1.33, respectively, but its functionality has not yet been proven. Therefore, these performance measures should be considered preliminary. (authors)« less

Computational Grounded Cognition: a new alliance between grounded cognition and computational modeling

PubMed Central

Pezzulo, Giovanni; Barsalou, Lawrence W.; Cangelosi, Angelo; Fischer, Martin H.; McRae, Ken; Spivey, Michael J.

2013-01-01

Grounded theories assume that there is no central module for cognition. According to this view, all cognitive phenomena, including those considered the province of amodal cognition such as reasoning, numeric, and language processing, are ultimately grounded in (and emerge from) a variety of bodily, affective, perceptual, and motor processes. The development and expression of cognition is constrained by the embodiment of cognitive agents and various contextual factors (physical and social) in which they are immersed. The grounded framework has received numerous empirical confirmations. Still, there are very few explicit computational models that implement grounding in sensory, motor and affective processes as intrinsic to cognition, and demonstrate that grounded theories can mechanistically implement higher cognitive abilities. We propose a new alliance between grounded cognition and computational modeling toward a novel multidisciplinary enterprise: Computational Grounded Cognition. We clarify the defining features of this novel approach and emphasize the importance of using the methodology of Cognitive Robotics, which permits simultaneous consideration of multiple aspects of grounding, embodiment, and situatedness, showing how they constrain the development and expression of cognition. PMID:23346065

Final Environmental Assessment: Addressing An Army and Air Force Exchange Service (AAFES) Lifestyle Center at Eglin Air Force Base, Florida

DTIC Science & Technology

2008-11-01

the proposed site has the potential for adverse effects on surface water bodies in the event of a spill or uncontrolled erosion. Implementation of...inclusion of a No Action Alternative against which potential effects can be compared. While the No Action Alternative would not satisfy the purpose... potential effects on project site and adjacent land uses. The foremost factor affecting a proposed action in terms of land use is its compliance

Reshaping the Sword and Chrysanthemum: Regional Implications of Expanding the Mission of the Japan Self Defense Forces

DTIC Science & Technology

2005-03-01

I could not have achieved the level success that I have without her. Finally, I would like to thank our little girl , for waiting until after this...MAJOR QUESTIONS AND ARGUMENTS This thesis investigates causal factors in determining how the changing mission of the JSDF affects the regional...to not only understand the changes called for in these documents, but also how the implementation has been carried out as perceptions can change

Human Factors Affecting Pilot Performance in Vertical and Translational Instrument Flight

DTIC Science & Technology

1986-01-01

purpose of a mission lie all the areas of information which together result in the accomplished flight. Since the only courve of’ action open to a pilot...any of these cases there is a diffi’cult t radeoff between the desire to present the largest possible outside angular representation ( field of view...is an urgent program to implement the cockpit display of traffic information (CDTL). Practical limitations on the fields of view of vertical situation

Unhealthy health care costs.

PubMed

Shelton, J K; Janosi, J M

1992-02-01

The private sector has implemented many cost containment measures in efforts to control rising health care costs. However, these measures have not controlled costs in the long run, and can be expected not to succeed as long as business cannot control factors within the health care system which affect costs. Controlling private sector health care costs requires constraints on cost shifting which necessitates a unified financing system with expenditure limits. A unified financing system will involve a partnership between the public and private sectors.

The diffusion of telehealth in rural American Indian communities: a retrospective survey of key stakeholders.

PubMed

Brooks, Elizabeth; Manson, Spero M; Bair, Byron; Dailey, Nancy; Shore, Jay H

2012-01-01

Mental health issues are a serious concern for many American Indian Veterans, especially for post-traumatic stress disorder and related psychiatric conditions. Yet, acquiring mental health treatment can be a challenge in Native communities where specialized services are largely unavailable. Consequently, telehealth is increasingly being suggested as a way to expand healthcare access on or near reservation lands. In this study, we wanted to understand the factors affecting the diffusion of telehealth clinics that provided mental health care to rural, American Indian Veterans. We surveyed 39 key personnel and stakeholders who were involved in the decision-making process, technological infrastructure, and implementation of three clinics. Using Roger Everett's Diffusion Theory as a framework, we gathered information about specific tasks, factors hindering progress, and personal reactions to telehealth both before and after implementation. Many participants expressed initial concerns about using telehealth; however, most became positive over time. Factors that influenced participants' viewpoint largely included patient and staff feedback and witnessing the fulfillment of a community health need. The use of outside information to support the implementation of the clinics and personal champions also showed considerable influence in the clinics' success. The findings presented here address critical gaps in our understanding of telehealth diffusion and inform research strategies regarding the cultural issues and outcomes related to telemental health services. Information contained in this report serves as a long overdue guide for developing telemental health programs and policies among American Indians, specifically, and rural populations in general.

Implementation of an education development project in pathology to improve student competency-lessons learnt.

PubMed

Negi, Gita; Harsh, Meena; Chauhan, Vijendra D; Kalra, Vinita; Agarwal, Pradeep; Kusum, Anuradha

2015-08-01

Basic medical sciences and clinical teachings are not coordinated in the present medical education system. They are not taught keeping in mind the outcomes required at the time of actual handling of patients in the community. An educational development project was implemented in the Department of Pathology with the aim that it will result in the student learning to link the pathophysiology of the disease to clinical scenarios and become fully competent for lifelong medical practice. The pathology teaching of the second professional batch was modified by starting with defining the desired outcomes/competencies in the student's knowledge, skills, and attitude which were then addressed by lectures, demonstrations, practical classes and small group activities where case scenarios and laboratory reports were included. The outcome was assessed by Objectively Structured Clinical/Practical Examination and multiple choice questions. Force field analysis, faculty and student interviews, and questionnaires were used to assess the factors affecting its implementation and impact. Totally 80 students of the 2(nd) Professional MBBS were exposed to a competency-based education development project. It was found that the system was appreciated by faculty and students, especially the integration with clinical scenarios. There were many factors which influenced the execution of this program, including motivation level of students and faculty, time, logistics and meticulous planning. There was a significant improvement in student's performance and satisfaction. Many factors including prior planning were a major determinant for the success of this education development project.

[Determining factors of overweight and obesity in children at school age in Peru].

PubMed

Mispireta, Monica L

2012-01-01

Obesity in children at school age is an increasing problem in Peru. It concentrates in urban areas, mainly in Lima where one out of three children is overweight. An initial study in 80 schools in Lima showed that the lack of physical activity would have a greater impact on overweight and obesity in school children than the amount of food intake. More detailed studies are required. In spite of the limited information available regarding its determining factors, it is necessary to implement culturally-sensitive measures to fight this problem as part of the current nutritional policies, and prevent the problem from spreading, making sure the sustainability of the health system is not affected.

Technologies to Increase PV Hosting Capacity in Distribution Feeders: Preprint

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ding, Fei; Mather, Barry; Gotseff, Peter

This paper studies the distributed photovoltaic (PV) hosting capacity in distribution feeders by using the stochastic analysis approach. Multiple scenario simulations are conducted to analyze several factors that affect PV hosting capacity, including the existence of voltage regulator, PV location, the power factor of PV inverter and Volt/VAR control. Based on the conclusions obtained from simulation results, three approaches are then proposed to increase distributed PV hosting capacity, which can be formulated as the optimization problem to obtain the optimal solution. All technologies investigated in this paper utilize only existing assets in the feeder and therefore are implementable for amore » low cost. Additionally, the tool developed for these studies is described.« less

Technologies to Increase PV Hosting Capacity in Distribution Feeders

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ding, Fei; Mather, Barry; Gotseff, Peter

This paper studies the distributed photovoltaic (PV) hosting capacity in distribution feeders by using the stochastic analysis approach. Multiple scenario simulations are conducted to analyze several factors that affect PV hosting capacity, including the existence of voltage regulator, PV location, the power factor of PV inverter and Volt/VAR control. Based on the conclusions obtained from simulation results, three approaches are then proposed to increase distributed PV hosting capacity, which can be formulated as the optimization problem to obtain the optimal solution. All technologies investigated in this paper utilize only existing assets in the feeder and therefore are implementable for amore » low cost. Additionally, the tool developed for these studies is described.« less

Recruitment of participants to a multiple sclerosis trial: The CombiRx experience

PubMed Central

Bhanushali, Minal J; Gustafson, Tarah; Powell, Steve; Conwit, Robin A; Wolinsky, Jerry S; Cutter, Gary R; Lublin, Fred; Cofield, Stacey S

2014-01-01

Background and Purpose: Participant recruitment is central to all clinical trials. Any delay in recruitment affects the completion and ultimate success of the trial. We report our experience with patient screening and randomization in CombiRx, which may inform the design of other trials. CombiRx was a multi-center, phase III, double-blind, randomized clinical trial comparing the combined use of interferon beta-1a and glatiramer acetate to either agent alone in patients with relapsing-remitting multiple sclerosis (RRMS). This trial was launched in January 2005 in 69 centers in the U.S. and Canada under a co-operative agreement with the National Institute of Neurological Disorders and Stroke (NINDS). The goal was to recruit 1000 patients over 1.5 years after a 6 month startup period. Instead, the investigators required 4.25 years to enroll 1008 patients. Methods: During this trial, we assessed the effectiveness of various recruitment strategies, utility of rescreening prior screen failures, and potential factors and strategies used in study conduct, research and infrastructure, all of which affected recruitment of participants and ultimately time to completion of CombiRx. We particularly were interested in the variability in time to site initiation between academic centers and private practice sites. Results: Physicians who were directly involved in the medical care of patients with RRMS were the primary source of patients recruited to CombiRx. A flexible study design that allowed for re-screening of the initial screen failures after a period of time was useful due to the relapsing/remitting course of the disease. Academic centers took longer to implement the trial than the private practice centers, but once sites were approved for enrollment, there was no important difference in the number of participants enrolled. Limitations: The CombiRx trial was conducted during a period when multiple new medications were being tested, thus affecting the pace of recruitment and limiting ability to generalize our experiences. However, the lessons we learned about process are relevant. Conclusion: Participants can be enrolled successfully in a clinical trial for RRMS, but factors affecting the time to achieve the requirements needed to start screening can be unpredictable and problematic. Prospective planning by the sponsors and investigators, use of central IRBs, master trial agreements and secure remote desktop access to the trial database may expedite trial implementation and participant recruitment. A good scientific research question with flexible study design and active involvement of the clinicians are important factors driving recruitment. Clinical trials can be implemented successfully both in private practices and at academic centers, a consideration when selecting sites. PMID:24686106

Factors affecting preparedness and capacity to manage pandemic influenza: perceptions of healthcare managers.

PubMed

Adini, B; Laor, D; Aharonson-Daniel, L

2014-08-01

Numerous interventions seeking to increase preparedness for pandemic influenza have been implemented, but low compliance of healthcare providers has been reported in many instances. The aim of this study was to identify factors that affect preparedness for pandemic influenza by examining: hospital managers' perceptions of measures implemented to promote preparedness for pandemic influenza; hospital managers' assessments of the readiness and capability of their hospitals to manage pandemic influenza; and the effectiveness of a national pandemic preparedness programme in Israel over time. A quasi-experiment was conducted following implementation of a national pandemic preparedness programme in Israel. A survey assessed hospital managers' perceptions of the effectiveness of the programme, and the preparedness and capacity of their hospitals to manage pandemic influenza. Two independent evaluations of preparedness for biological threats were conducted, based on a validated tool that included 60 objective parameters. Correlations between perceived preparedness and capacity and components of the preparedness programme were analysed using Statistical Package for the Social Sciences Version 17. Stepwise logistic regression was used to determine the components that influence preparedness and capability to manage pandemic influenza. All general hospital managers in Israel were approached twice (first and second evaluations). Ninety-one percent rated themselves as highly/very highly prepared for pandemic influenza, and 87% rated themselves as highly/very highly capable of dealing with pandemic influenza. Strong correlation was found between hospital managers' perceived preparedness and capacity to manage pandemic influenza (rho = 0.761, P = 0.000), and between perceived preparedness and familiarity with the disease (rho = 0.605, P = 0.003). Familiarity with guidelines accounted for 35% of the variance in perceived capability (adjusted R(2) = 0.346, P = 0.002). Inclusion of preparedness evaluations explained an additional 15% of the variance (R(2) change = 0.146, P = 0.026). An increase in mean total score for emergency preparedness was found in the second evaluation compared with the first evaluation. Familiarity with guidelines and preparedness evaluations affect the perceptions of healthcare managers regarding preparedness and capability to manage pandemic influenza. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Effects of people-centred factors on enterprise resource planning implementation project success: empirical evidence from Sri Lanka

NASA Astrophysics Data System (ADS)

Wickramasinghe, Vathsala; Gunawardena, Vathsala

2010-08-01

Extant literature suggests people-centred factors as one of the major areas influencing enterprise resource planning (ERP) implementation project success. Yet, to date, few empirical studies attempted to validate the link between people-centred factors and ERP implementation project success. The purpose of this study is to empirically identify people-centred factors that are critical to ERP implementation projects in Sri Lanka. The study develops and empirically validates a framework for people-centred factors that influence the success of ERP implementation projects. Survey research methodology was used and collected data from 74 ERP implementation projects in Sri Lanka. The people-centred factors of 'project team competence', 'rewards' and 'communication and change' were found to predict significantly the ERP implementation project success.

From a "perfect storm" to "smooth sailing": policymaker perspectives on implementation and sustainment of an evidence-based practice in two states.

PubMed

Willging, Cathleen E; Green, Amy E; Gunderson, Lara; Chaffin, Mark; Aarons, Gregory A

2015-02-01

Policymakers shape implementation and sustainment of evidence-based practices (EBPs), whether they are developing or responding to legislation and policies or negotiating public sector resource constraints. As part of a large mixed-method study, we conducted qualitative interviews with 24 policymakers involved in delivery of the same EBP in two U.S. states. We analyzed transcripts via open and focused coding techniques to identify the commonality, diversity, and complexity of implementation challenges; approaches to overcoming those challenges; and the importance of system-level contextual factors in ensuring successful implementation. Key findings centered on building support and leadership for EBPs; funding and contractual strategies; partnering with stakeholders; tackling challenges via proactive planning and problem solving; and the political, legal, and systemic pressures affecting EBP longevity. The policymaker perspectives offer guidance on nurturing system and organizational practice environments to achieve positive outcomes and for optimally addressing macro-level influences that bear upon the instantiation of EBPs in public sector child welfare systems. © The Author(s) 2014.

From a “Perfect Storm” to “Smooth Sailing”: Policymaker Perspectives on Implementation and Sustainment of an Evidence-Based Practice in Two States

PubMed Central

Willging, Cathleen E.; Green, Amy E.; Gunderson, Lara; Chaffin, Mark; Aarons, Gregory A.

2015-01-01

Policymakers shape implementation and sustainment of evidence-based practices (EBPs), whether they are developing or responding to legislation and policies or negotiating public sector resource constraints. As part of a large mixed-method study, we conducted qualitative interviews with 24 policymakers involved in delivery of the same EBP in two U.S. states. We analyzed transcripts via open and focused coding techniques to identify the commonality, diversity, and complexity of implementation challenges; approaches to overcoming those challenges; and the importance of system-level contextual factors in ensuring successful implementation. Key findings centered on building support and leadership for EBPs; funding and contractual strategies; partnering with stakeholders; tackling challenges via proactive planning and problem solving; and the political, legal, and systemic pressures affecting EBP longevity. The policymaker perspectives offer guidance on nurturing system and organizational practice environments to achieve positive outcomes and for optimally addressing macro-level influences that bear upon the instantiation of EBPs in public sector child welfare systems. PMID:25125232

Improving the quality of e-commerce web service: what is important for the request scheduling algorithm?

NASA Astrophysics Data System (ADS)

Suchacka, Grazyna

2005-02-01

The paper concerns a new research area that is Quality of Web Service (QoWS). The need for QoWS is motivated by a still growing number of Internet users, by a steady development and diversification of Web services, and especially by popularization of e-commerce applications. The goal of the paper is a critical analysis of the literature concerning scheduling algorithms for e-commerce Web servers. The paper characterizes factors affecting the load of the Web servers and discusses ways of improving their efficiency. Crucial QoWS requirements of the business Web server are identified: serving requests before their individual deadlines, supporting user session integrity, supporting different classes of users and minimizing a number of rejected requests. It is justified that meeting these requirements and implementing them in an admission control (AC) and scheduling algorithm for the business Web server is crucial to the functioning of e-commerce Web sites and revenue generated by them. The paper presents results of the literature analysis and discusses algorithms that implement these important QoWS requirements. The analysis showed that very few algorithms take into consideration the above mentioned factors and that there is a need for designing an algorithm implementing them.

Risk management analysis for construction of Kutai Kartanegara bridge-East Kalimantan-Indonesia

NASA Astrophysics Data System (ADS)

Azis, Subandiyah

2017-11-01

Many sources of risk that may impede the achievement of the project objectives through either cost or quality and time, especially for bridges that have collapsed before, so when the implementation of possible hazard / high hazard so when should the possible hazard/high hazard be implemented The purpose of this research is to identify, to analyze risks by classifying the risks using the method of Risk Breakdown Structure (RBS) and managing the dominant risk of execution of the installation work to determine the handling of the steel frame in order to maximize the positive and minimize the incidence of adverse events. The results of this study indicate there are 15 sources of risks are identified, and there are 6 risk indicates the dominant risks. Mitigation performed on the dominant risks unacceptable i.e. Project factor that shows the delays in the arrival of materials due to locations, schedule of the arrival of materials should be tailored to the needs of the field and the amount of material that comes with the required field should also be evaluated. The result is expected to be a guideline for identifying risks and mitigation measures for further research. Subsequent researchers to pay attention on the security factor that implementation time does not affect the productivity of work in construction projects.

Evolution of the US energy system and related emissions under varying social and technological development paradigms: Plausible scenarios for use in robust decision making.

PubMed

Brown, Kristen E; Hottle, Troy Alan; Bandyopadhyay, Rubenka; Babaee, Samaneh; Dodder, Rebecca Susanne; Kaplan, Pervin Ozge; Lenox, Carol; Loughlin, Dan

2018-06-21

The energy system is the primary source of air pollution. Thus, evolution of the energy system into the future will affect society's ability to maintain air quality. Anticipating this evolution is difficult because of inherent uncertainty in predicting future energy demand, fuel use, and technology adoption. We apply Scenario Planning to address this uncertainty, developing four very different visions of the future. Stakeholder engagement suggested technological progress and social attitudes toward the environment are critical and uncertain factors for determining future emissions. Combining transformative and static assumptions about these factors yields a matrix of four scenarios that encompass a wide range of outcomes. We implement these scenarios in the U.S. EPA MARKAL model. Results suggest that both shifting attitudes and technology transformation may lead to emission reductions relative to present, even without additional policies. Emission caps, such as the Cross State Air Pollution Rule, are most effective at protecting against future emission increases. An important outcome of this work is the scenario implementation approach, which uses technology-specific discount rates to encourage scenario-specific technology and fuel choices. End-use energy demands are modified to approximate societal changes. This implementation allows the model to respond to perturbations in manners consistent with each scenario.

Implementation of laser technology and treatment at county level in the Swedish Public Dental Service.

PubMed

Bergholm, Åsa; Östberg, Anna-Lena; Gabre, Pia

2014-01-01

The aim of this study was to obtain an understanding of the factors that affected the way new technology and methods were used in dentistry after a training program. A qualitative research method was used to collect data. Nine dentists working in the Public Dental Service (PDS) in Uppsala County in Sweden agreed to be interviewed in the study. They worked in five different clinics, all with laser equipment, and had received training in the use of lasers. The interviews were tape recorded and transcribed, and were analysed using manifest and latent qualitative content analysis. The categories in this study were identified as "Prerequisites and obstacles to imple- mentation", "Attitudes to laser technology and treatments" and "Laser technology in the future'". The dentists described working with lasers as complicated and problematic. They had concerns about the method relating to the working environment, evidence of efficacy of treatment, costs, and benefits for patients and dentists. The main finding was that the decision to adopt the technology seemed to be based on individual perceptions of the value of lasers compared to other ways of achieving the same goal. They provided uniform proposals regarding how an organization should implement new methods, including an emphasis on the importance of preparation and having opportunities to be able to test and evaluate the technology. Another important factor was support from surrounding staff, colleagues and management. Despite all the barriers, the respondents were positive about working with lasers in the future, mainly due to their belief that patients would demand laser treatment. In conclusion both individual and organizational factors affected the extent to which the respondents used the laser. The main finding was the individual perception of the value of lasers compared to other methods which could achieve the same goal.

Faculty and Technology: Implications for Faculty Training and Technology Leadership

NASA Astrophysics Data System (ADS)

Keengwe, Jared; Kidd, Terry; Kyei-Blankson, Lydia

2009-02-01

The purpose of this study was to explore the factors affecting ICT adoption process and the implications for faculty training and technology leadership. Respondents represented a wide range of academic and professional positions. They identified themselves as Assistant, Associate, and Professor as well as Instructional Designer, Director of Technology, Information Manager, eLearning Manager, Assistant Department Chair, Associate Vice President of Academic Affairs and Consultant. The respondents identified Organizational Support, Leadership, Training and Development, and Resources as the predominate themes affecting Information and Communication Technology (ICT) adoption process in higher education. Evidence from this study offers insights on how higher education administrators and technology leaders could help their faculty and staff to implement appropriate ICT tools and practices to improve student learning.

Redesigning a Ministry of Health's organizational structure: exploring implementation challenges through Botswana's experiences.

PubMed

Seitio-Kgokgwe, Onalenna; Gauld, Robin D C; Hill, Philip C; Barnett, Pauline

2016-04-01

The Botswana's Ministry of Health redesigned and adopted a new organizational structure in 2005, which was poorly implemented. This article explores factors that influenced the implementation of this organizational structure. This article draws from data collected through in-depth interviews with 54 purposively selected key informants comprising policy makers, senior managers and staff of the Ministry of Health (N = 40) and senior officers from various stakeholder organizations (N = 14). Participants generally felt that the review of the Ministry of Health organizational structure was important. The previous structure was considered obsolete with fragmented functions that limited the overall performance of the health system. The new organizational structure was viewed to be aligned to current national priorities with potential to positively influence performance. Some key weaknesses identified included lack of consultation and information sharing with workers during the restructuring process, which affected the understanding of their new roles, failure to mobilize key resources to support implementation of the new structure and inadequate monitoring of the implementation process. Redesigning an organizational structure is a major change. There is a need for effective and sustained leadership to plan, direct, coordinate, monitor and evaluate the implementation phase of the reform. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice – the Frankfurt Experience

PubMed Central

Fischer, Dania P.; Zacharowski, Kai D.; Müller, Markus M.; Geisen, Christof; Seifried, Erhard; Müller, Heiko; Meybohm, Patrick

2015-01-01

Introduction A multicomponent, evidence-based and interdisciplinary Patient Blood Management (PBM) program was introduced at the University Hospital Frankfurt in July 2013. The implementation strategy included practical and tactical components aimed to increase knowledge on the risks of preoperative anemia, to standardize hemotherapy, and to facilitate PBM components. Methods This article analyzes barriers to PBM implementation and outlines a strategy to introduce and manifest PBM. The effects in Frankfurt were measured in a before and after questionnaire study distributed among groups of physicians immediately before and 1 year after PBM implementation. Results 142 clinicians completed the questionnaire in July 2013 and 101 clinicians in August 2014. Absolute certainty that the treatment of preoperative anemia favorably influences morbidity and mortality rose from 25 to 37%. Transfusion behavior seems to have been affected: In 2014, 56% of clinicians stated that they clinically reassess the patient and analyze hemoglobin following each single red blood cell unit compared to only 38% stating this in 2013. Conclusion These results show that our implementation strategy was effective in changing physicians' risk perception, attitude, and knowledge on PBM principles. Our experience highlights key success factors for the implementation of a comprehensive PBM program. PMID:26019704

Factors affecting scholastic performances of adolescents.

PubMed

Shashidhar, Saraswati; Rao, Chandrika; Hegde, Radhakrishna

2009-05-01

The present study aims at recognizing the social influence, study habits and health factors affecting scholastic performances of adolescents and to compare these factors among the adolescents between two categories of school. A total of 1230 adolescents (13-18 yrs) were screened. Data was collected by personal interview, using the teenage screening questionnaire, Trivandrum, between May 2004 and November 2005. A total 615 students from corporation and private schools were studied. 39.76% (489) were high achievers, 13.5% (166) were low achievers with p < 0.001. In the low achievers, 12.03% were from the corporation schools and 1.46% from private schools. The incidence of poor study habits and social factors were increased in low achievers of corporation schools. On multivariate analysis, the predictor variables for poor scholastic performance were adolescent having refractory error, not having help for study at home, not doing home work regularly, not solving question bank papers and reading only before examinations. It is feasible and worthwhile to identify the determinants of scholastic performance and plan intervention strategies at each school. The results of this study highlight the importance of implementing newer strategies, focusing on strict study patterns and creating the conducive school and home environment for study, so as to achieve better scholastic performances.

The effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare: a systematic review.

PubMed

Sarkies, Mitchell N; Bowles, Kelly-Ann; Skinner, Elizabeth H; Haas, Romi; Lane, Haylee; Haines, Terry P

2017-11-14

It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The secondary aim of the review was to describe factors perceived to be associated with effective strategies and the inter-relationship between these factors. An electronic search was developed to identify studies published between January 01, 2000, and February 02, 2016. This was supplemented by checking the reference list of included articles, systematic reviews, and hand-searching publication lists from prominent authors. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data. After duplicate removal, the search strategy identified 3830 titles. Following title and abstract screening, 96 full-text articles were reviewed, of which 19 studies (21 articles) met all inclusion criteria. Three studies were included in the narrative synthesis, finding policy briefs including expert opinion might affect intended actions, and intentions persisting to actions for public health policy in developing nations. Workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making in US public health departments. Tailored, targeted messages were more effective in increasing public health policies and programs in Canadian public health departments compared to messages and a knowledge broker. Sixteen studies (18 articles) were included in the thematic synthesis, leading to a conceptualisation of inter-relating factors perceived to be associated with effective research implementation strategies. A unidirectional, hierarchal flow was described from (1) establishing an imperative for practice change, (2) building trust between implementation stakeholders and (3) developing a shared vision, to (4) actioning change mechanisms. This was underpinned by the (5) employment of effective communication strategies and (6) provision of resources to support change. Evidence is developing to support the use of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The design of future implementation strategies should be based on the inter-relating factors perceived to be associated with effective strategies. This systematic review was registered with Prospero (record number: 42016032947).

Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial

PubMed Central

2011-01-01

Background Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Methods Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. Discussion To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on intervention effects, as well as on the validity and feasibility of the theoretical-domain approach. The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers. Trial registration Current Controlled Trials ISRCTN15427433 PMID:21320312

Attitudes Affecting Online Learning Implementation in Higher Education Institutions

ERIC Educational Resources Information Center

Mitchell, Betty; Geva-May, Iris

2009-01-01

This study explores attitudes towards and affecting online learning implementation (OLI). In recent years there has been greater acceptance of online learning (OL) by institutional decision-makers, as evidenced by higher levels of institutional involvement; nevertheless, the increase in faculty acceptance lags behind. This gap affects the…

Multivariate analysis of factors influencing medical costs of acute pancreatitis hospitalizations based on a national administrative database.

PubMed

Murata, Atsuhiko; Matsuda, Shinya; Mayumi, Toshihiko; Okamoto, Kohji; Kuwabara, Kazuaki; Ichimiya, Yukako; Fujino, Yoshihisa; Kubo, Tatsuhiko; Fujimori, Kenji; Horiguchi, Hiromasa

2012-02-01

Little information is available on the analysis of medical costs of acute pancreatitis hospitalizations. This study aimed to determine the factors affecting medical costs of patients with acute pancreatitis during hospitalization using a Japanese administrative database. A total of 7193 patients with acute pancreatitis were referred to 776 hospitals. We defined "patients with high medical costs" as patients whose medical costs exceeded the 90th percentile in medical costs during hospitalization and identified the independent factors for patients with high medical costs with and without controlling for length of stay. Multiple logistic regression analysis demonstrated that necrosectomy was the most significant factor for medical costs of acute pancreatitis during hospitalization. The odds ratio of necrosectomy was 33.64 (95% confidence interval, 14.14-80.03; p<0.001). Use of an intensive care unit was the most significant factor for medical costs after controlling for LOS. The OR of an ICU was 6.44 (95% CI, 4.72-8.81; p<0.001). This study demonstrated that necrosectomy and use of an ICU significantly affected the medical costs of acute pancreatitis hospitalization. These results highlight the need for health care implementations to reduce medical costs whilst maintaining the quality of patient care, and targeting patients with severe acute pancreatitis. Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Affecting culture change and performance improvement in Medicaid nursing homes: the Promote Understanding, Leadership, and Learning (PULL) Program.

PubMed

Eliopoulos, Charlotte

2013-01-01

A growing number of nursing homes are implementing culture change programming to create a more homelike environment in which residents and direct care staff are empowered with greater participation in care activities. Although nursing homes that have adopted culture change practices have brought about positive transformation in their settings that have improved quality of care and life, as well as increased resident and staff satisfaction, they represent a minority of all nursing homes. Nursing homes that serve primarily a Medicaid population without supplemental sources of funding have been limited in the resources to support such change processes. The purpose of this project was to gain insight into effective strategies to provide culture change and quality improvement programming to low-performing, under-resourced nursing homes that represent the population of nursing homes least likely to have implemented this programming. Factors that interfered with transformation were identified and insights were gained into factors that need to be considered before transformational processes can be initiated. Effective educational strategies and processes that facilitate change in these types of nursing homes were identified. Despite limitations to the study, there was evidence that the experiences and findings can be of value to other low-performing, under-resourced nursing homes. Ongoing clinical work and research are needed to refine the implementation process and increase the ability to help these settings utilize resources and implement high quality cost effective care to nursing home residents. Copyright © 2013 Mosby, Inc. All rights reserved.

Social and organizational factors affecting implementation of evidence-informed practice in a public health department in Ontario: a network modelling approach

PubMed Central

2014-01-01

Objective The objective of this study is to develop a statistical model to assess factors associated with information seeking in a Canadian public health department. Methods Managers and professional consultants of a public health department serving a large urban population named whom they turned to for help, whom they considered experts in evidence-informed practice, and whom they considered friends. Multilevel regression analysis and exponential random graph modeling were used to predict the formation of information seeking and expertise-recognition connections by personal characteristics of the seeker and source, and the structural attributes of the social networks. Results The respondents were more likely to recognize the members of the supervisory/administrative division as experts. The extent to which an individual implemented evidence-based practice (EBP) principles in daily practice was a significant predictor of both being an information source and being recognized as expert by peers. Friendship was a significant predictor of both information seeking and expertise-recognition connections. Conclusion The analysis showed a communication network segregated by organizational divisions. Managers were identified frequently as information sources, even though this is not a part of their formal role. Self-perceived implementation of EBP in practice was a significant predictor of being an information source or an expert, implying a positive atmosphere towards implementation of evidence-informed decision making in this public health organization. Results also implied that the perception of accessibility and trust were significant predictors of expertise recognition. PMID:24565228

Review of critical factors for SEA implementation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang Jie, E-mail: jasmine@plan.aau.dk; Christensen, Per; Kornov, Lone

The implementation process involved in translating Strategic Environmental Assessment (SEA) intention into action is vital to an effective SEA. Many factors influence implementation and thus the effectiveness of an SEA. Empirical studies have identified and documented some factors influencing the implementation of an SEA. This research is fragmented, however, and it is still not clear what are the most critical factors of effective SEA performance, and how these relate to different stages of the implementation process or other contextual circumstances. The paper takes its point of departure in implementation theory. Firstly, we introduce implementation theory, and then use it inmore » practice to establish a more comprehensive model related to the stages in the implementation process. Secondly, we identify the critical factors in order to see how they are related to the different stages of SEA or are more general in character. Finally we map the different critical factors and how they influence the overall results of an SEA. Based on a literature review, we present a comprehensive picture of the critical factors and where they are found in the process. We conclude that most of the critical factors identified are of a more general character influencing the SEA process as such, while only one out of four of these factors relates to the specific stages of the SEA. Based on this mapping we can sketch a picture of the totality of critical factors. In this study 266 notions of critical factors were identified. Seen at the level of notions of critical factors, only 24% of these relate to specific stages while for 76% the critical factors are of a more general nature. These critical factors interact in complex ways and appear in different combinations in different stages of the implementation process so tracing the cause and effect is difficult. The pervasiveness of contextual and general factors also clearly suggests that there is no single way to put SEA into practice. The paper identifies some of the critical factors for effective SEA implementation, but further research is still needed to conclude which factors are more critical than others, just as the contingencies on which they depend are not easy to unravel. - Highlights: Black-Right-Pointing-Pointer The research on critical factors influencing SEA implementation is fragmented. Black-Right-Pointing-Pointer The critical factors are used to discuss 'hot-spots' in the implementation process. Black-Right-Pointing-Pointer Critical factors are just as broad as the concept of effectiveness. Black-Right-Pointing-Pointer Both stage and general factors are relevant in explaining the effectiveness of SEA.« less

Reviewing evidence on complex social interventions: appraising implementation in systematic reviews of the health effects of organisational-level workplace interventions

PubMed Central

Egan, M; Bambra, C; Petticrew, M; Whitehead, M

2009-01-01

Background: The reporting of intervention implementation in studies included in systematic reviews of organisational-level workplace interventions was appraised. Implementation is taken to include such factors as intervention setting, resources, planning, collaborations, delivery and macro-level socioeconomic contexts. Understanding how implementation affects intervention outcomes may help prevent erroneous conclusions and misleading assumptions about generalisability, but implementation must be adequately reported if it is to be taken into account. Methods: Data on implementation were obtained from four systematic reviews of complex interventions in workplace settings. Implementation was appraised using a specially developed checklist and by means of an unstructured reading of the text. Results: 103 studies were identified and appraised, evaluating four types of organisational-level workplace intervention (employee participation, changing job tasks, shift changes and compressed working weeks). Many studies referred to implementation, but reporting was generally poor and anecdotal in form. This poor quality of reporting did not vary greatly by type or date of publication. A minority of studies described how implementation may have influenced outcomes. These descriptions were more usefully explored through an unstructured reading of the text, rather than by means of the checklist. Conclusions: Evaluations of complex interventions should include more detailed reporting of implementation and consider how to measure quality of implementation. The checklist helped us explore the poor reporting of implementation in a more systematic fashion. In terms of interpreting study findings and their transferability, however, the more qualitative appraisals appeared to offer greater potential for exploring how implementation may influence the findings of specific evaluations. Implementation appraisal techniques for systematic reviews of complex interventions require further development and testing. PMID:18718981

Reviewing evidence on complex social interventions: appraising implementation in systematic reviews of the health effects of organisational-level workplace interventions.

PubMed

Egan, M; Bambra, C; Petticrew, M; Whitehead, M

2009-01-01

The reporting of intervention implementation in studies included in systematic reviews of organisational-level workplace interventions was appraised. Implementation is taken to include such factors as intervention setting, resources, planning, collaborations, delivery and macro-level socioeconomic contexts. Understanding how implementation affects intervention outcomes may help prevent erroneous conclusions and misleading assumptions about generalisability, but implementation must be adequately reported if it is to be taken into account. Data on implementation were obtained from four systematic reviews of complex interventions in workplace settings. Implementation was appraised using a specially developed checklist and by means of an unstructured reading of the text. 103 studies were identified and appraised, evaluating four types of organisational-level workplace intervention (employee participation, changing job tasks, shift changes and compressed working weeks). Many studies referred to implementation, but reporting was generally poor and anecdotal in form. This poor quality of reporting did not vary greatly by type or date of publication. A minority of studies described how implementation may have influenced outcomes. These descriptions were more usefully explored through an unstructured reading of the text, rather than by means of the checklist. Evaluations of complex interventions should include more detailed reporting of implementation and consider how to measure quality of implementation. The checklist helped us explore the poor reporting of implementation in a more systematic fashion. In terms of interpreting study findings and their transferability, however, the more qualitative appraisals appeared to offer greater potential for exploring how implementation may influence the findings of specific evaluations. Implementation appraisal techniques for systematic reviews of complex interventions require further development and testing.

Factors that affect implementation of a nurse staffing directive: results from a qualitative multi-case evaluation.

PubMed

Robinson, Claire H; Annis, Ann M; Forman, Jane; Krein, Sarah L; Yankey, Nicholas; Duffy, Sonia A; Taylor, Beth; Sales, Anne E

2016-08-01

To assess implementation of the Veterans Health Administration staffing methodology directive. In 2010 the Veterans Health Administration promulgated a staffing methodology directive for inpatient nursing units to address staffing and budget forecasting. A qualitative multi-case evaluation approach assessed staffing methodology implementation. Semi-structured telephone interviews were conducted from March - June 2014 with Nurse Executives and their teams at 21 facilities. Interviews focused on the budgeting process, implementation experiences, use of data, leadership support, and training. An implementation score was created for each facility using a 4-point rating scale. The scores were used to select three facilities (low, medium and high implementation) for more detailed case studies. After analysing interview summaries, the evaluation team developed a four domain scoring structure: (1) integration of staffing methodology into budget development; (2) implementation of the Directive elements; (3) engagement of leadership and staff; and (4) use of data to support the staffing methodology process. The high implementation facility had leadership understanding and endorsement of staffing methodology, confidence in and ability to work with data, and integration of staffing methodology results into the budgeting process. The low implementation facility reported poor leadership engagement and little understanding of data sources and interpretation. Implementation varies widely across facilities. Implementing staffing methodology in facilities with complex and changing staffing needs requires substantial commitment at all organizational levels especially for facilities that have traditionally relied on historical levels to budget for staffing. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Investigating variations in implementation fidelity of an organizational-level occupational health intervention.

PubMed

Augustsson, Hanna; von Thiele Schwarz, Ulrica; Stenfors-Hayes, Terese; Hasson, Henna

2015-06-01

The workplace has been suggested as an important arena for health promotion, but little is known about how the organizational setting influences the implementation of interventions. The aims of this study are to evaluate implementation fidelity in an organizational-level occupational health intervention and to investigate possible explanations for variations in fidelity between intervention units. The intervention consisted of an integration of health promotion, occupational health and safety, and a system for continuous improvements (Kaizen) and was conducted in a quasi-experimental design at a Swedish hospital. Implementation fidelity was evaluated with the Conceptual Framework for Implementation Fidelity and implementation factors used to investigate variations in fidelity with the Framework for Evaluating Organizational-level Interventions. A multi-method approach including interviews, Kaizen notes, and questionnaires was applied. Implementation fidelity differed between units even though the intervention was introduced and supported in the same way. Important differences in all elements proposed in the model for evaluating organizational-level interventions, i.e., context, intervention, and mental models, were found to explain the differences in fidelity. Implementation strategies may need to be adapted depending on the local context. Implementation fidelity, as well as pre-intervention implementation elements, is likely to affect the implementation success and needs to be assessed in intervention research. The high variation in fidelity across the units indicates the need for adjustments to the type of designs used to assess the effects of interventions. Thus, rather than using designs that aim to control variation, it may be necessary to use those that aim at exploring and explaining variation, such as adapted study designs.

Key Impact Factors on Dam Break Fatalities

NASA Astrophysics Data System (ADS)

Huang, D.; Yu, Z.; Song, Y.; Han, D.; Li, Y.

2016-12-01

Dam failures can lead to catastrophes on human society. However, there is a lack of research about dam break fatalities, especially on the key factors that affect fatalities. Based on the analysis of historical dam break cases, most studies have used the regression analysis to explore the correlation between those factors and fatalities, but without implementing optimization to find the dominating factors. In order to understand and reduce the risk of fatalities, this study has proposed a new method to select the impact factors on the fatality. It employs an improved ANN (Artificial Neural Network) combined with LOOCV (Leave-one-out cross-validation) and SFS (Stepwise Forward Selection) approach to explore the nonlinear relationship between impact factors and life losses. It not only considers the factors that have been widely used in the literature but also introduces new factors closely involved with fatalities. Dam break cases occurred in China from 1954 to 2013 are summarized, within which twenty-five cases are selected with a comprehensive coverage of geographic position and temporal variation. Twelve impact factors are taken into account as the inputs, i.e., severity of dam break flood (SF), population at risk (PR), public understanding of dam break (UB), warning time (TW), evacuation condition (EC), weather condition during dam break (WB), dam break mode (MB), water storage (SW), building vulnerability (VB), dam break time (TB), average distance from the affected area to the dam (DD) and preventive measures by government (PG).From those, three key factors of SF, MB and TB are chosen. The proposed method is able to extract the key factors, and the derived fatality model performs well in various types of dam break conditions.

Factors Affecting Husband Participation in Antenatal Care Attendance and Delivery

NASA Astrophysics Data System (ADS)

Rumaseuw, R.; Berliana, S. M.; Nursalam, N.; Efendi, F.; Pradanie, R.; Rachmawati, P. D.; Aurizki, G. E.

2018-02-01

The government has implemented several programs to prevent and reduce a mother’s mortality rate by enhancing active role of the family. The most responsible family member on maintaining the pregnancy and delivery process is the husband. The husband must be active to take care of his wife. Active participation of the husband in accompanying his wife during pregnancy and the delivery process is one of the substantial factors, which helps the husband to take decisions related to the health of his wife. This study aimed to identify variables and its trends, which significantly affect a husband’s participation in accompanying his wife during pregnancy and the delivery process. The data used in this study was from an Indonesian Demographic Health Survey 2012. The study used binary logistic regression as the analysis method. The result showed as many as 8,237 husbands accompanied their wife in antenatal care and the delivery process. The significant variables affecting the husband participation are the age of the wife, the education of wife, the education of the husband, the occupational status of the wife and the husband, the number of children, pregnancy status, and residency region. The possibility for a husband to accompany his wife is larger in several factors, such as the wife being between the ages of 21 - 35 years old, a husband who minimally graduated from junior high school, a working husband, as well as a wife, and the number of children less than and equal to two and the expected pregnancy. The government should consider those factors to create policy related women’s health and integrate the factors into various sectors.

Patients' support for health information exchange: a literature review and classification of key factors.

PubMed

Esmaeilzadeh, Pouyan; Sambasivan, Murali

2017-04-04

Literature indicates that one of the most important factors affecting the widespread adoption of Health Information Exchange (HIE) is patient support and endorsement. In order to reap all the expected benefits of HIE, patients' acceptance of technology is a challenge that is not fully studied. There are a few studies which have focused on requirements of electronic medical information exchange from consumers' views and expectations. This study is aimed at reviewing the literature to articulate factors that affect patients to support HIE efforts. A literature review of current studies addressing patients' views on HIE from 2005 was undertaken. Five electronic research databases (Science Direct, PubMed, Web of Science, CINAHL, and Academic Search Premiere) were searched to retrieve articles reporting pros and cons of HIE from patients' opinion. One hundred and ninety six articles were initially retrieved from the databases. Out of 196, 36 studies met the inclusion criteria and were fully reviewed. Our findings indicate that patient's attitude toward HIE is affected by seven main factors: perceived benefits, perceived concerns, patient characteristics, patient participation level in HIE, type of health information, identity of recipients, and patient preferences regarding consent and features. The findings provide useful theoretical implications for research by developing a classification of significant factors and a framework based on the lessons learned from the literature to help guide HIE efforts. Our results also have fundamental practical implications for policy makers, current and potential organizers of HIEs by highlighting the role of patients in the widespread implementation of HIE. The study indicates that new approaches should be applied to completely underline HIE benefits for patients and also address their concerns.

Analytical method development of nifedipine and its degradants binary mixture using high performance liquid chromatography through a quality by design approach

NASA Astrophysics Data System (ADS)

Choiri, S.; Ainurofiq, A.; Ratri, R.; Zulmi, M. U.

2018-03-01

Nifedipin (NIF) is a photo-labile drug that easily degrades when it exposures a sunlight. This research aimed to develop of an analytical method using a high-performance liquid chromatography and implemented a quality by design approach to obtain effective, efficient, and validated analytical methods of NIF and its degradants. A 22 full factorial design approach with a curvature as a center point was applied to optimize of the analytical condition of NIF and its degradants. Mobile phase composition (MPC) and flow rate (FR) as factors determined on the system suitability parameters. The selected condition was validated by cross-validation using a leave one out technique. Alteration of MPC affected on time retention significantly. Furthermore, an increase of FR reduced the tailing factor. In addition, the interaction of both factors affected on an increase of the theoretical plates and resolution of NIF and its degradants. The selected analytical condition of NIF and its degradants has been validated at range 1 – 16 µg/mL that had good linearity, precision, accuration and efficient due to an analysis time within 10 min.

Predictors affecting personal health information management skills.

PubMed

Kim, Sujin; Abner, Erin

2016-01-01

This study investigated major factors affecting personal health records (PHRs) management skills associated with survey respondents' health information management related activities. A self-report survey was used to assess individuals' personal characteristics, health knowledge, PHR skills, and activities. Factors underlying respondents' current PHR-related activities were derived using principal component analysis (PCA). Scale scores were calculated based on the results of the PCA, and hierarchical linear regression analyses were used to identify respondent characteristics associated with the scale scores. Internal consistency of the derived scale scores was assessed with Cronbach's α. Among personal health information activities surveyed (N = 578 respondents), the four extracted factors were subsequently grouped and labeled as: collecting skills (Cronbach's α = 0.906), searching skills (Cronbach's α = 0.837), sharing skills (Cronbach's α = 0.763), and implementing skills (Cronbach's α = 0.908). In the hierarchical regression analyses, education and computer knowledge significantly increased the explanatory power of the models. Health knowledge (β = 0.25, p < 0.001) emerged as a positive predictor of PHR collecting skills. This study confirmed that PHR training and learning should consider a full spectrum of information management skills including collection, utilization and distribution to support patients' care and prevention continua.

Leveraging Epidemiology and Clinical Studies of Cancer Outcomes: Recommendations and Opportunities for Translational Research

PubMed Central

2013-01-01

As the number of cancer survivors continues to grow, research investigating the factors that affect cancer outcomes, such as disease recurrence, risk of second malignant neoplasms, and the late effects of cancer treatments, becomes ever more important. Numerous epidemiologic studies have investigated factors that affect cancer risk, but far fewer have addressed the extent to which demographic, lifestyle, genomic, clinical, and psychosocial factors influence cancer outcomes. To identify research priorities as well as resources and infrastructure needed to advance the field of cancer outcomes and survivorship research, the National Cancer Institute sponsored a workshop titled “Utilizing Data from Cancer Survivor Cohorts: Understanding the Current State of Knowledge and Developing Future Research Priorities” on November 3, 2011, in Washington, DC. This commentary highlights recent findings presented at the workshop, opportunities to leverage existing data, and recommendations for future research, data, and infrastructure needed to address high priority clinical and research questions. Multidisciplinary teams that include epidemiologists, clinicians, biostatisticians, and bioinformaticists will be essential to facilitate future cancer outcome studies focused on improving clinical care of cancer patients, identifying those at high risk of poor outcomes, and implementing effective interventions to ultimately improve the quality and duration of survival. PMID:23197494

Association of School Characteristics and Implementation in the X:IT Study-A School-Randomized Smoking Prevention Program.

PubMed

Bast, Lotus S; Due, Pernille; Ersbøll, Annette K; Damsgaard, Mogens T; Andersen, Anette

2017-05-01

Assessment of implementation is essential for the evaluation of school-based preventive activities. Interventions are more easily implemented in schools if detailed instructional manuals, lesson plans, and materials are provided; however, implementation may also be affected by other factors than the intervention itself-for example, school-level characteristics, such as principal support and organizational capacity. We examined school-level characteristics of schools in groups of high, medium, and low implementation of a smoking prevention intervention. The X:IT study is a school-randomized trial testing a multicomponent intervention to prevent smoking among adolescents. Our data came from electronic questionnaires completed by school coordinators at 96.1% of participating intervention schools (N = 49) at first follow -up. Schools that implemented the X:IT intervention to a medium or high degree had higher levels of administrative leadership (77.3% and 83.3% vs 42.9%), school climate/organizational health (95.5% and 91.7% vs 66.7%), mission-policy alignment (90.9% and 100.0% vs 71.4%), personnel expertise (81.8% and 75.0% vs 46.7%), school culture (77.3% and 91.7% vs 53.3%), positive classroom climate (91.4% and 96.2% vs 82.9%) compared with low implementation schools. Our findings highlight the importance of considering the school context in future health prevention initiatives. © 2017, American School Health Association.

Promoting fit bodies, healthy eating and physical activity among Indigenous Australian men: a study protocol

PubMed Central

2012-01-01

Background Overall the physical health of Indigenous men is among the worst in Australia. Research has indicated that modifiable lifestyle factors, such as poor nutrition and physical inactivity, appear to contribute strongly to these poor health conditions. To effectively develop and implement strategies to improve the health of Australia's Indigenous peoples, a greater understanding is needed of how Indigenous men perceive health, and how they view and care for their bodies. Further, a more systematic understanding of how sociocultural factors affect their health attitudes and behaviours is needed. This article presents the study protocol of a community-based investigation into the factors surrounding the health and body image of Indigenous Australian men. Methods and design The study will be conducted in a collaborative manner with Indigenous Australian men using a participatory action research framework. Men will be recruited from three locations around Australia (metropolitan, regional, and rural) and interviewed to understand their experiences and perspectives on a number of issues related to health and health behaviour. The information that is collected will be analysed using modified grounded theory and thematic analysis. The results will then be used to develop and implement community events in each location to provide feedback on the findings to the community, promote health enhancing strategies, and determine future action and collaboration. Discussion This study will explore both risk and protective factors that affect the health of Indigenous Australian men. This knowledge will be disseminated to the wider Indigenous community and can be used to inform future health promotion strategies. The expected outcome of this study is therefore an increased understanding of health and health change in Indigenous Australian men, the development of strategies that promote healthy eating and positive patterns of physical activity and, in the longer term, more effective and culturally-appropriate interventions to improve health. PMID:22236166

Relating management practices and nutrient export in agricultural watersheds of the United States

USGS Publications Warehouse

Sprague, Lori A.; Gronberg, Jo Ann M.

2012-01-01

Relations between riverine export (load) of total nitrogen (N) and total phosphorus (P) from 133 large agricultural watersheds in the United States and factors affecting nutrient transport were evaluated using empirical regression models. After controlling for anthropogenic inputs and other landscape factors affecting nutrient transport-such as runoff, precipitation, slope, number of reservoirs, irrigated area, and area with subsurface tile drains-the relations between export and the area in the Conservation Reserve Program (CRP) (N) and conservation tillage (P) were positive. Additional interaction terms indicated that the relations between export and the area in conservation tillage (N) and the CRP (P) progressed from being clearly positive when soil erodibility was low or moderate, to being close to zero when soil erodibility was higher, to possibly being slightly negative only at the 90th to 95th percentile of soil erodibility values. Possible explanations for the increase in nutrient export with increased area in management practices include greater transport of soluble nutrients from areas in conservation tillage; lagged response of stream quality to implementation of management practices because of nitrogen transport in groundwater, time for vegetative cover to mature, and/or prior accumulation of P in soils; or limitations in the management practice and stream monitoring data sets. If lags are occurring, current nutrient export from agricultural watersheds may still be reflecting the influence of agricultural land-use practices that were in place before the implementation of these management practices.

Key success factors of health research centers: A mixed method study.

PubMed

Tofighi, Shahram; Teymourzadeh, Ehsan; Heydari, Majid

2017-08-01

In order to achieve success in future goals and activities, health research centers are required to identify their key success factors. This study aimed to extract and rank the factors affecting the success of research centers at one of the medical universities in Iran. This study is a mixed method (qualitative-quantitative) study, which was conducted between May to October in 2016. The study setting was 22 health research centers. In qualitative phase, we extracted the factors affecting the success in research centers through purposeful interviews with 10 experts of centers, and classified them into themes and sub-themes. In the quantitative phase, we prepared a questionnaire and scored and ranked the factors recognized by 54 of the study samples by Friedman test. Nine themes and 42 sub-themes were identified. Themes included: strategic orientation, management, human capital, support, projects, infrastructure, communications and collaboration, paradigm and innovation and they were rated respectively as components of success in research centers. Among the 42 identified factors, 10 factors were ranked respectively as the key factors of success, and included: science and technology road map, strategic plan, evaluation indexes, committed human resources, scientific evaluation of members and centers, innovation in research and implementation, financial support, capable researchers, equipment infrastructure and teamwork. According to the results, the strategic orientation was the most important component in the success of research centers. Therefore, managers and authorities of research centers should pay more attention to strategic areas in future planning, including the science and technology road map and strategic plan.

Key success factors of health research centers: A mixed method study

PubMed Central

Tofighi, Shahram; Teymourzadeh, Ehsan; Heydari, Majid

2017-01-01

Background In order to achieve success in future goals and activities, health research centers are required to identify their key success factors. Objective This study aimed to extract and rank the factors affecting the success of research centers at one of the medical universities in Iran. Methods This study is a mixed method (qualitative-quantitative) study, which was conducted between May to October in 2016. The study setting was 22 health research centers. In qualitative phase, we extracted the factors affecting the success in research centers through purposeful interviews with 10 experts of centers, and classified them into themes and sub-themes. In the quantitative phase, we prepared a questionnaire and scored and ranked the factors recognized by 54 of the study samples by Friedman test. Results Nine themes and 42 sub-themes were identified. Themes included: strategic orientation, management, human capital, support, projects, infrastructure, communications and collaboration, paradigm and innovation and they were rated respectively as components of success in research centers. Among the 42 identified factors, 10 factors were ranked respectively as the key factors of success, and included: science and technology road map, strategic plan, evaluation indexes, committed human resources, scientific evaluation of members and centers, innovation in research and implementation, financial support, capable researchers, equipment infrastructure and teamwork. Conclusion According to the results, the strategic orientation was the most important component in the success of research centers. Therefore, managers and authorities of research centers should pay more attention to strategic areas in future planning, including the science and technology road map and strategic plan. PMID:28979733

Key factors contributing to accident severity rate in construction industry in Iran: a regression modelling approach.

PubMed

Soltanzadeh, Ahmad; Mohammadfam, Iraj; Moghimbeigi, Abbas; Ghiasvand, Reza

2016-03-01

Construction industry involves the highest risk of occupational accidents and bodily injuries, which range from mild to very severe. The aim of this cross-sectional study was to identify the factors associated with accident severity rate (ASR) in the largest Iranian construction companies based on data about 500 occupational accidents recorded from 2009 to 2013. We also gathered data on safety and health risk management and training systems. Data were analysed using Pearson's chi-squared coefficient and multiple regression analysis. Median ASR (and the interquartile range) was 107.50 (57.24- 381.25). Fourteen of the 24 studied factors stood out as most affecting construction accident severity (p<0.05). These findings can be applied in the design and implementation of a comprehensive safety and health risk management system to reduce ASR.

Implementation of Mamdani Fuzzy Method in Employee Promotion System

NASA Astrophysics Data System (ADS)

Zulfikar, W. B.; Jumadi; Prasetyo, P. K.; Ramdhani, M. A.

2018-01-01

Nowadays, employees are big assets to an institution. Every employee has a different educational background, degree, work skill, attitude and ethic that affect the performance. An institution including government institution implements a promotion system in order to improve the performance of the employees. Pangandaran Tourism, Industry, Trade, and SME Department is one of government agency that implements a promotion system to discover employees who deserve to get promotion. However, there are some practical deficiencies in the promotion system, one of which is the subjectivity issue. This work proposed a classification model that could minimize the subjectivity issue in employee promotion system. This paper reported a classification employee based on their eligibility for promotion. The degree of membership was decided using Mamdani Fuzzy based on determinant factors of the performance of employees. In the evaluation phase, this model had an accuracy of 91.4%. It goes to show that this model may minimize the subjectivity issue in the promotion system, especially at Pangandaran Tourism, Industry, Trade, and SME Department.

Psychosocial stressors of sickle cell disease on adult patients in Cameroon.

PubMed

Wonkam, Ambroise; Mba, Caryl Zameyo; Mbanya, Dora; Ngogang, Jeanne; Ramesar, Raj; Angwafo, Fru F

2014-12-01

Sickle Cell Disease (SCD) is a debilitating illness that affects quality of life. Studies of the psychosocial burden of SCD on patients have been rarely reported in Africa. We used a quantitative method, with face-to-face administered questionnaires, to study indices of psychosocial stressors on adult SCD patients in Cameroon. The questionnaire included a 36-item stress factors scale evaluating general perceptions of stress and five main stressors' domain: disease factors, hospital factors, financial factors, family factors and quality of personal-life factors. Items pertaining to psychosocial stressors involved four response options with increasing severity: 0, 1, 2 or 3. Non-parametric tests were used for analysis. The majority of the 83 participants were urban dwellers, female, 20-30 years old, single, unemployed, with at least a secondary or tertiary education. Median age at diagnosis was 100 months; 47.8% had >3 painful vaso-oclusive crises annually. Only 4.8% had been treated with hydroxyurea. The majority reported moderate to severe difficulty coping with SCD. The "degree of clinical severity" category displayed the highest median score (2.0), while familial stressors showed the lowest (0.8). Being female, married, with low education level, an additional affected sibling and low direct income were significantly associated with specific stressors' categories. In Cameroon, there is an urgent need to implement policies that ensure affordable access to health-care and practices to reduce SCD morbidity and improve patients' quality of life.

Factors impeding flexible inpatient unit design.

PubMed

Pati, Debajyoti; Evans, Jennie; Harvey, Thomas E; Bazuin, Doug

2012-01-01

To identify and examine factors extraneous to the design decision-making process that could impede the optimization of flexibility on inpatient units. A 2006 empirical study to identify domains of design decisions that affect flexibility on inpatient units found some indication in the context of the acuity-adaptable operational model that factors extraneous to the design process could have negatively influenced the successful implementation of the model. This raised questions regarding extraneous factors that might influence the successful optimization of flexibility. An exploratory, qualitative method was adopted to examine the question. Stakeholders from five recently built acute care inpatient units participated in the study, which involved three types of data collection: (1) verbal protocol data from a gaming session; (2) in-depth semi-structured interviews; and (3) shadowing frontline personnel. Data collection was conducted between June 2009 and November 2010. The study revealed at least nine factors extraneous to the design process that have the potential to hinder the optimization of flexibility in four domains: (1) systemic; (2) cultural; (3) human; and (4) financial. Flexibility is critical to hospital operations in the new healthcare climate, where cost reduction constitutes a vital target. From this perspective, flexibility and efficiency strategies can be influenced by (1) return on investment, (2) communication, (3) culture change, and (4) problem definition. Extraneous factors identified in this study could also affect flexibility in other care settings; therefore, these findings may be viewed from the overall context of hospital design.

Organizational factors affecting successful adoption of innovative eHealth services: a case study employing the FITT framework.

PubMed

Tsiknakis, Manolis; Kouroubali, Angelina

2009-01-01

The paper presents an application of the "Fit between Individuals, Task and Technology" (FITT) framework to analyze the socio-organizational-technical factors that influence IT adoption in the healthcare domain. The FITT framework was employed as the theoretical instrument for a retrospective analysis of a 15-year effort in implementing IT systems and eHealth services in the context of a Regional Health Information Network in Crete. Quantitative and qualitative research methods, interviews and participant observations were employed to gather data from a case study that involved the entire region of Crete. The detailed analysis of the case study based on the FITT framework, showed common features, but also differences of IT adoption within the various health organizations. The emerging picture is a complex nexus of factors contributing to IT adoption, and multi-level interventional strategies to promote IT use. The work presented in this paper shows the applicability of the FITT framework in explaining the complexity of aspects observed in the implementation of healthcare information systems. The reported experiences reveal that fit management can be viewed as a system with a feedback loop that is never really stable, but ever changing based on external factors or deliberate interventions. Management of fit, therefore, becomes a constant and complex task for the whole life cycle of IT systems.

Spatiotemporal Heterogeneity Analysis of Hemorrhagic Fever with Renal Syndrome in China Using Geographically Weighted Regression Models

PubMed Central

Li, Shujuan; Ren, Hongyan; Hu, Wensheng; Lu, Liang; Xu, Xinliang; Zhuang, Dafang; Liu, Qiyong

2014-01-01

Hemorrhagic fever with renal syndrome (HFRS) is an important public health problem in China. The identification of the spatiotemporal pattern of HFRS will provide a foundation for the effective control of the disease. Based on the incidence of HFRS, as well as environmental factors, and social-economic factors of China from 2005–2012, this paper identified the spatiotemporal characteristics of HFRS distribution and the factors that impact this distribution. The results indicate that the spatial distribution of HFRS had a significant, positive spatial correlation. The spatiotemporal heterogeneity was affected by the temperature, precipitation, humidity, NDVI of January, NDVI of August for the previous year, land use, and elevation in 2005–2009. However, these factors did not explain the spatiotemporal heterogeneity of HFRS incidences in 2010–2012. Spatiotemporal heterogeneity of provincial HFRS incidences and its relation to environmental factors would provide valuable information for hygiene authorities to design and implement effective measures for the prevention and control of HFRS in China. PMID:25429681

The Implementation Leadership Scale (ILS): development of a brief measure of unit level implementation leadership.

PubMed

Aarons, Gregory A; Ehrhart, Mark G; Farahnak, Lauren R

2014-04-14

In healthcare and allied healthcare settings, leadership that supports effective implementation of evidenced-based practices (EBPs) is a critical concern. However, there are no empirically validated measures to assess implementation leadership. This paper describes the development, factor structure, and initial reliability and convergent and discriminant validity of a very brief measure of implementation leadership: the Implementation Leadership Scale (ILS). Participants were 459 mental health clinicians working in 93 different outpatient mental health programs in Southern California, USA. Initial item development was supported as part of a two United States National Institutes of Health (NIH) studies focused on developing implementation leadership training and implementation measure development. Clinician work group/team-level data were randomly assigned to be utilized for an exploratory factor analysis (n = 229; k = 46 teams) or for a confirmatory factor analysis (n = 230; k = 47 teams). The confirmatory factor analysis controlled for the multilevel, nested data structure. Reliability and validity analyses were then conducted with the full sample. The exploratory factor analysis resulted in a 12-item scale with four subscales representing proactive leadership, knowledgeable leadership, supportive leadership, and perseverant leadership. Confirmatory factor analysis supported an a priori higher order factor structure with subscales contributing to a single higher order implementation leadership factor. The scale demonstrated excellent internal consistency reliability as well as convergent and discriminant validity. The ILS is a brief and efficient measure of unit level leadership for EBP implementation. The availability of the ILS will allow researchers to assess strategic leadership for implementation in order to advance understanding of leadership as a predictor of organizational context for implementation. The ILS also holds promise as a tool for leader and organizational development to improve EBP implementation.

The implementation leadership scale (ILS): development of a brief measure of unit level implementation leadership

PubMed Central

2014-01-01

Background In healthcare and allied healthcare settings, leadership that supports effective implementation of evidenced-based practices (EBPs) is a critical concern. However, there are no empirically validated measures to assess implementation leadership. This paper describes the development, factor structure, and initial reliability and convergent and discriminant validity of a very brief measure of implementation leadership: the Implementation Leadership Scale (ILS). Methods Participants were 459 mental health clinicians working in 93 different outpatient mental health programs in Southern California, USA. Initial item development was supported as part of a two United States National Institutes of Health (NIH) studies focused on developing implementation leadership training and implementation measure development. Clinician work group/team-level data were randomly assigned to be utilized for an exploratory factor analysis (n = 229; k = 46 teams) or for a confirmatory factor analysis (n = 230; k = 47 teams). The confirmatory factor analysis controlled for the multilevel, nested data structure. Reliability and validity analyses were then conducted with the full sample. Results The exploratory factor analysis resulted in a 12-item scale with four subscales representing proactive leadership, knowledgeable leadership, supportive leadership, and perseverant leadership. Confirmatory factor analysis supported an a priori higher order factor structure with subscales contributing to a single higher order implementation leadership factor. The scale demonstrated excellent internal consistency reliability as well as convergent and discriminant validity. Conclusions The ILS is a brief and efficient measure of unit level leadership for EBP implementation. The availability of the ILS will allow researchers to assess strategic leadership for implementation in order to advance understanding of leadership as a predictor of organizational context for implementation. The ILS also holds promise as a tool for leader and organizational development to improve EBP implementation. PMID:24731295

Factors associated with early childhood education and care service implementation of healthy eating and physical activity policies and practices in Australia: a cross-sectional study.

PubMed

Wolfenden, Luke; Finch, Meghan; Nathan, Nicole; Weaver, Natasha; Wiggers, John; Yoong, Sze Lin; Jones, Jannah; Dodds, Pennie; Wyse, Rebecca; Sutherland, Rachel; Gillham, Karen

2015-09-01

Many early childhood education and care (ECEC) services fail to implement recommended policies and practices supportive of healthy eating and physical activity. The purpose of this study was to assess whether certain theoretically-based factors are associated with implementation of healthy eating and physical activity policies and practices in a sample of ECEC services. A cross-sectional survey was conducted with Service Managers of ECEC services. The survey assessed the operational characteristics, policy, and practice implementation, and 13 factors were suggested by Damschroder's Consolidated Framework for Implementation Research to impede or promote implementation. Logistic regression analyses found a significant association between implementation factor score and full implementation (OR 1.38; 95% CI 1.18-1.61; p = <0.01), indicating that for every one point increase in implementation score, ECEC services were 38 % more likely to be fully implementing the policies and practices. The findings highlight the opportunities for improving implementation of obesity prevention interventions in this setting by developing interventions that address such factors.

A multi-level analysis of counselor attitudes toward the use of buprenorphine in substance abuse treatment.

PubMed

Rieckmann, Traci R; Kovas, Anne E; McFarland, Bentson H; Abraham, Amanda J

2011-12-01

Despite evidence that buprenorphine is effective and safe and offers greater access as compared with methadone, implementation for treatment of opiate dependence continues to be weak. Research indicates that legal and regulatory factors, state policies, and organizational and provider variables affect adoption of buprenorphine. This study uses hierarchical linear modeling to examine National Treatment Center Study data to identify counselor characteristics (attitudes, training, and beliefs) and organizational factors (accreditation, caseload, access to buprenorphine, and other evidence-based practices) that influence implementation of buprenorphine for treatment of opiate dependence. Analyses showed that provider training about buprenorphine, higher prevalence of opiate-dependent clients, and less treatment program emphasis on a 12-step model predicted greater counselor acceptance and perceived effectiveness of buprenorphine. Results also indicate that program use of buprenorphine for any treatment purpose (detoxification, maintenance, and/or pain management) and time (calendar year in data collection) was associated with increased diffusion of knowledge about buprenorphine among counselors and with more favorable counselor attitudes toward buprenorphine. Copyright © 2011 Elsevier Inc. All rights reserved.

Counselor Attitudes toward the Use of Buprenorphine in Substance Abuse Treatment: A Multi-level Modeling Approach

PubMed Central

Kovas, Anne E.; McFarland, Bentson H.; Abraham, Amanda J.

2012-01-01

In spite of evidence that buprenorphine is effective, safe, and offers greater access as compared with methadone, implementation for treatment of opiate dependence continues to be weak. Research indicates that legal and regulatory factors, state policies, and organizational and provider variables affect adoption of buprenorphine. This study uses hierarchical linear modeling (HLM) to examine National Treatment Center Study (NTCS) data to identify counselor characteristics (attitudes, training, beliefs) and organizational factors (accreditation, caseload, access to buprenorphine and other evidence-based practices) that influence implementation of buprenorphine for treatment of opiate dependence. Analyses showed that provider training about buprenorphine, higher prevalence of opiate dependent clients, and less treatment program emphasis on a 12-step model predicted greater counselor acceptance and perceived effectiveness of buprenorphine. Results also indicate that program use of buprenorphine for any treatment purpose (detoxification, maintenance, and/or pain management) and time (calendar year in data collection) were associated with increased diffusion of knowledge about buprenorphine among counselors and with more favorable counselor attitudes toward buprenorphine. PMID:21821379

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chitra Sivaraman, PNNL

Cloud droplet number concentration is an important factor in understanding aerosol-cloud interactions. As aerosol concentration increases, it is expected that droplet number concentration (Nd) will increase and droplet size will decrease, for a given liquid water path. This will greatly affect cloud albedo as smaller droplets reflect more shortwave radiation; however, the magnitude and variability of these processes under different environmental conditions is still uncertain.McComiskey et al. (2009) have implemented a method, based onBoers and Mitchell (1994), for calculating Nd from ground-based remote sensing measurements of optical depth and liquid water path. They show that the magnitude of the aerosol-cloudmore » interactions (ACI) varies with a range of factors, including the relative value of the cloud liquid water path (LWP), the aerosol size distribution, and the cloud updraft velocity. Estimates of Nd under a range of cloud types and conditions and at a variety of sites are needed to further quantify the impacts of aerosol cloud interactions. In order to provide data sets for studying aerosol-cloud interactions, the McComiskey et al. (2009) method was implemented as the Droplet Number Concentration (NDROP) value-added product (VAP).« less

EV Charging Through Wireless Power Transfer: Analysis of Efficiency Optimization and Technology Trends

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, John M; Rakouth, Heri; Suh, In-Soo

This paper is aimed at reviewing the technology trends for wireless power transfer (WPT) for electric vehicles (EV). It also analyzes the factors affecting its efficiency and describes the techniques currently used for its optimization. The review of the technology trends encompasses both stationary and moving vehicle charging systems. The study of the stationary vehicle charging technology is based on current implementations and on-going developments at WiTricity and Oak Ridge National Lab (ORNL). The moving vehicle charging technology is primarily described through the results achieved by the Korean Advanced Institute of Technology (KAIST) along with on-going efforts at Stanford University.more » The factors affecting the efficiency are determined through the analysis of the equivalent circuit of magnetic resonant coupling. The air gap between both transmitting and receiving coils along with the magnetic field distribution and the relative impedance mismatch between the related circuits are the primary factors affecting the WPT efficiency. Currently the industry is looking at an air gap of 25 cm or below. To control the magnetic field distribution, Kaist has recently developed the Shaped Magnetic Field In Resonance (SMFIR) technology that uses conveniently shaped ferrite material to provide low reluctance path. The efficiency can be further increased by means of impedance matching. As a result, Delphi's implementation of the WiTricity's technology exhibits a WPT efficiency above 90% for stationary charging while KAIST has demonstrated a maximum efficiency of 83% for moving vehicle with its On Line Vehicle (OLEV) project. This study is restricted to near-field applications (short and mid-range) and does not address long-range technology such as microwave power transfer that has low efficiency as it is based on radiating electromagnetic waves. This paper exemplifies Delphi's work in powertrain electrification as part of its innovation for the real world program geared toward a safer, greener and more connected driving. Moreover, it draws from and adds to Dr. Andrew Brown Jr.'s SAE books 'Active Safety and the Mobility Industry', 'Connectivity and Mobility Industry', and 'Green Technologies and the Mobility Industry'. Magnetic resonant coupling is the foundation of modern wireless power transfer. Its efficiency can be controlled through impedance matching and magnetic field shaping. Current implementations use one or both of these control methods and enable both stationary and mobile charging with typical efficiency within the 80% and 90% range for an air gap up to 25 cm.« less

Barriers to and facilitators of implementing complex workplace dietary interventions: process evaluation results of a cluster controlled trial.

PubMed

Fitzgerald, Sarah; Geaney, Fiona; Kelly, Clare; McHugh, Sheena; Perry, Ivan J

2016-04-21

Ambiguity exists regarding the effectiveness of workplace dietary interventions. Rigorous process evaluation is vital to understand this uncertainty. This study was conducted as part of the Food Choice at Work trial which assessed the comparative effectiveness of a workplace environmental dietary modification intervention and an educational intervention both alone and in combination versus a control workplace. Effectiveness was assessed in terms of employees' dietary intakes, nutrition knowledge and health status in four large manufacturing workplaces. The study aimed to examine barriers to and facilitators of implementing complex workplace interventions, from the perspectives of key workplace stakeholders and researchers involved in implementation. A detailed process evaluation monitored and evaluated intervention implementation. Interviews were conducted at baseline (27 interviews) and at 7-9 month follow-up (27 interviews) with a purposive sample of workplace stakeholders (managers and participating employees). Topic guides explored factors which facilitated or impeded implementation. Researchers involved in recruitment and data collection participated in focus groups at baseline and at 7-9 month follow-up to explore their perceptions of intervention implementation. Data were imported into NVivo software and analysed using a thematic framework approach. Four major themes emerged; perceived benefits of participation, negotiation and flexibility of the implementation team, viability and intensity of interventions and workplace structures and cultures. The latter three themes either positively or negatively affected implementation, depending on context. The implementation team included managers involved in coordinating and delivering the interventions and the researchers who collected data and delivered intervention elements. Stakeholders' perceptions of the benefits of participating, which facilitated implementation, included managers' desire to improve company image and employees seeking health improvements. Other facilitators included stakeholder buy-in, organisational support and stakeholder cohesiveness with regards to the level of support provided to the intervention. Anticipation of employee resistance towards menu changes, workplace restructuring and target-driven workplace cultures impeded intervention implementation. Contextual factors such as workplace structures and cultures need to be considered in the implementation of future workplace dietary interventions. Negotiation and flexibility of key workplace stakeholders plays an integral role in overcoming the barriers of workplace cultures, structures and resistance to change. Current Controlled Trials: ISRCTN35108237. Date of registration: 02/07/2013.

Understanding motivation to implement smoking bans among mothers with a hospitalized infant.

PubMed

Stotts, Angela L; Klawans, Michelle R; Northrup, Thomas F; Villarreal, Yolanda; Hovell, Melbourne F

2016-07-01

Secondhand smoke exposure (SHSe) poses risks to hospitalized children upon discharge and no uniformly effective interventions have been identified. Understanding change-related processes and social-contextual factors related to motivation for implementing home and car smoking bans may inform interventions to reduce infant SHSe among mothers with a hospitalized infant. In this cross-sectional, secondary analysis, mothers of neonatal ICU infants who reported smoking or living with a smoker (N=205) were assigned to stages of change (pre-contemplation, contemplation, preparation, or action) based on behaviors and intentions for establishing smoking bans in their homes and cars. Processes of change (POC) for SHSe reduction practices, self-efficacy, depressive symptoms, generalized anxiety, and social support for not smoking in the home were examined across all four stages. The majority of mothers were in the action stage for having a home smoking ban in place (55%); only 35% of participants were in action for a car smoking ban. POC use differed across the stages of change for having a home ban (p=0.004) and car ban (p=0.02), with earlier stages using fewer overall and relatively fewer cognitive/affective processes. Earlier stage women also reported lower self-efficacy to change, less familial and partner support for in-home smoking bans, and more depressive symptoms. Novel intervention targets were identified, including cognitive/affective change processes, mental health, and familial/social contingencies for implementing SHSe protective practices. Creative ways in which to affect change at the individual and household level are needed in order to fully address the complexity of child SHSe. Copyright © 2016 Elsevier Ltd. All rights reserved.

Factors influencing HIV-risk behaviors among HIV-positive urban African Americans.

PubMed

Plowden, Keith O; Fletcher, Audwin; Miller, J Lawrence

2005-01-01

Urban African Americans are disproportionately affected by HIV, the virus associated with AIDS. Although incidence and mortality appear to be decreasing in some populations, they continue to remain steady among inner-city African Americans. A major concern is the number of HIV-positive individuals who continue to practice high-risk behaviors. Understanding factors that increase risks is essential for the development and implementation of effective prevention initiatives. Following a constructionist epistemology, this study used ethnography to explore social and cultural factors that influence high-risk behaviors among inner-city HIV-positive African Americans. Leininger's culture care diversity and universality theory guided the study. Individual qualitative interviews were conducted with HIV-positive African Americans in the community to explore social and cultural factors that increase HIV-risky behaviors. For this study, family/kinship, economic, and education factors played a significant role in risky behaviors. Reducing HIV disparity among African Americans is dependent on designing appropriate interventions that enhance protective factors. Clinicians providing care to HIV-positive individuals can play a key role in reducing transmission by recognizing and incorporating these factors when designing effective prevention interventions.

Collaboration, negotiation, and coalescence for interagency-collaborative teams to scale-up evidence-based practice.

PubMed

Aarons, Gregory A; Fettes, Danielle L; Hurlburt, Michael S; Palinkas, Lawrence A; Gunderson, Lara; Willging, Cathleen E; Chaffin, Mark J

2014-01-01

Implementation and scale-up of evidence-based practices (EBPs) is often portrayed as involving multiple stakeholders collaborating harmoniously in the service of a shared vision. In practice, however, collaboration is a more complex process that may involve shared and competing interests and agendas, and negotiation. The present study examined the scale-up of an EBP across an entire service system using the Interagency Collaborative Team approach. Participants were key stakeholders in a large-scale county-wide implementation of an EBP to reduce child neglect, SafeCare. Semistructured interviews and/or focus groups were conducted with 54 individuals representing diverse constituents in the service system, followed by an iterative approach to coding and analysis of transcripts. The study was conceptualized using the Exploration, Preparation, Implementation, and Sustainment framework. Although community stakeholders eventually coalesced around implementation of SafeCare, several challenges affected the implementation process. These challenges included differing organizational cultures, strategies, and approaches to collaboration; competing priorities across levels of leadership; power struggles; and role ambiguity. Each of the factors identified influenced how stakeholders approached the EBP implementation process. System-wide scale-up of EBPs involves multiple stakeholders operating in a nexus of differing agendas, priorities, leadership styles, and negotiation strategies. The term collaboration may oversimplify the multifaceted nature of the scale-up process. Implementation efforts should openly acknowledge and consider this nexus when individual stakeholders and organizations enter into EBP implementation through collaborative processes.

Collaboration, Negotiation, and Coalescence for Interagency-Collaborative Teams to Scale-up Evidence-Based Practice

PubMed Central

Aarons, Gregory A.; Fettes, Danielle; Hurlburt, Michael; Palinkas, Lawrence; Gunderson, Lara; Willging, Cathleen; Chaffin, Mark

2014-01-01

Objective Implementation and scale-up of evidence-based practices (EBPs) is often portrayed as involving multiple stakeholders collaborating harmoniously in the service of a shared vision. In practice, however, collaboration is a more complex process that may involve shared and competing interests and agendas, and negotiation. The present study examined the scale-up of an EBP across an entire service system using the Interagency Collaborative Team (ICT) approach. Methods Participants were key stakeholders in a large-scale county-wide implementation of an EBP to reduce child neglect, SafeCare®. Semi-structured interviews and/or focus groups were conducted with 54 individuals representing diverse constituents in the service system, followed by an iterative approach to coding and analysis of transcripts. The study was conceptualized using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Results Although community stakeholders eventually coalesced around implementation of SafeCare, several challenges affected the implementation process. These challenges included differing organizational cultures, strategies, and approaches to collaboration, competing priorities across levels of leadership, power struggles, and role ambiguity. Each of the factors identified influenced how stakeholders approached the EBP implementation process. Conclusions System wide scale-up of EBPs involves multiple stakeholders operating in a nexus of differing agendas, priorities, leadership styles, and negotiation strategies. The term collaboration may oversimplify the multifaceted nature of the scale-up process. Implementation efforts should openly acknowledge and consider this nexus when individual stakeholders and organizations enter into EBP implementation through collaborative processes. PMID:24611580

Implementing mentor mothers in family practice to support abused mothers: study protocol.

PubMed

Loeffen, Maartje Jw; Lo Fo Wong, Sylvie H; Wester, Fred Pjf; Laurant, Miranda Gh; Lagro-Janssen, Antoine Lm

2011-10-18

Intimate partner violence is highly prevalent and mostly affects women with negative consequences for their physical and mental health. Children often witness the violence which has negative consequences for their well-being too. Care offered by family physicians is often rejected because abused women experience a too high threshold. Mentor mother support, a low threshold intervention for abused mothers in family practice, proved to be feasible and effective in Rotterdam, the Netherlands. The primary aim of this study is to investigate which factors facilitate or hinder the implementation of mentor mother support in family practice. Besides we evaluate the effect of mentor mother support in a different region. An observational study with pre- and posttests will be performed. Mothers with home living children or pregnant women who are victims of intimate partner violence will be offered mentor mother support by the participating family physicians. The implementation process evaluation consists of focus groups, interviews and questionnaires. In the effect evaluation intimate partner violence, the general health of the abused mother, the mother-child relationship, social support, and acceptance of professional help will be measured twice (t = 0 and t = 6 months) by questionnaires, reporting forms, medical records and interviews with the abused mothers. Qualitative coding will be used to analyze the data from the reporting forms, medical records, focus groups, interviews, and questionnaires. Quantitative data will be analyzed with descriptive statistics, chi square test and t-test matched pairs. While other intervention studies only evaluate the feasibility and effectiveness of the intervention, our primary aim is to evaluate the implementation process and thereby investigate which factors facilitate or hinder implementation of mentor mother support in family practice.

Exploring readiness for the adoption of new molecular water quality tests: Insights from interviews with policy makers, laboratory managers and watershed managers.

PubMed

Henrich, Natalie; Holmes, Bev; Isaac-Renton, Judith; Prystajecky, Natalie

2016-01-01

Adoption of molecular-based water quality tests has been limited despite their advantage over traditional culture-based tests. A better understanding of the factors affecting adoption of these tests is needed for effective implementation. The Consolidated Framework for Implementation Research (CFIR) was used to analyze interviews with policy makers, watershed managers and laboratory managers in British Columbia (BC), Canada about their perceptions of molecular water tests currently under development in order to assess readiness for adoption and identify factors that may impact implementation. Many of the CFIR constructs were addressed by study participants, thus confirming their validity in the water-testing context. Other constructs were not mentioned, which suggests that awareness about these constructs need to be increased to ensure that they are incorporated into implementation strategies. In general, there was much enthusiasm for the new tests, which were seen to provide valuable information that could enable improved management of watersheds and treatment of source water. However, prior to adopting the tests, stakeholders would require evidence supporting the tests' validity and reliability, would need to assess the complexity of introducing the tests into laboratories and water sampling processes, and would require support interpreting the test results. Even if all the aforementioned issues are satisfactorily addressed, the tests may not be adopted unless regulations and policies were changed to allow the use of these test results to inform decision making. The results support that implementation of new technologies, such as these water quality tests, need to address potential barriers that could hinder uptake despite the advantages of the new product. Copyright © 2015 Elsevier Ltd. All rights reserved.

Testing the Implementation of the Veder Contact Method: A Theatre-Based Communication method in Dementia Care.

PubMed

Boersma, Petra; van Weert, Julia C M; Lissenberg-Witte, Birgit I; van Meijel, Berno; Dröes, Rose-Marie

2018-01-08

There is a lack of research on implementation of person-centered care in nursing home care. The purpose of this study was to assess the implementation of the Veder contact method (VCM), a new person-centered method using theatrical, poetic and musical communication for application in 24-hr care. Caregivers (n = 136) and residents (n = 141) participated in a 1-year quasi-experimental study. Foundation Theater Veder implemented VCM on six experimental wards and rated implementation quality. Six control wards delivered care-as-usual. Before and after implementation, caregiver behavior was assessed during observations using the Veder-observation list and Quality of Caregivers' Behavior-list. Caregiver attitude was rated with the Approaches to Dementia Questionnaire. Quality of life, behavior, and mood of the residents were measured with QUALIDEM, INTERACT and FACE. Residents' care plans were examined for person-centered background information. Significant improvements in caregivers' communicative behavior (i.e., the ability to apply VCM, establishing positive interactions) and some aspects of residents' behavior and quality of life (i.e., positive affect, social relations) were found on the experimental wards with a high implementation score, as compared to the experimental wards with a low implementation score, and the control wards. No significant differences were found between the groups in caregivers' attitudes, residents' care plans, or mood. The positive changes in caregivers' behavior and residents' well-being on the high implementation score wards confirm the partly successful VCM implementation. Distinguishing between wards with a high and low implementation score provided insight into factors which are crucial for successful implementation. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The evolution of the health system outcomes in Central and Eastern Europe and their association with social, economic and political factors: an analysis of 25 years of transition.

PubMed

Romaniuk, Piotr; Szromek, Adam R

2016-03-17

After the fall of communism, the countries of Central and Eastern Europe started the process of political, economic, and social transformation. In health system the reform directions were often similar, despite differences in transition dynamics and the degree of government determination to implement reforms. Nonetheless, for most post-communist countries, there is a gap in evidence regarding the effectiveness of implemented reforms and their impact on health system performance. The presented study attempts to analyse and evaluate the results of health reforms in CEE countries with regard to their influence on health system outcomes. We also analysed the external and internal health system environments during the transition period to determine the factors affecting the effectiveness of health reforms. We compared the indicators of population health status, lifestyle, occupational safety issues and health system resources in 21 post-communist countries between sub-periods across the entire transition period at the aggregate level. The dynamics of change in health system outcomes in individual countries, as well as between countries, was also compared. Finally, we analysed the correlations between health system outcomes gathered into one synthetic measure and factors considered as potential determinants affecting the effectiveness of health reforms. The analyses were performed based on one-dimensional, two-dimensional and multidimensional statistical methods. The data were retrieved from the international databases, such as WHO, World Bank, International Labour Organization, World Value Survey and the European Social Survey. Among the factors positively stimulating improvements in health system outcomes were the total expenditure on health and a lower financial burden on patients, but primarily they were determined by the broader economic context of the country. Another finding was that better initial position positively determined health system outcomes at later stages, but did not affect the degree of improvements. Countries that embarked on comprehensive reforms early on tended to achieve the greatest improvements in health system outcomes. Poorer countries may have only limited ability to improve health system outcomes by committing more financial resources to the health system. Progress can still be made in terms of health behaviours, since policies to address these have so far been insufficient or ineffective.

Succesful Lean Manufacturing Implementation: Internal Key Influencing Factors

NASA Astrophysics Data System (ADS)

Virginia, Iuga; Claudiu, Kifor

2015-09-01

Manufacturing sectors and companies all over the world are successfully implementing lean principles within their processes. Nowadays, lean has become an indispensable part of global players. Companies worldwide need to be aware of multiple factors which weigh heavily on the success or failure of lean implementation. This paper focuses on giving a brief and structured overview over the fundamental organizational factors which play a substantial role for the lean manufacturing (LM) implementation process. The study below focuses on internal factors which are indispensable for a successful LM implementation within organizations. It is imperative that these internal factors are known, recognized and taken into consideration during the whole LM implementation process. Ignoring their influence on the process's implementation may lead to endangering the expected results or to making the process more difficult which could result in much higher human resource consumption.

Formation of integrated structural units using the systematic and integrated method when implementing high-rise construction projects

NASA Astrophysics Data System (ADS)

Abramov, Ivan

2018-03-01

Development of design documentation for a future construction project gives rise to a number of issues with the main one being selection of manpower for structural units of the project's overall implementation system. Well planned and competently staffed integrated structural construction units will help achieve a high level of reliability and labor productivity and avoid negative (extraordinary) situations during the construction period eventually ensuring improved project performance. Research priorities include the development of theoretical recommendations for enhancing reliability of a structural unit staffed as an integrated construction crew. The author focuses on identification of destabilizing factors affecting formation of an integrated construction crew; assessment of these destabilizing factors; based on the developed mathematical model, highlighting the impact of these factors on the integration criterion with subsequent identification of an efficiency and reliability criterion for the structural unit in general. The purpose of this article is to develop theoretical recommendations and scientific and methodological provisions of an organizational and technological nature in order to identify a reliability criterion for a structural unit based on manpower integration and productivity criteria. With this purpose in mind, complex scientific tasks have been defined requiring special research, development of corresponding provisions and recommendations based on the system analysis findings presented herein.

Factors associated with the implementation of community-based peer-led health promotion programs: A scoping review.

PubMed

Lorthios-Guilledroit, Agathe; Richard, Lucie; Filiatrault, Johanne

2018-06-01

Peer education is growing in popularity as a useful health promotion strategy. However, optimal conditions for implementing peer-led health promotion programs (HPPs) remain unclear. This scoping review aimed to describe factors that can influence implementation of peer-led HPPs targeting adult populations. Five databases were searched using the keywords "health promotion/prevention", "implementation", "peers", and related terms. Studies were included if they reported at least one factor associated with the implementation of community-based peer-led HPPs. Fifty-five studies were selected for the analysis. The method known as "best fit framework synthesis" was used to analyze the factors identified in the selected papers. Many factors included in existing implementation conceptual frameworks were deemed applicable to peer-led HPPs. However, other factors related to individuals, programs, and implementation context also emerged from the analysis. Based on this synthesis, an adapted theoretical framework was elaborated, grounded in a complex adaptive system perspective and specifying potential mechanisms through which factors may influence implementation of community-based peer-led HPPs. Further research is needed to test the theoretical framework against empirical data. Findings from this scoping review increase our knowledge of the optimal conditions for implementing peer-led HPPs and thereby maximizing the benefits of such programs. Copyright © 2018 Elsevier Ltd. All rights reserved.

Lay health workers perceptions of an anemia control intervention in Karnataka, India: a qualitative study.

PubMed

Shet, Arun S; Rao, Abha; Jebaraj, Paul; Mascarenhas, Maya; Zwarenstein, Merrick; Galanti, Maria Rosaria; Atkins, Salla

2017-09-18

Lay health workers (LHWs) are increasingly used to complement health services internationally. Their perceptions of the interventions they implement and their experiences in delivering community based interventions in India have been infrequently studied. We developed a novel LHW led intervention to improve anemia cure rates in rural community dwelling children attending village day care centers in South India. Since the intervention is delivered by the village day care center LHW, we sought to understand participating LHWs' acceptance of and perspectives regarding the intervention, particularly in relation to factors affecting daily implementation. We conducted a qualitative study alongside a cluster randomized controlled trial evaluating a complex community intervention for childhood anemia control in Karnataka, South India. Focus group discussions (FGDs) were conducted with trained LHWs assigned to deliver the educational intervention. These were complemented by non-participant observations of LHWs delivering the intervention. Transcripts of the FGDs were translated and analyzed using the framework analysis method. Several factors made the intervention acceptable to the LHWs and facilitated its implementation including pre-implementation training modules, intervention simplicity, and ability to incorporate the intervention into the routine work schedule. LHWs felt that the intervention impacted negatively on their preexisting workload. Fluctuating relationships with mothers weakened the LHWs position as providers of the intervention and hampered efficient implementation, despite the LHWs' highly valued position in the community. Modifiable barriers to the successful implementation of this intervention were seen at two levels. At a broader contextual level, hindering factors included the LHW being overburdened, inadequately reimbursed, and receiving insufficient employer support. At the health system level, lack of streamlining of LHW duties, inability of LHWs to diagnose anemia and temporary shortfalls in the availability of iron supplements constituted potentially modifiable barriers. This qualitative study identified some of the practical challenges as experienced by LHWs while delivering a community health intervention in India. Methodologically, it highlights the value of qualitative research in understanding implementation of complex community interventions. On the contextual level, the results indicate that efficient delivery of community interventions will require streamlining of LHW workloads and improved health system infrastructure support. This trial was registered with ISRCTN.com (identifier: ISRCTN68413407 ) on 23 September 2013.

Implementation of Quality by Design for Formulation of Rebamipide Gastro-retentive Tablet.

PubMed

Ha, Jung-Myung; Seo, Jeong-Woong; Kim, Su-Hyeon; Kim, Ju-Young; Park, Chun-Woong; Rhee, Yun-Seok; Park, Eun-Seok

2017-11-01

The purpose of the present study was to develop a rebamipide (RBM) gastro-retentive (GR) tablet by implementing quality by design (QbD). RBM GR tablets were prepared using a sublimation method. Quality target product profile (QTPP) and critical quality attributes (CQAs) of the RBM GR tablets were defined according to the preliminary studies. Factors affecting the CQAs were prioritized using failure mode and effects analysis (FMEA). Design space and optimum formulation were established through a mixture design. The validity of the design space was confirmed using runs within the area. The QTPP of the RBM GR tablets was the orally administered GR tablet containing 300 mg of RBM taken once daily. Based on the QTPP, dissolution rate, tablet friability, and floating property were chosen as CQAs. According to the risk assessment, the amount of sustained-release agent, sublimating material, and diluent showed high-risk priority number (RPN) values above 40. Based on the RPN, these factors were further investigated using mixture design methodology. Design space of formulations was depicted as an overlaid contour plot and the optimum formulation to satisfy the desired responses was obtained by determining the expected value of each response. The similarity factor (f2) of the release profile between predicted response and experimental response was 89.463, suggesting that two release profiles are similar. The validity of the design space was also confirmed. Consequently, we were able to develop the RBM GR tablets by implementing the QbD concept. These results provide useful information for development of tablet formulations using the QbD.

Evaluating the impact of equity focused health impact assessment on health service planning: three case studies.

PubMed

Harris-Roxas, Ben; Haigh, Fiona; Travaglia, Joanne; Kemp, Lynn

2014-09-05

Health impact assessment has been identified internationally as a mechanism to ensure potential health impacts and health equity impacts of proposals are considered before implementation. This paper looks at the impact of three equity focused health impact assessments (EFHIAs) of health service plans on subsequent decision-making and implementation, and then utilises these findings to test and refine an existing conceptual framework for evaluating the impact and effectiveness of health impact assessments for use in relation to EFHIAs. Case study analysis of three EFHIAs conducted on health sector plans in New South Wales, Australia. Data was drawn from 14 semi-structured interviews and the analysis of seven related documents (draft plans and EFHIA reports). The case studies showed that the EFHIAs all had some impact on the decision-making about the plans and their implementation, most clearly in relation to participants' understandings of equity and in the development of options for modifying service plans to ensure this was addressed. The timing of the EFHIA and individual responses to the EFHIA process and its recommendations were identified as critical factors influencing the impact of the EFHIAs. Several modifications to the conceptual framework are identified, principally adding factors to recognise the role individuals play in influencing the impact and effectiveness of EFHIAs. EFHIA has the potential to improve the consideration of health equity in health service planning processes, though a number of contextual and individual factors affect this. Current approaches can be strengthened by taking into account personal and organisational responses to the EFHIA process.

Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region

PubMed Central

Odekunle, Florence Femi; Odekunle, Raphael Oluseun; Shankar, Srinivasan

2017-01-01

Poor health information system has been identified as a major challenge in the health-care system in many developing countries including sub-Saharan African countries. Electronic health record (EHR) has been shown as an important tool to improve access to patient information with attendance improved quality of care. However, EHR has not been widely implemented/adopted in sub-Saharan Africa. This study sought to identify factors that affect the adoption of an EHR in sub-Saharan Africa and strategies to improve its adoption in this region. A comprehensive literature search was conducted on three electronic databases: PubMed, Medline, and Google Scholar. Articles of interest were those published in English that contained information on factors that limit the adoption of an EHR as well as strategies that improve its adoption in sub-Saharan African countries. The available evidence indicated that there were many factors that hindered the widespread adoption of an EHR in sub-Saharan Africa. These were high costs of procurement and maintenance of the EHR system, lack of financial incentives and priorities, poor electricity supply and internet connectivity, and primary user’s limited computer skills. However, strategies such as implementation planning, financial supports, appropriate EHR system selection, training of primary users, and the adoption of the phased implementation process have been identified to facilitate the use of an EHR. Wide adoption of an EHR in sub-Saharan Africa region requires a lot more effort than what is assumed because of the current poor level of technological development, lack of required computer skills, and limited resources. PMID:29085270

Clinical observations of a Cantonese cognitive-behavioral treatment program for Chinese immigrants.

PubMed

Shen, Edward K; Alden, Lynn E; Söchting, Ingrid; Tsang, Pheobe

2006-01-01

In this article, the authors describe our clinical observations about the process of delivering a Cantonese-language cognitive- behavioral therapy program to treat depression in Hong Kong immigrants to Vancouver, Canada. Our experiences indicated that standard referral and assessment procedures were not optimal for this population. Other factors that required consideration were how to convert Cantonese terms for dysphoric affect into English equivalents and how to implement cognitive modification strategies when dealing with culture-syntonic beliefs about social relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Do large-scale hospital- and system-wide interventions improve patient outcomes: a systematic review.

PubMed

Clay-Williams, Robyn; Nosrati, Hadis; Cunningham, Frances C; Hillman, Kenneth; Braithwaite, Jeffrey

2014-09-03

While health care services are beginning to implement system-wide patient safety interventions, evidence on the efficacy of these interventions is sparse. We know that uptake can be variable, but we do not know the factors that affect uptake or how the interventions establish change and, in particular, whether they influence patient outcomes. We conducted a systematic review to identify how organisational and cultural factors mediate or are mediated by hospital-wide interventions, and to assess the effects of those factors on patient outcomes. A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches were conducted using MEDLINE from 1946, CINAHL from 1991, EMBASE from 1947, Web of Science from 1934, PsycINFO from 1967, and Global Health from 1910 to September 2012. The Lancet, JAMA, BMJ, BMJ Quality and Safety, The New England Journal of Medicine and Implementation Science were also hand searched for relevant studies published over the last 5 years. Eligible studies were required to focus on organisational determinants of hospital- and system-wide interventions, and to provide patient outcome data before and after implementation of the intervention. Empirical, peer-reviewed studies reporting randomised and non-randomised controlled trials, observational, and controlled before and after studies were included in the review. Six studies met the inclusion criteria. Improved outcomes were observed for studies where outcomes were measured at least two years after the intervention. Associations between organisational factors, intervention success and patient outcomes were undetermined: organisational culture and patient outcomes were rarely measured together, and measures for culture and outcome were not standardised. Common findings show the difficulty of introducing large-scale interventions, and that effective leadership and clinical champions, adequate financial and educational resources, and dedicated promotional activities appear to be common factors in successful system-wide change.The protocol has been registered in the international prospective register of systematic reviews, PROSPERO (Registration No. CRD42103003050).

Applications of Text Messaging, and Bibliotherapy for Treatment of Patients Affected by Depressive Symptoms.

PubMed

Taleban, Roya; Zamani, Ahmadreza; Moafi, Mohammad; Jiryaee, Nasrin; Khadivi, Reza

2016-01-01

Intensity of depressive symptoms could be exacerbated due to the paucity of appropriate treatments. We assessed the effectiveness of bibliotherapy and text messaging, which aimed at amelioration of patient's behavior and consciousness, which could lead to suicide prevention. This was a randomized clinical trial implemented in rural health centers of Isfahan district (Iran). Health centers were assigned in three trials consisting of the booklet, text messaging, and control groups. Each group consisted of 70 patients. Inclusion criteria were being affected by depressive symptom, <18 years, and cell phone accessibility. Mental retardation, drug and alcohol abuse, visual disability, dementia, suicide attempt history, electrotherapy, and receiving psychological interventions were our not met criteria. Our patient outcomes comprised intensity of depressive symptom and treatment compliance. The first two trials were requested to study instructive booklets in 30 days while the second cohort was demanded to study the booklet in accordance with the daily delivered text messaging. Out of 210 individuals, 198 patients finished this study. The intensity of depressive symptom was significantly affected through time and group factors as well as time-group interaction (F = 12.30, P < 0.001). Based on treatment compliance, the interactive effect of group factor and the time factor was statistically significant. It seems that bibliotherapy could efficiently decrease the intensity of depressive symptoms. Nevertheless, in comparison with our booklet trial, the text messaging group achieved neither durable nor significant success; thus, bibliotherapy could be utilized as a complementary methodology aiming depression treatment.

Implementation of health promotion programmes in schools: an approach to understand the influence of contextual factors on the process?

PubMed

Darlington, Emily Joan; Violon, Nolwenn; Jourdan, Didier

2018-01-22

Implementing complex and multi-level public health programmes is challenging in school settings. Discrepancies between expected and actual programme outcomes are often reported. Such discrepancies are due to complex interactions between contextual factors. Contextual factors relate to the setting, the community, in which implementation occurs, the stakeholders involved, and the characteristics of the programme itself. This work uses realist evaluation to understand how contextual factors influence the implementation process, to result in variable programme outcomes. This study focuses on identifying contextual factors, pinpointing combinations of contextual factors, and understanding interactions and effects of such factors and combinations on programme outcomes on different levels of the implementation process. Schools which had participated in a school-based health promotion programme between 2012 and 2015 were included. Two sets of qualitative data were collected: semi-structured interviews with school staff and programme coordinators; and written documents about the actions implemented in a selection of four schools. Quantitative data included 1553 questionnaires targeting pupils aged 8 to 11 in 14 schools to describe the different school contexts. The comparison between what was expected from the programme (programme theory) and the outcomes identified in the field data, showed that some of the mechanisms expected to support the implementation of the programme, did not operate as anticipated (e.g. inclusion of training, initiation by decision-maker). Key factors which influenced the implementation process included, amongst other factors, the mode of introduction of the programme, home/school relationship, leadership of the management team, and the level of delegated power. Five types of interactions between contextual factors were put forward: enabling, hindering, neutral, counterbalancing and moderating effects. Recurrent combinations of factors were identified. Implementation was more challenging in vulnerable schools where school climate was poor. A single programme cannot be suited or introduced in the same manner in every context. However, key recurrent combinations of contextual factors could contribute to the design of implementation patterns, which could provide guidelines and recommendation for grass-root programme implementation.

Barriers and facilitators related to the uptake of four strategies to prevent neonatal early-onset group B haemolytic streptococcus disease: a qualitative study.

PubMed

Kolkman, Diny G E; Fleuren, Margot A H; Wouters, Maurice G A J; de Groot, Christianne J M; Rijnders, Marlies E B

2017-05-09

Actions to prevent early onset disease in neonates are based on different strategies including administering antibiotic prophylaxis during labour in case of 1) maternal GBS colonisation (screening strategy), 2) identified risk factors (risk-based strategy) or 3) a combination of these two conditions (maternal GBS colonisation and identified risk factors: combination strategy and the Dutch guideline). Low adherence to guidelines preventing EOGBS has been reported. Each strategy has drawbacks and clinical outcomes are affected by care providers' and women's adherence. The actual impact of any preventive strategy is the product of efficacy of the strategy and the level of implementation. In order to reduce neonatal death due to EOGBS by developing the optimal guideline, we analysed barriers and facilitators of current used strategies. Focus group and personal interviews with care providers and women were performed. Impeding and enhancing factors in adherence to the preventive strategies were discussed and scored using the Measurement Instrument for Determinants of Innovations (MIDI) and analysed by two independent researchers. Overall, care providers identified 3.6 times more factors that would impede (n = 116) rather than facilitate (n = 32) adherence to the preventive strategies. 28% facilitative factors were reported in relation to the combination strategy and 86% impeding factors in relation to the Dutch guideline. The most preferred strategy was the combination strategy by 74% of the care providers and by 86% of the women. We obtained a detailed understanding of factors that influence adherence to preventive strategies. This insight can be used to develop implementation activities to improve the uptake of new strategies. The trial is registered in the Dutch Trial Register NTR3965 .

Understanding middle managers' influence in implementing patient safety culture.

PubMed

Gutberg, Jennifer; Berta, Whitney

2017-08-22

The past fifteen years have been marked by large-scale change efforts undertaken by healthcare organizations to improve patient safety and patient-centered care. Despite substantial investment of effort and resources, many of these large-scale or "radical change" initiatives, like those in other industries, have enjoyed limited success - with practice and behavioural changes neither fully adopted nor ultimately sustained - which has in large part been ascribed to inadequate implementation efforts. Culture change to "patient safety culture" (PSC) is among these radical change initiatives, where results to date have been mixed at best. This paper responds to calls for research that focus on explicating factors that affect efforts to implement radical change in healthcare contexts, and focuses on PSC as the radical change implementation. Specifically, this paper offers a novel conceptual model based on Organizational Learning Theory to explain the ability of middle managers in healthcare organizations to influence patient safety culture change. We propose that middle managers can capitalize on their unique position between upper and lower levels in the organization and engage in 'ambidextrous' learning that is critical to implementing and sustaining radical change. This organizational learning perspective offers an innovative way of framing the mid-level managers' role, through both explorative and exploitative activities, which further considers the necessary organizational context in which they operate.

Computerized Physician Order Entry

PubMed Central

Khanna, Raman; Yen, Tony

2014-01-01

Computerized physician order entry (CPOE) has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. In practice, however, CPOE affects health care delivery in complex ways, with benefits as well as risks. Every implementation of CPOE is associated with both generally recognized and unique local factors that can facilitate or confound its rollout, and neurohospitalists will often be at the forefront of such rollouts. In this article, we review the literature on CPOE, beginning with definitions and proceeding to comparisons to the standard of care. We then proceed to discuss clinical decision support systems, negative aspects of CPOE, and cultural context of CPOE implementation. Before concluding, we follow the experiences of a Chief Medical Information Officer and neurohospitalist who rolled out a CPOE system at his own health care organization and managed the resulting workflow changes and setbacks. PMID:24381708

Exploiting mAb structure characteristics for a directed QbD implementation in early process development.

PubMed

Karlberg, Micael; von Stosch, Moritz; Glassey, Jarka

2018-03-07

In today's biopharmaceutical industries, the lead time to develop and produce a new monoclonal antibody takes years before it can be launched commercially. The reasons lie in the complexity of the monoclonal antibodies and the need for high product quality to ensure clinical safety which has a significant impact on the process development time. Frameworks such as quality by design are becoming widely used by the pharmaceutical industries as they introduce a systematic approach for building quality into the product. However, full implementation of quality by design has still not been achieved due to attrition mainly from limited risk assessment of product properties as well as the large number of process factors affecting product quality that needs to be investigated during the process development. This has introduced a need for better methods and tools that can be used for early risk assessment and predictions of critical product properties and process factors to enhance process development and reduce costs. In this review, we investigate how the quantitative structure-activity relationships framework can be applied to an existing process development framework such as quality by design in order to increase product understanding based on the protein structure of monoclonal antibodies. Compared to quality by design, where the effect of process parameters on the drug product are explored, quantitative structure-activity relationships gives a reversed perspective which investigates how the protein structure can affect the performance in different unit operations. This provides valuable information that can be used during the early process development of new drug products where limited process understanding is available. Thus, quantitative structure-activity relationships methodology is explored and explained in detail and we investigate the means of directly linking the structural properties of monoclonal antibodies to process data. The resulting information as a decision tool can help to enhance the risk assessment to better aid process development and thereby overcome some of the limitations and challenges present in QbD implementation today.

Optimizing Air Transportation Service to Metroplex Airports. Par 2; Analysis Using the Airline Schedule Optimization Model (ASOM)

NASA Technical Reports Server (NTRS)

Donoue, George; Hoffman, Karla; Sherry, Lance; Ferguson, John; Kara, Abdul Qadar

2010-01-01

The air transportation system is a significant driver of the U.S. economy, providing safe, affordable, and rapid transportation. During the past three decades airspace and airport capacity has not grown in step with demand for air transportation; the failure to increase capacity at the same rate as the growth in demand results in unreliable service and systemic delay. This report describes the results of an analysis of airline strategic decision-making that affects geographic access, economic access, and airline finances, extending the analysis of these factors using historic data (from Part 1 of the report). The Airline Schedule Optimization Model (ASOM) was used to evaluate how exogenous factors (passenger demand, airline operating costs, and airport capacity limits) affect geographic access (markets-served, scheduled flights, aircraft size), economic access (airfares), airline finances (profit), and air transportation efficiency (aircraft size). This analysis captures the impact of the implementation of airport capacity limits, as well as the effect of increased hedged fuel prices, which serve as a proxy for increased costs per flight that might occur if auctions or congestion pricing are imposed; also incorporated are demand elasticity curves based on historical data that provide information about how passenger demand is affected by airfare changes.

Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society.

PubMed

Harden, Cynthia; Tomson, Torbjörn; Gloss, David; Buchhalter, Jeffrey; Cross, J Helen; Donner, Elizabeth; French, Jacqueline A; Gil-Nagel, Anthony; Hesdorffer, Dale C; Smithson, W Henry; Spitz, Mark C; Walczak, Thaddeus S; Sander, Josemir W; Ryvlin, Philippe

2017-04-25

To determine the incidence rates of sudden unexpected death in epilepsy (SUDEP) in different epilepsy populations and address the question of whether risk factors for SUDEP have been identified. Systematic review of evidence; modified Grading Recommendations Assessment, Development, and Evaluation process for developing conclusions; recommendations developed by consensus. Findings for incidence rates based on 12 Class I studies include the following: SUDEP risk in children with epilepsy (aged 0-17 years) is 0.22/1,000 patient-years (95% confidence interval [CI] 0.16-0.31) (moderate confidence in evidence). SUDEP risk increases in adults to 1.2/1,000 patient-years (95% CI 0.64-2.32) (low confidence in evidence). The major risk factor for SUDEP is the occurrence of generalized tonic-clonic seizures (GTCS); the SUDEP risk increases in association with increasing frequency of GTCS occurrence (high confidence in evidence). Level B: Clinicians caring for young children with epilepsy should inform parents/guardians that in 1 year, SUDEP typically affects 1 in 4,500 children; therefore, 4,499 of 4,500 children will not be affected. Clinicians should inform adult patients with epilepsy that SUDEP typically affects 1 in 1,000 adults with epilepsy per year; therefore, annually 999 of 1,000 adults will not be affected. For persons with epilepsy who continue to experience GTCS, clinicians should continue to actively manage epilepsy therapies to reduce seizures and SUDEP risk while incorporating patient preferences and weighing the risks and benefits of any new approach. Clinicians should inform persons with epilepsy that seizure freedom, particularly freedom from GTCS, is strongly associated with decreased SUDEP risk. © 2017 American Academy of Neurology.

Exploring Local Level Factors Shaping the Implementation of a Blended Learning Module for Information and Geospatial Literacy in Ontario

ERIC Educational Resources Information Center

Vine, Michelle M.; Chiappetta-Swanson, Catherine; Maclachlan, John; Brodeur, Jason J.; Bagg, Julianne

2016-01-01

The objectives of this research study were to examine local level factors shaping the implementation of a blended pedagogical approach for geospatial- and information-literacy, and to understand implementer satisfaction. As such, we addressed the following research questions: What local-level factors shape the implementation of the blended…

Making the Connection--Factors Influencing Implementation of Evidence Supported and Non-Evaluated Lifestyle Interventions in Healthcare: A Multiple Case Study

ERIC Educational Resources Information Center

van de Glind, Irene; Heinen, Maud; Geense, Wytske; Mesters, Ilse; Wensing, Michel; van Achterberg, Theo

2015-01-01

Many implementation barriers relate to lifestyle interventions (LIs) being developed by scientists. Exploring whether implementation of non-evaluated LIs is less complicated, might offer insight how to improve the use of effective interventions. This study aimed to identify influencing factors for implementation and compare factors between…

Mediation analysis of alcohol consumption, DNA methylation, and epithelial ovarian cancer.

PubMed

Wu, Dongyan; Yang, Haitao; Winham, Stacey J; Natanzon, Yanina; Koestler, Devin C; Luo, Tiane; Fridley, Brooke L; Goode, Ellen L; Zhang, Yanbo; Cui, Yuehua

2018-03-01

Epigenetic factors and consumption of alcohol, which suppresses DNA methylation, may influence the development and progression of epithelial ovarian cancer (EOC). However, there is a lack of understanding whether these factors interact to affect the EOC risk. In this study, we aimed to gain insight into this relationship by identifying leukocyte-derived DNA methylation markers acting as potential mediators of alcohol-associated EOC. We implemented a causal inference test (CIT) and the VanderWeele and Vansteelandt multiple mediator model to examine CpG sites that mediate the association between alcohol consumption and EOC risk. We modified one step of the CIT by adopting a high-dimensional inference procedure. The data were based on 196 cases and 202 age-matched controls from the Mayo Clinic Ovarian Cancer Case-Control Study. Implementation of the CIT test revealed two CpG sites (cg09358725, cg11016563), which represent potential mediators of the relationship between alcohol consumption and EOC case-control status. Implementation of the VanderWeele and Vansteelandt multiple mediator model further revealed that these two CpGs were the key mediators. Decreased methylation at both CpGs was more common in cases who drank alcohol at the time of enrollment vs. those who did not. cg11016563 resides in TRPC6 which has been previously shown to be overexpressed in EOC. These findings suggest two CpGs may serve as novel biomarkers for EOC susceptibility.

Qualitative analysis of programmatic initiatives to text patients with mobile devices in resource-limited health systems.

PubMed

Garg, Sachin K; Lyles, Courtney R; Ackerman, Sara; Handley, Margaret A; Schillinger, Dean; Gourley, Gato; Aulakh, Veenu; Sarkar, Urmimala

2016-02-06

Text messaging is an affordable, ubiquitous, and expanding mobile communication technology. However, safety net health systems in the United States that provide more care to uninsured and low-income patients may face additional financial and infrastructural challenges in utilizing this technology. Formative evaluations of texting implementation experiences are limited. We interviewed safety net health systems piloting texting initiatives to study facilitators and barriers to real-world implementation. We conducted telephone interviews with various stakeholders who volunteered from each of the eight California-based safety net systems that received external funding to pilot a texting-based program of their choosing to serve a primary care need. We developed a semi-structured interview guide based partly on the Consolidated Framework for Implementation Research (CFIR), which encompasses several domains: the intervention, individuals involved, contextual factors, and implementation process. We inductively and deductively (using CFIR) coded transcripts, and categorized themes into facilitators and barriers. We performed eight interviews (one interview per pilot site). Five sites had no prior texting experience. Sites applied texting for programs related to medication adherence and monitoring, appointment reminders, care coordination, and health education and promotion. No site texted patient-identifying health information, and most sites manually obtained informed consent from each participating patient. Facilitators of implementation included perceived enthusiasm from patients, staff and management belief that texting is patient-centered, and the early identification of potential barriers through peer collaboration among grantees. Navigating government regulations that protect patient privacy and guide the handling of protected health information emerged as a crucial barrier. A related technical challenge in five sites was the labor-intensive tracking and documenting of texting communications due to an inability to integrate texting platforms with electronic health records. Despite enthusiasm for the texting programs from the involved individuals and organizations, inadequate data management capabilities and unclear privacy and security regulations for mobile health technology slowed the initial implementation and limited the clinical use of texting in the safety net and scope of pilots. Future implementation work and research should investigate how different texting platform and intervention designs affect efficacy, as well as explore issues that may affect sustainability and the scalability.

Implementing an Injury Prevention Briefing to aid delivery of key fire safety messages in UK children's centres: qualitative study nested within a multi-centre randomised controlled trial.

PubMed

Beckett, Kate; Goodenough, Trudy; Deave, Toity; Jaeckle, Sally; McDaid, Lisa; Benford, Penny; Hayes, Mike; Towner, Elizabeth; Kendrick, Denise

2014-12-10

To improve the translation of public health evidence into practice, there is a need to increase practitioner involvement in initiative development, to place greater emphasis on contextual knowledge, and to address intervention processes and outcomes. Evidence that demonstrates the need to reduce childhood fire-related injuries is compelling but its translation into practice is inconsistent and limited. With this knowledge the Keeping Children Safe programme developed an "Injury Prevention Briefing (IPB)" using a 7 step process to combine scientific evidence with practitioner contextual knowledge. The IPB was designed specifically for children's centres (CCs) to support delivery of key fire safety messages to parents. This paper reports the findings of a nested qualitative study within a clustered randomised controlled trial of the IPB, in which staff described their experiences of IPB implementation to aid understanding of why or how the intervention worked. Interviews were conducted with key staff at 24 CCs participating in the two intervention arms: 1) IPB supplemented by initial training and regular facilitation; 2) IPB sent by post with no facilitation. Framework Analysis was applied to these interview data to explore intervention adherence including; exposure or dose; quality of delivery; participant responsiveness; programme differentiation; and staff experience of IPB implementation. This included barriers, facilitators and suggested improvements. 83% of CCs regarded the IPB as a simple, accessible tool which raised awareness, and stimulated discussion and behaviour change. 15 CCs suggested minor modifications to format and content. Four levels of implementation were identified according to content, frequency, duration and coverage. Most CCs (75%) achieved 'extended' or 'essential' IPB implementation. Three universal factors affected all CCs: organisational change and resourcing; working with hard to engage groups; additional demands of participating in a research study. Six specific factors were associated with the implementation level achieved: staff engagement and training; staff continuity; adaptability and flexibility; other agency support; conflicting priorities; facilitation. CCs achieving high implementation levels increased from 58% (no facilitation) to 92% with facilitation. Incorporating service provider perspectives and scientific evidence into health education initiatives enhances potential for successful implementation, particularly when supplemented by ongoing training and facilitation.

Understanding key factors affecting electronic medical record implementation: a sociotechnical approach.

PubMed

Cucciniello, Maria; Lapsley, Irvine; Nasi, Greta; Pagliari, Claudia

2015-07-17

Recent health care policies have supported the adoption of Information and Communication Technologies (ICT) but examples of failed ICT projects in this sector have highlighted the need for a greater understanding of the processes used to implement such innovations in complex organizations. This study examined the interaction of sociological and technological factors in the implementation of an Electronic Medical Record (EMR) system by a major national hospital. It aimed to obtain insights for managers planning such projects in the future and to examine the usefulness of Actor Network Theory (ANT) as a research tool in this context. Case study using documentary analysis, interviews and observations. Qualitative thematic analysis drawing on ANT. Qualitative analyses revealed a complex network of interactions between organizational stakeholders and technology that helped to shape the system and influence its acceptance and adoption. The EMR clearly emerged as a central 'actor' within this network. The results illustrate how important it is to plan innovative and complex information systems with reference to (i) the expressed needs and involvement of different actors, starting from the initial introductory phase; (ii) promoting commitment to the system and adopting a participative approach; (iii) defining and resourcing new roles within the organization capable of supporting and sustaining the change and (iv) assessing system impacts in order to mobilize the network around a common goal. The paper highlights the organizational, cultural, technological, and financial considerations that should be taken into account when planning strategies for the implementation of EMR systems in hospital settings. It also demonstrates how ANT may be usefully deployed in evaluating such projects.

Designing and implementing an authentic science research program

NASA Astrophysics Data System (ADS)

Rosvally, Harry Edward, Jr.

Science research programs have become a popular elective course in high schools around the country. As the popularity of these programs grows, school districts need a guide by which to implement science research in their own schools. This study sought to provide this information by answering the following questions: (1) What are the most important features in existing research program models? (2) How do schools that have an existing research program define "success"? (3) How do different factors (i.e., budget, professional development, scheduling, recruitment effort, curriculum, and mentors) affect the scope and implementation of a research program? (4) Which features and factors support inclusiveness as a goal for a research program? (5) What kinds of indicators are appropriate for assessing the progress toward an inclusive science research program? After reviewing the literature, six sites with existing research programs were selected for participation in the study. Interviews with teachers and students were conducted during site visits. Interviews with mentors were conducted by telephone. Although the six models in this study were different from one another, there were common characteristics. Students conducted their own review of the literature. Upon completion of the actual research, students published or otherwise communicated their findings to the larger scientific community through regional and national competitions and non-competitive science symposia. This study was also able to identify significant elements that contribute to successful programs. These included: teacher selection; budget requirements; mentor qualities; recruitment and retention practices; and overall structure. As a result of the findings during the research, this study makes recommendations for the successful implementation of a research program.

Health innovation for patient safety improvement.

PubMed

Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

2013-01-01

Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.

Appreciative Inquiry for quality improvement in primary care practices.

PubMed

Ruhe, Mary C; Bobiak, Sarah N; Litaker, David; Carter, Caroline A; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen J; Weyer, Sharon M; Werner, James J; Fry, Ronald E; Stange, Kurt C

2011-01-01

To test the effect of an Appreciative Inquiry (AI) quality improvement strategy on clinical quality management and practice development outcomes. Appreciative inquiry enables the discovery of shared motivations, envisioning a transformed future, and learning around the implementation of a change process. Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical-record review assessed change in PSD rates. Ethnographic field notes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. The PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives, and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited 1 or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective.

Appreciative Inquiry for Quality Improvement in Primary Care Practices

PubMed Central

Ruhe, Mary C.; Bobiak, Sarah N.; Litaker, David; Carter, Caroline A.; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen; Weyer, Sharon M.; Werner, James J.; Fry, Ronald E.; Stange, Kurt C.

2014-01-01

Purpose To test the effect of an Appreciative Inquiry (AI) quality improvement strategy, on clinical quality management and practice development outcomes. AI enables discovery of shared motivations, envisioning a transformed future, and learning around implementation of a change process. Methods Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical record review assessed change in PSD rates. Ethnographic fieldnotes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. Results PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited one or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. Conclusions An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective. PMID:21192206

Understanding Housing Delays and Relocations Within the Housing First Model.

PubMed

Zerger, Suzanne; Pridham, Katherine Francombe; Jeyaratnam, Jeyagobi; Hwang, Stephen W; O'Campo, Patricia; Kohli, Jaipreet; Stergiopoulos, Vicky

2016-01-01

This study explores factors contributing to delays and relocations during the implementation of the Housing First model in Toronto, Ontario. While interruptions in housing tenure are expected en route to recovery and housing stability, consumer and service provider views on finding and keeping housing remain largely unknown. In-person interviews and focus groups were conducted with 48 study participants, including 23 case managers or housing workers and 25 consumers. The following three factors contributed to housing delays and transfers: (1) the effectiveness of communication and collaboration among consumers and service providers, (2) consumer-driven preferences and ambivalence, and (3) provider prioritization of consumer choice over immediate housing access. Two strategies--targeted communications and consumer engagement in housing searches--supported the housing process. Several factors affect the timing and stability of housing. Communication between and among providers and consumers, and a shared understanding of consumer choice, can further support choice and recovery.

Factors affecting private forest landowner interest in ecosystem management: linking spatial and survey data.

PubMed

Jacobson, Michael G

2002-10-01

Many factors influence forest landowner management decisions. This study examines landowner decisions regarding participation in ecosystem management activities, such as a landscape corridor cutting across their private lands. Landscape corridors are recognized worldwide as an important tool in biodiversity conservation. For ecosystem management activities to occur in areas dominated by a multitude of small private forest landholdings, landowner participation and cooperation is necessary. Data from a survey of landowners combined with an analysis of their land's spatial attributes is used to assess their interest in ecosystem management. Results suggest that spatial attributes are not good predictors of an owner's interest in ecosystem management. Other factors such as attitudes and opinions about the environment are more effective in explaining landowner interest. The results have implications for any land manager using GIS data and implementing ecosystem management activities on private forestland.

Employees' Motivation for SPI: Case Study in a Small Finnish Software Company

NASA Astrophysics Data System (ADS)

Valtanen, Anu; Sihvonen, Hanna-Miina

In small software companies the resources available for SPI are often limited. With limited resources, the motivation of the employees becomes one of the key factors for SPI. In this article, the motivational factors affecting a small company's SPI efforts are discussed. In the research, we carried out interviews and a survey in a small Finnish software company considering the motivation towards SPI. The results are presented here and compared with earlier motivation research. There were differences revealed while comparing the motivating factors of smaller companies to those of larger ones. In large companies the focus seems to be on the business related motivators and in small ones the motivators related to comfortability of work are emphasized. Motivation survey and the interviews proved to be useful tools in planning the future SPI strategy. A lot of valuable information was discovered for planning and implementing the next steps of SPI.

Maintaining gender sensitivity in the family practice: facilitators and barriers.

PubMed

Celik, Halime; Lagro-Janssen, Toine; Klinge, Ineke; van der Weijden, Trudy; Widdershoven, Guy

2009-12-01

This study aims to identify the facilitators and barriers perceived by General Practitioners (GPs) to maintain a gender perspective in family practice. Nine semi-structured interviews were conducted among nine pairs of GPs. The data were analysed by means of deductive content analysis using theory-based methods to generate facilitators and barriers to gender sensitivity. Gender sensitivity in family practice can be influenced by several factors which ultimately determine the extent to which a gender sensitive approach is satisfactorily practiced by GPs in the doctor-patient relationship. Gender awareness, repetition and reminders, motivation triggers and professional guidelines were found to facilitate gender sensitivity. On the other hand, lacking skills and routines, scepticism, heavy workload and the timing of implementation were found to be barriers to gender sensitivity. While the potential effect of each factor affecting gender sensitivity in family practice has been elucidated, the effects of the interplay between these factors still need to be determined.

Interprofessional collaboration within Canadian integrative healthcare clinics: Key components.

PubMed

Gaboury, Isabelle; Bujold, Mathieu; Boon, Heather; Moher, David

2009-09-01

Research shows that interprofessional collaboration has become an important factor in the implementation of effective healthcare models. To date, the literature has not focused on the collaboration between medical doctors and complementary and alternative medicine (CAM) healthcare practitioners, an example of interdisciplinary collaboration called integrative healthcare (IHC). Drawing on in-depth, semi-standardized interviews conducted with 21 practitioners working in Canadian IHC clinics, this paper explored and interpreted how IHC is experienced by those working in Canadian IHC clinics. The interview questions and analysis were guided by the Input, Process, Output conceptual framework drawn from the organizational management theory (McGrath, J. E. (1964). Social psychology: A brief introduction. New York: Holt, Rinehart and Winston.) to study collaboration within teams. We found that constructs contributing to collaboration included practitioners' attitudes and educational background, as well as external factors such as the healthcare system and financial pressures. Major processes affecting collaboration included communication, patient referral and power relationships. These determinants of collaboration were found to result in learning opportunities for practitioners, modified burden of work and ultimately, higher affective commitment toward the clinic. These constructs serve as a guide for further investigation of interprofessional collaboration within an IHC clinic. This exploration of interprofessional collaboration in IHC identified a broad array of key factors associated with interprofessional collaboration. These factors are critical to better understand the functioning of IHC clinics, and provide guidance for creation or maintenance of successful clinics.

How Heterogeneity Affects the Design of Hadoop MapReduce Schedulers: A State-of-the-Art Survey and Challenges.

PubMed

Pandey, Vaibhav; Saini, Poonam

2018-06-01

MapReduce (MR) computing paradigm and its open source implementation Hadoop have become a de facto standard to process big data in a distributed environment. Initially, the Hadoop system was homogeneous in three significant aspects, namely, user, workload, and cluster (hardware). However, with growing variety of MR jobs and inclusion of different configurations of nodes in the existing cluster, heterogeneity has become an essential part of Hadoop systems. The heterogeneity factors adversely affect the performance of a Hadoop scheduler and limit the overall throughput of the system. To overcome this problem, various heterogeneous Hadoop schedulers have been proposed in the literature. Existing survey works in this area mostly cover homogeneous schedulers and classify them on the basis of quality of service parameters they optimize. Hence, there is a need to study the heterogeneous Hadoop schedulers on the basis of various heterogeneity factors considered by them. In this survey article, we first discuss different heterogeneity factors that typically exist in a Hadoop system and then explore various challenges that arise while designing the schedulers in the presence of such heterogeneity. Afterward, we present the comparative study of heterogeneous scheduling algorithms available in the literature and classify them by the previously said heterogeneity factors. Lastly, we investigate different methods and environment used for evaluation of discussed Hadoop schedulers.

Implementation of quality by design approach in manufacturing process optimization of dry granulated, immediate release, coated tablets - a case study.

PubMed

Teżyk, Michał; Jakubowska, Emilia; Milanowski, Bartłomiej; Lulek, Janina

2017-10-01

The aim of this study was to optimize the process of tablets compression and identification of film-coating critical process parameters (CPPs) affecting critical quality attributes (CQAs) using quality by design (QbD) approach. Design of experiment (DOE) and regression methods were employed to investigate hardness, disintegration time, and thickness of uncoated tablets depending on slugging and tableting compression force (CPPs). Plackett-Burman experimental design was applied to identify critical coating process parameters among selected ones that is: drying and preheating time, atomization air pressure, spray rate, air volume, inlet air temperature, and drum pressure that may influence the hardness and disintegration time of coated tablets. As a result of the research, design space was established to facilitate an in-depth understanding of existing relationship between CPPs and CQAs of intermediate product (uncoated tablets). Screening revealed that spray rate and inlet air temperature are two most important factors that affect the hardness of coated tablets. Simultaneously, none of the tested coating factors have influence on disintegration time. The observation was confirmed by conducting film coating of pilot size batches.

Factors Affecting Domestic Water Consumption in Rural Households upon Access to Improved Water Supply: Insights from the Wei River Basin, China

PubMed Central

Fan, Liangxin; Liu, Guobin; Wang, Fei; Geissen, Violette; Ritsema, Coen J.

2013-01-01

Comprehensively understanding water consumption behavior is necessary to design efficient and effective water use strategies. Despite global efforts to identify the factors that affect domestic water consumption, those related to domestic water use in rural regions have not been sufficiently studied, particularly in villages that have gained access to improved water supply. To address this gap, we investigated 247 households in eight villages in the Wei River Basin where three types of improved water supply systems are implemented. Results show that domestic water consumption in liters per capita per day was significantly correlated with water supply pattern and vegetable garden area, and significantly negatively correlated with family size and age of household head. Traditional hygiene habits, use of water appliances, and preference for vegetable gardening remain dominant behaviors in the villages with access to improved water supply. Future studies on rural domestic water consumption should pay more attention to user lifestyles (water appliance usage habits, outdoor water use) and cultural backgrounds (age, education). PMID:23977190

Factors affecting domestic water consumption in rural households upon access to improved water supply: insights from the Wei River Basin, China.

PubMed

Fan, Liangxin; Liu, Guobin; Wang, Fei; Geissen, Violette; Ritsema, Coen J

2013-01-01

Comprehensively understanding water consumption behavior is necessary to design efficient and effective water use strategies. Despite global efforts to identify the factors that affect domestic water consumption, those related to domestic water use in rural regions have not been sufficiently studied, particularly in villages that have gained access to improved water supply. To address this gap, we investigated 247 households in eight villages in the Wei River Basin where three types of improved water supply systems are implemented. Results show that domestic water consumption in liters per capita per day was significantly correlated with water supply pattern and vegetable garden area, and significantly negatively correlated with family size and age of household head. Traditional hygiene habits, use of water appliances, and preference for vegetable gardening remain dominant behaviors in the villages with access to improved water supply. Future studies on rural domestic water consumption should pay more attention to user lifestyles (water appliance usage habits, outdoor water use) and cultural backgrounds (age, education).

Sporting programs for inactive population groups: factors influencing implementation in the organized sports setting.

PubMed

Ooms, Linda; Veenhof, Cindy; Schipper-van Veldhoven, Nicolette; de Bakker, Dinny H

2015-01-01

The organized sports sector has received increased attention as a setting to promote health-enhancing physical activity (HEPA) to the general population. For significant public health impact, it is important that successful HEPA programs are widely adopted, implemented and continued as ongoing practice. The importance of evaluating the context in which programs are implemented has been identified as critical. However, little research has focused on understanding the organized sports implementation context, including factors facilitating and impeding implementation. In this study, the main factors influencing implementation of HEPA programs in the organized sports setting were studied. Fourteen sporting programs in the Netherlands aimed at increasing participation in sports by inactive population groups and funded within the National Action Plan for Sport and Exercise (NAPSE) were investigated. The programs were developed by ten Dutch National Sports Federations (NSFs) and implemented by different sports clubs in the Netherlands over a 3-year implementation period (June 2008-June 2011). The qualitative research component involved yearly face-to-face interviews (i.e. fourteen interviews each year, n = 12 program coordinators) and a group meeting with the program coordinators of the NSFs (n = 8). Cross-case comparisons and thematic analyses were performed to identify and categorize important facilitating and impeding factors respectively. The quantitative research component, used to identify the most important facilitating and impeding factors across all sporting programs, consisted of ranking of factors according to importance by the program coordinators (n = 12). Different factors act during six identified (implementation) phases. When comparing factors across phases, several key learnings were evident. Successful implementation relied, for example, on program design and enthusiastic individuals within sporting organizations. On the other hand, inactive people were hard to reach and participation of sports clubs was not self-evident. The findings were discussed in a broader context. This study adds to the knowledge base concerning the implementation of sporting programs, aimed at inactive people, in the organized sports setting. The main factors facilitating and impeding implementation were identified. The results of this study can be used by sports practitioners and policy makers when developing and implementing HEPA programs in this setting.

[Construction of a structural model about male and female adolescents' alienation, depression, and suicidal thoughts].

PubMed

Lee, Eunsook

2007-06-01

This study was designed to construct a structural model explaining alienation, depression, and suicidal thoughts in male and female adolescents. Data was collected by questionnairs from 204 male and 208 female students selected randomly in high schools in K city. This study found that depression was significantly affected by alienation, and was indirectly affected through alienation by school attachment, peer relationships, and academic performance. Suicidal thoughts were greatly affected by depression, and were directly and indirectly influenced by alienation. It was confirmed that alienation turned out to be a important mediating variable, while it had a effect significant on depression and suicidal thoughts. Also there were significant differences in affecting factors among male and female students. Intervention strategies for preventing alienation, depression and suicidal thoughts should be different according to gender. In addition, specific nursing intervention plans, including parent education and role training programs, fostering of humanistic and achievement-focused educational environment, peer support programs, and individual counselling, need to be developed and implemented to lessen a feeling of alienation from family and school.

Utilization of Services Provided by Village-Based Ethnic Minority Midwives in Vietnam: Lessons From Implementation Research.

PubMed

Doan, Duong Thi Thuy; Mirzoev, Tolib; Nguyen, Canh Chuong; Bui, Ha Thi Thu

Global progress in reducing maternal mortality requires improving access to maternal and child health services for the most vulnerable groups. This article reports results of implementation research that aimed to increase the acceptability of village-based ethnic minority midwives (EMMs) by local communities in Vietnam through implementing an integrated interventions package. The study was carried out in 2 provinces in Vietnam, Dien Bien and Kon Tum. A quasi-experimental survey with pretest/posttest design was adopted, which included 6 months of intervention implementation. The interventions package included introductory "launch" meetings, monthly review meetings at community health centers, and 5-day refresher training for EMMs. A mixed-methods approach was used involving both quantitative and qualitative data. A structured questionnaire was used in the pre- and posttest surveys, complemented by in-depth interviews and focus group discussions with EMMs, relatives of pregnant women, community representatives, and health managers. Introductions of EMMs to their local communities by local authorities and supervision of performance of EMMs contributed to significant increases in utilization of services provided by EMMs, from 58.6% to 87.7%. Key facilitators included information on how to contact EMMs, awareness of services provided by EMMs, and trust in services provided by EMMs. The main barriers to utilization of EMM services, which may affect sustainability of the EMM scheme, were low self-esteem of EMMs and small allowances to EMMs, which also affected the recognition of EMMs in the community. Providing continuous support and integration of EMMs within frontline service provision and ensuring adequate local budget for monthly allowances are the key factors that should allow sustainability of the EMM scheme and continued improvement of access to maternal and child health care among poor ethnic minority people living in mountainous areas in Vietnam.

Measles prevention in adolescents: lessons learnt from implementing a high school catch-up vaccination programme in New South Wales, Australia, 2014–2015

PubMed Central

Seale, Holly; Sheppeard, Vicky; Campbell-Lloyd, Sue

2016-01-01

Introduction In response to a significant increase of measles cases and a high percentage of unvaccinated adolescents in New South Wales, Australia, a measles high school catch-up vaccination programme was implemented between August and December 2014. This study aimed to explore the factors affecting school-based supplementary immunization activities (SIAs) and to inform future SIA and routine school-based vaccination programme implementation and service provision. Methods Focus group analysis was conducted among public health unit (PHU) staff responsible for implementing the SIA catch-up programme. Key areas discussed were pre-programme planning, implementation, resources, consent materials, media activity and future directions for school vaccination programme delivery. Sessions were audio recorded, transcribed verbatim and reviewed. Thematic analysis was conducted to identify the major themes. Results Two independent focus groups with 32 participants were conducted in January 2015. Barriers to the SIA implementation included lead time, consent processes, interagency collaboration, access to the targeted cohort and the impact of introducing a SIA to an already demanding curriculum and school programme immunization schedule. A positive PHU school coordinator rapport and experience of PHU staff facilitated the implementation. Consideration of different approaches for pre-clinic vaccination status checks, student involvement in the vaccination decision, online consent, workforce sharing between health districts and effective programme planning time were identified for improving future SIA implementation. Conclusion Although many barriers to school programme implementation have been identified in this study, with adequate resourcing and lead time, SIAs implemented via a routine school vaccination programme are an appropriate model to target adolescents. PMID:27757258

Development and testing of an implementation strategy for a complex housing intervention: protocol for a mixed methods study.

PubMed

Watson, Dennis P; Young, Jeani; Ahonen, Emily; Xu, Huiping; Henderson, Macey; Shuman, Valery; Tolliver, Randi

2014-10-17

There is currently a lack of scientifically designed and tested implementation strategies. Such strategies are particularly important for highly complex interventions that require coordination between multiple parts to be successful. This paper presents a protocol for the development and testing of an implementation strategy for a complex intervention known as the Housing First model (HFM). Housing First is an evidence-based practice for chronically homeless individuals demonstrated to significantly improve a number of outcomes. Drawing on practices demonstrated to be useful in implementation and e-learning theory, our team is currently adapting a face-to-face implementation strategy so that it can be delivered over a distance. Research activities will be divided between Chicago and Central Indiana, two areas with significantly different barriers to HFM implementation. Ten housing providers (five from Chicago and five from Indiana) will be recruited to conduct an alpha test of each of four e-learning modules as they are developed. Providers will be requested to keep a detailed log of their experience completing the modules and participate in one of two focus groups. After refining the modules based on alpha test results, we will test the strategy among a sample of four housing organizations (two from Chicago and two from Indiana). We will collect and analyze both qualitative and quantitative data from administration and staff. Measures of interest include causal factors affecting implementation, training outcomes, and implementation outcomes. This project is an important first step in the development of an evidence-based implementation strategy to increase scalability and impact of the HFM. The project also has strong potential to increase limited scientific knowledge regarding implementation strategies in general.

[Development of technologies of population health management in Kazakhstan based on an integrated assessment of the combined exposure to environmental factors].

PubMed

Sraubaev, E N; Serik, B

2013-01-01

At present there is overdue necessity of an integral approach to the assessment of health status and the impact of environmental factors on it, in the development of science-based management decisions and programs on improvement of the health status of the population of Kazakhstan and in the increase in life expectancy from the birth and healthy life expectancy. The purpose of the proposed program--improving health and increasing life expectancy from the birth and healthy life expectancy of the population of Kazakhstan. Based on a meta-analysis to justify the target age group in which an implementation of complex of preventive measures will increase both the life expectancy from the birth and healthy life expectancy, to perform a comprehensive health screening for the basic classes of diseases and behavioral characteristics of the target group in the course of a multicentre studies to give a comprehensive hygienic characteristics of the ecological status of the studied regions and to develop the Health Passport of the region, to develop a model of the combined effects of environmental factors on health; to create a theoretical model for the calculation of life expectancy from the birth and healthy life expectancy, taking into account the limits of modifiability of factors that affect them, and justify a comprehensive program of management decisions on modification of factors, to carry out pilot studies on the development and validation technological (managemental) solutions to control modifiable factors that affect life expectancy from the birth and healthy life expectancy.

Understanding clinician attitudes towards implementation of guided self-help cognitive behaviour therapy for those who hear distressing voices: using factor analysis to test normalisation process theory.

PubMed

Hazell, Cassie M; Strauss, Clara; Hayward, Mark; Cavanagh, Kate

2017-07-24

The Normalisation Process Theory (NPT) has been used to understand the implementation of physical health care interventions. The current study aims to apply the NPT model to a secondary mental health context, and test the model using exploratory factor analysis. This study will consider the implementation of a brief cognitive behaviour therapy for psychosis (CBTp) intervention. Mental health clinicians were asked to complete a NPT-based questionnaire on the implementation of a brief CBTp intervention. All clinicians had experience of either working with the target client group or were able to deliver psychological therapies. In total, 201 clinicians completed the questionnaire. The results of the exploratory factor analysis found partial support for the NPT model, as three of the NPT factors were extracted: (1) coherence, (2) cognitive participation, and (3) reflexive monitoring. We did not find support for the fourth NPT factor (collective action). All scales showed strong internal consistency. Secondary analysis of these factors showed clinicians to generally support the implementation of the brief CBTp intervention. This study provides strong evidence for the validity of the three NPT factors extracted. Further research is needed to determine whether participants' level of seniority moderates factor extraction, whether this factor structure can be generalised to other healthcare settings, and whether pre-implementation attitudes predict actual implementation outcomes.

Design and implementation of a micromechanical silicon resonant accelerometer.

PubMed

Huang, Libin; Yang, Hui; Gao, Yang; Zhao, Liye; Liang, Jinxing

2013-11-19

The micromechanical silicon resonant accelerometer has attracted considerable attention in the research and development of high-precision MEMS accelerometers because of its output of quasi-digital signals, high sensitivity, high resolution, wide dynamic range, anti-interference capacity and good stability. Because of the mismatching thermal expansion coefficients of silicon and glass, the micromechanical silicon resonant accelerometer based on the Silicon on Glass (SOG) technique is deeply affected by the temperature during the fabrication, packaging and use processes. The thermal stress caused by temperature changes directly affects the frequency output of the accelerometer. Based on the working principle of the micromechanical resonant accelerometer, a special accelerometer structure that reduces the temperature influence on the accelerometer is designed. The accelerometer can greatly reduce the thermal stress caused by high temperatures in the process of fabrication and packaging. Currently, the closed-loop drive circuit is devised based on a phase-locked loop. The unloaded resonant frequencies of the prototype of the micromechanical silicon resonant accelerometer are approximately 31.4 kHz and 31.5 kHz. The scale factor is 66.24003 Hz/g. The scale factor stability is 14.886 ppm, the scale factor repeatability is 23 ppm, the bias stability is 23 μg, the bias repeatability is 170 μg, and the bias temperature coefficient is 0.0734 Hz/°C.

Exploring the Influence of Nursing Work Environment and Patient Safety Culture on Missed Nursing Care in Korea.

PubMed

Kim, Kyoung-Ja; Yoo, Moon Sook; Seo, Eun Ji

2018-04-20

This study aimed to explore the influence of nurse work environment and patient safety culture in hospital on instances of missed nursing care in South Korea. A cross-sectional design was used, in which a structured questionnaire was administered to 186 nurses working at a tertiary university hospital. Data were analyzed using descriptive statistics, t-test or ANOVA, Pearson correlation and multiple regression analysis. Missed nursing care was found to be correlated with clinical career, nursing work environment and patient safety culture. The regression model explained approximately 30.3 % of missed nursing care. Meanwhile, staffing and resource adequacy (β = -.31, p = .001), nurse manager ability, leadership and support of nurses (β = -.26, p = .004), clinical career (β = -.21, p = .004), and perception on patient safety culture within unit (β = -.19, p = .041) were determined to be influencing factors on missed nursing care. This study has significance as it suggested that missed nursing care is affected by work environment factors within unit. This means that missed nursing care is a unit outcome affected by nurse work environment factors and patient safety culture. Therefore, missed nursing care can be managed through the implementation of interventions that promote a positive nursing work environment and patient safety culture. Copyright © 2018. Published by Elsevier B.V.

Work ability and stress in a bus transportation company in Belo Horizonte, Brazil.

PubMed

Sampaio, Rosana Ferreira; Coelho, Cecília Martins; Barbosa, Fábio Bonfim; Mancini, Marisa Cotta; Parreira, Verônica Franco

2009-01-01

Demographic, occupational and psychosocial characteristics affect the health and occupational performance of workers. The objective of the present study was to elaborate a profile of the work ability and factors that affect it in a bus transportation company in Belo Horizonte, Brazil. The instruments used included a socio-demographic and occupational questionnaire, the Work Ability Index and the Job Stress Scale. Demographic information revealed that 85.7% of the 126 employees of the company were active workers, 98% were males, with an average of 39 years of age (SD= 10) and 79 months working in the company (SD= 68); more than half reported having a low schooling level. In terms of personal habits, 88% were exposed to one or more risk factors, especially a sedentary lifestyle. The average strain value (as a consequence of stress) was 0.78 (SD= 0.2) and 75.3% reported episodes of violence at the workplace. The work ability was good to excellent among 89% of the workers. Results from the logistic regression analysis showed that strain was the only significant variable in relation to the Work Ability Index, (estimated odds ratio of 0.02). The results suggest that psychosocial factors presented the greatest association with work ability, and preventive and/or corrective measures should be implemented.

Workplace stress, job satisfaction, job performance, and turnover intention of health care workers in rural Taiwan.

PubMed

Chao, Ming-Che; Jou, Rong-Chang; Liao, Cing-Chu; Kuo, Chung-Wei

2015-03-01

Workplace stress (WS) has been found to affect job satisfaction (JS), performance, and turnover intentions (TIs) in developed countries, but there is little evidence from other countries and especially rural areas. In rural Taiwan, especially, there is an insufficient health care workforce, and the situation is getting worse. To demonstrate the relationship, we used a cross-sectional structured questionnaire, and data from 344 licensed professionals in 1 rural regional hospital were analyzed using the structural equation model. The results showed that WS had a positive effect on both TI and job performance (JP) but a negative effect on satisfaction. JS did improve performance. For the staff with an external locus of control, stress affected JP and satisfaction significantly. For the staff with lower perceived job characteristics, JS affected performance significantly. The strategies to decrease stress relating to work load, role conflict, family factors, and working environment should be focused and implemented urgently to lower the turnover rate of health care workers in rural Taiwan. © 2013 APJPH.

Using a social-ecological framework to inform the implementation of conservation plans.

PubMed

Guerrero, Angela M; Wilson, Kerrie A

2017-04-01

One of the key determinants of success in biodiversity conservation is how well conservation planning decisions account for the social system in which actions are to be implemented. Understanding elements of how the social and ecological systems interact can help identify opportunities for implementation. Utilizing data from a large-scale conservation initiative in southwestern of Australia, we explored how a social-ecological system framework can be applied to identify how social and ecological factors interact to influence the opportunities for conservation. Using data from semistructured interviews, an online survey, and publicly available data, we developed a conceptual model of the social-ecological system associated with the conservation of the Fitz-Stirling region. We used this model to identify the relevant variables (remnants of vegetation, stakeholder presence, collaboration between stakeholders, and their scale of management) that affect the implementation of conservation actions in the region. We combined measures for these variables to ascertain how areas associated with different levels of ecological importance coincided with areas associated with different levels of stakeholder presence, stakeholder collaboration, and scales of management. We identified areas that could benefit from different implementation strategies, from those suitable for immediate conservation action to areas requiring implementation over the long term to increase on-the-ground capacity and identify mechanisms to incentivize implementation. The application of a social-ecological framework can help conservation planners and practitioners facilitate the integration of ecological and social data to inform the translation of priorities for action into implementation strategies that account for the complexities of conservation problems in a focused way. © 2016 Society for Conservation Biology.

Implementation of Policy, Systems, and Environmental Community-Based Interventions for Cardiovascular Health Through a National Not-for-Profit: A Multiple Case Study.

PubMed

Garney, Whitney R; Szucs, Leigh E; Primm, Kristin; King Hahn, Laura; Garcia, Kristen M; Martin, Emily; McLeroy, Kenneth

2018-05-01

In 2014, the Centers for Disease Control and Prevention funded the American Heart Association to implement policy, systems, and environment-focused strategies targeting access to healthy food and beverages, physical activity, and smoke-free environments. To understand factors affecting implementation and variations in success across sites, evaluators conducted a multiple case study. Based on past literature, community sites were categorized as capacity-building or implementation-ready, for comparison. A sample of six communities were selected using a systematic selection tool. Through site visits, evaluators conducted interviews with program staff and community partners and assessed action plans. Evaluators identified important implications for nationally coordinated community-based prevention programming. Differences in implementation varied by the communities' readiness, with the most notable differences in how they planned activities and defined success. Existing partner relationships (or lack thereof) played a significant role, regardless of the American Heart Association's existing presence within the communities, in the progression of initiatives and the differences observed among phases. Last, goals in capacity-building sites were tied to organizational goals while goals in implementation-ready sites were more incremental with increased community influence and buy-in. Using national organizations as a mechanism to carry out large-scale community-based prevention work is a viable option that provides coordinated, wide-scale implementation without sacrificing a community's priorities or input. In funding future initiatives, the presence of relationships and the time needed to cultivate such relationships should be accounted for in the planning and implementation processes, as well as both local and national expectations.

Gender Differences in Introductory University Physics Performance: The Influence of High School Physics Preparation and Affect

NASA Astrophysics Data System (ADS)

Hazari, Zahra

2006-12-01

The attrition of females studying physics after high school has been a continuing concern for the physics education community. If females are well prepared, feel confident, and do well in introductory college physics, they may be inclined to study physics further. This quantitative study uses HLM to identify factors from high school physics preparation (content, pedagogy, and assessment) and the affective domain that predict female and male performance in introductory college physics. The study includes controls for student demographic and academic background characteristics, and the final dataset consists of 1973 surveys from 54 introductory college physics classes. The results highlight high school physics and affective experiences that differentially predict female and male performance. These experiences include: learning requirements, computer graphing/analysis, long written problems, everyday world examples, community projects cumulative tests/quizzes, father's encouragement, family's belief that science leads to a better career, and the length of time students believe that high school physics would help in university physics. There were also experiences that similarly predict female and male performance. The results paint a dynamic picture of the factors from high school physics and the affective domain that influence the future physics performance of females and males. The implication is that there are many aspects to the teaching of physics in high school that, although widely used and thought to be effective, need reform in their implementation in order to be fully beneficial to females and/or males in college.

Face landmark point tracking using LK pyramid optical flow

NASA Astrophysics Data System (ADS)

Zhang, Gang; Tang, Sikan; Li, Jiaquan

2018-04-01

LK pyramid optical flow is an effective method to implement object tracking in a video. It is used for face landmark point tracking in a video in the paper. The landmark points, i.e. outer corner of left eye, inner corner of left eye, inner corner of right eye, outer corner of right eye, tip of a nose, left corner of mouth, right corner of mouth, are considered. It is in the first frame that the landmark points are marked by hand. For subsequent frames, performance of tracking is analyzed. Two kinds of conditions are considered, i.e. single factors such as normalized case, pose variation and slowly moving, expression variation, illumination variation, occlusion, front face and rapidly moving, pose face and rapidly moving, and combination of the factors such as pose and illumination variation, pose and expression variation, pose variation and occlusion, illumination and expression variation, expression variation and occlusion. Global measures and local ones are introduced to evaluate performance of tracking under different factors or combination of the factors. The global measures contain the number of images aligned successfully, average alignment error, the number of images aligned before failure, and the local ones contain the number of images aligned successfully for components of a face, average alignment error for the components. To testify performance of tracking for face landmark points under different cases, tests are carried out for image sequences gathered by us. Results show that the LK pyramid optical flow method can implement face landmark point tracking under normalized case, expression variation, illumination variation which does not affect facial details, pose variation, and that different factors or combination of the factors have different effect on performance of alignment for different landmark points.

Contextual factors related to implementation of classroom physical activity breaks.

PubMed

Carlson, Jordan A; Engelberg, Jessa K; Cain, Kelli L; Conway, Terry L; Geremia, Carrie; Bonilla, Edith; Kerner, Jon; Sallis, James F

2017-09-01

Brief structured physical activity in the classroom is effective for increasing student physical activity. The present study investigated the association between implementation-related contextual factors and intervention implementation after adoption of a structured classroom physical activity intervention. Six elementary-school districts adopted structured classroom physical activity programs in 2013-2014. Implementation contextual factors and intervention implementation (structured physical activity provided in past week or month, yes/no) were assessed using surveys of 337 classroom teachers from 24 schools. Mixed-effects models accounted for the nested design. Availability of resources (yes/no, ORs = 1.91-2.93) and implementation climate z-scores (ORs = 1.36-1.47) were consistently associated with implementation. Teacher-perceived classroom behavior benefits (OR = 1.29) but not student enjoyment or health benefits, and time (OR = 2.32) and academic (OR = 1.63) barriers but not student cooperation barriers were associated with implementation (all z-scores). Four implementation contextual factor composites had an additive association with implementation (OR = 1.64 for each additional favorable composite). Training and technical assistance alone may not support a large proportion of teachers to implement structured classroom physical activity. In addition to lack of time and interference with academic lessons, school climate related to whether administrators and other teachers were supportive of the intervention were key factors explaining whether teachers implemented the intervention. Evidence-based implementation strategies are needed for effectively communicating the benefits of classroom physical activity on student behavior and improving teacher and administrator climate/attitudes around classroom physical activity.

Factors influencing a problem-based learning implementation: A case study of IT courses

NASA Astrophysics Data System (ADS)

Darus, Norida Muhd; Mohd, Haslina; Baharom, Fauziah; Saip, Mohamed Ali; Puteh, Nurnasran; Marzuki @ Matt, Zaharin; Husain, Mohd Zabidin; Yasin, Azman

2016-08-01

IT students must be trained to work efficiently as teamwork. One of the techniques that can be used to train them is through Problem-Based Learning (PBL) approach. The PBL implementation can be influenced by various factors depending on the ultimate goal of the study. This study is focusing on the IT students' perception of the PBL implementation. The student's perception is important to ensure the successfulness of the PBL implementation. Therefore, it is important to identify the factors that might influence the implementation of PBL of IT courses. This study aims to identify some catalyst factors that may influence the PBL implementation of IT courses. The study involved three (3) main phases: identifying PBL implementation factors, constructing a PBL model, and PBL model validation using statistical analysis. Four main factors are identified: PBL Characteristics, PBL Course Assessment, PBL Practices, and PBL Perception. Based on these four factors, a PBL model is constructed. Then, based on the proposed PBL model, four hypotheses are formulated and analyzed to validate the model. All hypotheses are significantly acceptable. The result shows that the PBL Characteristics and PBL Course Assessment factors are significantly influenced the PBL Practices and indirectly influenced the Students' Perception of the PBL Implementation for IT courses. This PBL model can assist decision makers in enhancing the PBL teaching and learning strategy for IT courses. It is also can be tested to other courses in the future.

Circle Hough transform implementation for dots recognition in braille cells

NASA Astrophysics Data System (ADS)

Jacinto Gómez, Edwar; Montiel Ariza, Holman; Martínez Sarmiento, Fredy Hernán.

2017-02-01

This paper shows a technique based on CHT (Circle Hough Transform) to achieve the optical Braille recognition (OBR). Unlike other papers developed around the same topic, this one is made by using Hough Transform to process the recognition and transcription of Braille cells, proving CHT to be an appropriate technique to go over different non-systematics factors who can affect the process, as the paper type where the text to traduce is placed, some lightning factors, input image resolution and some flaws derived from the capture process, which is realized using a scanner. Tests are performed with a local database using text generated by visual nondisabled people and some transcripts by sightless people; all of this with the support of National Institute for Blind People (INCI for their Spanish acronym) placed in Colombia.

[Ventilator associated pneumonia].

PubMed

Bellani, S; Nesci, M; Celotto, S; Lampati, L; Lucchini, A

2003-04-01

Ventilator associated pneumonia (VAP) is a nosocomial lower respiratory tract infection that ensues in critically ill patients undergoing mechanical ventilation. The reported incidence of VAP varies between 9% and 68% with a mortality ranging between 33% and 71%. Two key factors are implicated in the pathogenesis of VAP: bacterial colonization of the upper digestive-respiratory tract and aspiration of oral secretions into the trachea. Preventive measurements are advocated to reduce the incidence of VAP, such as selective decontamination of the digestive tract (SDD), supraglottic aspiration and positioning. Prompt recognition and treatment of established VAP has also been demostrated to affect outcome. Therefore, the knowledge of risk factors associated with the development of VAP and the implementation of strategies to prevent, diagnose and treat VAP are mainstems in the nursing of mechanically ventilated patients.