scholarly journals Anesthesiology Control Tower—Feasibility Assessment to Support Translation (ACTFAST): Mixed-Methods Study of a Novel Telemedicine-Based Support System for the Operating Room (Preprint)

2018 ◽  
Author(s):  
Teresa Murray-Torres ◽  
Aparna Casarella ◽  
Mara Bollini ◽  
Frances Wallace ◽  
Michael S Avidan ◽  
...  
Keyword(s):  
Support System ◽  
Information Technologies ◽  
Phase 1 ◽  
Usability Testing ◽  
Barriers And Facilitators ◽  
Routine Practice ◽  
Software Components ◽  
Phase 2 ◽  
Feasibility Assessment ◽  
Usability Problems

BACKGROUND Despite efforts to improve patient outcomes, major morbidity and mortality remain common after surgery. Health information technologies that provide decision support for clinicians might improve perioperative and postoperative patient care. Evaluating the usability of these technologies and barriers to their implementation can facilitate their acceptance within health systems. OBJECTIVE This manuscript describes usability testing and refinement of an innovative telemedicine-based clinical support system, the Anesthesiology Control Tower (ACT). It also reports stakeholders’ perceptions of the barriers and facilitators to implementation of the intervention. METHODS Three phases of testing were conducted in an iterative manner. Phase 1 testing employed a think-aloud protocol analysis to identify surface-level usability problems with individual software components of the ACT and its structure. Phase 2 testing involved an extended qualitative and quantitative real-world usability analysis. Phase 3 sought to identify major barriers and facilitators to implementation of the ACT through semistructured interviews with key stakeholders. RESULTS Phase 1 and phase 2 usability testing sessions identified numerous usability problems with the software components of the ACT. The ACT platform was revised in seven iterations in response to these usability concerns. Initial satisfaction with the ACT, as measured by standardized instruments, was below commonly accepted cutoffs for these measures. Satisfaction improved to acceptable levels over the course of revision and testing. A number of barriers to implementation were also identified and addressed during the refinement of the ACT intervention. CONCLUSIONS The ACT model can improve the standard of perioperative anesthesia care. Through our thorough and iterative usability testing process and stakeholder assessment of barriers and facilitators, we enhanced the acceptability of this novel technology and improved our ability to implement this innovation into routine practice. INTERNATIONAL REGISTERED REPOR RR2-10.1186/s40814-018-0233-4

scholarly journals The role of trained champions in sustaining and spreading nutrition care improvements in hospital: qualitative interviews following an implementation study

2021 ◽  
pp. e000281
Author(s):  
Celia Laur ◽  
Jack Bell ◽  
Renata Valaitis ◽  
Sumantra Ray ◽  
Heather Keller
Keyword(s):  
Phase 1 ◽  
Qualitative Interviews ◽  
Audit And Feedback ◽  
Routine Practice ◽  
Phase 2 ◽  
Process Measures ◽  
Link Type ◽  
Nutrition Care ◽  
Registration Number

BackgroundMany patients are already malnourished when admitted to hospital. Barriers and facilitators to nutrition care in hospital have been identified and successful interventions developed; however, few studies have explored how to sustain and spread improvements. The More-2-Eat phase 1 study involved five hospitals across Canada implementing nutrition care improvements, while phase 2 implemented a scalable model using trained champions, audit and feedback, a community of practice with external mentorship and an implementation toolkit in 10 hospitals (four continuing from phase 1). Process measures showed that screening and assessment from phase 1 were sustained for at least 4 years. The objective of this study was to help explain how these nutrition care improvements were sustained and spread by understanding the role of the trained champions, and to confirm and expand on themes identified in phase 1.MethodsSemistructured telephone interviews were conducted with champions from each phase 2 hospital and recordings transcribed verbatim. To explore the champion role, transcripts were deductively coded to the 3C model of Concept, Competence and Capacity. Phase 2 transcripts were also deductively coded to themes identified in phase 1 interviews and focus groups.ResultsTen interviews (n=14 champions) were conducted. To sustain and spread nutrition care improvements, champions needed to understand the Concepts of change management, implementation, adaptation, sustainability and spread in order to embed changes into routine practice. Champions also needed the Competence, including the skills to identify, support and empower new champions, thus sharing the responsibility. Capacity, including time, resources and leadership support, was the most important facilitator for staying engaged, and the most challenging. All themes identified in qualitative interviews in phase 1 were applicable 4 years later and were mentioned by new phase 2 hospitals. There was increased emphasis on audit and feedback, and the need for standardisation to support embedding into current practice.ConclusionTrained local champions were required for implementation. By understanding key concepts, with appropriate and evolving competence and capacity, champions supported sustainability and spread of nutrition care improvements. Understanding the role of champions in supporting implementation, spread and sustainability of nutrition care improvements can help other hospitals when planning for and implementing these improvements.Trial registration numberNCT02800304, NCT03391752.

scholarly journals Challenges and Successes in Raising a Child With Type 1 Diabetes and Autism Spectrum Disorder: Mixed Methods Study

10.2196/17184 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e17184
Author(s):  
Tamara K Oser ◽  
Sean M Oser ◽  
Jessica A Parascando ◽  
Lee Ann Grisolano ◽  
Kanthi Bangalore Krishna ◽  
...  
Keyword(s):  
Health Care ◽  
Autism Spectrum Disorder ◽  
Type 1 Diabetes ◽  
Phase 1 ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Barriers And Facilitators ◽  
Phase 2 ◽  
Web Based

Background Self-management of type 1 diabetes (T1D) requires numerous decisions and actions by people with T1D and their caregivers and poses many daily challenges. For those with T1D and a developmental disorder such as autism spectrum disorder (ASD), more complex challenges arise, though these remain largely unstudied. Objective This study aimed to better understand the barriers and facilitators of raising a child with T1D and ASD. Secondary analysis of web-based content (phase 1) and telephone interviews (phase 2) were conducted to further expand the existing knowledge on the challenges and successes faced by these families. Methods Phase 1 involved a qualitative analysis of publicly available online forums and blog posts by caregivers of children with both T1D and ASD. Themes from phase 1 were used to create an interview guide for further in-depth exploration via interviews. In phase 2, caregivers of children with both T1D and ASD were recruited from Penn State Health endocrinology clinics and through the web from social media posts to T1D-focused groups and sites. Interested respondents were directed to a secure web-based eligibility assessment. Information related to T1D and ASD diagnosis, contact information, and demographics were collected. On the basis of survey responses, participants were selected for a follow-up telephone interview and were asked to complete the adaptive behavior assessment system, third edition parent form to assess autism severity and upload a copy of their child’s most recent hemoglobin A1c (HbA1c) result. Interviews were transcribed, imported into NVivo qualitative data management software, and analyzed to determine common themes related to barriers and facilitators of raising a child with both ASD and T1D. Results For phase 1, 398 forum posts and blog posts between 2009 and 2016 were analyzed. Common themes related to a lack of understanding by the separate ASD and T1D caregiver communities, advice on coping techniques, rules and routines, and descriptions of the health care experience. For phase 2, 12 eligible respondents were interviewed. For interviewees, the average age of the child at diagnosis with T1D and ASD was 7.92 years and 5.55 years, respectively. Average self-reported and documented HbA1c levels for children with T1D and ASD were 8.6% (70 mmol/mol) and 8.7% (72 mmol/mol), respectively. Common themes from the interviews related to increased emotional burden, frustration surrounding the amount of information they are expected to learn, and challenges in the school setting. Conclusions Caregivers of children with both T1D and ASD face unique challenges, distinct from those faced by caregivers of individuals who have either disorder alone. Understanding these challenges may help health care providers in caring for this unique population. Referral to the diabetes online community may be a potential resource to supplement the care received by the medical community.

scholarly journals Contextualised strategies to increase childhood and adolescent vaccination coverage in South Africa: a mixed-methods study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e028476
Author(s):  
Charles Shey Wiysonge ◽  
Phetole Walter Mahasha ◽  
Duduzile Edith Ndwandwe ◽  
Ntombenhle Ngcobo ◽  
Karen Grimmer ◽  
...  
Keyword(s):  
South Africa ◽  
Mixed Methods ◽  
Vaccination Coverage ◽  
Phase 1 ◽  
Barriers And Facilitators ◽  
Phase 2 ◽  
Immunisation Coverage ◽  
Online Questionnaire ◽  
Phase 3 ◽  
Adolescent Vaccination

IntroductionDespite the unparalleled success of immunisation in the control of vaccine preventable diseases, immunisation coverage in South Africa remains suboptimal. While many evidence-based interventions have successfully improved vaccination coverage in other countries, they are not necessarily appropriate to the immunisation needs, barriers and facilitators of South Africa. The aim of this research is to investigate barriers and facilitators to optimal vaccination uptake, and develop contextualised strategies and implementation plans to increase childhood and adolescent vaccination coverage in South Africa.MethodsThe study will employ a mixed-methods research design. It will be conducted over three iterative phases and use the Adopt, Contextualise or Adapt (ACA) model as an overarching conceptual framework. Phase 1 will identify, and develop a sampling frame of, immunisation stakeholders involved in the design, planning and implementation of childhood and human papillomavirus immunisation programmes in South Africa. Phase 2 will identify the main barriers and facilitators to, and solutions for, increasing vaccination coverage. This phase will comprise exploratory qualitative research with stakeholders and a review of existing systematic reviews on interventions for improving vaccination coverage. Using the findings from Phase 2 and the ACA model, Phase 3 will develop a set of proposed interventions and implementation action plans for improving immunisation coverage in South Africa. These plans will be discussed, revised and finalised through a series of participatory stakeholder workshops and an online questionnaire, conducted as part of Phase 3.EthicsEthical approval was obtained from the South African Medical Research Council (EC018-11/2018). No risks to participants are expected. Various steps will be taken to ensure the anonymity and confidentiality of participants.DisseminationThe study findings will be shared at stakeholder workshops, the website of Cochrane South Africa and academic publications and conferences.

scholarly journals Challenges and Successes in Raising a Child With Type 1 Diabetes and Autism Spectrum Disorder: Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Tamara K Oser ◽  
Sean M Oser ◽  
Jessica A Parascando ◽  
Lee Ann Grisolano ◽  
Kanthi Bangalore Krishna ◽  
...  
Keyword(s):  
Health Care ◽  
Autism Spectrum Disorder ◽  
Type 1 Diabetes ◽  
Phase 1 ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Barriers And Facilitators ◽  
Phase 2 ◽  
Web Based

BACKGROUND Self-management of type 1 diabetes (T1D) requires numerous decisions and actions by people with T1D and their caregivers and poses many daily challenges. For those with T1D and a developmental disorder such as autism spectrum disorder (ASD), more complex challenges arise, though these remain largely unstudied. OBJECTIVE This study aimed to better understand the barriers and facilitators of raising a child with T1D and ASD. Secondary analysis of web-based content (phase 1) and telephone interviews (phase 2) were conducted to further expand the existing knowledge on the challenges and successes faced by these families. METHODS Phase 1 involved a qualitative analysis of publicly available online forums and blog posts by caregivers of children with both T1D and ASD. Themes from phase 1 were used to create an interview guide for further in-depth exploration via interviews. In phase 2, caregivers of children with both T1D and ASD were recruited from Penn State Health endocrinology clinics and through the web from social media posts to T1D-focused groups and sites. Interested respondents were directed to a secure web-based eligibility assessment. Information related to T1D and ASD diagnosis, contact information, and demographics were collected. On the basis of survey responses, participants were selected for a follow-up telephone interview and were asked to complete the adaptive behavior assessment system, third edition parent form to assess autism severity and upload a copy of their child’s most recent hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) result. Interviews were transcribed, imported into NVivo qualitative data management software, and analyzed to determine common themes related to barriers and facilitators of raising a child with both ASD and T1D. RESULTS For phase 1, 398 forum posts and blog posts between 2009 and 2016 were analyzed. Common themes related to a lack of understanding by the separate ASD and T1D caregiver communities, advice on coping techniques, rules and routines, and descriptions of the health care experience. For phase 2, 12 eligible respondents were interviewed. For interviewees, the average age of the child at diagnosis with T1D and ASD was 7.92 years and 5.55 years, respectively. Average self-reported and documented HbA<sub>1c</sub> levels for children with T1D and ASD were 8.6% (70 mmol/mol) and 8.7% (72 mmol/mol), respectively. Common themes from the interviews related to increased emotional burden, frustration surrounding the amount of information they are expected to learn, and challenges in the school setting. CONCLUSIONS Caregivers of children with both T1D and ASD face unique challenges, distinct from those faced by caregivers of individuals who have either disorder alone. Understanding these challenges may help health care providers in caring for this unique population. Referral to the diabetes online community may be a potential resource to supplement the care received by the medical community. CLINICALTRIAL

scholarly journals Development and usability testing of OSI: Online Support and Intervention for child anxiety (Preprint)

2021 ◽  
Author(s):  
Claire Hill ◽  
Tessa Reardon ◽  
Lucy Taylor ◽  
Cathy Creswell
Keyword(s):  
Phase 1 ◽  
Child Anxiety ◽  
Usability Testing ◽  
Online Support ◽  
Evidence Based ◽  
User Engagement ◽  
Phase 2 ◽  
Structured Interviews ◽  
Face To Face ◽  
Online Treatment

BACKGROUND Online treatments for child anxiety may help increase access to evidence-based therapies, however user engagement, uptake and adherence within routine clinical practice remains a challenge. Involving the intended end users in the development process through co-design and usability testing is argued to be crucial for maximising user engagement and adoption of online treatments, but so far this has been lacking for online treatments for child anxiety. OBJECTIVE To develop an online treatment for child anxiety through a process of co-design (Phase 1) and usability testing (Phase 2), based on an existing evidence-based face-to-face therapist-supported, parent-led CBT intervention. It was intended that the online version of this treatment would consist of a parent website, case management system for clinicians and mobile game application for children. METHODS Parents, children and clinicians who were familiar with the face-to-face version of the treatment were recruited from 2 NHS clinics. In Phase 1, participants took part in 3 workshops to gain feedback on the overall concept, explore their wants and needs for the websites/game, generate ideas on how the treatment may look and gain feedback on initial mock-ups of the websites/game. In Phase 2, participants attended 3 individual usability testing sessions where they were presented with working prototypes of the websites/game and asked to carry out a series of tasks on the website (parents/clinicians) or play the game (children). The frequency and detail of usability errors was recorded. Participants were asked for their feedback on the website/game using a standardised usability questionnaire and semi-structured interviews. The websites/game were iterated after each round of usability testing in response to this feedback. RESULTS In Phase 1, participants approved the general concept and rated the initial mock-ups of the website/game positively. In Phase 2, working prototypes were rated positively and usability errors declined across the iterations and were mainly cosmetic or minor issues relating to aesthetic preference, with few issues regarding ability to navigate the website or technical issues affecting functionality. Feedback from the semi-structured interviews further supported the positive response of participants to the website/game and helped identify areas for improvement during the iteration process. The final iteration of the website/game is presented. CONCLUSIONS Taking an iterative approach to development through co-design and usability testing has resulted in an online treatment for child anxiety (OSI: Online Support and Intervention for child anxiety) that appears to meet the needs and expectations of the intended users (parents, children and clinicians), and is easy and enjoyable to use.

Exploring Empathy and Compassion Using Digital Narratives (the Learning to Care project): A Study Protocol (Preprint)

2021 ◽  
Author(s):  
Manuela Ferrari ◽  
Sahar Fazeli ◽  
Claudia Mitchell ◽  
Jai Shah ◽  
Srividya Iyer
Keyword(s):  
Mental Illness ◽  
Social Marketing ◽  
Controlled Trial ◽  
Phase 1 ◽  
Practical Importance ◽  
Government Agencies ◽  
Phase 2 ◽  
Feasibility Assessment ◽  
Digital Stories ◽  
Digital Narratives

BACKGROUND Digital stories – first-person, self-made, 2-3-minute videos – generate awareness, impart knowledge, and promote understanding around topics like mental illness. Digital stories are a narrative-based art form often created by individuals without formal training in filmmaking to relate personal experiences. Somewhat like digital narratives, video testimonies created within the social marketing or fundraising campaigns of government agencies and private or public corporations aim to reduce the stigma of mental illness while supporting research and services. In video testimonies personal stories are captured on camera by professional filmmakers. Sharing critical life events greatly benefits tellers and listeners alike, supporting catharsis, healing, connectiveness, and citizenship. OBJECTIVE The proposed study explores digital stories and video testimonies featuring mental illness and recovery in their ability to elicit empathy and compassion while reducing stigma among viewers. METHODS Using mixed methods, Phase 1 will involve a search of Canadian social marketing activities and fundraising campaigns concerning mental illness and recovery while organizing digital storytelling workshops in which participants create digital stories about their own experiences of mental illness and recovery. During Phase 2, a pilot randomized controlled trial will be undertaken to compare marketing and fundraising campaigns versus digital stories for their impact on viewers. RESULTS Ethics approval was received in March 2021.Data on feasibility of the study design and results of the controlled trial will be generated. This study will produce new knowledge on effective ways of promoting mental health awareness and decreasing stigma with practical importance for future social marketing and fundraising campaigns. Anticipated time to completion within the two-year study period includes nine months for Phase 1 (preparation), eleven months for Phase 2 (feasibility assessment and data collection: RCT) and two months for Phase 3 (knowledge dissemination). CONCLUSIONS The knowledge generated will have practical implications for the public and for future social marketing and fundraising campaigns promoted by government agencies as well as non-profit and for-profit organizations by enhancing our understanding of how individuals and societies respond to stories of suffering and what prompts citizens to help others. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT04881084

The Training Development Decision Support System: An Aid to the Design of Cost-Effective Training Programs

1983 ◽  
Vol 27 (5) ◽  
pp. 397-401 ◽  
Author(s):  
John K. Hawley ◽  
Edward W. Frederickson
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Training Program ◽  
Support System ◽  
Phase 1 ◽  
Evaluation Procedure ◽  
Phase 2 ◽  
Trade Off ◽  
Training Development ◽  
Evaluation Phase

The Training Development Decision Support System (TDDSS) is a computer-aided training development and evaluation procedure designed to support the conduct of the instructional systems design process. Training program development using TDDSS is conducted in two phases: (1) Training Design and (2) Training Evaluation. Phase 1 is carried out in three steps: Job Function Analysis, Task Analysis, and Learning Requirements Analysis. The product of Phase 1 is a series of viable Training Program Alternatives (TPAs). In Phase 2, a cost-benefit trade-off analysis is performed on the TPAs. The benefits assessment portion of the trade-off analysis is based upon the use of a flexible multiattribute utility measurement procedure. Resource requirements and associated cost estimates for each TPA also are produced during Phase 2. Following the completion of both analyses—benefits assessment and cost estimation—training program merit and cost indices are integrated leading to the identification of a preferred TPA.

Rationalization and internalization

2001 ◽  
Vol 60 (4) ◽  
pp. 215-230 ◽  
Author(s):  
Jean-Léon Beauvois
Keyword(s):  
Phase 1 ◽  
Facilitatory Effect ◽  
Phase 2 ◽  
Causal Explanations ◽  
Reduction Effect ◽  
Dissonance Reduction

After having been told they were free to accept or refuse, pupils aged 6–7 and 10–11 (tested individually) were led to agree to taste a soup that looked disgusting (phase 1: initial counter-motivational obligation). Before tasting the soup, they had to state what they thought about it. A week later, they were asked whether they wanted to try out some new needles that had supposedly been invented to make vaccinations less painful. Agreement or refusal to try was noted, along with the size of the needle chosen in case of agreement (phase 2: act generalization). The main findings included (1) a strong dissonance reduction effect in phase 1, especially for the younger children (rationalization), (2) a generalization effect in phase 2 (foot-in-the-door effect), and (3) a facilitatory effect on generalization of internal causal explanations about the initial agreement. The results are discussed in relation to the distinction between rationalization and internalization.

PENERAPAN MODEL QUANTUM LEARNING UNTUK MENINGKATKAN HASIL BELAJAR AUTOCAD SISWA KELAS X TEKNIK PEMESINAN SMK NEGERI 1 STABAT

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Abdul Hasan Saragih
Keyword(s):  
Positive Response ◽  
Phase 1 ◽  
First Grade ◽  
Learning Model ◽  
Second Phase ◽  
Phase 2 ◽  
Phase 3 ◽  
The Third ◽  
Third Phase ◽  
Quantum Learning

This classroom research was conducted on the autocad instructions to the first grade of mechinary class of SMK Negeri 1 Stabat aiming at : (1) improving the student’ archievementon autocad instructional to the student of mechinary architecture class of SMK Negeri 1 Stabat, (2) applying Quantum Learning Model to the students of mechinary class of SMK Negeri 1 Stabat, arising the positive response to autocad subject by applying Quantum Learning Model of the students of mechinary class of SMK Negeri 1 Stabat. The result shows that (1) by applying quantum learning model, the students’ achievement improves significantly. The improvement ofthe achievement of the 34 students is very satisfactory; on the first phase, 27 students passed (70.59%), 10 students failed (29.41%). On the second phase 27 students (79.41%) passed and 7 students (20.59%) failed. On the third phase 30 students (88.24%) passed and 4 students (11.76%) failed. The application of quantum learning model in SMK Negeri 1 Stabat proved satisfying. This was visible from the activeness of the students from phase 1 to 3. The activeness average of the students was 74.31% on phase 1,81.35% on phase 2, and 83.63% on phase 3. (3) The application of the quantum learning model on teaching autocad was very positively welcome by the students of mechinary class of SMK Negeri 1 Stabat. On phase 1 the improvement was 81.53% . It improved to 86.15% on phase 3. Therefore, The improvement ofstudent’ response can be categorized good.

In situ deteriorating patient simulation in general practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711425
Author(s):  
Joanna Lawrence ◽  
Petronelle Eastwick-Field ◽  
Anne Maloney ◽  
Helen Higham
Keyword(s):  
Life Support ◽  
Early Recognition ◽  
Phase 1 ◽  
Patient Simulation ◽  
Medical Emergency ◽  
Phase 2 ◽  
Action Plans ◽  
Integrated Simulation ◽  
Deteriorating Patient

BackgroundGP practices have limited access to medical emergency training and basic life support is often taught out of context as a skills-based event.AimTo develop and evaluate a whole team integrated simulation-based education, to enhance learning, change behaviours and provide safer care.MethodPhase 1: 10 practices piloted a 3-hour programme delivering 40 minutes BLS and AED skills and 2-hour deteriorating patient simulation. Three scenarios where developed: adult chest pain, child anaphylaxis and baby bronchiolitis. An adult simulation patient and relative were used and a child and baby manikin. Two facilitators trained in coaching and debriefing used the 3D debriefing model. Phase 2: 12 new practices undertook identical training derived from Phase 1, with pre- and post-course questionnaires. Teams were scored on: team working, communication, early recognition and systematic approach. The team developed action plans derived from their learning to inform future response. Ten of the 12 practices from Phase 2 received an emergency drill within 6 months of the original session. Three to four members of the whole team integrated training, attended the drill, but were unaware of the nature of the scenario before. Scoring was repeated and action plans were revisited to determine behaviour changes.ResultsEvery emergency drill demonstrated improved scoring in skills and behaviour.ConclusionA combination of: in situ GP simulation, appropriately qualified facilitators in simulation and debriefing, and action plans developed by the whole team suggests safer care for patients experiencing a medical emergency.

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