Exploring factors that influence the spread and sustainability of a dysphagia innovation: an instrumental case study

Background: Swallowing difficulties challenge patient safety due to the increased risk of malnutrition, dehydration and aspiration pneumonia. A theoretically driven study was undertaken to examine the spread and sustainability of a locally developed innovation that involved using the Inter-Professional Dysphagia Framework to structure education for the workforce. A conceptual framework with 3 spread strategies (hierarchical control, participatory adaptation and facilitated evolution) was blended with a processual approach to sustaining organisational change. The aim was to understand the processes, mechanism and outcomes associated with the spread and sustainability of this safety initiative. Methods: An instrumental case study, prospectively tracked a dysphagia innovation for 34 months (April 2011 to January 2014) in a large health care organisation in England. A train-the-trainer intervention (as participatory adaptation) was deployed on care pathways for stroke and fractured neck of femur. Data were collected at the organisational and clinical level through interviews (n = 30) and document review. The coding frame combined the processual approach with the spread mechanisms. Pre-determined outcomes included the number of staff trained about dysphagia and impact related to changes in practice. Results: The features and processes associated with hierarchical control and participatory adaptation were identified. Leadership, critical junctures, temporality and making the innovation routine were aspects of hierarchical control. Participatory adaptation was evident on the care pathways through stakeholder responses, workload and resource pressures. Six of the 25 ward based trainers cascaded the dysphagia training. The expected outcomes were achieved when the top-down mandate (hierarchical control) was supplemented by local engagement and support (participatory adaptation). Conclusions: Frameworks for spread and sustainability were combined to create a ‘small theory’ that described the interventions, the processes and desired outcomes a priori. This novel methodological approach confirmed what is known about spread and sustainability, highlighted the particularity of change and offered new insights into the factors associated with hierarchical control and participatory adaptation. The findings illustrate the dualities of organisational change as universal and context specific; as particular and amendable to theoretical generalisation. Appreciating these dualities may contribute to understanding why many innovations fail to become routine

Participatory adaptation and mitigation strategies for climate change on mixed farms

The past two years has been an extraordinary time to address climate change and the adaptation/mitigation strategies for mixed farming systems in the northern region with ongoing political debate and policy changes on carbon pricing, extreme rainfall and big floods. This project made major progress. It engaged a network of growers and advisers to make a lasting contribution, one that will help growers understand climate change, assess how future climate scenarios may impact on their business and profitability and develop their own farm strategies to manage them. These contributions will support growers to make more informed decisions into the future

Participatory planning and investment in climate smart agriculture to reduce risks for small-scale farmers in Central American coffee landscapes

In this CCAFS project, we stimulate partnerships between farmer cooperatives and professionals from public, private and civil society spheres and couple participatory adaptation planning with the development of incentive and investment plans. In this way, we aim to establish a virtuous cycle of investment and adoption of cost-effective Climate Smart Agriculture (CSA) practices in coffee landscapes. This approach will be tested in collaboration with the farmer cooperatives ASOBAGRI in Huehuetenango Guatemala and the PROODECOP in the dry corridor of Nicaragua

Climate change, agriculture and Fairtrade: identifying the challenges and opportunities

This paper presents the findings of a study commissioned by the UK's Fairtrade Foundation on the implications of climate change for agricultural producers in Fairtrade value chains

Enhancing Vulnerable Groups’ Resilience to Climate Change: Lessons Learned from a Case Study with Older Adults

Certain groups are more vulnerable to climate change than others and will likely feel its effects more severely. These groups include children, older adults, refugees, minoritized racial and ethnic groups, and people living in poverty. To safeguard vulnerable groups, their knowledge and perspectives need to be integrated into climate change adaptation planning. Institutions of higher education have many resources to contribute to this effort. To inform and promote engaged scholarship focusing on adaptation planning in collaboration with vulnerable groups, this research presents a case study evaluation of a project conducted by researchers at Antioch University New England with the older-adult community of Bridgeport, Connecticut. The evaluation explores attributes of the project that contributed to both positive outcomes and challenges. Key themes include the value of developing a primary partnership with a local organization, fostering an accessible and inclusive process, connecting subject matter with participants’ concerns, using an iterative process to build capacity, collaborating with multiple other local organizations, recognizing ongoing community efforts, and generating initial actions. This evaluation also explores potential transferability to other contexts

Exploring scale-up, spread, and sustainability: an instrumental case study tracing an innovation to enhance dysphagia care

Background Adoption, adaptation, scale-up, spread, and sustainability are ill-defined, undertheorised, and little-researched implementation science concepts. An instrumental case study will track the adoption and adaptation, or not, of a locally developed innovation about dysphagia as a patient safety issue. The case study will examine a conceptual framework with a continuum of spread comprising hierarchical control or ‘making it happen’, participatory adaptation or ‘help it happen’, and facilitated evolution or ‘let it happen’. Methods This case study is a prospective, longitudinal design using mixed methods. The fifteen-month (October 2012 to December 2013) instrumental case study is set in large, healthcare organisation in England. The innovation refers to introducing a nationally recognised, inter-disciplinary dysphagia competency framework to guide workforce development about fundamental aspects of care. Adoption and adaptation will be examined at an organisational level and along two, contrasting care pathways: stroke and fractured neck of femur. A number of educational interventions will be deployed, including training a cadre of trainers to cascade the essentials of dysphagia management and developing a Dysphagia Toolkit as a learning resource. Mixed methods will be used to investigate scale-up, spread, and sustainability in acute and community settings. A purposive sample of senior managers and clinical leaders will be interviewed to identify path dependency or the context specific particularities of implementation. A pre- and post-evaluation, using mealtime observations and a survey, will investigate the learning effect on staff adherence to patient specific dysphagia recommendations and attitudes towards dysphagia, respectively. Official documents and an ethnographic field journal allow critical junctures, temporal aspects and confounding factors to be explored. Discussion Researching spread and sustainability presents methodological and practical challenges. These include fidelity, adaptation latitude, time, and organisational changes. An instrumental case study will allow these confounding factors to be tracked over time and in place. The case study is underpinned by, and will test a conceptual framework about spread, to explore theoretical generalizability

Analytical framework to assess the incorporation of climate change adaptation in water management : application to the Tordera River Basin Adaptation Plan

Projections indicate that the Mediterranean region is an area where drastic changes in climate will occur, which will significantly affect water resources. In a context of increasing pressure on water resources as a result of the reduction in water availability, it is essential and urgent to structure water management in a way that allows for adaptation to the challenges that the changing climate will bring to an already water scarce region. It is necessary to generate experiences and methodologies that are based on real case studies that will lay the foundations for the generalisation of practices of climate change adaptation in water management. In this study, we have developed a ready to use analytical framework to evaluate the coherence of water management plans and programs with climate change adaptation principles. We have tested the applicability of the framework that was developed on the Tordera River Basin Adaptation Plan (TRBAP). The analytical framework has proven to be easy to apply and to allow for identifying the inclusion or exclusion of key climate change adaptation features appropriately. We have structured this analytical framework as a starting point contributing to further assessments of how climate change adaptation is incorporated in water managemen

Government resettlement as participatory adaptation to climate change : exploring the role of knowledge in the Lower Shire region of Malawi

There has been debate over how environmental change will influence migration. This PhD explores one aspect of this: the impact of flooding on migration patterns and the subsequent move by government actors to govern these migration patterns through resettlement in Malawi. This research suggests that this move to govern migration reflects a broader shift in the discourse of seeing migration as a positive opportunity and as adaptation to environmental change. It focuses on the Lower Shire region of Malawi, an area particularly impacted by flooding, and especially reflects on the participatory nature of the resettlement process, as this is highlighted by influential international guidelines as being necessary for the resettlement to be adaptive rather than mal-adaptive. To this end the research focuses on the knowledges involved and the varying power dynamics. Fieldwork occurred between August and November 2017 and consisted of 48 Interviews and six focus group discussions with three communities in the Lower Shire that had three different attitudes (unwilling, undecided, and resettled) towards resettlement. As well as 21 interviews with stakeholders in government and NGOs involved in these communities and in the resettlement process at a national and district level. The data showed that flooding related movements already occur in the communities but, due to the increasing severity of flooding, there is a growing desire by those in government and NGOs to initiate their own resettlement. However, official resettlement due to flooding is novel in Malawi, and there is confusion over what it entails and who is involved. This appears to lead to a disconnect between Resettlement, established by the government and resettlement, movements initiated by those in vulnerable communities. The data suggests that a key reason this disconnect develops is due to the different perceptions of knowledge. It appears that there is a subtly pervasive disregard of community knowledge and this can reduce the community agency within the resettlement process and prevent it from being participatory. However, the data also highlighted the intriguing ways the communities themselves can re-appropriate resettlement to indicate their needs in the process, illustrating the fluidity of knowledge and power within the resettlement process in Malawi."This work was supported by the Scottish Graduate School of Social Science as part of the Economic Social Research Council [1649125]." -- Fundin

Resource box for resilient seed systems: handbook

The resource box for resilient seed systems, developed by a multidisciplinary team of Bioversity International researchers, is a tool that supports research and capacity building on resilient seed systems in the context of adaptation to climate change. The eight modules of the box represent eight steps of a participatory research cycle from situational analysis to knowledge sharing and communication. The handbook complements the online version which can be found at: http://www.seedsresourcebox.org The Resilient Seed Systems Handbook Second Edition, published in 2019, includes a new module on seed production and distribution and incorporates several of more recent useful ideas, examples of good practices and the latest references. See https://hdl.handle.net/10568/73256 Vernooy, R.; Bessette, G.; Otieno, G. (eds.) (2019) Resilient seed systems: handbook. Second edition. Rome (Italy): Bioversity International, 158 p. ISBN: 978-92-9255-138-