3,144 research outputs found
Implementing screening and brief Interventions for excessive alcohol consumption in primary health care
O consumo de bebidas alcoólicas é um dos principais fatores de risco da morbilidade e mortalidade prematura a nível mundial. As pessoas que consomem este género de bebidas têm um risco aumentado de vir a desenvolver mais de 200 problemas de saúde diferentes. A maioria do impacto do consumo de álcool na saúde humana é determinado por duas dimensões: o volume total de álcool consumido e o padrão de consumo. Existem várias medidas com comprovada eficácia que podem ser empregues para reduzir o risco associado ao consumo de álcool, entre as quais se encontra a deteção precoce e intervenção breve ao nível dos Cuidados de Saúde Primários. A maioria dos profissionais de saúde neste nível de cuidados considera o consumo de álcool como um importante problema de saúde e manifesta o seu apoio a medidas que visem reduzir o seu impacto. No entanto, poucos são os profissionais dos Cuidados de Saúde Primários que de forma sistemática identificam e aconselham os seus doentes relativamente aos seus hábitos etílicos. Como tal, o objetivo geral desta tese foi investigar como implementar a deteção precoce e intervenção breve no consumo excessivo de álcool nos Cuidados de Saúde Primários.
Foi realizada uma revisão sistemática das barreiras e facilitadores à implementação da deteção precoce e intervenção breve no consumo excessivo de álcool nos Cuidados de Saúde Primários. As barreiras e facilitadores identificados nesta revisão foram analisados à luz da teoria de modificação comportamental para compreender a ligação destes fatores aos determinantes da mudança de comportamento, e para identificar as estratégias conceptualmente mais eficazes para abordar as barreiras e facilitadores à mudança de comportamento dos profissionais dos Cuidados de Saúde Primários no sentido de aumentar as taxas de deteção precoce e intervenção breve no consumo excessivo de álcool. Esta metodologia foi utilizada para desenhar um programa de implementação com base em pressupostos teóricos que foi testado num estudo experimental randomizado e controlado em clusters.
Esta tese identificou diversas barreiras à implementação, ligadas a todos os domínios teóricos da mudança comportamental. As barreiras mais frequentemente mencionadas pelos profissionais foram: preocupação sobre as suas competências e eficácia para realizar a deteção precoce e intervenção breve; falta de conhecimento específico sobre o consumo de álcool; falta de tempo; falta de materiais; falta de apoio; e atitudes para com o doente com consumos excessivos de álcool. Esta tese mostrou também a existência de dois grupos distintos de médicos de família com base nas suas atitudes para com estes doentes, um com atitudes mais positivas, o outro com atitudes mais negativas. Esta tese mostrou ainda que um programa de implementação da deteção precoce e intervenção breve, desenhado com base em pressupostos teóricos de modificação comportamental, adaptado às barreiras e facilitadores da implementação, aumenta de forma significativa as taxas de identificação precoce dos consumos de álcool.
Esta tese contribui para aumentar o conhecimento atual no sentido em que põe à disposição dos investigadores evidência prática sobre como abordar os fatores com influência na implementação da identificação precoce e intervenção breve para o consumo de álcool ao nível dos Cuidados de Saúde Primários. Esta tese contribui também para um melhor entendimento dos mecanismos subjacentes à resistência e à mudança de comportamento dos profissionais dos Cuidados de Saúde Primários no que respeita à implementação da deteção precoce e intervenção breve do consumo de álcool. Os resultados desta tese poderão ser usados por investigadores e decisores políticos para desenhar novos programas de implementação tendo como objetivo modificar esta prática clínica ao nível dos Cuidados de Saúde Primários.Alcohol use is among the leading risk factors for the global burden of disease and premature death. People who drink alcoholic beverages are at risk of developing more than 200 diseases and injury conditions. Most of the impact of alcohol consumption on human health and well-being is determined by two dimensions of drinking: the total volume of alcohol consumed and the pattern of drinking. Several effective strategies exist to reduce the harmful use of alcohol, which includes screening and brief interventions for excessive alcohol use in primary health care. The majority of primary health care providers agree that the excessive consumption of alcohol is an important health issue and express their support to policies for reducing the impact of alcohol on the health of their patients. Notwithstanding, implementation of screening and brief interventions is low at the primary health care level. Therefore, the overall aim of this thesis is to investigate how to implement screening and brief interventions for excessive alcohol consumption in primary health care.
This thesis reviewed the barriers of, and facilitators for, the implementation of alcohol screening and brief interventions in primary health care. Behaviour change theory was used to understand how these factors linked to the determinants of behaviour change and how they could be addressed in order to change primary health care providers’ behaviour, i.e. to increase the delivery of alcohol screening and brief interventions. A comprehensive theory-based implementation programme was designed and tested in a cluster randomized controlled trial.
This thesis identified several barriers to implementation which were mapped to all the theoretical domains of behaviour change. Primary health care providers concerns about their ability to deliver alcohol screening and brief interventions and to help patients to cut down, lack of alcohol-related knowledge, lack of time, lack of materials and support, and providers’ attitudes towards at-risk drinkers were among the most commonly cited barriers. This thesis found evidence that the attitudes of family physicians could be used to divide practitioners into two distinct groups, one with more positive and the other with more negative attitudes towards at-risk drinkers.
This thesis also found that a behaviour change theory-based programme, tailored to the barriers for, and facilitators of, the implementation of screening and brief intervention in primary health care is effective in increasing alcohol screening rates.
This thesis contributed to the evidence base by providing researchers with practical evidence on how to address the factors influencing the implementation of screening and brief interventions in primary health care. This thesis also provides researchers with insight into the behavioural mechanisms mediating primary health care providers’ decision to deliver alcohol screening and brief interventions. The results of this thesis could be used by researchers and policymakers to inform the design of novel theory-oriented interventions to support the implementation of alcohol screening and brief interventions in primary health care
Multidisciplinary perspectives on Artificial Intelligence and the law
This open access book presents an interdisciplinary, multi-authored, edited collection of chapters on Artificial Intelligence (‘AI’) and the Law. AI technology has come to play a central role in the modern data economy. Through a combination of increased computing power, the growing availability of data and the advancement of algorithms, AI has now become an umbrella term for some of the most transformational technological breakthroughs of this age. The importance of AI stems from both the opportunities that it offers and the challenges that it entails. While AI applications hold the promise of economic growth and efficiency gains, they also create significant risks and uncertainty. The potential and perils of AI have thus come to dominate modern discussions of technology and ethics – and although AI was initially allowed to largely develop without guidelines or rules, few would deny that the law is set to play a fundamental role in shaping the future of AI. As the debate over AI is far from over, the need for rigorous analysis has never been greater. This book thus brings together contributors from different fields and backgrounds to explore how the law might provide answers to some of the most pressing questions raised by AI. An outcome of the Católica Research Centre for the Future of Law and its interdisciplinary working group on Law and Artificial Intelligence, it includes contributions by leading scholars in the fields of technology, ethics and the law.info:eu-repo/semantics/publishedVersio
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Cancer Care in Pandemic Times: Building Inclusive Local Health Security in Africa and India
This is a book about improving cancer care in Africa and India that is a child of its pandemic times. It has been collaboratively researched and written by colleagues in Kenya, Tanzania, India and the UK, working within a cross-country, multidisciplinary research project, Innovation for Cancer Care in Africa (ICCA). Since this was a health-focused research project, ICCA researchers during the pandemic not only continued to work on the cancer research project but were also called upon by their governments to respond to immediate pandemic needs. In combining these two concerns, for improving cancer care and responding to pandemic needs, our original project aims have been challenged, deepened and reworked. ICCA’s initial collaborative research focus included—against the grain of most global health literature—the potential role of enhanced local production of essential healthcare supplies for improving cancer care in African countries. The pandemic experience has strikingly validated these earlier findings on the importance of industrial development for health care. The pandemic crystallised for researchers and policymakers an often overlooked phenomenon: global health security is built on the foundations of strong local health security. We argue in this book that new analytical thinking from social scientists and others is required on how to build local health security. We use the “lens” of original research on cancer care in East Africa and India to build up an understanding of the scope for the development of stronger synergies between local health industries and health care, in order to strengthen local health security and develop tools for policy making. The rethinking and reimagining presented here is required for different African countries, for India and the wider world, and this research on cancer care has taught us that this imperative goes much wider than infectious diseases
Effects of municipal smoke-free ordinances on secondhand smoke exposure in the Republic of Korea
ObjectiveTo reduce premature deaths due to secondhand smoke (SHS) exposure among non-smokers, the Republic of Korea (ROK) adopted changes to the National Health Promotion Act, which allowed local governments to enact municipal ordinances to strengthen their authority to designate smoke-free areas and levy penalty fines. In this study, we examined national trends in SHS exposure after the introduction of these municipal ordinances at the city level in 2010.MethodsWe used interrupted time series analysis to assess whether the trends of SHS exposure in the workplace and at home, and the primary cigarette smoking rate changed following the policy adjustment in the national legislation in ROK. Population-standardized data for selected variables were retrieved from a nationally representative survey dataset and used to study the policy action’s effectiveness.ResultsFollowing the change in the legislation, SHS exposure in the workplace reversed course from an increasing (18% per year) trend prior to the introduction of these smoke-free ordinances to a decreasing (−10% per year) trend after adoption and enforcement of these laws (β2 = 0.18, p-value = 0.07; β3 = −0.10, p-value = 0.02). SHS exposure at home (β2 = 0.10, p-value = 0.09; β3 = −0.03, p-value = 0.14) and the primary cigarette smoking rate (β2 = 0.03, p-value = 0.10; β3 = 0.008, p-value = 0.15) showed no significant changes in the sampled period. Although analyses stratified by sex showed that the allowance of municipal ordinances resulted in reduced SHS exposure in the workplace for both males and females, they did not affect the primary cigarette smoking rate as much, especially among females.ConclusionStrengthening the role of local governments by giving them the authority to enact and enforce penalties on SHS exposure violation helped ROK to reduce SHS exposure in the workplace. However, smoking behaviors and related activities seemed to shift to less restrictive areas such as on the streets and in apartment hallways, negating some of the effects due to these ordinances. Future studies should investigate how smoke-free policies beyond public places can further reduce the SHS exposure in ROK
Talking about personal recovery in bipolar disorder: Integrating health research, natural language processing, and corpus linguistics to analyse peer online support forum posts
Background: Personal recovery, ‘living a satisfying, hopeful and contributing lifeeven with the limitations caused by the illness’ (Anthony, 1993) is of particular value in bipolar disorder where symptoms often persist despite treatment. So far, personal recovery has only been studied in researcher-constructed environments (interviews, focus groups). Support forum posts can serve as a complementary naturalistic data source. Objective: The overarching aim of this thesis was to study personal recovery experiences that people living with bipolar disorder have shared in online support forums through integrating health research, NLP, and corpus linguistics in a mixed methods approach within a pragmatic research paradigm, while considering ethical issues and involving people with lived experience. Methods: This mixed-methods study analysed: 1) previous qualitative evidence on personal recovery in bipolar disorder from interviews and focus groups 2) who self-reports a bipolar disorder diagnosis on the online discussion platform Reddit 3) the relationship of mood and posting in mental health-specific Reddit forums (subreddits) 4) discussions of personal recovery in bipolar disorder subreddits. Results: A systematic review of qualitative evidence resulted in the first framework for personal recovery in bipolar disorder, POETIC (Purpose & meaning, Optimism & hope, Empowerment, Tensions, Identity, Connectedness). Mainly young or middle-aged US-based adults self-report a bipolar disorder diagnosis on Reddit. Of these, those experiencing more intense emotions appear to be more likely to post in mental health support subreddits. Their personal recovery-related discussions in bipolar disorder subreddits primarily focussed on three domains: Purpose & meaning (particularly reproductive decisions, work), Connectedness (romantic relationships, social support), Empowerment (self-management, personal responsibility). Support forum data highlighted personal recovery issues that exclusively or more frequently came up online compared to previous evidence from interviews and focus groups. Conclusion: This project is the first to analyse non-reactive data on personal recovery in bipolar disorder. Indicating the key areas that people focus on in personal recovery when posting freely and the language they use provides a helpful starting point for formal and informal carers to understand the concerns of people diagnosed with bipolar disorder and to consider how best to offer support
Optimising delivery of the Childsmile nursery supervised toothbrushing programme in Scotland
Background.
Supervised toothbrushing in nurseries, delivered as a component of Childsmile, Scotland’s national oral health improvement programme for children, is associated with reduced caries experience and cost savings in prevented dental treatments. There is also evidence that it is effective in reducing oral health inequalities, with greater improvements in oral health observed among children living in the most deprived areas. However Childsmile process evaluation data indicate that the nursery supervised toothbrushing programme does not take place as intended in all nursery settings. This highlighted the need to undertake further research to optimise its delivery, to maximise the gains for children’s oral health and contribute to reducing oral health inequalities.
Aims:
The overarching aim of the research is to optimise delivery of the nursery supervised toothbrushing programme, which is achieved by: further developing its Theory of Change; assessing the fidelity of its implementation compared with the Theory of Change; identifying the barriers and facilitators to its implementation; and identifying implementation strategies to overcome those barriers. It is intended that findings will be fed back into the Childsmile programme to inform ongoing improvement of the nursery supervised toothbrushing programme component.
Methods:
The research was framed within the paradigm of pragmatism and utilised a mixed-methods approach, informed by a programme theory approach and implementation science methods, making it the first study of its kind to utilise this approach to investigate the implementation of a complex toothbrushing intervention delivered in educational settings. The researcher explicated the programme’s Theory of Change via documentary review, to identify its key components (the inputs, activities and outcomes); and qualitative interviews and focus groups with programme stakeholders, to discuss and agree the Theory of Change, which was depicted in a logic model.
Using a mixed methods approach, the researcher undertook national, crosssectional surveys of nurseries, qualitative interviews with programme stakeholders and extracted data from ongoing Childsmile process evaluation, to assess fidelity of implementation and identify barriers and facilitators to delivery. Delivery-in-reality was assessed in comparison with the intended model (per the logic model developed in the previous stage of the research). The researcher used the Consolidated Framework for Implementation Research to categorise the barriers and facilitators identified and mapped these to the Expert Recommendations for Implementing Change compilation of implementation strategies to identify potential methods and techniques to overcome barriers to programme delivery.
Results:
This novel study identified that optimising the Childsmile nursery supervised toothbrushing programme requires a shared vision to be developed and strengthened among partners involved in its implementation, supported by developing a formal implementation blueprint and further work to increase nursery staff’s buy-in, such as local champions and enhanced training. The fidelity of programme delivery should continue to be monitored and evaluated using the methodology and logic model developed via this research.
The inputs, activities and outcomes comprising the Theory of Change of the nursery supervised toothbrushing programme were specified, with consensus on those reached among programme stakeholders. This included stating the primary aim of the programme: 100% of children brush their teeth in nursery, every day they attend. However, national survey results showed that this target was not met, with 92% of eligible children brushing in nurseries on the day of the survey and variation in percentages of children brushing across geographical health boards. Nurseries with 100% toothbrushing rates were more likely to have fewer children attending, only have a single age group attending and were situated in certain geographical health board areas and not others.
Using a mixed methods approach highlighted inconsistencies between these quantitative data on nurseries’ participation and qualitative findings on stakeholders’ perceptions about nurseries’ participation. There were variations between health boards in the extent to which delivery-in-reality matched what was intended. This included the content and frequency of training provided to nursery staff to support their delivery of the programme, with no standardised training package available nationally. Relationships between Childsmile teams and local authorities’ education departments were identified as important although these required careful management and communication. Barriers and facilitators influencing programme implementation before and during the Covid19 pandemic were identified and the Consolidated Framework for Implementation Research provided good coverage of these (encompassing all five domains and 14 out of 26 constructs associated with intervention implementation). Relevant constructs included: ‘Complexity’, in relation to fitting toothbrushing in to nursery routines and perceptions about it being too time-consuming; ‘Patient Needs and Resources’, in terms of children’s ability to perform the required actions as well as their reluctance to participate in toothbrushing instead of other available activities; and ‘External Policies and Incentives’, which related to the interpretation of early years policies which conflicted with directing children to participate in activities, including toothbrushing. An overarching theme related to the prioritisation of the nursery supervised toothbrushing programme by nursery staff, including the extent to which other activities were given precedence over it; and nursery staff’s willingness to accommodate toothbrushing flexibly within nursery schedules.
The Covid-19 pandemic disrupted delivery of the programme due to nursery closures in 2020 and 2021, as well as creating additional pressures for nursery staff once establishments reopened. This affected the extent to which they engaged with efforts to restart the toothbrushing programme.
Conclusions:
This research has explicated the Theory of Change for Childsmile’s nursery supervised toothbrushing programme, from the perspective of programme stakeholders. There is scope for further specification of core, ‘essential’ programme components and adaptable, peripheral components, to identify an acceptable level of delivery which will allow progress towards outcomes. There are also opportunities to work with stakeholders from other organisations, aside from Childsmile, to identify changes to the Theory of Change to enhance its fit with their needs and priorities.
In assessing the fidelity of programme implementation, it was found that aspects were delivered as intended; however, most logic model activities had components that were not being delivered with fidelity, including that less than 100% of children brushed their teeth every day they attended nursery. It was identified that the nursery context in which the programme is delivered was complex and fluctuating, with competing demands on nursery staff’s time. This indicated a need to accept that the programme has to fit within overall nursery provision, to ensure it is given enough priority. This requires identifying implementation strategies to find ways to help it fit alongside other priorities, including strategies to enhance engagement among nursery staff while taking their perspectives into account.
A number of recommendations are made to support and optimise programme delivery going forward. These include supplementing the programme’s ongoing work in fostering relationships with partners with a focused communications campaign, targeted at stakeholders in individual nurseries and local authority education departments, which demonstrates how the programme fits within the wider nursery curriculum and its contribution to children’s health and wellbeing alongside information (tailored to stakeholders’ roles) that clarifies what is involved in programme delivery. It is also recommended that a knowledge exchange and support network should be established among nurseries, led by champions (invited to undertake this role among nursery staff with an interest in oral health working in nurseries identified to deliver the programme well) who support and mentor their peers to overcome challenges to delivering the toothbrushing programme. This could include enhanced training, tailored to individual nurseries’ needs, to provide practical solutions to overcome challenges encountered. To encourage participation among local authorities’ education departments and individual establishments’ head teachers and managers, it is recommended that further, supportive dialogue takes place between the Childsmile programme, the Scottish Government and local authority education departments
Facilitating prosociality through technology: Design to promote digital volunteerism
Volunteerism covers many activities involving no financial rewards for volunteers but which contribute
to the common good. There is existing work in designing technology for volunteerism in HumanComputer Interaction (HCI) and related disciplines that focuses on motivation to improve
performance, but it does not account for volunteer wellbeing. Here, I investigate digital volunteerism
in three case studies with a focus on volunteer motivation, engagement, and wellbeing. My research
involved volunteers and others in the volunteering context to generate recommendations for a
volunteer-centric design for digital volunteerism. The thesis has three aims:
1. To investigate motivational aspects critical for enhancing digital volunteers’ experiences
2. To identify digital platform attributes linked to volunteer wellbeing
3. To create guidelines for effectively supporting volunteer engagement in digital volunteering
platforms
In the first case study I investigate the design of a chat widget for volunteers working in an
organisation with a view to develop a design that improves their workflow and wellbeing. The second
case study investigates the needs, motivations, and wellbeing of volunteers who help medical
students improve their medical communication skills. An initial mixed-methods study was followed by
an experiment comparing two design strategies to improve volunteer relatedness; an important
indicator of wellbeing. The third case study looks into volunteer needs, experiences, motivations, and
wellbeing with a focus on volunteer identity and meaning-making on a science-based research
platform. I then analyse my findings from these case studies using the lens of care ethics to derive
critical insights for design.
The key contributions of this thesis are design strategies and critical insights, and a volunteer-centric
design framework to enhance the motivation, wellbeing and engagement of digital volunteers
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