From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument

<b>Background</b> Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.<p></p> <b>Methods</b> A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.<p></p> <b>Results</b> The developed instrument was pre-tested in two professional samples (N = 46; N = 231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.<p></p> <b>Conclusions</b> To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study

Designing theoretically-informed implementation interventions

Clinical and health services research is continually producing new findings that may contribute to effective and efficient patient care. However, the transfer of research findings into practice is unpredictable and can be a slow and haphazard process. Ideally, the choice of implementation strategies would be based upon evidence from randomised controlled trials or systematic reviews of a given implementation strategy. Unfortunately, reviews of implementation strategies consistently report effectiveness some, but not all of the time; possible causes of this variation are seldom reported or measured by the investigators in the original studies. Thus, any attempts to extrapolate from study settings to the real world are hampered by a lack of understanding of the effects of key elements of individuals, interventions, and the settings in which they were trialled. The explicit use of theory offers a way of addressing these issues and has a number of advantages, such as providing: a generalisable framework within which to represent the dimensions that implementation studies address, a process by which to inform the development and delivery of interventions, a guide when evaluating, and a way to allow for an exploration of potential causal mechanisms. However, the use of theory in designing implementation interventions is methodologically challenging for a number of reasons, including choosing between theories and faithfully translating theoretical constructs into interventions. The explicit use of theory offers potential advantages in terms of facilitating a better understanding of the generalisability and replicability of implementation interventions. However, this is a relatively unexplored methodological area

A modified theoretical framework to assess implementation fidelity of adaptive public health interventions

Background: One of the major debates in implementation research turns around fidelity and adaptation. Fidelity is the degree to which an intervention is implemented as intended by its developers. It is meant to ensure that the intervention maintains its intended effects. Adaptation is the process of implementers or users bringing changes to the original design of an intervention. Depending on the nature of the modifications brought, adaptation could either be potentially positive or could carry the risk of threatening the theoretical basis of the intervention, resulting in a negative effect on expected outcomes. Adaptive interventions are those for which adaptation is allowed or even encouraged. Classical fidelity dimensions and conceptual frameworks do not address the issue of how to adapt an intervention while still maintaining its effectiveness. Discussion: We support the idea that fidelity and adaptation co-exist and that adaptations can impact either positively or negatively on the intervention's effectiveness. For adaptive interventions, research should answer the question how an adequate fidelity-adaptation balance can be reached. One way to address this issue is by looking systematically at the aspects of an intervention that are being adapted. We conducted fidelity research on the implementation of an empowerment strategy for dengue prevention in Cuba. In view of the adaptive nature of the strategy, we anticipated that the classical fidelity dimensions would be of limited use for assessing adaptations. The typology we used in the assessment-implemented, not-implemented, modified, or added components of the strategy-also had limitations. It did not allow us to answer the question which of the modifications introduced in the strategy contributed to or distracted from outcomes. We confronted our empirical research with existing literature on fidelity, and as a result, considered that the framework for implementation fidelity proposed by Carroll et al. in 2007 could potentially meet our concerns. We propose modifications to the framework to assess both fidelity and adaptation. Summary: The modified Carroll et al.'s framework we propose may permit a comprehensive assessment of the implementation fidelity-adaptation balance required when implementing adaptive interventions, but more empirical research is needed to validate it

Methodological considerations when translating "burnout"

No study has systematically examined how researchers address cross-cultural adaptation of burnout. We conducted an integrative review to examine how researchers had adapted the instruments to the different contexts. We reviewed the Content Validity Indexing scores for the Maslach Burnout Inventory-Human Services Survey from the 12-country comparative nursing workforce study, RN4CAST. In the integrative review, multiple issues related to translation were found in existing studies. In the cross-cultural instrument analysis, 7 out of 22 items on the instrument received an extremely low kappa score. Investigators may need to employ more rigorous cross-cultural adaptation methods when attempting to measure burnout

Methods for the thematic synthesis of qualitative research in systematic reviews

<p>Abstract</p> <p>Background</p> <p>There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies.</p> <p>Methods</p> <p>We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved.</p> <p>Results</p> <p>We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses.</p> <p>Conclusion</p> <p>We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.</p

MOTYWACJA I MEDIA ELEKTRONICZNE W NAUCZANIU TŁUMACZEŃ SPECJALISTYCZNYCH

Expansion of IT-media in every field of human activity is one of the essential characteristics of modern time. This paper aims at presenting the role of electronic media in teaching translation in the field of law at the University of Osijek, Croatia, and analysing their impact on the motivation of the target group of students in the teaching process. The paper endeavours to provide some insight into the modern teaching practice and to analyse the interconnectedness of the use of electronic media and student motivation rather than to present some empirical research in the field. In the first part of the paper, a theoretical approach to teaching legal translation today is offered. In the main part, teaching legal translation by using modern media is presented on the examples of the Lifelong Learning Programme for Lawyer-Linguists at the Faculty of Law Osijek, and the course on legal translation within the German Language and Literature Studies at the Faculty of Humanities and Social Sciences of Osijek. The usage of electronic media in translation teaching is discussed with reference to the courses Introduction to the Theory of Legal Translation and Online Translation Tools and EU Vocabulary. Specific types of online materials, translation tools and sources are discussed from the point of view of student motivation. New media are also discussed from the perspective of their efficiency at different stages of translation teaching. In the concluding part, application of modern technologies in teaching legal translation is compared with other teaching methods, approaches and techniques. Finally, the author questions using IT as motivation tools in the higher education teaching discourse and argues for application of “moderate approach” in the teaching of legal translation.Ekspansja mediów informatycznych w każdej dziedzinie życia jest jedną z podstawowych cech współczesnego życia. Niniejszy artykuł ma na celu przedstawienie roli mediów elektronicznych w nauczaniu przekładu prawniczego na Uniwersytecie w Osijek w Chorwacji oraz przeanalizowanie ich wpływu na motywację grupy docelowej studentów w procesie nauczania. Autorka stara się przedstawić nowoczesną praktykę dydaktyczną i przeanalizować wzajemne powiązania korzystania z mediów elektronicznych i motywację studentów. W pierwszej części artykułu zaproponowano teoretyczne podejście do nauczania tłumaczenia prawniczego. Na przykładach programu „Lifelong Learning Programme for Lawyer-Linguists” na Wydziale Prawa Osijek oraz kursu tłumaczenia prawniczego w ramach „German Language and Literature Studies” na Wydziale Nauk Humanistycznych i Społecznych w Osijek autorka prezentuje nauczanie tłumaczenia prawniczego przy użyciu nowoczesnych mediów. Wykorzystanie mediów elektronicznych w nauczaniu tłumaczeń omawia się w odniesieniu do kursów „Wprowadzenie do teorii tłumaczenia prawniczego i narzędzi tłumaczenia online oraz słownictwa UE”. Konkretne rodzaje materiałów online, narzędzi tłumaczeniowych i źródeł omawia się z punktu widzenia motywacji studentów. Nowe media są również analizowane pod kątem ich skuteczności na różnych etapach nauczania przekładu. Podsumowując, zastosowanie nowoczesnych technologii w nauczaniu tłumaczenia prawniczego porównuje się z innymi metodami, podejściami i technikami nauczania. Na koniec autorka kwestionuje zasadność wykorzystania narzędzi IT jako motywatorów w dyskursie dydaktycznym szkolnictwa wyższego i opowiada się za zastosowaniem „umiarkowanego podejścia” w nauczaniu tłumaczenia prawniczego

It's about Power Stupid! - The interpretive study of environmental governance.

noNo Abstrac