Evaluation Champions: A Literature Review

Background: Numerous studies call for the identification and engagement of evaluation champions in the implementation of an evaluation initiative. However, no agreed definition of an evaluation champion exists in the extant literature. Published studies on evaluation champions are limited and motivations of evaluation champions are not well understood. Understanding of how evaluation champions interact with their colleagues to generate momentum for change is lacking. Purpose: This article explores champions in organizational settings and highlights the need for an increased understanding of evaluation champions. The research question posed is, ‘What does the literature tell us about evaluation champions in organizational settings?’ Setting: Not Applicable. Intervention: Not Applicable. Research Design: Relevant articles were identified through systematic searches of selected databases and reference reviews of retrieved articles from the evaluation and organizational development bodies of evidence. Theories that could assist with understanding the role of evaluation champions were also drawn upon. Data Collection and Analysis: Not Applicable. Findings: The analysis indicates evaluators and organizations value champions because they work to bring evaluative thinking into their practice and positively promote evaluation among their colleagues. A list of activities that may be indicative of the behaviours of champions has been compiled to contribute to the evidence base. Keywords: evaluation champions; social interdependence theory; evaluation use; evaluation capacity building

Including the voice of children:Towards patient-centered care

Patient-centered care (PCC) is characterized by the provision of care that respects and responds to individual patient preferences, needs and values, and ensures that patient’s wishes guide all clinical decisions. PCC places the patient, not the disease, at the center of health care and promotes a collaboration between patient, family, and clinicians to provide care that is tailored to the patient’s wishes and needs. Although the importance of PCC is recognized, its implementation is difficult because it requires a different mindset and changing roles of patients, parents, and clinicians. This thesis focused on scientific approaches and the development of tools to enhance PCC in children. Three aspects of PCC were examined; pediatric patient engagement, Patient Reported Outcome Measures (PROMs), and Patient Reported Experience Measures (PREMs). The first part of the thesis provides a synopsis of the existing literature on pediatric patient engagement and discusses the development of a tool to enhance pediatric patient engagement. The second part of the thesis focuses on facilitators and barriers in the implementation of PROMs in clinical practice, using the KLIK PROM portal and the PROMIS measures as an example. The last part of the thesis provides an overview of the available PREMs in pediatrics

Conservation Research, Policy and Practice

Developed following the success of an international symposium, this book examines how to make conservation more effective through strengthening links between science research, policy and practice. Ideal for practitioners, researchers, graduate students and policymakers. This title is also available as Open Access on Cambridge Core

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes:Development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Background: Dementia with challenging behaviour (CB) causes significant distress for caregivers and the person with dementia. It is associated with breakdown of care at home and disruption in care homes. Challenge Demcare aimed to assist care home staff and mental health practitioners who support families at home to respond effectively to CB. Objectives: To study the management of CB in care homes (ResCare) and in family care (FamCare). Following a conceptual overview, two systematic reviews and scrutiny of clinical guidelines, we (1) developed and tested a computerised intervention; (2) conducted a cluster randomised trial (CRT) of the intervention for dementia with CB in care homes; (3) conducted a process evaluation of implementation of the intervention; and (4) conducted a longitudinal observational cohort study of the management of people with dementia with CB living at home, and their carers. Review methods: Cochrane review of randomised controlled trials; systematic meta-ethnographic review of quantitative and qualitative studies. Design: ResCare – survey, CRT, process evaluation and stakeholder consultations. FamCare – survey, longitudinal cohort study, participatory development design process and stakeholder consultations. Comparative examination of baseline levels of CB in the ResCare trial and the FamCare study participants. Settings: ResCare – 63 care homes in Yorkshire. FamCare – 33 community mental health teams for older people (CMHTsOP) in seven NHS organisations across England. Participants: ResCare – 2386 residents and 861 staff screened for eligibility; 555 residents with dementia and CB; 277 ‘other’ residents; 632 care staff; and 92 staff champions. FamCare – every new referral (n = 5360) reviewed for eligibility; 157 patients with dementia and CB, with their carer; and 26 mental health practitioners. Stakeholder consultations – initial workshops with 83 practitioners and managers from participating organisations; and 70 additional stakeholders using eight group discussions and nine individual interviews. Intervention: An online application for case-specific action plans to reduce CB in dementia, consisting of e-learning and bespoke decision support care home and family care e-tools. Main outcome measures: ResCare – survey with the Challenging Behaviour Scale; measurement of CB with the Neuropsychiatric Inventory (NPI) and medications taken from prescriptions; implementation with thematic views from participants and stakeholders. FamCare – case identification from all referrals to CMHTsOP; measurement of CB with the Revised Memory and Behaviour Problems Checklist and NPI; medications taken from prescriptions; and thematic views from stakeholders. Costs of care calculated for both settings. Comparison of the ResCare trial and FamCare study participants used the NPI, Clinical Dementia Rating and prescribed medications. Results: ResCare – training with group discussion and decision support for individualised interventions did not change practice enough to have an impact on CB in dementia. Worksite e-learning opportunities were not readily taken up by care home staff. Smaller homes with a less hierarchical management appear more ready than others to engage in innovation. FamCare – home-dwelling people with dementia and CB are referred to specialist NHS services, but treatment over 6 months, averaging nine contacts per family, had no overall impact on CB. Over 60% of people with CB had mild dementia. Families bear the majority of the care costs of dementia with CB. A care gap in the delivery of post-diagnostic help for families supporting relatives with dementia and significant CB at home has emerged. Higher levels of CB were recorded in family settings; and prescribing practices were suboptimal in both care home and family settings. Limitations: Functionality of the software was unreliable, resulting in delays. This compromised the feasibility studies and undermined delivery of the intervention in care homes. A planned FamCare CRT could not proceed because of insufficient referrals. Conclusions: A Cochrane review of individualised functional analysis-based interventions suggests that these show promise, although delivery requires a trained dementia care workforce. Like many staff training interventions, our interactive e-learning course was well received by staff when delivered in groups with facilitated discussion. Our e-learning and decision support e-tool intervention in care homes, in its current form, without ongoing review of implementation of recommended action plans, is not effective at reducing CB when compared with usual care. This may also be true for staff training in general. A shift in priorities from early diagnosis to early recognition of dementia with clinically significant CB could bridge the emerging gap and inequities of care to families. Formalised service improvements in the NHS, to co-ordinate such interventions, may stimulate better opportunities for practice models and pathways. Separate services for care homes and family care may enhance the efficiency of delivery and the quality of research on implementation into routine care. Future work: There is scope for extending functional analysis-based interventions with communication and interaction training for carers. Our clinical workbooks, video material of real-life episodes of CB and process evaluation tool resources require further testing. There is an urgent need for evaluation of interventions for home-dwelling people with dementia with clinically significant CB, delivered by trained dementia practitioners. Realist evaluation designs may illuminate how the intervention might work, and for whom, within varying service contexts

Assuming Data Integrity and Empirical Evidence to The Contrary

Background: Not all respondents to surveys apply their minds or understand the posed questions, and as such provide answers which lack coherence, and this threatens the integrity of the research. Casual inspection and limited research of the 10-item Big Five Inventory (BFI-10), included in the dataset of the World Values Survey (WVS), suggested that random responses may be common. Objective: To specify the percentage of cases in the BRI-10 which include incoherent or contradictory responses and to test the extent to which the removal of these cases will improve the quality of the dataset. Method: The WVS data on the BFI-10, measuring the Big Five Personality (B5P), in South Africa (N=3 531), was used. Incoherent or contradictory responses were removed. Then the cases from the cleaned-up dataset were analysed for their theoretical validity. Results: Only 1 612 (45.7%) cases were identified as not including incoherent or contradictory responses. The cleaned-up data did not mirror the B5P- structure, as was envisaged. The test for common method bias was negative. Conclusion: In most cases the responses were incoherent. Cleaning up the data did not improve the psychometric properties of the BFI-10. This raises concerns about the quality of the WVS data, the BFI-10, and the universality of B5P-theory. Given these results, it would be unwise to use the BFI-10 in South Africa. Researchers are alerted to do a proper assessment of the psychometric properties of instruments before they use it, particularly in a cross-cultural setting

Leading Towards Voice and Innovation: The Role of Psychological Contract

Background: Empirical evidence generally suggests that psychological contract breach (PCB) leads to negative outcomes. However, some literature argues that, occasionally, PCB leads to positive outcomes. Aim: To empirically determine when these positive outcomes occur, focusing on the role of psychological contract (PC) and leadership style (LS), and outcomes such as employ voice (EV) and innovative work behaviour (IWB). Method: A cross-sectional survey design was adopted, using reputable questionnaires on PC, PCB, EV, IWB, and leadership styles. Correlation analyses were used to test direct links within the model, while regression analyses were used to test for the moderation effects. Results: Data with acceptable psychometric properties were collected from 11 organisations (N=620). The results revealed that PCB does not lead to substantial changes in IWB. PCB correlated positively with prohibitive EV, but did not influence promotive EV, which was a significant driver of IWB. Leadership styles were weak predictors of EV and IWB, and LS only partially moderated the PCB-EV relationship. Conclusion: PCB did not lead to positive outcomes. Neither did LS influencing the relationships between PCB and EV or IWB. Further, LS only partially influenced the relationships between variables, and not in a manner which positively influence IWB

A Cluster Randomised Trial to Support Screening and Treatment for Unhealthy Alcohol Use in Aboriginal Community Controlled Health Services.

Background: Evidence-based management of unhealthy alcohol use in primary care has been advocated since 1979. Few studies focus on improving implementation of alcohol screening and treatment in Indigenous primary care, despite greater harms from alcohol in that population group. Aims: To examine: (i) approaches used to improve screening and treatment for unhealthy alcohol use in primary care internationally; (ii) the effects of the 24-months’ support offered to 22 Aboriginal Community Controlled Health Services on screening and treatment for unhealthy alcohol use. Methods: Study 1 (systematic review) describes strategies to improve alcohol screening and treatment in primary care and investigates if they employed elements of continuous quality improvement. Studies 2 and 3 test the effect of the 24-month support on: (i) rates of screening and any alcohol treatment provision; (ii) recommended frequency of screening. Results: Study 1 found that few implementation strategies focussed on screening and treatments for the full spectrum of unhealthy alcohol use. About 20% of the studies employed the essential elements of continuous quality improvement. Study 2 showed significant improvement in the odds of screening. The effect on provision of any treatment as well as on individual treatment types was not clear and varied greatly between participating services. Study 3 was not able to show significant increases in the odds of first-time or annual screening. There were 841 (2%) clients who were screened four or more times annually. Conclusion: Support provided to Aboriginal Community Controlled Health Services over 24 months can improve the rates of alcohol screening. More focus is needed on screening frequency for individual clients. Further support for the delivery and accurate recording of alcohol treatment is needed. The thesis discusses practice, policy, and research recommendations for future directions in improving screening and treatment for unhealthy alcohol use