Factors that influence women’s engagement with breastfeeding support:a qualitative evidence synthesis

Breastfeeding is an integral part of early childhood interventions as it can prevent serious childhood and maternal illnesses. For breastfeeding support programmes to be effective, a better understanding of contextual factors that influence women's engagement and satisfaction with these programmes is needed. The aim of this synthesis is to suggest strategies to increase the level of satisfaction with support programmes and to better match the expectations and needs of women. We systematically searched for studies that used qualitative methods for data collection and analysis and that focused on women's experiences and perceptions regarding breastfeeding support programmes. We applied a maximum variation purposive sampling strategy and used thematic analysis. We assessed the methodological quality of the studies using a modified version of the CASP tool and assessed our confidence in the findings using the GRADE‐CERQual approach. We included 51 studies of which we sampled 22 for in‐depth analysis. Our sampled studies described the experiences of women with formal breastfeeding support by health care professionals in a hospital setting and informal support as for instance from community support groups. Our findings illustrate that the current models of breastfeeding support are dependent on a variety of contextual factors encouraging and supporting women to initiate and continue breastfeeding. They further highlight the relevance of providing different forms of support based on socio‐cultural norms and personal backgrounds of women, especially if the support is one‐on‐one. Feeding decisions of women are situated within a woman's personal situation and may require diverse forms of support

Premature Discontinuation of Pediatric Randomized Controlled Trials : A Retrospective Cohort Study

Objectives To determine the proportion of pediatric randomized controlled trials (RCTs) that are prematurely discontinued, examine the reasons for discontinuation, and compare the risk for recruitment failure in pediatric and adult RCTs. Study design A retrospective cohort study of RCTs approved by 1 of 6 Research Ethics Committees (RECs) in Switzerland, Germany, and Canada between 2000 and 2003. We recorded trial characteristics, trial discontinuation, and reasons for discontinuation from protocols, corresponding publications, REC files, and a survey of trialists. Results We included 894 RCTs, of which 86 enrolled children and 808 enrolled adults. Forty percent of the pediatric RCTs and 29% of the adult RCTs were discontinued. Slow recruitment accounted for 56% of pediatric RCT discontinuations and 43% of adult RCT discontinuations. Multivariable logistic regression analyses suggested that pediatric RCT was not an independent risk factor for recruitment failure after adjustment for other potential risk factors (aOR, 1.22; 95% CI, 0.57-2.63). Independent risk factors were acute care setting (aOR, 4.00; 95% CI, 1.72-9.31), nonindustry sponsorship (aOR, 4.45; 95% CI, 2.59-7.65), and smaller planned sample size (aOR, 1.05; 95% CI 1.01-1.09, in decrements of 100 participants). Conclusion Forty percent of pediatric RCTs were discontinued prematurely, owing predominately to slow recruitment. Enrollment of children was not an independent risk factor for recruitment failure.Peer reviewe

Cross border research requires researcher and participant’s flexibility

status: publishe

Knowledge Translation and Evidence-Based Practice: A Qualitative Study on Clinical Dietitians’ Perceptions and Practices in Switzerland

Background : Knowledge translation (KT) in health care is essential to promote quality of care and reduce the knowledge-to-practice gap. Little is known about KT among dietitians, and a better understanding of how this process pans out is fundamental to support their clinical practice. Objective : To explore clinical dietitians’ perceptions and practices concerning preferences and access to information sources in clinical practice, KT activities, research in nutrition and dietetics, and evidence-based practice (EBP). Design, participants, and setting : Eight interviews and two focus groups involving a total of 15 participants were conducted in 2013 among members of the Swiss Association for Registered Dietitians in the French- and German-speaking regions of Switzerland. Analysis performed : Thematic analysis drawn from a constructivist grounded theory approach. Results : Information from colleagues and experts of the field were favored when facing unfamiliar situations in clinical practice. Critically selecting evidence-based information was considered challenging, but dietitians declared they were at ease to integrate patients’ preferences and values, and their clinical expertise and judgment, in decision making, which are fundamental elements of EBP. A major reported barrier to KT was the perception that time to identify and read scientific literature was not expected during working hours and that instead, this time should be spent in clinical activities with patients. On the other hand, dietitians identified that their frequent involvement in educational activities such as knowledge dissemination or tailoring favored the integration of evidence into practice. Finally, dietitians struggled more to identify evidence-based information about counseling and communication than about biomedical knowledge. Conclusions : Dietitians mentioned being involved in each step of the KT process (ie, synthesis, dissemination, exchange, and ethically sound application of knowledge). Barriers and facilitators identified in this study need to be explored in a larger population to develop strategies to facilitate KT and EBP in dietetics practice

Knowledge Translation and Evidence-Based Practice: A Qualitative Study on Clinical Dietitians' Perceptions and Practices in Switzerland

BACKGROUND: Knowledge translation (KT) in health care is essential to promote quality of care and reduce the knowledge-to-practice gap. Little is known about KT among dietitians, and a better understanding of how this process pans out is fundamental to support their clinical practice. OBJECTIVE: To explore clinical dietitians' perceptions and practices concerning preferences and access to information sources in clinical practice, KT activities, research in nutrition and dietetics, and evidence-based practice (EBP). DESIGN, PARTICIPANTS, AND SETTING: Eight interviews and two focus groups involving a total of 15 participants were conducted in 2013 among members of the Swiss Association for Registered Dietitians in the French- and German-speaking regions of Switzerland. ANALYSIS PERFORMED: Thematic analysis drawn from a constructivist grounded theory approach. RESULTS: Information from colleagues and experts of the field were favored when facing unfamiliar situations in clinical practice. Critically selecting evidence-based information was considered challenging, but dietitians declared they were at ease to integrate patients' preferences and values, and their clinical expertise and judgment, in decision making, which are fundamental elements of EBP. A major reported barrier to KT was the perception that time to identify and read scientific literature was not expected during working hours and that instead, this time should be spent in clinical activities with patients. On the other hand, dietitians identified that their frequent involvement in educational activities such as knowledge dissemination or tailoring favored the integration of evidence into practice. Finally, dietitians struggled more to identify evidence-based information about counseling and communication than about biomedical knowledge. CONCLUSIONS: Dietitians mentioned being involved in each step of the KT process (ie, synthesis, dissemination, exchange, and ethically sound application of knowledge). Barriers and facilitators identified in this study need to be explored in a larger population to develop strategies to facilitate KT and EBP in dietetics practice.status: publishe

Knowledge translation and evidence-based practice ::a qualitative study on clinical dietitians' perceptions and practices in Switzerland

Background : Knowledge translation (KT) in health care is essential to promote quality of care and reduce the knowledge-to-practice gap. Little is known about KT among dietitians, and a better understanding of how this process pans out is fundamental to support their clinical practice. Objective : To explore clinical dietitians’ perceptions and practices concerning preferences and access to information sources in clinical practice, KT activities, research in nutrition and dietetics, and evidence-based practice (EBP). Design, participants, and setting : Eight interviews and two focus groups involving a total of 15 participants were conducted in 2013 among members of the Swiss Association for Registered Dietitians in the French- and German-speaking regions of Switzerland. Analysis performed : Thematic analysis drawn from a constructivist grounded theory approach. Results : Information from colleagues and experts of the field were favored when facing unfamiliar situations in clinical practice. Critically selecting evidence-based information was considered challenging, but dietitians declared they were at ease to integrate patients’ preferences and values, and their clinical expertise and judgment, in decision making, which are fundamental elements of EBP. A major reported barrier to KT was the perception that time to identify and read scientific literature was not expected during working hours and that instead, this time should be spent in clinical activities with patients. On the other hand, dietitians identified that their frequent involvement in educational activities such as knowledge dissemination or tailoring favored the integration of evidence into practice. Finally, dietitians struggled more to identify evidence-based information about counseling and communication than about biomedical knowledge. Conclusions : Dietitians mentioned being involved in each step of the KT process (ie, synthesis, dissemination, exchange, and ethically sound application of knowledge). Barriers and facilitators identified in this study need to be explored in a larger population to develop strategies to facilitate KT and EBP in dietetics practice

Österreichischer Kinder- und Jugendgesundheitsbericht

Der vorliegende Bericht gibt - nach Maßgabe der vorhandenen Daten - Auskunft über die gesundheitliche Situation von Kindern und Jugendlichen. Er thematisiert individuelle sowie verhältnisbezogene Gesundheitsdeterminanten und legt einen Schwerpunkt auf das Thema Chancengerechtigkeit. Er verweist auf diesbezügliche Entwicklungen und macht, u. a. über internationale Vergleiche, Herausforderungen und Problemfelder sichtbar. Der Kinder- und Jugendgesundheitsbericht liefert damit wichtige Anhaltspunkte zur Entwicklung geeigneter Gegenstrategien sowie Hinweise für gesundheitspolitische Schwerpunktsetzungen. Er identifiziert relevante Risikogruppen und ermöglicht eine zwischenbilanzierende Beurteilung bisheriger Strategien und Maßnahmen. Der Kinder- und Jugendgesundheitsbericht bildet die Basis für nachfolgende Planungsentscheidungen und richtet sich an die informierte Fachöffentlichkeit sowie an (politische) Entscheidungsträger

Handlungsmodule für Gesundheitsförderungsmaßnahmen mit dem Schwerpunkt Bewegung

Der Bericht hat zum Ziel, Wissen in Bezug auf gut funktionierende Ansätze und Methoden und damit verbundene Lernerfahrungen (Lessons learned) aus den vom FGÖ seit 2010 geförderten Bewegungsprojekten zur Verfügung zu stellen. Er wendet sich sowohl an Antragstellende aus dem organisierten Sport als auch an Personen aus unterschiedlichen Settings, die das Thema gesunde Bewegung in ihrem Umfeld aufgreifen und bearbeiten wollen. Er soll vor allem jenen als Unterstützung dienen, die in der Planung und Umsetzung entsprechender Maßnahmen auf wenig eigene oder institutionelle Erfahrung zurückgreifen können. ***** Methode: 20 Gesundheitsförderungsprojekte mit Schwerpunkt Bewegung, die nicht nur die Qualitätskriterien der Gesundheitsförderung berücksichtigten, sondern auch ein breites Spektrum von Zielgruppen abdeckten, wurden gesichtet. Die Lernerfahrungen daraus wurden anhand von Projektberichten, Evaluationsberichten und weiteren Projektmaterialien (z. B. Folder, Websites) identifiziert und mit den Projektverantwortlichen verifiziert. Die Aufbereitung der Lernerfahrungen orientierte sich einerseits am Projektmanagement-Cycle und andererseits am Monitoringmodell von Szabo et al. (2016). Ergänzend wurden auch Materialien aus Projekten erfasst, die zur allgemeinen Verwendung zur Verfügung gestellt werden können. ***** Schlussfolgerungen: Die Lernerfahrungen zeigen, dass sorgfältige Planung und abgestimmte Prozesse notwendig sind, um für eine gewählte Zielgruppe attraktive Bewegungsangebote dauerhaft etablieren zu können. Wesentliche Erfolgsfaktoren sind die Einbindung möglichst vieler Akteurinnen/Akteure aus der Gemeinde, aber auch der ausgewählten Zielgruppe bereits in der Planungsphase. Definierte Ansprechpersonen können nicht nur für gute Kommunikation, sondern auch für schnelle und kreative Lösungen vor Ort sorgen

Additional file 1: of Meeting physicians’ needs: a bottom-up approach for improving the implementation of medical knowledge into practice

Original citations from interviews, focus group discussions and online surveys. (DOC 38 kb