Context and the evidence based paradigm: The potential for participatory research and systems thinking in oral health

The implementation of research evidence to promote oral health is critical, given the intransigent and emerging challenges for policy-makers at a population level. Despite this, little attention has been paid to implementation research within the evidence-based paradigm. This is important as getting research evidence into clinical practice is not a linear path that consists of simple sequential steps. In this article, we argue that we need to consider a broader range of conceptual and methodological approaches to increase the value of information generated. This should be undertaken either in parallel with empirical and experimental designs, or in some cases, instead of. This is important if we are going to understand the complexity and contextual knowledge of the ‘system’, within which interventions are implemented. Involving key stakeholders alongside empirical and experimental designs is one helpful approach. Examples of these approaches include Patient and Public Involvement and the development of Core Outcome Sets, where the views of those that will be potentially affected by the research, are included. The use of theoretical frameworks and process evaluations alongside trials are also important, if they are fully integrated into the approach taken to address the research question. A more radical approach is using participatory designs and ‘systems thinking’. Participatory approaches include subject matter 'experts by experience’. These include patients, their families, carers, healthcare professionals, services managers, policy-makers, commissioners and researchers. Participatory approaches raise important questions about who facilitates the process, when it should happen and how the diverse actors become meaningfully engaged so that their involvement is active, democratic and on-going. We argue that the issues of control, power and language are central to this and represent a paradigmatic shift to conventional approaches. Systems thinking captures the idea that public health problems commonly involve multiple interdependent and interconnected factors, which interact with each other dynamically. This approach challenges the simplicity of the hierarchy of evidence and linear sequential logic, when it doesn’t account for context. In contrast, systems thinking accepts complexity de novo and emphasises the need to understand the whole system rather than its individual component parts. We conclude with the idea that participatory and systems thinking helps to unpack the diverse agents that are often involved in the generation and translation of evidence into clinical dental practice. It moves our conception of research away from a simple exchange between ‘knowledge producers’ and ‘knowledge users’ and raises both methodological and epistemological challenges

Low literacy and written drug information: information-seeking, leaflet evaluation and preferences, and roles for images

Background Low-literate patients are at risk to misinterpret written drug information. For the (co-) design of targeted patient information, it is key to involve this group in determining their communication barriers and information needs. Objective To gain insight into how people with low literacy use and evaluate written drug information, and to identify ways in which they feel the patient leaflet can be improved, and in particular how images could be used. Setting Food banks and an education institution for Dutch language training in the Netherlands. Method Semi-structured focus groups and individual interviews were held with low-literate participants (n = 45). The thematic framework approach was used for analysis to identify themes in the data. Main outcome measure Low-literate people’s experience with patient information leaflets, ideas for improvements, and perceptions on possible uses for visuals. Results Patient information leaflets were considered discouraging to use, and information difficult to find and understand. Many rely on alternative information sources. The leaflet should be shorter, and improved in terms of organisation, legibility and readability. Participants thought images could increase the leaflet’s appeal, help ask questions, provide an overview, help understand textual information, aid recall, reassure, and even lead to increased confidence, empowerment and feeling of safety. Conclusion Already at the stages of paying attention to the leaflet and maintaining interest in the message, low-literate patients experience barriers in the communication process through written drug information. Short, structured, visual/textual explanations can lower the motivational threshold to use the leaflet, improve understanding, and empower the low-literate target group

Co-design of Sustainability Models: Examples

The process to develop a Sustainability Model Canvas described in the previous chapter was applied to three different social innovation projects of the CampUs program: Plug Social TV, Shared Garden, and Adaptable Self-Managed Itinerant Pavilion (PAAI in Italian). In this chapter, we illustrate the canvases developed for these social innovation projects and the processes followed to obtain these results. Moreover, we describe the main issues which emerged from the first attempts to identify value propositions, customer segments, and revenue streams leading up to the final Sustainability Model Canvas defined for each project. The workshops and the processes described in this chapter have helped the three social innovation projects to define their economic sustainability path