Design and management considerations for control groups in hybrid effectiveness-implementation trials: Narrative review & case studies.

Hybrid effectiveness-implementation studies allow researchers to combine study of a clinical intervention's effectiveness with study of its implementation with the aim of accelerating the translation of evidence into practice. However, there currently exists limited guidance on how to design and manage such hybrid studies. This is particularly true for studies that include a comparison/control arm that, by design, receives less implementation support than the intervention arm. Lack of such guidance can present a challenge for researchers both in setting up but also in effectively managing participating sites in such trials. This paper uses a narrative review of the literature (Phase 1 of the research) and comparative case study of three studies (Phase 2 of the research) to identify common themes related to study design and management. Based on these, we comment and reflect on: (1) the balance that needs to be struck between fidelity to the study design and tailoring to emerging requests from participating sites as part of the research process, and (2) the modifications to the implementation strategies being evaluated. Hybrid trial teams should carefully consider the impact of design selection, trial management decisions, and any modifications to implementation processes and/or support on the delivery of a controlled evaluation. The rationale for these choices should be systematically reported to fill the gap in the literature

Un análisis del trabajo de equipos asistenciales de salud mental que acompañan a los hijos de desaparecidos en el proceso de restitución de su identidad en Buenos Aires / An analysis of mental health teams that work with the appropriated children of the desaparecidos throughout the judicial identity restitution process in Buenos Aires

Background: The Argentine national law of mental health (law 26.657) mentions human rights 11 times. This has particular importance in the context of the state of terrorism that the country was under surrounding the last “golpe militar” of 1976. Part of the implemented terror tactics included the kidnapping of 30,000 people—desaparecidos—who did not agree with state politics. The kidnappings were nondiscriminatory and included pregnant women. The babies, that were born in the clandestine centers of detention, torture and extermination, had their birth certificates falsified and became part of a systematic plan of appropriation. They were subsequently either taken in by military families complicit with the state of terrorism or adopted illegally. An estimated 500 children were taken this way and forced to live with their appropriators, unknowing of their true origins nor their real identity. The civil association known as Abuelas de Plaza de Mayo is a nongovernmental organization founded by the grandmothers of these lost children and is fighting to locate them and restitute their real identities. With the annulment of the laws Obediencia Debida and Punto Final, which granted impunity for those responsible for the countless crimes against humanity, identity restitutions have become national judicial processes that include trials of the appropriators. This investigation focuses on the work of three mental health teams that accompany the individuals going through this identity restitution process. Methodology: This is a qualitative investigation made up of primary and secondary sources. These sources are testimonies of coordinators of mental health teams and those of the recovered children of the desaparecidos. The primary sources are guided interviews with three licensed psychologists who coordinate a mental health team within a particular organization: Alicia Stolkiner from the Comisión Nacional de Derecho de la Identidad (CONADI), Alicia Lo Giúdice from the Abuelas de Plaza de Mayo, and Juliana Serritella from Centro Fernando Ulloa de Asistencia a Víctimas de Violaciones de Derechos Humanos. Testimonies of the restituted children for the most part came from the series documentary “Acá Estamos” and the documentary film “Quién soy yo?”, both of which were produced by the national Ministerio de Educación. Results: The three teams focused on in the paper accompany an individual through the identity restitution process in similar ways. The interdisciplinary team of CONADI principally serves to prepare the individuals for trial and prevent situations of maltreatment within judicial procedures. The team within the Abuelas and the team within Centro Ulloa both offer psychological and psychiatric treatments to assist with the psychological process of identity restitution, focusing predominantly on psychoanalytic strategies. The work of the three teams overlaps noticeably because their approach is characterized by the same three principles of do not force, do not generalize and try to dismantle tendencies of objectification

“Day or night, no matter what, I will go”: Women’s perspectives on challenges with follow-up care after cervical cancer screening in Iquitos, Peru: a qualitative study

Abstract Background The study’s objective was to explore the factors associated with loss to follow-up among women with abnormal cervical cancer screening results in Iquitos, Peru from women’s perspectives. Methods In-depth interviews were conducted with 20 screen-positive women who were referred for follow-up care but for whom evidence of follow-up was not found. Interview transcripts were thematically analyzed inductively, and the codes were then categorized using the Health Care Access Barriers Model for presentation of results. Results All interviewed women were highly motivated to complete the continuum of care but faced numerous barriers along the way, including cognitive barriers such as a lack of knowledge about cervical cancer and poor communication from health professionals regarding the process, structural barriers such as challenges with scheduling appointments and unavailability of providers, and financial barriers including out-of-pocket payments and costs related to travel or missing days of work. With no information system tracking the continuum of care, we found fragmentation between primary and hospital-level care, and often, registration of women’s follow-up care was missing altogether, preventing women from being able to receive proper care and providers from ensuring that women receive care and treatment as needed. Conclusions The challenges elucidated demonstrate the complexity of implementing a successful cervical cancer prevention program and indicate a need for any such program to consider the perspectives of women to improve follow-up after a positive screening test