Community health programs delivered through information and communications technology in high-income countries : Scoping review

Background: The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. Objective: The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. Methods: The Joanna Briggs Institute’s scoping review methodology guided the review of the literature. Results: The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. Conclusions: Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers

Patient views on asthma diagnosis and how a clinical decision support system could help:a qualitative study

Abstract Introduction Making a diagnosis of asthma can be challenging for clinicians and patients. A clinical decision support system (CDSS) for use in primary care including a patient‐facing mode, could change how information is shared between patients and healthcare professionals and improve the diagnostic process. Methods Participants diagnosed with asthma within the last 5 years were recruited from general practices across four UK regions. In‐depth interviews were used to explore patient experiences relating to their asthma diagnosis and to understand how a CDSS could be used to improve the diagnostic process for patients. Interviews were audio recorded, transcribed verbatim and analysed using a thematic approach. Results Seventeen participants (12 female) undertook interviews, including 14 individuals and 3 parents of children with asthma. Being diagnosed with asthma was generally considered an uncertain process. Participants felt a lack of consultation time and poor communication affected their understanding of asthma and what to expect. Had the nature of asthma and the steps required to make a diagnosis been explained more clearly, patients felt their understanding and engagement in asthma self‐management could have been improved. Participants considered that a CDSS could provide resources to support the diagnostic process, prompt dialogue, aid understanding and support shared decision‐making. Conclusion Undergoing an asthma diagnosis was uncertain for patients if their ideas and concerns were not addressed by clinicians and were influenced by a lack of consultation time and limitations in communication. An asthma diagnosis CDSS could provide structure and an interface to prompt dialogue, provide visuals about asthma to aid understanding and encourage patient involvement. Patient and Public Contribution Prespecified semistructured interview topic guides (young person and adult versions) were developed by the research team and piloted with members of the Asthma UK Centre for Applied Research Patient and Public Involvement (PPI) group. Findings were regularly discussed within the research group and with PPI colleagues to aid the interpretation of data

Descriptive profile of the academic integrity of Australian occupational therapy students

Academic integrity is the moral code of academia. Students who demonstrate trustworthiness in an academic setting are more likely to be dependable in a clinical setting. It is, therefore, important for occupational therapy academic and fieldwork educators to know the academic integrity profile of their students and to address any areas of academic dishonesty in curriculum design and delivery. To date, there has been no baseline description of the academic honesty profile of Australian occupational therapy students.To establish a baseline of academic integrity and academic dishonesty among occupational therapy undergraduate and graduate-entry masters students in a cohort of Australian students.Seven hundred and one students from five Australian universities completed a self-report questionnaire comprising demographic questions and six standardised scales measuring academic integrity.Overall, occupational therapy students reported high levels of academic and fieldwork integrity; however, some areas of concerns exist. Students report copying material without citations at least once during their studies (55%), obtaining test questions at least once during their studies (42.6%) or padding out a bibliography (39.5%).Occupational therapy education needs to continue to emphasise the importance of academic and fieldwork integrity. Students need to be explicitly taught what academic honesty and dishonesty is and be provided with the resources and time to complete academic work to reduce the risk of academic dishonesty

Clinician views on how clinical decision support systems can help diagnose asthma in primary care : a qualitative study

Funding This work was supported by Asthma & Lung UK under Grant AUK-PG-2018-404 and Chief Scientist Office under Grant CAF/17/01.Peer reviewe

Implementation interventions to promote the uptake of evidence-based practices in stroke rehabilitation (Review)

Background Rehabilitation based upon research evidence gives stroke survivors the best chance of recovery. There is substantial research to guide practice in stroke rehabilitation, yet uptake of evidence by healthcare professionals is typically slow and patients often do not receive evidence‐based care. Implementation interventions are an important means to translate knowledge from research to practice and thus optimise the care and outcomes for stroke survivors. A synthesis of research evidence is required to guide the selection and use of implementation interventions in stroke rehabilitation. Objectives To assess the effects of implementation interventions to promote the uptake of evidence‐based practices (including clinical assessments and treatments recommended in evidence‐based guidelines) in stroke rehabilitation and to assess the effects of implementation interventions tailored to address identified barriers to change compared to non‐tailored interventions in stroke rehabilitation. Search methods We searched CENTRAL, MEDLINE, Embase, and eight other databases to 17 October 2019. We searched OpenGrey, performed citation tracking and reference checking for included studies and contacted authors of included studies to obtain further information and identify potentially relevant studies. Selection criteria We included individual and cluster randomised trials, non‐randomised trials, interrupted time series studies and controlled before‐after studies comparing an implementation intervention to no intervention or to another implementation approach in stroke rehabilitation. Participants were qualified healthcare professionals working in stroke rehabilitation and the patients they cared for. Studies were considered for inclusion regardless of date, language or publication status. Main outcomes were healthcare professional adherence to recommended treatment, patient adherence to recommended treatment, patient health status and well‐being, healthcare professional intention and satisfaction, resource use outcomes and adverse effects. Data collection and analysis Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. The primary comparison was any implementation intervention compared to no intervention. Main results Nine cluster randomised trials (12,428 patient participants) and three ongoing trials met our selection criteria. Five trials (8865 participants) compared an implementation intervention to no intervention, three trials (3150 participants) compared one implementation intervention to another implementation intervention, and one three‐arm trial (413 participants) compared two different implementation interventions to no intervention. Eight trials investigated multifaceted interventions; educational meetings and educational materials were the most common components. Six trials described tailoring the intervention content to identified barriers to change. Two trials focused on evidence‐based stroke rehabilitation in the acute setting, four focused on the subacute inpatient setting and three trials focused on stroke rehabilitation in the community setting. We are uncertain if implementation interventions improve healthcare professional adherence to evidence‐based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence was very low (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.53 to 2.64; 2 trials, 39 clusters, 1455 patient participants; I2 = 0%). Low‐certainty evidence indicates implementation interventions in stroke rehabilitation may lead to little or no difference in patient adherence to recommended treatment (number of recommended performed outdoor journeys adjusted mean difference (MD) 0.5, 95% CI –1.8 to 2.8; 1 trial, 21 clusters, 100 participants) and patient psychological well‐being (standardised mean difference (SMD) –0.02, 95% CI –0.54 to 0.50; 2 trials, 65 clusters, 1273 participants; I2 = 0%) compared with no intervention. Moderate‐certainty evidence indicates implementation interventions in stroke rehabilitation probably lead to little or no difference in patient health‐related quality of life (MD 0.01, 95% CI –0.02 to 0.05; 2 trials, 65 clusters, 1242 participants; I2 = 0%) and activities of daily living (MD 0.29, 95% CI –0.16 to 0.73; 2 trials, 65 clusters, 1272 participants; I2 = 0%) compared with no intervention. No studies reported the effects of implementation interventions in stroke rehabilitation on healthcare professional intention to change behaviour or satisfaction. Five studies reported economic outcomes, with one study reporting cost‐effectiveness of the implementation intervention. However, this was assessed at high risk of bias. The other four studies did not demonstrate the cost‐effectiveness of interventions. Tailoring interventions to identified barriers did not alter results. We are uncertain of the effect of one implementation intervention versus another given the limited very low‐certainty evidence. Authors' conclusions We are uncertain if implementation interventions improve healthcare professional adherence to evidence‐based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence is very low

Oral health interventions for people living with mental disorders: protocol for a realist systematic review

Background The increasing number of people who experience mental disorders is a global problem. People with mental disorders have high rates of co-morbidity and significantly poorer oral health outcomes than the general public. However, their oral health remains largely a hidden and neglected issue. A complex range of factors impact the oral health of this group. These include anxiety and dental phobia, dietary habits, including the heavy consumption of sugary drinks, substance misuse of tobacco, alcohol, and/or psychostimulants, the adverse orofacial side effects of anti-psychotic and anti-depression medications, and financial, geographic, and social barriers to accessing oral health care. Methods The aim of this realist systematic review is to (a) identify and synthesise evidence that explores oral health interventions for people living with mental disorders; (b) explore the context and mechanisms that have contributed to the success of interventions or the barriers and challenges; (c) produce program theories on causal, contextual and mechanistic factors to facilitate outcomes and (d) produce recommendations and guidelines to guide future oral health interventions for people with mental disorders at both the policy and practice level. Using a five-step process, that incorporates primary data collection from key stakeholders, a beginning theoretical framework will be developed to describe contextual and mechanistic factors and how they might impact on the success or failure of oral health interventions for people with mental disorders. Key database searches will be conducted, with data extraction focused on the factors that might have impacted on intervention implementation and outcomes. Quality appraisal of studies will occur, and the theoretical framework will be populated with extracted data. Stakeholder input will support the development and refinement of a theory on oral health interventions for people with mental disorders. Discussion This will be the first review to take a realist approach to explore the broad scope of causal factors that impact on the success or failure of oral health interventions for people with mental disorders. The approach includes extensive stakeholder engagement and will advance realist systematic review methodology. Review outcomes will be important in guiding policy and practice to ensure oral health interventions better meet the needs of people with mental disorders. Systematic review registration This review protocol is registered with PROSPERO (Number) 155969

Professional care workforce: a rapid review of evidence supporting methods of recruitment, retention, safety, and education

Background: Across the care economy there are major shortages in the health and care workforce, as well as high rates of attrition and ill-defined career pathways. The aim of this study was to evaluate current evidence regarding methods to improve care worker recruitment, retention, safety, and education, for the professional care workforce. Methods: A rapid review of comparative interventions designed to recruit, retain, educate and care for the professional workforce in the following sectors: disability, aged care, health, mental health, family and youth services, and early childhood education and care was conducted. Embase and MEDLINE databases were searched, and studies published between January 2015 and November 2022 were included. We used the Quality Assessment tool for Quantitative Studies and the PEDro tools to evaluate study quality. Results: 5594 articles were initially screened and after applying the inclusion and exclusion criteria, 30 studies were included in the rapid review. Studies most frequently reported on the professional nursing, medical and allied health workforces. Some studies focused on the single domain of care worker education (n = 11) while most focused on multiple domains that combined education with recruitment strategies, retention strategies or a focus on worker safety. Study quality was comparatively low with a median PEDro score of 5/10, and 77% received a weak rating on the Quality Assessment tool for Quantitative Studies. Four new workforce strategies emerged; early career rural recruitment supports rural retention; workload management is essential for workforce well-being; learning must be contextually relevant; and there is a need to differentiate recruitment, retention, and education strategies for different professional health and care workforce categories as needs vary. Conclusions: Given the critical importance of recruiting and retaining a strong health and care workforce, there is an immediate need to develop a cohesive strategy to address workforce shortfalls. This paper presents initial evidence on different interventions to address this need, and to inform care workforce recruitment and retention. Rapid Review registration PROSPERO 2022 CRD42022371721 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202237172

Scoping reviews in occupational therapy: The what, why, and how to

Background/aim: Scoping reviews are a method of identifying, locating, analysing and summarising relevant empirical literature and research findings on a nominated topic. A description of scoping reviews is provided with examples that have been published in the occupational therapy and related literature and outline of the uses of scoping reviews for research and in evidence-based practice. Methods: Recent occupational therapy literature was searched to identify occupational therapy-related scoping reviews published in the refereed literature and to identify the methodologies used and topics covered. Results: A limited range of scoping reviews was located and a summary of their results is provided as examples of scoping reviews in the occupational therapy field. Conclusion: The scoping review methodology is an efficient and effective approach for locating, analysing, summarising and presenting available literature and research findings on a particular topic. In comparison to a systematic review, it does not have the same high level of rigour, however does provide a general overview of the literature using a structured methodology to ensure consistency. The methodology of scoping reviews is effective for researchers where there is limited high level evidence available about a topic that would be required by a systematic review and provides an efficient way of identifying previous research and current knowledge gaps. Although there has been some scoping reviews published, it is predicted that there will be an increase in the future when the use of scoping reviews in occupational therapy is more fully realised and operationalised

Clinical Supervision Frameworks for Allied Health Professionals: A Systematic and Critical Review

Purpose: Clinical supervision is an important element of professional support for allied health professionals and contributes to the provision of safe, high quality patient care and health professional wellbeing. Structured clinical supervision frameworks have been recommended to improve access and effectiveness of clinical supervision for allied health professionals by providing practical guidance and increased consistency. However, there is limited evidence relating to the availability and quality of clinical supervision frameworks for allied health. Method: A systematic and critical review was conducted to identify and appraise clinical supervision frameworks for allied health. Included were peer-reviewed studies and grey literature documents, available in full text and written in English. Six databases and government and professional association websites were searched. The AGREE Health Systems Guidance (AGREE-HS) tool was used to appraise framework quality. Three researchers independently reviewed the frameworks and reached consensus on scores through discussion. AGREE-HS scores were analysed descriptively. Results: Twenty-six frameworks were appraised by the AGREE-HS including 7 peer-reviewed studies and 19 grey literature documents. Over half of all frameworks were from Australia, and the profession/s that they related to were most commonly allied health, social work, or psychology. The combined mean of the AGREE-HS final items scores for all studies/documents was 14.5 (SD = 4.0) out of a possible score of 35. Frameworks published in peer-reviewed studies used more robust methods to inform their development than frameworks sourced from the grey literature. In contrast, grey literature frameworks were often more clearly outlined, succinct, practical, and flexible for stakeholders to implement. Conclusions: There are limited published frameworks available for allied health professionals, and the frameworks that do exist are generally of low quality. As a result, many existing frameworks may not provide the practical guidance required to improve clinical supervision practice and optimise the benefits of clinical supervision. It is recommended that future policy relating clinical supervision needs to focus on the development of common, evidence-based allied health clinical supervision frameworks. Future frameworks should be practically orientated and use robust methods and evaluation to inform their development and implementation