Immigrant families' perceptions on walking to school and school breakfast: a focus group study

Background: Immigrant children face an increased risk of being overweight. Little is known about how immigrant families perceive school programs that may help prevent obesity, such as walking to school and school breakfast. Methods: Six focus groups (n = 53) were conducted with immigrant parents of school-aged children, two each in three languages: Vietnamese, Spanish, and Somali. A facilitator and translator conducted the focus groups using a script and question guide. Written notes and audio transcripts were recorded in each group. Transcripts were coded for themes by two researchers and findings classified according to an ecological model. Results: Participants in each ethnic group held positive beliefs about the benefits of walking and eating breakfast. Barriers to walking to school included fear of children's safety due to stranger abductions, distrust of neighbors, and traffic, and feasibility barriers due to distance to schools, parent work constraints, and large families with multiple children. Barriers to school breakfast participation included concerns children would not eat due to lack of appealing/appropriate foods and missing breakfast due to late bus arrival or lack of reminders. Although some parents acknowledged concerns about child and adult obesity overall, obesity concerns did not seem personally relevant. Conclusion: Immigrant parents supported the ideals of walking to school and eating breakfast, but identified barriers to participation in school programs across domains of the ecological model, including community, institution, and built environment factors. Schools and communities serving immigrant families may need to address these barriers in order to engage parents and children in walking and breakfast programs.Group Health Community Foundation (JC), Robert Wood Johnson Foundation Injury Free Coalition for Kids Obesity Synergy Grant (KB), Health Resources and Services Administration (HRSA) NRSA fellowship (MG)

Pilot implementation of elder-friendly care practices in acute care setting: a mixed methods study

Abstract Background Frail older patients are at risk of experiencing a decline in physical and cognitive function unrelated to the reason for admission. The Elder-Friendly Care (EFC) program was designed to improve the care, experiences, and outcomes of frail older adults. The project supported 8 Early Adoption Sites (EAS) in a large Canadian healthcare organization by providing multiple strategies, educational opportunities, and resources. The purpose of this study was to assess the usefulness of EFC educational materials and resources, staff practice changes and perceptions in pilot sites, and readiness for scale and spread. Methods The study was conducted from May 2017 to June 2018 using a mixed-methods approach incorporating the Kirkpatrick Model of Training/Evaluation. A total of 76 Direct Care Staff participated in the staff survey, which assessed their awareness of, satisfaction with, and utilization of EFC principles, resources, and practices. Additionally, 12 interviews were conducted with staff who were directly involved in site implementation of EFC. Results Most survey participants were aware (86%, n = 63) of the EFC program, and 85% (n = 41) indicated they or their site/unit had implemented EFC. Out of these 41 participants, the most common practice changes identified were: incorporating alternatives to restraint (81%, n = 33), decreased use of pharmacological restraint (78%, n = 32), and patient and family care planning (76%, n = 31). Participants that attended all 3 EFC Learning Workshops (LWs) were significantly more likely to recommend the EFC Toolkit to others (87% versus 40%; χ2 = 8.82, p < 0.01) compared to participants attending less than 3 EFC LWs. Interview participants indicated that the program was well structured and flexible as sites/units could adopt changes that suited their individual sites, needs, contexts, and challenges. Conclusions The educational materials and resources used for the EFC project are useful and appreciated by the Direct Care Staff. Further, participants perceive the EFC intervention as effective in creating positive practice change and useful in reducing hospital-related complications for older patients. Future implementation will investigate the impact of EFC on system-level outcomes in acute care

Effect of a multimethod quality improvement intervention on antipsychotic medication use among residents of long-term care

Background Antipsychotic medications are used to address neuropsychiatric symptoms associated with dementia. Evidence suggests that among older adults with dementia, their harms outweigh their benefits. A quality improvement initiative was conducted to address inappropriate antipsychotic medication use in long-term care (LTC) in the province of Alberta.Methods We conducted a multimethod evaluation of the provincial implementation of the project in 170 LTC sites over a 3-year project period incorporating a quasi-experimental before–after design. Using a three-component intervention of education and audit and feedback delivered in a learning workshop innovation collaborative format, local LTC teams were supported to reduce the number of residents receiving antipsychotic medications in the absence of a documented indication. Project resources were preferentially allocated to supporting sites with the highest baseline antipsychotic medication use. Changes in antipsychotic medication use, associated clinical and economic outcomes, and the effects of the project on LTC staff, physicians, leaders and administrators, and family members of LTC residents were assessed at the conclusion of the implementation phase.Results The province-wide initiative was delivered with a 75% implementation fidelity. Inappropriate antipsychotic medication use declined from 26.8% to 21.1%. The decrease was achieved without unintended consequences in other outcomes including physical restraint use or aggressive behaviours. The project was more expensive but resulted in less inappropriate use of antipsychotics than the pre-project period (incremental cost per inappropriate antipsychotic avoided of $5 678.71). Accounts from family, organisational leaders, and LTC staff were supportive of the project activities and outcomes.Conclusion This quality improvement initiative was successfully delivered across an entire delivery arm of the continuing care sector. Quality of care in LTC was improved