Process evaluation of an integrated community-based intervention for promoting health equity in children in a new residential development area

Background: Reducing health inequities for children from a disadvantaged background is an important task in public health. While intersectoral partnerships are a promising way to achieve this, few studies have examined the factors influencing the success of these interventions. In this study, we conducted a process evaluation of the integrated community-based intervention Präventionskette Freiham that the city of Munich, Germany, has implemented in a new residential development area. The aim was to investigate the implementation process as well as barriers and facilitators. Methods: Following a mixed methods approach, we collected data from different core groups making up Präventionskette Freiham from April 2020 to August 2022, exploring their perspective on the implementation process. We conducted repeated qualitative interviews with the network coordinators and eleven local professionals from institutions engaged with or relevant for the intervention. We also undertook a focus group with four members of the advisory group representing the three municipal departments guiding the intervention. Ego-centered network maps were drawn by the network coordinators to chart the development of the network. Subsequently, we also conducted an online survey with local network members. Results: At the early stage of the implementation process, the intervention was able to integrate actors from different sectors, serving as a platform for mutual exchange. However, the network produced limited output. According to the interviews, this may be mainly attributable to the early development status of the area. We identified seven topics that may act as facilitators or barriers to implementation of Präventionskette Freiham: (1) availability of resources, (2) political and administrative support, (3) the network coordinators, (4) network-internal processes, (5) trans-institutional cooperation, (6) perceived benefits of engagement, and (7) the output of the network. Conclusions: The early development status of the area was a challenge for the intervention. This emphasizes the need to carefully consider context when planning and implementing integrated community-based public health interventions in new residential development areas

Implementing a psychosocial care approach in pediatric inpatient care: process evaluation of the pilot Child Life Specialist program at the University Hospital of Munich, Germany

BackgroundChild Life Specialists (CLSs) are psychosocial care professionals of child development and health who focus on the individual needs and rights of young patients. CLSs accompany sick children and focus on the children's perspective and their reality of life. CLS programs are already established in clinical settings in the United States and other Anglophone countries but have not yet been piloted in the German health care setting, neither has their implementation been evaluated in this context. This study aimed to explore the factors influencing the implementation of a pilot CLS program in pediatric inpatient care at the Dr. von Hauner Children's Hospital at the University Hospital of Munich, Germany.MethodsBuilding on methods commonly employed in the evaluation of complex interventions, we developed a logic model to guide the process evaluation of our program. Semi-structured interviews with four groups of stakeholders were conducted in person or via videoconferencing between June 2021 and January 2022. Data was analyzed collectively using the method of qualitative content analysis by Mayring.ResultsFifteen individual interviews were conducted with patients (children aged 5–17 years, n = 4), parents (n = 4), CLSs (n = 4) and other health professionals (n = 3). Factors influencing the implementation were identified on three levels: system, staff and intervention. On the system level, a clearer definition of CLSs’ tasks and responsibilities was perceived as important and would likely lead to a delineation from other (psychosocial) professions and a reduction of potential resistances. On the staff level, lacking training opportunities and feelings of being insufficiently skilled were limiting the CLSs professional self-confidence. On the intervention level, the emergence of a unique characteristic of the CLSs’ work (i.e., preparation for medical procedures) supported the acceptance of the new program.ConclusionsThe implementation of a CLS program into an established hospital system with existing psychosocial care services is challenging. Our results contribute to a better understanding of implementation processes of such an additional psychosocial care approach and provide recommendations for addressing upcoming challenges

Einflussfaktoren beim Aufbau von Präventionsketten in Neubaugebieten am Beispiel des Münchner Stadtteils Freiham – eine qualitative Studie

Introduction. Praventionsketten (prevention chains) are integrated municipal strategies to promote health and social participation for children, adolescents, and families and to prevent the negative consequences of child poverty. They exist as intersectoral networks in multiple communities in Germany. However, the implementation of such intersectoral networks in new residential development areas has not yet been systematically examined. As part of the process evaluation of the intervention Praventionskette Freiham , which is being implemented in the Munich district of Freiham, a qualitative interview and focus group study was conducted. The aim was to identify relevant influencing factors for the implementation of this integrated municipal strategy. Methods. For this study, repeated interviews were conducted with the network management of the Praventionskette , and a focus group was held with representatives of the involved municipal departments. Furthermore, interviews were undertaken with 12 professionals working locally in the education, social and health sectors. The data were analyzed using qualitative content analysis following Mayring. Results. According to participants, general key influencing factors for a successful implementation were the provision of financial and human resources as well as the support from local policy makers and high-level administrators. The network coordination, transparent communication, the integration of the interests of different network members, and a clear communication of the added value of engaging with the network were central factors for successful operations. Regarding the specific setting of a new residential development area, implementing demand-oriented network structures with only a small number of initial residents and a still-to-be-established supporting infrastructure presented challenges. Conclusion. Sufficient funding and commitment by policy makers and administrators are central influencing factors for the implementation of Praventionsketten in municipalities. Especially in a new residential development area without an established infrastructure, the development process requires a long-term commitment