A conceptualisation of scale-up and sustainability of social innovations in global health: a narrative review and integrative framework for action

Background The scale-up and sustainability of social innovations for health have received increased interest in global health research in recent years; however, these ambiguous concepts are poorly defined and insufficiently theorised and studied. Researchers, policymakers, and practitioners lack conceptual clarity and integrated frameworks for the scale-up and sustainability of global health innovations. Often, the frameworks developed are conceived in a linear and deterministic or consequentialist vision of the diffusion of innovations. This approach limits the consideration of complexity in scaling up and sustaining innovations. Objective By using a systems theory lens and conducting a narrative review, this manuscript aims to produce an evidence-based integrative conceptual framework for the scale-up and sustainability of global health innovations. Method We conducted a hermeneutic narrative review to synthetise different definitions of scale-up and sustainability to model an integrative definition of these concepts for global health. We have summarised the literature on the determinants that influence the conditions for innovation success or failure while noting the interconnections between internal and external innovation environments. Results The internal innovation environment includes innovation characteristics (effectiveness and testability, monitoring and evaluation systems, simplification processes, resource requirements) and organisational characteristics (leadership and governance, organisational change, and organisational viability). The external innovation environment refers to receptive and transformative environments; the values, cultures, norms, and practices of individuals, communities, organisations, and systems; and other contextual characteristics relevant to innovation development. Conclusion From these syntheses, we proposed an interconnected framework for action to better guide innovation researchers, practitioners, and policymakers in incorporating complexity and systemic interactions between internal and external innovation environments in global health. -- Keywords : Scale-up ; sustainability ; social innovation ; narrative review ; global health ; systems thinking.hinking

Patients' and Practitioners' Views of Knee Osteoarthritis and Its Management: A Qualitative Interview Study

PURPOSE: To identify the views of patients and care providers regarding the management of knee osteoarthritis (OA) and to reveal potential obstacles to improving health care strategies. METHODS: We performed a qualitative study based on semi-structured interviews of a stratified sample of 81 patients (59 women) and 29 practitioners (8 women, 11 general practitioners [GPs], 6 rheumatologists, 4 orthopedic surgeons, and 8 [4 GPs] delivering alternative medicine). RESULTS: Two main domains of patient views were identified: one about the patient-physician relationship and the other about treatments. Patients feel that their complaints are not taken seriously. They also feel that practitioners act as technicians, paying more attention to the knee than to the individual, and they consider that not enough time is spent on information and counseling. They have negative perceptions of drugs and a feeling of medical uncertainty about OA, which leads to less compliance with treatment and a switch to alternative medicine. Patients believe that knee OA is an inevitable illness associated with age, that not much can be done to modify its evolution, that treatments are of little help, and that practitioners have not much to propose. They express unrealistic fears about the impact of knee OA on daily and social life. Practitioners' views differ from those of patients. Physicians emphasize the difficulty in elaborating treatment strategies and the need for a tool to help in treatment choice. CONCLUSIONS: This qualitative study suggests several ways to improve the patient-practitioner relationship and the efficacy of treatment strategies, by increasing their acceptability and compliance. Providing adapted and formalized information to patients, adopting more global assessment and therapeutic approaches, and dealing more accurately with patients' paradoxal representation of drug therapy are main factors of improvement that should be addressed

Play and children’s recreational practices. Sociography of children’s leisure practices : An intercultural survey conducted with children aged 8 to 14 in six countries : Germany, Austria, China, the United-States, France, and Switzerland

Ce travail se propose de définir la place du jeu dans les pratiques de loisirs des enfants de 8 à 14 ans en identifiant les déterminations qui l’organisent et en esquissant une sociographie du jeu des enfants de cet âge. Il envisage le jeu comme un choix contingent sous contrainte, qui ne prend sens qu’à la lumière du système d’action concret dans lequel l’enfant évolue. Le jeu est une activité « sous contrainte », dont les contours sont esquissés par les adultes et dont l’occurrence est socialement organisée. La décision de jouer n’est pas une décision libre pour l’enfant. Elle est modelée par un ensemble de facteurs, matériels, sociaux et symboliques, qui viennent orienter, organiser et limiter son choix. La contrainte de temps, d’espace et le projet éducatif parental sont au cœur de ces contraintes. A partir de la question du jeu, il éclaire la question de la dépendance des enfants en donnant à voir ce que les « adultes font aux enfants » et la manière dont ils « réagissent aux situations qui leur sont faites ». En se penchant sur les pratiques de jeux des enfants, ce travail montre que le jeu est à la fois un espace de construction identitaire, de socialisation et de « libération dans l’imaginaire » des contraintes du quotidien. En replaçant le jeu dans le champ plus large des activités récréatives des enfants de 8 à 14 ans, il souligne le changement qui s’opère pendant cette période dans la vie des enfants et qui conduit à une évolution de leurs pratiques récréatives et à un déplacement du jeu vers de nouvelles sphères d’activités, plus fortement orientée vers la sociabilité entre pairs.This research analyzes the place of play in the recreational practices of children aged 8 to 14. It focuses on how these theses practices are determined and describes play practices of children of this age. Play is not a free choice but rather it is conditioned by a larger social system, drawn by adults and organized socially. The decision to play is not a free decision for children. It is shaped by a combination of material, social, and symbolic factors that direct, organize, and limit their choices. Time, space and parental educational priorities act as major constraints in this process. The research draws light on the issue of children’s dependency, by analyzing what "the adults do to children" and how children "react to the situations in where they are placed”. By focusing on children’s game practices, this research indicates that play is not only a part of identity construction and socialization; it nevertheless also allows a symbolic way to escape the constraints of daily life and adults’ control. Looking at play and the broader field of recreational activities provides insights on the change that occurs between 8 and 14, change that modifies children’s recreational practices and initiates a shift towards new areas of activities, more oriented towards peers

La place du jeu dans les pratiques de loisirs des enfants (Sociographie des activités récréatives des enfants âgés de 8 à 14 ans réalisée à partir d une enquête interculturelle conduite dans six pays)

Ce travail se propose de définir la place du jeu dans les pratiques de loisirs des enfants de 8 à 14 ans en identifiant les déterminations qui l organisent et en esquissant une sociographie du jeu des enfants de cet âge. Il envisage le jeu comme un choix contingent sous contrainte, qui ne prend sens qu à la lumière du système d action concret dans lequel l enfant évolue. Le jeu est une activité sous contrainte , dont les contours sont esquissés par les adultes et dont l occurrence est socialement organisée. La décision de jouer n est pas une décision libre pour l enfant. Elle est modelée par un ensemble de facteurs, matériels, sociaux et symboliques, qui viennent orienter, organiser et limiter son choix. La contrainte de temps, d espace et le projet éducatif parental sont au cœur de ces contraintes. A partir de la question du jeu, il éclaire la question de la dépendance des enfants en donnant à voir ce que les adultes font aux enfants et la manière dont ils réagissent aux situations qui leur sont faites . En se penchant sur les pratiques de jeux des enfants, ce travail montre que le jeu est à la fois un espace de construction identitaire, de socialisation et de libération dans l imaginaire des contraintes du quotidien. En replaçant le jeu dans le champ plus large des activités récréatives des enfants de 8 à 14 ans, il souligne le changement qui s opère pendant cette période dans la vie des enfants et qui conduit à une évolution de leurs pratiques récréatives et à un déplacement du jeu vers de nouvelles sphères d activités, plus fortement orientée vers la sociabilité entre pairs.This research analyzes the place of play in the recreational practices of children aged 8 to 14. It focuses on how these theses practices are determined and describes play practices of children of this age. Play is not a free choice but rather it is conditioned by a larger social system, drawn by adults and organized socially. The decision to play is not a free decision for children. It is shaped by a combination of material, social, and symbolic factors that direct, organize, and limit their choices. Time, space and parental educational priorities act as major constraints in this process. The research draws light on the issue of children s dependency, by analyzing what "the adults do to children" and how children "react to the situations in where they are placed . By focusing on children s game practices, this research indicates that play is not only a part of identity construction and socialization; it nevertheless also allows a symbolic way to escape the constraints of daily life and adults control. Looking at play and the broader field of recreational activities provides insights on the change that occurs between 8 and 14, change that modifies children s recreational practices and initiates a shift towards new areas of activities, more oriented towards peers.PARIS5-Bibliotheque electronique (751069902) / SudocSudocFranceF

Patients’ views and needs about systemic sclerosis and its management: a qualitative interview study

International audienceBACKGROUND: Systemic sclerosis (SSc) is a chronic connective-tissue disease responsible for reduced life expectancy, disability and a decreased quality of life. In order to optimize patients-physicians relationship and care strategy we aimed to survey views of patients on SSc and its management to reveal potential hurdles and improve health care strategies.METHODS: A qualitative study combined semi-structured interviews, focus groups, and a direct observation of an information session was performed between November 2008 and January 2009.RESULTS: Twenty-five patients with SSc were included. They encounter difficulties to have a clear representation of their disease. Physical, psychological, and social repercussions of SSc may lead to a psychological distress and different coping strategies, which widely differ among interviewed patients. Patients' views on their therapeutic journey and the management of their disease highlighted strong expectations about patient-physician relationship. These expectations were numerous, complex and sometimes ambivalent. Patients expected physicians to be human and attentive but also involved in research in the field and to provide psychological and affective support to help them to accept the uncertainty of disease evolution and lack of curative treatment. They also expected more individualized management, improvements in diagnosis and follow-up organization, more efforts in education and information, comprehensive behaviors and support from working colleagues and relatives, and increased funding from the health care system.CONCLUSIONS: Our results suggest that SSc management could be optimized, particularly with more attention to the patient-practitioner relationship. Patient profiles should be more precisely defined in terms of coping strategies and treatment preferences to propose more individualized options

Barriers to Effective Postmenopausal Osteoporosis Treatment: A Qualitative Study of Patients' and Practitioners' Views

Objective: Study patients’ and physicians’ views regarding postmenopausal osteoporosis (PMO) to identify impediments to good care.Methods: A qualitative study involving 18 physicians and 37 women (age 57–87) with PMO.Results: All women interviewed considered PMO to be somewhat normal wear-and-tear associated with old age. The women identified a large number of "causes" for osteoporosis but finally viewed it as chance. They all described its progression as slow. Three representations of PMO severity were identified: some women tended to interpreted it as benign (21), others tended to dramatize it (11), and the rest were uncertain (5). These representations did not appear linked to age or fracture. Even the women who associated fracture and PMO were uncertain of the link between them. Fractures were considered to be random events, independent of osteoporosis. Women received general life-style recommendations from their physicians positively, but did not connect them specifically to osteoporosis. Indeed, these recommendations, along with the fear of side effects, the absence of tangible results of treatments, the view of PMO as a natural process, and the representations of PMO severity are factors that may deter treatments and impact compliance. As for the physicians, they identified eight risk factors, recognizing menopause as central to PMO and recognized the link between risk of fracture and PMO. However, some considered the impact of fractures to be limited in time, and viewed PMO as a "benign" disease. Seeing the progression of PMO as slow and inevitable reduced their urgency to diagnose and treat it as compared to other diseases. Some physicians acknowledged limited mastery of the existing therapeutic arsenal and unsuccessful handling of patient compliance.Conclusion: Women’s and physicians’ perspectives on PMO converged to trivialize postmenopausal osteoporosis and thus disqualify it as a legitimate disease. A better understanding of women’s and physicians’ views, practices, and concerns related to PMO can improve osteoporosis management

Concise Review: In Vitro Formation of Bone - Like Nodules Sheds Light on the Application of Stem Cells for Bone Regeneration

International audienc

Development and validation of a questionnaire assessing fears and beliefs of patients with knee osteoarthritis: the Knee Osteoarthritis Fears and Beliefs Questionnaire (KOFBeQ).

ObjectiveWe aimed to develop a questionnaire assessing fears and beliefs of patients with knee OA.DesignWe sent a detailed document reporting on a qualitative analysis of interviews of patients with knee OA to experts, and a Delphi procedure was adopted for item generation. Then, 80 physicians recruited 566 patients with knee OA to test the provisional questionnaire. Items were reduced according to their metric properties and exploratory factor analysis. Reliability was tested by the Cronbach α coefficient. Construct validity was tested by divergent validity and confirmatory factor analysis. Test-retest reliability was assessed by the intra-class correlation coefficient (ICC) and the Bland and Altman technique.Results137 items were extracted from analysis of the interview data. Three Delphi rounds were needed to obtain consensus on a 25-item provisional questionnaire. The item-reduction process resulted in an 11-item questionnaire. Selected items represented fears and beliefs about daily living activities (3 items), fears and beliefs about physicians (4 items), fears and beliefs about the disease (2 items), and fears and beliefs about sports and leisure activities (2 items). The Cronbach α coefficient of global score was 0.85. We observed expected divergent validity. Confirmation factor analyses confirmed higher intra-factor than inter-factor correlations. Test-retest reliability was good, with an ICC of 0.81, and Bland and Altman analysis did not reveal a systematic trend.ConclusionsWe propose an 11-item questionnaire assessing patients' fears and beliefs concerning knee OA with good content and construct validity