Monitoring the inputs required to extend and sustain hygiene promotion: findings from the GLAAS 2013/2014 survey.

OBJECTIVES: There are significant gaps in information about the inputs required to effectively extend and sustain hygiene promotion activities to improve people's health outcomes through water, sanitation and hygiene (WASH) interventions. We sought to analyse current country and global trends in the use of key inputs required for effective and sustainable implementation of hygiene promotion to help guide hygiene promotion policy and decision-making after 2015. METHODS: Data collected in response to the GLAAS 2013/2014 survey from 93 countries of 94 were included, and responses were analysed for 12 questions assessing the inputs and enabling environment for hygiene promotion under four thematic areas. Data were included and analysed from 20 External Support Agencies (ESA) of 23 collected through self-administered surveys. RESULTS: Firstly, the data showed a large variation in the way in which hygiene promotion is defined and what constitutes key activities in this area. Secondly, challenges to implement hygiene promotion are considerable: include poor implementation of policies and plans, weak coordination mechanisms, human resource limitations and a lack of available hygiene promotion budget data. CONCLUSION: Despite the proven benefits of hand washing with soap, a critical hygiene-related factor in minimising infection, GLAAS 2013/2014 survey data showed that hygiene promotion remains a neglected component of WASH. Additional research to identify the context-specific strategies and inputs required to enhance the effectiveness of hygiene promotion at scale are needed. Improved data collection methods are also necessary to advance the availability and reliability of hygiene-specific information

Implementing evidence-based practice: the challenge of delivering what works for people with learning disabilities at risk of behaviours that challenge

There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that challenge. We suggest, is a problem of implementation. The purpose of this paper is to explore reasons why this might be the case: a failure to recognise the collective works of successive generations of research and practice; and a failure to address the macro-systems involved and systems changes needed to support implementation. Design/methodology/approach: This paper reviews the consensus that exists in respect of best practice. Drawing upon ideas from implementation science the paper highlights the complexities involved in the implementation of all evidence-based practices and uses this as a framework to propose ways in which an infrastructure that facilitates the delivery of services in the learning disabilities field might be built. Findings: This paper highlights core recommended practices that have been consistent over time and across sources and identifies the systems involved in the implementation process. This paper demonstrates that many of the necessary building blocks of implementation already exist and suggests areas that are yet to be addressed. Critically, the paper highlights the importance of, and the part that all systems need to play in the process. Originality/value: In the absence of any generalised implementation frameworks of evidence-based practice in the learning disabilities field, the paper suggests that the findings may provide the basis for understanding how the gap that exists between best practice and service delivery in the support of people with a learning disability at risk of behaviours that challenge might be closed

Learning together for and with the Martuwarra Fitzroy River

Co-production across scientific and Indigenous knowledge systems has become a cornerstone of research to enhance knowledge, practice, ethics, and foster sustainability transformations. However, the profound differences in world views and the complex and contested histories of nation-state colonisation on Indigenous territories, highlight both opportunities and risks for Indigenous people when engaging with knowledge co-production. This paper investigates the conditions under which knowledge co-production can lead to improved Indigenous adaptive environmental planning and management among remote land-attached Indigenous peoples through a case study with ten Traditional Owner groups in the Martuwarra (Fitzroy River) Catchment in Western Australia’s Kimberley region. The research team built a 3D map of the river and used it, together with an interactive table-top projector, to bring together both scientific and Indigenous spatial knowledge. Participatory influence mapping, aligned with Traditional Owner priorities to achieve cultural governance and management planning goals set out in the Fitzroy River Declaration, investigated power relations. An analytical framework, examining underlying mechanisms of social learning, knowledge promotion and enhancing influence, based on different theories of change, was applied to unpack the immediate outcomes from these activities. The analysis identified that knowledge co-production activities improved the accessibility of the knowledge, the experiences of the knowledge users, strengthened collective identity and partnerships, and strengthened Indigenous-led institutions. The focus on cultural governance and management planning goals in the Fitzroy River Declaration enabled the activities to directly affect key drivers of Indigenous adaptive environmental planning and management—the Indigenous-led institutions. The nation-state arrangements also gave some support to local learning and decision-making through a key Indigenous institution, Martuwarra Fitzroy River Council. Knowledge co-production with remote land-attached Indigenous peoples can improve adaptive environmental planning and management where it fosters learning together, is grounded in the Indigenous-led institutions and addresses their priorities

Implementing positive behavioural support: changing social and organisational contexts

Abstract: Background: Social and organisational contexts have a major influence on both challenging behaviour and interventions designed to ameliorate such behaviour and improve quality of life. Method and materials: A non-systematic review was conducted in order to identify social and organisational factors that impact upon positive behavioural support (PBS) intervention. Results: A series of micro and macro influences on intervention effectiveness were identified. Possibilities for improving intervention effectiveness that extend the scope of traditional behavioural interventions were discussed. Conclusions: Implications and opportunities for building capacity at an individual service user, organisational and cultural level are highlighted

A conceptual framework for understanding why challenging behaviours occur in people with developmental disabilities

Background: To be able to define positive behavioural support (PBS), describe PBS interventions and clarify the individual and organisational competencies needed to support PBS, a clear underlying conceptual framework is needed to identify why challenging behaviours occur. Method and materials: Non-systematic review and discussion of the state of research and theoretical evidence focusing on vulnerability factors for challenging behaviours, maintaining processes, and the social impact of challenging behaviour. Results: Understanding challenging behaviour is related most strongly to context. First, challenging behaviours are defined in terms of their social effects. Second, vulnerability factors for challenging behaviour include some biological factors, but mainly psycho-social risks relating to the life situation and inequalities experienced by people with developmental disabilities. Third, social contextual processes are primarily responsible for maintaining challenging behaviours. Conclusions: PBS is a broad approach to understanding and intervention referring to multiple contributing factors and processes. To describe PBS without reference to an underlying theoretically grounded conceptual framework would lead to an impoverished version of the approach

The STAR trial protocol: a randomised multi-stage phase II/III study of Sunitinib comparing temporary cessation with allowing continuation, at the time of maximal radiological response, in the first-line treatment of locally advanced/metastatic Renal Cancer.

Over recent years a number of novel therapies have shown promise in advanced renal cell carcinoma (RCC). Internationally the standard of care of first-line therapy is sunitinib™, after a clear survival benefit was demonstrated over interferon-α. Convention dictates that sunitinib is continued until evidence of disease progression, assuming tolerability, although there is no evidence that this approach is superior to intermittent periods of treatment. The purpose of the STAR trial is to compare the standard treatment strategy (conventional continuation strategy, CCS) with a novel drug free interval strategy (DFIS) which includes planned treatment breaks

Developing a core competencies framework for positive behavioural support: issues and recommendations

Background: Widespread adoption of positive behavioural support (PBS) will stand and fall on the extent to which we can develop a competent workforce. The case for the development of a competence framework for PBS is presented. Method and materials: We review the role that competence frameworks play in evidence-based practice and outline some of the ways in which they have been defined and structured. We describe the process used to develop the UK Autism Education Competence Framework (ABACF) and discuss the particular issues that need to be considered when developing a competence framework specifically for PBS. Results: We propose a conceptual model illustrating what a PBS competence framework might look like and suggest a process for its development. Conclusions: Competence frameworks are one means of translating evidence into practice. To be effective they must be an integral part of all aspects of service provision and must be grounded in the defining components of the discipline they describe

Definition and scope for positive behavioural support

Background: In light of forthcoming policy and guidance in the UK regarding services for people who display behaviour that challenges, we provide a refreshed definition and scope for positive behavioural support (PBS). Through doing this we aim to outline a framework for the delivery of PBS that is of practical and strategic value to a number of stakeholders. Method and materials: We draw extensively on previous definitions of PBS, relevant research and our professional experience to create a multi-component framework of PBS, together with an overall definition and a breakdown of the key ways in which PBS may be utilised. Results: The framework consists of ten core components, categorised in terms of values, theory and evidence-base and process. Each component is described in detail with reference to research literature and discussion regarding the interconnections and distinctions between these. Conclusions: We suggest the framework captures what is known and understood about best practice for supporting people with behaviour that displays as challenging and may usefully inform the development of competences in PBS practice, service delivery, training and research

Les cahiers de l'école qualité en recherche et en enseignement supérieur - Numéro 6

Ce cahier regroupe les actes relatifs à la quinzième école inter-organismes « Qualité en recherche et en enseignement supérieur » organisée par l’association QuaRES à Montpellier (France), du 6 au 8 septembre 2017