An evaluation of approaches used to teach quality improvement to preregistration healthcare professionals: an integrative review

Background  Improving the quality of healthcare remains central to UK and international policy, practice and research. In 2003, The Institute of Medicine's ‘Health Professions Education: A Bridge to Quality’, advocated quality improvement as a core competency for all healthcare professionals. As a result, developing capacity and capability of those applying improvement methodologies in the pre-registration population has risen, yet, little is known about the teaching approaches employed for this purpose.  Objectives To describe and analyse educational approaches used to teach quality improvement to pre-registration healthcare professionals and identify enabling and impeding factors.  Design  Integrative review.  Data sources  CINAHL, PsychINFO, MEDLINE, ERIC, ASSIA, SCOPUS and Google Scholar were accessed for papers published between 2000 and 2016.  Review methods  Publications where quality improvement education was delivered to pre-registration healthcare professionals were eligible. One author independently screened papers, extracted data using a modified version of the Reporting of Primary Studies in Education Guideline and evaluated methodological quality using the Weight of Evidence Framework. The Kirkpatrick Education Evaluation Model was used to explore the impact of teaching approaches. Enabling and impeding factors were thematically analysed. A narrative synthesis of findings is presented.  Results  Ten papers were included, representing nursing, pharmacy and medicine from UK, Norway and USA. Studies comprised four quantitative, four mixed method, one qualitative and one cluster randomised trial, all allocated medium Weight of Evidence. Teaching approaches included experiential learning cited in all studies, didactics in seven, group work in four, seminars in three, self-directed learning in three and simulation in one. Most studies measured Level 1 of the Kirkpatrick Model (reaction), all but one measured Level 2 (skills, knowledge or attitudes), none measured Level 3 (behaviour) and one measured Level 4 (patient outcomes). Enabling and impeding themes included: Teaching Approaches, Clinical/Faculty support, Information Provision, Curriculum Balance and Data.  Conclusions  Evaluating quality improvement education is complex. Experiential learning combined with didactics is the favoured approach; however, attributing causality to educational intervention proves difficult in light of poor methodological rigour, lack of validated tools and complex clinical settings. Clarity regarding which quality improvement competencies are priority for this population would be useful to streamline future educational development and evaluation. Stronger collaboration between educators and clinicians is recommended to explore the multiple components and contextual factors associated with quality improvement education in practice. Ethnographic enquiry may be a logical next step to advance knowledge within the field

Patterns of self-monitoring of blood glucose (SMBG) in insulin-treated diabetes: analysis of a Scottish population over time

Analysis of a diabetes clinical information system in Tayside, Scotland, shows that a significant proportion of insulin-treated patients with diabetes are not self-monitoring blood glucose according to current clinical guidance and recommendations, with some not self-monitoring their blood glucose at all. Although there has been an increase in the numbers of reagent strips dispensed over the past decade, this increase is mainly accounted for by increased testing frequency among people with diabetes already testing.Output Type: Research Lette

Risk and protective factors for suicide and suicidal behaviour: a literature review

The Scottish Development Centre for Mental Health, in partnership with the University of Edinburgh (Research Unit in Health, Behaviour and Change and General Practice Section) and the University of Stirling (Department of Applied Social Science and Department of Nursing and Midwifery), were commissioned by the then Scottish Executive to undertake a review of the literature on risk and protective factors for suicide and suicidal behaviour. The review had two overarching aims: first, to describe and assess current knowledge regarding the societal and cultural factors associated with increased incidence of suicide (risk factors), and to delineate the population subgroups that are at increased risk of suicidal behaviour; and second, to describe and assess current knowledge regarding factors that promote resilience and healthy survival against suicidal behaviour amongst people who are exposed to known suicidal risk conditions (protective factors)

A realist evaluation of a normal birth programme

Background. Complex programmes are characterised by multiple components, acting independently and interdependently, at multiple levels, within diverse and dynamic systems. High-quality evaluation of such programmes is imperative for optimising their development, implementation and effectiveness, but is often challenging. There is debate about whether the traditional outcome-focused approaches are feasible or appropriate for evaluations of large-scale, complex programmes as they often fall short of explaining how and why they do or do not work. Theory-driven approaches offer a more appropriate alternative as they attempt to uncover the black-box between the programme's inputs and the resulting complex pattern of outcomes. Aim. This paper illustrates drawing upon a realist evaluation to assess a complex programme to support normal birth. Method. Firstly, the programme theories - the ideas about how the programme would bring about change - were elicited from programme developers and key stakeholders. Secondly, these initial hypotheses were tested out by collecting data on how the programme worked in different contexts, using a multiple case study design. Thirdly, the data were analysed and interpreted to refine the programme theories in light of evidence on how the programme unfolded in practice. Findings. Described in detail are the process of conducting a realist evaluation, methods used, steps in data analyses, challenges encountered and the approach adopted to overcome them. The usefulness of this approach and some limitations are discussed

Health Benefits of Primary Care Social Work for Adults with Complex Health and Social Needs: A Systematic Review

The prevalence of complex health and social needs in primary care patients is growing. Furthermore, recent research suggests that the impact of psychosocial distress on the significantly poorer health outcomes in this population may have been underestimated. The potential of social work in primary care settings has been extensively discussed in both health and social work literature and there is evidence that social work interventions in other settings are particularly effective in addressing psychosocial needs. However, the evidence base for specific improved health outcomes related to primary care social work is minimal. This review aimed to identify and synthesise the available evidence on the health benefits of social work interventions in primary care settings. Nine electronic databases were searched from 1990 to 2015 and seven primary research studies were retrieved. Due to the heterogeneity of studies, a narrative synthesis was conducted. Although there is no definitive evidence for effectiveness, results suggest a promising role for primary care social work interventions in improving health outcomes. These include subjective health measures and self-management of long-term conditions, reducing psychosocial morbidity and barriers to treatment and health maintenance. Although few rigorous study designs were found, the contextual detail and clinical settings of studies provide evidence of the practice applicability of social work intervention. Emerging policy on the integration of health and social care may provide an opportunity to develop this model of care

The Performance Assessment Framework: experiences and perceptions of NHS Scotland. A Report to the Analytical Service Division, Directorate of Performance Management and Finance, Scottish Executive Health Department

The new Performance Assessment Framework (PAF) was introduced in NHSScotland in October 2001 and used in the annual NHS Board Accountability Reviews in 2002 and 2003. The PAF was assigned three objectives outlined in Our National Health: (1) ‘Support and encourage sustained improvement in the performance of NHS Scotland by focussing on key measures in relation to health priorities.' (2) ‘Reinforce and support the role of the 15 NHS Boards in managing the performance of their local NHS systems.' (3) ‘Enable NHS Scotland to account systematically for its performance both locally and through the Scottish Executive to the Scottish Parliament and to the people of Scotland.' The success with which the PAF appears to be meeting those objectives forms the focus of this investigation. A key element determining how and whether the PAF affects the behaviour of decision-makers within the organisations and subsequently NHS Scotland performance is the perception of the PAF and the signals it generates. Thus it is important to determine what these perceptions and understandings are. It is necessary to capture these views in order to appreciate fully the impact of the PAF within the NHS in Scotland and to appraise its salience and power as a performance tool

A review of the effectiveness of interventions, approaches and models at individual, community and population level that are aimed at changing health outcomes through changing knowledge attitudes and behaviour

This document is the summary of a ‘review of reviews’, which aims to bring together a large body of evidence and provide a critical and structured overview of the effectiveness of interventions and models to change attitudes, knowledge and behaviours in six different areas. This overview will provide researchers, policy and decision-makers, and practitioners with accessible, good quality evidence in these topic areas

Physical activity in South Asians: an in-depth qualitative study to explore motivations and facilitators

Background People of South Asian backgrounds living in the UK have a five-fold increased risk of diabetes and a two-fold increased risk of heart disease when compared to the general population. Physical activity can reduce the risk of premature death from a range of conditions. The aim of the study was to explore the motivating and facilitating factors likely to increase physical activity for South Asian adults and their families, in order to develop successful interventions and services. Methodology/Principal Findings This was a qualitative study using focus groups and in-depth interviews. Participants were 59 purposively selected Bangladeshi-, Indian- and Pakistani-origin men and women with an additional 10 key informants. The setting was three urban areas of Scotland: Aberdeen, Glasgow and Edinburgh. We undertook a theoretically informed thematic analysis of data. Study participants described engaging in a range of physical activities, particularly football and the gym for men, and walking and swimming for women. The main motivators for taking part in physical activity were external motivators - i.e. undertaking physical activity as a means to an end, which included the opportunities that physical activity provided for social activity and enjoyment. The goals of weight reduction and improving mental and physical health were also mentioned. Role models were seen as important to inspire and motivate people to undertake activities that they may otherwise lack confidence in. Few people undertook physical activity for its own sake (intrinsic motivation). Conclusions/Significance Attempts at promoting physical activity in people of South Asian origin need to take account of the social context of people's lives and the external motivators that encourage them to engage in physical activity. Undertaking group based physical activity is important and can be facilitated through religious, community, friendship or family networks. Role models may also prove particularly helpful

Intra-dance variation among waggle runs and the design of efficient protocols for honey bee dance decoding

Noise is universal in information transfer. In animal communication, this presents a challenge not only for intended signal receivers, but also to biologists studying the system. In honey bees, a forager communicates to nestmates the location of an important resource via the waggle dance. This vibrational signal is composed of repeating units (waggle runs) that are then averaged by nestmates to derive a single vector. Manual dance decoding is a powerful tool for studying bee foraging ecology, although the process is time-consuming: a forager may repeat the waggle run 1- >100 times within a dance. It is impractical to decode all of these to obtain the vector; however, intra-dance waggle runs vary, so it is important to decode enough to obtain a good average. Here we examine the variation among waggle runs made by foraging bees to devise a method of dance decoding. The first and last waggle runs within a dance are significantly more variable than the middle run. There was no trend in variation for the middle waggle runs. We recommend that any four consecutive waggle runs, not including the first and last runs, may be decoded, and we show that this methodology is suitable by demonstrating the goodness-of-fit between the decoded vectors from our subsamples with the vectors from the entire dances

Speechreading ability is related to phonological awareness and single-word reading in both deaf and hearing children

Purpose. Speechreading (lipreading) is a correlate of reading ability in both deaf and hearing children. We investigated whether the relationship between speechreading and single-word reading is mediated by phonological awareness in deaf and hearing children. Method. In two separate studies, 66 deaf children and 138 hearing children, aged 5–8 years old, were assessed on measures of speechreading, phonological awareness, and single-word reading. We assessed the concurrent relationships between latent variables measuring speechreading, phonological awareness, and single-word reading. Results. In both deaf and hearing children, there was a strong relationship between speechreading and single-word reading, which was fully mediated by phonological awareness. Conclusions. These results are consistent with ideas from previous studies that visual speech information contributes to the development of phonological representations in both deaf and hearing children, which, in turn, support learning to read. Future longitudinal and training studies are required to establish whether these relationships reflect causal effects