Capacity Building Interventions Research Articles

Characteristics of leadership that influence clinical learning: A narrative review

Leadership has been consistently implied in fostering clinical learning. However there is a lack of clarity about the form leadership should take. Limited quantitative research indicated a narrative approach to review literature from a broad perspective. A framework to guide the synthesis was developed to ensure a rigorous review process. Preliminary reading and review of papers using search terms nursing and leadership and clinical learning and learning culture narrowed the inclusion criteria to 245 papers published between 2000 and 2010. Given the diversity of the papers' focus, aim and context, a refined screening process justified the inclusion of twenty-six papers in the review. A critical appraisal of these peer-reviewed quantitative, qualitative and commentary papers identified factors/elements integral to effective leadership. Across the literature leadership was discussed in relation to two broad themes: influence of leadership on organisational learning and development and; influence of leadership on undergraduate clinical education. The factors central to leadership emerged as transformative principles, the role of the nurse unit/ward manager, collaboration and relationship building and role-modelling. The review has raised some suggestions for future research aimed at examining the impact of a leadership capacity building intervention that supports clinical learning.

Challenges of Making Donor-Driven Public Sector Reform in Sub-Saharan Africa Sustainable: Some Experiences from Ghana

This article investigates the difficulties associated with the sustainability of implementing donor supported public sector reform respecting human and institutional capacity building interventions in Ghana. It is based on an exploratory case study design; it triangulates both secondary and primary sources of data. Employing self-completing questionnaire and interview schedule tools it covered 105 local government employees from national, regional, and district levels as well as interviewed 16 senior public officers in 9 public and quasi-public organizations. These primary sources were complemented with relevant secondary documents. The article finds that donor funded public sector reform initiatives can either facilitate or constrain the expected improvement promised by reform due to the financial and technical resource inadequacies experienced in Ghana. In this regard, public sector reformers have to become innovative and adaptive in delivering public services, since the mechanistic donor-driven reform agenda tends to affect the quality of service delivery.

A qualitative evaluation of an Australian public health nutrition workforce development intervention involving mentoring circles

To evaluate a mentoring circle workforce development intervention among a group of public health nutrition novices. The mentoring circle intervention focused on facilitating practice-based public health nutrition competence development and supporting reorientation of practice from clinical services to preventive services. A retrospective post-intervention qualitative semi-structured interview was used to explore the experiences of those participating in the mentoring circle and to make evaluative judgements about intervention attributes and effectiveness. Victoria, Australia. Thirty-two novice public health nutrition practitioners employed in the state public health system. Key evaluative theme categories relating to the mentoring circle intervention were identified, including the structure and function of the group, the utility of using advanced-level competency items to guide planning, having a safe and supportive environment for learning and the utility of learning via mentoring and on-the-job experiences. These qualitative evaluation data identify the attributes of the mentoring circle intervention contributing to intervention effectiveness. This qualitative evaluation indicates that mentoring circles can be an effective workforce capacity-building intervention, particularly in novice workforces characterised by professional isolation and split function roles.

It is all about who you know: Social capital and health in low-income communities

There is an increasing understanding about the importance of social networks in the overall health of individuals. In the past year studies have found that strong social ties could promote brain health as we age; having obese friends increases the risk for obesity; and older people with many friends outlive those with fewer friends. This manuscript describes capacity-building interventions based on social capital, including empowerment, community youth development and collective efficacy models, which can work at the individual and community level in preventive and treatment-based interventions. These interventions allow public health practitioners working with low-income communities to reduce health disparities, promote well-being, and decrease inequalities.

Community-Based Organizational Capacity Building as a Strategy to Reduce Racial Health Disparities

One of the biggest challenges facing racial health disparities research is identifying how and where to implement effective, sustainable interventions. Community-based organizations (CBOs) and community-academic partnerships are frequently utilized as vehicles to conduct community health promotion interventions without attending to the viability and sustainability of CBOs or capacity inequities among partners. Utilizing organizational empowerment theory, this paper describes an intervention designed to increase the capacity of CBOs and community-academic partnerships to implement strategies to improve community health. The Capacity Building project illustrates how capacity building interventions can help to identify community health needs, promote community empowerment, and reduce health disparities.

Creating supportive clinical learning environments: an intervention study

To assess the impact of an intervention aimed to build capacity of registered nurses to enhance the clinical learning environment for undergraduate nursing students. Workplace learning is vital for the development of skills, attributes and knowledge of student nurses. Registered nurses need to be appropriately prepared to maximise student learning during clinical placement. The quality of student learning during clinical practicum is largely dependent on interactions with ward staff. A quasi-experimental design. Measurement of students' perceptions of the psycho social learning environment during and outside of the intervention period was used to evaluate the capacity building intervention. The capacity building intervention consisted of interactive education in clinical areas over a six-week period for registered nurses in two acute surgical wards. First, second and third year students (n = 62) who undertook their clinical practicum in the two surgical wards, before, during and six months after the capacity building intervention assessed the psycho-social learning environment at the time of their clinical practicum. Findings showed that students who undertook their clinical practicum during the intervention period rated the psycho-social clinical learning environment significantly higher than students who undertook their practicum at times outside of the intervention period. An experienced researcher/educator conducting capacity building sessions can effectively assist and support registered nurses to engage with students. Capacity building sessions can improve practice, however, structures and processes that ensure continuation of practice change need to be embedded for improvements to be sustained.

Evaluation of US Training for the Past 6 Years at ECUREI, the World Federation for Ultrasound in Medicine and Biology (WFUMB) Centre of Excellence, Kampala, Uganda

The objectives of this article are: To explore the impact of the Radiological Society of North America-sponsored "Teach the Teachers" training course and other capacity building interventions (CBIs) on Uganda's ultrasound (US) training capacity; compare performance of students undertaking a modular diploma ultrasound course to the non-modular; and compare performance among various health cadres undertaking US training. The impact of the "Teach the Teachers" training course and other capacity building interventions were evaluated through analysis of the planning, implementation, sustainability, and output of the training center. Comparison of students' performance in the modular and non-modular diploma courses was by a retrospective cohort methodology using odds ratios. Comparison of performance was by analyzing their mean test scores using a paired Student t-test. To date, 306 students from nine African countries have successfully completed the US diploma training. Fifty (16%) are non-Ugandans. The non-modular cohort has performed better than the modular (OR = 3.2) in the final written examination. The mean test scores for the final written examinations were: 73.4%, 71.9%, 61.2%, and 57% for the doctors, radiographers, assistant physicians, and nurses/midwives, respectively. The Radiological Society of North America-sponsored "Teach the Teacher's course in US" together with other capacity building interventions have led to an established center of excellence for US training in Uganda.

Building disaster resilience through capacity building in Ethiopia

Purpose – Building institutional capacity to prevent, prepare and respond to disasters is among aspects emphasized in the Hyogo Framework for Action 2005‐2015 to enhance the resilience of disaster‐affected communities. Lessons from past programmes could help the design and implementation of future capacity building interventions with a view to making them both a means and an end in themselves in building disaster resilience of communities and nations. This paper aims to explore the issues.

Conceptualizing the integration of HIV treatment and prevention: findings from a process evaluation of a community-based, national capacity-building intervention

This paper responds to a gap in knowledge about the conceptualization of integration in community-based AIDS organizations (CBAOs). A community-based process evaluation was conducted of a national intervention, developed by the Canadian AIDS Treatment Information Exchange (CATIE), to enhance treatment information provision in CBAOs and encourage its integration with prevention services. Our study involved 13 interviews with intervention participants in 6 CBAOs across Canada, CATIE staff, and funders, as well as a 25-person verification exercise. Intervention participants conceptualized integration as linking front-line HIV treatment, health promotion and prevention services, emphasizing mediation between scientific and lay knowledge, the political context of integration and the role of social determinants in clients' health and access to services. Challenges to integration include high staff turnover and inflexible funding structures. Complex health education related to the relationship between viral load and HIV transmission is a critical area of integrated service delivery. Study findings help distinguish a community-based concept of HIV-related integration from alternative uses of the term while pointing out key tensions associated with efforts to integrate HIV prevention and treatment in a community-based context.

Utilising Research 'Praxis' to Enhance Teaching Practice in The Domain of Apprenticeship Education: A Report on a Research Capacity Building Pilot Project Run in the School Of Construction Skills

The Dublin Institute of Technology is one of the largest multi-level higher education providers in Ireland, catering for over 22,000 students annually. Under the 1999 Qualifications (Education and Training) Act, DIT became an awarding body in its own right. Programme provision covers apprenticeships, short continuous professional development courses, taught undergraduate and postgraduate, research MPhil and PhDs. While the Institute's traditional mission1 was focused on teaching and learning in the field of advanced technical vocational education and training (TVET), over the last decade the importance of developing a research informed culture has become prominent in the strategic policy development of the Institute. Within this new emerging research agenda substantial achievements have been made in specific fields such as; science, engineering, ICT, tourism & food. However the research potential of a large portion of staff who work in the apprenticeship and craft area has been underdeveloped. This paper reviews some contextual information relating to the emerging research agenda as expressed in documents produced by the Institutes of Technology in Ireland and the DIT. It sign-posts significant Irish national strategies and notes some European Union initiatives that have relevance to research policy in this sector of higher education. The research then applies a 'single case study' (Yin 1996) to describe a new initiative which seeks to unlock the research potential of staff in the apprenticeship and craft area in DIT. Reporting the findings from a pilot Research Capacity Building project, which was run in DIT in 2008. This was a collaborative project between the Head of Department of Construction Skills and the Project Manager of the Skills Research Initiative, offered to Assistant Lecturers in the Wood Skills area. The paper details the emergence of this project and utilises '4th generation evaluation' methodology (Guba & Lincoln 1986) to access the effectiveness and future potential of this type of initiative. Further by adopting a participatory 'insider' research approach the 'lived experience' and 'voice' of staff who participated in the project is captured through in-depth ethnographic interviews.The research demonstrates a willingness of staff working in the apprenticeship and craft area to engage in, and develop skills, competencies and knowledge relating to research 'praxis'. However there seems to be a 'cultural gap' and mismatch between the high level national and sectoral research policy narratives, and the direct research capacity and capability needs of apprenticeship and craft staff. The research recommends that in order for this staff cohort to gain a footprint in the research domain, there is a need for localized and flexible research capacity building initiatives. This type of proactive research capacity building intervention can facilitate the unlocking, production and dissemination of the rich expert knowledge, experience and skills inherent in the apprenticeship and craft areas.

Coping with Asthma in the Central City: Parental Experiences with Children’s Health Care

Asthma is the most common chronic illness among children in the United States. Poverty and asthma are tightly related, with poor children having higher rates of asthma than non-poor children. To document how poor parents with asthmatic children cope with health care-related barriers on a day-to-day basis, the author conducted 38 in-depth interviews with central city Phoenix (Arizona) parents. Barriers facing parents include a lack of health insurance and/or personal transportation, the expense of using private insurance, treatment delays, and language/communication. Instances of parents overcoming barriers are highlighted and offered as opportunities for designing capacity building interventions and policies that build on parents' strengths.

Enquiring into skills development with SSM: a South African experience

AbstractSince the first democratic elections in 1994, vocational education and training (VET) in South Africa has undergone major changes in order to equip the country to enhance its skills base, and to face post apartheid and globalization challenges. Part of the change has involved the adoption (by some players) of ‘Mode 2’ ideas of knowledge production as suggested by Gibbons and those studying the sociology of knowledge in modern societies. Mode 2 production is trans‐disciplinary and uses socially accountable forms to generate scientific knowledge in contrast to ‘Mode 1’ which is mainly based on single scientific disciplines and knowledge generation by the scholarly community. The objective of this adoption in the South African context is to enable a variety of stakeholders to be involved both in enhancing research in South Africa and responding to the needs of different economic sectors. However, the dynamics of stakeholder interaction can be complex. In this paper, we report on a skills capacity building intervention involving the application of Systems Thinking approaches and methodologies in a South African setting. Our intervention was informed by the use of soft systems methodology (SSM) as a means of assisting different groups of researchers firstly to share their perceptions about research in the skills development context, and secondly to collaborate together in generating suggestions for improvements. A key objective was to improve the interactions between researchers and other stakeholders in the organization of skills development research projects. The use of SSM methodology enabled us to ‘qualify’ the nature of these interactions. It also gave us clues about particular issues (e.g. power) that need to be tackled to improve capacity building in this area. Copyright © 2008 John Wiley & Sons, Ltd.

Realistic Expectations: Investing in Organizational Capacity Building for Chronic Disease Prevention

This article presents findings that explore investment in organizational capacity building for chronic disease prevention. Specifically, this analysis examines variation in investment inputs, intervention outputs, and capacity changes to inform expectations of health-promotion capacity-building investment. This multiple case study involving both qualitative and quantitative data is based on seven provincial dissemination projects involved in the Canadian Heart Health Initiative. Data on investment, number, and type of capacity-building activities and capacity changes come from a questionnaire, key informant interviews, and project report analysis. Quantitative data were analyzed descriptively and for trends, while qualitative data were analyzed thematically. Per capita investments in capacity building ranged from a low of $0.21 in Ontario to $167.41 in Prince Edward Island. Multiple, tailored capacity-building interventions were used in each project. Mostly positive but modest changes were observed in at least five dimensions of capacity in all but one project. These findings reveal that capacity building for chronic disease prevention requires a long-term investment and is context specific. Even limited investment can produce interventions that appear to positively influence capacity for chronic disease prevention. The findings also suggest an urgent need to expand surveillance to include indicators of capacity-building investments and interventions to allow policy makers to make more informed decisions about investments in public health.

Studying Self-Evaluation Capacity Building in a Large International Development Organization

This action research study addresses the link between building evaluation capacity and enhancing evaluation use for learning. The author shares her experiences and reports on the evidence collected from a set of self-evaluation capacity-building interventions that she implemented. Using a mixed-method approach, the author first determined that the organization lacked the prerequisites to learn from evaluation. She then implemented self-evaluation capacity-building interventions, accompanied by a real-time study of how the participants changed attitudinally, cognitively, and behaviorally. Results indicate the potential of these interventions to facilitate an individual’s ability to learn from evaluation and underscore the need for supportive organizational contexts, structures, and processes if evaluation use for learning is to occur throughout the organization.

Evaluating the Capacity of Faith-Based Programs in Colorado

Organizational capacity refers to the ability of nonprofit organizations to fulfill their missions in an effective manner. Through the JVA Consulting Colorado Compassion Initiative, a comprehensive, capacity-building program was developed and provided for faith- and community-based organizations. This study examined faith-based organizations' capacity gains after participating in a targeted capacity-building intervention. A comprehensive tool to assess organizations' levels of capacity was developed specifically for the study. Members of 44 faith-based and 46 community-based organizations across Colorado were interviewed and assessed using the new instrument at baseline and 15-month follow-up. The study demonstrated that targeted technical assistance predicted improvements in organizational capacity. Faith-based organizations showed significant improvements in almost all areas of capacity. In addition, comparisons between faith- and community-based organizations showed few differences in capacity gains.

Climate change, adaptive capacity and policy direction in the Canadian North: Can we learn anything from the collapse of the east coast cod fishery?

Scientific evidence gathered over the past five years suggests that northern Canada and the Arctic have undergone, and are undergoing, formidable environmental changes linked to global climate change. Environmental change in the north is expected to persist and intensify over the course of the next century. When large-scale environmental changes take place, they inevitably affect people, especially when the cultures and livelihoods of those people depend on their relationship with the environment. Managing the local impacts of these changes is a matter of adaptation. This paper discusses some of the policy implications of adaptation––government interventions aiming to build communities’ and regions’ capacities to adapt to environmental changes. Three arguments for adaptive capacity building interventions in the north are discussed, and these arguments are augmented by a comparative review of government reactions to the collapse of the cod fishery in Atlantic Canada. Reactive and proactive policy approaches are discussed, and it is suggested from the comparison that proactive approaches to intervention are desirable for building adaptive capacity.

A Forced March for Failing Schools: Lessons from the New York City Chancellor's District.

In the mid-nineties, the New York City Schools Chancellor created a citywide improvement zone to take over a significant proportion of the city's lowest performing schools whose local community school districts had failed to improve them. This "Chancellor's District" defined centralized management, rather than local control, as the critical variable necessary to initiate, enforce and ensure the implementation of school improvement. This large-scale intervention involved both a governance change and a set of capacity-building interventions presumably unavailable under local sub-district control. Our study retrospectively examined the origins, structure and components of the Chancellor's District, and analyzed the characteristics and outcomes of the elementary schools mandated to receive these interventions. Our longitudinal analysis compared Chancellor's District schools to New York City's other state-identified low performing schools, based on a school-level panel of performance, demographic, human resource, and expenditure data collected from district Annual School Report Cards and School Based Expenditure Reports from 1998-99 through 2001-02. The results suggest that the Chancellor's District intervention improved these schools' instructional capacity and academic outcomes, both relative to where these schools would have been and relative to comparable schools.

Impediments to Integrated Urban Stormwater Management: The Need for Institutional Reform

It is now well established that the traditional practice of urban stormwater management contributes to the degradation of receiving waterways, and this practice was more recently critiqued for facilitating the wastage of a valuable water resource. However, despite significant advances in alternative "integrated urban stormwater management" techniques and processes over the last 20 years, wide-scale implementation has been limited. This problem is indicative of broader institutional impediments that are beyond current concerns of strengthening technological and planning process expertise. Presented here is an analysis of the institutionalization of urban stormwater management across Sydney with the objective of scoping institutional impediments to more sustainable management approaches. The analysis reveals that the inertia with the public administration of urban stormwater inherently privileges and perpetuates traditional stormwater management practices at implementation. This inertia is characterized by historically entrained forms of technocratic institutional power and expertise, values and leadership, and structure and jurisdiction posing significant impediments to change and the realization of integrated urban stormwater management. These insights strongly point to the need for institutional change specifically directed at fostering horizontal integration of the various functions of the existing administrative regime. This would need to be underpinned with capacity-building interventions targeted at enabling a learning culture that values integration and participatory decision making. These insights also provide guideposts for assessing the institutional and capacity development needs for improving urban water management practices in other contexts.

Bottom Up and Top Down? Community Development in Post‐Soviet Armenia: The Social Fund Model

Abstract The main objective of this article is to discuss the effectiveness of bottom‐up, community‐driven approaches in promoting community participation and building local capacity within the post‐Soviet social, institutional and political context of Armenia. In exploring this issue, the article examines the nature of local participation and social relations in rural communities in Armenia and the impact of the World Bank‐supported Armenia Social Investment Fund (ASIF) project on the existing forms of local social organization. One of the objectives of the ASIF project was to promote the participation of local communities in their own economic and social development. The research finds that the project did not change the existing patterns of local social organization and had no significant impact on the nature of participation in the beneficiary communities. Bottom‐up, capacity‐building interventions that mainly focus on changing patterns of interpersonal social relations may not be effective in fostering sustainable civic institutions without changes in the nature of a country's governance.

Science and technology capacity building and partnership in African agriculture: perspectives on Mali and Egypt

AbstractScience and technology (S&T) have long been seen as key for development. This paper considers the issue of capacity building in the light of recent reconceptualization of the role of science and technology in development. Reconceptualization suggests that science and technology are better seen as key elements of innovation systems, which are themselves the means of gaining value from knowledge creation; and, that innovation, knowledge and development are tightly knit elements of a system of organisations and institutions that must function coherently for improved knowledge and innovation systems to emerge. Developing such systems requires linkages of many types. The paper describes and discusses the conceptual basis for capacity building interventions, using partnership‐based capacity building initiatives in new agricultural technologies from Mali and Egypt. The empirical analysis from both countries shows evidence of research capacity building in the form of recruitment, training of scientific staff and provision of research infrastructure. Unsurprisingly, given the S&T knowledge base, the Malian case illustrates the difficulty of moving beyond basic forms of research capacity building. In Egypt, with significant S&T capacity, there is evidence of organizational and institutional innovation towards broader knowledge, and innovation system development in agri‐biotechnology. The role of partnerships, and government as ‘systems‐builder’, are shown to be important. Lessons are drawn from these (and other) cases about the relationship between partnerships, S&T and innovation capacity building. Copyright © 2005 John Wiley & Sons, Ltd.