Contextual Circumstances Research Articles

Making implementation science more real

Implementation science in healthcare aims to understand how to get evidence into practice. Once this is achieved in one setting, it becomes increasingly difficult to replicate elsewhere. The problem is often attributed to differences in context that influence how and whether implementation strategies work. We argue that realist research paradigms provide a useful framework to express the effect of contextual factors within implementation strategy causal processes. Realist studies are theory-driven evaluations that focus on understanding how and why interventions work under different circumstances. They consider the interaction between contextual circumstances, theoretical mechanisms of change and the outcomes they produce, to arrive at explanations of conditional causality (i.e., what tends to work, for whom, under what circumstances). This Commentary provides example applications using preliminary findings from a large realist implementation study of system-wide value-based healthcare initiatives in New South Wales, Australia. If applied judiciously, realist implementation studies may represent a sound approach to help optimise delivery of the right care in the right setting and at the right time.

Exploring the digital footprint of depression: a PRISMA systematic literature review of the empirical evidence

BackgroundThis PRISMA systematic literature review examined the use of digital data collection methods (including ecological momentary assessment [EMA], experience sampling method [ESM], digital biomarkers, passive sensing, mobile sensing, ambulatory assessment, and time-series analysis), emphasizing on digital phenotyping (DP) to study depression. DP is defined as the use of digital data to profile health information objectively.AimsFour distinct yet interrelated goals underpin this study: (a) to identify empirical research examining the use of DP to study depression; (b) to describe the different methods and technology employed; (c) to integrate the evidence regarding the efficacy of digital data in the examination, diagnosis, and monitoring of depression and (d) to clarify DP definitions and digital mental health records terminology.ResultsOverall, 118 studies were assessed as eligible. Considering the terms employed, “EMA”, “ESM”, and “DP” were the most predominant. A variety of DP data sources were reported, including voice, language, keyboard typing kinematics, mobile phone calls and texts, geocoded activity, actigraphy sensor-related recordings (i.e., steps, sleep, circadian rhythm), and self-reported apps’ information. Reviewed studies employed subjectively and objectively recorded digital data in combination with interviews and psychometric scales.ConclusionsFindings suggest links between a person’s digital records and depression. Future research recommendations include (a) deriving consensus regarding the DP definition and (b) expanding the literature to consider a person’s broader contextual and developmental circumstances in relation to their digital data/records.

Interrogating hegemonic embraces: Representative bureaucracy, methodological Whiteness, and non‐West exclusions

AbstractThe United States' racial history infrequently defines the representativeness of bureaucracies outside of the United States. This article explores how selective historical memories and insufficiently critical concept importations limit disciplinary understandings. We articulate how policy transfer assumptions, narrow administrative histories, methodological Whiteness, and incomplete considerations of non‐West administration alter our understanding of what is or is not representative bureaucracy. We encourage scholars to recall how concepts like representative bureaucracy may lack exact comparability outside the West and to be open to its potential alteration by contextual circumstances. The implications for further exploration of the representative bureaucracy concept and the challenges for pedagogy are also discussed.Evidence for Practice West‐derived hegemonic understandings of the public administration discipline limit the development of public administration practice and scholarship outside the West. Insufficient historical and comparative circumspection is a frequent output of West‐based scholars seeking to implement their concepts in non‐West administrations. The discipline and practice of public administration may increase its global dialogues by conversing with non‐West actors and recognizing the limitations of Western data and theories. Like many administrative concepts, the representative bureaucracy concept as developed in the West may not operate similarly in other contexts.

Meaningful moments of interaction with people with profound intellectual disabilities: Reflections from direct support staff.

High-quality, affective relationships are built on meaningful moments of interaction, which are challenging for support staff to establish with people with profound intellectual disabilities. Therefore, we explored what makes a moment of interaction meaningful to support staff and what circumstances facilitate meaningful moments of interaction taking place. Five direct support staff took part in unstructured, in-depth interviews. The interviews were analysed using interpretative phenomenological analysis (IPA). Member checks were also conducted. Support staff experienced moments of interaction as meaningful because they felt a connection with a person with profound intellectual disabilities and/or they had the feeling of being meaningful for this person. Staff-related and contextual circumstances facilitating meaningful moments of interaction to take place were described. Meaningful moments of interaction are highly valued by support staff, who believe these moments are valued by persons with profound intellectual disabilities as well. Implications for daily practice are described.

Local and Regional Management Approaches for the Redesign of Local Development: A Case Study of Greece

The efforts of different local and regional administrations are increasingly seen as very important drivers of the economic vitality and well-being of territories in a world where subnational government levels continue to gain levels of authority. This study sought to investigate the efficacy of revamping local and regional development through local and regional management practices with a key focus on Greece. A mixed-methods research design was utilized; data were collected using a questionnaire from 200 entrepreneurs and investors from the local community in Kozani and through interviews with six local government leaders in Kozani city, Greece. The study shows that effective local–regional management practices normally function within the constraints provided by local contextual circumstances and traits as well as the possibilities offered by them. In this case, localized techniques may be used in areas with varying degrees of ex ante favorability, economic structures, and different resource endowments, as well as capacities that are essential for regional and local development. Any barriers that may affect the effectiveness of local–regional management practices can be eliminated through proper decision making, the proper allocation of resources, and participatory leadership at the local government level.

Organizational logics in time of crises: How physicians narrate the healthcare response to the Covid-19 pandemic in Swedish hospitals

BackgroundThe COVID-19 pandemic has challenged healthcare organizations and puts focus on risk management in many ways. Both medical staff and leaders at various levels have been forced to find solutions to problems they had not previously encountered. This study aimed to explore how physicians in Sweden narrated the changes in organizational logic in response to the Covid-19 pandemic using neo-institutional theory and discursive psychology. In specific, we aimed to explore how physicians articulated their understanding of if and, in that case, how the organizational logic has changed during this crisis response.MethodsThe empirical material stems from interviews with 29 physicians in Sweden in the summer and autumn of 2020. They were asked to reflect on the organizational response to the pandemic focusing on leadership, support, working conditions, and patient care.ResultsThe analysis revealed that the organizational logic in Swedish healthcare changed and that the physicians came in troubled positions as leaders. With management, workload, and risk repertoires, the physicians expressed that the organizational logic, to a large extent, was changed based on local contextual circumstances in the 21 self-governing regions. The organizational logic was being altered based upon how the two powerbases (physicians and managers) were interacting over time.ConclusionsGiven that healthcare probably will deal with future unforeseen crises, it seems essential that healthcare leaders discuss what can be a sustainable organizational logic. There should be more explicit regulatory elements about who is responsible for what in similar situations. The normative elements have probably been stretched during the ongoing crisis, given that physicians have gained practical experience and that there is now also, at least some evidence-based knowledge about this particular pandemic. But the question is what knowledge they need in their education when it comes to dealing with new unknown risks.

Shippers’ willingness to use flexible transportation services

Factors driving the choice of shipper firms for services of logistics service providers have long been recognized in the freight transportation literature. However, the willingness among shippers to choose flexible transportation services, where the service package can be adapted during planning and execution, has received less attention. In particular, little is known about the contextual circumstances under which shippers would be inclined to select such flexible transportation service. In this study, experimental scenarios and discrete choice modeling are used to investigate the willingness among shippers to use flexible transportation services. We estimate multinomial logit, mixed logit, and latent class models for a sample of nearly 200 global shipper firms and calculate willingness-to-pay measures for flexibility. The findings indicate that flexible services are essential in demand-volatile markets. Since logistics services may provide external flexibility for shipper firms, we also study which related internal flexibilities in supply chains drive these choices. In particular, our findings show that it is mainly the volume flexibility of shippers that mediates the choice of flexible transportation services.

Дорофей Бохан в межвоенной польской печати

This article discusses speeches by the outstanding Russian literary figure in interwar Poland, publicist and critic Dorofey Bokhan, that appeared in the Polish press and have not yet been a subject of research. The contextual circumstances of Bokhan’s publications in Polish in the Vilnius-based socio-political and literary newspaper “Przegląd Wileński” from 1926-1927 and in the Krakow magazine of literature and art “Gazeta Literacka” from 1932-1934 are presented, supported with materials from interwar periodicals and some archival documents. The study clarifies the perceptions of the activities of Dorofey Bokhan as a Russian public figure, popularizer of Russian literature in Poland and Polish literature in Russia, a supporter of Russian-Polish rapprochement. The research materials expand knowledge concerning Russian-Polish literary and cultural connections in the period between two world wars.

The long history of gentrification in Vienna, 1890–2020

This article distinguishes between six historical phases of gentrification in Vienna. These phases emanate from shifting demographic, economic and housing policy circumstances that have decisively shaped gentrification dynamics in the city. Vienna is a rather unusual context compared to cities that are typically in the focus of gentrification research: for considerable parts of the 20th century, the city experienced pronounced demographic decline and economic stagnation. Meanwhile, strong state intervention from the 1920s onwards has shaped the urban housing market. We show how these particular circumstances have moulded gentrification processes throughout the past 130 years. We draw three broader arguments from our analysis: first, there is great value in historicizing gentrification research. Not only does it add empirical evidence to whether and how gentrification functioned prior to it first being mentioned in 1960s London, but also offers a substantial insight into current mechanisms of gentrification. In Vienna, institutions, rules and buildings from earlier periods persist and continue to exert considerable influence on the specificities of gentrification dynamics today. Second, the Vienna case highlights the need to develop more locally specific periodizations of gentrification that give more consideration to contextual circumstances. Third, the analysis points to two specific forms of neighbourhood downgrading since 1890, which are relevant in Vienna and possibly also in other cities: ‘incumbent downgrading’ for 1918–1938, and ‘reverse gentrification’ for the atrocities of Nazi housing policy between 1938 and 1945.

Analysis of biology students' problem-solving skills using the PBL model through Lesson Study (LS) online

Problem-based learning models train students to develop thinking and problem-solving skills in contextual circumstances. This research aims to analyze the problem-solving ability of 32 biology students in 2020 at Malang State University in the course of Plant Physiology. This study is a second-cycle action study using the PBL model through lesson study activities. Data analysis uses a problem-solving skills essay test consisting of identifying problems, identifying strategies, formulating hypotheses, evaluating potential, implementing solutions and evaluating results. The results showed that there was an increase in students' problem-solving ability from cycle I by 60.0% to 72.0% in cycle II and there were several indicators that experienced an increase in scores, namely indicators identifying strategies, formulating hypotheses, implementing solutions, and evaluating results. But the indicator score identifies the problem, and implements the solution decreases.

Real Talk: A Realist Dialogic Approach in a Realist Evaluation

Realist evaluation is a method increasingly adopted to provide an understanding of how and why a program works, for whom, and under what circumstances. Initial program theories (IPT) are the crucial starting point of any realist evaluation, however descriptions about how they are developed in practice remain under-reported in the published literature. This article argues for the value of genuine research-group conversations using David Bohm’s concept of dialogue in realist research. We label it the realist dialogic approach. We draw out the relational qualities as well as the contextual circumstances of dialogue through our development of IPT and interview guides for a research study on the implementation and scaling of a large-system value-based program to transform complex health services. We selected the relevant middle-range theories, conducted a literature review, and drew on informal discussions with key stakeholders, to develop IPT through research-group conversations. The benefits of this approach were: 1) development of rigorous, novel, deep and well-tailored IPT, 2) detailed understanding of the complex intervention under investigation and development of rapport and networks with participants, 3) empirically grounded Context-Mechanism-Outcome (CMO) configurations, predicated on suitable abstract and contextually-contingent middle-range theories, and 4) productive research team interactions which supported the entire research process. The challenges of this approach include: 1) establishing and retaining a sense of humility across the research team, 2) contextual circumstances can hinder dialogic relationship, and 3) time and resource heavy. This paper uses middle-range theory and ethnographic insights to advance the existing practice of realist evaluations and offer transferable lessons to other scholars considering similar approaches. Moreover, we content that the use of middle-range theory to extend the methodological literature is a novel contribution to realist work.

Model of Acceptance and Use of Market-Ready Home-Based e-Care Services: A Qualitative Study with Care Receivers and Informal Caregivers

Because of population aging, home-based e-care services (HBECSs) have raised interest among users and service providers. Recently, scholars have focused extensively on the needs and motives of older adults as care receivers that shape their pre-implementation acceptance of such technologies. Yet, little is known to date about post-implementation experiences and interrelationships between acceptance factors of market-ready services among care receivers and caregivers. To fill this research gap, an intervention study lasting up to eight weeks tested three market-ready HBECSs. Semi-structured interviews were conducted with seven informal caregivers and six care receivers. Qualitative analysis combining grounded theory with thematic analysis was used to present a thematic description of participants’ experiences and inductively develop a substantive model of HBECS acceptance and use. The results detail the impact and expected benefits of such technologies and various barriers to HBECSs use in conjunction with their functionalities and users’ social interactions. Acceptance and future use are determined by a complex mix of interrelated factors. These range from contextual circumstances to characteristics of the caregivers and care receivers to the service properties and perceived outcomes of use, such as safety, psychological relief, and peace of mind.

Exploring the feasibility and acceptability of a physical activity programme for individuals with serious mental illness: A case study

ABSTRACT Partnering with community agencies to implement physical activity (PA) interventions within the care for individuals with serious mental illness is important for improving the translation of research into practice. As such, a case study was conducted to explore individual participant experiences (N= 5, 60% male) and contextual circumstances that may influence the acceptability and feasibility of a pilot one-on-one 6-week PA intervention, within the broader context of a university-community organisation partnership. Interviews were conducted with participants and key implementation stakeholders (i.e. a community organisation stakeholder and a PA programme trainer). Deductive thematic analysis was used to identify themes related to programme feasibility and acceptability. Insights pertaining to programme development and delivery were reported to understand feasibility. Programme participants and key implementation stakeholders also described trainers, the gym environment/external collaboration, and the one-on-one, tailored nature of the programme as being key aspects of programme acceptability. These findings provide support for a university-community agency collaboration in the context of a PA intervention for mental illness. Suggestions for future community-based research are provided.

Linguistic ecology of Bangladeshi higher education: A translanguaging perspective

ABSTRACT This article reports on findings from a larger study that explored the promise of translanguaging pedagogies at two public and two private universities in Bangladesh. Four language learning and four content acquisition courses offered in the first year of undergraduate programmes were observed. A ‘Russian doll approach’ was employed to analyse the macro, meso and micro levels of policy decisions and implementation to build two robust case-studies on public and private universities. Findings reveal a disconnect between macro-level language policy and actual practice at meso and micro-level within universities. The study demonstrates varying degrees of natural translanguaging practices in the classrooms of both public and private universities. Under the particular contextual circumstances, this study recommends promoting translanguaging pedagogies in higher education to enhance language and content learning of Bangladeshi students while also developing bilingual identities through such practices.

Evidence-based strategies to advance BSN student diversity.

Minoritized nurses understand the cultural and contextual circumstances that lead to health disparities, yet they are underrepresented in the RN workforce. This underrepresentation can have serious health consequences. However, to have more representation, it must be understood the pipeline for diversity begins with the admission of diverse students into baccalaureate nursing education programs. This manuscript describes an Initiative that increased the enrollment of students from underrepresented backgrounds and provided the students with the support necessary for retention through graduation. The Initiative incorporated five evidence-based strategies that created a culturally responsive academic environment and enabled diverse students to succeed. Forty-two students were admitted to the baccalaureate nursing program. Thirty-six of the 42 remain in the program resulting in a retention rate of 86%. Six of the thirty-six recently graduated and the remaining 30 students are on track to graduate in their respective years. Through the use of the five-prong evidence-based strategies, the School was able to establish the infrastructure to support the academic advancement and achievement of students from diverse backgrounds. The impact is yet to be determined, but more diverse individuals will graduate, suggestive of a more diverse workforce which will hopefully advance the nation toward health equity.

Socio-demographic associations with pregnancy loss among Bakiga and Indigenous Batwa women in Southwestern Uganda

ObjectiveTo assess the extent of pregnancy loss (i.e., miscarriage and/or stillbirth) and examine its association with socio-demographic characteristics among Bakiga and Indigenous Batwa women in Kanungu District, southwest Uganda. MethodsAs part of a larger community-based, participatory project, a retrospective survey of maternal health histories was conducted in ten Batwa and ten Bakiga communities (n = 555 participants) collecting data on self-reported pregnancy loss (i.e., miscarriage and stillbirth) and socio-demographic characteristics. Socio-demographic associations with pregnancy loss (i.e., total miscarriages and stillbirths) were examined using multivariable Poisson and negative binomial regression. ResultsBatwa women experienced pregnancy loss more commonly than Bakiga women did (149.8/1000 vs. 96.3/1000 pregnancies). In the final adjusted model for Batwa women, being in the middle (RR 1.92; CI: 1.21–3.07) and highest (RR 1.79; CI: 1.14–2.82) wealth tertiles (compared to lowest wealth tertile) and living in Community X (RR 4.33; CI 2.27–8.28) (compared to all other communities) were associated with increased pregnancy loss. For Bakiga women, the proportion of pregnancy loss was higher for those who reported drinking alcohol during pregnancy (RR: 1.54; CI: 1.04–2.13) and being food insecure (RR 1.39; CI: 1.02–1.91). ConclusionThe proportion of, and the socio-demographic associations with, pregnancy loss differed for Bakiga and Indigenous Batwa women. These differences underscore the importance of collecting Indigenous health data to understand not only the extent of, but also the varied contextual circumstances that are associated with pregnancy loss. This nuanced and stratified information is critical for planning meaningful health programming to reduce pregnancy loss for Indigenous women.

Translating Theory into Practice: Evaluating a Prevention Program for LGBTQ+ Youth and Young Adults

Currently, sexual and gender minority youth live in a heteronormative society that does not provide consistent access to preventative social support services or safe spaces essential for healthy adolescent developmental experiences. This contextual circumstance is a catalyst for having unrecognized preventative risks and needs that are comprehensive to sexual and gender minority youth which further increases the likelihood for this distinct population to become justice involved. This study took place with the Lambert House: LGBTQ+ Youth Community Center, the only social service agency in Seattle, WA dedicated exclusively to LGBTQ+ youth and young adults. Data analyzed for this qualitative study includes: review of program documents, field observation notes, and semi-structured interviews. The aim of the study was to: 1) develop an innovative theoretical and methodological strategy to assess fluid programs and their potential to be effective, 2) determine what program theory is driving the program structure and content based on the program stakeholders and participants points of view, and 3) assess how well the final blueprint of the local program theory model aligns with principles of evidence-based practice.

How companions speak on patients' behalf without undermining their autonomy: Findings from a conversation analytic study of palliative care consultations.

Companions are individuals who support patients and attend health‐care appointments with them. Several studies characterised companions’ participation in broad terms, glossing over the details of how they time and design their actions, and how patients and health‐care practitioners (HCPs) respond to them. This article aims to examine these aspects in detail by using conversation analysis, focusing on actions whereby companions speak on patients’ behalf—mentioning delicate aspects of patients’ experience (specifically, by alluding to patients’ thoughts or feelings about dying). Some studies suggested that these actions undermine patients’ autonomy. By contrast, through examination of palliative care consultations in a UK hospice, we found that these interventions are warranted by contextual circumstances: they are either invited by patients or HCPs (through questions or gaze) or volunteered to help with the progression of an activity (e.g. when a patient does not answer an HCP’s question). Additionally, all parties collaborate in constructing these companion interventions as temporary departures from an otherwise prevailing normative orientation to patients’ right to speak for themselves. The study contributes to the sociology of health and illness by characterising how companions contribute to the ways in which participants coordinate their relative rights and responsibilities, and ultimately their relationships, within health‐care interactions.

Identifying latent classes of empowerment among early adolescent girls and the factors that cultivate them: Evidence from a community-based skills training program.

Efforts to empower adolescent girls remain constrained by confusion around how to conceptually define empowerment and how to design interventions. More research, particularly among young adolescents, is needed that considers contextual and age-specific circumstances. This paper examines the latent classes of empowerment among early adolescent girls in Bangladesh and factors associated with membership in these classes. Using data from the Bangladeshi Association for Life Skills, Income, and Knowledge for Adolescents project, a four-arm randomized controlled trial designed to evaluate different community-based approaches for adolescents' skills development, we identify the latent classes before and after intervention and explore whether girls' membership in the study arms was associated with latent class membership at endline. To identify underlying subgroups among the sample, we conducted latent class analysis at baseline and endline using indicators of seven different constructs of empowerment based on the literature. Using multinomial logistic regression analysis, we assessed whether respondents' background characteristics and membership in the study arms were predictive of latent class membership at both timepoints. A three-class model at baseline and a four-class model at endline showed optimal fit. In both models, three distinct latent classes were observed: (1) a least empowered class, (2) a mobile, socially active class, and (3) a socially progressive class. At endline, a fourth class emerged-the most empowered-that was mobile, socially active, and socially progressive. Girls' marital status, religion, and parents' level of education predicted latent class membership; household wealth was predictive at baseline, but not endline. Study arm was also associated with class membership at endline: girls in the Gender-Rights Awareness Arm had the highest probability of belonging to the fourth, most empowered class. This paper identifies and characterizes latent classes of empowerment that exist among the sample before and after the intervention. The apparent differential effects of interventions in predicting latent class membership have implications for community-based programming. Findings suggest that skills-building curriculum focused on promoting gender equitable norms, voice, and agency has potential to influence early adolescent girls across multiple dimensions of empowerment.

Triggering Factors that Reinforce or Change EFL Preservice Teachers’ Beliefs during the Practicum

This exploratory case study seeks to examine the role that specific factors exert on the evolution of beliefs in preservice English teachers during their final teaching practicum. Data were collected through reflections, interviews, focus groups, and observations. The findings revealed that three groups of factors affect belief evolution during the practicum: participant subjectivity, contextual circumstances, and university support community. Subjectivities encompassed preservice teachers’ fears, reactions to real-life teaching challenges, and enthusiasm to become teachers. Contextual circumstances incorporated classroom circumstances and cooperating teachers. The university support community concerned their peers and the university tutor. Implications discuss the relevance of curricular and reflective agendas that enrich the education of future teachers through beliefs exploration.