Context-mechanism-outcome Configurations Research Articles

MHealth interventions for postpartum family planning in LMICs: A realist review.

The unmet need for family planning is a pervasive public health concern in many low- and middle-income countries (LMICs). Mobile health (mHealth) interventions have been designed and implemented in LMIC settings to address this issue through health information dissemination via voice calls, apps, and short message services (SMS). Although the impact of mHealth programmes on postpartum family planning outcomes have been systematically reviewed, the contexts, conditions, and mechanisms underpinning programme engagement and their impact on outcomes remain unclear. This study aims to formulate hypotheses in the form of context-mechanism-outcome configurations (CMOCs) of whether, how, why, for whom, and in what contexts mHealth interventions implemented in LMICs influence postpartum family planning (PPFP) outcomes. We conducted a realist review of peer-reviewed and grey literature. Peer-reviewed literature was identified through MEDLINE, Embase, Global Health, Web of Science, and Google Scholar. Grey Literature was identified through The National Grey Literature Conference, FHI 360, Guttmacher Institute, Population Council, and MSI Reproductive Choices. Inclusion criteria were updated as the review progressed. Narrative data were analysed using dimensional analysis to build CMOCs. Two overarching concepts (underpinned by 12 CMOCs) emerged from the 37 included records: mobile phone access, use, and ownership as well as women's motivation. Women's confidence to independently own, access, and operate a mobile phone was a central mechanism leading to mHealth programme engagement and subsequent change in PPFP knowledge, awareness, and outcomes. Receiving family and social support positively interacted with this while low digital literacy and harmful gender norms pertaining to prescribed domestic duties and women's household influence were barriers to programme engagement. Intrinsic motivation for health improvement functioned at times both as a context and potential mechanism influencing mHealth programme engagement and PPFP outcomes. However, these contexts rarely occur in isolation and need to be evaluated as co-occurring phenomena. (Review registration: PROSPERO CRD42023386841).

How Communities of Practice Generate Knowledge Translation Outcomes to Support Public Health Issues: A Realist Synthesis

Communities of practice in health settings often serve to address contemporary public health issues by sharing knowledge and experiences about accelerating implementations and innovative solutions. Because there are gaps between the practical application of communities of practice and the scientific knowledge about their effectiveness, this realist synthesis aimed to identify how and why members of communities of practice translate the shared knowledge and apply it in their daily practice. In a six‐step process, this realist synthesis included a scoping review that led to an initial theory map (Step 1), followed by searches (Step 2), appraisal (Step 3), extracts and organisation (Step 4), and analysis and synthesis (Step 5). These steps organised the literature into context–mechanism–outcome configurations that guided the development of a realist framework that can support research and practice (Step 6). We identified three key ways in which knowledge translation may occur: (1) Members bring (new) knowledge to their parent organisation; (2) members change the (daily) practice in their parent organisation; and (3) members improve health outcomes through systemic changes. We found that an initial outcome of knowledge sharing within the community of practice is conditional to achieving outcomes of knowledge translation outside the community of practice. This knowledge sharing within the community of practice is more likely to occur in a structured and trusted environment where members feel safe, as well as where members recognise individual and organisational benefits from participation. To achieve knowledge translation outside the community of practice, support from the parent organisation becomes important, alongside learning and developing confidence to implement the knowledge. The synthesis of the different contexts that potentially trigger mechanisms that lead to desired outcomes provides insight into how best to inform community of practice initiators and facilitators about supporting effective public health responses.

Keeping Girls in Sport: A Two-Part Evaluation of an E-Learning Program for Coaches and Activity Leaders

The purpose of this study was twofold: first, to identify who engaged with the Keeping Girls in Sport e-learning program and, second, to evaluate coach and activity leaders’ perceptions of the program and their perceived learnings gained from completing the program. An explanatory sequential mixed-method design was adopted. First, an online survey was distributed to all individuals who had participated in the program. In total, 511 (33% response rate) completed the survey. Quantitative survey data were analysed using descriptive statistics. Subsequently, interviews were conducted with 20 survey respondents. A realist logic of analysis was applied to the qualitative data, and context–mechanism–outcome configurations were formed. Overall, survey findings indicated that most participants identified as women (56%), coaches (69%), and were between 40 and 49 years of age (37%). In general, participants had positive perceptions of the program. Participants perceived that the accessibility and flexibility of the program increased opportunities to engage with content and, thus, their learning. They described improvements in knowledge and perspective regarding working with female athletes. This increase in knowledge provided participants with confidence to establish trusting and positive relationships with others, specifically parents. Nevertheless, participants highlighted a need for more tailored but also more expansive programs.

A Protocol for a Rapid Realist Review of Literature Examining Co-Production in Youth Mental Health Services

An overview of internationally published literature on what works for co-production in youth mental health services is missing, despite a practice and policy context strongly recommending this approach. The proposed rapid realist review aims to develop a theory about how and why co-production methods in youth mental health services work (or do not work), for whom, in which contexts, and through what mechanisms. Relevant evidence will be synthesised to develop context–mechanism–outcome (CMO) configurations that can inform policy and practice. Stakeholders will be iteratively involved in the development of these theories (CMO configurations) by engaging an expert panel and youth advisory group. The review results will be reported according to the RAMESES guidelines and are intended to be published in an academic journal. Additionally, a plain English summary will be produced with the support of the youth advisory group.

Mitigating risks of online engagement; considering the contexts and mechanisms of cybercrime among older adults

AbstractBackgroundThis talk will explore how benefits of remote interventions can be realised for older people with cognitive impairments alongside risk mitigation, drawing on a realist review of how and in what circumstances older people become victims of cybercrime. We aimed to identify factors leading to older adults' victimisation, and review theory and evidence for interventions to reduce victimisation risks.MethodWe conducted a realist review synthesising published literature and gathering stakeholder experiences via an online workshop to understand how, why and in what circumstances older adults are at risk of financial cybercrime victimisation. We used the evidence to develop a programme theory and Context, Mechanism, Outcome Configurations (CMOCs) to explain the mechanisms by which older adults become victims of financial cybercrime in different contexts, and to inform the development of interventions to produce desired outcomes of reducing and preventing cybercrime.ResultWe analysed 52 primary and secondary data sources and consulted with 21 stakeholders from across health, social, legal, and financial sectors. Our programme theory comprised 16 CMOCs describing how social isolation, cognitive decline, physical and mental health problems; wealth status, limited cyber security skills or awareness, societal attitudes and content of scams led to increased risk of victimisation. Only evidence for interventions to enhance cyber security awareness and skills of potential older victims was identified. Targeting offender motivation, redesign of security software to increase usability by older people and training programmes for professionals and family members are rational, yet untested interventions. A shift in societal attitudes, conveying positive messages, of older people’s rights to be safely active online, is needed too.ConclusionProtection from cybercrime is instrumental to supporting ageing in a digital world. Incorporating cyber security awareness into future interventions that promote social connectedness, cognition and healthy lifestyles, alongside legal structural protections, and measures to improve societal attitudes towards financial cybercrime victimisation will help older adults navigate online spaces safely. Training programmes targeting older adults, or their supporters should be deliverable by a range of professionals for greatest reach; and be co‐designed with end users to ensure that if they are useful, they are acceptable and used.

Sleep disturbance in people living with dementia or mild cognitive impairment: a realist review of general practice.

Sleep disturbance is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex because of the comorbidities, older age, and cognitive impairment typical of this patient group. To explore how primary care clinicians assess, understand, and manage sleep disturbance for PLwD or MCI; if and why such initiatives work; and how people and their carers experience sleep disturbance and its treatment. A realist review of existing literature conducted in 2022. Six bibliographic databases were searched. Context-mechanism-outcome configurations (CMOCs) were developed and refined. In total, 60 records were included from 1869 retrieved hits and 19 CMOCs were developed. Low awareness of and confidence in the treatment of sleep disturbance among primary care clinicians and patients, combined with time and resource constraints, meant that identifying sleep disturbance was difficult and not prioritised. Medication was perceived by clinicians and patients as the primary management tool, resulting in inappropriate or long-term prescription. Rigid nursing routines in care homes were reportedly not conducive to good-quality sleep. In primary care, sleep disturbance among PLwD or MCI is not adequately addressed. Over-reliance on medication, underutilisation of non-pharmacological strategies, and inflexible care home routines were reported as a result of low confidence in sleep management and resource constraints. This does not constitute effective and person-centred care. Future work should consider ways to tailor the assessment and management of sleep disturbance to the needs of individuals and their informal carers without overstretching services.

Focusing a realist evaluation of peer support for paediatric mental health

ObjectiveMental health problems are a leading and increasing cause of health-related burden in children across the world. Peer support interventions are increasingly used to meet this need using the lived experience of people with a history of mental health problems. However, much of the research underpinning this work has focused on adults, leaving a gap in knowledge about how these complex interventions may work for different children in different circumstances. Realist research may help us to understand how such complex interventions may trigger different mechanisms to produce different outcomes in children. This paper reports on an important first step in realist research, namely the construction of an embryonic initial programme theory to help ‘focus’ realist evaluation exploring how children’s peer support services work in different contexts to produce different outcomes in the West Midlands (UK).MethodsA survey and preliminary semi-structured realist interviews were conducted with 10 people involved in the delivery of peer support services. Realist analysis was carried out to produce context-mechanism-outcome configurations (CMOC).ResultsAnalysis produced an initial programme theory of peer support for children’s mental health. This included 12 CMOCs. Important outcomes identified by peer support staff included hope, service engagement, wellbeing, resilience, and confidence; each generated by different mechanisms including contextualisation of psychoeducation, navigating barriers to accessing services, validation, skill development, therapeutic relationship, empowerment, and reducing stigma.ConclusionThese data lay the groundwork for designing youth mental health realist research to evaluate with nuance the complexities of what components of peer support work for whom in varying circumstances.

Racialised staff–patient relationships in inpatient mental health wards: a realist secondary qualitative analysis of patient experience data

BackgroundThe current study is a secondary analysis of qualitative data collected as part of EURIPIDES, a study which assessed how patient experience data were used to improve the quality of...

O.4.4-8 Promoting men’s health through sports clubs: a rapid realist review

Abstract Purpose Traditional health promotion interventions have failed to engage men. Sports clubs offer male-friendly environments that have been identified as an attractive setting for men’s health promotion, but little is known about implementable intervention strategies and subsequent effects. This rapid realist review (RRR) aims to close this gap by assessing context, mechanisms and effects of health promotion interventions targeting men by or in collaboration with sports clubs. Methods The RRR methodology was developed in collaboration with a panel of Danish practice and policy representatives and international academics. A systematic literature search was conducted in February 2023 for studies published after 2013 in MEDLINE, Embase, and SportDiscus databases. Included studies: 1) targeted men aged 18+ years, 2) reported health promotion outcomes, and 3) were delivered primarily by or in collaboration with sports clubs. A grey literature search of National Sports Associations and Federations and non-government men’s health organizations was also performed. Dalkin’s conceptualization of mechanisms in realist methodology was used to identify context- mechanism-outcome configurations (CMOc) and develop a program theory. The study follows Cochrane’s guidance for rapid reviews and is registered in Research Registry (ID: reviewregistry1556). Results We identified 2.720 studies after duplicates removal. Preliminary analyses indicate that interventions delivered through sports clubs show promise for engaging men and producing favorable health outcomes (e.g., weight loss, increased physical activity and improved social support). The realist synthesis suggests that health interventions delivered through sports clubs (resource mechanism) targeted at men who have high attachment to the sport or club (context), may align with their interests and identities (mechanism), to increase the potential for engagement and health behavior change (outcome). The analysis will be finalised by August. Conclusions Our study indicates that men’s health promotion through sports clubs is emergent. While great strides have been made to increase men’s involvement in health promoting activities by delivering interventions through sports clubs, research has predominantly focused on select behaviours (e.g., physical activity) and sub-groups (e.g., sports fans). Support/Funding Source This work was funded by the five Steno Diabetes Centers in Denmark, which are partly funded by the Novo Nordisk Foundation.

Understanding communication incommunity engagement formaternal andnewborn health programmes inlow- andmiddle-income countries: a realist review.

As community engagement (CE) is implemented for sustainable maternal and newborn health (MNH) programming, it is important to determine how these approaches work. Low- and middle-income countries (LMICs) have become a particular focus for MNH CE activities due to their high burden of maternal and neonatal deaths. MNH messaging and communication to engage communities are likely to differ by context, but how these approaches are actually developed and implemented within CE is not well understood. Understanding how communications in CE actually work is vital in the translation of learnings across programmes and to inform future projects. The purpose of this realist review is to describe how, why, to what extent and for whom communications in CE contribute to MNH programming in LMICs. After searching academic databases, grey literature and literature suggested by the expert advisory committee, documents were included if they described the CE communication processes/activities used for MNH programming in an LMIC. Relevant documents were assessed for richness (depth of insight) and rigor (trustworthiness and coherence of data/theories). Data were extracted as context-mechanism-outcome configurations (CMOCs) and synthesized into demi-regularities to contribute to theory refinement. After screening 416 records, 45 CMOCs were extracted from 11 documents. This informed five programme theories explaining that communications in CE for an MNH programme work when: communities are actively involved throughout the programme, the messaging and programme are acceptable, communication sources are trusted, the community has a reciprocal relationship with the programme and the community sees value in the programme. While these findings reflect what is often anecdotally known in CE or acknowledged in communications theory, they have implications for policy, practice and research by highlighting the importance of centring the community's needs and priorities throughout the stages of developing and implementing communications for CE in MNH.

Health technology assessment implementation in WHO South-East Asia Region: a realist review protocol

Background: A robust Health Technology Assessment (HTA) mechanism is crucial to address the rising burden of healthcare costs and expenditures of patients. This research aims to describe the HTA methods and mechanisms for successful implementation of HTA in the WHO South-East Asia region, and contextualize the synthesized evidence relevant to Indian settings. Methods: Realist review involves developing a program theory by conducting a systematic search strategy, screening, study selection, data extraction, and data synthesis. A systematic search for literature will be conducted on PubMed (NCBI), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate), and ProQuest Central for identifying the methods used for HTA of health technology interventions. Stakeholder consultations will be conducted to develop a program theory following the Context-Mechanism-Outcome configurations (CMOcs) framework. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. The proposed realist review will be reported as per the Realist and MEta-narrative Evidence Syntheses: Evolving Standards [RAMESES II] guidelines. Conclusions: To our knowledge, there has been no comprehensive review conducted to understand the mechanisms of HTA methods in the WHO South-East Asia region. The findings from the realist review will help us understand the mechanisms through which the HTA could work in WHO South-East Asian countries. We will then contextualize the findings obtained from evidence to Indian settings, based on program theory development through stakeholder consultation. A framework will be developed that can be used by policymakers/HTA experts in India for effective implementation of the same.

Enhancing Student Wellbeing Through Social Prescribing: A Rapid Realist Review.

Objectives: A Rapid Realist Review of social prescribing in Higher Education (HE) was undertaken to determine what works, for whom, how, why, and within what circumstances. The review resulted in the development of a Realist Programme Theory articulating the way in which social prescribing can be implemented within the HE environment. Methods: Searches of 12 electronic databases were supplemented by citation chaining and grey literature surfaced by the Project Advisory Group. The RAMESES Quality Standards for Realist Review were followed, and the retrieved articles were systematically screened and iteratively analysed to develop Context-Mechanism-Outcome Configurations (CMOCs) and an overarching Realist Programme Theory. Results: A total of 57 documents were included. The overarching programme theory was developed from the analysis of these documents and comprised of a social prescribing pathway with the following components: (1) An Accessible Gateway, (2) A Skilled Peer, (3) Trusted-Safe-Credible Resources, and (4) A Healthy Setting. Conclusion: A Realist Programme Theory was developed-this model and associated principles will provide a theoretical basis for the implementation of social prescribing pathways within higher education. Whilst the direct project outputs are of particular significance to the UK HE audience, the underpinning principles can support practice within the global arena.

P02 Strategies for Older People living in care homes to prevent Urinary Tract Infection: the ‘StOP UTI’ realist synthesis of evidence

Abstract Background Urinary tract infection (UTI) is the most diagnosed infection in older people living in care homes, accounting for more than 50% of antibiotic prescriptions in this setting. Older people often present with non-specific or atypical symptoms, which may have other origins and are difficult for care home staff to interpret. Objectives To identify interventions that could be effective for preventing and recognizing UTI in older people living in care homes in the UK and explore the mechanisms by which they work, for whom and under what circumstances. Methods A synthesis of evidence using a realist approach was undertaken to develop, test and refine programme theories, which are the units of analysis within the realist approach. These were expressed as context + mechanism=outcome configurations (CMOc). Their practical relevance and potential for implementation was established through consultation with stakeholders and teacher-learner interviews. Results We identified nine CMOc, which describe what needs to happen in care homes to facilitate improvement in practice for the prevention and recognition of UTI. These were arranged under three theory areas: (i) supporting accurate recognition of UTI; (ii) preventing UTI and catheter-associated UTI; and (iii) the infrastructure and systems required to make best practice happen. Our programme theories draw on evidence from a range of areas including infection prevention and control, antimicrobial stewardship, leadership and safety culture in care homes and person-centred care. The findings suggest a whole care team approach, involving residents, their family carers, care home staff and visiting health professionals is needed to develop and implement strategies to improve UTI prevention and recognition. Support at system level, with regulatory and inspection frameworks aligned to evidence on prevention and recognition of UTI, is imperative to ensure the resources and infrastructure are available to enable care home managers and their staff to prioritize this as part of person-centred care. Conclusions Our findings have identified the active components of strategies that are effective in preventing and recognizing UTI in older people living in care homes and will help guide delivery of future improvement programmes and research.

Understanding for whom, under what conditions, and how atrial fibrillation screening interventions are successful: a realist review

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme. Background/introduction The treatment of atrial fibrillation (AF) with oral anticoagulants reduces stroke risk. Most initial AF diagnoses result from symptom related rhythm monitoring or are after stroke. However, as AF is often asymptomatic detecting it by screening could initiate oral anticoagulant treatment. Purpose We aimed to understand for whom, under what conditions, and how AF screening programmes can increase the number of new AF diagnoses and lead to guideline-adherent care. Methods A realist review of AF screening for those aged ≥18 years. We developed an initial programme theory; systematically searched four databases until October 2022; and selected documents that included details about factors relating to the implementation of AF screening programmes. We extracted, analysed, and synthesised data using realist techniques to create context–mechanism–outcome configurations, and a refined programme theory. Results We screened 2,707 documents and included 70. The refined programme theory included 15 context–mechanism–outcome configurations to explain how different screening programme implementation affects outcomes. Key factors in successful implementation included 1) locations accessible to those at most risk of undiagnosed AF; 2) targeted, inclusive invitations; 3) training to increase understanding and competence of those undertaking screening; 4) using digital technology for convenience and accuracy; 5) organisational support mechanisms such as automated prompts to increase awareness of who to screen; and 6) standardised follow-up pathways. The best system for screening is unclear. Single time point screening is convenient, potentially leading to higher uptake. Prolonged screening may result in a higher paroxysmal AF yield (Figure 1). Conclusions Well implemented AF screening programmes could increase the number of new AF diagnoses and lead to guideline-adherent care, thereby reducing stroke risk.

Linking leadership development programs for physicians with organization-level outcomes: a realist review

BackgroundHospitals invest in Leadership Development Programs (LDPs) for physicians, assuming they benefit the organization’s performance. Researchers have listed the advantages of LDPs, but knowledge of how and why organization-level outcomes are achieved is missing.ObjectiveTo investigate how, why and under which circumstances LDPs for physicians can impact organization-level outcomes.MethodsWe conducted a realist review, following the RAMESES guidelines. Scientific articles and grey literature published between January 2010 and March 2021 evaluating a leadership intervention for physicians in the hospital setting were considered for inclusion. The following databases were searched: Medline, PsycInfo, ERIC, Web of Science, and Academic Search Premier. Based on the included documents, we developed a LDP middle-range program theory (MRPT) consisting of Context-Mechanism-Outcome configurations (CMOs) describing how specific contexts (C) trigger certain mechanisms (M) to generate organization-level outcomes (O).ResultsIn total, 3904 titles and abstracts and, subsequently, 100 full-text documents were inspected; 38 documents with LDPs from multiple countries informed our MRPT. The MRPT includes five CMOs that describe how LDPs can impact the organization-level outcomes categories ‘culture’, ‘quality improvement’, and ‘the leadership pipeline’: 'Acquiring self-insight and people skills (CMO1)', 'Intentionally building professional networks (CMO2)', 'Supporting quality improvement projects (CMO3)', 'Tailored LDP content prepares physicians (CMO4)', and 'Valuing physician leaders and organizational commitment (CMO5)'. Culture was the outcome of CMO1 and CMO2, quality improvement of CMO2 and CMO3, and the leadership pipeline of CMO2, CMO4, and CMO5. These CMOs operated within an overarching context, the leadership ecosystem, that determined realizing and sustaining organization-level outcomes.ConclusionsLDPs benefit organization-level outcomes through multiple mechanisms. Creating the contexts to trigger these mechanisms depends on the resources invested in LDPs and adequately supporting physicians. LDP providers can use the presented MRPT to guide the development of LDPs when aiming for specific organization-level outcomes.

How local, first-line nurse leaders can positively influence nurse intent to stay and retention: A realist review.

To explore evidence on how local nurse leaders can positively influence nurse retention. Nurse turnover and retention is a wicked problem with multiple interrelated factors and no one solution. Local nurse leadership has the potential to positively influence nurse intent to stay directly or via various factors. A realist review. Having designed a search strategy based on a tentive programme theory, 1386 initial hits in three databases were screened and reduced to 48 research articles published between 2010-2021. The articles' content were coded for findings that supported, refined or contradicted four ContextMechanismOutcome configurations. Sufficient evidence was found to support four guiding lights encouraging local nurse leaders to: (1) foster relational connectedness; (2) enable professional practice autonomy; (3) cultivate healthful workplace cultures; (4) support professional growth and development. Mutuality and reciprocity is also key if leaders themselves are to experience wellbeing and growth. Person-centred, transformational and resonant local nurse leaders can positively influence nurse intent to stay within the workplace or organisation. Conform JCN guideline 'What to cover in the main tekst by article type' for reviews. No Patient or Public Contribution.

How and why educational interventions work to increase knowledge of delirium among healthcare professionals in nursing homes: a protocol for a realist review

BackgroundDelirium is a neuropathological condition that impairs cognitive performance, attention and consciousness and can be potentially life-threatening. Nursing home residents are particularly vulnerable to developing delirium, but research thus far...

Understanding primary care diagnosis and management of sleep disturbance for people with dementia or mild cognitive impairment: a realist review.

Sleep disturbance (SD) is common among people living with dementia (PLwD) or mild cognitive impairment (MCI). It has a significant impact on the wellbeing of PLwD and caregivers, and makes care at home more difficult. Within primary care, assessment and management of SD for this population is complex and challenging. To identify what works, how, and for whom, in the assessment and management of SD for PLwD or MCI in primary care. We conducted a realist review to develop explanations of causal relationships, using context-mechanism-outcome configurations (CMOCs). An initial programme theory was iteratively tested and refined, using data from relevant literature and stakeholder feedback. The study followed RAMESES reporting quality. In total, 71 papers from OECD countries were included for analysis, generating 19 CMOCs. Low awareness of SD and assessment methods resulted in underdiagnosis in primary care. Assessment and treatment of PLwD/MCI were, respectively, more challenging when people were unable to accurately report concerns or implement interventions independently. Sedative medication was commonly used to manage SD, often driven by low confidence in nonpharmacological strategies. Long-term medication use was common despite guidelines indicating limited efficacy, which was driven by perceived pressures to prescribe or concerns of relapse. In nursing homes, environments and routines could exacerbate SD. Increasing awareness, knowledge, and confidence in diagnosis and assessment of SD is needed. Primary care-specific assessment tools may help. Long-term medication use is the default option in absence of pragmatic and effective non-pharmacological interventions that can be easily incorporated into routine general practice.

Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: a realist review

BackgroundFalls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals.MethodsA realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers.ResultsTwo CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging.ConclusionsOrganisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients’ individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate.Trial registrationPROSPERO: CRD42020184458.

Engaging Industry in Health Professions' Education: Benefits and Challenges.

Effective partnerships between universities and industry facilitate health-profession students' learning and work readiness. However, developing sustainable industry engagement in academic curricula remains challenging. This study utilised Social Exchange Theory (SET) to explore the benefits of and barriers to industry engagement within health-profession preparation programs. A realist evaluation framework was used to consider factors that impacted experiences and outcomes for academics and clinicians who engaged in the development and delivery of curriculum for a new health professional preparation program in speech pathology. A sequential mixed-methods design was adopted to explore factors influencing clinicians' motivation to engage with the university, using an online survey (n = 18) and focus group (n = 5). Clinicians rated "personal development" and contributing to the "future workforce" as the highest personal benefits. "Sharing knowledge" was the highest team benefit, and "staff satisfaction" was the highest employer benefit. Time and workload were perceived barriers. Academics (n = 2) and clinicians (n = 3) who collaborated in learning and teaching experiences also participated in a post-engagement focus group. Three Context Mechanism Outcome configurations were shown to facilitate engagement outcomes: engagement as opportunity, partnership, and work readiness. In accordance with SET, the nature of exchange processes and professional relationships contributed to positive engagement outcomes for clinicians, academics, and enhanced health-profession education.