Deliberative Dialogue Research Articles

Teaching argumentative synthesis writing through deliberative dialogues: instructional practices in secondary education

Dialogical argumentation practice contributes positively to argumentative writing skills. Specifically, deliberative dialogues are effective in promoting argument and counterargument integration in students' essays. However, the potential of dialogic activities may be increased if they are combined with instructional practices. The primary objective of this research is to compare the impact of four intervention programs, aimed at improving argumentative synthesis writing from conflicting sources. The four programs resulted from the combination of two instructional components (Explicit Instruction through video modelling—EI, or a Procedural Guideline—G), while Deliberative Dialogues—DD—were a constant element. We conducted a pre-post quasi-experimental study in which 186 Spanish third grade secondary school students (aged 14–15) participated. We evaluated the quality of the syntheses by examining the level of argumentative coverage (the total number of arguments included in the synthesis) and the level of integration (the type and frequency of the argumentative strategies used in the syntheses). The results showed that the effectiveness of the instructional methods varies according to the synthesis quality indicator. Explicit instruction, in combination with deliberative dialogues, was especially helpful in improving the level of integration of syntheses. The procedural guideline, in combination with deliberative dialogues, contributed significantly to the coverage of arguments. The combination of these two elements did not favor the writing of synthesis as expected, probably due to the conditions in which the intervention was carried out. The findings of this study revealed that the coverage of arguments and integration processes are of different nature, follow different learning paths and require different instructional processes.

Study and promotion of safety culture using mixed methods research

Abstract Objective With a positive safety culture, institutions offer the best quality and safe care to their patients. The objective of this study was to analyze patient safety culture from the perspective of the multidisciplinary team, to identify factors that influence patient safety culture, and to create/promote—jointly with the study participants—strategies for improving processes of change. Methods The study design represented a mixed methods research approach, with a sequential explanatory design. A multidisciplinary team of workers at a general hospital was eligible for the study. To collect quantitative data, we administered the Safety Attitudes Questionnaire (SAQ). The qualitative phase was accomplished via focus groups (FGs), with participants from the first phase of the study using the principles of deliberative dialogue (DD) as a knowledge-translation strategy. The STROBE guideline was used to develop the study. Results The overall SAQ score was positive (75.1 ± 10.4). Negative scores were found in the fields of Safety Climate, Working Conditions, and Stress Recognition. Focus group discussions identified the aspects that create a negative impact on safety culture, such as ineffective communication, punitive approach in the event of errors, the lack of commitment and adherence to the protocols, and the non-recognition of the stress and the mistakes. Actions for the promotion of safety culture were developed and implemented during the study. Conclusions The use of the principles of DD as a strategy for knowledge translation (KT) made it possible to identify and plan for joint actions to generate improvements in safety culture.

Community views on short birth interval in Northern Uganda: a participatory grounded theory

BackgroundShort birth interval is associated with adverse perinatal, maternal, and infant outcomes, although evidence on actionable factors underlying short birth interval remains limited. We explored women and community views on short birth intervals to inform potential solutions to promote a culturally safe child spacing in Northern Uganda.MethodsGendered fuzzy cognitive mapping sessions (n = 21), focus group discussions (n = 12), and an administered survey questionnaire (n = 255) generated evidence on short birth intervals. Deliberative dialogues with women, their communities, and service providers suggested locally relevant actions promote culturally safe child spacing.ResultsWomen, men, and youth have clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice as women are disempowered to exercise child spacing. Women who use contraceptives without their husbands’ consent risk losing financial and social assets and are likely to be subject to intra-partner violence. Women were not comfortable with available contraceptive methods and reported experiencing well-recognized side effects. They reported anxiety about the impact of contraception on the health of their future children. This fear was fed by rumors in their communities about the effects of contraceptives on congenital diseases. The women and their communities suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives.ConclusionsThe economic context, gender power dynamics, inequality, gender bias in land tenure and ownership regulations, and the limited contraceptive supply reduce women’s capacity to practice child spacing.

Stakeholder perceptions of current practices and challenges in priority setting for non-communicable disease control in Kenya: a qualitative study

ObjectiveTo explore the stakeholders’ perceptions of current practices and challenges in priority setting for non-communicable disease (NCD) control in Kenya.DesignA qualitative study approach conducted within a 1-day stakeholder workshop that...

Childhood Acute Leukemias in Developing Nations: Successes and Challenges.

Acute leukemias represent a tremendous threat to public health around the globe and the main cause of death due to disease in scholar age children from developing nations. Here, we review their current status in Mexico, as a paradigm of study, and the major challenges to control systemic diseases like childhood cancer. A unique molecular epidemiology, late/low precision diagnosis, limited access to treatment, toxicity associated with therapy, continuous exposure to environmental risk factors, and the high frequency of early relapses are some of the factors cooperating to low rates of survival in low-to-medium-income countries. Deliberative dialogues and exhaustive programs have emerged as promising means of advancing evidence-informed policy, by providing a structured forum for key stakeholders to integrate scientific and pragmatic knowledge about complex health concerns. A system-wide strategy based on the comprehensive leukemia identity is essential for a meaningful decline in early childhood mortality.

Communities and service providers address access to perinatal care in postconflict Northern Uganda: socialising evidence for participatory action

ObjectivesDescribe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda.Study designMixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups...

Creating an action plan to advance knowledge translation in a domestic violence research network: a deliberative dialogue

Background: There is limited research on how knowledge translation of a domestic violence (DV) research network is shared. This lack of research is problematic because of the complexity of establishing a research network, encompassing diverse disciplines, methods, and focus of study potentially impacting how knowledge translation functions. Aims and objectives: To address the limited research, we completed a deliberative dialogue with the following questions: Is there a consensus regarding a coherent knowledge translation framework for a domestic violence research network? What are the key actions that a domestic violence research network could take to enhance knowledge translation? Methods: Deliberative dialogue is a group process that blends research and practice to identify potential actions. In total, 16 participants attended three deliberative dialogue meetings. We applied a qualitative analysis to the data to identify the key actions. Findings: The deliberative dialogue facilitated mutual agreement regarding four key actions: (1) agreement on a knowledge translation approach; (2) active promotion of dedicated leadership within an authorising environment; (3) development of sustainable partnerships through capacity building and collaboration, particularly with DV survivors; and (4) employment of multiple strategies applying different kinds of evidence for diverse purposes and emerging populations. Discussion and conclusions: The use of the deliberative dialogue has uncovered specific factors required for the successful knowledge translation of domestic violence research. These factors have been added to the Integrated Knowledge Translation (IKT) capacity framework to enhance its application for domestic violence research. Future research could explore these organisational, professional and individual factors further by evaluating them in practice.

Stories and voices: Engaging community differences by designing a deliberative public dialogue

Students engage in a pedagogy that fosters deliberation on civic issues that elicit different perspectives relevant to a community through a semester-long project that culminates in the execution of public dialogue forum. This project facilitates three learning objectives: dialogic praxis, communication as design, and facilitative leadership. Students design, organize, and implement a public dialogue on campus, facilitating dialogic discussions on a relevant community topic. The aim of the “Stories and Voices” project is to elicit and contextualize disparate experiences, as well as to lift voices that are often unheard on civic issues. Students marry practice with deep consideration of equity, diversity, and power. Courses Relevant upper-division courses, including deliberation, dialogue, public participation, public communication/public sphere, deliberative democracy, small, group and organizational communication, and could be adapted to subject specific courses such as environmental communication, health communication, or social justice-oriented courses. The semester-long activity also provides a mechanism for examining systematic racism in various aspects of civic policy. Objectives The course engages students in a pedagogy grounded in dialogue and deliberation on civic issues that elicit different perspectives relevant to a community through a semester-long project that culminates in the execution of public dialogue forum. The project’s primary objective prepares students to foster civic dialogue as they marry practice with deep consideration of equity, diversity, and power. The “Stories and Voices” event elicits and contextualizes disparate experiences, as well as elevates voices that are often unheard on civic issues. A second objective focuses on communication as design as students develop, organize, and implement an event on campus that is marketed and open to the community to attend. Students learn how to frame issues, include those frequently marginalized, and create reciprocity in the program design. They distinguish between advocacy and inquiry models, generative and deliberative models; and learn the power of asking questions. They explore the distinctions and appropriateness of different types and aims of public discourse, and how best to facilitate conversations important in the public sphere. The final objective animates Barber’s concept of facilitative leadership, as the project requires outside commitments from students to facilitate and weigh the roles of expertise, impartiality, and conflict as conversation leaders responsible for the outcomes of the forum.

Understanding and Improving the Care of Older Adults Living with Dementia Across Four Canadian Provinces during the COVID-19 Pandemic: A Mixed-Methods Study to Inform Policy and Practices

Introduction: The implications of the COVID-19 pandemic are far reaching for persons living with dementia (PLWD) in the community and in long-term care (LTC), as they are among the most vulnerable. PLWD are at risk for severe COVID-19 and a disruption in accessing supportive and health care due to the confinement measures. Objectives: 1) To measure the impact of the pandemic on health and social services use, mortality, COVID-19 infection where possible of PLWD both in the community and in LTC facilities compared to before the pandemic; 2) To understand PLWDs’ and care partners’ perceived needs, behaviours related to health service use and the experiences of PLWD, care partners, and physicians with health and social services; 3) To generate and disseminate evidence-based and actionable recommendations on effective strategies to address the current pandemic and prepare for subsequent waves. Methods: A convergent mixed-methods design with a participatory approach in 4 Canadian provinces. Objective 1 will use a retrospective observational cohort design to examine administrative health data. Outcomes will include mortality (all-cause; COVID-19 related), health service use and, where possible, infection rates. Objective 2 will use an explanatory multiple case study, with surveys and semi-structured interviews to explore the experiences of PLWD and care partners using health and social services and the role of sociodemographic factors. The third, knowledge translation objective will integrate these results using a deliberative dialogue with key stakeholders (decision-makers, healthcare managers, PLWD, care partners, and clinicians) to develop and disseminate evidence-based recommendations for practice and policy. Impact and conclusion: This project will provide an understanding of the impact of the COVID-19 pandemic on PLWD and care partners in Canada and highlight areas for improvement.

Implementation of national childbirth guidelines in Brazil: barriers and strategies.

ABSTRACTThe present report describes the process and results obtained with a knowledge translation project developed in three stages to identify barriers to the Implementation of the National Guidelines for Normal Childbirth in Brazil, as well strategies for effective implementation. The Improving Programme Implementation through Embedded Research (iPIER) model and the Supporting Policy Relevant Reviews and Trials (SUPPORT) tools provided the methodological framework for the project. In the first stage, the quality of the Guidelines was evaluated and the barriers preventing implementation of the recommendations were identified through review of the global evidence and analysis of contributions obtained in a public consultation process. In the second stage, an evidence synthesis was used as the basis for a deliberative dialogue aimed at prioritizing the barriers identified. Finally, a second evidence synthesis was presented in a new deliberative dialogue to discuss six options to address the prioritized barriers: 1) promote the use of multifaceted interventions; 2) promote educational interventions for the adoption of guidelines; 3) perform audits and provide feedback to adjust professional practice; 4) use reminders to mediate the interaction between workers and service users; 5) enable patient-mediated interventions; and 6) engage opinion leaders to promote use of the Guidelines. The processes and results associated with each stage were documented and formulated to inform a review and update of the Guidelines and the development of an implementation plan for the recommendations. Effective implementation of the Guidelines is important for improving the care provided during labor and childbirth in Brazil.

Lessons learned from descriptions and evaluations of knowledge translation platforms supporting evidence-informed policy-making in low- and middle-income countries: a systematic review

BackgroundKnowledge translation (KT) platforms are organisations, initiatives and networks that focus on supporting evidence-informed policy-making at least in part about the health-system arrangements that determine whether the right programmes, services and products get to those who need them. Many descriptions and evaluations of KT platforms in low- and middle-income countries have been produced but, to date, they have not been systematically reviewed.MethodsWe identified potentially relevant studies through a search of five electronic databases and a variety of approaches to identify grey literature. We used four criteria to select eligible empirical studies. We extracted data about seven characteristics of included studies and about key findings. We used explicit criteria to assess study quality. In synthesising the findings, we gave greater attention to themes that emerged from multiple studies, higher-quality studies and different contexts.ResultsCountry was the most common jurisdictional focus of KT platforms, EVIPNet the most common name and high turnover among staff a common infrastructural feature. Evidence briefs and deliberative dialogues were the activities/outputs that were the most extensively studied and viewed as helpful, while rapid evidence services were the next most studied but only in a single jurisdiction. None of the summative evaluations used a pre–post design or a control group and, with the exception of the evaluations of the influence of briefs and dialogues on intentions to act, none of the evaluations achieved a high quality score.ConclusionsA large and growing volume of research evidence suggests that KT platforms offer promise in supporting evidence-informed policy-making in low- and middle-income countries. KT platforms should consider as next steps expanding their current, relatively limited portfolio of activities and outputs, building bridges to complementary groups, and planning for evaluations that examine ‘what works’ for ‘what types of issues’ in ‘what types of contexts’.

Shaping Policy on Chronic Diseases through National Policy Dialogs in CHRODIS PLUS.

Policy dialogs are deliberative dialogue that gather policy makers and relevant stakeholders from across disciplines to discuss a topic of mutual interest. They typically serve as a single element in a broader policymaking cycle, either informing the content of new policy or forming a component of policy evaluation and review. In the joint action CHRODIS PLUS, national policy dialogs were conducted in fourteen EU Member States. The aim of the dialogs was to identify new policies or changes to existing policies and legislation that are capable of tackling major risk factors for chronic disease, to strengthen health promotion and prevention programs and to ensure health systems are equipped to respond to priority issues within the chronic diseases field. In this paper, we present the CHRODIS PLUS policy dialog methodology, as well as results and lessons learnt from three national policy dialogs held in Ireland, Portugal and Spain. After discussion of the results, we conclude that the CHRODIS PLUS methodology is an effective mechanism to provoke deliberative discussion around chronic disease prevention and management in different countries. However, it is essential to ensure adequate human and financial resources—as well as political commitment—to accomplish objectives set out during the policy dialogs. We argue that priority-setting across sectors can improve the resilience of health systems and opportunities for investment in Health in All Policies (HiAP), both at European Union and Member State levels.

Prevention and control of antimicrobial stewardship: a review of evidenceGestión de las intervenciones en materia de prevención y control de la resistencia a los antimicrobianos en los hospitales: revisión de la evidencia

RESUMOObjetivo.Identificar intervenções efetivas para enfrentar a resistência a antimicrobianos em hospitais e possíveis barreiras para sua implementação.Métodos.Realizou-se uma síntese de evidências para a elaboração de políticas com base na metodologia proposta nas ferramentas SUPPORT. As buscas na literatura foram realizadas em novembro e dezembro de 2018, em 14 bases de dados. Um diálogo deliberativo, para identificar barreiras na implementação das intervenções, foi realizado presencialmente com 23 participantes (gestores, pesquisadores e profissionais de saúde) e 14 ouvintes, divididos em três grupos. A moderação foi feita por pesquisadores com experiência na condução de diálogos deliberativos.Resultados.Foram identificadas 27 revisões sistemáticas sobre intervenções para gestão de antimicrobianos (programas de stewardship) combinadas e individuais. Essas intervenções abordaram estratégias de educação, sistemas eletrônicos, biomarcadores e diversas formas de manejo de antimicrobianos. As principais barreiras para a implementação das intervenções, identificadas por meio da literatura e do diálogo deliberativo, foram: falta de infraestrutura e recursos humanos, insatisfação do paciente em relação à conduta terapêutica; diferenças culturais da equipe multidisciplinar; sobrecarga de trabalho da equipe; falta de financiamento/planejamento.Conclusão.A maioria das estratégias identificadas mostrou-se efetiva para gestão da resistência aos antimicrobianos em âmbito hospitalar. Deve-se enfatizar que a confiança nos resultados pode ser melhorada com novas pesquisas de maior qualidade metodológica.

Integrative Systems Praxis for Implementation Research (INSPIRE): An Implementation Methodology to Facilitate the Global Elimination of Cervical Cancer.

The World Health Organization (WHO) has called for a systems thinking approach to health systems strengthening to increase adoption of evidence-based interventions (EBI). The Integrative Systems Praxis for Implementation Research (INSPIRE) methodology operationalizes the WHO systems thinking framework to meet cervical cancer elimination-early detection and treatment (CC-EDT) goals. Using a systems thinking approach and grounded in the consolidated framework for implementation research, INSPIRE integrates multiple research methodologies and evaluation frameworks into a multilevel implementation strategy. In phase I (creating a shared understanding), soft systems methodology and pathway analysis are used to create a shared visual understanding of the CC-EDT system, incorporating diverse stakeholder perspectives of the "what, how, and why" of system behavior. Phase II (finding leverage) facilitates active stakeholder engagement in knowledge transfer and decision-making using deliberative dialogues and multiple scenario analyses. Phase III (acting strategically) represents stakeholder-engaged implementation planning, using well-defined implementation strategies of education, training, and infrastructure development. In phase IV (learning and adapting), evaluation of key performance indicators via a reach, effectiveness, adoption, implementation, and maintenance framework is reviewed by stakeholder teams, who continuously adapt implementation plans to improve system effectiveness. The INSPIRE methodology is a generalizable approach to context-adapted implementation of EBIs. Replacing static dissemination of implementation "roadmaps" with learning health systems through the integration of systems thinking and participatory action research, INSPIRE facilitates the development of scalable and sustainable implementation strategies adapted to local contexts.

Advancing in the institutionalization of Evidence-Informed Policy in Brazil

Abstract EVIPNet Brazil was launched in 2007, coordinated by the Ministry of Health. Its expansion has promoted the institutionalization of a national knowledge translation platform, and has also been active at the local level. Local Health Evidence Labs were implemented to institucionalize working groups linked to EVIPNet. In this multiple case study, we discuss the advances in the institutionalization of Evidence-Informed Policy-making in Brazil, based on a mapping of the Health Evidence Labs' institutional capacity to acquire, evaluate, adapt and apply evidence and analyzed organizational arrangements and implementation barriers. The coordinators of 15 responded to a self-assessment questionnaire from the Canadian Health Services Research Foundation. The main products reported are evidence briefs and deliberative dialogues focused on regional problems, training activities and different kinds of rapid responses. Health Evidence Labs have the resources to acquire and evaluate research evidence, but have a low capacity to adapt and apply evidence, indicating that they do not have all the factors (skills, structures, processes, and organizational culture) to promote and use research results in decision-making. The lower capacity to 'adapt' and 'apply' evidence may be related to low development of exchange process with external experts. Governance is joined between managers of the departments with technical bodies; the service provision occurs to attend internal and external demands; financing is public or utilizing public research calls. The implementation barriers described are the staff turnover, inadequate funding arragements for develop knowledge translation products, paid access to evidence databases, lack of a repository for their production, and lack of monitoring and evaluation. Brazil has improved in the institutionalization of evidence-informed policy but still some important barriers to achieve a complete national knowledge translation platform. Key messages Brazil has institutionalized evidence-informed policy from the structuring of EVIPNet Brazil Network. To achieve the network sustainability, it is vital to consider the alignment of organizational elements with an emphasis on governance, financing, and its monitoring.

31 Strengthening care for infants with medical complexity during the transition from the neonatal intensive care unit to the community

Abstract Background With advances in technology and innovative medical treatments, infants who previously would have died in early infancy are living longer. These infants have significant needs in the medical system and pose challenges in coordinating care from multiple providers, especially after discharge from NICU. Objectives To engage neonatal-to-early-childhood care-transition stakeholders in implementing system-level change to champion the successful transition of infants with medical complexity into early childhood. We believe this engagement activity will spark action amongst stakeholders to adopt best practices leading to improvements in care for this vulnerable patient population. Design/Methods We explored four key care transition related questions: We organized journey mapping and focus groups with NICU alumni families whose children have medical complexity. We conducted a literature review to identify evidence-based interventions. We compiled this information to create evidence briefs that were presented to an interprofessional group of senior stakeholders using the deliberative dialogue approach. Following presentation of the evidence briefs surveys were administered to measure stakeholder intention to act on solutions presented. Results Twenty-five opportunities for improving transitions between hospital and community care teams were identified through engagement with families and project team members (graphic A). These opportunities focused on facilitating clinical navigation, navigating community services, and improving parental mental health. Forty-two stakeholders representing a children’s and women’s hospital, families, community care providers, and provincial bodies were engaged in this project. A rapid review of the literature was carried out using multiple databases searches to ensure comprehensiveness and flexible search strategies to ensure literature was found for all issues. This included a broader search of NICU discharges and nine targeted searches with medical complexity populations. Proposed solutions from stakeholders were further validated through comparisons with the literature and ultimately thirty-five papers were included in the evidence briefs. Specific care interventions were recommended to key healthcare decision makers, such as providing post-discharge care coordination in a specialized complex care clinic, implementing patient-oriented discharge summaries, and facilitating access to mental health resources. Using a seven point Likert scale the majority of stakeholders agreed that both the evidence briefs and deliberative dialogues were very successful in achieving their aim. Stakeholder intention to act on solutions presented in evidence briefs and deliberative dialogues were rated as very likely. Conclusion

Priority measures for publicly reporting primary care performance: Results of public engagement through deliberative dialogues in 3 Canadian provinces.

ObjectiveWhile public reporting of hospital‐based performance measurement is commonplace, it has lagged in the primary care sector, especially in Canada. Despite the increasing recognition of patients as active partners in the health‐care system, little is known about what information about primary care performance is relevant to the Canadian public. We explored patient perspectives and priorities for the public reporting of primary care performance measures.MethodsWe conducted six deliberative dialogue sessions across three Canadian provinces (British Columbia, Ontario, Nova Scotia). Participants were asked to rank and discuss the importance of collecting and reporting on specific dimensions and indicators of primary care performance. We conducted a thematic analysis of the data.ResultsFifty‐six patients participated in the dialogue sessions. Measures of access to primary care providers, communication with providers and continuity of information across all providers involved in a patient's care were identified as the highest priority indicators of primary care performance from a patient perspective. Several common measures of quality of care, such as rates of cancer screening, were viewed as too patient dependent to be used to evaluate the health system or primary care provider's performance.ConclusionsOur findings suggest that public reporting aimed at patient audiences should focus on a nuanced measure of access, incorporation of context reported alongside measurement that is for public audiences, clear reporting on provider communication and a measure of information continuity. Participants highlighted the importance the public places on their providers staying up to date with advances in care.

An alternate level of care plan: Co-designing components of an intervention with patients, caregivers and providers to address delayed hospital discharge challenges.

ObjectiveTo engage with patients, caregivers and care providers to co‐design components of an intervention that aims to improve delayed hospital discharge experiences.DesignThis is a qualitative study, which entailed working groups and co‐design sessions utilizing World Café and deliberative dialogue techniques to continually refine the intervention.Setting and ParticipantsOur team engaged with 61 participants (patients, caregivers and care providers) in urban and rural communities across Ontario, Canada. A 7‐member Patient and Caregiver Advisory Council participated in all stages of the research.ResultsKey challenges experienced during a delayed discharge by patients, caregivers and care providers were poor communication and a lack of care services. Participants recommended a communication guide to support on‐going conversation between care providers, patients and caregivers. The guide included key topics to cover and questions to ask during initial and on‐going conversations to manage expectations and better understand the priorities and goals of patients and caregivers. Service recommendations included getting out of bed and dressed each day, addressing the psycho‐social needs of patients through tailored activities and having a storyboard at the bedside to facilitate on‐going engagement.Discussion and ConclusionsOur findings outline ways to meaningfully engage patients and caregivers during a delayed hospital discharge. Combining this with a minimal basket of services can potentially facilitate a better care experience and outcomes for patients, their care providers and families.

P091: Essential elements to implementing the paramedics providing palliative care at home program: an application of the Consolidated Framework for Implementation Research (CFIR)

Introduction: Providing comfort care support at home without transport to hospital has not traditionally been part of paramedic practice. The innovative Paramedics Providing Palliative Care at Home Program includes a new clinical practice guideline, medications, a database to share goals of care, and palliative care training. This study aimed to determine essential elements for scale and spread of this model of care through the application of an implementation science model, the Consolidated Framework for Implementation Research (CFIR). Methods: Deliberative dialogue sessions were held with paramedic, palliative care, primary care, and administrative experts in a province that had the Program (Nova Scotia, March 2018) and one that had not (British Columbia, July 2018). Sessions were audio recorded and transcribed. The CFIR was used as the foundation for a framework analysis, which was conducted by four team members independently. Themes were derived by consensus with the broader research team. Results: Inter-sectoral communication between paramedics and other health care providers was key, and challenging due to privacy concerns. Relationships with health care providers are critical to promoting the new model of care to patients, managing expectations, and providing follow up/ongoing care. Training was an essential characteristic of the intervention that can be adapted to suit local needs, although cost is a factor. There were challenges due to the culture and implementation climate as a shift in the mindset of paramedics away from traditional roles is required to implement the model. Paramedic champions can play an important role in shifting the mindset of paramedics towards a new way of practice Conclusion: The CFIR construct of cosmopolitanism, emphasizing the importance of breaking down silos and engaging diverse stakeholders, emerged as one of the most important. This will be helpful for successful scale and spread of the program.

Strengthening Congregational Communities: Social Justice Engagement Through Deliberative Dialogue

ABSTRACT
 Christianity and social work have a longstanding history of social justice engagement. However given our current politically-charged society, discussion and engagement in social justice issues are often avoided in congregations because they are seen as divisive. This article discusses the potential impact of implementing public deliberation with pastors and congregations through the lens of two pastors’ experiences, one equipped with deliberative dialogue skills and one who was not. Deliberative dialogue and civil discourse values can positively impact congregational health as the process allows others to share with honesty and vulnerability. Implementing the process of deliberative dialogue into congregational communities increases the potential for civic capacity when people can trust each other to share their stories, principles, and goals.