Dissemination Plan Research Articles

The Alliance for Healthier Communities' journey to a learning health system in primary care.

The Alliance for Healthier Communities represents community-governed healthcare organizations in Ontario, Canada including Community Health Centres, which provide primary care to more disadvantaged populations. In this experience report, we describe the Alliance's journey towards becoming a learning health system using examples for organizational culture, data and analytics, people and partnerships, client engagement, ethics and oversight, evaluation and dissemination, resources, identification and prioritization, and deliverables and impact. Many of the foundational elements for a learning health system were already in place at the Alliance including an integrated and accessible data platform. Leadership championed and embraced the movement towards a learning health system, which led to restructuring of the organization. This included role changes for data support personnel, better communication, and dissemination plans, strategies to engage clinicians and other front-line staff, restructuring of committees for more collaborative planning and prioritization of quality improvement and research initiatives, and the development of a new Practice-Based Learning Network for more opportunities to use the data for research and evaluation. Next steps will focus on continued clinical engagement and partnerships as well as ongoing reflection on the transition and success of the learning health system work.

Playing for Keeps: Designing Serious Games for Climate Adaptation Planning Education With Young People

Citizen engagement around climate change remains a wicked problem. It is particularly challenging in relation to climate change adaptation at the local level. In response, this article presents the design steps taken to create a serious game for young people (aged 15–17) as a means to increase engagement in planning for climate change adaptation in Dublin. The iAdapt game acts as the capstone component of the audio and visual teaching and learning resources for adaptation education on the Climate Smart platform and uses open data, interactive in-browser 2.5D mapping and spatial analysis, and exemplar socio-technical adaptation interventions. Its primary aim is to empower young people to understand and engage with the complexities, uncertainties, and processes of climate adaptation planning by using scientifically validated flood data predictions, grounded in a place-based setting and with diverse examples of diverse adaptation interventions. Participants experience the difficulties of decision-making under conditions of democratic governance and uncertainty in order to educate, increase awareness, and stimulate discussions around the multiple possible pathways to planning for climate adaptation. Initial testing results with a cohort of young people in Dublin are presented. We conclude by reflecting upon the challenges of creating a game that has broad appeal yet remains enjoyable to play and the value of integrating real-world flood data with gamified elements. We also discuss the “value question” regarding the impact of games on expanding public engagement. Finally, the article sets out a plan for further development and dissemination of the platform and game.

Guidelines of the International Headache Society for Clinic-Based Headache Registries, 1st edition.

Clinic-based headache registries collect data for a wide variety of purposes including delineating disease characteristics, longitudinal natural disease courses, headache management approaches, quality of care, treatment safety and effectiveness, factors that predict treatment response, health care resource utilization, clinician adherence to guidelines, and cost-effectiveness. Registry data are valuable for numerous stakeholders, including individuals with headache disorders and their caregivers, healthcare providers, scientists, healthcare systems, regulatory authorities, pharmaceutical companies, employers, and policymakers. This International Headache Society document may serve as guidance for developing clinic-based headache registries. Use of registry data requires a formal research protocol that includes: 1) research aims; 2) methods for data collection, harmonization, analysis, privacy, and protection; 3) methods for human subject protection; and 4) publication and dissemination plans. Depending upon their objectives, headache registries should include validated headache-specific questionnaires, patient reported outcome measures, data elements that are used consistently across studies (i.e., "common data elements"), and medical record data. Amongst other data types, registries may be linked to healthcare and pharmacy claims data, biospecimens, and neuroimaging data. Headache diagnoses should be made according to the International Classification of Headache Disorders diagnostic criteria. The data from well-designed headache registries can provide wide-ranging and novel insights into the characteristics, burden, and treatment of headache disorders and ultimately lead to improvements in the management of patients with headache.

The CLASS Study (Circadian Light in Adolescence, Sleep and School): protocol for a prospective, longitudinal cohort to assess sleep, light, circadian timing and academic performance in adolescence

BackgroundDuring adolescence, sleep and circadian timing shift later, contributing to restricted sleep duration and irregular sleep-wake patterns. The association of these developmental changes in sleep and circadian timing with cognitive...

LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS (LOCOMOTION): protocol for a mixed-methods study in the UK

IntroductionLong COVID, a new condition whose origins and natural history are not yet fully established, currently affects 1.5 million people in the UK. Most do not have access to specialist...

Ethical research landscapes in fragile and conflict-affected contexts: understanding the challenges

As the prevalence of conflict and fragility continue to rise around the world, research is increasingly heralded as a solution. However, current ethical guidelines for working in areas suffering from institutional and social fragility, insecurity or violent conflict have been heavily critiqued as highly abstract; focussed only on data collection; detached from the realities of academia in the Global South; and potentially extractive. This article seeks to respond to that assessment by spotlighting some of the most prevalent challenges researchers face in the pursuit of ethical working practices. It explores the material and epistemic injustices that often shape and underpin research structures and relationships in these contexts. The paper draws on the authors’ experiences of research in conflict-affected and fragile contexts over the last fifteen years and on workshop discussions with researchers based in fragile and conflict-affected contexts conducted in Amman, Bogotá and Dhaka in 2019-2020. The paper works from the premise that achieving ethical research in fragile spaces is not dependent solely on activity at the site of research, but also on decisions made across the entire ecosystem of a research project. It therefore interrogates the full research landscape, from funding models, to research design (including research topics, partnerships, methods, participant selection, and researcher positionality), to dissemination plans and ethical gatekeeping. The paper critically reflects on inequities in the processes of knowledge production about conflict and fragility and the key ethical challenges that researchers encounter. It highlights the need for further guidance, support and accountability to ensure ethical research practices.

Efficacy and Safety of Electro-Thumbtack Needle Therapy for Patients With Chronic Neck Pain: Protocol for a Randomized, Sham-Controlled Trial.

BackgroundChronic neck pain is a prevalent condition adversely impacting patients' wellbeing in both life and work experience. Electro-thumbtack needle (ETN) therapy, combining acupuncture with transcutaneous stimulation, might be one of the effective complementary and alternative medicine (CAM) therapies in treating chronic neck pain, although the evidence is scarce. This study aims to estimate the efficacy and safety of ETN therapy for chronic neck pain.Methods and AnalysisThis is a sham-controlled, randomized clinical trial. A total of 180 subjects will be randomly allocated to either the ETN group or the sham ETN group. Treatment will be administrated three times a week for four consecutive weeks, with a 6-month follow-up. The primary outcome measure will be the Numerical Rating Scale for neck pain (NRS-NP) over a period of the 4 weeks. Secondary outcome measures include the Northwick Park Neck Pain Questionnaire (NPQ), Neck Disability Index (NDI), Patient Global Impression of Change (PGIC), patient expectation, and preference assessment. The chi-square test or Fisher's exact test will be used for proportions of participants having clinically meaningful improvement. Analysis of covariance or repeated-measures analysis of variance will be applied to examine changes in the outcome measures from baseline.DiscussionsThis prospective trial will contribute to evaluating the efficacy and safety of ETN in the treatment of chronic neck pain, with an intermediate-term follow-up. This study will provide further evidence for clinical neck pain management.Ethics and DisseminationThis trial has been approved by the Research Ethical Committee of Guang'anmen Hospital (ethical approval number: 2021-039-KY-01). Recruitment began in March 2022 and will continue until December 2023. Dissemination plans include posters, WeChat, websites, and bulletin boards in hospital and communities.Clinical Trial RegistrationThis trial is registered at ClinicalTrials.gov (identifier: NCT04981171).

Effect of a multicomponent intervention in postnatal mothers’ groups on meeting the Australian Physical Activity Guidelines for infants: protocol for a randomised controlled trial

IntroductionGiven the importance of tummy time and the low levels of tummy time reported globally, there is a need for high-quality intervention strategies to promote tummy time. This study describes...

Longitudinal costs and health service utilisation associated with primary care reforms in Ontario: a retrospective cohort study protocol

IntroductionOver the last 20 years, the Canadian province of Ontario implemented several new models of primary care focusing on changes to physician remuneration, clinics led by nurse practitioners and the...

Guidelines for Treatment of Umbilical and Epigastric Hernias From the European and Americas Hernia Societies-A Web-Based Survey on Surgeons' Opinion.

Background and aims: The European and Americas Hernia Society's (EHS and AHS) Guidelines on the treatment of primary midline ventral hernias were launched to guide surgeons. As a part of a dissemination plan of the guideline, this study aimed to evaluate the level of consensus between recommendations and the current surgical practices of EHS and AHS members before implementation. Material and methods: A questionnaire was constructed including questions on the current practice of the members and nine selected key recommendations from the guidelines. An on-stage consensus voting was performed at the EHS Congress in Hamburg 2019 followed by a SurveyMonkey sent to all EHS and AHS members. Consensus with a recommendation was defined as an agreement of ≥70%. Results: A total of 178 votes were collected in Hamburg. A further 499/1,754 (28.4%) of EHS and 150/1,100 (13.6%) of AHS members participated in the SurveyMonkey. A consensus was reached for 7/9 (78%) of the recommendations. The two recommendations that did not reach consensus were on indication and the technique used for laparoscopic repair. In current practice, more AHS participants used a preformed patch; 50.7% (76/150) compared with EHS participants 32.1% (160/499), p < 0.001. Conclusion: A consensus was achieved for most recommendations given by the new guideline for the treatment of umbilical and epigastric hernias. Recommendations that did not reach consensus were on indication and technique for laparoscopic repair, which may reflect the lack of evidence on these topics.

Supporting researchers in knowledge translation and dissemination of their research to increase usability and impact.

One of the key areas of delivery of the 'Action Plan for Health Research 2019-2029', for the Health Service Executive (HSE) in Ireland, is adding value and using data and knowledge, including health-related quality of life (HRQoL), for improved health care, service delivery and better population health and wellbeing. The development of governance, management and support framework and mechanisms will provide a structure for ensuring research is relevant to the organisation's service plan, well designed, has a clear plan for dissemination and translation of knowledge, and minimises research waste. Developing a process for the translation, dissemination and impact of research is part of the approach to improving translation of research into practice and aligning it with knowledge gaps. A project was undertaken to develop a clear, unified, universally applicable approach for the translation, dissemination, and impact of research undertaken by HSE staff and commissioned, sponsored, or hosted by the organisation. This included the development of guidance, training, and information for researchers. Through an iterative process, an interdisciplinary working group of experts in knowledge translation (KT), implementation science, quality improvement and research management, identified KT frameworks and tools to form a KT, dissemination, and impact process for the HSE. This involved a literature review, screening of 247 KT theories, models, and frameworks (TMFs), review of 18 TMFs selected as usable and applicable to the HSE, selection of 11 for further review, and final review of 6 TMFs in a consensus workshop. An anonymous online survey of HSE researchers, consisting of a mixture of multiple choice and free text questions, was undertaken to inform the development of the guidance and training. A pilot of the KT process and guidance, involving HSE researchers testing its use at various stages of their research, demonstrated the need to guide researchers through planning, stakeholder engagement, and disseminating research knowledge, and provide information that could easily be understood by novice as well as more experienced researchers. A survey of all active researchers across the organisation identified their support and knowledge requirements and led to the development of accompanying guidance to support researchers in the use of the process. Researchers of all levels reported that they struggled to engage with stakeholders, including evidence users and policy makers, to optimise the impact of their research. They wanted tools that would support better engagement and maximise the value of KT. As a result of the project a range of information, guidance, and training resources have been developed. KT is a complex area and researchers need support to ensure they maximise the value of their research. The KT process outlined enables the distilling of a clear message, provides a process to engage with stakeholders, create a plan to incorporate local and political context, and can show a means to evaluate how much the findings are applied in practice. This is a beneficial application of KT in the field of patient reported outcomes. In implementing this work, we have reinforced the message that stakeholder engagement is crucial from the start of the research study and increases engagement in, and ownership of, the research knowledge.

Opportunities and challenges for the development of "core outcome sets" in neuro-oncology.

Core Outcome Sets (COS) define minimum outcomes to be measured and reported in clinical effectiveness trials for a particular health condition/health area. Despite recognition as critical to clinical research design for other health areas, none have been developed for neuro-oncology. COS development projects should carefully consider: scope (how the COS should be used), stakeholders involved in development (including patients as both research partners and participants), and consensus methodologies used (typically a Delphi survey and consensus meeting), as well as dissemination plans. Developing COS for neuro-oncology is potentially challenging due to extensive tumor subclassification (including molecular stratification), different symptoms related to anatomical tumor location, and variation in treatment options. Development of a COS specific to tumor subtype, in a specific location, for a particular intervention may be too narrow and would be unlikely to be used. Equally, a COS that is applicable across a wider area of neuro-oncology may be too broad and therefore lack specificity. This review describes why and how a COS may be developed, and discusses challenges for their development, specific to neuro-oncology. The COS under development are briefly described, including: adult glioma, incidental/untreated meningioma, meningioma requiring intervention, and adverse events from surgical intervention for pediatric brain tumors.

Protocol for the IMPART study: IMplementation of the preterm birth surveillance PAthway – a RealisT evaluation

IntroductionNew guidance, from NHS England (Saving Babies Lives Care Bundle Version 2 Element 5 (SBLCBv2)) has recommended a best practice pathway for women at risk of preterm birth (the Preterm...

Efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis: a protocol for a multicentre, randomised, parallel three arms, active-controlled, phase III open label with blinded outcome assessment study

IntroductionNon-infectious uveitis include a heterogeneous group of sight-threatening and incapacitating conditions. Their correct management sometimes requires the use of immunosuppressive drugs (ISDs), prescribed in monotherapy or in combination. Several observational...

The We Can Quit2 Smoking Cessation Trial: Knowledge Exchange and Dissemination Following a Community-Based Participatory Research Approach.

Background: ‘We Can Quit2’ pilot randomised controlled trial determined the feasibility [of conducting a community-based trial of We Can Quit, a peer-delivered stop-smoking programme (group support, combination nicotine replacement therapy (NRT), and tailored individual support) for women living in socioeconomically disadvantaged areas in Ireland. Lessons from a knowledge exchange (KE) workshop that reengaged trial stakeholders are presented. Methods: The trial dissemination plan included invitation of community, regional and national stakeholders (n = 176) to a KE interactive workshop, who received an accessible brief beforehand. Trial findings were presented. Enhancements to community engagement, participants’ recruitment and retention, and policy priorities arising from the research were discussed. Field notes and responses to a post-event anonymous questionnaire were analysed using thematic content analysis. Results: Workshop attendees (41/176, 23%) recommended: dedicated additional time to engage community stakeholders; social prescribing pathways to enhance recruitment; more adaptation of trial-related information and assistance in completion of data forms for low literacy individuals; encouraging women to join healthy community programmes to facilitate retention and sustainability; removal of barriers to access NRT; and ongoing provision of cessation services tailored to disadvantaged groups. Conclusions: The findings are relevant to the implementation of other community-based health interventions for disadvantaged groups, to policy makers and to service providers.

Dissemination of validated health literacy videos: A tailored approach.

BackgroundPreviously, we showed that chemotherapy terminology is difficult for patients to understand. Therefore, we developed short videos explaining key terminology and though proven effective, they will only be helpful if appropriately disseminated. Therefore, we aimed to determine the best dissemination method at three different healthcare settings.MethodsWith consent, we interviewed healthcare workers from (1) an academic cancer center, Winship Cancer Institute (Winship) serving higher SES patients, (2) an inner‐city, safety‐net hospital Grady Memorial (GMH), (3) clinics serving rural Georgia, from the Winship Community Network (Network). All interviews were transcribed and analyzed using a semantic content analysis method. Suggested dissemination plans were then implemented.ResultsTwenty‐two Winship, 11 GMH, and 4 Network healthcare workers were interviewed. Seventy‐two percent (n = 8) of the GMH and 100% (n = 4) of Network healthcare workers felt that the best place for patients to view the videos was in the clinic, compared to 27% (n = 6) of the Winship clinicians. 68% (n = 15) of the Winship clinicians stated an app would be the most useful format, compared to 27% (n = 3) at GMH, and 0% at Network sites. Video viewing increased after dissemination plans were implemented.CONCLUSIONEducational materials explaining oncology treatment terminology enhance patient understanding, yet without proper dissemination, these tools may never reach the intended patient population. Our study shows that dissemination plans need to be tailored to each individual patient population, with rural and lower SES patients needing to view the videos during clinic visits, and patients of more means viewing them using technology at home.

Role of mHealth applications for emergency medical system activation in reducing mortality in low-income and middle-income countries: a systematic review protocol

IntroductionPrehospital care is an essential component in reducing mortality for patients presenting with emergency medical conditions. Prehospital systems tend to be underdeveloped or non-existent in these areas, with less than...

Effectiveness of transcranial direct current stimulation on hand dexterity in stroke patients: a protocol for a systematic review and meta-analysis

IntroductionHand dexterity is the ability to execute the skilful movements using the hand and fingers. It is commonly impaired poststroke resulting in a profound deterioration in the quality of life...

Development and Dissemination of a Neurology Palliative Care Curriculum: Education in Palliative and End-of-Life Care Neurology.

Despite increasing awareness of the importance of a palliative care approach to meet the needs of persons living with neurologic illness, residency and fellowship programs report meeting this educational need due to a limited pool of neuropalliative care educators and a lack of adequate educational resources. To meet this need, a group of experts in neuropalliative care and palliative medicine leveraged resources from the Education in Palliative and End-of-life Care (EPEC) program and the National Institutes of Nursing Research to create a library of modules addressing topics relevant for neurology trainees, palliative medicine fellows, and clinicians in practice. In this article, we describe the development and dissemination plan of the EPEC Neurology program, initial evidence of efficacy, and opportunities for neurology educators and health services researchers to use these resources.

Utility of itraconazole and terbinafine in mucormycosis: a proof-of-concept analysis

An epidemic of mucormycosis followed the second wave of COVID 19 in the state of Uttar Pradesh, India in May 2021. This epidemic, however, had additional challenges to offer in...