Evidence-informed Strategies Research Articles

Giving condoms to school children: educators’ views on making condoms available in South African schools

One of the policy goals of the South African Department of Basic Education’s National Policy on HIV, STIs and TB of 2017 is to reduce the incidence of HIV and pregnancy among learners. This is expected to be achieved by improving access to prevention services, including the provision of condoms in schools. This study uses street- level bureaucracy theory to explain how educators can play a more productive role in ensuring that policy goals are achieved. Educators provide their views on their role as condom promotion agents, their perception of demand and utilisation among learners, as well as their insights on suitable distribution mechanisms in the school setting. Trepidation exists among educators about their roles in the promotion and education of condoms. Educator statements suggest that they see the value in their policy-ascribed role to deliver sexual health messages and are also open to performing a role in the distribution of condoms at schools. However, our findings reveal that their role as policy communicators or “street-level bureaucrats” is complicated by inadequate policy guidance. We therefore conclude that to achieve optimal outcomes in terms of safer sexual practices among learners, condom messaging and distribution mechanisms in school settings require evidence-informed implementation strategies.

Promoting resilience in persons with serious mental health conditions during the Coronavirus pandemic.

This article highlights the profound and far-reaching impact of the Coronavirus disease 2019 (COVID-19) health crisis on persons with serious mental health conditions. To understand and mitigate against the negative effects of the crisis on this population, we offer a resilience intervention framework that attends to three key resilience processes, namely control, coherence, and connectedness (3Cs). We then detail interventions and associated evidence-informed intervention strategies at the individual, interpersonal, and systemic levels that behavioral health professionals can employ to bolster each of the 3Cs for persons with serious mental health conditions. These intervention strategies, which must be implemented in a flexible manner, are designed to enhance the biopsychosocial functioning of persons with serious mental health conditions during the COVID-19 pandemic and beyond and strengthen their interpersonal and systemic environments. We conclude with recommendations for future directions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Repeating purposefully: Empowering educators with functional communication models of echolalia in Autism.

Echolalia, the repetition of speech, is highly prevalent in school aged children with Autism. Prior research has found that individuals with echolalia use their repetitions to engage in communicatively functional speech, in the absence of self-generated speech. Educators are the natural audience for a wide vary of echoed utterances across environments and in differing contexts. The objectives of this paper were three-fold: (1) to systematically investigate how researchers identify and ascribe communicative function to echoed utterances; (2) to gather and evaluate the evidence that might assist teachers to identify and better understand echoed utterances as being communicatively purposeful; and (3) to provide teachers with evidence-informed response strategies they can use to assist their students on their journey towards more self-generated speech. Prior research in the field of echolalia has generally been segmented into opposing viewpoints. A paucity of work in the echolalia field has meant that there is limited work that has sought to view how a communicative function to echolalia has been ascribed from across multiple disciplines and fields. As such, there is limited literature to guide the practice of classroom educators. This review combines communicative models from across various disciplines with the view to supporting classroom educators by providing guidance on how they might assist their students with echolalia. This review represents the first contribution to the research literature in this area. Research into echolalia did not originally emanate from the field of education; however, anecdotes from classroom educators were cited as the primary impetus for the creation of some of the communicatively functional models. We found that although there are many techniques that researchers have used to attribute a communicative function to echolalia, some of these can be easily employed by educators in their practice. By adopting these techniques, educators are placed in a position that may assist with the identification of communicative echolalia; subsequently they are better placed to acknowledge and respond to their students.

Alzheimer disease in African American individuals: increased incidence or not enough data?

Research on racial differences in Alzheimer disease (AD) dementia has increased in recent years. Older African American individuals bear a disproportionate burden of AD and cognitive impairment compared with non-Latino white individuals. Tremendous progress has been made over the past two decades in our understanding of the neurobiological substrates of AD. However, owing to well-documented challenges of study participant recruitment and a persistent lack of biological data in the African American population, knowledge of the drivers of these racial disparities has lagged behind. Therapeutic targets and effective interventions for AD are increasingly sought, but without a better understanding of the disease in African American individuals, any identified treatments and/or cures will evade this rapidly growing at-risk population. In this Perspective, I introduce three key obstacles to progress in understanding racial differences in AD: uncertainty about diagnostic criteria, disparate cross-sectional and longitudinal findings; and a dearth of neuropathological data. I also highlight evidence-informed strategies to move the field forward.

Using participatory design to inform cyber/bullying prevention and intervention practices: Evidence-Informed insights and strategies

Bullying and cyberbullying are global phenomena negatively impacting on children’s and young people’s (CYP’s) mental health and wellbeing and affecting their school social experiences and learning outcomes. Many interventions and prevention approaches have been employed over the decades, most impacting differentially, with some success in certain contexts and situations but not universally, suggesting the need for more contextualised, nuanced approaches at the whole school, community, individual and peer-group levels. The recognition of the importance of student and teacher voice in recent years has heralded interest in co-design practices to deliver more context-relevant interventions and prevention strategies. This article considers how participatory design and co-design practices can form part of the prevention and intervention repertoire for schools, teachers, counsellors and psychologists in their quest to understand and reduce cyberbullying and/or bullying (C/B) behaviours. Two case-study exemplars are provided that reflect the importance of context and student-centred relevancy to inform practice.

Teaching Simple Strategies to Foster Emotional Well-Being.

The COVID-19 pandemic has presented considerable disruptions to routines that have challenged emotional well-being for children and their caregivers. One direction for supporting emotional well-being includes strategies that help children feel their best in the moment, which can bolster their capacity to respond appropriately to thoughts and behaviors. Strengthening emotional well-being equitably, however, must include opportunities in settings that are easily accessible to all, such as schools. In this paper, we focus on simple, evidence-informed strategies that can be used in schools to promote positive feelings in the moment and build coping behaviors that facilitate tolerance of uncertainty. We focus on those strategies that educators can easily and routinely use across ages, stages, and activities. Selected strategies are primarily tied to cognitive behavioral theory, with our review broadly organized across categories of self-awareness, self-soothing, and social relationships. We review evidence for each, providing examples that illustrate ease of use in school settings.

9.L. Workshop: Injury epidemiology, treatment, costs and legislation during the COVID-19 pandemic

The recent lockdown and containment measures have brought about major changes in the daily routines of people and this resulted in profound changes in the cause of injury (e.g. traffic, falls, interpersonal violence) and nature of injury (e.g. hip fracture, traumatic brain injury). Despite the changes in the aetiologies, injuries remained frequent throughout the pandemic. Evidence from the COVID-19 period suggest a decrease in road traffic crashes, work and leisure injuries and a noteworthy increase in interpersonal violence and self-harm. These different causes and patterns of injury have brought about changes in the clinical characteristics and demand of health services. Hospitals have experienced organisational constraints with redeployment of medical staff in different units and suspension of non-emergency medical activity. At the same time, new priorities have been set for hospital admissions and new protocols have been developed to guide the emergencies' pathways and clinical/health services approach. Non-essential medical treatment has been postponed with increased risk of delayed treatment, late recovery and mortality from causes different than COVID-19, including injury complications. The impact of COVID-19 in the provision and coverage of health services needs to be urgently mitigated, including the treatment and rehabilitation from physical and psychological effects of untreated injuries. This is expected to place additional pressure on the health systems and increase health care costs. Hospital discharge data are a potentially valuable source of information for injury prevention planning yet there is much work to be done on the improvement of hospital and injury data quality.The workshop aims to discuss the effect of COVID-19 lockdown on the epidemiology and clinical characteristics of injuries, as well as the barriers of maintaining (or even improving) data quality during the different phases of the pandemic. The workshop will further discuss hospital demand and will identify the challenges for the health systems in handling the complex needs of vulnerable patients under serious restrictions. The workshop will also highlight the legal and regulatory measures taken and their level of efficacy in promoting free movement of workers within EU but also the right to work guaranteed under ECHR and ILO Conventions and Declaration. The high human and societal costs as well as inequalities of injury mortality and burden will be highlighted based on comparisons with long-term trends. The workshop will contribute to the identification of evidence-informed strategies and will promote effective planning and optimization of health services response for future pandemics.Key messages The new map of injuries resulting from COVID-19 pandemic is likely to affect health care targets and priorities.Evidence-informed strategies are necessary to capture the magnitude and address the after-COVID effects and the health burden of untreated conditions.

Primary care-based models of care for osteoarthritis: a scoping review protocol.

Background: The burden of osteoarthritis (OA) to individuals and health systems is substantial and is expected toincrease due to population ageing and rising prevalence of obesity and multimorbidity. Primary care-based models of care (MoCs) are being increasingly developed in response to this growing burden. However, these MoCs have yet to be formally reviewed. A MoC can be defined as an 'evidence-informed strategy, framework or pathway that outlines the optimal manner in which condition-specific care should be delivered to consumers within a local health system'. Objective: To identify and describe the available research regarding the extent, nature and characteristics of MoCs for OA that have been developed or evaluated in primary care. Methods: A scoping review will be conducted in accordance with the Arksey and O'Malley scoping review framework and the PRISMA-ScR guidelines. Systematic literature searches of MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and LILACs will be conducted from 2010 to present, aligning with publication dates of recent clinical guidelines. A structured iterative search of grey literature will be conducted. Full-text original quantitative or mixed method studies which describe the development or evaluation of MoCs for OA in primary care will be considered. Data will be charted and synthesised and a narrative synthesis will be conducted. Conclusions: This scoping review will provide a broad overview regarding the extent, nature and characteristics of the available literature on primary care based MoCs for OA. Findings will be used to identify gaps in the current evidence to identify areas for future research.

Using blood wisely in oncology patients: An institutional analysis of the Choosing Wisely Canada restrictive transfusion strategy guidelines.

10 Background: Numerous studies support the safety of single-unit red red blood cell (RBC) transfusions and restrictive pre-transfusion hemoglobin (Hg) thresholds (≤ 70-80 g/L) among diverse populations of hospitalized patients, including those with malignancies on myelosuppressive systemic therapy. Using Blood Wisely is a national Choosing Wisely Canada (CWC) initiative that challenges hospitals to benchmark themselves on evidence-informed restrictive transfusion strategies, with the aim to decrease inappropriate RBC transfusions in Canada. We assessed transfusion practices among oncology inpatients at BC Cancer Vancouver Centre as part of this initiative and performed an exploratory analysis among outpatients. Methods: BC Cancer Vancouver RBC transfusion records were obtained for the period of October 2019-September 2020. The percentage of single-unit transfusions and transfusions for Hg ≤ 80 g/L were measured, to assess adherence to CWC targets of ≥ 65% and ≥ 80%, respectively, for these metrics. Univariate analyses were used to compare treatment variables and transfusion outcomes. Results: During the 1-year audit period, 120 inpatient and 586 outpatient RBC transfusions occurred. For inpatient transfusions, 40.8% (n = 49) were single-unit and 79.2% (n = 95) were for Hg ≤ 80 g/L. For outpatient transfusions, 11.8% (n = 69) were single-unit and 65.7% (n = 304) were for Hg ≤ 80 g/L. Outpatients and patients with solid malignancies were more likely to receive multiple-unit transfusions, compared to inpatients (p < 0.001) and patients with hematological malignancies (p < 0.001), respectively. Patients with solid malignancies and those on active treatment were more likely to be transfused when Hg was > 80 g/L, compared to patients with hematological malignancies (p = 0.004) and those off treatment (p = 0.003), respectively. Multiple RBC units were more likely to transfused when the interval from pre-transfusion bloodwork to receipt of transfusion was > 3 days (p = 0.029). Conclusions: A high rate of inappropriate RBC transfusions are being ordered for oncology patients at our institution, in discordance with CWC restrictive transfusion strategy guidelines. Quality improvement interventions are planned to adopt best practices in transfusion medicine in this high-use population.[Table: see text]

Ontario adults\u2019 health behaviors, mental health, and overall well-being during the COVID-19 pandemic

BackgroundPublic health measures such as physical distancing and work-from-home initiatives have been implemented to slow the spread of COVID-19. These measures may also be associated with unhealthy lifestyle behaviors, which could be particularly problematic for those already at highest risk for losing years of healthy life due to chronic disease (i.e., 30–59-year-olds). The purpose of this paper is two-fold: (1) to provide an overview of Ontario adults’ health behaviors (i.e., physical activity, sedentary behaviors, and dietary intake), mental health, and well-being during the first few months of the COVID-19 pandemic (April–July 2020); and (2) to explore the difference between physical activity and various health behaviors (i.e., well-being, mental health, and dietary intake).MethodsAs a part of a larger, longitudinal study, participants completed an online survey that included demographic information, the Global Physical Activity Questionnaire, Starting the Conversation, the Mental Health Inventory, and the Personal Wellbeing Index-Adult. Data analyses involved computing measures of central tendency and dispersion for demographic characteristics and tools followed by descriptive statistics. Separate independent t-tests were conducted to investigate the difference between physical activity status and well-being, mental health, and dietary intake.ResultsA total of 2157 Ontarians completed an online survey. Descriptive statistics indicated that respondents met physical activity and sedentary behavior guidelines, reported double the amount of recommended recreational screen time, practiced moderately healthy dietary behaviors, experienced mental health problems, and scored below “normal” in some well-being domains.ConclusionAs the end of the COVID-19 pandemic is currently unknown, its associated restrictions and society changes may influence adults’ behaviors in both the short- and longer-term. As such, our findings might provide immediate insight into the development of timely and evidence-informed health promotion and disease prevention strategies for Canadians, which could support adults’ health behaviors, mental health, and well-being during the COVID-19 pandemic and other, future pandemics.

The incorporation of body composition assessments as part of routine clinical care in a tertiary hospital's dietetic department: a best practice implementation project.

Our aim was to incorporate body composition assessment (BCA) into dietetic department procedures using interventions tailored to previously identified barriers and enablers. BCA is recommended as part of routine malnutrition assessment and follow-up but is not yet part of usual care. Evidence-informed strategies to overcome barriers and enablers were operationalized and delivered as three overarching interventions: upskilling (professional development strategy), modelling and reducing fear of change (Clinical Champion project), and embedding as usual practice (departmental integration). Process evaluation assessed intervention fidelity. A survey assessed utilization of BCA devices, (perceived) competency, and attitudes of clinical dietitians towards BCA before and after interventions. Two of the three elements were incorporated as planned (upskilling and embedding as usual practice), with one element (modelling and reducing fear of change) modified through iterative processes. The Clinical Champion project ran for 12 rather than 6 months, and resulted in the majority of champions confident with their skills, completing BCA within their daily clinical workload and feeling BCA was useful. Pre-surveys and post-surveys within the department of 26 dietitians showed a marked reduction in most perceived barriers and improved recognition of enablers across all theoretical framework domains; with a large proportion of 'not applicable' responses given for many barriers at follow-up. This evidence-informed implementation strategy successfully integrated BCA into dietitians' practice and departmental processes highlighting direction for future service changes. Continual assessment of barriers and success of integration into routine workloads is required to facilitate this.

Telehuman Services Improves the Engagement of Low-Income Populations

The paper describes a range of evidence-informed strategies that a Historically Black, Colleges and University (HBCU) work readiness program adopted to increase the engagement of Temporary Assistance for Needy Families (TANF) program participants during the COVID-19 pandemic. The program successfully engaged half of the program participants through two-generational (2Gen) approach. The 2Gen approaches target low-income children and parents from the same household and combine parent and child interventions to interrupt the cycle of poverty. These approaches emphasize early childhood education, economic supports, postsecondary education, social capital and health and well-being to create a legacy of economic security. The paper highlights the human services delivery strategies utilized to engage individuals into work readiness training activities during the pandemic. The paper presents data where certain 2Gen activities engaged TANF participants more than other 2Gen activities. The data reveals that half of the participants completed online digital literacy courses and earned training certifications. The intent of the paper is to offer state and local human service agency policymakers’ guidance on strategies to increase TANF participant engagement.

The Influence of Human Support on the Effectiveness of Digital Mental Health Promotion Interventions for the General Population.

Mental wellbeing amongst the general population is languishing—exacerbated by the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health promotion interventions, that improve mental health literacy and encourage adoption of evidence-informed practical strategies are essential. However, attrition and non-adherence are problematic in digital interventions. Human support is often applied as an antidote; yet, there is a paucity of randomized trials that compare different human support conditions amongst general population cohorts. Limited trials generally indicate that human support has little influence on adherence or outcomes in DMHPIs. However, providing participants autonomy to self-select automated support options may enhance motivation and adherence.

Physical activity and sedentary behaviour counselling: Attitudes and practices of mental health professionals.

Despite recent interest in the mental health benefits of increasing physical activity (PA) and reducing sedentary behaviour (SB), little is known about PA and SB counselling provided by mental health professionals. Therefore, the aim of this study was to explore the attitudes and practices of mental health professionals in recommending more PA and less SB to their clients. Quantitative data were collected using a modified version of the Exercise in Mental Illness Questionnaire in a sample of 17 Australian mental health professionals. The collected data were reported using percentages (for categorical data) and means and standard deviations (for numerical data). Additionally, in focus group discussions, 10 mental health professionals provided in-depth information about their clinical practice, facilitators, and perceived barriers in recommending more PA and less SB. They also provided suggestions on how to potentially improve their PA and SB counselling practices. The focus groups were audio-recorded, transcribed and analysed using thematic analysis. Only 35.3% of participants have undergone formal training in recommending PA in the treatment of mental illness. Most participants (64.7%) ranked PA counselling among the top three types of mental health treatment. All participants reported recommending PA to their clients at least "occasionally", while 88% of them also provided SB counselling. However, the recommendations provided were usually not specific. The most commonly reported barriers for providing PA and SB counselling were a lack of knowledge and confidence. Participants also believed that, if they were more active themselves, they would be in a better position to recommend PA to their clients, by sharing their own experience of evidence-informed strategies designed to increase PA and reduce SB. The findings of this study indicate that mental health professionals commonly provide generic PA and SB counselling to their clients. PA and SB counselling in the mental health setting could be improved by: including training on PA and SB counselling in formal education and continued professional training for mental health professionals; implementing interventions to increase PA and reduce SB among mental health professionals themselves; and ensuring support from an exercise or PA promotion specialist as a part of a multi-disciplinary approach to mental health care.

Contextualizing care: An essential and measurable clinical competency

Contextualizing care is the process of adapting research evidence to patient life context. The failure to do so, when it results in a care plan that is not likely to achieve its intended aim, is a contextual error. There is substantial evidence that contextual errors are common, adversely affect patient outcomes and health care costs, and are preventable. This evidence comes from over 5000 mostly incognito recordings of physician-patient encounters over a range of practice settings that have been analyzed along with the medical records of each encounter utilizing a specialized coding algorithm. Educational and practice improvement interventions have been tested at the medical student, resident, and attending level, each with evidence of benefits and limitations. The author argues that contextualizing care is an essential clinician competency and proposes an evidence-informed strategy for building and reinforcing the requisite skills across the continuum of medical education and professional development.

A scenario-based approach for urban water management in the context of the COVID-19 pandemic and a case study for the Tabriz metropolitan area, Iran

The world's poorest countries were hit hardest by COVID-19 due to their limited capacities to combat the pandemic. The urban water supply and water consumption are affected by the pandemic because it intensified the existing deficits in the urban water supply and sanitation services. In this study, we develop an integrated spatial analysis approach to investigate the impacts of COVID-19 on multi-dimensional Urban Water Consumption Patterns (UWCPs) with the aim of forecasting the water demand. We selected the Tabriz metropolitan area as a case study area and applied an integrated approach of GIS spatial analysis and regression-based autocorrelation assessment to develop the UWCPs for 2018, 2019 and 2020. We then employed GIS-based multi-criteria decision analysis and a CA-Markov model to analyze the water demand under the impacts of COVID-19 and to forecast the UWCPs for 2021, 2022 and 2023. In addition, we tested the spatial uncertainty of the prediction maps using the Dempster Shafer Theory. The results show that the domestic water consumption increased by 17.57% during the year 2020 as a result of the COVID-19 pandemic. The maximum increase in water consumption was observed in spring 2020 (April–June) when strict quarantine regulations were in place. Based on our results, the annual water deficit in Tabriz has increased from ~18% to about 30% in 2020. In addition, our projections show that this may further increase to about 40–45% in 2021. Relevant stakeholders can use the findings to develop evidence-informed strategies for sustainable water resource management in the post-COVID era. This research also makes other significant contributions. From the environmental perspective, since COVID-19 has affected resource management in many parts of the world, the proposed method can be applied to similar contexts to mitigate the adverse impacts and developed better informed recovery plans.

Promoting social emotional development during the paediatric well-child visit: a demonstration project

Supporting social emotional development, beginning at birth, can improve lifelong health. The American Academy of Paediatrics recommends 12 well-child visits between birth and age 3 years. Each well-child visit provides...

Primary care-based models of care for osteoarthritis: a scoping review protocol

Background: The burden of osteoarthritis (OA) to individuals and health systems is substantial and is expected to increase due to population ageing and rising prevalence of obesity and multimorbidity. Primary care-based models of care (MoCs) are being increasingly developed in response to this growing burden. However, these MoCs have yet to be formally reviewed. A MoC can be defined as an ‘evidence-informed strategy, framework or pathway that outlines the optimal manner in which condition-specific care should be delivered to consumers within a local health system’. Objective: To identify and describe the available research regarding the extent, nature and characteristics of MoCs for OA that have been developed or evaluated in primary care. Methods: A scoping review will be conducted in accordance with the Arksey and O’Malley scoping review framework and the PRISMA-ScR guidelines. Systematic literature searches of MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and LILACs will be conducted from 2010 to present, aligning with publication dates of recent clinical guidelines. A structured iterative search of grey literature will be conducted. Full-text original quantitative or mixed method studies which describe the development or evaluation of MoCs for OA in primary care will be considered. Data will be charted and synthesised and a narrative synthesis will be conducted. Conclusions: This scoping review will provide a broad overview regarding the extent, nature and characteristics of the available literature on primary care based MoCs for OA. Findings will be used to identify gaps in the current evidence to identify areas for future research.

Primary care-based models of care for osteoarthritis: a scoping review protocol.

Background: The burden of osteoarthritis (OA) to individuals and health systems is substantial and is expected toincrease due to population ageing and rising prevalence of obesity and multimorbidity. Primary care-based models of care (MoCs) are being increasingly developed in response to this growing burden. However, these MoCs have yet to be formally reviewed. A MoC can be defined as an 'evidence-informed strategy, framework or pathway that outlines the optimal manner in which condition-specific care should be delivered to consumers within a local health system'. Objective: To identify and describe the available research regarding the extent, nature and characteristics of MoCs for OA that have been developed or evaluated in primary care. Methods: A scoping review will be conducted in accordance with the Arksey and O'Malley scoping review framework and the PRISMA-ScR guidelines. Systematic literature searches of MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and LILACs will be conducted from 2010 to present, aligning with publication dates of recent clinical guidelines. A structured iterative search of grey literature will be conducted. Full-text original quantitative or mixed method studies which describe the development or evaluation of MoCs for OA in primary care will be considered. Data will be charted and synthesised and a narrative synthesis will be conducted. Conclusions: This scoping review will provide a broad overview regarding the extent, nature and characteristics of the available literature on primary care based MoCs for OA. Findings will be used to identify gaps in the current evidence to identify areas for future research.

Rethinking Assessment Design: Evidence-Informed Strategies to Boost Educational Impact in the Anatomical Sciences.

University assessment is in the midst of transformation. Assessments are no longer designed solely to determine that students can remember and regurgitate lecture content, nor in order to rank students to aid with some future selection process. Instead, assessments are expected to drive, support, and enhance learning and to contribute to student self-assessment and development of skills and attributes for a lifetime of learning. While traditional purposes of certifying achievement and determining readiness to progress remain important, these new expectations for assessment can create tensions in assessment design, selection, and deployment. With the recognition of these tensions, three contemporary approaches to assessment in medical education are described. These approaches include careful consideration of the educational impact of assessment-before, during (test or recall enhanced learning) and after assessments; development of student (and staff) assessment literacy; and planning of cohesive systems of assessment (with a range of assessment tools) designed to assess the various competencies demanded of future graduates. These approaches purposefully straddle the cross purposes of assessment in modern health professions education. The implications of these models are explored within the context of medical education and then linked with contemporary work in the anatomical sciences in order to highlight current synergies and potential future innovations when using evidence-informed strategies to boost the educational impact of assessments.