Innovative Service Delivery Research Articles

The national health service England diabetes prevention program—A narrative review

Abstract The National Health Service (NHS) Diabetes Prevention Program (DPP) is a comprehensive initiative in the United Kingdom aimed at preventing type 2 diabetes (T2DM) among individuals with prediabetes. The NHS DPP emphasizes early intervention and underscores the potential for preventing or delaying T2DM. Currently, it operates since 2015 at 44 geographically defined sites, serving an estimated annual volume of 200,000 patients. This narrative review evaluates the NHS DPP. A literature search, adhering to the Participants, Concept, and Context review framework, was conducted in various databases and sources, limited to the period from 2015 to 2023. Data were categorized based on publication date, study type, program indicators, and focus areas, forming the framework for the review discussion. The review search yielded a total of 18,357 articles, of which 45 were included, with a predominant focus on program effectiveness. The NHS DPP demonstrates strengths in risk reduction and cost-effectiveness but faces challenges related to fidelity and the needs of diverse populations. The review highlights the importance of evidence-based service delivery, stakeholder engagement, and digital innovation in future DPP programs. While a centralized approach provides structure, local flexibility is essential to cater to population-specific needs. This review underscores the importance of strategic planning, political support, partnerships, and robust data collection in DPP implementation. It recommends targeting high-risk individuals, intensive lifestyle interventions, and embracing digital solutions for program delivery. Ongoing research, including analysis of long-term data and user perspectives, will further enhance the evidence base for DPP programs worldwide.

84 What works and why for interprofessional collaboration in older people’s care integration: realist evidence synthesis

Abstract Background Interdisciplinary Community Specialist Teams for older people (CSTs) are a novel innovation in Irish health service delivery and require, over time, a shift in cultures of care to allow for the development of interprofessional collaboration. However, there is limited international guidance on how to foster, enhance and sustain meaningful interprofessional collaboration in the context of interdisciplinary team-based care integration for older people. This realist review presents initial programme theories of what works and why in fostering competencies for interprofessional collaboration in CSTs for older persons. Methods Realist reviews are an interpretive theory-driven approach to evidence synthesis which uses multiple sources of evidence including published peer-reviewed studies, policy documents and grey literature. This evidence is combined with stakeholder theories and explanations of how interventions might work. Four stakeholder cohorts were identified: public and patient representatives of older people and family carers, healthcare professionals who are members of CSTs; team leads responsible for the operational management of CSTs, and healthcare managers responsible for national clinical programme design. Results This synthesis resulted in a series of evidence-based Initial Programme Theories (IPT) in the form of statements that explain the Mechanisms (M) and Resources (R), generated within particular Contexts (C) in response to interprofessional collaboration, that are thought to lead enhanced care Outcomes (O). For example: Where CST members have professional experience in different areas of service delivery (C), they bring to the team pre-existing relationships with other HCPs (R), enabling good cross-sectoral communication and trust (M) leading to enhanced continuity of care (O). Conclusion The IPTs generated from this realist synthesis of international literature support workforce education, development and planning. They also provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and realise the goals of care integration for older people.

64 Driving positive ageing at home: older adults’ engagement with ALONE support services

Abstract Background It is estimated that by 2050 approximately 1.6 million Irish people will be aged 65 or over. This dramatic shift in population highlights the importance of supporting positive ageing, and the need to develop medical and non-medical infrastructure and services that can meet the needs of this growing age group. ALONE is a national organisation that aims to transform ageing in Ireland, by supporting older adults to age within their own homes and communities positively and securely. This research aims to provide a descriptive portrayal of the response of older adults to ALONE’s services. Specifically, this study examined the demographic and clinical characteristics of older adults who seek support from ALONE and described the implications of these findings for policy and service delivery. Methods Data from older people who engage with ALONE services are captured through an online system designed to record salient clinical and service delivery information. Data analysed for this study included demographic characteristics, presenting needs, and nature, duration, and frequency of service engagement. Results Most older people engaging with ALONE were female, aged 76–85 years and were referred to ALONE from the HSE, hospitals and primary care centres. Older people living in non-owner occupied homes, and reporting a recent fall and mobility issues were overrepresented in the data whilst social isolation, physical health issues and housing needs were commonly reported. Visitation support and befriending represented the highest area of need among older people, who generated an average of 3.4 interventions. Conclusion The findings from this research provide insights into older people’s needs and contribute to our understanding of emerging features of innovative health service delivery for older people. These findings will support policymakers and service providers in creating and implementing integrated psychosocial and medical community services for older people.

INNOVATIVE PUBLIC SERVICE DELIVERY FOR SUSTAINABLE DEVELOPMENT (A STUDY OF GENERAL HOSPITAL IGANDO, LAGOS STATE, NIGERIA)

Innovative public service delivery is essential for enhancing the efficiency of resource utilisation and enhancing the standard of public service delivery for sustainable development. Hence, the purpose of this paper is to examine innovative public service delivery for sustainable development. Innovative public service delivery was operationalized using innovative service process and innovative service outcomes and was proxied by sustainable development. Two hypotheses were formulated and tested at a 0.01 level of significance. Using Yaro Yamane’s formula 259 staff of General Hospital Igando were selected. Out of 259 questionnaires administered, 231 questionnaires were retrieved while 33 of them were not filled and returned leaving the sample size to 198. The data collected were analysed using Pearson Correlation with the aid of Statistical Package for Social Sciences (SPSS) version 23.0. The findings however indicate that there is a significant relationship between innovative service process and sustainable development (P.value 0.721 < 0.01); results also show that there is a significant relationship between innovative service outcome and sustainable development (P.value 0.840<0.01). This study concludes that the innovative public service of public institutions ranges from the products and services offered and is determined by the technology that is revolutionizing the current global world and has improved the service delivery at General Hospital Igando. Based on these findings, the study recommended that government at all levels in Nigeria should continue to contribute in terms of budgetary allocation for the sustenance of innovative service delivery towards achieving sustainable development. Furthermore, a need for monitoring, supervising, and ensuring that all the financial and other public sector investments to achieve sustainable development are not diverted for selfish purposes.

COVID-19 Vaccination: Opportunity to Strengthen Immunization System in Belize

Objective: To describe the process of leveraging COVID-19 vaccination roll out to strengthen immunization system in Belize. Methodology: The Case study was conducted using desk review of relevant documents for the roll out of COVID 19 vaccination in response to the pandemic and analysis of the COVID-19 vaccination and routine immunization data extracted from the Belize Health Information System. The approach was a retrospective review of the strategies adopted by the government of Belize with support of UNICEF and other health partners using the roll out of COVID-19 vaccination to strengthen the country’s immunization system. Descriptive data is presented in graph and table and a test of association was done using a paired t-test to compare the mean change in annual routine immunization coverage before (2020) and after (2022) roll out of COVID-19 vaccination and p-value was set at a significant level of 5% Results: The National Vaccine Implementation Plan for the introduction of COVID-19 vaccination in 2021 was used as a transformative opportunity for building resilient immunization programs. Key areas focused on in the study were the enhancement of cold chain equipment and storage capacity, utilization of digital tools, improved data management, and innovative immunization service delivery. The result shows that the annual coverage of the first dose and third dose of pentavalent vaccine (Penta 3) increased from 79% and 78.5% in 2020 to 91% and 84.3% in 2022 respectively though not statistically significant (p value> 0.05). So far, 258,443 (65% of the total population) have received at least one dose of COVID-19 vaccine and 221,402 individuals (51.3% of the total population) have been fully vaccinated. Conclusion: The study contributes to the existing literature on the use of COVID-19 investments as an opportunity to strengthen the health system with a focus on immunization services which is essential in building a resilient health system.

Experiences of Food Pantry Stakeholders and Emergency Food Providers in Rural Minnesota Communities

ObjectiveThis study aimed to describe the experiences influencing food pantry stakeholders’ and emergency food providers’ ability to meet their shoppers’ needs. DesignWe conducted 5 focus groups. SettingFood pantries in Minnesota in late 2019 and early 2020. ParticipantsThe sample included 37 participants with various roles in the emergency food system. Phenomenon of InterestBarriers and challenges facing emergency food providers/stakeholders and practices and resources providers employ. AnalysisWe identified major themes using a thematic analysis approach. ResultsParticipants reported multiple barriers to accessing food pantries, that shopper demographics were changing, and shoppers needed nonfood support, such as personal hygiene items and mental health services. Food pantries required appropriate and sustainable food supplies, additional financial, labor, technical support, and physical infrastructure improvements. Participants described the benefits of their relationship with the University of Minnesota Cooperative Extension, explained how pantries offered healthier foods, highlighted innovative service delivery models, and stressed that their organization connected to many facets of their community. Conclusion and ImplicationsFood pantries serving rural areas reported meeting community needs by distributing food to their shoppers in an inclusive and health-promoting way but require additional support. These data support nutrition practitioners working to understand the local, place-based context and needs of emergency food providers while building wider and deeper connections between nutrition professionals and the emergency food system.

Workforce Implications of Increased Referrals to Hereditary Cancer Services in Canada: A Scenario-Based Analysis.

Over the last decade, utilization of clinical genetics services has grown rapidly, putting increasing pressure on the workforce available to deliver genetic healthcare. To highlight the policy challenges facing Canadian health systems, a needs-based workforce requirements model was developed to determine the number of Canadian patients in 2030 for whom an assessment of hereditary cancer risk would be indicated according to current standards and the numbers of genetic counsellors, clinical geneticists and other physicians with expertise in genetics needed to provide care under a diverse set of scenarios. Our model projects that by 2030, a total of 90 specialist physicians and 326 genetic counsellors (1.7-fold and 1.6-fold increases from 2020, respectively) will be required to provide Canadians with indicated hereditary cancer services if current growth trends and care models remain unchanged. However, if the expansion in eligibility for hereditary cancer assessment accelerates, the need for healthcare providers with expertise in genetics would increase dramatically unless alternative care models are widely adopted. Increasing capacity through service delivery innovation, as well as mainstreaming of cancer genetics care, will be critical to Canadian health systems' ability to meet this challenge.

The WHO abortion care guideline: Law and policy-Past, present, and future.

In the 2022 Abortion Care Guideline, the World Health Organization (WHO) undertook systematic evidence reviews of seven law and policy interventions to assess their health and social impacts. Distinct recommendations were formulated for each. The present article highlights how the Guideline reconceptualizes abortion regulation as a complex structural intervention that shapes clinical care and service delivery and distributes risks and resources within these systems and in the care relations that define them. It then presents the Guideline recommendations and summarizes their evidence base, drawing on recent legal and policy developments to emphasize their real-world significance. The article concludes by anticipating the future of abortion law and policy, focusing on service delivery innovations and diverse care models, drug regulation and the supply of abortion pills, and protective interventions crafted in the context of political crisis and immediate need that serve policy objectives and take regulatory forms different from the past.

A multi-site, non-randomized study of the feasibility and acceptability of a family-led postnatal care model in the Ada District, Ethiopia

Background: Postnatal care is a critical intervention to reduce newborn and maternal mortality in high-mortality settings. However, it is underutilized in many countries. Family-led postnatal care (FPNC) is an innovative postnatal care service delivery model that leverages self-care principles to address key barriers identified in the Ethiopian context, including women’s preference to stay home in the first week after delivery and receive support from trusted family members. Utilizing an improved discharge process, coupled with user-friendly monitoring devices made available as a home care kit kept with preferred community custodians, this self-care model for postnatal care will be evaluated as a potential solution to very low coverage of postnatal care in the first week of life. Methods: The study will use mixed sequential methods: quantitative pre-intervention and post-intervention survey and phenomenological qualitative study. Four health centers in Ada Districtof Oromia, Ethiopia will be purposively selected. A pre-intervention survey will measure coverage and content of postnatal checks and care-seeking behavior. Health centers will then implement family led postnatal care. Once FPNC is initiated, post-intervention quantitative data will be collected. Approximately 218 postnatal women are to be included in the quantitative survey. Qualitative interviews with approximately 20 mothers, 20 partners, 20 families, eight health managers, 12 postnatal discharge counselors, 20 health extension workers, and eight home care kit custodians will be conducted. A quantitative measurement of sustainability six months after the endline will also be assessed. Conclusions: Optimally, the study will contribute evidence to inform decision makers locally and globally on whether FPNC is a feasible and acceptable service delivery model for postnatal care, and whether it improves women’s empowerment and/or increases men’s support and connection to women and newborns in the early postnatal period.

The Fono's 'Alert Level 4' Story

During the 1970s and 1980s, Pacific people tended to seek medical care from Accident and Emergency centres only when they were in an acute condition. As a result, Pacific mortality rates were high and Pacific people were unnecessarily suffering with poorer health outcomes. By 1987, a group of Pacific community leaders in Auckland came together and formed The Fono (originally known as Pasifika Health Care), to provide a Pacific community-led health practice and improve access to high quality, culturally appropriate primary care services. By 2020, The Fono had nine sites with four medical clinics, three dental clinics, a vast range of public health and social services, and a trades training academy. Aotearoa New Zealand’s initial Covid-19 Alert Level 4 period was a time of intensive service delivery and significant innovation at The Fono. As a result, incubation projects were catapulted into life, transforming key aspects of the organisation. For The Fono, this transformation occurred on the following timeline: pre-Covid (time before Alert Level 4, before 26/03/2020); Covid (Alert Level 4 period, 26/03/2020–3/05/2020); post-Covid (the time after Alert level 4, 13/05/2020 onwards). This viewpoint outlines the projects that contributed to organisational change at The Fono with the first Covid wave in 2020.

Contraceptive method switching and discontinuation during the COVID-19 pandemic in Myanmar: findings from a longitudinal cohort study

The objective of this paper was to document contraceptive dynamics and associated correlates of contraceptive method switching and discontinuation in Myanmar during the COVID-19 pandemic. We conducted a secondary analysis of panel data collected between August 2020 and March 2021 among married women of reproductive age of households registered for a strategic purchasing project in Yangon. Statistical analysis included descriptive statistics, bivariate tests of association and adjusted log-Poisson models with generalised estimating equations to examine relative risks and 95% confidence intervals. Among the study sample, 28% of women reported method switching and 20% method discontinuation at least once during the study period. Difficulties accessing resupply/removal/insertion of contraception due to COVID-19 and method type at baseline were identified as correlates of method switching and discontinuation. Women who reported difficulty obtaining their method due to COVID-19 had an increased risk of method switching (RRadj: 1.85, 95%CI: 1.27, 2.71). Women who reported injectables as their initial contraceptive method at baseline had an increased risk of method switching (RRadj:1.71, 95%CI: 1.06, 2.76) and method discontinuation (RRadj: 2.16, 95%CI: 1.16, 4.02) compared to non-injectable users. As Myanmar evaluates its public health response to COVID-19, the country should consider innovative service delivery models that allow women to have sustained access to their method of choice during a health emergency. (211).

EXPERTS II - How are patient and caregiver participation in health and social care shaped by experienced burden of treatment and social inequalities? Protocol for a qualitative synthesis.

The workload health and social care service users and caregivers take on, and their capacity to do this work is important. It may play a key part in shaping the implementation of innovations in health service delivery and organisation; the utilisation and satisfaction with services; and the outcomes of care. Previous research has often focused on experiences of a narrow range of long-term conditions, and on factors that shape adherence to self-care regimes. With the aim of deriving policy and practice implications for service redesign, this evidence synthesis will extend our understanding of service user and caregiver workload and capacity by comparing how they are revealed in qualitative studies of lived experience of three kinds of illness trajectories: long-term conditions associated with significant disability (Parkinson's disease, schizophrenia); serious relapsing remitting disease (Inflammatory Bowel Disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early onset dementia). We will review and synthesise qualitative studies of lived experience of participation in health and social care that are shaped by interactions between experienced treatment burdens, social inequalities and illness trajectories. The review will involve:1.Construction of a theory-informed coding manual; systematic search of bibliographic databases to identify, screen and quality assess full-text papers.2.Analysis of papers using manual coding techniques, and text mining software; construction of taxonomies of service user and caregiver work and capacity.3.Designing a model of core components and identifying common factors across conditions, trajectories, and contexts.4.Work with practitioners, and a Patient and Public Involvement (PPI) group, to explore the validity of the models produced; to develop workload reduction strategies; and to consider person-centred service design. We will promote workload reduction models to support service users and caregivers and produce policy briefs and peer-reviewed publications for practitioners, policy-makers, and researchers.

Understanding and exploring the value co-creation of cloud computing innovation using resource based value theory: An interpretive case study

Research on the intrinsic mechanisms of how cloud computing ecosystems may enable value co-creation within business alliances and partnerships and their underlying mechanisms are scarce. Having identified this gap in the extant literature, and acknowledging that cloud computing is still taking off, our study seeks to explore and develop an understanding of the underlying mechanisms of value co-creation within business alliances of cloud computing providers and third-party enterprises. This study is informed by the Resource Based View (RBV)Theory and four layers of value co-creation to build on a qualitative case study using the interpretivist epistemological stance. In this study we illustrate how knowledge is shared between two firms and unpack the value co-creation process for the design and delivery of innovative cloud services. In terms of the RBV, it was discovered that reputation as a resource is valuable because it offers the smaller firms with the assets of global reach and a large partner network, which eventually may support in building its competitive advantage. For the larger organization the alliance offered the ability to provide clients with an innovation without additional facilities, and personnel.

Exploring the experience of service users following attendance at a student-led interprofessional neurodevelopmental clinic

Purpose The aim of the current study was to understand service users’ experiences at a recently established student-led interprofessional neurodevelopmental clinic for children and adolescents with suspected or confirmed prenatal alcohol exposure. Method Semi-structured interviews were completed at 3-months post-clinic attendance with 10 service users: eight parents/caregivers and two youth workers/case managers. Interview data were analysed thematically using NVivo12. Results Four main themes were developed: (1) clinic attendance seen as a positive event; (2) validation, clarification, and relief, but also challenges post-assessment; (3) need for further support and importance of advocacy; and (4) drawing on lived experiences for future service improvements. Conclusions The current study demonstrated that service users reported benefits from tailored services delivered by student practitioners that were validating, supportive, and holistic. Findings from the current study can inform the development and implementation of future innovative service delivery models for individuals with suspected or confirmed prenatal alcohol exposure.

Sexual and Reproductive Healthcare Visits as a Venue for PrEP Service Delivery among Women in the United States: Results from a Nationally-Representative Survey.

Pre-Exposure Prophylaxis (PrEP) for HIV is disproportionately under prescribed to women. Centers for Disease Control and Prevention (CDC) guidelines identify a group of women at risk of HIV acquisition who should be offered PrEP, but opportunities remain to improve patient awareness of and provider counseling about PrEP, and to expand service delivery of PrEP. Using nationally representative data from the 2017-2019 National Survey of Family Growth, we compared women with (n = 689) and without (n = 5,452) CDC indications for PrEP on measures of PrEP awareness, counseling by a provider, and interaction with the health care system. Women with PrEP indications were no more likely to report awareness of PrEP (OR 1.03, 95% CI 0.82-1.29) or PrEP counseling by a provider (OR 1.32, 95% CI 0.77-2.27), compared to those without PrEP indications. However, women with PrEP indications were more likely than those without to report a birth control visit (OR 1.82, 95% CI 1.39-2.38) or an abortion within the last 12 months (OR 5.93, 95% CI 1.48-23.73), and to currently use prescription contraception (OR 1.45, 95% CI 1.19-1.78). A majority of both groups reported accessing prenatal care within the last 12 months. There remains a gap in PrEP awareness and counseling among women at highest risk for HIV acquisition. Sexual and reproductive health visits represent a logical and feasible venue for PrEP provision. Obstetrician-gynecologists and other family planning providers may be able to aid in service delivery innovations by providing PrEP alongside other sexual and reproductive health care.

Determinants of Implementation of a Critical Care Registry in Asia: Lessons From a Qualitative Study.

The Collaboration for Research, Implementation, and Training in Critical Care in Asia (CCA) is implementing a critical care registry to capture real-time data to facilitate service evaluation, quality improvement, and clinical studies. The purpose of this study is to examine stakeholder perspectives on the determinants of implementation of the registry by examining the processes of diffusion, dissemination, and sustainability. This study is a qualitative phenomenological inquiry using semistructured interviews with stakeholders involved in registry design, implementation, and use in 4 South Asian countries. The conceptual model of diffusion, dissemination, and sustainability of innovations in health service delivery guided interviews and analysis. Interviews were coded using the Rapid Identification of Themes from Audio recordings procedure and were analyzed based on the constant comparison approach. A total of 32 stakeholders were interviewed. Analysis of stakeholder accounts identified 3 key themes: innovation-system fit; influence of champions; and access to resources and expertise. Determinants of implementation included data sharing, research experience, system resilience, communication and networks, and relative advantage and adaptability. The implementation of the registry has been possible due to efforts to increase the innovation-system fit, influence of motivated champions, and the support offered by access to resources and expertise. The reliance on individuals and the priorities of other health care actors pose a risk to sustainability.

Her Broken English

Her Broken English Melissa Akie Wiley (bio) Grandma said, “Mr. and Mrs. Wrench live next door.” When I learned to read, I noted the white letters on their mailbox. L-Y-N-C-H Broken English. The term used for the Japanese American accent. And that’s how I saw her then. Broken, embarrassing, simple. “My glass is perspiration from the heat,” she said. “I think you mean condensation,” I said. “No tell me what I mean,” she snapped. In the morning, she took the night’s soaked-rice pot to the backyard and dumped the loosened grains. Then she stretched her arms toward the sun. Her daily rejoicing ritual. To the wonderment of God. Before Buddhism captivated America. Before yoga pants and high-end sushi restaurants signaled the country’s wealthiest white enclaves. I asked her to read to me. “I don’t speak English very well,” she said. Then she turned silent. I apologized. Disconnection from her felt unbearable. [End Page 89] I knew every crack in her dried fingernails, her wispy hair, her wide feet. Our time together long enough to memorize her physicality. But not long enough to know her. “You’re the best person I’ve ever known,” she said and pressed her forehead to mine. Did I love her as much as she loved me? I corrected her. I cowered in embarrassment. I look for her now. I dip my hands into a soaked-rice pot. I rejoice at the morning sky. To have been loved by her. To the wonderment of her God. I want to tell her I’m sorry. [End Page 90] Melissa Akie Wiley Melissa Akie Wiley is a writer, keynote speaker, and nationally-recognized leader in local government. She is the survivor of a facially disfiguring childhood dog attack and creator of an anti-bullying curriculum for children focused on the intersection of storytelling and disability. Her work was most recently published by The New York Times, The Manifest-Station, and Public Management Magazine. She is writing a forthcoming memoir about coming-of-age as a disfigured, bi-racial girl in America. She has traveled throughout the country teaching government officials how to drive innovation, change, and equity in public service delivery. Her mission is to restore faith in government and to redefine beauty for women and girls. She holds a master’s degree from the University of Pennsylvania and lives with her husband, daughter, and dog in Erie, Colorado where she currently serves as the Deputy Town Administrator. Copyright © 2023 River Teeth

Engagement in HIV continuum of care: Another step needed to close the gap toward UNAIDS 90-90-90 targets among younger men in Rwanda.

In this study, we measured Rwandan men's engagement in HIV services based on the UNAIDS 90-90-90 targets and assessed factors associated with linkage to HIV services. We analyzed the Rwanda Population-based HIV Impact Assessment (RPHIA) data for 15- to 64-year-old males. We conducted bivariate analysis to assess the distribution and association of sociodemographic characteristics with UNAIDS 90-90-90 targets. We adjusted multivariable models to understand the effect measurement of associated factors and determine the factors that best predict the achievement of UNAIDS 90-90-90. Of 13 780 males aged 15-64 years who participated in the RPHIA and consented to the blood draw and HIV testing, 302 had a positive HIV result, while 301 had valid responses to all variables analyzed in this paper and were included in the analysis. We found that age group was an explanatory and predictive factor for achievement of UNAIDS 90-90-90. Younger men living with HIV (MLHIV) are less likely to have achieved UNAIDS 90-90-90 compared to MLHIV 50-64 years old: adjusted odds ratio (aOR) for MLHIV aged 15-34 years was 0.21 (0.08-0.53) and aOR for MLHIV aged 35-49 years was 0.77 (0.36-1.66). To close the UNAIDS 90-90-90 gap in Rwanda, innovative service delivery strategies are needed to support young MLHIV to reach 90-90-90.

“We adapted because we had to”: how domestic violence perpetrator programmes adapted to work under COVID-19 in the UK, the USA and Australia

PurposeThis study explores responses by domestic violence perpetrator programme (DVPP) providers of three Western countries (UK, USA and Australia) to the COVID-19 pandemic and population movement control measures on their practice. The purpose of this paper was to offer an evidence base for changes to programme and intervention delivery around domestic violence to sustain integrity of safe, effective working practices with perpetrators, survivors and staff.Design/methodology/approachBased on 36 semi-structured qualitative interviews conducted from July to September 2020, the authors mapped the experiences of changes in service with frontline staff, managers and sector-wide representatives.FindingsThe findings focus on how providers of DVPPs adapted to the increase in referrals and workload that had a positive impact on service delivery innovation but an adverse impact on staff wellbeing. Digital services were reported to be adopted into mainstream approaches but introduced new barriers to service access and group dynamics. Integrated safety support for survivors, if not adequately connected to programmes pre-pandemic, risked being disconnected from DVPP that may undermine positive programme outcomes.Originality/valueThe paper provides a documentation of changes in DVPPs, and a cross-comparison of services across three Western countries during the first wave of COVID-19. The work offers implications of the development of digital modes of service delivery for DVPPs and highlights the need for focus on resource management and integration of safety services for survivors in DVPP services.

Framework for Evaluating and Developing Sustainable Telehealth Programs.

During the COVID-19 pandemic and public health emergency, telehealth programs vastly expanded with strong support from various federal and state agencies. However, the uncertainty regarding future reimbursement policies for telehealth services has resulted in concerns about long-term sustainability of innovative health service delivery models beyond the financial support. Given the limited literature on creating telehealth programs with long-term sustainability in consideration, we have developed a framework for gathering appropriate data during various stages of program implementation to evaluate clinical effectiveness and economic sustainability that is applicable across various settings, with additional attention to health equity. Recognizing the difficulty of sustaining telehealth programs solely through a fee-for-service payment model, we encourage all telehealth stakeholders, especially payers and policymakers, to consider cost-effectiveness of telehealth programs and support alternate payment models for ensuring long-term sustainability.