Framework For Interventions Research Articles

5.A. Scientific session: From theory to action - Applying the Medical Research Council framework on complex interventions

Abstract The reasons for the workshop: Globally, public health problems such as obesity, poor mental health, and social inequality in health are on the rise. Tackling these significant challenges requires well-designed complex interventions. Interventions rarely follow linear sequences from intervention design toward large-scale implementation. Rather, they take non-linear trajectories by constantly adapting the intervention design according to the context. This thinking is outlined in the British Medical Research Council’s (MRC) 2021 framework for developing and evaluating complex interventions. This workshop encompasses four case projects, each corresponding to one of the four phases in the framework: i) development, ii) feasibility, iii) implementation, and iv) evaluation. However, recognising the deliberately generic nature of this framework, our workshop also encompasses co-creation, process evaluation, and implementation theories and methodology. Combining these methodologies presents challenges that necessitate clear argumentation and critical reflection. In this workshop, we will share the challenges encountered when applying the MRC 2021 framework and hopefully inspire future innovative opportunities in intervention research. Specifically, this workshop aims to: i) exchange challenges from intervention research methods and theories drawing on presenters’ experiences across four public health case projects. Presenters will critically reflect on the key concepts from the MRC framework including context, programme theory, engagement of stakeholders, uncertainties, and refinement of interventions. ii) discuss opportunities for future complex intervention research and outline best practices for using the MRC 2021 framework for complex interventions. The added value of organising the workshop: The audience attending this workshop will reflect on multiple on-the-ground experiences of applying methodology and principles from the MRC 2021 framework as well as methods and theories relevant to intervention research: co-creation, qualitative (e.g., ethnography, interviews) and quantitative (e.g. experimental, observational) methods applied to all core phases of complex interventions. At the end of the workshop, the audience will be invited to participate in an open, plenary discussion facilitated by the workshop’s chairs: two international experts on complex interventions, Reader Rhiannon Evans and Prof. Helle Terkildsen Maindal. The experts will encourage the presenters and audience to reflect critically on the case projects and ways forward for complex intervention research. Coherence between the presentations in relation to the workshop topic: The four case projects are guided by the MRC 2021 framework for complex interventions and involve public health interventions at the individual, interpersonal, and structural levels in Denmark and Canada. Key messages • Tackling public health challenges demands innovative and well-designed complex interventions combining research traditions, principles from health promotion, and cutting-edge best-practice frameworks. • The symposium will create a platform for cross-disciplinary knowledge exchange through case projects and expert-led joint discussions on how to apply the MRC 2021 framework for complex interventions.

The role of the organisational context in the implementation of a complex mental health intervention

Abstract Introduction The 2021 framework for complex interventions introduced by the UK Medical Research Council highlights context as one of the core elements. In the implementation phase, context is considered especially critical as it affects the intervention’s effect, sustainability, and transferability. However, in public health implementation research, there is a lack of understanding of the interrelatedness between intervention and context conditions. This study aimed to explore the role of the organisational context in implementing a complex mental health intervention. Methods The study was designed as an ethnographic case study. This design enabled a comprehensive exploration of the relation between the case and its context by providing insights into the process of change implied in the implementation and how this collides with the organisational norms, culture, and structure. Four general practices participating in The Healthy Mind Intervention were included as cases. One-person interviews with clinic owners, focus group interviews with personnel, and observations of intervention activities and everyday life in the practices were used to collect data. Results Three themes were identified. First, existing organisational norms, ideals, and values were replicated in the implementation process and either inhibited or facilitated the process of change. Second, different narratives of both implementation and context existed among some of the professional groups, which complicated the collaborative efforts in the implementation. Last, conflicts in the organisations were actualised in the implementation process, which enabled a discussion and improvement of these issues. Conclusions Ethnographic case studies provide extensive insights into the role of the organizational context in implementing complex interventions, which is critical for the implementation to be effective, qualified, and sustainable.

11.D. Scientific session: Participatory approaches and co-creation in complex interventions to reduce inequity in health

Abstract Health disparities are linked to social inequalities, necessitating health researchers to address the health gaps that exist between different social groups, particularly in the realm of health interventions. This workshop delves into the significance of co-creation processes and participatory approaches in complex health interventions to reduce social inequities in health outcomes. Through empirical cases illustrating co-creation processes in intervention research, the workshop aims to enlighten the audience on the continuum of participatory approaches. The MRC/NIH framework of complex interventions highlights the importance of engagement with relevant stakeholders throughout the research phases to enhance the likelihood of developing or identifying interventions that can positively impact health outcomes. However, the extent and nature of stakeholder involvement may vary depending on the specific context and stage of the research. While stakeholder involvement has been a longstanding focus, the concept of co-creation, where stakeholders actively participate in the entire process of intervention development, implementation, and evaluation, has emerged more recently. This shift from creating interventions for the target population to collaborating with them in the intervention’s creation has led to the emergence of more inclusive health interventions that are contextually relevant and tailored to the local settings where they are intended to create change. Yet, introducing participatory approaches in intervention research may raise new questions about decision-making and power dynamics. While interventions led solely by experts and researchers may overlook the empowerment and capacity-building potential among stakeholders and intervention sites, co-creation processes have the capacity to empower stakeholders and address health inequities effectively. However, challenges persist in ensuring equal collaboration between researchers and participants, especially in disadvantaged groups. This workshop aims to prompt reflection on ethical issues arising from traditional health intervention approaches and approaches to ensure participants’ ownership of interventions when they are adapted in new contexts. Moreover, this workshop will discuss the design of participatory interventions: What methods can we use to co-create? What stakeholders to involve? At what stages of the intervention should co-creation occur? The workshop program begins with an introductory presentation of participatory approaches and co-creation in health intervention research, with examples from a school-based intervention. Next, three empirical cases of co-creation processes introduced in interventions in different contexts are presented. Finally, the audience is invited to a take part in a discussion focusing on how participatory approaches among disadvantaged populations can potentially contribute to reduced social inequity in health. Key messages • The involvement of stakeholders in the development, implementation and evaluation of health interventions can take many forms, and what is meaningful for the specific context needs to be considered. • Co-creation approaches in health interventions empower participants and address unequal power dynamics between those who deliver and those who receive health interventions.

Development of the health literacy responsiveness (HLR) evaluation framework for HLR interventions

Abstract Background Health literacy responsiveness (HLR) interventions include actions at different levels of an organization to provoke change and improve environments ensuring equitable access to and use of information and services (1). However, generic instruments measuring the effect of HLR at intervention level are inconsistent, making evidence on HLR intervention effects difficult to compare (2). The objective of this study was to develop an evaluation framework based on core outcome domains of HLR to facilitate higher consistency in future evaluations of HLR interventions. Methods HLR outcomes were identified through a narrative literature review and categorized into domains through a content mapping process. Expert consensus on core outcome domains was reached through a Delphi process. Experts within the field of HLR were invited to participate and answer three questionnaires designed to rank and clarify potential core outcome domains. Quantitative and qualitative analysis was performed to select and complete the final core outcome domains in the HLR evaluation framework (HLR-EF). Results The literature search resulted in identification of nine reviews. A total of 383 outcomes were identified from these reviews and included in the content mapping process, which resulted in a total of 26 core outcome domains. Experts (n = 15) participated in the three-round Delphi process, which resulted in consensus on 15 core outcome domains in HLR-EF allocated under five headings. Conclusions The study has successfully managed to identify a set of core outcome domains applicable in future evaluations of HLR interventions based on systematic methodologies and expert consensus. Context-sensitive manuals for the use of the HLR-EF is under development and the instrument is ready to be applied in future evaluation of HLR interventions, potentially making future measuring, reporting and comparison of results significantly easier. Key messages • Instruments facilitating evaluation of HLR interventions are non-generic and inconsistent. • HLR-EF has been developed using a narrative literature review, content mapping, and a Delphi process, and defines 15 core outcome domains for evaluation of HLR interventions.

Role of nonpharmacological concussion management in children: systematic review of randomized controlled trials.

Concussion is a global public health problem that affects many children worldwide. Most patients present with postconcussion syndrome and normal brain imaging find- ings. Despite the high incidence of concussion in children, published research on nonpharmacological management is lacking and much more often concerns pharmacological interventions. This systematic review aimed to evaluate the role of nonpharmacological interventions in managing concussion based on randomized controlled trials. The PubMed, Scopus, Web of Science, and Cochrane data- bases were extensively searched for articles published between January 2013 and July 2023. A modified patient intervention, comparison, and outcome framework was used to construct the search strategy and eligibility criteria. Risk of bias was assessed using the Risk of Bias-2 tool. A total of 16 studies conducted between January 2013 and July 2023 were analyzed. Three studies were conducted in an acute care setting (<24-hour postinjury) involving rest, computer time, and doing nothing, while the other 13 studies were conducted in a chronic care setting (>24-hour postinjury) and included aerobic exercise, collaborative care intervention, cervical spine rehabilitation, education by physiotherapists, a hyperbaric oxygen therapy protocol, family intervention therapy, virtual reality, traditional occupational therapy, virtual rehabilitation, oculomotor control exercises, vestibular rehabilitation, coordination exercises, and balance exercises. This systematic review highlights the importance of nonpharmacological therapy in pediatric concussion cases. Active rehabilitation may yield promising outcomes. Another interesting approach may be useful in pediatric concussion management. How- ever, this systematic review shows a lack of high-quality literature supporting nonpharmacological pediatric con- cussion treatments.

A systematic review of cancer overdiagnosis in multimorbid patients

Abstract Background Cancer screening looks for early signs of cancer in people who do not currently exhibit symptoms. However, screening can also identify abnormalities that do not progress to produce symptoms or death. This could include the identification of tumours, which stop growing or grow very slowly; patients usually die with them rather than from them. We systematically reviewed the literature to investigate the harmful consequences of cancer overdiagnosis in multi-morbid patients. Methods We followed the PRISMA reporting guidelines and registered the review with PROSPERO (CRD42024475175). A Population, Intervention, Comparator, Outcome and Study design (PICOS) framework was used as an organising framework. Peer-reviewed studies were included except case series, case report reviews and conference abstracts. Four large databases (Medline, Embase, APA Psych INFO and Scopus) were searched in Nov23 using appropriate keywords grouped into categories: multimorbidity, overdiagnosis, patient harms, cancer screening. Titles were screened according to the eligibility criteria and their quality assessed. Studies needed to have investigated the extent of harm caused by overdiagnosis (e.g., overtreatment). Results A total of 200 articles were retrieved, with seven meeting our inclusion criteria. All included studies were based in the US. Breast and prostate cancer overdiagnosis was reported to be 15% higher in multimorbid populations compared to the average-risk population. Multimorbid individuals were more vulnerable to the harms of cancer overdiagnosis, with psychological, physical and financial harms reported. Conclusions These findings contribute valuable insights into the intricate interplay between comorbidities, cancer overdiagnosis, and associated harms. Radical treatment interventions in multi-morbid patients can carry greater risk of complications. Current screening guidelines only address average-risk populations; future guidelines need to reflect these findings. Key messages • Cancer overdiagnosis was found to be higher in multimorbid populations compared to the average-risk population. • Multimorbid individuals are also more vulnerable to the harms of cancer overdiagnosis.

Real-world evidence supports superior efficacy of prasugrel over ticagrelor in individuals with acute coronary syndrome

Abstract Background In patients with acute coronary syndrome (ACS) undergoing invasive treatment, ticagrelor and prasugrel are guideline-recommended P2Y12 receptor inhibitors. Preference for one of the two drugs is under debate although the ISAR-REACT5 trial revealed advantages for prasugrel. This real-world data study evaluated the efficacy and safety of ticagrelor versus prasugrel in individuals with ACS undergoing invasive treatment by emulating a target trial analogous to ISAR-REACT5. Methods Following the Population, Intervention, Comparator, Outcome, and Timing (PICOT) framework, within a German health claims database, we adapted the inclusion and exclusion criteria from ISAR-REACT5 and identified a 1:1 propensity score-matched cohort with ACS being treated after hospital discharge with either ticagrelor or prasugrel (n=9,380, each). End points were defined as in ISAR-REACT5 at 1-year follow-up. Additionally, subgroup analyses of individual ACS components ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) were conducted. Results The primary composite end point occurred in 9.2% of ticagrelor and 7.4% of prasugrel treated individuals (hazard ratio 1.22; 95% confidence interval 1.10-1.35). Likewise, the secondary end points MI and stroke occurred significantly more often in the ticagrelor arm. All-cause mortality, stent thrombosis, and the safety end point bleeding revealed no significant differences. Subgroup analysis revealed superiority for prasugrel particularly in individuals with STEMI. Statistically, test results and hazard ratios of this real-world data study were in agreement with the findings of ISAR-REACT5. Conclusions With over four times the cohort size of ISAR-REACT5, this study indicates superior efficacy of prasugrel over ticagrelor in individuals with ACS undergoing invasive strategy.Cumulative incidence of primary endpointGraphical abstract

Rescue and return: Translocating a semi‐wild platypus (Ornithorhynchus anatinus) population during the 2019 drought

SummaryPlatypus (Ornithorhynchus anatinus) are an endemic Australian freshwater mammal, impacted by synergistic threats across their range. During the extreme drought of 2017–2019, declining water levels threatened Platypus at Tidbinbilla Nature Reserve (TNR), Australian Capital Territory (ACT), Australia. TNR supports a population of Platypus, occupying interconnected ponds within a predator proof fence. During drought conditions in 2019, Platypuses could not move out of the fenced area to refugia as floodgates were closed due to low water levels. In winter of 2019, eight Platypuses were found deceased resulting from starvation. By December, water levels were extremely low and ponds were continuing to dry. Given these circumstances, a rescue intervention was undertaken to capture stranded Platypuses. They were temporarily relocated and housed at Taronga Zoo, Sydney, until they were returned when conditions at TNR improved. Seven Platypuses were rescued, with five successfully housed at Taronga for 5 months. One Platypus was lost after escaping from its enclosure and another Platypus died when trapped in a crevice. The Platypuses were returned after water levels increased at TNR and were monitored for 500 days post‐release, demonstrating successful repatriation. This case study outlines the key stages and considerations required for this intervention, providing critical information for rescue attempts on drought‐affected Platypus populations. There is a need to continue developing a decision framework for interventions of climate‐affected populations, including quantifying trigger thresholds and conservation prioritisation of populations. This will become increasingly necessary given the trajectories of habitat degradation, coupled with the increasingly frequent and severe droughts, expected under anticipated climate change scenarios.

The Critical Role of the 4th “P”: Addressing the Impact of “Otherness” on Human Trafficking Prevention Efforts

ABSTRACT Prevention is the key to reducing human trafficking prevalence, and awareness-raising campaigns are the most common form of trafficking intervention; however, there is little evidence that these activities translate to actions that prevent human trafficking. The “otherness” issue – the belief that human trafficking is a problem for “other” communities but not a problem within one’s own community – has been identified as a potential barrier to effective human trafficking prevention interventions. In this article, we unpack the “otherness” issue and build on Todres (2009) “otherness-aware” framework to develop a theoretical model for understanding otherness within the context of human trafficking prevention interventions. Drawing on evidence from public health, we discuss the community mobilization intervention framework, which is centered on partnership and community engagement, as a potentially useful strategy for addressing the “otherness” issue and improving the effectiveness of human trafficking prevention interventions. We conclude that meaningful partnership with communities is a key to developing contextually relevant, community-empowering approaches to prevent human trafficking. This article has implications for achieving UN Sustainable Development Goal (SDG) 16, which aims to support inclusive communities through targets such as reducing violence, ending human trafficking and amplifying developing countries’ participation in global decision-making.

Mechanical Thrombectomy Access Score: A Systematic Review and Modified Delphi of Global Barriers to Endovascular Therapy.

The availability of mechanical thrombectomy (MT) for acute ischemic stroke is limited, and vast disparities exist between countries. We aim to create a MT access score to measure the drivers of access to help quantify and accelerate treatment worldwide. We used a systematic review complemented by a modified Delphi method. In the first of 3 rounds, 4 independent investigators performed a systematic literature review using key search terms that drive MT access, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the second round, a panel of 6 anonymous international experts selected key attributes needed for scoring. In the final round, a total of 12 attributes were selected on consensus, each given a score on a 0 to 3 scale. An ultimate MT access score (range, 0-36) was proposed as a new tool to use in identifying barriers to MT access and assist in providing an initial framework for public health interventions. Of 2864 abstracts screened, 121 studies were included in the final systematic review. A total of 34 attributes that potentially drive MT access were initially identified. In the final round, 12 attributes were selected by the expert panel: public awareness, emergency medical services transportation, prehospital large vessel occlusion screening, interhospital transfer policy, emergency department protocols, stroke imaging protocols, emergency department stroke expertise or telestroke availability, interventionalists, MT-capable centers, device availability, and insurance coverage. These attributes were weighted as part of the final score of 0 to 36. The MT access score represents the first tool to quantify barriers to global MT access. Its implementation stands not just as an academic achievement but as a beacon of hope for improving stroke care and outcomes worldwide, bringing us a step closer to bridging the gap in stroke treatment disparities.

Exploring Implementation of Reasonable Adjustments in Hospitals for People With Intellectual Disability: Using a Realist Lens.

To explore the factors influencing the implementation of reasonable adjustments in hospitals for people with intellectual disability: using a realist lens. A qualitative study using a realist lens. Data collection involved one focus group interview and three semi-structured interviews with healthcare professionals working in hospital or community settings in September 2023. Data were analysed using qualitative content analysis and findings were mapped to the Context and Implementation of Complex Interventions (CICI) framework across the dimension's context, implementation and setting. Healthcare professionals support the provision of reasonable adjustments in acute hospitals as a person-centred approach to caring for people with intellectual disability. While reasonable adjustments are evident in practice, they are mostly individual-level cases with little evidence of strategic system-level implementation. The factors influencing the implementation of reasonable adjustments in practice were conceptualised using the CICI framework. Context factors spanned the domains of epidemiological (e.g., ageing population), socio-cultural (e.g., historical healthcare), political (e.g., lack of integrated care pathways) and ethical (e.g., provision of person-centred care). Implementation factors spanned the domains of strategies (e.g., leadership strategies), agents (e.g., liaison and advocacy roles) and outcomes (e.g., individual-level reasonable adjustments). The setting for the complex intervention was the acute hospital. System-level indicators for successful implementation include intellectual disability specific policies/procedures for integrated care pathways, education and awareness training for hospital staff, and leadership strategies such as the development of liaison nursing roles and the appropriate allocation of physical and human resources. A radical change is needed where implementation of reasonable adjustments in acute hospitals are broadened beyond isolated individual-level cases to system-level healthcare. This research highlights the importance of exploring the integrated dimensions of context, implementation and setting in complex interventions such as reasonable adjustments and sets foundation for further implementation research in this area. Reasonable adjustments at the system-level within acute hospitals would promote person-centred care and help address the inequities and health disparities experienced by people with intellectual disability. This research uses a realist lens to explore the factors influencing the implementation of reasonable adjustments in acute hospitals for people with intellectual disability. The factors influencing the implementation of reasonable adjustments in practice were conceptualised using the CICI framework across the dimensions of context (domains epidemiological, socio-cultural, political and ethical), implementation (domains strategies, agents and outcomes) and setting. System-level indicators for successful implementation include intellectual disability specific policies/procedures for integrated care pathways, education and awareness training for hospital staff, and leadership strategies such as the development of liaison nursing roles and the appropriate allocation of physical and human resources. This research highlights the importance of exploring the integrated dimensions of context, implementation and setting of complex interventions such as reasonable adjustments and sets a foundation for further implementation research in this area. This research adhered to the Equator research reporting guideline: standards for reporting qualitative research. A parent of a child with intellectual disability was involved in the conduct of this research, specifically in the design, data collection and preparation of the manuscript.

Evaluating the Reliability of Name Writing Rubric Scoring

Early literacy screening tools are often a critical component of schools’ intervention frameworks. As the use of screening tools becomes more prevalent for identifying students who may be at risk for learning difficulties and in need of additional instruction, it is important to continuously evaluate teachers’ implementation of these screening tools and to improve efforts to support their implementation. Measures of name writing as a part of a screening tool can pose specific implementation challenges due to the subjectivity that rubric scoring allows. As such, this study aimed to evaluate the reliability of a rubric used by pre-kindergarten teachers to score a name writing task, as part of a larger screening tool, in the context of their own classrooms, and to examine scoring patterns between researchers and teachers on the name writing rubric. Results revealed that researchers had higher interrater reliability among themselves than the reliability between researchers and teachers. Although there was not a substantial difference between the two groups, it is worthwhile to examine the implementation of screening tool scoring systems in the field to ensure proper identification of and intervention for students who may be at risk for learning difficulties. Implications for researchers and teachers are discussed.

Contextual success and pitfalls of mHealth service for maternal and child health in Africa: An Intervention, Context, Actors, Mechanism, and Outcome (ICAMO) framework guided systematic review of qualitative evidence

IntroductionMobile health (mHealth) interventions have shown potential to improve maternal and child health outcomes in Africa, but their effectiveness depends on specific interventions, context, and implementation quality. Challenges such as limited infrastructure, low digital literacy, and sustainability need to be addressed. Further evaluation studies are essential to summarize the impact of mHealth interventions. Thus, this synthesis focuses on qualitative evidence of the impact of mHealth on maternal and child health in Africa to summarize such evidence to help policy decisions.MethodsA qualitative systematic review guided by the concepts of Intervention, Context, Mechanism, and Outcome (ICAMO) was employed in this study. The GRADE CERQual assessment and methodological constraints tools were utilized in the review to ascertain the level of confidence in the evidence and to examine the methodological limitations. The JBI checklist for qualitative research appraisal was also consulted during the review.ResultsThe current review contains 32 eligible studies from databases such as CINAHL, EMBASE, MEDLINE, Scopus, Web of Science, HINARI, and Cochrane Library. The review demonstrated substantial improvements in the HCP-woman relationship, communication system, maternal and child healthcare uptake, health-seeking behavior, and HCP skills. Economic capacities, maternal education, and the low quality of existing services challenged participants.ConclusionmHealth significantly improves maternal and child health outcomes in Africa. This review showed it can improve healthcare access, empower women, and contribute to the region's goal of universal health coverage. However, the challenges such as low partner support, high costs for services, and poor quality of current care as narrated by women need commitment from health authorities in the continent. The evidence from this review suggests that mHealth can be implemented to improve maternal and child health in Africa.Trial registrationPROSPERO: CRD42023461425.

An Evidence-Based Nurse-Led Intervention to Reduce Diabetes Distress Among Adults With Type 1 Diabetes and Diabetes Distress (REDUCE): Development of a Complex Intervention Using Qualitative Methods Informed by the Medical Research Council Framework.

Diabetes distress refers to the negative emotional reaction to living with the demands of diabetes; it occurs in >40% of adults with type 1 diabetes (T1D). However, no interventions to reduce diabetes distress are specifically designed to be an integral part of diabetes care. This study aims to modify and adapt existing evidence-based methods into a nurse-led group intervention to reduce diabetes distress among adults with T1D and moderate to severe diabetes distress. The overall framework of this study was informed by the initial phase of the Medical Research Council's complex intervention framework that focused on undertaking intervention identification and development to guide the adaptation of the intervention. This study took place at 2 specialized diabetes centers in Denmark from November 2019 to June 2021. A total of 36 adults with T1D participated in 10 parallel workshops. A total of 12 diabetes-specialized nurses were interviewed and participated in 1 cocreation workshop; 12 multidisciplinary specialists, including psychologists, educational specialists, and researchers, participated in 4 cocreation workshops and 14 feedback meetings. Data were analyzed by applying a deductive analytic approach. The intervention included 5 biweekly 2.5-hour small group sessions involving adults with T1D and diabetes distress. Guided by a detailed step-by-step manual, the intervention was delivered by 2 trained diabetes specialist nurses. The intervention material included visual conversation tools covering seven diabetes-specific sources derived from the 28-item Type 1 Diabetes Distress Scale for measuring diabetes distress: (1) powerlessness, (2) self-management, (3) fear of hypoglycemia, (4) food and eating, (5) friends and family, (6) negative social perception, and (7) physician distress. The tools are designed to kick-start awareness and sharing of diabetes-specific challenges and strengths, individual reflections, as well as plenary and peer-to-peer discussions about strategies to manage diabetes distress, providing new perspectives on diabetes worries and strategies to overcome negative emotions. Diabetes specialist nurses expressed a need for a manual with descriptions of methods and detailed guidelines for using the tools. To deliver the intervention, nurses need increased knowledge about diabetes distress, how to support diabetes distress reduction, and training and supervision to improve skills. This co-design study describes the adaptation of a complex intervention with a strong evidence base, including detailed reporting of the theoretical underpinnings and core mechanisms.

The Mellow Babies parenting programme: role of group processes and interpersonal change mechanisms

IntroductionGroup-based parenting programmes have specific mechanisms of change compared to individual delivery. The Mechanisms of Action in Group-based Interventions framework (MAGI); distinguishes between interpersonal and intrapersonal mechanisms of change. This paper articulates a theory of change for Mellow Babies, a 14-week attachment-based group parenting programme for mothers of infants aged under 18 months, identifying the inter and intrapersonal change processes.MethodsThirty-two semi-structured interviews were conducted with mothers and practitioners who participated in Mellow Babies, including twenty post-group interviews and nine telephone fidelity checks. Data were analysed using Deductive Qualitative Analysis based on the components identified within the MAGI framework.ResultsKey interpersonal change mechanisms included: 1. Normalisation through social comparisons; 2. Validation and cognitive reframing through group feedback; 3. Peer support, offering accountability for the implementation of new habits, and providing opportunities to give and receive advice; and 4. Social and experiential learning, including internalisation of group responses leading to increased self-compassion. Intrapersonal change mechanisms were: 1. Developing new self-insight, including parenting self-awareness; 2. Increasing parenting knowledge and understanding of infant development; 3. Having time and space for self; 4. Motivation to implement new habits. Interpersonal change mechanisms had a moderating role on intrapersonal change mechanisms and subsequent programme outcomes.DiscussionThe contribution of group processes and interpersonal mechanisms of change are often overlooked within programme evaluations. Findings from this study implicate their mediating role on intrapersonal change mechanisms and subsequent programme outcomes. It is important for programme deliverers and evaluators to understand the interrelationships between group processes, change mechanisms and programme outcomes to optimise efficacy and ensure cross-contextual replicability.

Adolescents’ health literacy is directly associated with their physical activity but indirectly with their body composition and cardiorespiratory fitness: mediation analysis of the Slovak HBSC study data

BackgroundHealth literacy is a core public health issue in relation to children and adolescents associated with multiple health behaviours and health outcomes. The aim of the study is to test the direct associations between health literacy, physical activity behaviour, health outcomes of body composition and cardiorespiratory fitness among Slovak adolescents and possible indirect effect of health literacy on health outcomes of body composition and cardiorespiratory fitness mediated by adolescents’ physical activity behaviour.MethodsData from the Slovak Health Behaviour in School-aged Children (HBSC) study conducted in 2022 were used. For the purposes of this study, a subsample of the adolescents (n = 508; mean age = 14.50; SD = 0.82; 54.3% boys) which provided HBSC questionnaire data on health literacy, moderate-to-vigorous physical activity and vigorous physical activity and participated in body composition (InBody 230) and cardiorespiratory fitness (20-m shuttle run test) measurements. Data were analysed using linear regression analysis.ResultsThe findings showed that higher health literacy of the adolescents was directly associated with higher frequency of physical activity represented by moderate-to-vigorous physical activity and vigorous physical activity and only with the visceral fat area in the crude model. Furthermore, there was an indirect effect of health literacy on cardiorespiratory fitness and most of the body composition variables (except the Body Mass Index) which was mediated by physical activity of the respondents.ConclusionsHealth literacy is indirectly associated to body composition and cardiorespiratory fitness through higher frequency of physical activity. It seems that health literacy as cognitive and social competencies need behavioural components to be involved in the proposed causal pathway between health literacy and health outcomes. Our findings may contribute to the process of creating a framework for future health literacy interventions in adolescents.

Effects of pulsed electromagnetic fields on bone fractures: a systematic review update.

Fractures are common bone injuries, which have a great burden on global health. Fracture healing is a long-term process that may be influenced by a number of factors. The 10-15% of all bone fractures may be complicated by an impaired healing (i.e. delayed union or non-union). The application of weak electromagnetic fields has been proposed to have different effects on bones such as enhancing proliferation - orientation - migration of osteoblast-like cells and supporting osteogenic differentiation in bone marrow-derived mesenchymal stem cells. Despite the amount of evidence on cellular and histological effects, to date the application of pulsed electromagnetic fields has not achieved univocal consensus in daily practice. The purpose of this systematic review update is to research, select, analyze and summarize the most recent scientific evidence regarding the effects of pulsed electromagnetic fields in the treatment of acute bone fractures. A systematic review using the following MeSH terms (Magnetic Field Therapy; Electromagnetic Fields; Bone and Bones; Fractures, Bone; Fractures Healing) and strings {("Magnetic Field Therapy [mh]" OR "Electromagnetic Fields [mh]) OR "magnetotherapy" OR "pulsed electromagnetic field") and ("Fractures, bone [mh]" OR "Bone and Bones [mh]") and ("Fractures Healing [mh]")} was conducted on PubMed, Cochrane Library, Epistemonikos and Scopus electronic databases. Only full articles published in English between January 2014 and December 2022 were considered. Eligibility criteria were defined according to the Population, Intervention, Comparison, Outcomes, and Study (PICOS) design framework. Case reports, case series, uncontrolled studies and expert opinions were excluded. All articles were checked for quality and risk of bias. Three randomized controlled trials were included (197 patients in total). None of the studies found significant effects of pulsed electromagnetic fields on the acute bone healing process. Contradictory results about pain relief emerged. Only one study showed a transitory positive effect of pulsed electromagnetic fields on strength and range of motion recovery in patients with acute bone fracture. This systematic review update does not support the use of pulsed electromagnetic fields for improving the bone healing process in patients with acute fractures. Controversial evidence was found about the effects of pulsed electromagnetic fields on pain and functional recovery. Considering the scant and heterogenous literature published to date, which represents a limit for our conclusion, further studies with rigorous and high-quality methodology are needed.

The ABCs of mental health at the university: a multi-level intervention design for promoting mental well-being.

There is an escalating concern for the mental health of university students being recognized as a high-risk group for psychological distress. Despite research emphasizing the need to integrate mental well-being into higher education, existing interventions primarily focus on challenges and support services, leaving a gap in practical insights for promoting mental well-being at the university as a whole. This paper aims to cover the theoretical and methodological foundations for the design and development of a complex multi-level intervention called the ABCs of mental health at the university (ABC-uni). Following the MRC framework for complex interventions, the design and development of a novel complex intervention is described (Phase I). Using the socio-ecological model and incorporating principles from health promotion charters, capacity building, organizational change models, and the principles of the ABCs of mental health a program theory for mental health promotion at the university is proposed. Following this theoretical foundation a logic model outlines the ABC-uni intervention components at structural, community, and individual levels. The components include staff training, campaign materials, a photovoice project, integration of mental well-being literacy into introductory programs, a credit-bearing course, and an online module. Preferably, most of these components are developed and carried out collaboratively with students at the university. As proposed in the logic model expected outcomes encompass heightened awareness, supportive environments, commitment, and accountability, aiming to enhance mental well-being across the entire university. The design and development of the intervention components occur at a Danish public university. This section addresses the strengths and limitations of the design of the ABC-uni intervention. Future research will cover the feasibility phase of each components of the ABC-uni intervention (phase II). The conceptual framework and program theory outlining mental health promotion at the university, along with the detailed description of the intervention components, provides valuable insights for fostering mental well-being in the university community.

Proof of concept, feasibility, and acceptability of spiritual care assessment and intervention-pediatric with caregivers of children receiving home mechanical ventilation

Caregivers of children with medical complexity face daily tasks comparable to pediatric critical care nursing with multiple stressors. This may result in emotional and spiritual distress. Caregivers may also rely on their religion and spirituality to cope. Chaplains have the potential to support caregivers in this setting, beginning with spiritual assessment. This study’s purpose was to verify the feasibility and acceptability of the Spiritual Care Assessment and Intervention framework adapted for home-based chaplaincy with caregivers of children receiving home mechanical ventilation (SCAI-Peds). A quasi-experimental, proof-of-concept trial with N = 6 caregivers and two board certified chaplains was carried out. SCAI-Peds was acceptable and feasible to caregivers, delivered with high fidelity, and was also acceptable to the chaplains. Home-based intervention delivery may provide more room for reflection and reframing than acute care settings. The results warrant advancing SCAI-Peds beyond the pilot stage.

Integrating deep phenotyping with genetic analysis: a comprehensive workflow for diagnosis and management of rare bone diseases.

Phenotypes play a fundamental role in medical genetics, serving as external manifestations of underlying genotypes. Deep phenotyping, a cornerstone of precision medicine, involves precise multi-system phenotype assessments, facilitating disease subtyping and genetic understanding. Despite their significance, the field lacks standardized protocols for accurate phenotype evaluation, hindering clinical comprehension and research comparability. We present a comprehensive workflow of deep phenotyping for rare bone diseases from the Genetics Clinic of Skeletal Deformity at Peking Union Medical College Hospital. Our workflow integrates referral, informed consent, and detailed phenotype evaluation through HPO standards, capturing nuanced phenotypic characteristics using clinical examinations, questionnaires, and multimedia documentation. Genetic testing and counseling follow, based on deep phenotyping results, ensuring personalized interventions. Multidisciplinary team consultations facilitate comprehensive patient care and clinical guideline development. Regular follow-up visits emphasize dynamic phenotype reassessment, ensuring treatment strategies remain responsive to evolving patient needs. In conclusion, this study highlights the importance of deep phenotyping in rare bone diseases, offering a standardized framework for phenotype evaluation, genetic analysis, and multidisciplinary intervention. By enhancing clinical care and research outcomes, this approach contributes to the advancement of precision medicine in the field of medical genetics.