Mandated Changes Research Articles

Pilot implementation study of a web-based men’s health screening app in primary care during COVID-19: a mixed-methods approach

BackgroundThe traditional delivery of healthcare services, including crucial preventive measures such as health screenings, faced significant disruption due to the COVID-19 pandemic. In response, eHealth technology emerged as a practical alternative for conducting screening services. This pilot study introduces ScreenMen, a web-based app for men’s health screening, implemented in a primary care setting. The study aims to assess patient uptake and healthcare provider’s acceptability and feasibility of implementing ScreenMen, emphasizing the importance of implementation science research in healthcare innovation.MethodsThis study employed a mixed-method explanatory sequential design, using a tailored implementation intervention to implement ScreenMen in an urban health clinic. Quantitative phase focused on patient uptake of ScreenMen and healthcare provider involvement, utilizing Google Analytics and provider questionnaires. Qualitative phase, using in-depth interviews with providers, explored factors influencing uptake and implementation. Data analysis employed means and percentages for quantitative data and framework analysis for qualitative data.ResultsWe invited 47 healthcare providers to attend the ScreenMen implementation workshop, with 26 participating, resulting in a 55.3% participation rate. Throughout the five-month study, there were 75 recorded accesses, with a completion rate of 20%. The primary way users accessed the app was through QR codes on buntings (38.7%), followed by postcards (12%). In qualitative interviews with three healthcare providers, it was found that the Identify and prepare champions strategy was helpful, as these champions led the implementation and encouraged other providers to promote ScreenMen. The use of QR codes on buntings, part of the Provide education and training strategy, was effective due to their visibility in patient waiting areas. However, the Mandate change strategy was considered ineffective, as providers felt obligated rather than motivated to implement ScreenMen.ConclusionThis study highlighted the uptake of ScreenMen and found barriers and facilitators during the pilot implementation. Two useful strategies were Identify and prepare champions and QR codes while Mandate change was not helpful. Further studies are needed to study the effectiveness of these implementation strategies to implement web-based apps.Trial registrationClinical Trial Number: NCT06388473 (Retrospectively registered 05/04/2024).

Resisting by not resisting: Constructing inconsistencies to resist dual mandated changes

This article explains how employees construct inconsistencies between two separate mandated changes and use these inconsistencies to progressively resist the realization of both changes. Specifically, they use three practices – (1) demonstrating interdependencies between change elements, (2) framing these change elements as inconsistent and (3) establishing the consequentiality of specific change elements by constructing poor outcomes for these – to build capacity to critique, revise and eventually reject elements of both changes. As a result of this resistance, neither mandated change is fully realized. Our findings contribute to the literature on strategic change by illuminating the specific processual dynamics through which actors construct and manipulate the relationship between changes. This also allows us to contribute to the literature on resistance to change by illuminating the dynamics that over time enable actors to resist even mandated – that is, externally imposed – changes, by camouflaging resistance as non-resistance.

More than a mask: Possible relationships between lifting of COVID-19 mask requirements and depression symptoms experienced by US adults with disabilities

BackgroundLifting of masking restrictions at key periods during the COVID-19 pandemic may have disproportionately negatively impacted the mental health of individuals with disabilities. ObjectiveThis study examines the prevalence of depression-related symptoms in individuals with and without disabilities preceding and following the US rollback of COVID-19 masking mandates. MethodsPandemic-era data on reported symptoms of depression from the federal Household Pulse Survey from dates surrounding two major announcements on masking relaxations were analyzed. Possible interactions between disability status and type, age grouping, educational attainment, race/Hispanic ethnicity, and sex variables were considered. ResultsFollowing relaxation of major masking restrictions, people with disabilities experienced elevation in depression symptom presence while people without disabilities experienced lessening in these symptoms. Differences between people with and without disabilities were significant. ConclusionsDirect causation between masking mandate relaxations and changes in symptoms of depression cannot be drawn from the available data. However, when considered with greater vulnerabilities to COVID-19 experienced by many individuals with disabilities and dismissive rhetoric surrounding masking decisions, negative feelings arising from mandate changes may have led to elevations in symptoms of depression in people with disabilities in sharp contrast to people without disabilities who may have felt relief. Findings indicate future public health decision making, even in times of crisis, should be undertaken with as much caution as possible regarding and in partnership with populations already at risk.

Safewards in acute medical/surgical care wards: Capability, Opportunity, Motivation and Behaviour model and Theoretical Domains Framework analysis

BackgroundSafewards is an evidence-based practice improvement model to minimise conflict in inpatient mental health units. There is limited published research on implementing Safewards in acute medical/surgical care wards. ObjectiveTo identify, from nurses' perspectives, barriers, and facilitators to implement four Safewards interventions in acute medical/surgical care wards. MethodsThis article reports qualitative findings from a funded mixed-method evaluation of the Safewards Acute Care Pilot Project. Six focus group interviews comprising 35 nursing staff from four hospitals in Victoria, Australia were completed between April and October 2022. The semi-structured interview guide included questions developed using the Capability, Opportunity, Motivation and Behaviour model. Data was thematically analysed and mapped to a matrix combining Capability, Opportunity, Motivation and Behaviour model and the Theoretical Domains Framework to elucidate barriers and facilitators to implementing four Safewards interventions in acute medical/surgical care wards. ResultsThree components in the Capability, Opportunity, Motivation and Behaviour model and three Theoretical Domains Framework domains were identified as barriers to the adoption of Safewards in acute medical/surgical care wards. Specific barriers included physical opportunity challenges related to the environmental context and resources domains. The key themes included time constraints and competing priorities; lack of physical space and infrastructure; and poor patient uptake due to lack of understanding. Gaps emerged as a psychological capability barrier within the Theoretical Domains Framework knowledge domain. Additionally, resistance to practice changes was associated with the motivation component of the Capability, Opportunity, Motivation and Behaviour model. Conversely, six TDF domains were relevant to facilitating the implementation of the Safewards interventions: memory, attention, and decision processes; physical skills; social influences; social/professional role and identity; goals; and beliefs about consequences. Key facilitators included the Safewards interventions serving as reminders to focus on compassionate nursing care; nursing staff possessing the skillset for interventions; peer pressure and mandated change; supportive and passionate leadership; presence of champions to drive momentum; belief in nursing staff ownership and expertise for leading implementation; personal commitment to improve work environments and care quality; and the belief that Safewards would improve ward culture. ConclusionsAddressing barriers and leveraging facilitators can inform strategies for enhancing staff capability to implement Safewards in acute care wards. Specifically, a tailored, multilayered approach focusing on leadership support, training, resources, patient input, and feedback can promote effective adoption of the Safewards model and adaptation of discrete interventions. Tweetable abstractSafewards adaptation: Addressing barriers like resources, space, and patient awareness; leveraging peer modelling and leadership strategies for success.

Predictors of change outcomes in mandated change: unpacking the outcome triangle

ABSTRACT This study utilizes the unique opportunity provided by a mandated change from cash-based to accrual-based reporting in local governments to explore the role of contextual, organizational and individual change-process-related factors in predicting different change outcomes. Based on two surveys conducted in 2019 and 2021, it investigates how information quality, interactional justice, organizational change readiness resources, and change-related perceived behavioural control affect three different change outcomes: implementation performance, enhanced reporting quality, and improved decision making. By offering a nuanced understanding of the mechanisms driving mandated change outcomes, the study provides key insights for policymakers and practitioners initiating or embarking on mandatory reforms.

Using implementation science to promote the use of the fascia iliaca blocks in hip fracture care.

There is variable and suboptimal use of fascia iliaca compartment nerve blocks (FICBs) in hip fracture care. Our objective was to use an evidence-based and theory-informed implementation science approach to analyze barriers and facilitators to timely administration of FICB and select evidence-based interventions to enhance uptake. We conducted a qualitative study at a single centre using semistructured interviews and site observations. We interviewed 35 stakeholders including health care providers, managers, patients, and caregivers. We mapped barriers and facilitators to the Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR). We compared the rate and timeliness of FICB administration before and after evidence-based implementation strategies were applied. The study identified 18 barriers and 11 facilitators within seven themes of influences of FICB use: interpersonal relationships between health care professionals; clinician knowledge and skills related to FICB; roles, responsibilities, and processes for delivering FICB; perceptions on using FICB for pain; patient and caregiver perceptions on using FICB for pain; communication of hip fracture care between departments; and resources for delivering FICBs. We mapped the behaviour change domains to eight implementation strategies: restructure the environment, create and distribute educational materials, prepare patients to be active participants, perform audits and give feedback, use local opinion leaders, use champions, train staff on FICB procedures, and mandate change. We observed an increase in the rates of FICBs administered (48% vs 65%) and a decrease in the median time to administration (1.63 vs 0.81days). Our study explains why FICBs are underused and shows that the TDF and CFIR provide a framework to identify barriers and facilitators to FICB implementation. The mapped implementation strategies can guide institutions to improve use of FICB in hip fracture care.

Challenges and contexts in mandated organizational change: Consolidation in Alberta's health care system

AbstractThe research reported here is a case study of mandated consolidation in the organization of Alberta's health care system. Informed by the concept of organizational context, this study illustrates the complexity of factors affecting outcomes of mandated change and draws implications for theory and practice. Consolidation of separate agencies was initiated in 2008. Data were obtained through 2020 via interviews of key informants, reviews of official documents, and searches of news media. Ultimately, the mandate appears to have succeeded, but at substantial and potentially avoidable cost. An understanding of multiple dimensions of context can contribute to successful strategies for change.

A cluster randomised controlled trial to assess the effectiveness of a multi-strategy sustainability intervention on teachers’ sustained implementation of classroom physical activity breaks (energisers): study protocol

BackgroundGovernments internationally have invested hugely in the implementation and scale-up of school-based physical activity interventions, but have little evidence of how to best sustain these interventions once active implementation support ceases. This study will assess the effectiveness of a multi-strategy sustainability intervention on classroom teachers’ sustainment of energisers (short 3–5 min physical activity breaks during class-time) scheduled across the school day from baseline to 12 and 24-month follow-up.MethodsA cluster randomised controlled trial will be conducted in 50 primary schools within the Hunter New England, Illawarra Shoalhaven, Murrumbidgee and Northern New South Wales (NSW) Local Health Districts of NSW Australia. Schools will be randomly allocated to receive either usual support or the multi-strategy sustainability intervention that includes: centralised technical assistance from a trained project officer; formal commitment and mandated change obtained from school principals; training in-school champions; reminders for teachers; educational materials provided to teachers; capturing and sharing local knowledge; and engagement of parents, carers and the wider school community. The primary trial outcome will be measured via a teacher logbook to determine the between-group difference in the change in mean minutes of energisers scheduled across the school day at 12 and 24-month follow-up compared to baseline. Analyses will be performed using an intention to treat framework. Linear mixed models will be used to assess intervention effects on the primary outcome at both follow-up periods.DiscussionThis study will be one of the first randomised controlled trials to examine the impact of a multi-strategy sustainability intervention to support schools’ sustainment of a physical activity intervention. The proposed research will generate new evidence needed for the partnering organisations to protect their considerable investments to date in physical activity promotion in this setting and will provide seminal evidence for the field globally.Trial registrationACTRN12620000372987 version 1 registered 17th March 2020. Version 3 (current version) updated 4th August 2023.

The evolution of mandatory continuing professional development (CPD) for diagnostic radiographers in Ireland - A longitudinal study

IntroductionThis longitudinal research study reports on aspects of CPD immediately before and in the years following the simultaneous introduction of state registration and mandatory CPD for diagnostic radiographers in Ireland. MethodsSurveys captured information through closed and open questions distributed nationally across various hospital types in hard copy and online formats. Opinion was gathered over 8-years at three time points, prior to the introduction of mandated changes, post-introduction at the end of the first audit cycle, and as society was emerging from a period of pandemic. ResultsResponses were received across age and grade ranges with response rates in keeping with previous surveys. The overall importance with which radiographers held CPD decreased over time, and while small changes were seen, the narrow focus of what radiographers considered CPD had stayed the same, with attendance-based activities remaining the most popular. Respondents indicated that their enthusiasm for undertaking CPD and willingness to undertake CPD outside of working hours had also decreased, with the perceived primary barrier to CPD shifting from funding to time. ConclusionsAn appetite to undertake CPD amongst the majority is evident; however, addressing issues such as decreasing importance levels and willingness to use personal time for CPD is crucial. While the perceived cost of CPD has lessened as a barrier, lack of time for CPD is now a principal concern. Further research is recommended to explore the broader impacts of time pressures and optimises CPD for radiographers. Implications for practiceFindings highlight the need for collaborative engagement and support to optimise CPD opportunities for all radiographers in the future.

Management factors affecting gestating sows' welfare in group housing systems - A review.

Public concern on the methods of raising food-producing animals has increased, especially in the last two decades, leading to voluntary and mandated changes in the animal production methods. The primary objective of these changes is to improve the welfare of farm animals. The use of gestational stalls is currently a major welfare issue in swine production. Several studies assessed the welfare of alternative housing systems for gestating sows. A comparative study was performed with gestating sows housed in either individual stalls or in groups in a pen with an electronic sow feeder. This review assessed the welfare of each housing system using physiological, behavioral, and reproductive performance criteria. The current review identified clear advantages and disadvantages of each housing system. Individual stall housing allowed each sow to be given an individually tailored diet without competition, but the sows had behavioral restrictions and showed stereotypical behaviors (e.g., bar biting, nosing, palate grinding, etc.). Group-housed sows had increased opportunities to display such behavior (e.g., ability to move around and social interactions); however, a higher prevalence of aggressive behavior, especially first mixing in static group type, caused a negative impact on longevity (more body lesions, scratch and bite injuries, and lameness, especially in subordinate sows). Conclusively, a more segmented and diversified welfare assessment could be beneficial for a precise evaluation of each housing system for sows. Further efforts should be made to reduce aggression-driven injuries and design housing systems (feeding regimen, floor, bedding, etc.) to improve the welfare of group-housed sows.

Embracing uncertainty: medical student perceptions of a pediatric bootcamp developed in response to mandated changes during the pandemic

BackgroundThe start of the COVID-19 pandemic led to both shortened clinical rotations and consequent loss of embedded formal teaching time. In response to these learning gaps, a novel, virtual pediatric bootcamp was developed to provide a consolidated 3-week learning opportunity for clinical medical students. Pre-clinical students were encouraged but not required to participate, given the suspension of clinical patient experiences for all undergraduate medical learners and the uncertainty of when clinical rotations would resume. This group of students were particularly challenged with adapting their learning in response to the pandemic while also preparing to apply their pre-clinical knowledge to solve clinical problems.MethodsA qualitative thematic analysis was used for this study. Ten semi-structured phone interviews were conducted with second-year medical students to explore their experiences and perceptions of the pediatric bootcamp. The six phases of thematic analysis proposed by Braun and Clark guided data analysis. To ensure rigour, the three aspects of rigour—credibility, transferability and confirmability were utilized throughout the project.ResultsQualitative exploration from semi-structured phone interviews of second-year medical students’ perceptions and experiences of this new and unanticipated learning experience revealed four main themes: (a) clinical relevance, describing how students were pushed to think about clinical problems in a new way; (b) timing, which explored conflicts related to competing interests, mental preparedness, and the interval between learning and application; (c) teaching strategies, describing how active learning and interaction were facilitated and challenges that arose; and (d) learning resources, highlighting the curated and accessible resources made available to the students, as well as those resources that learners develop for themselves.ConclusionsA novel three-week online case-based pediatric bootcamp fostered application of knowledge for clinical reasoning at a time when students were transitioning from preclinical to clinical learning. Students were stretched to balance competing priorities, and the bootcamp curated synchronous and asynchronous learner opportunities while allowing them to reflect on their own learning styles and effective virtual learning strategies. While bootcamps are often used to prepare learners for transitions between clinical stages, our findings suggest the bootcamp format can also facilitate transition from preclinical to clinical roles.

Patients’ Experience of the Newly Implemented Virtual Clinic during the COVID-19 Pandemic in PHCs, Riyadh, Saudi Arabia

The COVID-19 pandemic mandated changes in the healthcare system to ensure uninterrupted patients care. We aimed to evaluate patients’ satisfaction with the virtual clinic service during the COVID-19 pandemic.

Exploring the Potential Impact of a Virtual Body Scan Meditation Exercise Conducted With Pet Dogs on Recipients and Facilitators.

Numerous recent studies have shown that COVID-19 and the accompanying mandated lifestyle changes have resulted in significant negative effects on people’s mental health. To meet the increased need for mental health support, while also maintaining physical safety, a variety of telehealth services have been created or expanded. A body scan mindfulness program is an intervention that can easily be modified to be offered virtually. This study was designed to determine if a virtual body scan mindfulness exercise, with participants’ holding their dog or a pillow/blanket, could reduce their stress and anxiety as well as that of the facilitators. Significant differences in pre/post-State Anxiety Assessment scores for participants and facilitators were found. These results are discussed within the framework of the human animal bond and the potential of this form of intervention as a useful virtual tool for participants and facilitators alike.

Policy integration as a means to address policy fragmentation: Assessing the role of Vietnam’s national REDD+ action plan in the central highlands

The Vietnamese National REDD + Action Plan (NRAP) seeks to reduce emissions from forest clearing and land use, especially from the main drivers of coffee and rubber commodity expansion. Achieving the NRAP goals, however, means negotiating a complex and fragmented forest policy arena, with conflicting sector goals, disconnects between global and local ambition and action, and imbalanced power dynamics between actors. We map the fragmentation of this policy arena and explore the extent to which the NRAP is able to integrate policy responses to drivers to achieve emissions reductions. We examine what the NRAP sought to integrate, what was not taken into account, what is integrated at which scale, and which actors are part of integration (or not) across the policy process components. We conclude that if policy integration does not affect a ‘whole of government’ shift in priorities or change in mandate among driver sectors, fragmented policy arenas will persist and forest-based climate mitigation objectives will not be achieved.

Achieving Goals While Making an Impact: Balancing Financial Goals with Impact Investing

For investors who wish to engage in impact investing and who have specific goals to achieve, there exists the potential for a trade-off. When impact investments yield lower returns than nonimpact portfolios, how much return should an investor be willing to give up to incorporate it? Using recent advances in goals-based utility theory, this article explores an answer to that question and offers practical and concrete advice for advisors to individual investors and fiduciaries of trusts. Using the goals-based framework, the author shows how an investor’s willingness to sacrifice return for an impact investing mandate changes in response to market and portfolio conditions. <b>TOPICS:</b>ESG investing, portfolio theory, performance measurement <b>Key Findings</b> ▪ For investors who wish to incorporate an impact mandate in goals-based portfolios, a trade-off may exist between the two. Using advances in goals-based utility, this discussion provides a framework for evaluating that trade-off. ▪ The author finds that investor willingness to sacrifice return is not constant through time, but subject to various market and personal conditions. Expected volatility, return, and risk tolerance requirements all affect how willing an investor is to sacrifice return for an impact mandate. This has direct bearing on not just individual investors but also on portfolio managers of private trusts whose legal ability to pursue impact strategies is highly constrained. ▪ This analysis also reveals a philanthropy limit—the point at which someone ceases to become an investor and is instead a philanthropist. Advisors and individuals would do well to be cognizant of that limit and structure impact portfolios accordingly.

Regional variation in the impacts of the COVID-19 pandemic on the quantity and quality of data collected by the project eBird

The COVID-19 pandemic has likely affected natural systems around the world; the curtailment of human activity has also affected the collection of data needed to identify the indirect effects of this pandemic on natural systems. We describe how the outbreak of COVID-19 disease, and associated stay-at-home orders in four political regions, have affected the quantity and quality of data collected by participants in one volunteer-based bird monitoring project, eBird. The four regions were selected both for their early and prolonged periods of mandated changes to human activity, and because of the high densities of observations collected. We compared the months of April 2020 with April in previous years. The most notable change was in the landscapes in which observations were made: in all but one region human-dominated landscapes were proportionally more common in the data in April 2020, and observations made near the rarer wetland habitat were less prevalent. We also found subtler changes in quantity of data collected, as well as in observer effort within observation periods. Finally, we found that these effects of COVID-19 disease varied across the political units, and thus we conclude that any analyses of eBird data will require region-specific examination of whether there have been any changes to the data collection process during the COVID-19 pandemic that would need to be taken into account.

The Concurrent Effects of IFRS Mandate and Formal Institutional Quality on the Aftermarket Performance of IPO Firms in Emerging Countries

This paper provides the first empirical investigation seeking to find whether International Financial Reporting Standards (IFRS) mandate, changes in the quality of formal institutions, or, the concurrent effect of these two elements can explain the ongoing phenomenon of the aftermarket performance difference of Initial Public Offerings (IPO) firms. We perceive little awareness of the concurrent effect of IFRS mandate and the quality of formal institutions in emerging countries, although these nations account for more than half of the IFRS mandating countries. We employ numerous Difference-in-Differences (DiD) models utilizing reliable IPO and formal institutional data for Saudi Arabia from 2005 to 2017. Our empirical results show that the absence of IFRS influence in the aftermarket performance of IPO firms led us to posit that the quality of formal institutions is the key player in influencing long-term performance of IPO firms in Saudi Arabia. We uncover evidence showing that an improvement in formal institutional quality increases the long-term performance of IPO firms. We find no evidence of a concurrent effect of changes in formal institutional quality and IFRS mandate on the aftermarket performance of IPO firms. Our results show that what does really matter in relation to the aftermarket performance of IPO firms in Saudi Arabia, are the enhancements in the level of formal institutional quality. Our results provide some important implications for IFRS-IPO research.

YOU DON’T KNOW WHAT YOU DON’T KNOW: IMPROVEMENTS IN INVESTMENT EFFICIENCY PRIOR TO A MANDATED ACCOUNTING CHANGE

Theory suggests mandated changes in accounting standards can lead to increases in investment efficiency through two mechanisms: (1) increases in internal information quality (IIQ), or (2) reductions in information asymmetry with external parties. We use the long transition period of the new lease accounting standard to isolate the effects of increases in IIQ on investment efficiency. Using a difference-in-differences design we find that firms affected by the new lease standard experience significant increases in investment efficiency in the year immediately preceding the standards implementation. The improvements in investment efficiency are largest for firms with high lease intensity and multiple operating segments. The increases in investment efficiency are driven by over-investing firms that reduce their capital expenditures and net acquisitions. We contribute to the investment efficiency literature by identifying the effect of IIQ on investment behavior. Further, we document that internal information gathering in anticipation of a new accounting standard can improve managerial decision-making, an explicit goal of the FASB’s post-implementation review of the lease standard.

Pandemic mandated changes to dental candidate interviews at UTHSC College of Dentistry.

Pandemic mandated changes to dental candidate interviews at UTHSC College of Dentistry.

Bourdieu and position‐making in a changing field: Enactment of the national curriculum in Australia

AbstractThis paper draws on Bourdieu's theorising (particularly habitus and field) to think about position‐making of teachers in respect of the early enactment of the Australian Curriculum. Position‐making, a concept developed from the analysis proffered, can be contrasted with the more common practice of position‐taking endemic in a relatively stable field. Position‐making is an ongoing phenomenon in a changing field when the habitus is out of place, here the field of the new Australian Curriculum, creating the effect of what Bourdieu sees as hysteresis. This paper explores the positioning and re‐positioning of agents (teachers and school leaders) due to an external change (the Australian curriculum) in the schooling field. Data for this study were collected from a middle‐class state high school in Brisbane Australia, which was an early adopter of the new Australian Curriculum. The initial enactment phase of curriculum change was an unsettling one that (re)positioned agents—hence, the concept of position‐making, which is a contribution to Bourdieu's theoretical resources and which complements the idea of policy enactment as opposed to policy implementation. Both allow some agency in mediation of mandated changes in the specific contexts of schools and teacher/leader habitus.