Mixed-methods Evaluation Research Articles

Delivering Education Through a Podcast to Change Provider Practice: A Mixed Methods Evaluation of a Fetal Alcohol Spectrum Disorders Podcast

Education delivery through multi-media such as podcasts has become more common yet impacts on behavior change are understudied. To address this, we evaluated an educational podcast available for continuing education (CE) credit to all providers but specifically tailored for children and/or women-focused specialties (i.e., family medicine, OBGYN, pediatric, prenatal, primary care). The podcast consisted of three 20-minute episodes focused on: (1) prevalence of Fetal Alcohol Spectrum Disorders (FASDs); (2) perspectives from those with lived experience; and (3) treatment and prevention of FASDs at the provider level. Podcast effectiveness to educate providers was assessed using a mixed-methods evaluation. Participants completed registration information and an immediate post-test, which examined provider knowledge, self-efficacy, and practice behaviors related to FASD prevention. Qualitative data was collected from a sample of those who completed the post-test via focus groups conducted 6 months later. From March 2021 to March 2022 there were 579 listeners with 103 claiming CE credit (the evaluation sample) who participated in the evaluation. Participants reported high FASD-related knowledge; more than 85% were better able to educate patients about prenatal alcohol use risk and FASDs post-podcast. The majority (59.3%) intended to change practice based on what they learned. Qualitative results contextualized the benefits and challenges to changing practice, including structural barriers, and suggestions for enhancing the podcast in future seasons. Education delivered through podcasts can be effective in improving provider knowledge and self-efficacy and in promoting practice change. Podcasts offer broad reach and accessibility providing an opportunity to educate on topics including FASD.

The Role of Arts in Health Program Evaluation

Arts-based interventions are gaining recognition for their potential to enhance health outcomes, reduce stigma, and improve the well-being of individuals and communities. As such programs proliferate across healthcare settings, from hospitals to senior centers, the need for rigorous evaluation frameworks becomes essential to assess their effectiveness. This paper examines the intersection of arts and health programs, examining their contribution to physical, emotional, and mental well-being. It emphasizes the importance of evaluation in validating these interventions, outlines key components of arts program evaluation, and highlights methods for assessing impact, including mixed-method approaches. The aim is to provide a comprehensive guide for evaluating arts in health programs, ensuring their sustained integration into healthcare practices. Keywords: Arts in health, Health program evaluation, Mental health, Community well-being, Mixed-methods evaluation, Arts-based interventions.

Improving screening, brief intervention and referral to treatment for unhealthy alcohol use in diverse, low-resourced primary care clinics.

Implementation of screening brief intervention and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) remains low in primary care. ANTECEDENT (Partnerships to Enhance Alcohol Screening, Treatment, and Intervention) was a practice-facilitator led implementation study to increase SBIRT and MAUD use in diverse primary care clinics. From November 2019 - April 2023, we conducted a convergent parallel mixed methods evaluation. Participants were small and medium-sized primary care clinics in the Northwestern U.S. Clinics received foundational support (i.e., baseline/exit assessment, access to SBIRT Oregon website) and the option for supplemental implementation support (e.g., practice facilitation, expert consultation) over the 15-month intervention to improve SBIRT and MAUD. Qualitative and quantitative data regarding clinic characteristics, implementation strategies, and SBIRT/MAUD outcomes were collected through practice facilitator interviews, periodic reflections and clinic contact logs, interviews, pre-post surveys, and electronic health record (EHR) queries. Quantitative analyses included descriptive statistics, logistic regression, and the Wilcoxon sign-ranked test. Qualitative analysis took an immersion crystallization approach. Data were reviewed in a matrix to evaluate intervention adoption, implementation, and effectiveness. We recruited 75 unique clinics; 66 participated and 48 (73%) completed the study. Eight participating clinics chose to receive foundational support only (12%) while 58 chose to engage in supplemental support (88%) activities. Clinics that received supplemental support and completed the intervention (n = 42) engaged in practice facilitation (Mean: 293min, range: 75-550min); data review (38%), HIT support (31%), expert consultation (19%), and peer-to-peer learning (5%). Pre- and post-intervention assessments showed significant improvement in self-reported SBIRT process outcomes. Performance data improved among the subset of completing clinics able to produce data (n = 17). Clinics described positive experiences with ANTECEDENT support and highlighted remaining barriers to SBIRT and MAUD implementation. Participating clinics engaged in a diverse range of supportive activities. A flexible approach using practice facilitation and implementation support could be helpful for low-resourced primary care clinics in improving SBIRT and MAUD for unhealthy alcohol use.

Navigating the First Years: Newly Qualified Teachers’ Experiences with Professional Learning Communities

AbstractDrawing on a mixed-methods evaluation of the New Teacher Induction Programme of the South African Department of Basic Education, this paper examines the role of Professional Learning Communities in enabling the transition of newly qualified teachers (NQTs) into their professional roles in schools. The article focuses on one of the four components of the induction programme, namely, the participation of NQTs in Professional Learning Communities (PLCs) and examines the experiences of newly qualified teachers as members of their respective professional learning communities. It begins by examining the range of typical early career challenges and, thereafter, shows how the social capital fostered through their collaboration in communities enables to overcome a range of challenges they face. As the results of the study show, PLCs provide safe spaces where new teachers experiment, share experiences and engage in collective reflection and problem-solving. The new teachers reported a range of professional and personal benefits, including their professional growth, expanded peer networks, and a stronger sense of belonging. Moreover, their responses show how their participation in PLCs contributes to developing their self- and collective efficacy, increasing their resilience, and enabling their transition into the teaching profession. As a participatory action research study, the paper shows the dual benefits of the PLCs – both in supporting the personal and professional development of novice teachers and in informing the development of broader educational policy. The results of the study led to the expansion of the New Teacher Induction Programme and the national adoption of PLCs – illustrating how teacher experiences can inform policy in bringing about meaningful change.

Group Motivational Interviewing for Adolescents at Risk of Internet Gaming Disorder: A Mixed-Methods Preliminary Evaluation

Group Motivational Interviewing for Adolescents at Risk of Internet Gaming Disorder: A Mixed-Methods Preliminary Evaluation

Mixed method evaluation of factors influencing the adoption of organic participatory guarantee system certification among Vietnamese vegetable farmers

AbstractIn markets where vegetables are commonly cultivated with heavy use of synthetic pesticides, it is particularly important for consumers to be able to identify genuine organic produce. Organic Participatory Guarantee Systems (PGS) certification offers smallholder farmers an affordable way to build trust among consumers and secure premium prices for their organic produce. In Vietnam, the demand for vegetables with no, or low, pesticide residues is growing. The attractiveness of PGS certification should increase accordingly, but the number of organic PGS certified farmers in Vietnam are stagnating or even decreasing. The aim of this study is to explain this paradox by investigating the factors that influence the adoption of organic PGS certification among Vietnamese vegetable farmers. We follow a mixed methods approach, combining a qualitative analysis of farmer interviews (n = 62) and a quantitative analysis of a farm survey data (n = 434) using a sample selection model that estimates adoption contingent on farmers’ awareness of PGS certification. Drawing on the Unified Theory of Acceptance and Use of Technology, we found that social relationships and positive attitudes towards farming and the environment drive the adoption of organic PGS. Barriers include insufficient knowledge of organic farming techniques, labour shortages, and ageing farmers. At the systemic level, support by (non-)governmental institutions facilitates adoption, but challenges such as lower yields and limited access to premium markets remain. To promote organic PGS among Vietnamese vegetable farmers, efforts should focus on disseminating organic farming techniques that boost yields, alleviate labour demands, and ensure secure markets for premium-priced organic vegetables.

Improving hospital-based opioid substitution therapy (iHOST): protocol for a mixed-methods evaluation

Background Opioid substitution therapy (also known as ‘opioid agonist therapy’ or ‘medication treatment of opioid use disorder’) is associated with improved health and social outcomes for people who use heroin and other illicit opioids. It is typically managed in the community and is not always continued when people are admitted to hospital. This causes opioid withdrawal, patient-directed discharge, and increased costs. We are establishing a project called iHOST (improving hospital opioid substitution therapy) to address these problems. This is an applied health research project in which we will develop and evaluate an intervention that aims to improve opioid substitution therapy in three acute hospitals in England. The intervention was developed in collaboration with stakeholders including people who use opioids, hospital staff, and other professionals who work with this group. It includes five components: (1) a card that patients can use to help hospital clinicians confirm their opioid substitution therapy, (2) a helpline for patients and staff, (3) an online training module for staff, (4) a clinical guideline for managing opioid withdrawal in hospital, and (5) ‘champion’ roles at each hospital. Methods We will do a mixed-methods study including a quasi-experimental quantitative study and a qualitative process evaluation. The primary outcomes for the quantitative study are patient-directed discharge and emergency readmission within 28 days. We will do a difference-in-difference analysis comparing changes in these outcomes for patients at iHOST sites with changes for patients at control hospitals. The process evaluation will use in-depth interviews, focus groups, and site observations with people who use opioids and staff. We will assess acceptability of the intervention, barriers and facilitators to implementation, and contextual factors impacting outcomes. Impact We anticipate that iHOST will improve care for hospital patients who use illicit opioids and/or are receiving community-based opioid substitution therapy. Depending on the results, we will promote the intervention at hospitals across the UK. Dissemination, including through publication, will inform hospital-based services for people who use drugs both in the UK and other countries.

Evaluation of the quality of physiotherapy service in university of Gondar comprehensive specialized hospital, northwest Ethiopia: A mixed method evaluation.

Currently, the number of people with physical disability and impairment is increasing significantly in Ethiopia, especially in the northern part. In that regard, the Ethiopian government has been providing physical rehabilitation services to recover patients. However, due to the widespread problem of healthcare service and the increase in patients seeking physiotherapy service, the quality of the service might be compromised, and the evidence is limited. Thus, this study aimed to evaluate the quality of physiotherapy services at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia. A single case study with concurrent mixed method research design was conducted from June 02- August 10, 2022. The evaluation used patient-centeredness, timeliness, compliance and availability dimensions with 27 indicators. A total of 415 systematically selected patients who came for physiotherapy service for exit interviews, 9 service providers and managers for key-informant interviews, and 8 patients for in-depth interviews participated in the study. Approximately 176 patient medical charts were reviewed, and direct observation of 14 patient-provider interactions was performed. Binary logistic regression analysis was computed to identify factors associated with patient-centeredness. In the final model, variables with a p value < 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare statistical significance. Thematic analysis for the qualitative data using OPEN CODE version 4.03 was performed. Finally, the dimensions and overall quality of physiotherapy service were judged using predetermined criteria. The overall quality of the physiotherapy service was found to be fair or intermediate (66.5%), computed from the availability of resources 63.4%, compliance of service providers 68.6%, timelines 64.2%, and patient centeredness 73.1%. Qualitative findings also revealed that insufficient staffing and heavy workload, lack of resources, inconvenient facilities, relocation of resources in the academic division of physiotherapy department, lack of training and continuous professional development opportunities, lack management attention and institutional support and nonexistence of multidisciplinary approaches leads to significant gaps in quality service delivery. Attending primary school (AOR = 3.22, 95% CI: 1.56, 6.61), secondary (AOR = 4.24, 1.91, 9.41), and higher education (AOR = 4.79, 1.94, 11.84) and being a private employee (AOR = 0.34, 95% CI: 0.16, 0.76) were significantly associated with patient centeredness. The overall quality of physiotherapy service was deemed intermediate and needs further improvement. The required resources, such as clinical assessment tools, therapeutic exercise equipment, electrotherapy modalities and infrastructure, were not adequate. Educational level and occupation were significantly associated with patient centeredness.

Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation

BackgroundInfection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown.MethodsWe conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively.ResultsThirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators.ConclusionsEfforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.

Improving Retention and Success of African American Students in Computer Science: A Mixed-Method Case Study at an HBCU

This case study introduces the STARS (Supporting Talented African American Undergraduates for Retention and Success) project, designed to foster the retention and success of academically talented African American computer science students from low-income backgrounds at Historically Black Colleges and Universities (HBCUs) in the U.S. The STARS program employs a holistic approach, integrating four primary pillars of support: academic, social, career, and financial. Specific support provided includes near-peer mentoring, technical skill development seminars, undergraduate research, and high school outreach activities. To explore the program’s effectiveness and areas of improvement, a mixed-method evaluation study was conducted, collecting data through surveys, observations, individual interviews, and focus group interviews. The findings revealed that the STARS program contributed to high levels of retention among its scholars, and the mentoring program provided valuable networking opportunities. The study suggests that the program’s comprehensive approach, tailored to scholars’ needs, and combined with a culturally affirming learning environment, facilitates the retention and success of talented African American students in computer science.

Solihull Approach training in undergraduate midwifery education: a pilot study

Background/Aims To date, Solihull training for midwives in Northern Ireland has been facilitated as continuing professional development; however, incorporating Solihull Approach Antenatal Foundation Training in undergraduate midwifery education has been recommended. The aim of this pilot study was to evaluate the provision of this training for undergraduate midwifery students. Methods This mixed-method evaluation study used pre- and post-test questionnaires with a purposive sample of 24 final year midwifery students. The data were analysed using descriptive statistics with thematic analysis of free text comments. Results Four themes emerged: perceived benefits in clinical practice; increased knowledge and confidence; increased recognition of the public health role of the midwife; and integration and timing of the training. Conclusions The innovative initiative was positively evaluated and considered an enhancement to current education provision. However, the initiative would have been welcomed earlier in the education programme. Implications for practice Solihull Approach training will be provided at undergraduate level and introduced earlier in the programme, with the subsequent potential to incrementally build on this foundation and include further tiers of training. The impact of students' application of the Solihull Approach in clinical practice warrants further investigation.

Community mental health for migrant women in Barcelona (“Self-Care Among Women”): Protocol for a mixed-methods process evaluation of a pilot psychological intervention

IntroductionMigrant populations, especially women, are often more susceptible to poor mental health and they face healthcare access barriers. This study aims to develop and evaluate a community-based mental health intervention through a participative research process to promote mental health and prevent psychiatric disorders among migrant women in Barcelona city. The intervention is built upon two evidence-based guidelines: Group Problem Management Plus (Group PM+) and Self-Help Plus (SH+). Methods“Self-Care Among Women” is a mixed-methods process evaluation study for the development of a community-based psychological pilot intervention. A participatory approach will be employed to adapt the content agenda of the community mental health intervention. Process indicators on context, implementation and mechanisms of change will be assessed through an intersectionality lens to explore the way in which the intervention is developed and implemented. The contextual fit, acceptability and feasibility of the proposed psychological intervention will be examined through participants' and facilitators' perceptions of the intervention. Further, women's clinical mental health condition and wellbeing will be assessed before and after the intervention, through standardized and culturally-validated instruments. Ethics and disseminationEthical approval of the research protocol has been obtained by the Research Ethics Committees of Hospital Clínic, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol) and Parc Sanitari Sant Joan de Déu. Written informed consent will be requested from all research participants for inclusion in the study. The study results will be published in peer-reviewed journals and communicated to congresses.

Patient and clinician perspectives of an eHealth intervention for supporting cancer treatment in the UK: mixed methods evaluation of the eRAPID randomised controlled trial

ObjectivesDuring 2015–2018, a randomised controlled trial (RCT) evaluated eRAPID, an eHealth intervention designed to capture patient-reported symptoms online during cancer treatment. eRAPID provides patients with advice on when to self-manage...

Attitudes and Beliefs Regarding Pain and Discrimination Among Black Adults with Sickle Cell Disease: A Mixed Methods Evaluation of an Adapted Chronic Pain Intervention.

This study sought to adapt a chronic pain group curriculum for adults with sickle cell disease (SCD). Given the association of experiences of racism and discrimination with health outcomes, this study also explored how such experiences for patients with SCD impact their interactions with clinicians and health-care systems. This mixed methods study recruited patients (aged ≥18 years) in a sickle cell treatment program; all self-identified as Black or African American. Key informant interviews evaluated a chronic pain program curriculum and rated the curriculum sessions' importance for SCD pain management. A survey containing six validated instruments then measured experiences of pain and discrimination, level of emotional expressivity, and trust in physicians and health insurers. Of the 19 adult patients approached, 12 (63%) completed the interview and survey. Interview data analysis resulted in five themes comprising pain, treatment, mental/emotional, health-care clinicians, and differences in SCD versus other chronic conditions. Each curriculum session was rated as "very important" or "important" by participants. Most described at least one experience of racism or discrimination in the medical setting and identified clinicians' lack of knowledge as a barrier to appropriate SCD care. Participants identified the importance of non-pharmacological treatments for SCD pain and appropriately managing pain caused by comorbid chronic conditions. Conversely, survey responses reported moderate levels of pain, infrequent discriminatory experiences in the medical setting, and moderate trust in medical professionals, whereas most reported experiences of discrimination in general settings. Many participants reported they either accepted it or did nothing in response to discriminatory experiences. Study findings emphasize the need to address experiences of racism and stigma in addition to experiences of emotional and physical pain among patients with SCD in the context of pain management. Findings from this study will inform the development of a SCD pain group curriculum for adult patients.

Exploring Trismus Management in Australia: A Mixed Methods Evaluation of Surveys and Interviews With Health Professionals.

This study evaluates how health care professionals manage trismus in Australia and identifies facilitators and barriers experienced by clinicians in routine patient care. A mixed-methods approach was used to evaluate the experience of clinicians. Medical, nursing, and allied health practitioners in Australia were invited to participate if they had treated patients with trismus in the last 5 years. Participants completed an investigator-designed survey and were invited to participate in a semi-structured audio-recorded interview to explore practice in more depth. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed thematically using an inductive, data-driven approach. Fifty-six clinicians (38 speech pathologists, 9 physiotherapists, 7 medical doctors, 1 nurse, and 1 osteopath) completed the survey, 12 of which also participated in an interview. The most common assessment tool was a commercially available measurement tool (Therabite or Orastretch), the most common treatment approach was stacked tongue depressors, and the most common exercise regimen was a 30- s stretch 25 times per day. Common barriers to trismus management included the high cost of devices, lack of clinical experience, and lack of training opportunities outside their institution. Clinician-perceived facilitators were different modes of information provision and time to consider the exercise instructions and rationale. Several clinicians relied on telehealth to reach patients in remote locations and improve efficiency. A range of clinicians treat trismus arising from a variety of conditions. Training opportunities are critical for clinicians to develop and extend their skills in assessing and treating trismus. The morbidity associated with trismus, and the absence of a clinical guideline or consensus document warrants careful consideration as to the translation of evidence into the clinical context.

LifeLab Dublin; a process evaluation of a pilot health literacy intervention for socioeconomically disadvantaged adolescents

ABSTRACT Developing health literacy (HL) in youth populations, as a means to improving lifelong health behaviours and outcomes, has garnered increased interest in both research and practice in recent years. This mixed-methods process evaluation examines the acceptability, fidelity and dose delivered of the pilot of LifeLab Dublin: a nine-week, school-based HL intervention for low socioeconomic adolescents. The intervention, which comprised of two, out-of-school, interactive HL experiences in conjunction with seven school-based lessons, took place between September and December in 2021 and involved first-year students (aged 11–13) from one socioeconomically disadvantaged school in Dublin, Ireland. Data sources included focus groups, a questionnaire and self-reflection checklists. Overall, the intervention was perceived positively by the students and teachers, particularly the two interactive out-of-school experiences. The evaluation provided valuable insight into the refinements required to enhance the efficacy of the LifeLab intervention, as well as providing an evidence-base that can be used to inform future school-based HL interventions for low socioeconomic adolescents.

Health Catch-UP!: a realist evaluation of an innovative multi-disease screening and vaccination tool in UK primary care for at-risk migrant patients

BackgroundMigrants to the UK face disproportionate risk of infections, non-communicable diseases, and under-immunisation compounded by healthcare access barriers. Current UK migrant screening strategies are unstandardised with poor implementation and low uptake. Health Catch-UP! is a collaboratively produced digital clinical decision support system that applies current guidelines (UKHSA and NICE) to provide primary care professionals with individualised multi-disease screening (7 infectious diseases/blood-borne viruses, 3 chronic parasitic infections, 3 non-communicable disease or risk factors) and catch-up vaccination prompts for migrant patients.MethodsWe carried out a mixed-methods process evaluation of Health Catch-UP! in two urban primary healthcare practices to integrate Health Catch-UP! into the electronic health record system of primary care, using the Medical Research Council framework for complex intervention evaluation. We collected quantitative data (demographics, patients screened, disease detection and catch-up vaccination rates) and qualitative participant interviews to explore acceptability and feasibility.ResultsNinety-nine migrants were assessed by Health Catch-UP! across two sites (S1, S2). 96.0% (n = 97) had complete demographics coding with Asia 31.3% (n = 31) and Africa 25.2% (n = 25), the most common continents of birth (S1 n = 92 [48.9% female (n = 44); mean age 60.6 years (SD 14.26)]; and S2 n = 7 [85.7% male (n = 6); mean age 39.4 years (SD16.97)]. 61.6% (n = 61) of participants were eligible for screening for at least one condition and uptake of screening was high 86.9% (n = 53). Twelve new conditions were identified (12.1% of study population) including hepatitis C (n = 1), hypercholesteraemia (n = 6), pre-diabetes (n = 4), and diabetes (n = 1). Health Catch-UP! identified that 100% (n = 99) of patients had no immunisations recorded; however, subsequent catch-up vaccination uptake was poor (2.0%, n = 1). Qualitative data supported acceptability and feasibility of Health Catch-UP! from staff and patient perspectives, and recommended Health Catch-UP! integration into routine care (e.g. NHS health checks) with an implementation package including staff and patient support materials, standardised care pathways (screening and catch-up vaccination, laboratory, and management), and financial incentivisation.ConclusionsClinical Decision Support Systems like Health Catch-UP! can improve disease detection and implementation of screening guidance for migrant patients but require robust testing, resourcing, and an effective implementation package to support both patients and staff.

The ASK trial: a randomised controlled feasibility trial and process evaluation of a complex multicomponent intervention to improve AccesS to living-donor Kidney transplantation

Background Following identification of barriers to living-donor kidney transplantation, and subsequent development of a multicomponent intervention, we undertook a feasibility trial of the intervention. Trial design Two-arm, parallel group, pragmatic, individually-randomised, controlled, feasibility trial, comparing the new intervention with usual care, with a mixed-methods parallel process evaluation. Based at two UK hospitals. Participants Individuals were eligible if ≥18 years old, active on the kidney transplant waiting list or had been referred for transplant listing without a contraindication to transplantation. Individuals with a living-donor undergoing surgical assessment were excluded. Intervention i) A meeting between a home educator for a dedicated discussion about living-donor kidney transplantation, living kidney donation and potential donors; ii) A standardized letter from a healthcare professional to a candidate’s potential donors; iii) A home-based education and family engagement session undertaken by a living kidney donor and a nurse specialist. Objective To establish the acceptability and feasibility i) of delivering the developed intervention in existing care pathways, and ii) of undertaking a randomised controlled trial of the intervention. Primary outcomes Recruitment and retention. Randomisation Participants were randomly allocated 1:1 to i) the intervention or ii) usual care, stratified by site. Minimisation was used to ensure balance in sex, age group, and socioeconomic strata, with probability weighting of 0.8. Results 183 people were invited to participate. 62 people (34% recruitment) were randomised. 62/62 (100%) completed nurse assessed follow-up at 6 weeks. 51/62 (82%) completed follow-up questionnaires. 3/30 (10%) in the usual care arm and 9/32 (28%) in the intervention arm had individuals ask to be tested for living kidney donation following recruitment to the trial. Conclusions Intervention and trial delivery are feasible and acceptable. Findings have informed the design of an effectiveness and cost-effectiveness trial. Trial registration ISRCTN Registry ISRCTN10989132 https://doi.org/10.1186/ISRCTN10989132. The trial was registered on 6/11/2020.

Cohort retention in a pandemic response study: Lessons from the SIREN study

Abstract Background Cohort studies represent an important research-tool, yet participant retention is difficult. SIREN followed a cohort of healthcare workers across 135 NHS sites in the UK during a pandemic. We designed an evolving retention programme, underpinned by our Participant Involvement Panel (PIP). We aimed to evaluate cohort retention over time and identify learnings. Methods Mixed method evaluation of our evolving retention programme in the 12 and 24-month cohort. We described cohort retention by demographics and site, using odds ratios from logistic regression. Withdrawal reasons were collected by survey. We collected participant feedback via cross-sectional survey using a behavioural science approach. We conducted focus groups with research teams and conducted thematic analysis. Results 37,275 (84.7%) participants at 135 sites completed 12-months of follow-up. 12,635 (85.5%) participants at 87 sites completed 24-months. Retention increased with age (24-months: &amp;gt;65 vs &amp;lt; 25 years OR = 2.92; 95%CI: 1.78-4.88; p &amp;lt; 0.001) and was highest in the Asian and Black ethnic groups (24-months OR = 1.78; 95%CI: 1.42-2.25; p &amp;lt; 0.001, and OR = 2.12; 95%CI: 1.41-3.35; p &amp;lt; 0.001, respectively, Ref=white). SIREN scored highly in participant feedback. Lessons for future studies include the need to monitor changing participant motivation; using inclusive and comprehensive communication; acknowledging the contributions of participants and investing in the skillset of research teams. Conclusions Despite challenges to running a large multicentre cohort study in an evolving pandemic, retention in SIREN has remained very high. Some factors impacting retention were outside of study control, including the altruistic motivation of participants. Participant feedback was positive, suggesting SIREN methodology will provide useful learning for future retention programmes. Site feedback provided learning for future multicentre research studies, offering insights into key facilitators and common challenges. Key messages • Cohort retention is difficult. Mixed methods evaluation shows SIREN achieved high retention while following a cohort of healthcare workers across 135 NHS sites in four UK nations during a pandemic. • Lessons learned include the need to monitor changing participant motivation; using inclusive communication; acknowledging participants contributions and investing in the research team skillset.

A Training-of-Trainers program for health facilitators fighting malaria in a vulnerable community

Abstract Background When Public Health is challenged by issues related to migrant and vulnerable populations, health facilitators’ profiles are crucial to accessing communities and increasing intervention effectiveness and acceptability. The French overseas region, French Guiana, is concerned with a migrant population living in vulnerable conditions far from healthcare and being a major reservoir of malaria. Curema is an intervention implemented to fight malaria in this population by distributing RDTs, and treatments after an appropriate training of participants. Facilitators from the community are employed to provide health education and enroll participants. Objectives An intensive theoretical-practical training program was realized to enable facilitators to master procedures related to the intervention. The training was designed using the CDC Training-of-Trainers (ToT) framework and adult learning principles. It was composed of initial and on-the-field training, both based on bidirectional, participative, and dynamic working spaces. A mixed-method evaluation was carried out to assess training effectiveness and quality. Results Group dynamics and adaptations driven by facilitators’ needs were key elements of a high-quality training program. Satisfaction was elevated for training format and learning results. Statistically significant improvements in knowledge level demonstrated good effectiveness. During the initial training, difficulties persisted regarding some tasks to be performed during the intervention: further on-the-job training addressed them, improving facilitators’ practices in the field. Conclusions High-quality, effective, and appropriate training programs are required for intervention involving facilitators’ profiles. Training design is crucial to achieve it. ToT model has been shown to allow high satisfaction, learning results, and good implementation in the field. Initial and on-the-job training are an indispensable continuum to sustain good practices and motivation. Key messages • If health facilitators from the community are actors in public health interventions, appropriate training is necessary to ensure good implementation. • ToT seems an optimal model for training health facilitators.