Positive Program Outcomes Research Articles

Implementing the information system for older adult patients post-discharge self-management: a qualitative study.

Discharging older adult patients from the hospital poses risks due to their vulnerable conditions, complex instructions and limited health literacy. Insufficient information about medication side effects adds to patient concerns. To address this, a post-discharge information summary system was developed. While it has shown positive impacts, concerns exist regarding implementation fidelity. This study employed a theory-driven approach to understand health providers' perspectives on effective implementation. Individual semi-structured interviews were conducted via telephone with nurses, doctors and pharmacists from local public hospitals. All interviews were audio-recorded and transcribed verbatim. Theoretical Domains Framework (TDF) was applied for direct content analysis. Belief statements were generated by thematic synthesis under each of the TDF domains. A total of 98 participants were interviewed. Out of the 49 belief statements covering eight TDF domains, 19 were determined to be highly relevant to the implementation of the post-discharge information summary system. These TDF domains include knowledge, skills, social/professional role and identity, beliefs about consequences, intentions, memory, attention and decision processes, environmental context and resources and social influences. Our study contributes to the understanding of determinants in implementing discharge interventions for older adult patients' self-care. Our findings can inform tailored strategies for frontline staff, including aligning programme rationale with stakeholders, promoting staff engagement through co-creation, reinforcing positive programme outcomes and creating default settings. Future research should employ rigorous quantitative designs to examine the actual impact and relationships among these determinants.

Unlocking policy success: is codesign the key to achieving effective policy outcomes?

Codesign is increasingly promoted as best-practice and a solution to many policy ills, yet there is little empirical evidence suggesting that it is actually more effective for designing and implementing policy. This article investigates whether codesigned policies and programs are in fact more successful in achieving positive policy outcomes by applying the policy success framework to the codesign process behind the Australian Capital Territory’s Family Safety Hub. Using this framework, we conclude that codesign can have a significant positive impact on the process when it is done well, but its effect on longer-term program and political success depends heavily on other factors. The use of codesign as a stand-alone policy tool is limited, but further research is needed to understand how the value it generates in the early design stages can be translated into better implementation and positive program outcomes.

Navigating intersectoral collaboration in nutrition programming: implementors’ perspectives from Assam, India

BackgroundThere is a growing interest in the use of intersectoral collaborative (ISC) approaches to address complex health-related issues. However, relatively little empirical research exists on the challenges of implementing, fostering and sustaining these approaches. Our study explores the perceptions and experiences of programme implementers regarding the implementation of an ISC approach, focusing on a case study of nutrition programming in Assam, India.MethodsWe conducted qualitative semi-structured face-to-face in-depth interviews with eleven programme implementers from two selected districts of Assam, India. These participants were purposefully sampled to provide a comprehensive understanding of the experiences of implementing intersectoral collaboration. Following the interviews, an inductive thematic analysis was performed on the collected data.ResultsThe study identified three main themes: operationalisation of ISC in daily practice, facilitators of ISC, and barriers to effective ISC. These were further broken down into six subthemes: defined sectoral mandates, leadership dynamics, interpersonal relationships and engagement, collective vision and oversight, resource allocation, and power dynamics. These findings highlight the complexity of ISC, focusing on the important structural and relational aspects at the macro, meso, and micro levels. Interpersonal relationships and power dynamics among stakeholders substantially influenced ISC formation in both the districts.ConclusionDespite challenges, there is ongoing interest in establishing ISC in nutrition programming, supported by political development agendas. Success relies on clarifying sectoral roles, addressing power dynamics, and engaging stakeholders systematically. Actionable plans with measurable targets are crucial for promoting and sustaining ISC, ensuring positive programme outcomes. The insights from our study provide valuable guidance for global health practitioners and policymakers dealing with similar challenges, emphasising the urgent need for comprehensive research given the lack of universally recognised policies in the realm of ISC in global health practice.

Promoting Clinical Instructors’ Success in Advance Practice Nursing Programs

Advance practice nursing programs use clinical instructors (CIs) to bridge the theory-practice gap and to maintain relationships with clinical preceptors. A clear understanding and support of the CI role for advanced practice nursing is needed to promote positive program outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide were used to conduct the review. Nineteen articles met the inclusion criteria. Findings from the review revealed several themes including role development, competency, communication, evaluation, technology, plan of study, and teaching resources. Findings were used to develop a multitouch electronic resource guide to support CI success in their role in advance practice education. The implementation of training programs to promote CI competency should be considered. Further investigation of CI competencies specific to advance practice nursing and the development of evaluation tools to assess competency are recommended.

Delivering the National Diabetes Prevention Program: Assessment of Outcomes in In-Person and Virtual Organizations.

The Centers for Disease Control and Prevention's Diabetes Prevention Recognition Program (DPRP) has helped organizations deliver the National Diabetes Prevention Program (National DPP) lifestyle change program for over 10 years. Four delivery modes are now approved: in person, online (self-paced, asynchronous delivery), distance learning (remote, synchronous delivery), and combination (hybrid delivery using more than one delivery mode). We assessed outcomes using data from 333,715 participants who started the 12-month program between January 1, 2012, and December 31, 2018. The average number of sessions attended was highest for in-person participants (15.0), followed by online (12.9), distance learning (12.2), and combination (10.7). The average number of weeks in the program was highest for in-person participants (28.1), followed by distance learning (20.1), online (18.7), and combination (18.6). The average difference between the first and last reported weekly physical activity minutes reflected an increase for in person (42.0), distance learning (27.1), and combination (15.0), but a decrease for online (-19.8). Among participants retained through session 6 or longer, average weekly physical activity minutes exceeded the program goal of 150 for all delivery modes. Average weight loss (percent of body weight) was greater for in person (4.4%) and distance learning (4.7%) than for online (2.6%) or combination (2.9%). Average participant weight loss increased gradually by session for all delivery modes; among participants who remained in the program for 22 sessions, average weight loss exceeded the program goal of 5% for all delivery modes. In summary, if participants stay in the program, most have positive program outcomes regardless of delivery mode; they have some outcome improvement even if they leave early; and their outcomes improve more the longer they stay. This highlights the benefits of better retention and increased enrollment in the National DPP lifestyle change programs, as well as enhancements to online delivery.

Relationship-building, community-building, and security of the building: staff perspectives on tenant retention in permanent supportive housing

Abstract Objectives: The objective of this article is to explore how housing practitioners navigate the challenge of tenant retention within Permanent Supportive Housing (PSH) programs and the practices they associate with program success. Methods: This article draws on semistructured interviews with 10 housing practitioners from 7 organizations operating 8 PSH programs in Edmonton, a city with roughly one million people in Alberta, Canada. Results: This article focuses on 3 specific challenges that have implications for the retention of residents: (1) interpersonal conflict, (2) property damage, and (3) guest management. It also focuses on 3 “promising practices” that practitioners have utilized to mitigate these challenges: (1) relationship-building, (2) community-building, and (3) security of the buildings. Conclusions: Tenant retention is integral to the realization of positive program outcomes in PSH. There are several factors affecting tenant retention. To address these challenges, the staff interviewed in this research found success in building programmatic elements that fostered positive interpersonal relationships, managed the behavior of guests on the property, and ensured the physical integrity of the buildings.

Abstract 84: The Process of Setting Up an Inter-Country Cancer Care Program in Low-And-Middle-Income Countries: A Case of International Cancer Institute’s Uganda Blueprint for Innovative Healthcare Access Program

Abstract Purpose: Close to 70% of all cancer deaths occur in low- and middle-income countries (LMICs) with the rising cancer burden causing a strain on the already weak health care and economic infrastructures. The extrapolation of the experiences of cancer control programs in High Income Countries (HICs) to LMICs is often inappropriate requiring a regional scale up of successfully implemented cancer programs across LMICs. Methods: International Cancer Institute (ICI) is a non-governmental, not-for-profit organization whose main purpose is to expand education and training opportunities in cancer care, education and research across Sub-Saharan Africa through multisectoral corroborations and partnerships. ICI successfully implemented two Blueprint programs in Kenya thus sought to scale up the program to Western Uganda. An online search of key players in Cancer care in Uganda was conducted that identified six potential partners including Ministry of Health – Uganda, Uganda Cancer Institute (UCI), Uganda Cancer Society (UCS), Uganda Non-communicable Diseases Alliance (UNCDA), Mbarara Regional Referral Hospital and Mbarara University of Science and Technology. Virtual meetings were held with two of them with a site visit scheduled for face-to-face meetings. Results: ICI team met with UCS and UNCDA teams in Uganda where contacts of other potential partners were obtained resulting in face-to-face meetings with UCI; Mbarara Regional Referral Hospital; Ministry of Health Western Uganda; District leadership of Western Uganda; Kampala International University Teaching Hospital; and Kampala International University, Western Campus. An assessment of the scope of districts of focus, distribution of facilities and the health system structure was done. A technical working group with representatives from ICI and the identified partners will then be formed to guide program design, implementation, monitoring and evaluation. Conclusion: The process of setting up a cancer care program in LMICs applies not only new innovations but also resource appropriate interventions. Leveraging on existing partner expertise maximizes positive program outcomes. Citation Format: Gloria Kitur, Kevin Makori, Chite Asirwa. The Process of Setting Up an Inter-Country Cancer Care Program in Low-And-Middle-Income Countries: A Case of International Cancer Institute’s Uganda Blueprint for Innovative Healthcare Access Program [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 84.

Program Outcomes and Health Care Utilization of People Experiencing Homelessness and Substance Use Disorder after Transitional Care Program Engagement.

People experiencing homelessness (PEH) have a high prevalence of mental illness and substance use disorder (SUD) and substantial acute and chronic disease burden. Transitional care and medical respite programs facilitate a safe transfer for PEH from the acute care to community setting. Many medical respite programs practice harm reduction strategies that can increase the opportunity for positive program outcomes for PEH with SUD. This transitional care and medical respite program evaluation explored program outcomes, health care utilization patterns, and comorbid conditions of persons with and without SUD. People experiencing homelessness with SUD had similar program outcomes and both groups had decreased acute care utilization after program engagement. A high prevalence of trimorbidity, which is associated with early mortality, was noted. Opportunities for harm reduction strategies to promote both social and clinical outcomes are offered.

A School Wellness Partnership to Address Childhood Obesity.

Childhood obesity is a complex public health issue that requires community and environmental factors be addressed. Efforts to combat childhood obesity must be multifaceted and include community-based partnerships. The objective of this paper is to describe a partnership between a county health department and a local school district to address childhood obesity. As part of a formal School Wellness Partnership, a nutrition and physical activity program was designed to meet the needs of a school community. The program included parent and teacher education, school-wide messaging and take-home activities. The partnership generated positive program outcomes, including increased teacher knowledge and confidence and parental knowledge regarding healthy childhood behaviors. Lessons learned included the importance of resource sharing and building a stronger program with mutual partner benefits. Community partnerships can lead to expanding health outreach and building community capacity to promote health through collaborative program development efforts.

Mentoring: A key element in succession planning

An essential component of succession planning is mentoring for faculty (full- and part-time) and the nurse administrator. Effective mentoring programs contribute to the continuity of nursing programs and positive outcomes for nursing programs. The literature is replete with research that identifies benefits of mentoring programs for faculty and nurse administrators. Acknowledging the impact mentoring programs for nurse administrators and faculty have on positive program outcomes, this article explores the benefits of mentoring, stages of mentoring, and characteristics of successful mentoring programs. Unlike other articles related to mentoring programs for faculty and nurse administrators, this article correlates mentoring with selected Accreditation Commission for Education in Nursing Criteria.

Prevalence and Characteristics of House Staff Quality and Safety Councils Within Clinical Learning Environments: Results of a National Survey.

House Staff Quality and Safety Councils (HQSCs) are relatively new multispecialty groups led by residents and fellows that focus on quality and safety activities at their training site. The authors sought to estimate the prevalence of HQSCs, describe their common characteristics and determine any perceived impacts. A national survey was conducted with Designated Institutional Officers (DIO) of graduate medical education programs in 2019. For institutions with an HQSC, a second survey was sent to program leaders to obtain additional details. Responses were obtained from 204 DIOs, 47% of whom currently have an HQSC. Forty-five percent of sites provided details about HQSC membership, leadership, funding, activities/initiatives, facilitators, and barriers. The majority reported positive program outcomes. This study found that HQSCs are common and share key characteristics, yet at the same time have many unique features tailored to their clinical learning environment. Participants report positive outcomes associated with these groups.

Developing sustainable small-scale fisheries livelihoods in Indonesia: Trends, enabling and constraining factors, and future opportunities

Small-scale fisheries (SSF) provide crucial contributions to livelihoods, food and nutrition security, and the well-being of coastal communities worldwide. In Indonesia, 2.5 million households are involved in SSF production, yet these households are characterised by high poverty rates and vulnerability due to declining ecosystem health and climatic change. In this study we applied the Sustainable Livelihoods Framework to analyse the characteristics and immediate and longer-term outcomes of 20 SSF livelihood-focused intervention programs implemented in coastal communities across the Indonesian Archipelago over the last two decades. Projects covered a wide range of spatial scales, funding providers and key participants. Factors supporting positive program outcomes included application of inclusive and holistic approaches to sustainable livelihoods, implemented and supported over appropriate time frames; use of participatory capacity development methodologies and locally-situated project facilitators; and collaborative engagement with local government, non-government organisations and private-sector actors. However, it was impossible to identify evidenced successes from a longer-term sustainability perspective. Short project timeframes, absence of baseline or monitoring data, pressure for satisfactory reports to donors, and limited post-project evaluation, together with invisibility of women’s work and non-commercial exchanges, affected the adequacy of assessments. Given the lack of post-project assessment among projects studied, a thorough review of longer-term project impacts is recommended, guided by the Sustainable Livelihoods Framework, to evaluate sustained improvements in livelihoods outcomes and environmental sustainability. This would support best-practice design and implementation of SSF livelihood-focused interventions, disseminated beyond academia, to influence policy and development to achieve socio-economic equity and environmental goals.

The implementation of Lego®‐Based Therapy in two English mainstream primary schools

AbstractSmall‐group interventions are often used in schools to support the development of children’s social skills. One such intervention, Lego®‐Based Therapy (LBT), is increasingly popular internationally in schools. Although LBT has an emerging evidence‐base, there is limited research exploring effective LBT implementation. An in‐depth, exploratory multiple‐case study design was used to explore the process of LBT assimilation in two English mainstream primary schools which were considered to have implemented LBT effectively and reported positive programme outcomes. Data collection was through structured observations and semi‐structured interviews based upon Durlak and DuPre’s (2008) established implementation framework. Transcripts were subjected to Hybrid inductive–deductive thematic analysis was used to identify themes which were triangulated with observation data. The data largely correlated with the Durlak and DuPre (2008) framework, identifying ley themes of: provider characteristics, characteristics of the intervention, organisational capacity and the need for a support system when implementing the intervention. Themes of facilitator factors and participant responsiveness emerged inductively, suggesting that a revised model of implementation is required for LBT. Recommendations include calling for EPs to use models of implementation when working with schools, as a cyclical, iterative process to promote positive outcomes and, therefore, cost‐effectiveness of school investment in interventions. Limitations and future research are discussed.

Participant Perceptions of the Double Up Food Bucks Program at Oregon Farmers’ Markets

ObjectiveTo explore perceptions of program impact among Double Up Food Bucks participants in Oregon. MethodsData were collected from 1,223 Double Up Food Bucks participants at 42 Oregon farmers’ markets. Chi-square tests of independence and logistic regressions were used to examine associations among key variables. ResultsMost participants reported buying more fruits and vegetables (FVs) (91.0%), trying new FV types (82.2%), eating less processed food (69.8%), having more food available at home (81.1%), and perceiving improvements in health (87.9%). Perceptions of affordability were higher among younger adults (P < 0.001) and households with 3–5 people (P = 0.02), with children (P < 0.001), and without chronic disease (P = 0.003). Perceptions of increased FV purchases were higher in households with children (P = 0.009) and reported overall health improvements were higher among non-White participants (P = 0.04). Perceptions of increased FV purchases and affordability were associated with other positive program outcomes. Conclusions and ImplicationsParticipants may perceive barriers to purchasing FVs from farmers’ markets, which are not fully addressed by the increased purchasing power from a FV incentive. Targeted redesign, outreach, and education may improve program experiences among groups with less positive perceptions. Further research to identify explanations for variation in program experience is needed.

A framework for assessing the effectiveness of USAID’s food security programme in a developing country

ABSTRACT This article presents a simple framework for gauging the effectiveness of an international development agency food security programme in a small developing country. It focuses on the United States Agency for International Development’s (USAID) Feed the Future programme and uses Ghana as a case study. The article develops a basic regression discontinuity model of food security outcomes and tests the model using simulated data on food availability, access, and utilisation in Ghana. Results show positive programme outcomes for crop yield, production value, and dietary diversity among smallholder farmer households. The evaluation framework may be useful as a preliminary test and leading indicator of country programme effectiveness.

Associations between participation in a Physical Activity-Based Positive Youth Development Program and Academic Outcomes

IntroductionPhysical activity-based positive youth development (PYD) programs offer asset building experiences to foster the overall well-being of youth. These programs have the potential to enhance success in other important contexts for children, such as school. However, rigorous examination of this potential impact is needed. MethodsPropensity score matching was used to compare school outcomes among children who participated in a short, summer physical activity-based PYD program in the USA and children who were from similar backgrounds and from the same school district but did not attend the program. The sample included 149 pairs of students aged 7–12 years (M = 10.11, SD = 1.26) and, in each group, 62% were from ethnically diverse backgrounds, 38% were from primarily Caucasian backgrounds, and 80 were female and 69 were male, and birth years were equally distributed. Ordinal and logistic regression models were used to test for differences between standardized math and language arts test scores, excused and unexcused absences, and total suspensions and expulsions between the two groups. ResultsPYD program youth had 55% and 46% greater odds being in the highest math (χ2(1, N = 298) = 4.06, p = .04) and total days attended categories (χ2(1, N = 298) = 5.58, p = .02) respectively. No other significant differences were found. When using a more rigorous quasi-experimental and longitudinal design, participation in a PYD program predicted some but not all academic performance and behaviors. PYD programs may need to be designed to specifically nurture academic skills to consistently impact academic outcomes.

The role of thinking styles in program satisfaction and perceived intellectual competence among STEM doctoral students.

This research pioneered the investigation of the role of doctoral students’ thinking styles in their program satisfaction and perceived intellectual competence. Participants were 285 STEM (science, technology, engineering, mathematics) students in Hong Kong. Results showed that students’ thinking styles as measured by the Thinking Styles Inventory—Revised II (Sternberg, Wagner, & Zhang, 2007) statistically significantly predicted their program satisfaction and perceived intellectual competence as assessed by two of the scales in the newly constructed Graduate Student Survey (Shin et al., 2015)—beyond their gender, program year, and academic discipline. Findings have brought new insights into the assessment of doctoral students’ program satisfaction and perceived intellectual competence. At the same time, findings have contributed to the literature on intellectual styles and that on doctoral education in STEM fields. Practical implications of the findings are proposed for STEM doctoral students in understanding their own ways of thinking and program experiences and outcomes, as well as for academics and senior managers in their efforts to enhance students’ access to positive program experiences and outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Daybreak in Dayton: Assessing characteristics and outcomes of previously homeless youth living in transitional housing

Each year, more than 1 million American children and youth experience homelessness (Hammer, Finkelhor, & Sedlak, 2002; Office of Applied Studies, 2004). The transient nature of this population makes it difficult to study, but youth homelessness has been identified with a number of problematic outcomes as well as a pathway to chronic adult homelessness (Baker Collins, 2013; Chamberlain & Johnson, 2011). Yet, few empirical studies evaluate the effectiveness of a common intervention for homeless youth—transitional housing. In this paper, we describe the outcomes of homeless youth who participated in a youth-only transitional housing program. We analyze administrative data on 174 youth who entered and exited the Daybreak Transitional Housing program (Daybreak TH) between 2011 and 2014. We find that the majority of Daybreak TH participants were employed at least 20 h a week at program exit. Youth exited Daybreak TH with higher wages on average, while nearly half achieved educational gains from program entry to exit. Youth who resided in Daybreak TH for 12 months or longer were more likely to achieve positive program outcomes than youth who entered and exited the program in fewer than 12 months. Finally, youth who used drugs and alcohol were less likely than their peers to achieve desired program outcomes, as were those who suffered from chronic illnesses or attention deficit, conduct, or disruptive behavior disorders. We conclude with a discussion of policy implications and areas for future research.

Integrating Hospital and Community Care for Homeless People with Unmet Mental Health Needs: Program Rationale, Study Protocol and Sample Description of a Brief Multidisciplinary Case Management Intervention

The Coordinated Access to Care for Homeless People (CATCH) program is a brief multidisciplinary case management intervention for homeless adults discharged from hospital in Toronto, Canada. Here we describe the rationale for CATCH program development, details of the mixed methods evaluation underway, and the characteristics of 225 CATCH service users. Funded in 2010 by the local health authority, CATCH aimed to improve access, continuity of care, health and service use outcomes for homeless adults discharged from hospital. To assess the feasibility, acceptability and impact of the program, a mixed methods case study was undertaken in 2013. In total, 225 CATCH program users were enrolled in the study and completed quantitative survey measures at program entry to assess key health and social outcomes using a pre-post cohort study design. Follow-up assessments took place at 3- and 6-months. At study entry, most participants were male (79%), white (65%), Canadian-born (74%), single or never married (60%), and their average age was 39.9 ± 12.0 years. Nearly all participants (88%) had at least one emergency department visit in the past 6 months, more than half (53%) indicated at least three chronic health conditions, and 44% indicated at least three mental health diagnoses. In addition, qualitative data was collected to evaluate the experiences of continuity of care and challenges during care transitions for this population using in-depth interviews with a sample of CATCH service users (n = 22) and managers of partnered organizations (n = 7), as well as focus groups with CATCH staff (n = 8), other service providers (n = 7) and people with lived experience of homelessness (n = 8). Improving health and health service use outcomes among homeless adults with chronic health conditions are key priorities in many jurisdictions. Future findings can inform service delivery to homeless adults discharged from hospital, by exposing factors associated with positive program outcomes, as well as barriers and facilitators to continuity of care for this disadvantaged population.

EVALUATION AND EXPLORATION OF THE PERCEIVED VALUE OF THE “HELPING DIVORCED PARENTS TO BENEFIT ADOLESCENT CHILDREN” PROGRAMME

The aim of the study was to evaluate and explore the subjective experiences of parents who participated in the “Helping Divorced Parents to Benefit Adolescent Children” enrichment programme. A qualitative approach with a phenomenological research design was followed. Participants were selected by convenience sampling and included twelve divorced custodial parents of adolescents who attended the four-week programme. Content analysis was done and themes were extracted from the data. The main themes that emerged from the interpretations were: Positive group experience (value of shared experience and support in the group context); Co-parenting challenges (relationship with former spouse remained challenging); Feelings of guilt and self-blame (for their children’s post-divorce adjustment); Parent’s own personal needs not met (causing frustration); Positive post-divorce and programme outcomes. The general evaluation of the programme was positive and recommendations to improve the programme were made. It was concluded that a group intervention programme for parents can contribute towards positive change in parenting adolescents after parental divorce.