Pragmatic Evaluation Research Articles

Pragmatic evaluation of transdisciplinary research on gender equity in the New Zealand public service

PurposeDespite the need for such, little scholarly attention has been paid to transdisciplinary enquiry into gender inequities in workplaces. The authors provide a pragmatic evaluation of the transdisciplinary research (TDR) model by Hall et al. (2012) for framing the study of this societal issue, shedding light on the challenges, principles and values that could usefully inform subsequent TDR in organisational settings.Design/methodology/approachThis paper evaluates the model in relation to TDR on gender inequities in New Zealand's public service by Hall et al. (2012) Content analysis on our reflective narratives from research team meetings, email exchanges, informal discussions and a workshop reveals TDR study insights. Findings show support for the model and its four broad phases and surface principles and values for applied TDR enquiry that addresses societal challenges in the organisational context.FindingsThe adoption of a TDR model to examine a study of equity in the public service revealed practical and conceptual challenges, encouraging ongoing reflection and adaptive behaviour on the researchers' part. The pragmatic evaluation also highlighted environmental constraints on undertaking TDR, with implications for the ambition of future studies.Research limitations/implicationsThis evaluative enquiry encourages similar research in other organisational and national settings to validate the use of TDR to gain insightful, contextualised understandings of social challenges centred in the organisational setting.Practical implicationsThis pragmatic evaluation of a TDR model's capacity to approximate the approach and phases of our applied enquiry lays the groundwork to refining TDR approaches used in subsequent studies aimed at addressing societal issues in the organisational setting.Social implicationsThis paper can potentially promote greater collaboration between research scholars and other stakeholders wanting to develop TDR paradigms and applied enquiry that can meaningfully inform workplace and societal impacts.Originality/valueThis pragmatic evaluation of a TDR approach involves its initial application to the study of equity at work and develops principles and values that could inform TDR paradigms and methodologies of subsequent enquiries in the field.

Placental growth factor in assessment of women with suspected pre-eclampsia to reduce maternal morbidity: a stepped wedge cluster randomised control trial (PARROT Ireland)

ObjectiveTo determine whether the addition of placental growth factor (PlGF) measurement to current clinical assessment of women with suspected pre-eclampsia before 37 weeks' gestation would reduce maternal morbidity without increasing...

Identity, Belonging and Strategic Citizenship. Considerations About Naturalisation Among Italians and Spaniards Living in the EU

The subject of naturalisation among intra-EU migrants has only recently drawn the attention of social science scholars. Empirical evidence from quantitative studies shows an increase in citizenship applications among this new wave of mobile people, indicating a strategic use of naturalisation. However, there is not a great deal of micro-level research, especially as to the subjective meanings attached to citizenship take-up in a new EU member state. Drawing on 68 in-depth interviews conducted with Italians and Spaniards living in London and Berlin, we argue that an individual’s understanding of naturalisation within the EU context is based on two aspects: on one hand, a strictly pragmatic evaluation of the pros and cons of the new status; on the other, a new sense of belonging as well as new cultural and territorial identifications that intra-EU migrants are not often willing to experience. Therefore, this article suggests that EU migrants that strongly identify with their country of origin and the EU see national and EU identities as conflicting with naturalisation, thus setting aside instrumental considerations. This constitutes a critique to theoretical approaches claiming the diminishing importance of a nation’s cultural self-understanding. Our paper also sheds light on the possible effect of the UK’s departure from the EU on young Southern European migrants choosing to apply for British citizenship, highlighting that it is mostly the implementation of the formal exit process and the actual abrogation of EU citizenship rights that reconfigure patterns in naturalisation, rather than the uncertainty and fears about the future.

A Naturalistic Evaluation of Group Integrative Adapt Therapy (IAT-G) with Rohingya Refugees During the Emergency Phase of a Mass Humanitarian Crisis in Cox's Bazar, Bangladesh.

Background: Studies of scalable psychological interventions in humanitarian setting are usually carried out when the acute emergency has stabilized. We report the first evaluation of an evidence-based group psychological intervention, Group Integrative Adapt Therapy (IAT-G), during the emergency phase of a mass humanitarian crisis amongst Rohingya refugees in Cox's Bazar, Bangladesh.Methods: We did a pragmatic naturalistic evaluation (2018-2020) of a seven-session group intervention with adult Rohingya refugees with elevated symptoms of depression (≥10 on the Patient Health Questionnaire) and/or posttraumatic stress disorder, PTSD, (≥3 on the Posttraumatic Stress Disorder-8), and functional impairment (≥17 on WHO Disability Assessment Schedule or WHODAS-brief). Screening was done across the most densely populated campsites. Blind assessments were completed at baseline, posttreatment, and at 3-month follow-up using culturally adapted measures of depression, anxiety, posttraumatic stress symptoms, complicated bereavement, adaptive stress associated with disrupted psychosocial support systems, functional impairment, and resilience.Findings: 383 persons were screened and of the 144 persons who met inclusion criteria all participated in the group intervention. Compared to baseline scores, IAT-G participants recorded significantly lower mean scores on key outcome indices (mental health symptoms, adaptive stress, and functional impairment) at posttreatment and 3-month follow-up (all pairwise tests significant Ps<.05). From baseline to 3-month follow-up, score changes were greatest for functional impairment (d = 2.24), anxiety (d = 2.15) and depression (d = 1.9), followed by PTSD symptoms (d = 1.17).Interpretation: A group-based intervention designed specifically to reflect the refugee experience and adapted to the language and culture, showed positive outcomes in the context of a pragmatic, naturalistic trial implemented in a mass humanitarian emergency.Funding: United Nations High Commissioner for Refugees; National Health and Medical Research Council Australia.

Pragmatic economic evaluation of community-led delivery of HIV self-testing in Malawi

IntroductionCommunity-based strategies can extend coverage of HIV testing and diagnose HIV at earlier stages of infection but can be costly to implement. We evaluated the costs and effects of community-led...

Airline service quality evaluation for Indonesian low-cost carriers based on Extenics innovation theory

Nowadays, the market is getting competitive in all aspects of the survival of the company. Companies, especially in the service industry, realize that in order to win the market, they need to explore new ways of delighting customers. The airline industry has played a vital role in Indonesia's modern development and competitiveness. Fierce competition and shrinking profits have impelled the airlines to stress upon improving the quality of the services being provided to the passengers. Passengers have become very specific about their service needs and often tend to shift to others that pro-vide better services. Service quality has emerged as a critical consideration for airlines in the competitive global mar-ket, coinciding with Low-Cost Carriers' rapid proliferation (LCCs), bringing a paradigm shift in airline business strat-egy. Twenty-five service quality attributes identified through extensive literature review and results obtained through five modified AIRQUAL dimensions are fruitful for airline managers to address service quality issues. This paper aims to evaluate LCCs’ service quality in Indonesia using the Extenics innovation theory. The Extenics innovation theory is a kind of method with the combination of formalization, quantification, and logicalization. It is effectively applied to put forward creative ideas of new services of airlines. The concepts and principles of service attributes classification based on Extenics are also discussed. To consider interdependence and to calculate the relative importance of each criterion, the AHP method is applied. The study demonstrates and signifies that the Extenics theory and AHP method are promising and pragmatic evaluation model for customer-oriented airline strategic planning. This study has a number of practical implications for LCC airlines, its policy makers and managers. Findings of this study suggest that LCC airlines should focus on appropriate strategies for improving their customers’ satisfaction. Airlines should con-cern on service failures such as delays by providing extra customer care to supplement required material compensation and provide valuable objective feedback and information. A theoretical implication of this study is that Extenics inno-vation theory can classify and prioritize the service attributes of airlines. Further, the scope of future research works has been discussed at the end to conclude the paper.

The impact of improved water supply on cholera and diarrhoeal diseases in Uvira, Democratic Republic of the Congo: a protocol for a pragmatic stepped-wedge cluster randomised trial and economic evaluation

IntroductionDiarrhoeal disease remains a leading cause of mortality and morbidity worldwide. Cholera alone is estimated to cause 95,000 deaths per year, most of which occur in endemic settings with inadequate water access. Whilst a global strategy to eliminate cholera by 2030 calls for investment in improved drinking water services, there is limited rigorous evidence for the impact of improved water supply on endemic cholera transmission in low-income urban settings. Our protocol is designed to deliver a pragmatic health impact evaluation of a large-scale water supply intervention in Uvira (Democratic Republic of the Congo), a cholera transmission hotspot.Methods/designA stepped-wedge cluster randomised trial (SW-CRT) was designed to evaluate the impact of a large-scale drinking water supply intervention on cholera incidence among the 280,000 inhabitants of Uvira. The city was divided into 16 clusters, where new community and household taps will be installed following a randomised sequence over a transition period of up to 8 weeks in each cluster. The primary trial outcomes are the monthly incidence of “confirmed” cholera cases (patients testing positive by rapid detection kit) and of “suspected” cholera cases (patients admitted to the cholera treatment centre). Concurrent process and economic evaluations will provide further information on the context, costs, and efficiency of the intervention.DiscussionIn this protocol, we describe a pragmatic approach to conducting rigorous research to assess the impacts of a complex water supply intervention on severe diarrhoeal disease and cholera in an unstable, low-resource setting representative of cholera-affected areas. In particular, we discuss a series of pre-identified risks and linked mitigation strategies as well as the value of combining different data collection methods and preparation of multiple analysis scenarios to account for possible deviations from the protocol. The study described here has the potential to provide robust evidence to support more effective cholera control in challenging, high-burden settings.Trial registrationThis trial is registered on clinicaltrials.gov (NCT02928341, 10th October 2016) and has received ethics approval from the London School of Hygiene and Tropical Medicine (8913, 10603) and from the Ethics Committee from the School of Public Health, University of Kinshasa, Democratic Republic of the Congo (ESP/CE/088/2015).

Protocol for a two-arm pragmatic stepped-wedge hybrid effectiveness-implementation trial evaluating Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship (ENCOMPASS)

BackgroundSepsis survivors experience high morbidity and mortality, and healthcare systems lack effective strategies to address patient needs after hospital discharge. The Sepsis Transition and Recovery (STAR) program is a navigator-led, telehealth-based multicomponent strategy to provide proactive care coordination and monitoring of high-risk patients using evidence-driven, post-sepsis care tasks. The purpose of this study is to evaluate the effectiveness of STAR to improve outcomes for sepsis patients and to examine contextual factors that influence STAR implementation.MethodsThis study uses a hybrid type I effectiveness-implementation design to concurrently test clinical effectiveness and gather implementation data. The effectiveness evaluation is a two-arm, pragmatic, stepped-wedge cluster randomized controlled trial at eight hospitals in North Carolina comparing clinical outcomes between sepsis survivors who receive Usual Care versus care delivered through STAR. Each hospital begins in a Usual Care control phase and transitions to STAR in a randomly assigned sequence (one every 4 months). During months that a hospital is allocated to Usual Care, all eligible patients will receive usual care. Once a hospital transitions to STAR, all eligible patients will receive STAR during their hospitalization and extending through 90 days from discharge. STAR includes centrally located nurse navigators using telephonic counseling and electronic health record-based support to facilitate best-practice post-sepsis care strategies including post-discharge review of medications, evaluation for new impairments or symptoms, monitoring existing comorbidities, and palliative care referral when appropriate. Adults admitted with suspected sepsis, defined by clinical criteria for infection and organ failure, are included. Planned enrollment is 4032 patients during a 36-month period. The primary effectiveness outcome is the composite of all-cause hospital readmission or mortality within 90 days of discharge. A mixed-methods implementation evaluation will be conducted before, during, and after STAR implementation.DiscussionThis pragmatic evaluation will test the effectiveness of STAR to reduce combined hospital readmissions and mortality, while identifying key implementation factors. Results will provide practical information to advance understanding of how to integrate post-sepsis management across care settings and facilitate implementation, dissemination, and sustained utilization of best-practice post-sepsis management strategies in other heterogeneous healthcare delivery systems.Trial registrationNCT04495946. Submitted July 7, 2020; Posted August 3, 2020.

A pragmatic health centre-based evaluation comparing the effectiveness of a PCV13 schedule change from 3+0 to 2+1 in a high pneumococcal carriage and disease burden setting in Malawi: a study protocol

IntroductionStreptococcus pneumoniae (the pneumococcus) is commonly carried as a commensal bacterium in the nasopharynx but can cause life-threatening disease. Transmission occurs by human respiratory droplets and interruption of this process...

Pragmatic Evaluation of a Health System-Based Employee Weight Management Program.

Objective: We aimed to evaluate the fidelity and estimate the effectiveness of a novel health system employee weight-management program. Methods: Employees participating in a weight loss program consisting of self-monitoring, health coaching and meal replacements optionally enrolled in the 12-month study. Longitudinal, single-arm analyses were conducted evaluating change over time via survey, claims and programmatic data. Token participation incentives were offered for survey completion. Results: In total, 140 participants enrolled (51.2 ± 9.8 years; BMI = 33.2 ± 6.5 kg/m2; 89.3% female). During 1 year, participants attended 18.0 ± 12.2 coaching appointments and self-reported significant improvements in weight (−8.2 ± 10.5% body weight), BMI (−3.9 ± 6.5 kg/m2), fruit/vegetable intake, home food preparation, added sugar, sugar sweetened beverages and life satisfaction (all p < 0.05). No significant changes were reported in physical activity, weight-related social support, self-efficacy or healthcare utilization (all p > 0.05). Conclusions: The findings from this evaluation establish implementation fidelity. Clinically significant self-reported weight loss, coupled with improvements in many weight-related behaviors, suggest the program is an effective weight management tool when offered as an employee well-being program.

Popular digital knowledge dissemination platforms: Evaluating the pragmatic professional credibility from Wikipedia to Academia.edu and ResearchGate

This contribution discusses pragmatic linguistic aspects that indicate professional credibility in three popular digital knowledge dissemination platforms. Credibility here does not refer to the correspondence of platform content to ‘reality’, but to the pragmatic metalanguage interaction of researchers and platforms. Whereas Wikipedia is only a platform for distributing (multi-modal) information, Academia.edu and ResearchGate include a messaging system. Given their millions of users, all three systems include automated replies by (programmed) agents (bots), which can be classified as share, profit, and vanity agents – and only the first is usually perceived as a credible communication partner by a (linguistic) researcher. An analysis of pragmatic metalanguage (incl. interactive pronouns and reader address) makes this clear. Whereas Wikipedia only addresses its readers collectively in Wikipedia community style, Academia.edu and ResearchGate address their users individually; thus the first mentioned uses few personal pronouns, the latter many of them. For Academia.edu and ResearchGate, the internal platform structures and agents' email messages can be compared. A pragmatic corpus-linguistic evaluation of their (automated) language shows partly contrasting functions: some linguistic cues (e.g. modal auxiliaries) enhance the “sharing” community, others profit and vanity. For successful academic interaction, persuasive polite cooperation language contributes to the impression of credibility and professionalism.

Future and Development Direction of Digital Healthcare.

ObjectivesDigital healthcare is expected to play a pivotal role in patient-centered healthcare. It empowers patients by informing, communicating, and motivating them. However, a pragmatic evaluation of the present status of digital healthcare has not been presented; therefore, we aimed to examine the status of digital healthcare in Korea.MethodsThis article discusses digital healthcare, examples of assessment in Korea and other countries, the implications of past examples, and future directions for development.ResultsOver the years, various clinical studies have used clinical evidence to assess the feasibility of digital healthcare. If feasible, it is actually clinically effective. If it is effective, can it be commercialized at an acceptable cost? These questions have been investigated in various evidence-based studies. In addition, great efforts are being made to secure ample evidence to assess various aspects of digital healthcare, such as safety, quality, end-user experience, and equity.ConclusionsDigital healthcare requires a deep understanding of both the technical and medical aspects. To strengthen the competence of the medical aspect, medical staff, patients, and the government must work together with continuous interest in this goal.

Longitudinal cohort study on preoperative pain as a risk factor for chronic postoperative inguinal pain after groin hernia repair at 2-year follow-up.

To assess the rate of late chronic postoperative inguinal pain (CPIP) after groin hernia repair in patients with different categories of preoperative VRS (Verbal Rating Scale) pain and to make a pragmatic evaluation of the rates of potentially surgery-related CPIP vs. postoperative continuation of preexisting preoperative pain. Groin pain of patients operated from 01/11/2011 to 01/04/2014 was assessed preoperatively, postoperatively and at 2-year follow-up using a VRS-4 in 5670 consecutive groin hernia repairs. A PROM (Patient Related Outcomes Measurement) questionnaire studied the impact of CPIP on the patients' daily life. Relevant (moderate or severe VRS) pain was registered preoperatively in 1639 of 5670 (29%) cases vs. 197 of 4704 (4.2%) cases at the 2-year follow-up. Among the latter, 125 (3.7%) cases were found in 3353 cases with no-relevant preoperative pain and 72 (5.3%) in 1351 cases with relevant preoperative pain. Relevant CPIP consisted of 179 (3.8%) cases of moderate pain and 18 (0.4%) cases of severe pain. The rate of severe CPIP was independent of the preoperative VRS-pain category while the rate of moderate CPIP (3.1%, 3.4%, 4.1%, 6.8%) increased in line with the preoperative (none, mild, moderate, and severe) VRS-pain categories. The VRS probably overestimated pain since 71.6% of the relevant CPIP patients assessed their pain as less bothersome than the hernia. At the 2-year follow-up, relevant CPIP was registered in 4.2% cases, of which 63.5% were potentially surgery-related (no-relevant preoperative pain) and 36.5% possibly due to the postoperative persistence of preoperative pain. The rate of severe CPIP was constant around 0.4%.

Defining Data Quality in Bibliographic and Authority Records: A Case Study of the COBISS.SI System

Various studies have shown that low data quality in bibliographic and authority records is one of the main obstacles in data management. In order to evaluate and improve data quality in the Slovenian union bibliographic database (COBIB.SI), a pragmatic dimension-based data quality measurement and evaluation case study was carried out in 2019. The article presents the set-up and application of a methodological framework that was used for the definition and measurement of bibliographic and authority records quality in COBIB.SI. The results of the case study and the framework’s applicability in data quality measurement and evaluation, as well as in data profiling that would benefit further development of COBISS + catalog, are also discussed.

A Simulated Prospective Evaluation of a Deep Learning Model for Real-Time Prediction of Clinical Deterioration Among Ward Patients.

The National Early Warning Score, Modified Early Warning Score, and quick Sepsis-related Organ Failure Assessment can predict clinical deterioration. These scores exhibit only moderate performance and are often evaluated using aggregated measures over time. A simulated prospective validation strategy that assesses multiple predictions per patient-day would provide the best pragmatic evaluation. We developed a deep recurrent neural network deterioration model and conducted a simulated prospective evaluation. Retrospective cohort study. Four hospitals in Pennsylvania. Inpatient adults discharged between July 1, 2017, and June 30, 2019. None. We trained a deep recurrent neural network and logistic regression model using data from electronic health records to predict hourly the 24-hour composite outcome of transfer to ICU or death. We analyzed 146,446 hospitalizations with 16.75 million patient-hours. The hourly event rate was 1.6% (12,842 transfers or deaths, corresponding to 260,295 patient-hours within the predictive horizon). On a hold-out dataset, the deep recurrent neural network achieved an area under the precision-recall curve of 0.042 (95% CI, 0.04-0.043), comparable with logistic regression model (0.043; 95% CI 0.041 to 0.045), and outperformed National Early Warning Score (0.034; 95% CI, 0.032-0.035), Modified Early Warning Score (0.028; 95% CI, 0.027- 0.03), and quick Sepsis-related Organ Failure Assessment (0.021; 95% CI, 0.021-0.022). For a fixed sensitivity of 50%, the deep recurrent neural network achieved a positive predictive value of 3.4% (95% CI, 3.4-3.5) and outperformed logistic regression model (3.1%; 95% CI 3.1-3.2), National Early Warning Score (2.0%; 95% CI, 2.0-2.0), Modified Early Warning Score (1.5%; 95% CI, 1.5-1.5), and quick Sepsis-related Organ Failure Assessment (1.5%; 95% CI, 1.5-1.5). Commonly used early warning scores for clinical decompensation, along with a logistic regression model and a deep recurrent neural network model, show very poor performance characteristics when assessed using a simulated prospective validation. None of these models may be suitable for real-time deployment.

From Paper to E-Prescribing of Multidose Drug Dispensing: A Qualitative Study of Workflow in a Community Care Setting.

E-prescribing is now widespread and, in some countries, has completely replaced paper prescriptions. In Norway, almost all prescribing is electronic, except for multidose drug dispensing (MDD), which is still sent to the pharmacy by fax or ordinary mail. MDD is an adherence aid used by one-third of all patients receiving home care services. In this paper, we present results from a qualitative study evaluating the introduction of e-prescribing for MDD in a community health care setting. The focus is on the work and workflow for the pharmacists and nurses involved in the medication-handling process. We used the pragmatic process evaluation framework and the systematic text condensation method to analyse the data. We conducted 12 interviews with 34 nurses and pharmacists. This study shows that the e-prescribing of MDD led to greater integration between systems, both within the existing MDD system and across care levels, potentially improving patient safety. However, the structured prescriptions increased the need for clarifications, resulting in an increased overall workload. A greater understanding of the roles and responsibilities of the different professionals in the medication management chain and their needs would improve the workflow of the nurses and pharmacists involved.

Development and rapid evaluation of services to support the physical health of people using psychiatric inpatient units during the COVID-19 pandemic: study protocol

BackgroundPeople diagnosed with a serious mental illness have worse physical health and lower life expectancy than the general population. Integration of mental and physical health services is seen as one service development that could better support this. This protocol describes the evaluation of the provision of a Virtual Physical Health Clinic (VPHC) and Consultant Connect (CC) services to one UK-based mental health Trust.MethodsProspective, formative, pragmatic evaluation using both quantitative and qualitative techniques and driven by implementation science theoretical frameworks. The VPHC and CC are described along with the methodology being used to rapidly evaluate their implementation, effectiveness and potential economic impact in order to inform future roll out. We will assess the implementation process through quantitative data on uptake and reach and through self-reported data to be collected from interviews and the use of validated implementation outcome assessment measures. We will assess implementation strategies using the Expert Recommendations for Implementing Change (ERIC) strategies as a framework. We will assess the health economic impact of both services using established health economic methods including cost comparison scenarios and health service utilisation analyses.DiscussionSupporting the physical health management of people in psychiatric inpatient units is important in improving the physical health of this population. Integration of mental and physical health can help this to happen effectively. This initiative provides one of the first service evaluation protocols of its kind to be reported in the UK at the time of the COVID-19 pandemic.

Using Information Technology to Assess Patient Risk Factors in Primary Care Clinics: Pragmatic Evaluation

BackgroundTobacco use, physical inactivity, and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice, and support by a primary care provider lead to behavior change attempts among patients. However, although physicians consider preventative health important, there is often a larger focus on symptom presentation, acute care, and medication review.ObjectiveThis study evaluated the feasibility, adoption, and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics.MethodsThis is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. The RFIT was implemented in 2 primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation.ResultsClinicians reported a smooth and fast transfer of RFIT responses to an electronic medical record encounter note. The RFIT was used by 207 patients, with a completion rate of 86%. Clinic staff reported that approximately 3%-5% of patients declined the use of the RFIT or required assistance to use the tablet. Among the 207 patients that used the RFIT, 22 (12.1%) smoked, 39 (21.2%) felt their diet could be improved, 20 (12.0%) reported high alcohol consumption, 103 (56.9%) reported less than 150 minutes of physical activity a week, and 6 (8.2%) patients lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups.ConclusionsClinicians and clinic staff positively reviewed the use of information technology in primary care. Algorithmic information technology can collect, organize, and synthesize individual health information to inform and tailor primary care counseling to the patients’ context and readiness to change. The RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, the RFIT can inform brief interventions within primary care.

Developing a whole-school mental health and wellbeing intervention through pragmatic formative process evaluation: a case-study of innovative local practice within The School Health Research network

BackgroundThe evidence-base for whole school approaches aimed at improving student mental health and wellbeing remains limited. This may be due to a focus on developing and evaluating de-novo, research-led interventions, while neglecting the potential of local, contextually-relevant innovation that has demonstrated acceptability and feasibility. This study reports a novel approach to modelling and refining the programme theory of a whole-school restorative approach, alongside plans to scale up through a national educational infrastructure in order to support robust scientific evaluation.MethodsA pragmatic formative process evaluation was conducted of a routinized whole-school restorative approach aimed at improving student mental health and wellbeing in Wales.ResultsThe study reports the six phases of the pragmatic formative process evaluation. These are: 1) identification of innovative local practice; 2) scoping review of evidence-base to identify potential programme theory; outcomes; and contextual characteristics that influence implementation; 3) establishment of a Transdisciplinary Action Research (TDAR) group; 4) co-production and confirmation of an initial programme theory with stakeholders; 5) planning to optimise intervention delivery in local contexts; and 6) planning for feasibility and outcome evaluation. The phases of this model may be iterative and not necessarily sequential.ConclusionsFormative, pragmatic process evaluations can support researchers, policy-makers and practitioners in developing robust scientific evidence-bases for acceptable and feasible local innovations that do not already have a clear evidence base. The case of a whole-school restorative approach provides a case example of how such an evaluation may be undertaken.

The effect of age on the degree of improvement of pragmatics in delayed language developed children

Background The study of actual language use is called “pragmatics.” The literal meaning of an utterance is necessary, but not sufficient for the partner to reconstruct the meaning conveyed by the actor. The interventions of pragmatic impairments depend mainly on improving the four important aspects for any effective social communication contexts that are social interactions, social cognition, language processing, and pragmatic skills.Aim The paper aims to study the effect of age on pragmatic intervention to decide what age is more appropriate to give the better response of pragmatic impaired children.Patients and methods This study was conducted on 20 children with pragmatic impairments attending the Unit of Phoniatrics, in the outpatient clinic of Alexandria Main University Hospital. The children of the study were divided into two groups: group A: 10 children with pragmatic skill impairments aged (5–<6.5) years old and group B: 10 children with pragmatic skills impairments aged (6.5–8) years old. First, Initial assessment: (A) elementary diagnostic procedures: history taking, general examination. (B) Clinical diagnostic aids: psychometric evaluation, Arabic language test, and pragmatic language skills evaluation by using the Arabic version of Test of Pragmatic Language second edition, which is a subtest of Comprehensive Arabic language test. Second, Intervention: the program was applied to all children in groups of 2–3 children, one session per week, each session ranging from 45 to 60 min. Two types of interventions were applied which were: (a) direct intervention: typically delivered by speech-language pathologist and (b) indirect interventions: typically consisted of advices and instructions to the parents or to support the generalization of social communication skills in the child’s environment. “Say and Do Positive Pragmatic Fun Sheets” program helps children learn to use appropriate social communication skills in everyday situations. The fun sheets target a variety of social communication skills in the following areas: giving information, persuasion, requesting, problem solving, feelings, appropriate interaction, greetings/politeness, and topic maintenance. The duration of therapy was about 3–6 months. Third, Reevaluation: after a period of 3–6 months of therapy using the protocol of initial assessment.Results A statistically highly significant increase in the scores of the cases of the school-age studied groups A and B was seen when comparing between pre- and posttherapy, and no statistically significant difference when comparing posttherapy scores between the two studied groups.Conclusion There is no difference in improvement degree of pragmatics in the two age groups so starting therapy can be done at any age to improve the pragmatic skills of children.