Evaluation Process Research Articles

Effect of Fines Content on Cyclic Strength Development of Sand–Clay Mixtures under Cyclic Loading: A Process Evaluation Using Energy Methods

Effect of Fines Content on Cyclic Strength Development of Sand–Clay Mixtures under Cyclic Loading: A Process Evaluation Using Energy Methods

Clinical skills examination as part of the Swedish proficiency test of dentists educated outside of the EU/EEA.

The increase in the migration of dentists educated outside the EU/EEA calls for the sharing of information and evaluation of recognition processes within countries in the EU. In 2017, the Swedish National Board of Health and Welfare implemented the Proficiency test, a recognition process for dentists who have completed an education programme outside the EU/EEA. The Proficiency test consists of a theoretical and an integrated clinical skills examination, followed by a 6-month clinical practice. The clinical skills examination is a two-part examination that includes an OSCE and an operative test on a dental manikin. This paper presents data from proficiency tests between 2018 and 2022, and explores factors related to grade fail, that is, demographics, theoretical exam scores and language comprehension. In a cohort study, demographics and factors associated with grade fail were explored using test results from theoretical and clinical skills examinations (n = 181) from 2018 to 2022. Pearson correlation coefficient and linear regression analysis were used for studying correlations and associations between exam results. Univariable linear and logistic regression models were used for background variable associations with clinical skills exam outcomes. Higher age was a significant risk factor for failing the clinical skills examination and the OSCE. Higher scores in the theoretical exam reduced the odds of failing the OSCE but were not associated with results in the operative test or the overall results of the clinical skills examination. Regarding the OSCE there was a statistically significant difference within all professional qualifications explored between participants who passed and participants who failed the OSCE. Four years of data collection reveal that age and previous theoretical exam results influence the odds of failing the clinical examination. The study results also highlight the necessity of multiple assessment formats to assess clinical and communication skills of foreign-trained dentists.

Lessons learned from implementing a digital rehabilitation care planning platform to improve care access for patients with work disability: qualitative process evaluation of the RehaPro-SERVE study

BackgroundInpatient rehabilitation therapies can be applied for in Germany by patients of working age to support their return to work. However, there are some problems that impede an easy and uncomplicated application process. An interdisciplinary case management approach for rehabilitation care planning was developed to facilitate the access to rehabilitation. Case conferences (CCs) were held with relevant stakeholders and took place on a digital communication platform. We conducted a qualitative process evaluation to understand the implementation of the intervention and to identify contextual factors as well as mechanisms for a successful implementation in the context of primary care.MethodsThe process evaluation included interviews with primary care physicians (PCPs), patients and stakeholders involved in the intervention process. Reflexive thematic analysis was used to analyse the data. Emerging themes were structured according to the Donabedian framework of structure, process and outcomes.ResultsA total of 18 interviews were conducted. Important results included the desire for more patient involvement and case management. Patients especially valued the opportunity to receive support from a social worker. Limitations of the platform related to usability and limited opportunities for stakeholder communication. Despite training for PCPs, several problems arose regarding the clarity of the intervention process. Patients were satisfied with their application process and the treatments offered, while PCPs reported an increase in workload.ConclusionsA digitalisation of the application procedure for rehabilitation and further treatment options is acceptable to patients and personal support of a social worker is particularly valued. However, patients should be included in the CC in terms of a shared decision-making process. The digital platform requires sufficient training and adjustments have to be made to enhance usability and to improve the efficiency of the process for PCPs. Overall, the exchange between the various stakeholders in the CC is considered particularly useful in more complex cases.Trial registrationDRKS German Clinical Trials Register, DRKS0 00242 07. Registered on 22 March 2021.

A neural network approach for unstructured mesh quality evaluation

PurposeThe quality of the unstructured mesh has a considerable impact on the stability and accuracy of aerodynamic simulation in computational fluid dynamics (CFD). Typically, engineers spend a significant portion of their time on mesh quality evaluation to ensure a valid, high-quality mesh. The extensive manual interaction and a priori knowledge required to undertake an accurate and timely evaluation process have become a bottleneck in the idealized efficient CFD workflow. This paper aims to introduce a neural network-based quality evaluation approach for unstructured meshes to enable higher efficiency and the level of automation.Design/methodology/approachThe paper investigates the capability of deep neural networks for the quality evaluation of unstructured meshes. For training the network, we build a training dataset for mesh quality learning algorithms. The dataset contains a rich variety of unstructured aircraft meshes with different mesh sizes, densities, cell distribution, growth ratios and cell numbers to ensure its diversity and availability. We also design a neural network, AircraftNet, to learn the effect of mesh quality on the convergent properties of the numerical solutions. The proposed network directly manipulates raw point data in mesh source files rather than passing it to an intermediate data representation. During training, AircraftNet extracts non-linear quality features from high-dimensional data spaces and then automatically predicts the overall quality of the input unstructured mesh.FindingsThe paper provides a series of experimental results on GPUs. It shows that AircraftNet is able to effectively analyze the quality-related features like mesh density and distribution from the extracted features and achieve high prediction accuracy on the proposed dataset with even a small number of training runs.Research limitations/implicationsBecause of the limited training dataset, the research results may lack generalizability. Therefore, researchers are encouraged to test the proposed propositions further.Originality/valueThe paper publishes a benchmarking dataset for mesh quality learning algorithms and designs a novel neural network approach for unstructured mesh quality evaluation.

Hypoglycaemia Prevention, Awareness of Symptoms, and Treatment (HypoPAST): protocol for a 24-week hybrid type 1 randomised controlled trial of a fully online psycho-educational programme for adults with type 1 diabetes

BackgroundManagement of type 1 diabetes (T1D) requires the use of insulin, which can cause hypoglycaemia (low blood glucose levels). While most hypoglycaemic episodes can be self-treated, all episodes can be sudden, inconvenient, challenging to prevent or manage, unpleasant and/or cause unwanted attention or embarrassment. Severe hypoglycaemic episodes, requiring assistance from others for recovery, are rare but potentially dangerous. Repeated exposure to hypoglycaemia can reduce classic warning symptoms (‘awareness’), thereby increasing risk of severe episodes. Thus, fear of hypoglycaemia is common among adults with T1D and can have a negative impact on how they manage their diabetes, as well as on daily functioning, well-being and quality of life. While advances in glycaemic technologies and group-based psycho-educational programmes can reduce fear, frequency and impact of hypoglycaemia, they are not universally or freely available, nor do they fully resolve problematic hypoglycaemia or associated worries. This study aims to determine the effectiveness of a fully online, self-directed, scalable, psycho-educational intervention for reducing fear of hypoglycaemia: the Hypoglycaemia Prevention, Awareness of Symptoms, and Treatment (HypoPAST) programme.MethodsA 24-week, two-arm, parallel-group, hybrid type 1 randomised controlled trial, conducted remotely (online and telephone). Australian adults (≥ 18 years) with self-reported T1D and fear of hypoglycaemia will be recruited, and allocated at random (1:1) to HypoPAST or control (usual care). The primary outcome is the between-group difference in fear of hypoglycaemia (assessed using HFS-II Worry score) at 24 weeks. A sample size of N = 196 is required to detect a 9-point difference, with 90% power and allowing for 30% attrition. Multiple secondary outcomes include self-reported psychological, behavioural, biomedical, health economic, and process evaluation data. Data will be collected at baseline, 12 and 24 weeks using online surveys, 2-week ecological momentary assessments, website analytics and semi-structured interviews.DiscussionThis study will provide evidence regarding the effectiveness, cost-effectiveness and acceptability of a novel, online psycho-educational programme: HypoPAST. Due to the fully online format, HypoPAST is expected to provide an inexpensive, convenient, accessible and scalable solution for reducing fear of hypoglycaemia among adults with T1D.Trial registrationAustralian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000894695 (21 August 2023).

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.

A Process Evaluation in a Randomized Controlled Trial among Adults with Acetabular Dysplasia

Abstract Introduction The 2021 framework from the UK’s Medical Research Council defines evaluation as a theory-driven approach to examine how well an intervention works. However, the application of these guidelines can be challenging. Therefore, using a process evaluation case study on an exercise and patient education intervention for adults with acetabular dysplasia, we reflect on which specific aspects were relevant for the evaluation of the intervention and why. We focus on detailing methods to assess implementation (process, dose, reach), acceptability, mechanisms of change, and the impact of contextual factors. Methods Two hundred trial participants aged 18-50 years will be recruited from a University Hospital in Denmark and randomised to intervention and control groups. The process evaluation adopts a concurrent mixed-methods design involving self-report questionnaires at baseline and 6-month follow-up, training records and semi-structured focus groups with intervention providers (n = 10) and healthcare managers (n = 4-6). The mechanisms of change will be explored through semi-structured one-to-one interviews (at baseline and 6-month follow-up) with 15-20 purposefully sampled trial participants, and additionally, through exploratory examinations of associations between dose and change in health outcomes at 6-month follow-up), via simple linear regression models. The acceptability and contextual factors will be explored through one-to-one participant interviews, plus focus groups with 4-6 healthcare managers. Thematic analyses of the interviews will focus on expectations, experiences, events, personal understandings and interpersonal and organisational interactions. Conclusions The presentation will explore how the operational aspects of the intervention can be assessed through a process evaluation and how these findings may improve and expand any future implementation efforts.

An evaluation over time: Dipsalut’s “Program for families”

Abstract Issue Dipsalut’s “Program for Families” is a parental skills and positive parenting program aimed at all fathers, mothers, and other adult caregivers of children aged 3 to 12 in the province of Girona, Spain. The Program is based on the Convention on the Rights of the Child (1989), which recommends that states promote programs that develop parenting styles that respect children’s rights to be heard and recognized. Research supports that offering parenting skills to parents contributes to the child’s well-being throughout the growth stage. Description The program began in 2018 in a pilot phase that lasted until 2019, when the first evaluation was done to compare different methodologies. After selecting a definitive one (based on the method of Adele Faber and Elaine Mazlish), in 2023, an external evaluation was done, with a follow-up of participants from previous editions. In this evaluation process, we considered the durability of the contents over time, evolutions of assistance, and comparison of the modalities of 4 and 6 sessions. A quantitative methodology has been used through a self-administered questionnaire addressed to the participants (387 responses). Results Impact of the program: 78% of parents value the program as having a positive impact on their parenting skills. Durability: there are differences in how the passage of time affects content retention. Impact of attendance: the parenting skills of those who have attended all program sessions last longer. The attendance percentage at all sessions was higher (61.4%) in the four-session modality. Lessons Although families do not remember all the tools learned, their confidence, the improvement in the family atmosphere, and the fact that they feel more skilled are maintained over time. Main messages: Families have improved their parenting skills since the program gives them more tools to manage family conflicts, to promote their children’s self-esteem and to encourage their autonomy. Key messages • With the positive parenting program, parents increase their self-confidence to manage the challenges of parenting, especially in intra-family communication and conflict management. • It is essential to promote positive parenting programs with an experiential methodology and maintained over time.

Social prescribers’ referral processes and decision-making about healthy eating and physical activity

Abstract Background Social Prescribing (SP) connects primary care patients with non-medical sources of support within the community. There are various SP models, with different referral routes. Many involve patients being referred to a link practitioner, who considers their needs and then “prescribes” or links them to appropriate local support services or resources, typically provided by the third sector. The present study aimed to explore the SP process and the decision-making of link practitioners, particularly around food and physical activity practices. Methods Sixteen semi-structured interviews were conducted with link practitioners working across Aberdeen City. A pragmatic Thematic Framework analysis was undertaken. Findings Participating link practitioners described their approach with clients as building rapport and trust while maintaining boundaries and managing expectations, and their community role as resource mapping and networking. Three broad categories of factors were considered during referral: 1) practicality (e.g., location, transport, cost, mobility, availability), 2) clients’ engagement (e.g., interest, motivation, readiness for change), and 3) link practitioners’ past experiences with services. Challenges identified included navigating waiting lists and service limitations, clients’ engagement and expectations, under-resourced services, navigating waiting lists with caseloads and the emotional burden of seeing people in very difficult situations. All link practitioners considered diet and exercise to fit within the remit of social prescribing but emphasised that clients should lead this discussion. Dietary support via social prescribing typically revolved around poverty rather than health. Discussion The study provides insight into the practical reality of making social prescribing decisions and has the potential to inform training and evaluation processes and support the development of health-focused social prescribing lifestyle interventions. Key messages • Social prescribing – a personalised approach, with clients supported to identify and achieve their health and wellbeing goals based on their strengths and resources available in the local community. • Social Prescribing - a promising platform for offering healthy eating interventions tailored to individual needs.

Inclusive Life Projects for people with Serious Mental Disorder and/or addictions

Abstract Project “Inclusive Life Projects” offers comprehensive and community care to people with SMD/A within projects of autonomous living, which provide a concrete and real response to their needs, with the ultimate objective of avoiding the risk of institutionalization. Currently, 26 actions have been designed and are being implemented within JA ImpleMENTAL pilot in five municipalities in the Region of Murcia: Caravaca, Cartagena, Lorca. Molina de Segura and Yecla with a participation of 50 people with SMD/A. The following elements are selected from the Belgian good practice: • Creation of local intersectoral networks promoting person-centered care process; • Personalization of care through the Individualized Care Plan, responding to the needs, and desires of people with SMI/A, activating the appropriate support; • Professional case manager. It generates the well-being of people on an empathy and trust basis and articulates coordination so that the agreed Plan can be developed as planned. A strategic and support coordination tool for action and facilitation of institutional support, the Social and Health Coordination Protocol for people with SMI/A, has been developed. The protocol facilitates the creation of coordination structures, among them the Socio-Health Coordination Base Teams stand out, teams made up of professionals from the different agents involved, multi-professional and intersectoral, (Mental Health, Primary Health Care, Social Services, Social Initiative) taking into account the needs of the person. It also serves to share information, detect training needs, influence resources, etc. PETRA, a computer platform, has been developed for sharing information between the systems involved, especially the health system and the social services system, both primary care, hospital care and specialized care. It allows the exchange of information, in real time, between professionals, the planning of actions, and the design of indicators and control and evaluation processes.

Development of an assessment process for digital medical devices in Austria

Abstract Issue/problem Digital medical devices have experienced a rapid development in recent years and are playing an increasingly important role in healthcare. These devices offer numerous benefits and can improve patient care. However, despite their potential benefits, the use of digital medical devices also poses risks and regulation from governmental side is needed from a Public Health Perspective. This is why some countries already implemented assessment processes for Digital Medical Devices (e.g. Germany and France) leading to the question how such a process could be established in Austria too. Description of the problem While digital medical devices must fulfil requirements set by the medical device regulation to enter market, several other aspects are of interests when offering digital medical devices in routine care. These include e.g. medical effectiveness, data security and interoperability. The objective of the ongoing pilot project is to develop a process for the assessment of quality-assured digital medical devices in Austria in 2024. For this, a combination of literature research, interviews and workshops with relevant stakeholders is used in order to gain all necessary information. Process and assessment criteria will be tested and revised in a pilot phase with several digital medical devices. Results At the end of the project, an assessment framework as well as a potential evaluation process will be designed in accordance with relevant stakeholders. Moreover, legals aspects and the potential integration into the austrian health telematics infrastrucutur will be assessed. This will form a basis for implementing digital medical devices within the austrian healthcare system. Key messages • The result of this project aims to build the basis for implementing an evaluation process for digital medical devices in Austria. • The establishment of an evaluation process for digital medical devices supports the integration of quality assured digital medical devices in healthcare.

Holistic Approach to Strategic Management in Islamic Education

This study aims to analyze the strategic management of Islamic education through the process of formulation, implementation, monitoring, and evaluation. The methodology used is qualitative research with data collection techniques in the form of in-depth interviews, observations, and document analysis. The results of the study indicate that the process of formulating strategies in Islamic education involves identifying clear visions, missions, and objectives, as well as analyzing the internal and external environment. Implementation of strategies is carried out through the preparation of work programs, allocating resources, and developing appropriate curriculum. Monitoring and evaluation are carried out periodically to ensure the achievement of objectives and make improvements if necessary. The conclusion of this study is that effective strategic management in Islamic education requires careful planning, consistent implementation, and continuous evaluation. The recommendations given include: (1) strengthening the managerial capacity of Islamic education leaders, (2) increasing stakeholder participation in the planning and evaluation process, and (3) developing a management information system that supports appropriate decision making

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

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

SustentAÇÃO: E-learning training on food sustainability for teachers in the Lisbon Metropolitan Area

Abstract Background It is essential to address food sustainability (FS) within the school community to enhance both public and environmental health. In Portugal, in the scope of AML Alimenta, teachers’ training on FS was identified as a priority. Therefore, local partners along with academia developed, implemented, monitored, and evaluated the SustentAÇÃO. Objectives SustentAÇÃO aimed to empower school teachers in the Lisbon Metropolitan Area to teach students between 6 and 14 years old on FS. The program consisted of 10 hours of asynchronous online learning (MoodleTM), structured in 4 modules, and 10 hours of autonomous learning (5 students’ educational sessions), offering autonomy and flexible time management. The contents were adapted for different age groups. The teacher’s performance was monitored and evaluated continuously. A process evaluation was conducted for both teachers and students. Results Of the 79 teachers enrolled, 47% completed the program. Teachers’ performance (0-20) on the 4 evaluation questionnaires was on average 17,9±3,13. Most teachers found the program benefited their work (94%) and considered it essential for enhancing student’s knowledge (98%). Considering overall satisfaction, 85% of teachers were satisfied or very satisfied with the training and 91% would recommend it to their colleagues. Additionally, 86% of students enjoyed the activities delivered, 76% considered that they were wasting less food, and 78% believed they had improved their ability to make healthier and more sustainable food choices. Conclusions Through a collaborative work between local partners and academia, an innovative e-learning training programme on FS was developed, implemented, monitored, and evaluated, responding to the local needs identified. SustentAÇÃO complies with national education guidelines and contributes to the sustainable development goals agenda. Key messages • SustentAÇÃO E-learning training highlights the importance of collaborative work, based on an initial assessment to target local needs. • SustentAÇÃO E-learning training improve teachers’ knowledge on FS and benefit their students.

An integrated work health intervention among cleaners in Denmark

Abstract Introduction Work-related diseases are increasing and considered a global health challenge. Meanwhile, work-related risk factors and diseases are not equally distributed across occupational groups. Previous work health interventions have not succeeded in reducing the prevalence of work-related diseases. Therefore, integrated approaches combining prevention of disease and promotion of health in work health interventions have been developed. The aim of the Integrated Approach to Health, Wellbeing, and Productivity at Work (ITASPA) intervention was to prevent work-related injuries and diseases and promote the health, safety and wellbeing of cleaners. Methods The ITASPA intervention was implemented at two Danish workplaces among cleaners. At each workplace a committee of employees was established to develop their own initiatives to promote the health of the workers. By use of the British Medical research Council’s framework, a process evaluation was conducted. Qualitative data (focus group interview and field notes) and quantitative data (questionnaires) of participants evaluated the implementation. Results A total of 91 cleaners participated in health checks, and three workshops were held at each workplace. The development and implementation of activities was affected by mechanisms, such as lack of information about the intervention, new power dynamics, and lack of motivation for behavior changes, and contextual factors, such as many replacements, time pressure and absence of managers. Conclusions Integrated approaches in work health interventions among employees with short or no education may positively impact employees’ health, wellbeing and safety if comprehensively implemented. However, attention should be drawn to interventions that adapt a participatory design, as unintended power dynamics may occur when employees are given the tasks of implementing behavior changes among colleagues. The role of managers to obtain successful implementation should be highlighted.

In development intervention, professionals aim to enhance working practices and interaction

Abstract Background The social services and healthcare professions are experiencing a global labor shortage. Enhancing the appeal and retention requires the development of work and processes through community-level interventions that reduce workload and bolster resources. Further research into such interventions is necessary. This study focuses on a systematic community-based practice development model (Breakthrough Collaboratives) to evaluate the change in alignment with the development intervention’s objectives and the prerequisites for change. The evaluation will utilize the process evaluation model for well-being at work projects and health promotion interventions. Methods This qualitative process evaluation employs a multi-case study approach to depict the changes occurring during the development intervention. It assesses the development processes of fifteen workplaces across Finland. The research material includes recorded group discussions from the initial workshop, where professionals establish goals and development targets for their work. The qualitative data are analyzed using content analysis. The analysis is guided by questions such as: What goals and development objectives do participants set for their work? What workplace-specific characteristics inform these objectives? Results Preliminary findings indicate that the work units’ development objectives concentrate on updating the unit’s common rules, enhancing the induction process for new employees, improving work behavior, and refining meeting practices. Workplace-specific characteristics differ based on the work unit’s sector, the level of trust among professionals, and their willingness to critically evaluate management. Additionally, competence and professionalism emerge as prominent themes in group discussions. Conclusions In a workplace development intervention, professionals aim to enhance common working practices and interaction, with the goal of improving well-being at work. Key messages • Enhancing operational practices and promoting positive interpersonal conduct among colleagues constitutes a pivotal goal in advancing social and health care work units. • The Community based intervention provides workplaces with concrete models to support co-creation and permanent changes in working practices.

A process evaluation of a LifeLab Dublin; an interactive health literacy intervention

Abstract The argument for targeting adolescent health has been made strongly, with poor lifestyle behaviours often emerging during this life stage. Furthermore, there is consistent evidence of a widening socioeconomic gap in health indicators. Developing health literacy (HL) in youth populations to improve lifelong health behaviours has garnered increased interest in recent years. This 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 students aged 11 - 13. The health issues targeted were previously identified by the teachers and students of the target population, and the learning activities within the out-of-school experiences were co-designed by adolescents of a similar demographic. Overall, the intervention was perceived positively by the students and teachers, particularly the two interactive out-of-school experiences. The teachers, however, highlighted issues with the volume and content of the school-based lessons, resulting in a reduced number of lessons being delivered. The fidelity of the two LifeLab experiences was high, demonstrating that the students engaged well with the learning activities and that the experience aligned with LifeLab’s core principles and underpinning theoretical constructs. The findings from this study highlight the value in implementing experiential style learning in school-based HL education and the benefit of involving participants in the design of intervention. The evaluation provided valuable insight into the refinements required to enhance the efficacy of the intervention, as well as providing an evidence-base to inform future school-based HL interventions for low socioeconomic adolescents. Key messages • The benefit of adopting experiential style health literacy education with young people. • The benefit of including young people in the design of a health literacy intervention.

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

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

Revisiting values in evaluation: exploring the role of values in shaping evaluation practices and their influences on decision-making within English higher education providers

AbstractTheoretical and empirical contributions to research on evaluation have advanced our understanding of how values influence evaluation practice. Yet rather than understand how values shape evaluation and its use, research on the evaluation of widening participation (WP) programmes delivered by English higher education (HE) providers has focused on methodological deficits. Rather, this study explores the complexity of how national policy, organisational imperatives and the individual values of staff responsible for WP within HE providers influence how evaluation is practised and used to inform decision-making. The results of semi-structured interviews with 17 staff members spanning the organisational hierarchy of three diverse English HE providers highlight conflicts between staff values, job roles and responsibilities and espoused organisational values, and how they can influence symbolic and legitimising evaluation practices. Alternatively, at the individual level staff values support the process and instrumental use of evaluation to inform programme improvements. The findings identify implications for how HE providers can shape their evaluation systems, and how staff choose to enact evaluation within their programme areas.

Patient engagement in pulmonary embolism research: Insights form the Attend-PE study

Abstract Background There is growing recognition of the significance of a close collaboration between patients, clinicians, and researchers to ensure that research and health service delivery effectively meets the needs of end users [1-3]. However, there is limited understanding of best practices for patient engagement in research among patients with venous thromboembolism, and there is sparse knowledge about challenges to and facilitators of this process [4, 5]. Purpose To describe and explore the process and evaluate the impact of patient engagement in the development of a structured nurse-led post pulmonary embolism care model (the Attend-PE model). Method This prospective embedded case study of patient engagement was conducted within the research project - A structured Integrated post Pulmonary Embolism care model (Attend-PE). The study was based on documents from patient journey mapping (PJM), documents and field notes from workshops, and semi-structured interviews with two patients with pulmonary embolism, two clinicians working with pulmonary embolism patients and the Attend-PE researchers. Data were analyzed based on research questions guided by the United Kingdom six Standards for Public Involvement; Inclusive opportunities, Working together, Support & learning, Governance, Communications and Impact [6]. Result Patients played a crucial role throughout the entire Attend-PE study, contributing to research questions, design, execution, and dissemination, as illustrated in Figure 1. The patients were involved at a higher engagement level in the co-creation of the Attend-PE model and co-creation of patient education and information material. Comparatively the engagement level was lower in decisions regarding outcomes, feasibility testing and implementation of the Attend-PE model, as shown in Figure 2. Notably, despite lower engagement level, the continuous involvement in the research process was invaluable to the patients. This ensured that they maintained insight in the research process, even though their contributions varied in the different phases. Important facilitators of patient engagement within the Attend-PE were related to "Inclusive opportunities" and "Support and learning". Patients highlighted the importance of being a part of the process, working together as a team, and being prepared for the work. Important challenges to patient involvement related to "Communication" and "Governance", including lack of expectation alignment and communication regarding clinical elements where clinicians often dominated the discussions. Conclusion Patient involvement has been invaluable in the development of a structured nurse-led post pulmonary embolism care model. Further, patients will be involved in evaluation of the national implementation process and dissemination of study results.Figure 1Figure 2