Programming Theory Research Articles

Обеспечение "функциональности" систем управления охраной труда: действующий обзор стандарта OHSAS 18001

Over the past decade, an increasing number of studies have yielded results on many aspects of occupational health and safety management systems, however, a review of scientific results does not provide an unambiguous sample. We eliminate this gap in the study with a realistic review of the mechanisms of occupational health and safety management systems (OSMS). After a thorough literature search, 14 articles with empirical studies were selected for the review, which we used as a realistic synthesis procedure for analyzing software theories and for analyzing context-mechanism-result (CMR) configurations. OHSAS System Analysis Standard 18001 describes three program theories: operational, institutional, and compliance. Five CMR configurations confirm the program's theories: integration, learning, motivation, translation, and attention. The configurations emphasize that certain combinations of context and mechanisms are necessary for the successful application of the QMS. Therefore, we describe specific ways to successfully implement the «Certified Occupational Health and Safety Management Systems» (SSMSS), as well as internal contextual elements. Thus, the conducted research can be used by organizations as a basis for a thorough internal assessment before the implementation of the standardization system. However, additional research is needed for a more detailed understanding of how to ensure a successful result, and for the functioning of the new ISO 45001 standard

Mechanisms behind gender transformative approaches targeting adolescent pregnancy in low- and middle-income countries: a realist synthesis protocol

IntroductionAdolescent pregnancy is defined as pregnancy at the age of 19 or below. Pregnancy and childbirth complications are the most significant cause of death among 15–19-year-old girls. Several studies have indicated that inequitable gender norms can increase the vulnerability of adolescent girls, including violence exposure, early marriage, and adolescent pregnancy. To address these disparities, gender transformative approaches aim to challenge and transform restrictive gender norms, roles, and relations through targeted interventions, promoting progressive changes. This realist review aims to synthesise existing evidence from a broad range of data sources to understand how, why, for whom, and in what contexts gender transformative approaches succeed in reducing adolescent pregnancy in low- and middle-income countries.Method and analysisWe employ a five-step realist synthesis approach: (1) clarify the scope of review and assessment of published literature, (2) development of initial programme theories, (3) systematic search for evidence, (4) development of refined programme theories, and (5) expert feedback and dissemination of results. This protocol presents the results of the first three steps and provides details of the next steps.We extracted data from 18 studies and outlined eight initial programme theories on how gender transformative approaches targeting adolescent pregnancy work in the first three steps. These steps were guided by experts in the field of sexual and reproductive health, implementation science, and realist methodology. As a next step, we will systematically search evidence from electronic databases and grey literature to identify additional studies eligible to refine the initial programme theories. Finally, we will propose refined programme theories that explain how gender transformative approaches work, why, for whom, and under which circumstances.Ethics and disseminationEthics approval is not required because the included studies are published articles and other policy and intervention reports. Key results will be shared with the broader audience via academic papers in open-access journals, conferences, and policy recommendations. The protocol for this realist review is registered in PROSPERO (CRD42023398293).

Codeveloping theories of change for improved community-based violence intervention evaluation.

Community-based violence intervention (CVI) programs are considered important strategies for preventing community violence and promoting health and safety. Mixed and inconclusive results from some prior CVI evaluations, as well as our general lack of understanding about the reasons for such varied findings, may be explained in part by misalignment of program theories of change and evaluation measures. Furthermore, most prior evaluations have focused solely on deficit-based outcomes; this narrow focus is inconsistent with the premise of CVI and may fail to capture improvements in health and well-being that are on the hypothesized pathway from intervention to violence reduction. This article describes the process and results of codeveloping a theory of change for community-based youth firearm violence intervention and prevention programs in Washington state through a community-researcher partnership. We followed a multistep iterative process, involving (1) CVI program documentation review, (2) individual meetings, and (3) a day-long workshop. The theory of change included six key domains: (1) root causes, (2) promotive factors, (3) activities, (4) intermediate outcomes, (5) longer-term outcomes, and (6) multilevel context (youth/family, staff/organizational, community, and societal). Root causes were social and structural drivers of community violence. Promotive factors were assets and resources among the community, youth/their families, and community organizations that promote health and safety. Activities were supports and services the program provided to youth and their families, staff, and, potentially, the broader community. Intermediate and longer-term outcomes were the changes among youth, their families, staff, and the community that resulted from program activities. Intermediate outcomes may be felt within 6 months to 1 year, and longer-term outcomes may be felt after 1 to 2 years and beyond. The theory of change we codeveloped provides a common lens to conceptualize, compare, and evaluate CVI programs in Washington state and may support more rigorous and equity-centered evaluations. Diagnostic Test/Criteria; Level V.

The Use of Vignettes to Improve the Validity of Qualitative Interviews for Realist Evaluation.

Although realist evaluation (RE) requires multiple data collection methods, qualitative interviews are considered most valuable and are most frequently used. The guiding principles of RE may limit the emergence of new Context-Mechanism-Outcome (CMO) configurations by evoking particular underlying mechanisms. This paper proposes a new method for conducting semi-structured interviews in the RE context by drawing on the literature and examining the ability of vignettes to explore perceptions about specific situations. Vignettes are developed based on researchers' knowledge of the setting and program theory and are updated through an iterative process throughout data collection. Interviews focus on situations illustrated in the vignette to capture variations in interviewees' perceptions. This method constrains interviewees to using retroduction to identify the hidden underlying mechanisms that link contextual elements to outcomes based on their experiences. This method allows researchers to focus on CMO configurations without evoking mechanisms, which contributes to the rigor of the method.

Exploring accessible, inclusive and sustainable simulation-based education in remote and rural communities: a realist review

Access to and inclusion in simulation-based education (SBE) for remote and rural (RR) healthcare practitioners, irrespective of geographic setting, professional background and workplace context, is challenging. This challenge is compounded because simulation in healthcare education is acknowledged as a complex intervention, and healthcare systems are in and of themselves complex. A realist review of published and grey literature was conducted, seeking to identify programme theories and to explore what works, how and why, in respect of mobile and distance SBE for healthcare practitioners in RR and harder-to-reach communities. There is limited rigorous research in this field. Mobile and distance simulation programmes exist in physical, digital and hybrid forms. This makes simulation more accessible and inclusive for RR healthcare professionals in respect of facilitating simulation. It allows for clinical and simulation centres of expertise to collaborate with harder-to-reach communities enabling the contextualizing of learning with, from and about the needs of a target population. However, the challenges of implementing and sustaining mobile and distance simulation interventions are underexplored. Mobile and distance programmes of SBE are introduced into and are subject to dynamic and heterogeneous social contexts. The intended outcomes of such programmes are dependent on building relationships, trust and networks between geographically distanced communities of practice. These social connections are the key mechanisms which support accessibility, inclusivity and sustainability. Further explorations of mobile and distance simulation innovations are critical to building capacity, sustainable solutions and enhancing future use.

Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic review.

Patient involvement in goals of care decision-making has shown to enhance satisfaction, affective-cognitive outcomes, allocative efficiency, and reduce unwarranted clinical variation. However, the involvement of patients in goals of care planning within hospitals remains limited, particularly where mismatches in shared understanding between doctors and patients are present. To identify and critically examine factors influencing goals of care conversations between doctors and patients during acute hospital illness. Realist systematic review following the RAMESES standards. A protocol has been published in PROSPERO (CRD42021297410). The review utilised realist synthesis methodology, including a scoping literature search to generate initial theories, theory refinement through stakeholder consultation, and a systematic literature search to support program theory. Data were collected from Medline, PubMed, Embase, CINAHL, PsychINFO, Scopus databases (1946 to 14 July 2023), citation tracking, and Google Scholar. Open-Grey was utilized to identify relevant grey literature. Studies were selected based on relevance and rigor to support theory development. Our analysis included 52 papers, supporting seven context-mechanism-output (CMO) hypotheses. Findings suggest that shared doctor-patient understanding relies on doctors being confident, competent, and personable to foster trusting relationships with patients. Low doctor confidence often leads to avoidance of discussions. Moreover, information provided to patients is often inconsistent, biased, procedure-focused, and lacks personalisation. Acute illness, medical jargon, poor health literacy, and high emotional states further hinder patient understanding. Goals of care conversations in hospitals are nuanced and often suboptimal. To improve patient experiences and outcome of care interventions should be personalised and tailored to individual needs, emphasizing effective communication and trusting relationships among patients, families, doctors, and healthcare teams. Inclusion of caregivers and acknowledgment at the service level are crucial for achieving desired outcomes. Implications for policy, research, and clinical practice, including further training and skills development for doctors, are discussed.

Regulatory experiments and real-world labs: A fruitful combination for sustainability

What are regulatory experiments and how can they contribute to sustainability transformations? We seek to answer these questions by considering regulatory experiments in the energy sector and exploring their potential impact pathways. Different kinds of regulatory experiments can be combined with real-world labs to expand their scope and their impacts to the regulatory realm.Regulatory experiments (RegExs) can be considered an element of mission-oriented innovation policies. As such, we discuss how they relate to real-world labs (RwLs) and how they can contribute to sustainability transformations. We distinguish between two types of experiments: 1. regulatory sandboxes that help innovators to bring new products, services, and other innovations to market, and 2. regulatory-innovation experiments that are specifically designed to explore new solutions for evolving regulatory frameworks. The two types can be linked to RwLs such that an RwL can be embedded in a regulatory sandbox, enabling the RwL to try out solutions that would not be feasible without the sandbox, given the regulatory framework in place. Alternatively, the various experiments in the RwL are complemented by one or several regulatory-innovation experiments. RegExs, as a form of experimental policy engagement, are an important addition to RwL concepts in a sustainability transformation context. They contribute to both innovative sustainability solutions as well as regulatory learning and testing of regulatory innovations. By applying the programme theory approach and developing a Theory of Change for RegEx, we discuss their potential impact on sustainability transformations in terms of the directionality and the acceleration of change, based on examples from the energy sector.

Peer interventions to improve HIV testing uptake among immigrants: A realist review.

As a vulnerable group in HIV control programs, immigrants face various obstacles to HIV testing. Despite the effectiveness of peer interventions on health promotion in HIV testing, relatively little is known about how these interventions work. This realist review aims to understand why, how, and under what conditions peer interventions can improve immigrants' HIV testing uptake. We followed the steps suggested by Pawson and colleagues for conducting the realist review. To test a initial program theory, we first systematically searched databases of PubMed, Web of Science, Scopus, Embase, and Cochrane, as well as the websites of UNAIDS, World Bank, Global Fund, WHO, and IOM. After data extraction and quality appraisal, data synthesis was conducted to explain the intervention pathways corresponding to context-mechanism-outcome configurations. Seventeen studies were included in the review. Peer interventions for improving immigrants' HIV testing uptake worked through four pathways: Following the improvement of communications (as a proximal mechanism): 1) increasing awareness, 2) reduced stigma, 3) improved support, and 4) increased access to services could lead to improved HIV testing uptake among immigrants. The identified mechanisms were influenced by three groups of individual/ interpersonal, service delivery, and structural factors. Peer interventions with multiple strategies to be designed and implemented considering the barriers to HIV testing and also moving beyond one-size-fits-all approaches can successfully improve the immigrants' HIV testing uptake. The refined program theory in this study can help the healthcare providers and policy-makers promote the immigrants' HIV testing uptake and reduce the risk of disease transmission.

A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study.

Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through "think-aloud" testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals' priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users' inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers.

Pain management interventions of the non-communicating patient in intensive care: What works for whom and why? A rapid realist review.

The utility and uptake of pain management interventions across intensive care settings is inconsistent. A rapid realist review was conducted to synthesise the evidence for the purpose of theory building and refinement. A five-step iterative process was employed to develop project scope/ research questions, collate evidence, appraise literature, synthesise evidence and interpret information from data sources. Realist synthesis method was employed to systematically review literature for developing a programme theory. Initial searches were undertaken in three electronic databases: MEDLINE, CINHAL and OVID. The review was supplemented with key articles from bibliographic search of identified articles. The first 200 hits from Google Scholar were screened. Three action-oriented themes emerged as integral to successful implementation of pain management interventions. These included health facility actions, unit/team leader actions and individual nurses' actions. Pain assessment interventions are influenced by a constellation of factors which trigger mechanisms yielding effective implementation outcomes. The results have implications on policy makers, health organisations, nursing teams and nurses concerned with optimising the successful implementation of pain management interventions. The review enabled formation of a programme theory concerned with explaining how to effectively implement pain management interventions in intensive care. This review was informed by RAMESES publication standards for realist synthesis. No patient or public contribution. The study protocol was registered in Open Science Framework. 10.17605/OSF.IO/J7AEZ.

Implementation of large, multi-site hospital interventions: a realist evaluation of strategies for developing capability

BackgroundThis study presents guidelines for implementation distilled from the findings of a realist evaluation. The setting was local health districts in New South Wales, Australia that implemented three clinical improvement initiatives as part of a state-wide program. We focussed on implementation strategies designed to develop health professionals’ capability to deliver value-based care initiatives for multisite programs. Capability, which increases implementers’ ability to cope with unexpected scenarios is key to managing change.MethodsWe used a mixed methods realist evaluation which tested and refined program theories elucidating the complex dynamic between context (C), mechanism (M) and outcome (O) to determine what works, for whom, under what circumstances. Data was drawn from program documents, a realist synthesis, informal discussions with implementation designers, and interviews with 10 key informants (out of 37 identified) from seven sites. Data analysis employed a retroductive approach to interrogate the causal factors identified as contributors to outcomes.ResultsCMO statements were refined for four initial program theories: Making it Relevant– where participation in activities was increased when targeted to the needs of the staff; Investment in Quality Improvement– where engagement in capability development was enhanced when it was valued by all levels of the organisation; Turnover and Capability Loss– where the effects of staff turnover were mitigated; and Community-Wide Priority– where there was a strategy of spanning sites. From these data five guiding principles for implementers were distilled: (1) Involve all levels of the health system to effectively implement large-scale capability development, (2) Design capability development activities in a way that supports a learning culture, (3) Plan capability development activities with staff turnover in mind, (4) Increased capability should be distributed across teams to avoid bottlenecks in workflows and the risk of losing key staff, (5) Foster cross-site collaboration to focus effort, reduce variation in practice and promote greater cohesion in patient care.ConclusionsA key implementation strategy for interventions to standardise high quality practice is development of clinical capability. We illustrate how leadership support, attention to staff turnover patterns, and making activities relevant to current issues, can lead to an emergent learning culture.

A nutrition education service learning programme: Development, implementation and impact on participants

Objective: The aim of this study was to investigate the perceptions of university students who served as outside facilitators for evidence-based nutrition education for elementary-age children. Design: Qualitative case study. Methods: Thirteen undergraduate university students facilitated four nutrition education sessions for elementary-age students in an after-school programme using the Choice, Control, Change model as part of service learning curriculum. University students completed pre- and post-participation surveys. Elementary-age participants completed surveys after each session. Results: University students saw the benefit of this type of experiential learning with the following themes: knowledge application, learning about diverse perspectives and having a positive impact. Before the first nutrition education session, the university students felt excited, nervous and/or enthusiastic, and during and immediately after the sessions reported they felt confident. Participant engagement was low/mixed and classroom management was challenging, which may be linked to the university students’ perceptions that they were underprepared to work in a distracting social environment, and with behaviour typical to elementary-age children. The education session recipients reported they gained knowledge about healthy behaviours and believed that eating healthy foods is important. Conclusion: There are gaps in nutrition education programme theory and implementation by outside facilitators. These findings are relevant to those who provide health education services for surrounding communities. This study provides information about implementation barriers when outside facilitators lead nutrition education, alongside recommendations to improve these types of programmes in the future.

Design and analysis of unequal aperture off-axis optical integrator for solar simulators.

The unequal aperture off-axis optical integrator design method is proposed to improve the irradiation uniformity of solar simulators and solve the problem of limited uniformity of optical integrator due to aberrations and uneven distribution of incident radiation. Firstly, the unequal aperture off-axis optical integrator structure is designed based on the scalar diffraction theory to analyze the factors affecting the optical homogenization ability of the optical integrator. Then, the relationship between sub-eye lens aperture and arrangement is explored in combination with Lagrange invariance principle and semi-definite programming theory. Finally, the optimum off-axis amount of sub-eye lens with different ring band is determined from the perspective of geometric optics by using the aberration theory and following the principle of edge light, so as to improve the evenness of optical integrator. The design results are verified by the simulation analysis. The simulation results show that: In the picture plane of optical integrator, the irradiation non-uniformity in the ф 26 mm irradiation plane is 14.87%, which is better than 26.02% in the traditional optical integrator. At the same time, at the effective irradiated surface, the irradiation non-uniformity of 0.53% within the ф 300 mm reaches the irradiation standard of the class A + solar simulator, and the irradiance only decreases by 16.5% compared with the traditional optical integrator, which still meets the index requirement of a solar constant. The goal of improving the evenness of optical integrator is realized without greatly affecting irradiance and without introducing aspherical design.

A realist synthesis of multicentre comparative audit implementation: exploring what works and in which healthcare contexts

BackgroundMulticentre comparative clinical audits have the potential to improve patient care, allow benchmarking and inform resource allocation. However, implementing effective and sustainable large-scale audit can be difficult within busy and...

Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement.

The COVID pandemic prompted an increase in the use of digital clinical consultations (telephone or video calls) within midwifery and nursing care. This paper reports on a realist review project related to maternity care that seeks to illuminate for whom such consultations can safely and acceptably be used, how, for what purposes and in what contexts. This paper addresses the first phase of a realist enquiry - initial programme theory development - focusing particularly on the role of stakeholder involvement (including digital transformation leaders, midwives, obstetricians, service users and community organisations). Three sub-stages of initial programme theory development are described highlighting the contribution of stakeholder groups to each stage: (i) consultation to focus the review question, (ii) focused searching and (iii) further consultation. Realist literature searching strategies yielded limited theory-rich evidence on digital consultations. Stakeholders provided essential additional contributions resulting in the development of 13 initial programme theories and a conceptual framework. More research on the implementation of virtual midwifery/nursing consultations is needed. Nursing/midwifery digital researchers should involve stakeholders to help shape research priorities, deepen contextual understanding and sense-check emerging findings.

Understanding the inclusion and participation of adults from Black African Diaspora Communities (BAFDC) in health and care research in the UK: a realist review protocol

IntroductionPeople from Black African Diaspora Communities (BAFDC) experience poorer health outcomes, have many long-term conditions and are persistently under-represented in health and care research. There is limited focus on programmes,...

Realist evaluation of maternity waiting home intervention models in Inhambane, Mozambique: protocol for a comparative embedded case study, the Mozambique-Canada Maternal Health Project

IntroductionThis is a study protocol that tests and refines realist theories regarding the uptake and scale-up of the linked maternity waiting home (hereafter MWH) and facility birth intervention in the...

Commentary: Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement.

Commentary: Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement.

Improvement of the method of time rationing for assembling car groups on one track

Purpose. To improve the method for standardizing the duration of the shunting operation of assembling cars on one track. This can be achieved as a result of solving the following research problems: development of a method for searching the optimal order of assembling cars on one track; distribution parameters estimation of the random value of the duration of shunting operation of assembling cars on one track based on calculation experiments. Methodology. During the research, the methods of theory of railway operation, dynamic programming and mathematical statistics were used. Findings. Research on the assembling process of car group to one track established the distribution parameters of the random variable of time spent for shunting. In the course of the research, the problem of choosing the optimal order of shunting operations during car assembling was formalized and solved as a problem of dynamic programming. The time spent for shunting work was chosen as the optimality criterion. The paper considers the possibility of approximating the data of calculation experiments by analytical dependencies. It was found out that the use of linear polynomials with interaction allows obtaining dependencies describing time standards with a relative accuracy of ±5 %. Originality. The method is improved for developing the time standards for shunting work, which, unlike the existing one, is based on the performance of a series of calculation experiments, each of which solves the optimization problem of finding such an order of assembling cars that ensures minimum time consumption for shunting. Practical value. The methods developed in the work and the dependencies obtained allow improving the quality of decisions made when developing technology and designing railway stations and sidings of industrial enterprises.

Influence of Monitoring and Evaluation on the Performance of “Give Directly” Project in Rwanda

The study aimed at determining the influence of Monitoring and Evaluation (M&E) on the Give Directly project performance in Rwanda. The study was specifically to examine how Monitoring and Evaluation plans influence the performance of Give Directly project in Rwanda, to assess how Monitoring and evaluation training influences Give Directly project performance in Rwanda, to evaluate whether stakeholders’ involvement in Monitoring and evaluation influences Give Directly project performance in Rwanda and to determine whether M&E Budget influences Give Directly project performance in Rwanda. The study was important to Give Directly project, other Non-Government and Government organizations and further researchers. The study was directed by three theories including evaluation theory, Program theory and theory of change. This research may be used as a source of information for further research. Both descriptive and correlation research design were used for the study. The targeted population were all 90 project implementers of Give Directly project in Rwanda whereby census method was considered. Data was collected using Likert scale questionnaire. Data was processed, analyzed by quantitative method and Statistical Package for Social Science (SPSS) software version 20 was used to code and enter quantitative data for analysis. Both descriptive including mean and standard deviation and inferential statistical analysis (linear regression analysis, correlation) were used. Data was presented using tables. Inferential statistics were also performed using the field data and tested at 5% level of significance and it resulted the followings: the results demonstrate a moderate strong positive relationship between M&E plans and project performance of Give Directly in Rwanda (r= 0.545, sig=.000) followed by M&E Training which had a moderate strong positive relationship (r=0.537, sig=.000) and M&E Budget had a moderate strong positive relationship (r=0.532, sig=.000). Furthermore, the results revealed a weak correlation between Stakeholders involvement in M&E and project performance (r=0.253, sig=0.016). By using linear regression analysis, it indicated that all explanatory variables including M&E Plans, M&E Training, Stakeholders involvement in M&E and M&E budget have an influence on the Give Directly project performance.